Instruction: Generate impression based on findings.

Input: No evidence for acute intracranial hemorrhage, mass effect, or edema. There is normal ventricular size with no midline shift. There are T2/FLAIR hyperintensities in the subcortical and periventricular white matter, unchanged from the previous study. There is no diffusion restriction. No evidence of abnormal enhancement. There are normal vascular flow voids.

Output: 1. There are no acute findings. No evidence for acute intracranial hemorrhage, mass effect, or edema.2. There are T2/FLAIR hyperintensities in the subcortical and in the periventricular white matter, unchanged from the previous study, and most likely representing chronic ischemic small vessel disease.


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Few small enhancing foci are seen in the lateral breasts, left more than right but none of them are uniquely enhancing. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for meningitis an edematous lesion in pons seen on the outside hospital MRI. LP was performed prior to this exam. Signs and symptoms: Meningitis slight symptoms with edema in pons and an outside MRI. Nonenhanced brain MRI:This examination is performed without the benefit of intravenous contrast as patient refused contrast administration.Examination demonstrates a large ill-defined focus of flair/T2 hyperintensity extensively involving the pons and extending into the medulla and superiorly into the midbrain. The finding results in subtle expansion/increased volume of the pons. There is also subtle crowding of the central tonsils at the level of foramen magnum which is best appreciated on sagittal sequences. The CSF space at the level of foramen magnum however is not significantly effaced.Lack of IV contrast reduces the sensitivity of the exam for further assessment. The finding is nonspecific however differentials of an inflammatory process such as encephalitis, demyelinating process or a neoplastic cause should be considered.Examination demonstrates no evidence of any additional foci of signal abnormality.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise. Excellent calvarium, orbits, paranasal sinuses and mastoid air cells are unremarkable.Unenhanced cervical spine MRI:This examination is also performed without the benefit of IV contrast as patient refused contrast administration.Examination redemonstrate above detailed finding of the pons and medulla.Additionally there is small focus of T2 hyperintensity within the anterior cervical cord on the right at C3 level, small focus of T2 hyperintensity on the left at C6 which extends inferiorly as an ill-defined focus of T2 hyperintensity to C7 level. There is very subtle expansion of the cord at this level.The signal intensity in the alignment of vertebral column is unremarkable. There is however mild left neural foraminal compromise at C6 -- C7 moderate right neural foraminal compromise at C7 -- T1 levels.

Output: 1.Nonenhanced MRI of brain and cervical spine demonstrate a single large focus of T2 hyperintensity in the pons with extension superiorly into the midbrain and inferiorly to medulla and multiple foci of T2 hyperintensity within the cervical cord as detailed. Differential diagnosis of demyelinating disease, inflammatory process or granulomatous disease should be considered.2.Nonenhanced MRI of brain is otherwise unremarkable.3.Nonenhanced MRI of the cervical spine is otherwise unremarkable with the exception of minimal degenerative disease.


Instruction: Generate impression based on findings.

Input: Myositis Right humerus:There is mild fatty atrophy of the deltoid muscle. Otherwise the muscle of the chest wall and shoulder are normal in signal and caliber. The underlying marrow signal is normal. Following contrast administration, there is no focal collection or obvious muscle enhancement.Left humerus:Note that intravenous contrast was not present for evaluation of the left humerus. There is mild fatty atrophy of the deltoid muscle. Otherwise the muscle of the chest wall and shoulder are normal in signal and caliber. The underlying marrow signal is normal. There is no lymphadenopathy. The exam is not tailored for the evaluation of the shoulder however no gross abnormalities are identified. There is an incompletely evaluated hypointensity within the superior pole left kidney. Further evaluation with dedicated imaging or correlation with prior imaging recommended.

Output: Mild fatty atrophy of the deltoid muscle bilaterally. Otherwise remaining evaluation of the bilateral humerus is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 53-year-old female with radicular upper extremity pain bilateral right worse than left. Evaluate for cervical disc disease. At C4-5, there is a disc osteophyte complex eccentric to the left, which causes mild spinal canal stenosis and minimal left neural foraminal narrowing. At C5-6 there is a small disc osteophyte complex, without significant neural foraminal narrowing. However, there is no significant spinal canal or neural foramen stenosis at this level. There is no significant disc disease involving the remainder of the cervical spine, but there are multiple cystic structures in the lateral aspect of the neural foramina of C6-7, C7-T1, and T1-T2, the largest of which measures up to 12 mm. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: 1.Mild spondylotic changes involving the cervical spine involving the C4-5 and C5-6 levels, with up to mild spinal canal narrowing at C4-5.2.Multiple bilateral neural foraminal perineural cysts at the C6-7, C7-T1, and T1-T2 levels.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, with weakness. Evaluate for progression of MS. Brain:Numerous scattered T2 hyperintense lesions are redemonstrated within the cerebral hemispheres, brainstem and cerebellum showing morphology and distribution compatible with multiple sclerosis. While the majority of these lesions are unchanged, multiple new or larger lesions are identified, particularly on the left (see key images for examples). Many of these new lesions demonstrate enhancement. T1 signal characteristics range from mildly to moderately hypointense. No evidence of significant parenchymal edema or mass effect is seen. Brain parenchymal volume is generally preserved. The ventricles are normal in size and morphology. A mucous retention cyst is evident in the left maxillary sinus.Cervical:Ill-defined T2 signal abnormality affects the spinal cord somewhat diffusely at the C2 and C3 levels, and to a lesser degree at lower cervical levels. It is difficult to appreciate individual lesions, but overall it does appear that the extent of signal abnormality has progressed from the prior examination. One clear focus of pathologic enhancement is evident within the right aspect of the spinal cord at the C7-T1 level, though there may be additional smaller foci of enhancement as well.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is seen. No significant compromise of the spinal canal or neural foramina is detected.Thoracic:Scattered ill-defined areas of T2 signal abnormality are seen within the thoracic spinal cord without significant or convincing interval change. No definite enhancing lesions are seen. As on the prior examination, the spinal cord in the thoracic region is somewhat generally thinned.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is seen. No significant compromise of the spinal canal and neural foramina is detected.

Output: 1.Progression of demyelinating disease intracranially with new and/or enhancing lesions on a background of numerous chronic lesions.2.Progression of demyelinating disease in the cervical region.3.Stable demyelinating disease in the thoracic region.


Instruction: Generate impression based on findings.

Input: 57 years Female (DOB:1/2/1959)Reason: re-evaluate for pathologic source of intermittent R hemianopsia History: re-evaluate for pathologic source of intermittent R hemianopsia, probable migraine with aura, hx of stroke 2014 w/ R hemiparesis and slurred speechPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ There is redemonstration of a T2 and FLAIR hyperintense focus located along the right middle frontal gyrus posteriorly measuring approximately 27 x 7 mm axial dimensions involving cortex. This has not changed significantly compared to the prior exam. There are more periventricular and subcortical punctate T2 and FLAIR hyperintense lesions in the periventricular and subcortical white matter compared to the prior exam.There is redemonstration of a small focus of encephalomalacia in the left cerebellar hemisphere. There is an associated focus of signal loss and susceptibility weighted imaging present. Similar smaller lesions are present in the left inferior parietal lobule and left middle frontal gyrus which are new compared to the prior exam.There is no focus of diffusion restriction appreciated brain.There is a focus of susceptibility effect present in the subcortical white matter of the left frontal lobe. As a punctate focus of signal loss and susceptibility weighted imaging the left cerebellar hemisphere. Another punctate focus of signal loss and susceptibility is present in the midbrain anteriorly. Another one is present along the right inferior temporal gyrus. Another couple 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 demonstrate a large mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam there is been accumulation of more periventricular and subcortical white matter lesions. These are nonspecific. Most likely they are vascular related.2.There are multiple microhemorrhages present subcortical white matter as well as in the brainstem and cerebellum3.Cortically based lesion along the right middle frontal gyrus associated with encephalomalacia is also present on the prior exam. It is suspected to be a result of prior vascular event. Similar smaller lesions are present in the left inferior parietal lobule and left middle frontal gyrus which are new compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 22-year-old woman with lateral knee pain. MENISCI: The lateral and medial menisci are intact and normal in appearance.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. The articular cartilage is intact. No fracture.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex are intact. EXTENSOR MECHANISM: The quadriceps tendons and patellar tendon are intact.ADDITIONAL

Output: Normal.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cervical disc disorder with myelopathy, unspecified cervical regionClinical question: history of herniated cervical discSigns and Symptoms: numbness tingling weakness 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. There is straightening of the normal cervical curvature present. Overall the alignment of the cervical vertebrae is stableAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is a diffuse disc bulge present associated with endplate and uncovertebral osteophytes and encroachment of the neural foramina bilaterally with encroachment of the exiting nerve roots. Some disc material extrudes behind the adjacent endplates and encroaches the nerve roots at the right lateral recess and neural foramen more than the left. There is effacement of spinal fluid ventral and posterior the spinal cord with mild to moderate spinal stenosis. Overall when compared to the exam from 11/13/2010 there does not appear to be a substantial change.At C6-7 there is loss of disc space height, disc desiccation, endplate and uncovertebral osteophytes as well as a disc bulge associated with effacement of fat surrounding the exiting nerve roots within the neural foramina bilaterally. There is effacement of spinal fluid ventral and posterior the spinal cord at this level with mild to moderate degree of spinal stenosis. Overall there is very mild progression of the spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine mainly at C5-6 and C6-7 where there is mild to moderate spinal stenosis and neural foraminal encroachment of exiting nerve roots. There is a subtle progression of the spinal stenosis at C6-7 when compared to the prior exam. The spinal stenosis at C5-6 remains stable.


Instruction: Generate impression based on findings.

Input: Male; 59 years old. Reason: Eval liver lesions, masses, HCC S/P TACE/RFA on 3/5-6/15 History: HCC, cirrhosis, HBV LIVER, BILIARY TRACT: New right hepatic lobe anterior/superior ablation measures 3.4 x 1.9 cm (series 10/36).Right hepatic lobe posterior/superior ablation cavity measures 2.7 x 1.9 cm (series 10/34), previously 2.7 x 1.9 cm.Right hepatic lobe inferior ablation cavity measures 2.1 x 1.9 cm (series 10/42), previously 2.1 x 1.9 cm.Between the two superior ablation cavities, there is mild nodular arterial enhancement measuring up to 0.6 x 0.8 cm posteriorly (series 10/33), with smaller focus seen slightly anteriorly (series 10/32), suspicious for mild residual disease though not entirely specific with no restricted diffusion or washout seen.No biliary ductal dilatation. Main portal vein is patent. SPLEEN: Stable splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric adenopathy.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Gastroesophageal varices.

Output: New right hepatic lobe ablation cavity with mild adjacent nodular arterial enhancement, suspicious for mild residual disease though not entirely specific with no restricted diffusion or washout seen.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with nausea, occipital headache, vertical nystagmus. No restricted diffusion is seen. Several scattered small foci of T2 hyperintensity are seen within the periventricular and subcortical white matter, a nonspecific finding. No evidence of parenchymal edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.

Output: No evidence of acute ischemia or any other acute intracranial abnormality which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. There is extensive prevertebral soft tissue swelling, measuring up to 2.8 cm at the lower C2 level. Indwelling instrumentation is identified from previous anterior cervical fusion of C3 and C4, with associated susceptibility artifact limiting evaluation of surrounding structures. Lack of fat saturated axial postcontrast images limits evaluation for areas of abnormal enhancement, although fat saturation would also likely be degraded secondary to the instrumentation.Within these limitations, there is redemonstration of a bilobed appearing peripherally enhancing fluid collection within the prevertebral space extending from the lower C2 to the C4 level, measuring 4.0 cm CC. The collection measures approximately 1.3 x 1.1 cm in greatest axial dimensions on 1301/34 on postcontrast images, with the area of abnormality measuring up to 1.4 x 1.8 cm on axial T2-weighted images. This essentially involves the oropharynx, with again significant narrowing of the airway focally at this level as there is also prominence of the lingual tonsils. The previously described sinus tract extending to the left anterolateral skin surface near the level of the thyroid cartilage is better delineated on CT, but is visualized on the axial T1 precontrast images.Evaluation of the bone marrow signal and enhancement on MRI is extremely limited secondary to the artifactual hyperintensity present from the indwelling instrumentation. Bone integrity and possibility of infection is likely better assessed on CT, where subtle periosteal reaction or destruction could be appreciated. STIR hyperintensity is present within the C2-C3 disc space posteriorly which could be artifactual and ventrally within the C4-C5 disc although not contiguous with the prevertebral abnormal signal.There is redemonstration of extensive inflammatory changes within the left greater than right prevertebral soft tissues at these levels, with extension of abnormal signal and enhancement into the left longus coli muscle, with involvement that is located more medially along its cranial aspect although more diffuse involvement is noted at the greatest levels or prevertebral soft tissue swelling. At the C3-C4 level, there is a small partially exophytic portion of the abscess extending posteriorly on 701/29 towards the anterior cortical margin upper C4 vertebral body.The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. There is no pathological enhancement. The spinal cord appears somewhat diminutive in size diffusely. In addition, focal abnormal signal is seen within the cord the right side at C3-C4, likely relating to myelomalacia.At C2-C3, there is a prominent central disc protrusion and bilateral uncovertebral hypertrophy resulting in moderate central spinal canal stenosis. There is mild bilateral foraminal narrowing.At C3-C4, there is likely moderate central spinal canal stenosis with no evidence of disc pathology at this level previous surgery. There is bilateral uncovertebral hypertrophy with moderate lateral foraminal narrowing.At C4-C5, there is bilateral uncovertebral hypertrophy with mild bilateral foraminal narrowing.At C5-C6, there is a shallow central disc protrusion with left paramedian annular fissure. There is mild bilateral foraminal narrowing.At C6-C7, there is a trace disc bulge without stenosis.At C7-T1 and T1-T2, there is no significant disk pathology or stenosis.At T2-T3, there are biforaminal small disc protrusions with bilateral facet arthropathy resulting in moderate bilateral foraminal narrowing.

Output: 1. Motion limited exam. Redemonstration of known left posterior oropharyngeal wall abscess with prevertebral extension from the lower C2 to upper C4 level. Osseous and disc involvement is somewhat difficult to assess due to the extensive artifact from the indwelling spinal instrumentation at these levels, although osseous integrity appears to be preserved on the CT neck exam. Increased STIR signal within the relevant disc spaces may simply be artifactual. Normally, diffusion weighted imaging could be attempted to evaluate for discitis/osteomyelitis, although likely these would not be helpful in this patient secondary to the presence of instrumentation and related artifact. Close follow-up is recommended, as a component of the abscess does extend superiorly towards the anterior margin of the upper C4 vertebral body, and there is extensive left longus coli involvement likely representing myositis.2. Redemonstration of known sinus tract extending to the left anterolateral neck skin surface, not as well delineated as on CT.3. Evidence of myelomalacia of the cervical cord focally at C3-C4 likely relating to previous disc pathology, with overall mild atrophy of the cervical cord. Multilevel spondylotic changes as detailed above.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with spasmodic torticollis, right posterior neck lumps, easy bleeding after Botox injection. A skin marker has been placed along the right posterolateral neck presumably indicating the area of concern. No masslike or vascular lesion is seen in the vicinity of the skin marker. The right upper sternocleidomastoid muscle and overlying subcutaneous soft tissues are mildly edematous. Elsewhere, no pathologic signal abnormality is seen in the neck. The aerodigestive mucosa is within normal limits. No pathologically enlarged lymph nodes are seen. The salivary glands are unremarkable. The thyroid is not clearly visualized. Multilevel disc osteophyte formation is seen with perhaps a mild spinal canal stenosis at C5-6.

Output: 1.No abnormality is identified to account for the easy bleeding after right neck Botox injections.2.Edema of the upper right sternocleidomastoid muscle and the overlying subcutaneous tissues may be related to the patient's torticollis or Botox injections.


Instruction: Generate impression based on findings.

Input: Previous stem cell transplantation, post of 180 days. Disseminated AFB infection, suspicious for Nocardia infection. No evidence of acute ischemic or hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Extensive mucosal thickening of bilateral maxillary sinuses, ethmoid sinus, frontal sinus and sphenoid sinus

Output: No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.Pansinusitis.


Instruction: Generate impression based on findings.

Input: 37-year-old male with medial line tenderness to palpation, please for MCL tear. MENISCI: No significant abnormality noted. Menisci appear intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: Soft tissue edema about the proximal and mid fibers of the MCL, however the fibers of the MCL are visualized and appear intact. This may represent a mild strain of the MCL. The ACL, PCL, and LCL complex appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Soft tissue edema about the fibers of the MCL, however the ligament appears intact. This likely represents a strain of the MCL.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:8/21/1952)Reason: one weak history of leg weakness, hx of epidural involvement of cancer from 2015, eval for cord compression History: see abovePROVIDER/ATTENDING NAME: OLWEN M HAHN OLWEN M HAHN The vertebral bodies are appropriate in the overall alignment and height. There is no compromise of the spinal cord.There are multiple foci of marrow replacement scattered throughout the patient's spine compatible with metastatic disease. The uterus appears enlarged with multiple lesions. There are some degenerative changes present in the lower lumbar spine with disc bulges at L3-4 L4-5 and L5-S1 which results in some narrowing of the spinal canal.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.3.Findings suggest skeletal metastases throughout the spine.4.There are degenerative changes present in the lower lumbar spine with some mild narrowing of the spinal canal.5.The uterus appears large with multiple lesions. Please correlate clinical history and symptoms. One possibility is that this represents multiple fibroids


Instruction: Generate impression based on findings.

Input: 27-year-old male with pain and effusion. Evaluate for soft tissue injury or meniscal injury. MENISCI: There is linear increased signal abnormality within the posterior horn of the medial meniscus which extends to the femoral articular surface consistent with a horizontal tear. There is blunting of the body of the meniscus suggesting extension of the aforementioned tear. The anterior horn appears intact. There is increased signal abnormality within the body of the lateral meniscus which is slightly blunted suggestive of fraying/tearing of the free edge of the body of the meniscus. The posterior and anterior horns appear intact.ARTICULAR CARTILAGE AND BONE: There is subchondral edema within the posterior aspect of the medial tibial plateau which may represent a contusion. There is also increased bone marrow signal abnormality within the lateral femoral condyle and posterior aspect of the lateral tibial plateau also consistent with contusions. There is a focal full-thickness articular cartilage defect along the weightbearing surface of the lateral femoral condyle, above the body of the meniscus, with underlying subchondral signal abnormality.LIGAMENTS: There is rupture of the proximal and mid substance fibers of the ACL. The PCL appears intact. The MCL and LCL appear intact.EXTENSOR MECHANISM: The Insall-Salvati ratio measures 1.3 suggesting patella alta. The tibial tubercle to trochlear groove distance is within normal limits. The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus.2. Fraying/tearing of the free edge of the body of the lateral meniscus.3. Rupture of the ACL.4. Large joint effusion and focal articular cartilage defect along the lateral femoral condyle as well as other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Memory loss with vascular risk factors. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion weighted images.Examination demonstrate periventricular and subcortical foci of FLAIR hyperintensity in bilateral cerebral hemispheres. Minimal similar signal changes are also present in bilateral basal ganglia and pons. Although nonspecific considering patient's stated age of 79 this appearance is often result of microvascular ischemic changes. The findings are not associated with any hemorrhagic changes.There is generalized prominence of cortical sulci for patient of stated age of 79. The ventricular system are mildly prominent however likely within normal for stated age.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are normal.Unremarkable images through the orbits, calvarium, soft tissues of the scalp and paranasal sinuses.

Output: 1.No diffusion-weighted abnormalities.2.Changes suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.3.Generalized prominence of cerebral cortical sulci for patient's stated age as detailed.


Instruction: Generate impression based on findings.

Input: 43 years Female (DOB:12/16/1973)Reason: evaluate for demyelinating disease History: abnormal non-contrast c-spine MRI; asymmetric hyper-reflexia PROVIDER/ATTENDING NAME: NAOUM ISSA SERVICES ANCILLARY Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is redemonstration of a globular appearing T2 signal hyperintensity along the posterior midline of the spinal cord extending from approximately C2-3 disc space down to the C6 vertebral level. No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present associated disc material layering in some mild encroachment of the exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are small disc bulges present at T6-7 T7-8 without significant compromise spinal canal or neural foramina.No abnormal enhancing lesions are appreciated in the thoracic spine.

Output: 1.There is a T2 hyperintense lesion along the posterior midline of the cervical spinal cord. It has not changed since the prior exam. It does not extend into the thoracic spinal cord. There is no abnormal enhancement to suggest breakdown barrier at this time. The differential diagnosis has not changed. Differential considerations could include demyelination subacute combined degeneration possible cord ischemia post transverse myelitis and vacuolar myelopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: R/O acute stroke. Signes and symptoms: Aphasis. Pre and post enhanced brain MRI:No evidence of acute intracranial finding including acute ischemic stroke.There is very extensive confluent foci of flair/T2 hyperintensity in the periventricular and subcortical white matter of the cerebral hemispheres, bilateral basal ganglia ( L> R ), thalami and the pons. Findings represent advanced chronic small vessel ischemic disease. There is resultant ex vacuo dilatation of the supratentorial ventricular system and prominent of the cortical sulci. Small chronic cortical stroke in right posterior parietal is also noted.Susceptibility MRI images demonstrate multiple small foci of microhemorrhages in the subcortical and periventricular white matter of cerebral hemispheres. The signal void of the major intracranial vasculature is identified.No abnormal enhancement of brain parenchyma, leptomeninges, calvarium, scalp or the orbits.Unremarkable calvarium, scalp, orbits, paranasal sinuses and the mastoids air cells.

Output: 1.No acute intracranial finding.2.Advanced chronic small vessel ischemic strokes, some with evidence of chronic hemorrhage.3.Small chronic right posterior parietal cortical stroke.4.No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Male 63 years old Reason: R/o new myelomatous lesion History: lower back pain, left hip pain ACETABULAR LABRUM: Although the study is not protocoled for detailed evaluation of the labrum, no labral tear is identified.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the of the marrow of the bones of the hip on T1-weighted images which could simply represent residual red marrow or low burden multiple myeloma but we see no discrete lesions on T2-weighted or contrast-enhanced images. Mild osteoarthritis affects the hip joint with a small focus of signal abnormality within the anterosuperior acetabulum which likely represents a small cyst. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Mild heterogeneity of the bone marrow signal could represent residual red marrow or multiple myeloma of low tumor burden however we see no large/discrete lesions.2. Vertebral body compression fractures, degenerative disk disease, and other findings as above.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at L2. There is transitional anatomy with 12 thoracic and 5 lumbar vertebral bodies with lumbarization of S1 vertebral body. The paravertebral soft tissues are unremarkable.

Output: 1.Normal MRI of the spine.2.Lumbarization of S1 vertebral body.


Instruction: Generate impression based on findings.

Input: Concern for acute ischemic stroke: right arm paralysis. There is an area of restricted diffusion with corresponding high T2 signal in the left precentral gyrus that measures up to approximately 20 mm. There also appears to be a small area of restricted diffusion in the white matter adjacent to the left frontal horn and linear restricted diffusion in the right parietal lobe. There is a right transoccipital ventricular catheter that terminates in the left lateral ventricle. There are bilateral cerebral convexity subdural effusions, which measure up to 6 mm in width on the right and 12 mm in width on the left. The ventricular system is unchanged in size. Artifact from the reservoir obscures surrounding structures. There is fluid signal within the bilateral mastoid air cells.

Output: 1. Acute infarction in the left precentral gyrus and perhaps small smaller recent infarcts in the left frontal and right parietal lobes superimposed upon a background of chronic small vessel ischemic white matter disease.2. Bilateral cerebral convexity subdural effusions, which may indicate chronically low intracranial pressure. 3. Unchanged shunted ventricular system.Discussed with Dr. Stern at 1:00 PM on 4/22/15.


Instruction: Generate impression based on findings.

Input: Female, 18 years old, history of pseudotumor cerebri with LP shunt now with worsening headache. Brain:No evidence of intracranial mass, mass effect or parenchymal edema is seen. No areas of parenchyma signal abnormality are detected including no evidence of restricted diffusion. Ventricles are normal in size and morphology. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Prominence of the optic nerve sheathes and flattening of the globe at the level of the optic nerve heads are findings compatible with pseudotumor cerebri.The cerebellar tonsils are ectopic terminating up to 3 mm below the level of the foramen magnum. Normal biphasic CSF flow is seen both anteriorly and posteriorly through the foramen magnum including around the cerebellar tonsilsSpine:A shunt catheter enters the thecal sac at the L3-4 level from which point it travels superiorly and seems to terminate at approximately the L1 level. No paraspinal or epidural fluid collections are seen. The nerve roots of the cauda equina disperse evenly through the thecal sac.The central canal of the spinal cord is minimally prominent at the C6 and C7 levels where it measures no more than 1 mm in diameter. Elsewhere spinal cord signal and morphology are entirely within normal limits. The conus tip terminates at the L1 level.Spinal alignment is anatomic. A full complement of vertebral bodies is seen with mild transitional morphology of L5. No evidence of marrow replacement or marrow edema is detected. No significant spinal canal or neuroforaminal stenosis is seen. There is a very small small right paracentral disk protrusion at T7-8.The right vertebral artery is noted to be of uniformly small caliber, likely a developmental variation.

Output: 1. Ectopic cerebellar tonsils with preservation of CSF space and CSF flow through the foramen magnum.2. Slight prominence of the optic nerve sheaths and flattening of the globe at the level of the optic nerve heads may reflect pseudotumor cerebri. No other significant intracranial findings are noted.3. A shunt catheter enters the thecal sac at the L3-4 level from which point it travels superiorly to terminate at approximately the L1 level. No paraspinal or epidural fluid collections are seen. Adjacent cauda equina nerve roots are unremarkable.4. Very slight prominence of the central canal of the spinal cord is seen at the C6 and C7 levels. The canal measures no more than 1 mm in diameter. This finding is of uncertain significance and can be a normal variation.


Instruction: Generate impression based on findings.

Input: Evaluate for CAD in setting or atypical chest pain along with past abnormal stress echo. Left VentricleThe left ventricle is normal sized. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 219 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 95 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 140 g (normal range 164+/-36). 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.There is [ no ]myocardial iron overload. There is [no ]LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 83 ml/m2 (normal range 82+/-16), the RVEDV is 180 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 109 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Borderline Left Ventricular EF. Mildly reduced Right Ventricular EF.2. No evidence of delayed gadolinium hyperenhancement in the LV myocardium.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67 years Male (DOB:11/15/1948)Reason: neck pain History: neck painPROVIDER/ATTENDING NAME: JAVAD HEKMATPANAH JAVAD HEKMATPANAH The cervical vertebral bodies are appropriate in overall alignment and height. There is T2 signal hyperintensity within the cervical spinal cord at the C3-4 level where there is a spinal stenosis.Within the C7 vertebral body anteriorly there is a 10 mm T1 hyperintense lesion which suppresses on the inversion recovery images and most likely represents a vertebral body hemangioma.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is loss of disc space height, endplate reactive changes and endplate and uncovertebral osteophytes associated with flattening of the spinal cord and T2 signal hyperintensity in the spinal cord. Overall there is a moderate to severe degree of spinal stenosis. There is also encroachment of the exiting nerve roots bilaterally at this level. The endplate reactive changes are bright on T2 and predominantly low signal on T1 suggesting that they are subacute.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a diffuse disc bulge present this level associated with ligamentum flavum hypertrophy resulting in some mild narrowing of the spinal canal. There is mild narrowing of the neural foramina at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There is a moderate to severe degree of spinal stenosis at C3-4 related to degenerative changes which results in flattening of the spinal cord and signal changes within the spinal cord. There is associated bilateral encroachment of exiting nerve roots and some subacute inflammatory reactive type changes.


Instruction: Generate impression based on findings.

Input: A 18 year old female with s/p tetralogy of Fallot repair with pulmonic valve regurgitation referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 100 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10), the LV mass index is 51 g/m2 (normal range 67+/-11), and the LV mass is 65 g (normal range 114+/-24). There is flattening of the interventricular septum throughout the entire cardiac cycle, greatest in diastole, suggesting a combination of elevated right ventricular pressure and volume.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with moderately reduced systolic function. The overall RV ejection fraction is 36%, the RV end diastolic volume index is 128 ml/m2 (normal range 69+/-14), the RVEDV is 163 ml (normal range 110+/-24), the RV end systolic volume index is 82 ml/m2 (normal range 22+/-8), and the RVESV is 105 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 appears narrowed with antegrade susceptibility artifact during systole, indicative of accelerated antegrade flow (2101/6). There is narrowing at the valvular level measuring 11 mm in minimal diameter, noted on the RVOT view. There is moderate pulmonic regurgitation (assessed by qualitative and quantitative analyses, main pulmonary artery regurgitant fraction of 32%, right pulmonary artery regurgitant fraction of 19%, left pulmonary artery regurgitant fraction of 16%).Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a right-sided aortic arch. The aortic root is normal in size.Duplicated superior vena cava with the left drain into an enlarged coronary sinus.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery and the right and left branches are normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsSternal wires were noted. Mid thoracic vertebral abnormalities which can be better characterized with chest radiograph.

Output: Severe dilatation of the right ventricle reduced systolic function with ejection fraction of 36%. Well preserved left ventricular systolic function with an ejection fraction of 57%.Pulmonic regurgitation, quantified as moderate with a regurgitant fraction of 32%. There is a degree of pulmonic stenosis at the valvular level, maximum 11 mm on the sagittal view (RVOT view). There is antegrade acceleration of flow above the valve.Postsurgical findings of tetralogy of Fallot repair without evidence of significant ventricular septal defect. Duplicated superior vena cavae with right-sided aortic arch.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right ear tinnitus, pain, and fullness since May 2015. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. The regional vascular flow voids are grossly intact. The temporomandibular joints are grossly unremarkable. There are secretions in the right posterior ethmoid sinuses.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Reason: eval for signs of crystal arthropathy, ankle pain, difficulty ambulating History: as above TENDONS: There is lobulated fluid signal intensity within the tendon sheath of the flexor hallucis longus, and to a lesser degree, the flexor digitorum longus tendon sheath, just proximal to the level of the master knot of Henry indicating a tenosynovitis. The peroneal tendons appear intact. The Achilles tendon appears intact. The anterior tendons are unremarkable.LIGAMENTS: There is disruption of the anterior talofibular ligament. There is a tiny avulsion off the distal fibular tip at the insertion of the posterior talofibular ligament (image 6 series 5). The calcaneofibular ligament is also poorly visualized and may be disrupted. The imaged portion of the deltoid ligament is thickened with intermediate signal intensity suggesting prior injury or sprain. Portions of the ligament are poorly visualized suggesting partial disruption. There is also a tiny ossicle along the distal tip of the medial malleolus which may reflect prior trauma.ARTICULAR SURFACES AND BONE: There is bone marrow signal abnormality within the distal fibula which may represent a contusion in the correct clinical context. No discrete fracture line is identified. There is bone marrow signal abnormality within the posterior aspect of the tibial plafond which may be degenerative in etiology. No convincing erosions are evident.ADDITIONAL

Output: 1. Disruption of the ATFL as well as probable calcaneofibular ligament disruption. There is also a tiny avulsion fracture of the distal fibula at the insertion of the PTFL, which may be subacute or chronic in etiology. There is bone marrow signal abnormality within the distal fibula in the surrounding area, which is nonspecific, but may represent a bone contusion in the correct clinical context. 2. Findings indicating an intersection syndrome with tenosynovitis involving the flexor hallucis longus and flexor digitorum longus tendons as described above.3. Partial disruption of the imaged portions of the deltoid ligament with a tiny ossicle along the distal tip of the medial malleolus likely reflecting prior remote trauma.4. Osteoarthritis of the ankle and midfoot.


Instruction: Generate impression based on findings.

Input: 52-year-old female. CT scan OSH with small calcifications in head of pancreas. Please use gadolinium and secretin to rule out chronic pancreatitis. Persistent nausea. ABDOMEN:LIVER, BILIARY TRACT: Small left hepatic lobe cyst. Small wedge shaped intrinsically T1 hyperintense area adjacent to the falciform ligament likely represents a perfusion abnormality. No suspicious hepatic mass. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum is noted. No pancreatic ductal dilatation and appropriate physiologic response of the pancreas to secretin. T1 signal intensity of the pancreas is normal. No focal mass is identified.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: Mild degenerative changes in the spine.OTHER: No significant abnormality noted.

Output: No specific evidence of chronic pancreatitis. Pancreatic divisum. Appropriate physiologic response of the pancreas to secretin.


Instruction: Generate impression based on findings.

Input: Postoperative changes are seen from interval suboccipital craniectomy and resection of posterior arch of C1 for decompression of a Chiari I malformation. The previously pointed cerebellar tonsils are no longer visualized, which suggests surgical resection. There is a widely patent neoforamen magnum, filled with CSF. CSF flow imaging was inadvertently not obtained although was included in the prescribed protocol.The cervical spine is in normal alignment, with trace reversal of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.On the previous MR, there was noted to be focal prominence of the CSF space posterior to the left paramedian cerebellum, grossly appearing similar to prior MRI brain from 2013. This is not included within the axial field of view. It does not appear significantly increased in size within comparing across sagittal images, although the posterior margin is now somewhat obscured by susceptibility artifact from the recent surgery.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. Expected postoperative changes following decompression of Chiari I malformation, with surgical resection of cerebellar tonsils and widely patent neoforamen magnum. It CSF flow is clinically desired as was originally ordered, patient may return for additional imaging at no additional charge.2. Partial visualization of previously questioned focal prominence of CSF space dorsal to the left paramedian cerebellum. Previous imaging demonstrated scalloping of the inner table the calvarium, favoring a right small retrocerebellar cyst, versus focal prominence of the cistern. Posterior margin evaluation is limited due to susceptibility artifact from the recent surgery.


Instruction: Generate impression based on findings.

Input: 13-year-old male with right knee pain and medial femoral articular surface lesion identified on radiograph presents for further characterization of this finding. MENISCI: The anterior and posterior horns of both menisci are intact and show normal signal intensity.ARTICULAR CARTILAGE AND BONE: An oval region of signal abnormality in the subchondral surface of the lateral aspect of the medial femoral epiphysis shows decreased signal intensity on T1-weighted images with mild surrounding marrow edema seen on T2-weighted images, consistent with an osteochondral defect. Mild cystic changes along the medial border of this defect suggests a chronic nature. Otherwise, bone marrow signal intensity is within normal limits. The articular cartilage of the femur, tibia, fibula and patella is intact.LIGAMENTS: The anterior ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament are intact.EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Chronic-appearing osteochondral defect of the right medial femoral metaphysis.


Instruction: Generate impression based on findings.

Input: 38-year-old male with knee pain, patellar tendon pain. Some sequences are limited by patient motion artifact.MENISCI: There is tearing of the posterior horn of the medial meniscus consisting of blunting of the free edge as well as a more linear horizontal component that extends to the tibial articular surface. There is slight blunting of the free edge of the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is subjective thinning of the articular cartilage of the medial compartment. The lateral compartment appears relatively spared. There are small cysts within the tibial plateau near the attachment of the PCL which are not necessarily of any clinical significance.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is mild increased signal intensity within the undersurface fibers of the proximal patellar tendon which may represent minimal tendinosis but this is of questionable clinical significance.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above.2. Mild articular cartilage degeneration.3. Findings suggestive of minimal patellar tendinosis which is of questionable clinical significance.4. Nonspecific subcutaneous edema along the anterior aspect of the patellar tendon as described above.


Instruction: Generate impression based on findings.

Input: Wrist pain following injury The exam is limited by motion artifact.LIGAMENTS: No significant abnormality noted. Specifically, the scapholunate and lunotriquetral ligaments are intact as there is no extravasation of contrast from the proximal carpal row into the mid carpal row.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted. There is no extravasation of contrast into the distal radioulnar joint.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Unremarkable MR arthrogram of the wrist. Specifically, the TFCC is intact.


Instruction: Generate impression based on findings.

Input: Re-staging nasopharynx carcinoma treated with chemoradiation. There is an intrinsically T1 and T2 hyperintense lesion with a complete hemosiderin rim in the left midbrain. The lesion now measures up to 3 mm, previously 5 mm. There is no associated enhancement or associated surrounding edema. There is an unchanged punctate lesion in the anterior right frontal lobe with mild T1 hyperintensity and susceptibility effect, as well as an associated developmental venous anomaly. There is an unchanged enhancing extra-axial mass overlying the left middle frontal gyrus that measures up to 7 mm in width with associated calvarial hyperostosis. There is no evidence acute infarct. The ventricles and basal cisterns are unchanged in size and configuration with prominence of the left lateral ventricle choroid plexus glomus that likely represents hyperplasia. There is no midline shift or herniation. There is no appreciable residual nasopharyngeal mass.

Output: 1. Decrease in size of the left midbrain lesion, which is compatible with a cavernous malformation. 2. A lesion in the anterior right frontal lobe is also compatible with a cavernous malformation and is unchanged.2. The small extra-axial lesion overlying the left middle frontal gyrus is unchanged and likely represents a meningioma.3. No evidence of recurrent nasopharyngeal tumor.


Instruction: Generate impression based on findings.

Input: Reason: RUE/RLE numbness History: RUE/RLE weakness, eval for CVA. Brain: There is no restricted diffusion to suggest acute infarct. Again noted are changes compatible with prior suboccipital craniectomy and resection of posterior arch of C1 for posterior fossa decompression, with low-lying cerebellar tonsils which extend to the inferior margin of the anterior arch of C1 not significantly changed since the prior study. The ventricles are normal in size without hydrocephalus. There is prominent volume loss involving the superior cerebellar vermis similar to prior. There is no mass, mass effect, or midline shift. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as the pons, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Tiny lipoma along the falx incidentally noticed. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Postcontrast images demonstrate no abnormal parenchymal or meningeal enhancement. Cervical spine: Again seen is T2 signal abnormality involving the right central and dorsal cervical cord from C2 to the C7 level. There is also a associated prominence of the central canal which extends to the lower T1 level on the axial T2 sequence. Overall appearance of the signal abnormality is unchanged. No abnormal enhancement in the cervical spine.Cervical spine alignment is unchanged with reversal of cervical lordosis and mild retrolisthesis of C4 on C5. Bone marrow signal is benign. The vertebral body heights are preserved. No abnormal enhancement. Degenerative changes are specified by the intervertebral level as follows: C2-C3: Minimal disc osteophyte complex without spinal canal stenosis or neural foraminal compromise is identified. C3-C4: Small disk osteophyte complex with mild narrowing of the spinal canal and effacement of the ventral thecal sac. No significant neural foraminal stenosis.C4-C5: Small disk osteophyte complex with effacement of the ventral thecal sac. Minimal right foraminal narrowing, otherwise no significant neural foramina stenosis. C5-C6: Disk-osteophyte complex without significant spinal canal or neural foramina stenosis.C6-C7: Small disk osteophyte complex without significant spinal canal or neural foramina stenosis.C7-T1: No spinal canal stenosis or neural foraminal compromise.

Output: 1.No evidence of acute infarct. No intracranial mass or mass effect. Postsurgical changes of prior Chiari I decompression without significant interval change in position of the low-lying cerebellar tonsils. 2.No significant change in extensive right cervical cord myelomalacia with small adjacent syrinx.3.Mild multilevel degenerative changes as detailed above with mild spinal canal stenosis at C3-C4 and C4-C5. No high-grade spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Unsteadiness on feet [R26.81] / Essential (primary) hypertension [I10] / Other symptoms and signs involving cognitive functions and awareness [R41.89] / Hereditary ataxia, unspecified [G11.9], Reason for Study: ^Reason: cerebellar pathology History: gait No evidence of acute ischemic or hemorrhagic lesion.Scattered minimal T2/FLAIR high signal intensity lesions on periventricular white matter which are nonspecific but indicate small vessel ischemic disease at this age.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 32-year-old male with renal cell carcinoma and lesion in the pancreatic neck, evaluate for abnormalities ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: 1 cm arterially enhancing mass in the proximal pancreatic body (series 14, image 38). No communication with the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post partial left nephrectomy. Multiple bilateral renal cystic lesions without interval change, likely benign.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.No interval change in arterially enhancing pancreatic lesion, likely representing a neuroendocrine tumor.2.Status post partial left nephrectomy.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient more lethargic today. Signs and symptoms: Acute mental status change. Lethargic. Unenhanced head CT:Since prior examination from 7 -- 19 -- 11 there is no evidence of any new intracranial hemorrhage. Previously seen small patchy areas of superficial located cortical and subcortical as well as minimally of the subarachnoid hemorrhage remains essentially stable since prior exam.Extensive area of low attenuation involving the cortex and subcortical white matter of right frontal and parietal lobes with extension into the right posterior temporal is also stable in appearance since prior study. Findings are believed to represent extensive encephalomalacia however new overlapping ischemic changes can be obscured. If patient has new symptoms recommend follow-up with an MRI exam.There is evidence of a large right temporal -- frontal craniotomy and small amount of air under the craniotomy flap. A combination of postop changes as well as parenchymal changes results in mass effect and midline shift are proximately 9 mm. There Is evidence of interval increase in the midline shaft which on prior exam measured between 5 to 6-mm.expected residual air within the subarachnoid space in the peri-surgical site remains stable.

Output: 1.Interval increase in leftward midline shift since prior exam.2.No definitive evidence of any additional new findings in the brain parenchyma since prior study.3.Previously noted small amount of parenchymal and subarachnoid hemorrhage in the surgical site shows no interval change.4.Very extensive right hemispheric encephalomalacia/edema remains similar to prior study.5.Recommend further follow-up with an MRI examination if clinical concern persists.


Instruction: Generate impression based on findings.

Input: 39-year-old female with left wrist pain. LIGAMENTS: Contrast was injected into the mid-carpal joint, and there is communication of the mid-carpal joint with radiocarpal joint space. Contrast can be seen entering the scapholunate interval, which is widened, compatible with a tear of the scapholunate ligament.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage is intact, and no contrast is seen entering the distal radioulnar joint.TENDONS: No significant abnormality noted. BONES: The bone marrow signal is normal.ADDITIONAL

Output: 1.Tear of the scapholunate ligament with contrast entering the widened scapholunate interval.2.Intact triangular fibrocartilage complex.


Instruction: Generate impression based on findings.

Input: Reason: Visualize the small bowel and areas of narrowing History: RLQ Abdominal Pain ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 3-cm segment of distal ileum is again narrowed in caliber with bowel wall thickening and increased enhancement (image 59, series 13). The degree of narrowing has improved from the prior MRI with more of the lumen now visible. The ileum just proximal to this area of narrowing is mildly dilated, however contrast material appears to pass distally into the colon.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Distal ileal stenosis with evidence of active inflammation likely representing acute on chronic disease. This has slightly improved from the prior MRI.


Instruction: Generate impression based on findings.

Input: 41-year-old female patient with history of Crohn's disease, ileocolitis, perianal abscess. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense lesion in the right lobe of the liver is too small to characterize but likely represents a cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a 6 cm segment of markedly thickened and enhancing terminal ileum, appearance consistent with active inflammation, lumen narrowed and underlying element of chronicity a consideration. There is mild fibrofatty proliferation at the terminal ileum. No evidence of small bowel obstruction. No evidence of large bowel involvement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Endometrial stripe measures 2.0 cm. Recommend correlation with menstruation. Nabothian cyst formation. Left adnexal cyst is likely physiologic. Trace pelvic free fluid likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a transsphincteric tract that arises from the posterior anus at the 7:00 position, extends into the intersphincteric space, traverses the external anal sphincter and terminates in a collection containing air in the ischioanal fat that measures 1.8 x 1.2 cm (series 20 image 45), compatible with history of perianal abscess with transanal drainage. Intervening more linear appearing fluid-containing tract measures 1.6 x 0.7 cm on image 50 series 20. There are mild adjacent inflammatory changes (series 20 image 45).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Acutely inflamed terminal ileum, luminal narrowing seen may be primarily secondary to aforementioned inflammation but an element of underlying chronicity is a consideration, adjacent fibrofatty proliferation present. No additional areas of inflammatory change seen.2.Right perianal transsphincteric fistula with associated abscess formation as described above.3.Likely physiologic thickening of the endometrium and adnexal cyst.


Instruction: Generate impression based on findings.

Input: Status epilepticus. Acute subdural hematoma. Rule out vascular abnormality.Additional history from EMR: Concern for possible nonaccidental trauma. BRAIN MRI:There is a relatively thin T1-hyperintense, T2-hypointense subacute appearing subdural hemorrhage overlying the posterior cerebral (right parietal and occipital and left occipital) and cerebellar convexities, that is most pronounced in the right occipital region with a maximum thickness of 7 mm, compared to 5 mm on previous CT scan. The subdural hematoma is also involving the fixed edges of the cerebral falx and cerebellar tentorium, reaching close to the superior lip of the left porus acoustics. Overall distribution of the subdural hematoma has not significantly changed from the previous CT scan and mild mass-effect on the underlying brain remains minimal. In addition, there is a near CSF intensity more chronic appearing subdural collection that overlies the left cerebral convexity near the vertex, which has a maximum thickness of 5 mm. It is mildly FLAIR hyperintense. This is unchanged and only minimally displaces the underlying brain parenchyma.The large area of parenchymal hypoattenuation in the posterior aspect of the right cerebral hemisphere on CT correlates with relatively mild diffusion restriction and mild gray- and white-matter edema with partial loss of gray-white-matter differentiation. There is also mild asymmetric sulcal effacement in these areas. This involves the right parietal lobe and part of the right temporal and occipital lobes, as well as the posterolateral right thalamus. There is questioned focal mild gyriform diffusion restriction involving the left occipital and parietal lobes as well. These are also conspicuous diffusion restriction involving the splenium of the corpus callosum and also extending along the right corticospinal tract into the posterior limb of the internal capsule and cerebral peduncle, likely reflecting acute Wallerian degeneration. There is no intraparenchymal or subarachnoid hemorrhage. There is a prominent vessel along right occipital lobe which seems to join the vein of Galen (1201/47). This is associated with an adjacent area of mildly confluent hypervascularity on the contrast enhanced MR angiogram neck images in the right occipital lobe (3001/23). It is also associated with prominent vein of Galen on MR venography along with poor visualization and apparent slight irregularity of the anterior aspect of the straight sinus on both planes of MRV acquired. The ventricles are normal in size. There is no midline shift or herniation. There is no gross orbital abnormality. The posterior pituitary bright spot is preserved.CRANIAL MRA:Accounting for the limitation caused by the small patient size, there is no significant stenosis or aneurysm of the major intracranial arteries. Flow related signal is increased in the parietal branches of the right middle cerebral artery and the right posterior cerebral artery and its branches. There is also hypervascularity on the contrast enhanced MR angiogram in the right occipital lobe which correlates with the prominent vessels described above on conventional and susceptibility weighted imaging brain sequences. It is also associated with prominent vein of Galen on MR venography along with poor visualization of the anterior aspect of the straight sinus. CRANIAL MRV:The superior sagittal, transverse and sigmoid sinuses are patent. As described above, the vein of Galan is prominent while the anterior aspect of the straight sinus is poorly visualized. This prominent vein of Galen is associated with the prominent vessels in the right occipital lobe described above. The internal cerebral veins and the posterior part of the straight sinus are patent. The included upper parts of the internal jugular veins are patent as well. NECK MRA:The study is further limited by patient motion which most significantly affects the lower part of the right vertebral artery on the time-of-flight imaging. Within the limitation of the pre and postcontrast examinations, there is no occlusion or severe stenosis of the major cervical arteries. The aortic arch branching pattern is conventional.

Output: 1.Thin supratentorial and infratentorial probably subacute subdural hematomas, with minimal mass-effect on the underlying brain. Additional larger left cerebral convexity more chronic appearing subdural hematoma.2.Mild diffusion restriction involving the right parietal as well as portions of the right temporal and occipital lobes in addition to the right dorsolateral thalamus, with smaller areas questioned in the left parietal and occipital lobes. Findings are of uncertain etiology given the nonterritorial distribution, involving portions of the posterior MCA as well as PCA territory. While the appearance may reflect pseudonormalization in the subacute phase of recent acute ischemia, the unusual distribution raises the possibility of venous congestion/ischemia as well as underlying transient seizure-related signal change given patient's history of status epilepticus. 3.Asymmetrically prominent right occipital region vessel likely a vein may represent incidental developmental venous anomaly. Also, suggestion of asymmetric mildly confluent faint enhancement of the right occipital parenchyma in the area adjacent to this prominent vessel, which could potentially relate to venous congestion secondary to suboptimal venous drainage in the area of potential DVA in an area of underlying seizure activity. However, the associated poor visualization of the anterior segment of the straight sinus along with a mildly prominent vein of Galen immediately proximal make it difficult to exclude an underlying vascular malformation or abnormality. High-resolution, 3-D MR imaging of the brain with contrast may provide more details about these findings. In addition, CT angiogram or conventional cerebral angiogram can also be considered.4.The associated diffusion restriction along the right corticospinal fibers and corpus callosal splenium is probably related to acute Wallerian degeneration.5.There is no gross intracranial arterial abnormality. There is suggestion of mild hypervascularity in the parietal right middle cerebral artery branches and the right posterior cerebral artery and its branches, probably reactive to ischemia or seizure activity, and possibly compressive due to mild residual cerebral edema.6.There is no gross neck arterial abnormality.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:11/6/1960)Reason: evaluate likely TB abscesses, interval change History: see abovePROVIDER/ATTENDING NAME: KAMALA GULLAPALLI COTTS KAMALA GULLAPALLI COTTS A previously noted ring-enhancing lesion along the right centrum semiovale hasn't changed in appearance and size. It now measures 6 mm in diameter where as previously measured 11 mm and enhances homogeneously rather than any ringlike pattern. The degree of facet associated surrounding T2 and FLAIR signal hyperintensity is decreased relative to the previous exam. Diffusion restriction is no longer present within the center of this lesion.A previously noted right cerebellar ring-enhancing lesion has also changed in appearance. It is also now more confluent enhancement, however, is associated with a couple satellite lesions and slightly more T2 and FLAIR signal hyperintensity adjacent to it. Diffusion restriction is no longer present within the center of this lesion.Since prior exams ependymal enhancement along the occipital horn and trigone of the right lateral ventricle has thickened and is associated with narrowing of the occipital horn and trigone of the right lateral ventricle. There is an additional focus of enhancement now present along the temporal horn of the right lateral ventricle. Vasogenic edema surrounding the trigone and occipital horn of the right lateral ventricle has increased. There is significantly less diffusion restriction within the right lateral ventricle on the current exam versus the prior exam. This diffusion restriction involves the tip of the occipital horn of the right lateral ventricle and is not present in the frontal horn on the body of the right lateral ventricle or the trigone of the right lateral ventricle as it was on prior exams.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam a ring-enhancing lesion in the right centrum semiovale has decreased in size and has evolved. The patient is known to have tuberculosis.2.Since the prior exam right lateral ventricle ependymal enhancement compatible with ventriculitis and thickening has progressed and is associated with a greater inflammatory reaction on the current exam relative to the prior. 3.Since the prior exam a right cerebellar lesion known to represent tuberculous abscess has also evolved. It now has a couple satellite lesions but overall has slightly increased in extent/inflammatory reaction on imaging.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: please rule out acute on chronic brain infarct History: presenting with acute on chronic right sided weakness There are scattered restricted diffusion areas on the left precentral gyrus indicating acute ischemic infarct. There is no evidence of hemorrhagic conversion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst on the left maxillary sinus.

Output: Acute ischemic infarct on the left precentral gyrus without hemorrhagic transformation as described above.


Instruction: Generate impression based on findings.

Input: 50 years Male (DOB:12/25/1965)Reason: History brain mets s/p SRS. please eval and compare History: NonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA Since the prior exam patient has developed a new lesion located in the right inferior parietal lobule which measures 6 mm in diameter. On the 1/22/2016 exam it measured 2 mm but was partly obscured by patient motion. It is currently surrounded by vasogenic edema.There is redemonstration of status post right-sided craniotomy for right parietal lobe lesion which is associated with susceptibility effect . Compared to the prior exam there is some retraction of the enhancing lesion in the right parietal lobe and evolution of blood products. There is no associated contrast enhancement. The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a right parietal lobe lesion present which is suspicious for new metastatic disease. 2.There is a hemorrhagic lesion present in the right parietal lobe. Changing MR appearance may be attributed to evolution of blood products. Continued retraction of the lesion suggests this lesion most likely represents scar formation rather than residual tumor.


Instruction: Generate impression based on findings.

Input: Reason: hx crani for parafalcine Meningoma. eval for change/recurrence History: none Postoperative changes are again seen from previous frontal craniotomy for resection of a right parafalcine meningioma. Extent of T2/FLAIR hyperintense gliosis along the posterior aspect of the right superior frontal gyrus and cingulate gyrus remain similar, as does associated susceptibility relating to chronic hemosiderin. Again noted is a small area of enhancement along the anteromedial aspect of the resection cavity. Allowing for differences in technique, this likely has not significantly changed since the May 2012 exam. On coronal images, it has a somewhat stellate appearance except for the most rightward component as seen on 1101/102, where it appears more nodular. This component measures 3 mm transverse on 1101/102, compared to previous 2 mm on prior 1100/49 in November 2012. Evaluation is also limited due to presence of surrounding enhancing vessels. It overall measures 8 x 6 mm, essentially not significant changed since the May 2012 exam.There is redemonstration of scattered punctate foci of T2/FLAIR hyperintensity within the white matter which remains stable, likely relating to chronic small vessel ischemic changes.The ventricles and sulci are within normal limits for age. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.There is a persistent right maxillary sinus mucosal retention cyst. There is partial opacification of the left frontal sinus.

Output: Allowing for differences in technique, no significant interval change in size of a small enhancing nodular focus along the anteromedial aspect of the right parafalcine resection cavity, comparing back to May 2012. Differences in measurement may relate to slice selection and/or differences in technique. Findings are overall favored at least in part to represent granulation tissue, although continued follow-up is recommended as the right lateral component is slightly rounded in contour with perhaps subtle increased prominence since November 2012, although the finding overall appears stellate on coronal imaging.


Instruction: Generate impression based on findings.

Input: follow up of previously shown multiple pial enhancing lesions. There is relatively well defined ovoid shaped enhancing nodule on the right cerebellar hemisphere. The size of the lesion is about 7.6mm x 9.2mm. There is minimal surrounding edema on FLAIR images indicating possible metastatic nodule considering the patient's clinical history. Comparing to prior study, the lesion is identifiable but due to significant motion artifacts, it was not clearly appreciable on prior exam. The size of the lesion measured on prior scan is about 6.9mm x 5.3mm. Suspicious but similar nature nodular lesion is also seen on the right insula.Most of previously identified patchy sulcal enhancements including right side parieto-occipital fissure are not seen on today's scan but remains one of unusual subtle enhancements on the right central sulcus caudal aspect.Previously shown patchy cortical high signal intensity on FLAIR images are not seen on today's scan.  The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval increase in size of the right cerebellar hemispheric enhancing nodule which most likely represent metastatic nodule. A small suspicious nodular enhancement on the right insular could also represent a small nodular metastatic lesion.2. Previously seen sulcal enhancement and cortical high signal intensities on FLAIR are not seen except the left central sulcal lesion indicating interval improvement.


Instruction: Generate impression based on findings.

Input: Clinical question: Epidural abscess, diskitis. Signs and symptoms: Paraspinal pain, elevated WBC. Pre-and post-enhanced cervical spine MRI:Examination demonstrate normal anatomical alignment vertebral column however with mild reversal of cervical lordosis.The signal intensity of spine is unremarkable other than changes secondary to degenerative disease.There is no evidence of diskitis, osteomyelitis or epidural abscess as these questioned clinically.The signal intensity of the cord remains reading normal.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate a central and rightward broad based disk protrusion with resultant flattening and posterior displacement of the cord and moderate central spinal stenosis. Patent bilateral neural foramina and no detectable cord signal abnormality.C4 -- C5 demonstrate moderate disk disease, loss of disk height and a broad-based disk osteophyte complex. There is flattening and posterior displacement of the cord and moderate central spinal stenosis. There is mild bilateral neural foraminal compromise.C5 -- C6 demonstrate mild disk disease, a disk/osteophyte complex on the left results in flattening and posterior displacement of the cord and mild central spinal stenosis. Mild right neural foraminal compromise is also present.C6 -- C7 is unremarkable.C7 -- T1 is unremarkable.Pre-and post-enhanced thoracic MRI:There is normal anatomical alignment the vertebral column however with mild exaggerated kyphosis of thoracic spine. There is unremarkable signal intensity of thoracic spine.There is no evidence of diskitis, osteomyelitis or epidural abscess as clinically is questioned.There is normal signal intensity of the thoracic cord and without evidence of abnormal enhancement.There is no evidence of central spinal stenosis or significant neuroforaminal compromise at any level. Mild degenerative disk disease and hypertrophic changes of posterior elements are noted in the thoracic spine.Pre-and post-enhanced lumbar spine:Examination demonstrate no evidence of diskitis, osteomyelitis or epidural abscess as is questioned clinically.There is normal anatomical alignment the vertebral column. There is no evidence of spinal canal or neural foraminal compromise at any level. Incidentally note is made of an enlarged uterus with multiple well-demarcated foci of low-attenuation suspect that a fibroma. Recommend follow-up with the dictated imaging for better assessment and to exclude other pathology.

Output: 1.Pre-and post-enhanced MRI of the cervical spine demonstrate no evidence of diskitis/osteomyelitis or epidural abscess. There is evidence of extensive degenerative disk disease and with multilevel osteophytes and disk protrusion resulting in central spinal stenosis at C3 -- C4, C4 -- C5 and C5 -- C6 levels and multilevel neural foraminal compromise as detailed per level.2.Pre-and post-enhanced MRI of thoracic spine demonstrate no evidence of osteomyelitis, diskitis or epidural abscess. There is no redness on the spinal canal or neural foraminal compromise. Mild degenerative changes of thoracic spine and slight exaggeration of thoracic kyphosis is noted.3.Pre-and post-enhanced lumbar MRI demonstrate no evidence of diskitis, osteomyelitis or an epidural abscess. No spinal stenosis or neuroforaminal compromise at any level. 4.Incidental note is made of an enlarged uterus and highly suspected multiple fibromas. Recommend follow-up with dedicated imaging to exclude other pathologies.


Instruction: Generate impression based on findings.

Input: 46-year-old female with history of cystic lesion in the pancreatic tail. Please evaluate for changes or abnormalities. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The bilobed/septated cystic lesion of the pancreatic tail measuring 1.8 x 1.4 cm (axial series 4 image 22) is stable to slightly increased in size (prior 1.8 x 1.2 cm). The larger cystic component measures 1.4 x 1.4 cm (coronal series 9 image 37). No main pancreatic ductal dilatation. The cystic lesion is adjacent to the pancreatic duct, but not clear connection to the nondilated pancreatic duct is not identified. Thin enhancing septations are again noted. No mural nodularity is identified.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: Mild degenerative changes at L4/L5 (series 7 image 17).OTHER: Fibroid at the uterine fundus (series 7 image 16).

Output: Stable to slightly increased size of the known bilobed/septated cystic lesion of the pancreatic tail measuring 1.8 x 1.4 cm (prior 1.8 x 1.2 cm). This mildly complex cystic lesion again shows a thin enhancing septations and no mural nodularity. Differential includes IPMN and mucinous cystic neoplasm.


Instruction: Generate impression based on findings.

Input: 17 year old female with a history of coarctation of the aorta status-post repair during infancy, hypertension who is referred to cardiac MR to evaluate for residual coarctation noted on echocardiography. AortaStable aortic morphology with mild eccentric, shelflike narrowing immediately proximal to the origin of the left subclavian artery, as before, and question of mild flow acceleration at this level.There is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The left common carotid artery arises approximately 7 mm distal to the origin of the innominate artery. The distance between the left common carotid artery and the left subclavian artery is approximately 14 mm. There is mild tapering of this segment. The transverse diameter of the arch at the level of the innominate artery is approximately 14 mm while the transverse diameter of the distal portion between the left carotid artery and left subclavian artery if 10 mm. Immediately distal to the left subclavian artery the diameter is approximately 13 mm. The descending aorta is free from focal diease (maximum diameter approximately 14 mm). 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. Left VentricleQualitatively the left ventricle appears to have normal systolic function. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: Stable aortic morphology with mild eccentric, shelflike narrowing immediately proximal to the origin of the left subclavian artery, as before, and question of mild flow acceleration at this level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Newly diagnosed extra-pulmonary small cell cancer. Assess for brain involvement (PET scan with brain uptake). There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is deformity of the left inferior orbital wall, which may represent a fracture.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Persistent left shoulder pain The exam is limited by motion artifact and the patient's body habitus. There are multiple foci of signal void overlying the shoulder representing metallic susceptibility artifact from prior surgical intervention.ROTATOR CUFF: There is moderate fatty atrophy of the supraspinatus muscle. The distal fibers of the supraspinatus tendon are seen attaching to the greater tuberosity; however few if any of these fibers can confidently be traced to the atrophied supraspinatus muscle suggesting a high-grade and possibly full-thickness chronic tear of the myotendinous junction. There is mild fatty infiltration along the myotendinous junction of the infraspinatus but the tendon can be traced to its insertion upon the greater tuberosity. There is mild fatty atrophy of the teres minor muscle but the tendon can also be traced to its insertion on the greater tuberosity. The subscapularis muscle and tendon are normal.SUPRASPINATUS OUTLET: The acromion process is attenuated and there is widening of the AC joint compatible with prior surgery. There is no frank fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is normal. Evaluation of the labrum is limited secondary to the lack of intra-articular contrast. We see no fluid-filled tear. There is no joint effusion.BICEPS TENDON: Evaluation of the long head of the biceps tendon is limited secondary to motion artifact. There is increased signal intensity of the tendon at its transition from the rotator interval to the intertubercular groove indicating tearing.

Output: 1. Surgical changes of subacromial decompression as detailed above.2. Fatty atrophy of the supraspinatus muscle with poor definition of the myotendinous transition suggestive of a chronic high-grade and perhaps complete tear at the myotendinous junction.3. Relatively mild fatty atrophy of the infraspinatus and teres minor muscles.4. Tearing of the long head of the biceps tendon at its transition from the rotator interval to the intertubercular groove.


Instruction: Generate impression based on findings.

Input: Patient with multiple vertebral lesions. History of MEN II with carcinoid. Please perform bone biopsy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Following needle removal images obtained that demonstrate no complications .

Output: T5 vertebral bosdy and right pedicle bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Mark Cichra is a 32Yrs male with history of bicuspid aortic valve with associated dilated aortic root, bradycardia and history of vasovagal syncope presenting for routine evaluation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 214 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). 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 size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 98 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 88 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is bicuspid opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated with sinus of Valsalva 43x32mm and the sino-tubular junction at 30mm. The ascending aorta is 31x30mm when measured 5cm from the aortic valve plane. No aortic coarctation is noted. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild LV dilation with normal systolic function (LVEF 68%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 55%).3. Mild aortic root dilation.4. Bicuspid aortic valve. When compared to the prior study, there is no significant change.