Instruction: Generate impression based on findings.

Input: Male 41 years old Reason: assess herniated cervical disc. Right arm pain numbness and tingling to fingers History: right arm pain numbness and tingling to fingers Alignment is normal. There is again straightening of the normal cervical lordosis. Mild disc narrowing at C4-5 and C5-6 is unchanged. Vertebral body and disc heights are otherwise maintained. Bone marrow signal is within normal limits. Developmental narrowing of the cervical spinal canal due to shortened pedicles appears similar to prior exam.Degenerative changes are specified by the intervertebral level as follows: C2-C3: Mild to moderate developmental spinal stenosis. Minimal right uncovertebral hypertrophy. Overall unchanged.C3-C4: Mild posterior disc osteophyte complex with right-sided prominence. Right greater than left uncovertebral hypertrophy. Moderate central stenosis and moderate to severe right greater than left neural foraminal stenosis. Overall unchanged.C4-C5: Small posterior disc osteophyte complex with mild to moderate spinal stenosis. Right greater than left uncovertebral hypertrophy, with moderate to severe right and moderate left neural foraminal stenosis. Overall unchanged.C5-C6: Central disc extrusion appears flatter and slightly less bulky compared to prior exam, with continued impingement on the spinal cord. No definite cord edema is seen. Moderate generalized spinal stenosis. Mild right and moderate to severe left neural foraminal stenosis, similar to prior exam.C6-C7: Mild disc bulge with superimposed shallow left paramedian central disc protrusion abutting the ventral spinal cord. Mild to moderate spinal stenosis and minimal left neural foraminal stenosis. Overall unchanged.C7-T1: No neuroforaminal narrowing or spinal stenosis.

Output: 1.Central disc extrusion at C5-6 with impingement on the cord appearing slightly less bulky compared to prior exam. No definite cord edema at this level.2.Otherwise multilevel degenerative changes are similar to prior exam, as described above.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with low back pain radiating to the feet, right more than left. The last vertebral body bearing well-formed ribs will be considered T12. This implies 6 lumbar type vertebral bodies with a mildly transitional morphology of L6.Slight retrolisthesis of L3 relative to L4 and L4 relative to L5. A grade 1 anterolisthesis of L5 relative to L6 is also seen.Vertebral body heights are preserved. Marrow signal characteristics are remarkable for scattered endplate degenerative signal change and scattered Schmorl's nodes at lower levels. No worrisome marrow replacement or significant marrow edema is seen.The visualized spinal cord and conus are within normal limits. Details of the cauda equina are discussed below.The intervertebral discs show diffuse loss of T2 signal and moderate loss of height at L3-4, L4-5 and L5-6. Additional level specific findings are as follows:T11-12: Ligamentum flavum hypertrophy on the left causing mild left foraminal narrowing.T12-L1: No significant spinal canal or foraminal stenosis.L1-2: Anterior osteophytosis, but no significant spinal canal or neuroforaminal stenosis. L2-3: Right lateral disc osteophyte formation. Mild right foraminal narrowing. No significant spinal canal stenosis. L3-4: Mild facet hypertrophy. Congenitally shortened pedicles. Prominence of the epidural fat. Mild disc bulging. Findings contribute to produce a moderate to severe narrowing of the thecal sac with crowding of the cauda equina. The neural foramina are moderately narrowed. L4-5: Facet hypertrophy. Ligamentum flavum thickening. Congenitally shortened pedicles. Prominence of the epidural fat. Disc bulging. Findings contribute to produce a moderate to severe narrowing of the thecal sac with crowding of the cauda equina. Moderate to severe bilateral foraminal narrowing. L5-L6: Marked facet hypertrophy. Ligamentum flavum thickening. Congenitally shortened pedicles. Disc bulging. Prominence of the epidural fat. Findings contribute to produce a severe spinal canal stenosis with crowding and likely impingement of the cauda equina. Moderate bilateral foraminal narrowing. L6-S1: Facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: A combination of findings, including posterior element hypertrophy, prominence of the epidural fat, disc bulging and congenitally shortened pedicles, contribute to produce significant spinal canal stenoses at L3-4, L4-5, and L5-6. Scattered foraminal narrowing is also demonstrated, most severely affecting the L4-5 level.


Instruction: Generate impression based on findings.

Input: 23-year-old male with change in mental status. Evaluate for interval changes. There is no evidence of intracranial hemorrhage, mass or edema. The left-sided region of encephalomalacia or porencephalic cyst is unchanged in appearance. Ventricular size is unchanged from the previous study. Basal cisterns are preserved.A healed left parietal craniotomy is present. Orthopedic hardware of cervico-occipital fusion is present. The middle ear cavities are opacified. Foreign bodies or debris are present in the external auditory canals bilaterally.Ossified structures appear to narrow the cervical spinal canal. This region is incompletely visualized. If clinically appropriate consider further evaluation with dedicated cervical spine CT or MRI.

Output: No significant interval change.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of unspecified site [D49.9], Reason for Study: ^Reason: eval s/p tumor resection History: s/p tumor resection Near total resection status of the posterior fossa mass through midline suboccipital craniotomy. Post surgical changes including blood products are seen at the resection sites with minimal surrounding edema.On post enhanced scan, there is focal patchy enhancing area especially around the area of the right inferior cerebellar peduncle and foramen Luschka (lateral aperture). These enhancement could represent small portion of residual mass but could also represent reactive changes or enhancing venous structure or choroid plexus. Follow up imaging is recommended for further clarification.Otherwise, there is no evidence of abnormal enhancement on the 4th ventricle wall where main portion of the tumor was seen.There is no evidence of acute ischemic lesion on this scan.Ventricle size is stable with air fluid level which indicate postoperative status. 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: Post posterior fossa (4th ventricle) tumor near total resection status.Overall, there is no postoperative unusual finding.Subtle patchy enhancing area around the right 4th ventricular lateral aperture is seen. Follow up imaging appears to be needed to clarify the nature of the lesion.


Instruction: Generate impression based on findings.

Input: Left sided radicular pain X 2 months, status post ACDF at C6-7 in 2007, and T5-6 disc herniation. Cervical Spine: There are postoperative findings related to anterior fusion at C6 and C7. There is loss of the usual cervical lordosis, but no spondylolisthesis. There are small posterior disc-osteophyte complexes at C4 through C6 with effacement of the anterior thecal sac cerebrospinal fluid, but no spinal cord compression. In addition, uncovertebral hypertrophy results in mild right C3-4 and C5-6 neural foraminal narrowing. The vertebral body heights are preserved. Thoracic Spine: There is a small posterior disc-osteophyte complex at T5-6 that slightly indents the spinal cord. The spinal cord signal is otherwise unremarkable. Smaller posterior disc-osteophytes at T6 though T9 do not result in significant spinal canal stenosis at the other levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are scattered foci of focal fat and/or hemangioma in the vertebrae. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to anterior fusion at C6 and C7 and multilevel degenerative spondylosis of cervical spine, including small posterior disc-osteophyte complexes at C4 through C6 with effacement of the anterior thecal sac cerebrospinal fluid, but no spinal cord compression, as well as uncovertebral hypertrophy that results in mild right C3-4 and C5-6 neural foraminal narrowing.2. A small posterior disc-osteophyte complex at T5-6 slightly indents the spinal cord.


Instruction: Generate impression based on findings.

Input: 5 week old male ex 40 weeker with recurrent global and focal seizures. There are subcentimeter foci of low T1 and high T2 signal in the bilateral thalami, as well as peripheral T1 hyperintensity in the right side. The degree of myelination otherwise appears to be within normal limits. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Subcentimeter lesions in the bilateral thalami may represent chronic infarcts, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: There is motion degradation limiting evaluation. There is more prominent ill-defined heterogeneous enhancement in the left masticator space extending toward the left parotid space which could be due to post treatment change. There is unchanged but more prominently enhancing tumor surrounding the left foramen ovale, which may also be due to posttreatment change. There remains enhancement of the left Vidian nerve, left pterygopalatine fossa, and left foramen ovale as well as rotundum, with left V2 and V3 involvement. There remains erosion of the left pterygoid plates and persistent heterogeneous enhancement of the clivus. There is fluid within the left middle ear and mastoid air cells. The major flow voids are intact. The orbits are unremarkable. No suspicious enhancement is seen within the brain parenchyma.

Output: Motion degraded exam with no significant interval change in post treatment findings related to left nasopharynx adenoid cystic carcinoma with perineural spread as described above.


Instruction: Generate impression based on findings.

Input: 86 year old female with abdominal mass and weight loss. ABDOMEN:LIVER, BILIARY TRACT: The reference heterogeneous large mass with some areas of discontinuous nodular enhancement and progressive enhancement on delayed images suggested, measures 17.3 x 15.1 x 20.1 cm (AP X TR X CC), previously 12.9 x 12.1 x 18 cm. Some areas of intralesional T2 hyperintense signal seen. Although evaluation is suboptimal due to the large size of the mass, a hepatic origin is favored. The mass is at least partially exophytic. Mass effect on adjacent intraabdominal structures again noted. Gallstones in gallbladder without evidence of acute cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: There is stable prominence of the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is mass effect with associated inferior displacement of the right kidney, appearing similar to the prior study.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small fat-containing ventral hernia. Bibasilar atelectasis.

Output: 1.Slight interval increase in size of the patient's large hepatic mass with imaging characteristics most consistent with an atypical giant hemangioma.2.Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: 43-year-old female with left shoulder pain. ROTATOR CUFF: The supraspinatus muscle and tendon are normal. There is mild fatty atrophy along the myotendinous junction of the infraspinatus, but otherwise the muscle and tendon appear normal. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial/subdeltoid bursa, not necessarily of any clinical significance. The acromioclavicular joint is within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the glenohumeral joint, but no frank effusion. Although we see no fluid-filled labral tear, there is increased intermediate signal intensity within the anterior inferior labrum, extending into the anterior superior labrum, that may reflect degeneration or the sequela of prior tearing. The posterior superior labrum appears slightly attenuated, but this may represent normal anatomic variation for this patient.BICEPS TENDON: There is a small amount of fluid within the biceps tendon sheath which may represent a mild tenosynovitis. ADDITIONAL

Output: 1. Normal-appearing rotator cuff.2. Increased signal intensity within the anterior labrum may represent degeneration or the sequela of prior tearing. If there are clinical signs and symptoms of instability, this could be further evaluated with MR arthrography.3. Small amount of fluid within the biceps tendon sheath may represent a mild tenosynovitis, but this is equivocal.


Instruction: Generate impression based on findings.

Input: The cervical lordosis, thoracic kyphosis and lumbar lordosis are preserved. The vertebral bodies are normally aligned. There is subtle anterior wedging of the T8 vertebral body as well as approximately 50% loss of central T9 vertebral body height. Subtle irregularity and enhancement at the inferior endplate of T9 may be related to Schmorl's node formation, as this process appears to extend from the disc. The remaining vertebral body heights and intervertebral disc spaces are maintained.There is prominent leptomeningeal enhancement within the visualized posterior fossa, brainstem, and cervical through lower thoracic spinal canal. The spinal leptomeningeal enhancement is most prominent in the dependent cranial portions. The spinal cord itself demonstrates normal signal and morphology. Of note, posterior fossa and brainstem leptomeningeal enhancement as well as upper cervical spinal canal enhancement was grossly not present on outside brain MRI from 8/25/2016.C3-C4: There is a left paracentral posterior disc osteophyte complex causing moderate to severe left and mild right neuroforaminal stenosis.C4-C5: There is a small posterior disc osteophyte complex without significant spinal canal or neural foraminal stenosis.C5-C6: There is a small posterior disc osteophyte complex causing moderate to severe left and moderate right neuroforaminal stenosis.C6-C7: There is moderate left greater than right neuroforaminal stenosis secondary to uncovertebral joint hypertrophic degenerative change.L3-L4: Thre is a diffuse disc bulge effacing the right ventral thecal sac and crowding resulting in posterior displacement of the descending right L4 nerve root.L4-L5: There is a diffuse disc bulge and mild narrowing of the right greater than left neural foramina.A subcentimeter cyst is visualized in the right kidney.

Output: 1. There is leptomeningeal enhancement involving the visualized posterior fossa, brainstem, and cervical through lower thoracic cord. Considering that enhancement was grossly not present on prior brain MRI from August 25, 2016 and that the enhancement is most prominent involving the dependent cranial portions of the spinal canal rather than layering in the distal thecal sac, these findings are favored to relate to hemorrhagic product deposition from recent pineal region tumor biopsy and associated reactive enhancement. However, metastatic disease is difficult to exclude. Follow-up exam is recommended.2. Chronic appearing T9 compression deformity and mild chronic anterior wedging of the T8 vertebral body.


Instruction: Generate impression based on findings.

Input: 80-year-old female patient with weakness. Evaluate for cervical stenosis. Mild to moderate multilevel degenerative changes affect the cervical spine, particularly at C2-C3 and C7-T1. There is is moderate to severe multilevel facet joint osteoarthritis and mild to moderate neuroforaminal narrowing, please refer to recent MRI exam for further details. There is exaggerated cervical lordosis. The anterior atlantodental interval increases to 4-5 mm on flexion view, indicating atlantoaxial instability. There is 2 to 3 mm of retrolisthesis of C2 on C3 that corrects on flexion. There is approximately 1 mm of retrolisthesis of C3 on C4 that corrects on flexion. There is 2 to 3 mm of anterolisthesis of C4 on C5 that is elicited on flexion. There is 3 mm of anterolisthesis of C5 on C6 and 3 mm of anterolisthesis of C6 on C7, both of which are stable between neutral, flexion, and extension views.

Output: Multilevel degenerative disc disease, facet joint osteoarthritis, and multilevel spondylolistheses as described above, including widening of the anterior atlantoaxial interval indicating instability.


Instruction: Generate impression based on findings.

Input: Ms. SHIRLEY KONRATH is a 69 years old female with a personal history of right lumpectomy in 1997 and radiation for breast cancer. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution.A linear marker is placed on the scar overlying the right breast. There are stable post-lumpectomy changes present in the right breast, including decreased size of the right breast, architectural distortion, increased density, and dystrophic calcifications. Additional scattered benign calcifications are present. Mildly prominent left lower axillary lymph nodes appear not significantly changed compared to MRI 9/10/2014 where fatty hila were demonstrated.There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in either breast.

Output: Stable postsurgical changes in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: There is an extra-axial fluid collection within the superior cerebellar cistern that measures approximately 16 x 26 mm and follows CSF signal intensity on all pulse sequences. There is resultant mild mass effect upon the tectum and superior cerebellar vermis. There may be some associated mild superior vermian hypoplasia. There is no evidence of intracranial hemorrhage, suspicous mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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 and scalp soft tissues are unremarkable. Bilateral hippocampi are grossly symmetric in size and signal. There is a retention cyst within the left maxillary sinus and minimal fluid within the right mastoid air cells.

Output: 1.Superior cerebellar cistern arachnoid cyst with mild mass effect on the superior vermis and tectum. Otherwise unremarkable MRI. 2.No structural abnormalities are seen to suggest seizure focus. If there is continued suspicion, examination per epilepsy protocol can be obtained.


Instruction: Generate impression based on findings.

Input: 52-year-old woman with history of jejunal and mesenteric desmoid tumor status post resection in April 2014. ABDOMEN:LIVER, BILIARY TRACT: Mildly T2 hyperintense segment 6 lesions appear similar to the prior examination measuring 10 x 8 mm (9/33), previously 10 x 10 mm and 14 x 12 mm (9/39), previously 17 x 13 mm. These lesions follow the signal of the liver parenchyma across all phases of perfusion imaging. A few, scattered subcentimeter cysts are noted. No new suspicious focal liver lesions identified.There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is visualized and normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes from mass resection, partial duodenal and jejunal resection, and re-anastomosis noted. There is stable dilated bowel at the anastomotic site. No evidence of local recurrent disease.There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Anterior abdominal wall postoperative changes noted with small ventral hernia.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right Bartholin's cyst noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of recurrent desmoid tumor. 2.Stable liver lesions, likely focal nodular hyperplasia or adenoma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified epilepsy without mention of intractable epilepsy. Congenital anomaly of cerebrovascular system. Other specified delay in development. Obstructive hydrocephalusClinical question: vein of galen malformation , embolized , seizures, yearly follow up for changes MRI of the brainNo diffusion weighted abnormalities are appreciated.There is redemonstration of ventriculomegaly. There is redemonstration of periventricular white matter lesions which are stable compared to the previous exam and associated with loss of the white matter mantle.The patient is status post embolic occlusion of a vein of Galen malformation. There are embolic coils present within the vein of Galen aneurysm.The third ventricle is shifted mildly towards the right side. There is partial opacification of the right mastoid air cells.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 superior sagittal sinus. The internal cerebral veins are identified. The straight sinus, however, is not readily identified.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The vertebral arteries are similar in size. The left A1 segment is larger than the right A1 segment. The posterior communicating arteries are medium-sized. The anterior communicating artery is medium-sized.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent but are not connected to the vein of Galen which is not present. . The straight sinus appears diminutive and possibly drains the inferior sagittal sinus. The basal veins drain into the perimesencephalic venous system. Drainage of the internal cerebral veins appears to be into the posterior fossa venous drainage system.

Output: 1.Examination is stable and compared to the prior exam. The patient status post embolic coil occlusion of vein of Galen aneurysm.2.There is alteration of the venous drainage system which appears stable.3.No new arteriovenous fistulas are appreciated.4.There is redemonstration of ventriculomegaly and periventricular leukomalacia.


Instruction: Generate impression based on findings.

Input: 43-year-old female. Crohn's disease, status post complete colectomy with ileostomy. Report from outside hospital shows a 3 x 3 cm mass containing gas adjacent to ileostomy compatible with probable abscess. Pus from JP drain. Evaluate for abscess. Evaluate for new fistula. ABDOMEN: LUNG BASES: No significant abnormality noted. LIVER, BILIARY TRACT: No significant abnormalities seen within the liver or gallbladder. SPLEEN: No significant abnormality noted. KIDNEYS, URETERS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted. PANCREAS: No significant abnormality noted. Prominent pancreatic duct is unchanged.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes. Small mesenteric nodes identified as well. Several mildly enlarged nodes adjacent to ostomy site are probably reactive. BOWEL, MESENTERY: There is a percutaneous drain in the anterior abdominal wall which has resolved the loculated fluid collection in the subcutaneous fat at the site of the ileostomy. No new abscess. BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted. PELVIS: UTERUS, ADNEXAE: Patient is status post hysterectomy. There is a 2.6 x 3.7 cm cystic mass in the right adnexa (image 109/150 series number 3). This is this was present on the prior examination and it appears slightly smaller. If indicated the mass may be further evaluated with transvaginal ultrasound or MRI. The left adnexa is unremarkable. BLADDER: Unremarkable LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: Right lower quadrant ileostomy is present compatible with patient's known Crohn's disease and total colectomy. Stable multiple loops of small bowel with wall thickening in the pelvis. No intraperitoneal abscess and no bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No other significant abnormality was found.

Output: 1. Status post colectomy with right lower quadrant ileostomy. Status post drainage of abscess lateral to ostomy site. Thickening of pelvic small bowel loops is stable. No new abscess or fistula. 2. Stable right adnexal mass. If indicated, transvaginal ultrasound or MRI would be helpful in further evaluating this lesion.


Instruction: Generate impression based on findings.

Input: History of ampullary adenocarcinoma. Questioned liver lesions on CT. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 mildly to moderately hyperintense liver lesions are noted in both lobes of the liver. These lesions demonstrate very thin peripheral enhancement on postcontrast images compatible with metastatic disease. There are associated with restricted diffusion and some have suggestion of internal complexity/coalescing small cystic components.Intra and extrahepatic biliary ductal dilatation to the level of the ampullary mass. Susceptibility artifact from patient's biliary stent is noted.Air in the gallbladder fundus.SPLEEN: No significant abnormality noted.PANCREAS: Large heterogeneous enhancing solid and cystic mass centered at the ampulla/pancreatic head measuring 7.3 x 7.2 x 8.7 cm resulting in marked pancreatic ductal dilatation and parenchymal atrophy. There is no encasement of the superior mesenteric artery or celiac artery. The mass abuts the portal vein/SMV which is normal in caliber and is otherwise patent. Punctate peripancreatic nonspecific lymph nodes are noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts and minimally complex proteinaceous/hemorrhagic cyst in the left kidney. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The bilobar liver lesions demonstrate very thin peripheral enhancement and restricted diffusion. Given their configuration/morphology, the patient's recent leukocytosis and biliary obstruction these could represent small abscess, favored over necrotic metastases although the later cannot be entirely excluded. Large ampullary mass is again demonstrated. Biliary stent with persistent significant biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Other transient cerebral ischemic attacks and related syndromes [G45.8], Reason for Study: ^Reason: TIA, please evaluate for diffusion restriction or stenosis History: Left leg and arm tingling, transient Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.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. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Minimal mucosal thickening is seen on frontal sinus.About 7mm tonsilar ectopia is seen.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Cervical spine MRIThere is minimal bulging of disc C67 level without showing evidence of spinal canal stenosis. Disc dessication is seen at C23 to CT7T1 level.No evidence of abnormal enhancement.There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy.

Output: 1. Tonsilar ectopia as described above.2. No evidence of acute ischemic or hemorrhagic lesion.3. Normal brain and Neck MRA4. Unremarkable c spine MRI.


Instruction: Generate impression based on findings.

Input: Female, 18 years old, status post left parietal cranioplasty for treatment of large eroding arachnoid granulations. Postoperative findings are seen at the left parietal convexity compatible with cranioplasty. The previously demonstrated CSF-filled presumed arachnoid granulations are no longer evident. No fluid collections are seen intracranially or extracranially. Thinning of the right parietal convexity is unchanged.Brain parenchymal morphology and signal characteristics are within normal limits. No evidence of edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricles are normal in size and morphology.

Output: Findings are demonstrated compatible with cranioplasty at the left parietal convexity. The previously seen presumed arachnoid granulations are no longer evident.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with low back pain, worsening over the past 9-10 months. Alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are mildly heterogeneous but no concerning marrow replacement or marrow edema is seen.The visualized distal spinal cord and conus are unremarkable. The spinal canal is congenitally slender. The discs show loss of height. Additional level specific findings are as follows:Low thoracic spine: Mild disc bulging, only assessed on sagittal images.L1-2: Mild facet arthropathy. Mild bulging disc. Prominence of the epidural fat. Mild spinal canal narrowing. No significant foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Mild bulging disc. Prominence of the dorsal epidural fat. Mild to moderate generalized spinal canal narrowing with borderline crowding of the cauda equina. No significant foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Prominence of the dorsal epidural fat. Moderate generalized spinal canal narrowing with exclusion of CSF and crowding of the cauda equina. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Prominence of the dorsal epidural fat. Mild to moderate generalized spinal canal stenosis with some crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. Bulging disc. No significant spinal canal stenosis. Severe right and moderate to severe left foraminal narrowing.

Output: Spinal canal narrowing is seen at L3-4, L4-5, and to a lesser degree at L2-3, due to a combination of disc degeneration, posterior element hypertrophy, prominence of the dorsal epidural fat and a congenitally slender spinal canal. Significant foraminal narrowing is also evident bilaterally at L5-S1.


Instruction: Generate impression based on findings.

Input: Dizziness, abnormal VNG, headache. 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 orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

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


Instruction: Generate impression based on findings.

Input: Status post cervical laminoplasty. Evaluate healing of hinge of the lamina. History of breast cancer and stenosis. Reformatted images of the cervical spine demonstrates extensive degenerative changes of cervical spine with slight reversal cervical lordosis. There is no definitive evidence of any destructive bony lesion. However irregular and sclerotic lesion within the right aspect of vertebral body of T3 which also involves the right pedicle, a sclerotic and lytic changes of the right aspect of vertebral body of T1 and sclerotic changes of the right aspect of C6 are noted. There are no prior CT examinations of the cervical spine or an MRI examination of cervical spine for comparison.Considering the provided clinical date of possibility of a sclerotic met cannot be ruled out. Some of these lesions have the appearance of a capillary skeletal hemangioma.Foramina magnum. Examination of this level is unremarkable.C2 -- C3.Degenerative changes are noted in mild compromise of left neural foramina is suspected. Broad-based bulging of disk material is in contact with ventral aspect of the cord and borderline central spinal stenosis is suspected.C3 -- C4.Degenerative disk disease and slight bulge of disk material is noted. There is evidence of left sided laminectomy with no evidence of laminoplasty. Left neural foramina appears widely compromise secondary to degenerative changes. A very small metallic density is noted within the right inferior articulating facet. C4 -- C5.Left-sided laminectomy of C5 with no evidence of laminoplasty. Small metallic density within the inferior facet of C5 on the right is also noted.C5 -- C6.Left-sided laminectomy but no evidence of laminoplasty. A small metallic fragment within the inferior facet of C6 on the right. Degenerative changes are noted.C6 -- C7.Exam of the stomach is unremarkable. No evidence of any fixating devices or bony graft is detected.

Output: 1.Extensive areas of sclerotic bony changes as detailed above. Concerning for metastases lesions or treated metastatic lesion. No prior MRI of cervical spine or CT of cervical spine for comparison.2.Multi-level laminectomies on the left with no areas of laminoplasty.3.Small metallic densities within the inferior facets of C4, C5 and C6. Correlate with prior surgical intervention.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with intermittent radicular pain down the right lower extremity more than the left lower extremity. A transitional morphology of the L5 vertebral body is seen. Spinal alignment is anatomic. Vertebral body morphology and marrow signal characteristics are within normal limits.Visualized spinal cord and conus are unremarkable. The cauda equina dispersed evenly through the thecal sac.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Mild laterally bulging disc. No spinal canal stenosis. Mild neuroforaminal narrowing. No significant interval changes. L3-4: Moderate facet arthropathy and ligamentum flavum thickening. The previously seen large left lateral recess disc extrusion has resolved with relief of previously seen lateral recess narrowing and nerve impingement. Mild residual bulging disc is seen with perhaps a minimally progressive focal component within the left neural foramen. No significant spinal canal stenosis. Moderate left foraminal narrowing, slightly progressed from the prior examination. Mild right foraminal narrowing, unchanged. L4-5: Moderate facet arthropathy and ligamentum flavum thickening. Mild bulging disc with a small superimposed central protrusion, stable. Moderate spinal canal stenosis, stable. Mild bilateral foraminal narrowing, stable. L5-S1: Unremarkable.

Output: 1.Interval resolution of the previously seen large left lateral recess disc extrusion spanning the L3 vertebral body. Previously seen lateral recess stenosis and nerve root impingement has been relieved.2.Minimal progression of a very small left foraminal disc protrusion at L3-4 which results in mild worsening of the foraminal narrowing.3.Disc and posterior element degeneration at L4-5 resulting in a moderate generalized spinal canal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: 65-year-old male with right sided weakness and paresthesia. MRI brain:Examination is somewhat limited by motion artifact. Within these limitations, there is no evidence of intracranial mass or acute infarct. There is scattered mild periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is near complete opacification of the left maxillary sinus with mild mucosal thickening involving the right maxillary sinus. There is opacification of many of the ethmoid air cells and minimal mucosal thickening of the frontal sinus.MRI C-spine:This is a severely limited exam secondary to patient motion. There are degenerative changes involving the cervical spine with mild spinal canal stenosis involving the C4-5, C5-6 and C6-7 levels. A disc osteophyte complex and facet arthropathy contribute to severe bilateral neuroforaminal narrowing at C4-5. In addition, a disc-osteophyte complex and facet arthropathy at C5-6 contribute to severe left and moderate to severe right neuroforaminal stenosis at this level.There is straightening of the cervical spine which is nonspecific. The vertebral body heights are maintained. The cervical spinal cord normal signal cannot be adequately assessed secondary to patient motion. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Limited exam of the brain without acute abnormalities.2.Mild scattered chronic small vessel ischemic disease3.Severely limited examination of the cervical spine shows degenerative changes most prominent at the C4-5 and C5-6 level at most severe neuroforaminal narrowing involving the bilateral C4-5 and left C5-6 levels. There is at most mild spinal canal stenosis from C4-5 through C6-7.4.Note that the cervical spinal cord cannot be adequately assessed secondary to the limitations of motion.5.Paranasal sinus inflammation, greatest involving the left maxillary sinus, as described above.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and weakness ROTATOR CUFF: There is a high-grade partial-thickness undersurface tear of the supraspinatus tendon situated at the 11:00 position approximately 2 cm proximal to the greater tuberosity. The tear involves greater than 50% thickness of the tendon with sparing of the bursal surface fibers. This measures approximately 10 mm in the longitudinal dimension and 8 mm in the AP dimension. There is mild to moderate tendinosis of the remaining supraspinatus tendon but the supraspinatus muscle appears normal in caliber and signal. There is perhaps mild tendinosis of the infraspinatus tendon but there is no evidence of tear. The infraspinatus muscle is normal in caliber and signal. The teres minor and subscapularis tendons and muscles are normal.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. A trace amount of fluid is noted within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is attenuation of the posterior superior labrum which may reflect normal variation or degenerative tearing but we see no fluid-filled SLAP tear. There is linear intermediate signal intensity in the anterior labrum which likely represents tearing with small adjacent paralabral cysts anterior to the glenoid.BICEPS TENDON: No significant abnormality noted.

Output: Focal but high-grade partial-thickness undersurface tearing of the supraspinatus tendon and additional findings described above.


Instruction: Generate impression based on findings.

Input: Straightening of the cervical spine is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.The central canal appears congenitally slender from C3/4 through C6/7.C2/3: UnremarkableC3/4: Apart from the congenitally slender canal, unremarkable.C4/5: There is a left paracentral disc extrusion deforming the left hemicord without intrinsic T2 abnormality causing significant proximal neural foraminal obstruction with nerve root compression.C5/6: Apart from the congenitally slender canal, unremarkable.C6/7: Mild disc bulge causing slight anterior cord flattening without intrinsic cord signal abnormality. Apart from the congenitally slender canal, there are no significant stenoses.C7/T1: Unremarkable

Output: 1.The central canal appears congenitally slender from C3/4 through C6/7.2.C4/5: There is a left paracentral disc extrusion deforming the left hemicord without intrinsic T2 abnormality causing significant proximal neural foraminal obstruction with nerve root compression.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, history of right acoustic neuroma, status post SRS. A mass is again seen occupying the right IAC with protrusion into the CP angle. On comparison with the prior study, the tumor is more heterogeneously enhancing, but not significantly changed in size. No new lesions are demonstrated.

Output: The presumed right IAC schwannoma shows no interval change in size but is more heterogeneously enhancing which may represent an effect of therapy.


Instruction: Generate impression based on findings.

Input: Reason: evaluate lesion on left knee History: left knee lesion MENISCI AND LIGAMENTS: Cruciate ligaments and collateral ligaments are intact. Medial and lateral menisci are normal in morphology and signal characteristics. Quadriceps tendon and patellar tendon are intact.BONE AND MARROW: Osseous alignment is anatomic. The bone marrow signal is within normal limits. The patellofemoral and femorotibial articular cartilage appears appropriate for age.SYNOVIUM: No significant abnormality.MUSCULATURE: No significant abnormality.ADDITIONAL

Output: Lesions with calcification and enhancement in the subcutaneous tissue adjacent to the patella. The appearance of this lesion is likely representing tumoral calcinosis. Other considerations include renal osteodystrophy (correlate with biochemical profile), heterotopic ossification, synovial osteochondromatosis, and mixed connective tissue disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for ischemic stroke. Signs and symptoms: 69 year old with right upper extremity weakness, dysarthria, possible right facial droop and alteration of mental status. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no evidence of acute ischemic stroke as is questioned clinically.There is normal anatomical morphology of brain parenchyma and with normal signal intensity on all MRI sequences. Mild prominence of cortical sulci and the supratentorial ventricular system likely still within normal range for patient's stated age of 69.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits.Unremarkable images through the paranasal sinuses.Extensive bilateral mastoid air cell opacification and suspected partial opacification of the right middle ear cavity. Recommend correlation with clinical symptomatology and dedicated imaging.

Output: 1.Negative nonenhanced brain MRI.2.Extensive bilateral opacification of mastoid air cells and suspected partial opacification of right middle cavity.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Mild perihepatic ascites. No intra or extra hepatic biliary ductal dilatation. Cholelithiasis. Patent vasculature.Segment 7 intrinsic T1 hyperintense/T2 hyperintense lesion with postcontrast enhancement with washout measures 3.3 x 3.3 cm (image 68 of series 1100).Right hepatic dome lesion is not well-visualized on today's study.Additional T2 hypointense nodules are present scattered diffusely throughout the liver parenchyma.SPLEEN: Splenomegaly.PANCREAS: Pancreatic body cystic lesion without enhancement measuring 1.7 x 1.4 cm (image 23 of series 4). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace right pleural effusion.

Output: 1. Cirrhosis with extensive fibrosis. Small volume perihepatic ascites.2. Enhancing segment 7 lesion with probable washout concerning for HCC has not significantly changed in size.3. Stable pancreatic body cystic lesion, likely an IPMN.


Instruction: Generate impression based on findings.

Input: Patient with history of metastatic lung cancer, presenting with right leg numbness, evaluate for metastatic disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. No mass effect or abnormal enhancement is identified to indicate intracranial metastatic disease. The ventricles and sulci are prominent likely reflecting global parenchymal volume loss. There are multiple areas of T2/FLAIR hyperintensity in the subcortical and periventricular deep white matter which are nonspecific but suggestive of moderate chronic microvascular ischemic disease, unchanged as compared to prior exam. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is patchy opacification of the paranasal sinuses, relatively more prominent in the right maxillary sinus. No discrete destructive calvarial lesions are identified.

Output: 1.No mass or abnormal enhancement to suggest intracranial metastatic disease.2.Multiple areas of T2/FLAIR hyperintensity in the subcortical and periventricular deep white matter which are nonspecific but suggestive of chronic microvascular ischemic disease, unchanged as compared to prior exam.3.No evidence of acute intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and limited mobility ROTATOR CUFF: There is mildly increased signal intensity of the distal fibers of the supraspinatus suggesting tendinosis with perhaps mild bursal surface tearing but we see no fluid-filled full-thickness tear. The supraspinatus muscle is normal. The infraspinatus and teres minor tendons and muscles are normal. There is thinning of the distal subscapularis tendon with probable undersurface tearing. The subscapularis muscle is normal. A cystic focus within the humeral head appears unchanged, of doubtful significance. SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a trace amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Again seen is abnormal signal intensity within the superior labrum indicating a SLAP tear with adjacent small paralabral cyst formation. This appears similar to the prior examination. The inferior labrum is intact. There is a trace amount of fluid within the joint but no joint effusion. Alignment of the glenohumeral joint is normal.BICEPS TENDON: The biceps tendon appears slightly perched upon the lesser tuberosity which may be the result of tearing of the overlying subscapularis tendon. The biceps tendon otherwise appears intact.ADDITIONAL

Output: AC joint osteoarthritis, rotator cuff tendinopathy, and superior labral tearing as described above with no evidence of mass.


Instruction: Generate impression based on findings.

Input: There are postsurgical changes of right occipital craniotomy and insertion of Rickham reservoir with the tip in the right CP angle cyst. There has been interval significant decrease in size and partial collapse of the right cerebellopontine angle cyst compared to previous MRI. The margin of the cyst shows mildly heterogeneous enhancement. The residual tumor in the posterior fossa to the left of the decompressed cyst, is at least subjectively somewhat larger than on the prior examination. Accurate measurement of the mass is difficult because of decreased mass effect and change in parenchymal morphology compared to previous.There is a left frontal approach ventriculostomy catheter and the ventricles have increased in size to a relatively normal caliber, compared to the previous study where they were slitlike. There are postprocedural changes related to bilateral frontal instrumentation. There is mild opacification of the bilateral mastoid air cells.

Output: Interval shunting of a cystic tumor component in the right cerebellopontine angle with collapse of the cyst. Findings are seen, however, suspicious for growth of residual tumor medial to the collapsed cyst.


Instruction: Generate impression based on findings.

Input: LV dysfunction Left VentricleThe left ventricle is mildly reduced. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 142 ml (normal range 109+/-23), the LV end systolic volume index is 44 ml/m2 (normal range 18+/-5), the LVESV is 73 ml (normal range 31+/-10). 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. Right VentricleThe right ventricle is mildly reduced. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVEDV is 141 ml (normal range 110+/-24), the RV end systolic volume index is 51 ml/m2 (normal range 22+/-8), and the RVESV is 84 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings . This 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. Mildly reduced LV EF at 48%2. Mildly reduced RV EF at 40%.


Instruction: Generate impression based on findings.

Input: Assess olfactory bulb/cleft, as well as sinuses: moderate microsomia and phantosmia, headaches, and fatigue also. The olfactory bulbs and tracts appear to be intact. There is an apparent small defect in the anterior nasal septum and irregularity of the nasal skeleton. There is mild right frontal sinus mucosal thickening. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are punctate right hippocampal sulcus remnant cysts. There is a punctate T2 hyperintense focus in the left caudate head, which may represent a prominent perivascular space or chronic lacunar infarct. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. The olfactory bulbs and tracts appear to be intact. 2. Apparent small defect in the anterior nasal septum and irregularity of the nasal skeleton perhaps related to prior trauma and/or rhinoplasty.3. Mild right frontal sinus mucosal thickening, but otherwise unremarkable paranasal sinuses and olfactory recesses. 4. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male, 4 months old. Klippel-Trenaunay malformation left leg. There is extensive circumferential thickening and edema of the superficial soft tissues of the left lower extremity, extending from level of the hip to the ankle. Multiple lobulated fluid collections are noted, compatible with vascular malformations, particularly in the left gluteal region, with extension across the midline to the contralateral buttock and gluteal musculature as well as extension into the left pelvis. The deep veins of the left lower extremity appear hypoplastic, including inability to visualize a normal popliteal vein. Multiple dilated vascular structures are noted within the lateral soft tissues (series 1001, images 21, 29, 40; series 1101, image 4) likely corresponding to persistent embryonic veins. Patchy areas of soft tissue enhancement correlating with vascular malformations, without significant abnormal enhancement about any of the larger collections to indicate superimposed infection.The osseous structures and muscles are symmetric compared to the contralateral lower extremity.

Output: Extensive subcutaneous soft tissue thickening/edema and multiple fluid collections, compatible with a known history of Klippel-Trenaunay syndrome and multiple vascular malformations. Hypoplastic deep veins and dilated superficial vascular structures throughout the lower extremity, likely corresponding to persistent embryonic veins.


Instruction: Generate impression based on findings.

Input: 74-year-old female with a history of ALL with acute right hip pain and unable to bear weight. Assess for AVN versus leukemic infiltration versus infection. There is mild diffuse heterogeneous bone marrow signal abnormality on T1-weighted imaging that is nonspecific and could reflect the patient's known history of leukemia versus residual red marrow. We see no specific imaging features to suggest avascular necrosis or osteomyelitis. We see no findings to suggest abscess formation. The signal intensity of the hip musculature is within normal limits.Mild osteoarthritis affects the right hip. Deformity of the superior labrum likely represents chronic tearing. There are small quantities of fluid within both hip joints which are not necessarily of current clinical significance. We see no inflammatory changes in the adjacent soft tissues. There is high signal intensity within the lower paraspinal musculature which may reflect atrophy.Note is made of Tarlov cysts along the second sacral nerve roots. Mild facet joint osteoarthritis affects the lower lumbar spine. Note is made of multiple uterine fibroids.

Output: Degenerative arthritic changes and other findings as described above, with no specific findings to suggest avascular necrosis or infection.These findings were text paged to Eisha Wali at 3:55 PM on 7/7/2015.


Instruction: Generate impression based on findings.

Input: Reason: PCNSL, re-eval History: NHL The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The patient is status post suboccipital craniotomy.A small focus of encephalomalacia is present in the right middle frontal gyrus. This is unchanged since the prior exam.There is encephalomalacia present along the right cerebellar hemisphere which is unchanged since prior examNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Small foci of encephalomalacia in the right middle frontal gyrus and right cerebellar hemisphere are redemonstrated and unchanged.2.There is no evidence for recurrent lymphoma.


Instruction: Generate impression based on findings.

Input: BRAIN: There is an unchanged 1 cm thick subdural hematoma along the right temporal convexity with layering blood products. There is also an unchanged 1.2-cm right temporal lobe intraparenchymal hematoma that extends through the cortex into the subdural compartment and is contiguous with the subdural hematoma. There is surrounding edema throughout the lateral aspect of the right temporal lobe as well decreased diffusion compatible with acute infarction. There is also mildly decreased diffusion along the mesial right temporal lobe with extension superiorly into the dorsolateral aspect of the right thalamus. These findings result in unchanged minimal effacement of the right aspect of the suprasellar cistern as well as the right ambient cistern. There is minimal susceptibility effect layering within the occipital horns compatible with intraventricular hemorrhage. The ventricles have mildly increased in size. There is also mild susceptibility effect along the posterior falx cerebri and tentorium that likely represents birth related trauma. The major cerebral flow voids are intact. The myelination pattern is appropriate for age. The midline sagittal structures and craniocervical junction are unremarkable. MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis, aneurysm or vascular malformation.

Output: 1.Unchanged right temporal intraparenchymal and subdural hematoma with associated infarction of the lateral right temporal lobe. There is unchanged mild effacement of the right ambient and suprasellar cisterns.2.Mild intraventricular hemorrhage with an interval increase in ventricular size concerning for early absorptive hydrocephalus.3.Additional mild hemorrhage along the tentorium and posterior falx is most compatible with birth related trauma.4.No evidence of intracranial aneurysm or vascular malformation.


Instruction: Generate impression based on findings.

Input: 39 year old man with newly diagnosed LV dysfunction referred to determine etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 10%, the LV end diastolic volume index is 273 ml/m2 (normal range: 74+/-15), the LVEDV is 466 ml (normal range 142+/-34), the LV end systolic volume index is 246 ml/m2 (normal range 25+/-9), the LVESV is 419 ml (normal range 47+/-19), the LV mass index is 135 g/m2 (normal range 85+/-15), and the LV mass is 229 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a mid myocardial stripe and epicardial pattern of late gadolinium enhancement involving the septum and the inferior/inferolateral walls at the mid ventricular level. This finding suggests the presence of an underlying fibrosing infiltrative and inflammatory process. It is very atypical for prior myocardial infarction. The finding has been classically described in dilated cardiomyopathy. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 8%, the RV end diastolic volume index is 195 ml/m2 (normal range 82+/-16), the RVEDV is 332 ml (normal range 142+/-31), the RV end systolic volume index is 179 ml/m2 (normal range 31+/-9), and the RVESV is 305 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall right pleural effusion with evidence of a wedge shaped infarct involving the right lower lung. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation was severely reduced systolic function (LVEF 10%) with evidence of epicardial and mid wall fibrosis involving the entire mid left ventricle. No evidence of prior myocardial infarction. No evidence of myocardial infarction. No evidence of acute myocarditis.2. Severe RV dilation with severely reduced systolic function (RVEF 8%)3. Severe biatrial dilation4. Severe mitral regurgitation5. See extracardiac findings


Instruction: Generate impression based on findings.

Input: 64 year old male with history of hypertension, diabetes and dyslipidemia presenting after troponin elevation during EGD study. MEDICATIONS: aspirin, simvastatin, nebivolol, losartan, hydrochlorothiazide First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no evidence of prior myocardial infarction. There is subtle diffuse uptake of late gadolinium enhancement involving much of the basal left ventricle but not the rest the ventricle. Similarly, the native T1 time at the left ventricular base is approximately 1200ms; where as, it is only 1100ms at the apex. The gadolinium kinetics based on the TI scout are unremarkable. There continues to be increased signal at the RV insertion points. Taken together, these findings suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. The diagnosis of early cardiac amyloidosis should be entertained. Left VentricleThe left ventricle is normal in size with mild left ventricular hypertrophy and low normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 185 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 108 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 67 ml/m2 (normal range 82+/-16), the RVEDV is 148 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly enlarged.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with low normal systolic function and mild left ventricular hypertrophy (LVEF 55%). There is subtle diffuse uptake of late gadolinium enhancement involving much of the basal left ventricle but not the rest the ventricle. Similarly, the native T1 time at the left ventricular base is approximately 1200ms; where as, it is only 1100ms at the apex. Taken together, these findings suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. The diagnosis of early cardiac amyloidosis should be entertained. 4. Normal RV size and systolic function (RVEF 50%).5. Moderate left atrial dilation.6. Mild main pulmonary artery dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: acute stroke on ct History: hemiparesis Brain MRIThere are multifocal scattered restricted diffusion lesions involving bilateral cerebellar hemispheres, pons, left thalamus and right occipital lobe indicating acute ischemic infarctions. There is no evidence of hemorrhagic transformation.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.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate occluded right ICA but patent and normal appearing left ICA, bilateral MCAs and bilateral ACAs. Bilateral PCAs are fetal origin.Vertebrobasilar system appears to be normal.

Output: 1. Multifocal acute ischemic infarctions involving bilateral cerebellar hemispheres, pons, left thalamus and right occipital lobe.2. Bilateral fetal PCAs. Otherwise no evidence of intracranial arterial stenosis or occlusion. No aneurysm was seen.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, with memory loss. Extensive, nearly confluent bilateral periventricular T2 hyperintensity is seen without evidence of mass effect. Diffusion weighted images are normal.No evidence of parenchymal edema is detected. No acute intracranial hemorrhage or any other abnormal extra-axial fluid is seen. Ventricular size and morphology are within normal limits. Mild generalized parenchymal volume loss is suspected but without any specific pattern or distribution.

Output: 1. Extensive white matter signal abnormality is nonspecific but would most commonly represent chronic small vessel ischemic disease.2. No definite evidence of any acute intracranial abnormality.3. Mild non specific parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: Female, 53 years old. Hip pain Several sequences are slightly limited by patient motion artifact.ACETABULAR LABRUM: We see no gadolinium traversing the labrum; however there is increased signal intensity within the anterior superior labrum best seen on the radial sequence, suggesting degeneration and perhaps partial thickness tearing, of questionable clinical significance.ARTICULAR CARTILAGE AND BONE: There is loss of the articular cartilage along the superior and posterior margins of the joint as well as small osteophytes indicating osteoarthritis. We see no marrow signal abnormality in the bones of the right hip. We see no frank cam deformity on this study.SOFT TISSUES: There is mild bilateral peritrochanteric edema. There is a small collection of fluid signal intensity anterior to the distal right gluteus medius tendon with surrounding edema compatible with a subgluteus medius bursitis. There is also mild edema anterior to the left gluteus medius tendon suggesting perhaps a mild subgluteus medius bursitis. There is increased signal intensity within the left hamstring origin indicating degeneration and chronic insertional tearing, not necessarily of any current clinical significance. ADDITIONAL

Output: 1.Mild degeneration and perhaps partial thickness tearing of the anterior superior labrum, but no gadolinium filled full-thickness tear of the labrum is seen.2.Osteoarthritis of the right hip.3.Right subgluteus medius bursitis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for malignancy History: NMDA encephalitis, R ala lesion on PET, neg TVUS No bone marrow signal abnormality is identified. No enhancing mass lesions are seen. The imaged musculature of the pelvis is unremarkable. There is a small amount of fluid within the vaginal cuff of uncertain significance. There is a small amount of fluid within the hips which is likely of no current clinical significance. No acute fracture or malalignment.

Output: No bone marrow signal abnormality or enhancing mass lesion to correspond to the findings seen on recent PET examination. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: Concern for rotator cuff tear History: Limited ROM, trauma ROTATOR CUFF: The distal 6 to 7 mm of the supraspinatus tendon is replaced with intermediate signal intensity. This could either represent insertional tendinosis or a high-grade partial-thickness insertional tear that has filled with granulation tissue. This intermediate signal intensity extends in the AP dimension for just over 1 cm. More proximally, there is a focus of high signal intensity along the undersurface fibers of the supraspinatus tendon indicating a small articular surface tear, measuring approximately 5 mm in diameter and involving less than 50% of the tendon thickness. There is additional tendinosis along the myotendinous junction of the supraspinatus more proximally. Additionally, there is a small focus of low signal intensity within the distal fibers of the supraspinatus tendon with mild edema within the adjacent soft tissues raising the possibility of calcific tendinosis. This could be better evaluated with dedicated shoulder radiographs. The infraspinatus and teres minor muscles and tendons appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is slight lateral downsloping and lateral spurring of the acromion process. There is minimal, if any, fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is no effusion. There is increased signal intensity within the anterior superior labrum which may reflect tearing, but this is of questionable clinical significance.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Tendinosis and focal undersurface tearing of the supraspinatus tendon. There is additional intermediate signal intensity within the distal most fibers of the tendon which may represent insertional tendinosis, although we cannot exclude the possibility of a high-grade partial-thickness tear that has filled with granulation tissue. Furthermore, there is a focus of low signal intensity within the distal supraspinatus tendon with adjacent soft tissue edema which raises the possibility of calcific tendinosis and would be better evaluated with shoulder radiographs.2. Osteoarthritis of the acromioclavicular joint and other findings as described above.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: dbs removal. Evaluate status of inflammation. History: ams Focal susceptibility lesions are seen on the right frontal lobe where prior DBS insertion track as well as posterior aspect of right insular cavitary lesion indicating blood products.The fluid fluid level, indicating blood products within the cavitary lesion seen on the dependent portion of the cavitary lesion appears to be either significantly reduced or disappeared since prior scan.Maximum diameter was measured about 52mm x 21mm, comparing to prior scan, no significant interval change in terms of size. Surrounding edema as well as mass effects toward right lateral ventricle also do not show any significant interval change in terms of the degree and its extent since prior scan.Peripheral rim enhancement is again seen and does not show any significant interval change since prior scan.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. Decreased or disappeared fluid fluid level on the dependent portion of the rim enhancing lenticular shaped cavitary lesion at the right insular. 2. Other MR characteristics including the size and the degree of surrounding edema and mass effects do not show any significant interval change since prior scan.


Instruction: Generate impression based on findings.

Input: The evaluation is limited due to the lack of contrast.There is stable extensive left occipito temporoparietal confluent vasogenic pattern hyperintensity on T2 and FLAIR. There is vasogenic pattern T2/FLAIR hyperintensity in the right parietal white matter, also similar to the prior exam. The lesion that was noted in the previous study in the posterior left cingulate gyrus, which has a low T2/FLAIR intensity rim and a center that is isointense to the white matter, is stable and is unchanged in size. Currently it measures 18 x 19 mm. On the susceptibility-weighted images, hemosiderin rim is seen associated with this lesion. The posterior left lateral ventricle remains effaced by localized mass effect. There is midline shift of approximately 6 mm, unchanged from the previous study.Since the prior exam there is interval increase in the extent of the FLAIR hyperintensity associated with the right superior temporal gyrus lesion, the lesion measuring 3 x 4 mm (501/21).The previously not measurable lesion in the right inferior temporal gyrus currently measures 4 x 4 mm with associated increase in the extent of the surrounding FLAIR hyperintensity.Medial to the left temporal horn is now a discrete lesion that measures 11 x 15 mm with increased surrounding edema.There is unchanged right cerebellar hemispheric encephalomalacia. The flow voids of the major intracranial vascular structures are within the normal limits. Ventricular size is stable.There is old lamina papyracea fracture. Fluid is seen in the right mastoids.

Output: 1. Progression of the metastatic lesions that was seen in the previous study in the right temporal lobe.2. Interval emergence of new metastatic lesion in the left temporal lobe with increased extent of vasogenic edema.3. The metastatic lesion that was seen in the previous study in the posterior aspect of the left cingulate gyrus is stable, with similar degree of localized mass effect and midline shift.


Instruction: Generate impression based on findings.

Input: Uveitis with concern for involvement of optic nerve/brain: blurry vision and eye pain. Orbits: There is right preseptal soft tissue swelling and enhancement. There is also swelling and hyperenhancement of the right lacrimal gland. However, there is no evidence of drainable abscess. There appears to be mild prominence of the bilateral optic nerve sheath cerebrospinal fluid and perhaps flattening of the bilateral optic nerve discs. Otherwise, the bilateral optic nerve signal characteristics, extraocular muscles, and orbital fat are unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, cerebellum, and optic chiasm appear unremarkable. The superior aspect of the pituitary gland is flattened, but there is not a partially empty sella. There is no abnormal intracranial enhancement. The ventricles are normal in size and configuration, including trace cavum septum pellucidum. However, there is prominence of the bilateral Meckel caves. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are bilateral maxillary sinus retention cysts.

Output: 1. Findings compatible with right preseptal cellulitis and dacryoadenitis, but no evidence of abscess or optic neuritis.2. Prominence of the bilateral Meckel caves, prominence of the bilateral optic nerve sheath cerebrospinal fluid, possible flattening of the bilateral optic nerve discs and flattening of the superior aspect of the pituitary gland can represent a manifestation of idiopathic intracranial hypertension, although this appears to be an isolated finding.3. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: History of bilateral retinoblastoma (left enucleation and right eye cryo- and laser therapy and five rounds of chemotherapy): off therapy evaluation. Orbits: There are postoperative findings related to left enucleation with an implant and prosthesis in position. There is expected volume loss and T2 hyperintensity of the remaining portions of the left optic nerve. There is no evidence of mass lesions in the left orbit. The right orbit appears unremarkable. There is diffuse moderate mucosal thickening in the paranasal sinuses. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, pineal gland, 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.

Output: 1. Postoperative findings related to left enucleation without evidence of tumor recurrence in the left orbit.2. No evidence of measurable tumor recurrence in the right orbit.3. No evidence of intracranial tumors.


Instruction: Generate impression based on findings.

Input: 55 year old female with fever and old brain mass; evaluate state of intracranial mass There is no evidence of intracranial hemorrhage or edema. No obvious mass or fluid collection is seen on this noncontrast CT. If further evaluation is warranted, MRI or CT with contrast may be obtained.Diffuse areas of hypoattenuation are noted in the periventricular and subcortical white matter, most prominent in the right frontal lobe, which most likely represents gliosis or post-treatment demyelination, versus small vessel ischemic disease of indeterminate age. Presence of vasogenic edema is difficult to be completely excluded in the absence of a prior study for comparison.There is mild asymmetric dilatation of the right lateral ventricle with the remaining ventricles and basal cisterns appearing normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality or obvious mass is seen on this noncontrast CT. However, this study has limited sensitivity for small intracranial neoplasm or infection. If further evaluation is warranted, MRI or CT with contrast of the brain may be obtained.


Instruction: Generate impression based on findings.

Input: 77 years, Male, parkinsonism, dementia.. Left-sided spasticity. Brain: There is severe volume loss involving the bilateral anterior and medial temporal lobes including the bilateral hippocampi with pronounced ex vacuo dilatation of the bilateral temporal horns. There is associated FLAIR hyperintensity compatible with nonspecific gliosis. There is also more generalized global parenchymal volume loss. No findings to suggest hydrocephalus. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Multiple patchy areas areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic changes. Major flow-voids are preserved.There is evidence of bilateral intraocular lens replacement. There appears to be a small circumferential effusion within the right globe suggestive of prior ocular detachment. Ovoid densities are noted in the inferior aspect of the bilateral globes. Suggest correlation of these findings with prior surgical history examination.Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are grossly within normal limits. Cervical spine: Examination is mildly motion degraded. Vertebral body heights in the cervical spine are normal. There is partial ankylosis involving the C2 and C3 vertebrae. There is mild retrolisthesis of C3 on C4 and C5 on C6. Bone marrow signal is benign. No suspicious osseous lesions are demonstrated. No cord signal abnormality.Multilevel degenerative changes, individual described below:C2-3: Partial osseous fusion. No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is disc osteophyte complex with uncovertebral hypertrophy resulting in moderate left-sided neural foraminal stenosis. No significant right neural foraminal narrowing.C4-5: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to facet arthropathy.C5-6: Mild spinal canal narrowing related to disc osteophyte complex and ligamentum flavum thickening. There is also minimal right neural foraminal narrowing. Left neural foramen is patent. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of acute infarct, hemorrhage, or intracranial mass. 2. Mild to moderate chronic small vessel ischemic disease.3. Pronounced volume loss involving the bilateral anterior and medial temporal lobes. There is associated T2/FLAIR hyperintensity compatible with nonspecific gliosis. Findings may be related to neurodegenerative disorder such as Alzheimer's, although sequela of prior encephalitis or other injury are possibilities.4. Multilevel degenerative changes in the cervical spine without high-grade spinal canal stenosis or cord signal abnormality. Additional details as above.5. Bilateral ocular findings, as described above, which can be correlated with surgical history.


Instruction: Generate impression based on findings.

Input: Sacral decubitus ulcer, evaluate for osteomyelitis Soft tissues: There is also skin irregularity overlying the distal sacrum and coccyx with increased edema and enhancement overlying the area. Small foci of low signal representing gas noted. Following contrast administration, there is no focal fluid collection identified.Osseous structures: There is diffuse heterogeneity of the marrow signal particularly involving the femoral bilaterally. Focal areas of increased marrow signal are seen within the posterior ileum bilaterally as well as the distal sacrum/coccyx. There is diffuse enhancement of the distal sacrum/coccyx. There is no definite bony erosion to suggest osteomyelitis. There are mild osteoarthritic changes in the hips bilaterally.

Output: Diffuse marrow edema and enhancement of the sacrum/coccyx without definite bony erosion to suggest osteomyelitis. Soft tissue defect, enhancement, and foci of air are noted overlying the area however. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1] / Aphasia [R47.01], Reason for Study: ^Reason: stroke History: weakness There is no evidence of acute ischemic or hemorrhagic lesion.Underlying brain shows patch scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating minimal nonspecific small vessel ischemic disease.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.Mucosal thickenings are seen on bilateral maxillary sinus, sphenoid sinus, frontal sinus and ethmoid sinus indicating pansinusitis.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal nonspecific small vessel ischemic disease.Pansinusitis.


Instruction: Generate impression based on findings.

Input: There are postsurgical changes of suboccipital craniotomy and resection of the posterior arch of C1 for resection of posterior fossa tumor. There is near-total if not total resection of the tumor in the surgical bed. There are foci of restricted diffusion along the medial surface of the left cerebellar hemisphere and left inferior cerebellar peduncle with some foci of susceptibility effect, which favors postsurgical change rather than minimal residual tumor. Deformity involving the inferior cerebellar vermis, fourth ventricle, and dorsal brainstem remains but improved. There are foci of T1 hyperintensity involving the interpeduncular cistern which was present preoperatively.There are scattered foci of T2/FLAIR hyperintensity in the supratentorial white matter which are nonspecific but compatible with chronic small vessel ischemic changes. 9 x 10 mm lesion involving the left aspect of the pituitary gland is again seen. No other intracranial mass, mass effect, midline shift, or herniation. There is mild prominence of the lateral and third ventricles similar to prior. There is a small fluid collection in the posterior fossa surgical bed which may represent seroma or perhaps pseudomeningocele.

Output: 1. Expected postsurgical changes of posterior fossa epidermoid/dermoid tumor resection. There is no definite evidence of residual tumor in the surgical bed. Minimal foci of restricted diffusion along the medial left cerebellar surface and left inferior cerebellar peduncle may be postsurgical although given the signal features and location of the original tumor, minimal residual foci of tumor in these regions is not entirely excluded; more definitive assessment can be made on follow up study.2. There are T1 hyperintense foci in the interpeduncular cistern which are also evident on outside preoperative studies. Findings suggest prior dermoid rupture/CSF dissemination.3. 9x10 mm lesion involving the left aspect of the sella again seen. Dedicated pituitary MRI with gadolinium can be considered for further evaluation as clinically indicated.


Instruction: Generate impression based on findings.

Input: Clinical question: Bladder cancer with new lung primary. Evaluate for CNS metastases. Signs and symptoms: Lung and bladder cancer. CT of brain with contrast:Examination demonstrates multiple bilateral hemispheric and cerebellar metastatic lesions with enhancement and central necrosis and surrounding vasogenic edema. The metastatic lesion within the left cerebellum measures 16.8-mm x 20.7-mm. There is mass effect on the fourth ventricle without complete collapse of the fourth ventricle. There are multiple supratentorial metastatic lesions. The largest of these lesions is along the medial aspect of right temporal lobe and measures 16 mm times 60-mm on axial image 9. There is no evidence of midline shift or hydrocephalus. There is no evidence of leptomeningeal enhancement. Edema surrounding the metastatic lesions produces subtle focal mass effect only. No detectable hemorrhage.The bony density of calvarium is diffusely abnormal with numerous small areas of low density. This is concerning for diffuse miliary metastases lesions to the calvarium. Further study would nuclear medicine scan or an MRI is recommended.108 cc of Omnipaque 350 was utilized for the above study.

Output: 1.Multiple intracranial metastatic lesions two bilateral cerebral hemispheres and left cerebellum as detailed.2.There is only focal mass effect secondary to surrounding vasogenic edema of these tumors.3.There is no evidence of hemorrhage or midline shift or hydrocephalus.4.Diffusely abnormal density of the calvarium concerning for miliary metastatic lesions.


Instruction: Generate impression based on findings.

Input: Small cell lung cancer. Please evaluate for metastases. There is no evidence of intracranial hemorrhage or acute infarct. There are no areas of pathological enhancement. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which have increased compared to MRI of 10/1/2014. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of intracranial metastases.2. No evidence of intracranial hemorrhage or acute infarct.3. Interval increased scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease and/or treatment related changes.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chronic pain and numbness of the left upper extremity. Recent motor vehicle accident and left upper extremity thrombosis of the basilic vein in December 2014 per Epic notes. Assess for brachial plexopathy. There is no axillary lymphadenopathy. There are no signal abnormalities along the course of the left brachial plexus or neurovascular bundle or evidence of pseudomeningoceles. There is no abnormal enhancement or mass lesions. A limited evaluation of the cervical spine demonstrates mild reversal of lordosis at C4-C5, where there is a mild disc-osteophyte bulge that abuts the spinal cord. However, there is no spinal cord signal abnormality or significant spinal canal or neuroforaminal narrowing. In the remaining cervical spine, there is no significant spinal canal stenosis or neuroforaminal narrowing. The thyroid and salivary glands are unremarkable. There are no masses or significant lymphadenopathy identified. The cervical flow voids appear to be grossly intact, within the limits of technique.

Output: 1.Mild degenerative changes of the spine with a small disc-osteophyte complex at C4-5 that abuts the spinal cord. No spinal cord lesions, neural foramen stenoses, or mass lesions are apparent, however.2.No discernible evidence of left brachial plexopathy.3. The previously demonstrated venous thrombosis is not readily depicted, either due to interval resolution or technique, which is not optimized for the evaluation of vasculature. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 70 year-old male with metastatic lung cancer and known metastasis, please do violate for progression. No evidence of acute intracranial hemorrhage. There is a 5-mm focus of high attenuation in the peripheral cortex of the right frontal lobe (image 22/30, series 2) which may correlate with a previously seen metastatic lesion at this site on the previous brain MRI. Other metastasis there were previously demonstrated and not well seen given the lack of intravenous contrast on this examination.There are a few foci of subtle low attenuation in a periventricular distribution compatible with small vessel ischemic disease of indeterminate age.The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection.The calvaria and skull base are radiographically normal. The left frontal sinuses are completely opacified. There is partial opacification of the ethmoid air cells and sphenoid sinuses. There is slight erosion of bone of the posterior right lamina papyracea near the orbital apex. The soft tissue density previously seen in the ethmoid air cells in this region has partially resolved. Please see recent MRI for further detail. The mastoid air cells are appropriately pneumatized. The maxillary antra are not visualized on the current exam.

Output: 1. Stable noncontrast CT of the head without new acute abnormality. Please note that the lack of intravenous contrast limits the sensitivity of this examination for metastatic disease.


Instruction: Generate impression based on findings.

Input: 84 years Male (DOB:3/12/1931)Reason: r/o progression of leptomeningeal pathology (unclear origin, progressive word finding difficulties and cerebellar findings on exam) History: progressive word finding difficulties and cerebellar findings on examPROVIDER/ATTENDING NAME: TANGUY Y LIM-SEIWERT TANGUY Y LIM-SEIWERT The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of some leptomeningeal signal hyperintensity along the right central sulcus this has not resolved since the prior exam it is not associated with susceptibility effect.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are punctate foci of T2 and FLAIR signal hyperintensity in the brainstem and left thalamus as well as the basal ganglia.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.There is some leptomeningeal disease present along the right central sulcus. The underlying cause cannot be established on this exam. Please correlate with clinical symptoms. Perhaps a contrast-enhanced exam would be helpful if that would be clinically possible.2.Punctate lesions in the brainstem, left thalamus and basal ganglia most likely represent prior ischemic insults.3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.