Instruction: Generate impression based on findings.

Input: Redemonstrated are changes from previous anterior cervical fusion and diskectomy at C6/7.Straightening of the normal cervical lordosis is again noted. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: No disk herniation, central canal or neural foraminal stenosis, unchanged.C3/4: Minimal disk osteophyte complex. No central canal stenosis. Mild left foraminal stenosis secondary to facet arthropathy is unchanged.C4/5: Shallow posterior disk osteophyte complex. No central canal stenosis. Left greater than right facet arthropathy. Mild left foraminal stenosis. These findings are unchanged.C5/6: Shallow posterior disk osteophyte complex. No central canal stenosis. Bilateral facet arthropathy, left greater than right. Mild right neural foraminal stenosis is stable. Progression of left uncinate hypertrophy causes new slight anterior left cord flattening (without intrinsic cord signal abnormality) as well as now moderate left neural foraminal stenosis (previously mild).C6/7: Mild foraminal stenosis left greater than right, is unchanged. Although there is been progression of left uncinate hypertrophy, there is no significant new resulting mass effect or stenosis.C7/T1: No central canal stenosis. Mild to moderate left and mild right neural foraminal stenosis secondary to facet arthropathy and ligament flavum thickening, unchanged.

Output: 1.C3/4: Mild left foraminal stenosis, unchanged.2.C4/5: Mild left foraminal stenosis, unchanged.3.C5/6: Mild right neural foraminal stenosis is stable. Progression of left uncinate hypertrophy causes new slight anterior left cord flattening as well as now moderate left neural foraminal stenosis (previously mild).4.C6/7: Mild foraminal stenosis left greater than right, unchanged.5.C7/T1: Mild to moderate left and mild right neural foraminal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: 51-year-old female. Left proximal tibia lesion. Evaluate for interval progression. The mixed lucent and sclerotic lesion in the lateral aspect of the proximal tibial metaphysis measures approximately the same at 3 x 4 cm. It has features on OSH CT and MRI most consistent with an enchondroma. No frank cortical destruction.

Output: Mixed lucent and sclerotic lesion in the proximal tibia, unchanged, and has features most consistent with an enchondroma based on OSH imaging.


Instruction: Generate impression based on findings.

Input: Cervical lymph node enlargement. Neck Mass. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and petrous bones are free of malignancy and unremarkable.Previously noted right tonsillar mass is no longer identified. There is no evidence of any measurable mass. Very minimal soft tissue thickening however still is present.A necrotic right-sided lymph node is again identified. This finding measures 23.5-mm x 21.5-mm (axial image 38 of 82) in transaxial dimension. The measurement of this node on the prior examination was 22.9-mm times 20.9-mm.This node is at the level of the right carotid bifurcation and appears to partially encase right internal carotid artery, right carotid bifurcation and possibly of the proximal right external carotid artery. The overall appearance of this finding (although not typical), its location and relation with carotid and lack of any interval change since prior examination also raises the possibility of a thrombosed carotid aneurysm. Extreme close proximity of this finding with the carotid warrants further evaluation in particular with an MRI.There is no evidence of any new lymphadenopathy.Limited images through the mediastinum are intact.Limited images through the apices of the lungs are unremarkable. 100 cc of Omnipaque 350 was utilized for the above study.

Output: 1.No evidence of a mass in the soft tissues of the neck. Previously noted soft tissue mass in the right tonsil is no longer identified.2.Unusual appearance of the right cervical lymph node with very close proximity and encasement of the carotid as detailed above. This finding demonstrates no interval change since prior study. Its overall unusual appearance, close proximity to the carotid, no appreciable interval change since prior exam warrants further evaluation with an MRI examination to entirely exclude possibility of a vascular abnormality (aneurysm).3.A message was left on Dr. Joyner office number regarding the findings on this patient.


Instruction: Generate impression based on findings.

Input: 51 year old male with a history of hypertension, hyperlipidemia, and frequent premature ventricular contractions referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 81 ml/m2 (normal range: 74+/-15), the LVEDV is 170 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 73 ml (normal range 47+/-19). LV wall thickness is normal. 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. The pre-contrast native myocardial T1 relaxation time is normal (1054 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 57%). 2. The right ventricle is normal in size with normal systolic function (RVEF 55%). 3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. 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. A previously identified cyst in the right thyroid lobe is not well appreciated with current MRI technique. Otherwise the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild left and moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex causes anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is mild central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is severe bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C3/4: Moderate bilateral neural foraminal stenosis.2.C4/5: Mild left and moderate right neural foraminal stenosis.3.C5/6: Mild central and severe bilateral neural foraminal stenosis.4.C6/7: Severe bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Urinary retention. There is loss of cervical lordosis, but no spondylolisthesis and the rest of the spinal column alignment is normal. There is disc-osteophyte complex at C5-6 level without significant spinal canal narrowing. The vertebral body heights are maintained. The spinal cord signal is normal. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

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


Instruction: Generate impression based on findings.

Input: 67 year old with milky right nipple discharge for several months. Recent ultrasound detected multiple intraductal lesions in the right breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are multiple enhancing foci in both breasts, right greater than left.There is a linear non-mass enhancing lesion in the right breast at the central aspect, measuring 18 x 4 x 3 mm. This lesion likely corresponds to the elongated intraductal lesion detected on the recent ultrasound study.There are a few enhancing foci in the right breast showing rapid uptake kinetic pattern, which are distinct from others. Those foci are predominantly located in upper inner and upper outer right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Linear non-mass enhancing lesion in the right breast at the central aspect, which likely corresponds to an elongated intraductal lesion detected on recent ultrasound. Ultrasound guided biopsy is recommended.2. A few enhancing foci in the right breast showing rapid uptake kinetic pattern, which are distinct from others.3. No MR evidence for malignancy in the left breastBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: A 50 year old male with known sarcoid in the lungs, COPD and paroxysmal atrial fibrillation. He is being considered as a candidate for lung transplant and thus referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 112 g (normal range 164+/-36). There is global hypokinesis with regional variation (the basal segments seem to be worse than the apical segments). There is no obvious late gadolinium enhancement noted to suggest an underlying fibrosing, infiltrative, or inflammatory process. However, the native myocardial T1 times is significantly increased (1,227ms), raising the possibility of diffuse interstitial fibrosis or inflammation. These findings are not diagnostic of cardiac sarcoid but might represent an early stage of involvement; cardiac PET may be helpful for further evaluation. No intracavitary thrombus was noted.No myocardial iron overload was noted.Left AtriumThe left atrium is normal in size (50ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 mildly dilated (32mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 45%. The base of the left ventricle seems to be functioning worse than the apex. 2. There is no obvious late gadolinium enhancement noted to suggest an underlying fibrosing, infiltrative, or inflammatory process. However, the native myocardial T1 times is significantly increased (1,227ms), raising the possibility of diffuse interstitial fibrosis or inflammation. These findings are not diagnostic of cardiac sarcoid but might represent an early stage of involvement; cardiac PET may be helpful for further evaluation. 3. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 42%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ulcerative colitis with adenocarcinoma of colon status post colectomy with concerning liver lesions ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly. There is a peripheral mildly T2 hyperintense focus in segment 6, which measures 2.1 x 1.5 cm (series 701, image 21) and demonstrates no significant enhancement, no corresponding restricted diffusion. This area was present on CT 4/13/2015 but smaller at that time, and is more prominent on CT 8/19/2015. Similar peripheral lesions demonstrating relatively decreased signal are noted on the hepatobiliary postcontrast phase. The visualized hepatic vasculature is patent. Replaced right and left hepatic arteries. Trace perihepatic ascites. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Peripheral nonenhancing hepatic lesions with linear margins may reflect regions of vascular compromise, possibly in the setting of hepatic venoocclusive disease, largest/most pronounced lesion located in hepatic segment 6.


Instruction: Generate impression based on findings.

Input: 6-year-old female with neck pain after fall. Evaluate for ligamentous injury. Examination is moderately motion degraded. Within these limitations, no significant abnormality is appreciated. No appreciable spinal cord signal abnormality is seen with no evidence of spinal cord edema, hematoma or other abnormalities. The ligamentous structures are intact. There is no epidural hematoma. No prevertebral soft tissue swelling. Apparent straightening of the cervical spine may be related to positioning, otherwise alignment is anatomic. Alignment at the craniocervical junction is also maintained. Vertebral body heights are maintained. No fracture is appreciated within the limits of MRI. No abnormal marrow signal is noted.

Output: Examination is moderately motion degraded. No evidence of cord edema, hemorrhage, or evidence of ligamentous injury in the cervical spine. No evidence of cervical spine fracture within the limits of MRI.


Instruction: Generate impression based on findings.

Input: Reason: Eval for berry aneurysm in patient with PCKD History: PCKD, headache, history of stroke in family MRI of the brainthere is a punctate focus of diffusion restriction present at the right inferior parietal lobule.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Small lesions hyperintense on T2 and flair are present in the basal ganglia and left thalamus as well as the brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium-size paired there is triplication of the intercerebral artery. The posterior communicating arteries are very small. The vertebral arteries are similar in size.

Output: 1.An acute microinfarct is present in the right inferior parietal lobule.2.Small lesions in the thalami, basal ganglia and brainstem are suspected to represent lacunar infarcts.3.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.5.No evidence for intracranial cerebrovascular occlusion.


Instruction: Generate impression based on findings.

Input: There skull appears heterogeneous with multiple skull lesions, which are otherwise incompletely characterized without contrast. There is also an incompletely imaged and characterized left mandibular lesion. There is no mass effect upon the underlying brain parenchyma. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged minimal nonspecific scattered nonspecific T2 hyperintense foci in the supratentorial white matter. There is chronic right cerebellar infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: 1. No evidence of intracranial hemorrhage or acute infarct.2. Redemonstration of multiple skull lesions and left mandibular lesions,are incompletely characterized in the absence of contrast, but are compatible with multiple myeloma.


Instruction: Generate impression based on findings.

Input: 65 years, Female, prior CVA who initially presented with HHS c/b AKI and AMS. Her AKI and HHS improved however as she was being set up for discharge she had an acute hypoxemic event requiring intubation, likely in the setting of an aspiration event. There is an area of high DWI signal in the left lateral aspect of the medulla with associated low ADC signal and mildly increased T2/FLAIR signal indicating acute infarct. Additional areas of diffusion restriction are present in the right occipital lobe, right frontal lobe white matter, and posterior limb of the left internal capsule. There is asymmetric heterogeneous T1 shortening in the left basal ganglia, which could reflect asymmetric mineralization or minimal blood products from subacute to chronic infarct. There appears to be volume loss in the right caudate nucleus with susceptibility artifact indicating old hemorrhagic infarct. Chronic lacunar infarct in the left paramedian pons is also noted. No intracranial mass or significant mass-effect. Mild prominence of the ventricles and sulci are compatible with generalized cerebral volume loss. There is no evidence of hydrocephalus. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with background of mild chronic small vessel ischemic changes. Major intracranial vascular flow-voids are preserved. Sella and orbits are grossly within normal limits. There is mild mucosal thickening in scattered ethmoid air cells and moderate mucosal thickening in the right sphenoid sinus. Secretions are noted filling the posterior nasal cavity and nasopharynx. A moderate amount of fluid signal is present in bilateral mastoid air cells. Orogastric and endotracheal tubes are partially visualized.

Output: Multiple small acute, subacute, and chronic supra and infratentorial infarcts as detailed above. In particular acute infarcts involve the left lateral medulla as well as bilateral cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The myelination pattern is appropriate for corrected age. There is prominence of the subarachnoid spaces compatible with benign enlargement. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The midline structures and craniocervical junction are within normal limits. There is no evidence of structural abnormality. The skull and scalp soft tissues are unremarkable.

Output: Benign enlargement of the subarachnoid spaces. Otherwise, unremarkable MRI brain.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/21/15, 10/14/15), ultrasound images of right breast (10/14/15), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (10/21/2015) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (5/27/14, 12/6/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (4/21/15, 10/14/15):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. Multiple surgical clips are present at 12:00 position in the right breast, at the site of prior surgery. There is a developing mass at the site of prior surgery in the right breast, measuring 35 x 30 mm on CC view of 10/14/2015. No abnormal findings are seen in the right retroareolar region, where breast MRI (11/2/15) demonstrated an enhancing mass.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/14/15):An irregularly shaped hypoechoic mass is visualized at 12:00 position in the right breast, measuring 21 x 18 x 23 mm, corresponding to the mass seen on the mammogram. No abnormal lymph nodes are visualized in 4 images of right axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (10/21/2015):Ultrasound guided needle biopsy was performed for the mass in the right breast with an appropriate needle placement. A marker clip (coil shaped) is present within the mass at anterior aspect.Per outside radiology report, the result was malignant; invasive ductal carcinoma.

Output: Biopsy proven carcinoma in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is global volume loss as well as confluent T2 hyperintensity throughout the supratentorial and infratentorial white matter most compatible with chronic small vessel ischemic disease. In addition, there are numerous chronic appearing infarcts supratentorially and infratentorially, including multiple cerebellar infarcts. There is no hydrocephalus, midline shift or herniation. The major cerebral flow voids are intact.

Output: 1.No evidence of acute infarct.2.Moderate chronic small vessel ischemic disease and numerous supratentorial and infratentorial chronic lacunar infarcts.


Instruction: Generate impression based on findings.

Input: Ptosis, low facial weakness No evidence of acute ischemic or hemorrhagic lesion.There are a few scattered susceptibility lesions on bilateral hemispheres indicating possible calcifications or prior hemorrhagic lesion, however, no significant interval change comparing to prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:3/18/1967)Reason: evaluate and stage brain mets History: brain mets seen on CT-HeadPROVIDER/ATTENDING NAME: RITA NANDA RITA NANDA There are multiple ring-enhancing lesions scattered throughout the brain parenchyma which have associated susceptibility effect and a vasogenic pattern of edema.. One in the left precentral gyrus is hyperdense and measures 14 x 11 mm axial dimensions. Another one is present in the right precentral gyrus and measures 13 x 13 mm. Another in the right postcentral gyrus measures 6 x 6 mm axial dimensions. Another ringlike enhancing lesion associated with fluid fluid level is present in the right frontal lobe measuring 16 x 15 mm axial dimensions involves the anterior aspect of the right middle frontal gyrus and is also associated with subcortical white matter hypodensity. Another couple are present in the left cuneus one measuring 8 mm in adjacent 1 measuring 5 mm. Couple punctate 1's are present in the left occipital lobe.There is associated sulcal effacement with the above described lesions.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: There are multiple hemorrhagic lesions associated with the vasogenic edema scattered throughout the brain. These are suspicious for hemorrhagic metastases.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to right parietal craniotomy for resection of a subjacent meningioma with subjacent dural thickening. There are unchanged confluent foci of T2 hyperintensity within the periventricular white matter, right greater left. There are also additional patchy foci of T2 hypertensity throughout the supratentorial white matter that are unchanged as well as unchanged T2 hyperintensity along the resection margins. There is unchanged global volume loss. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is paranasal sinus mucosal thickening and secretions as well as fluid within the lateral mastoid air cells, right greater then left. There are bilateral lens implants and right-sided axial myopia.

Output: 1.Postoperative findings related to right convexity meningioma resection without evidence of recurrence.2.Confluent signal abnormality within the periventricular and deep white matter is unchanged and is most compatible with chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for interval change. Signs and symptoms: Status post removal of calvarial implant with resection of recurrent tumor. Nonenhanced head CT:Examination demonstrates a large left temporal and parietal craniectomy.The parietal bone posterior to the craniectomy site demonstrates extensive lytic changes which traverses the midline to the right paramedian. This is a new finding since prior exam and is best appreciated on axial images 27 through 30. Finding is concerning for osteomyelitis. Fluoroscopy and an enhanced MRI exam is recommended.There is a surgical drain traversing the craniectomy site.There is no evidence of intracranial hemorrhage.There is a focus of encephalomalacia in the left posterior temporal similar to prior study.There is diffuse decreased density of left posterior frontal parietal white matter similar to prior study. This is believed to represent either residual in the normal and or partial encephalomalacia considering the duration of presence of this finding. There is slight ex vacuo dilatation of the left lateral ventricle and without evidence of midline shift. Follow up with an enhanced study is limited for better overall assessment.

Output: 1.There is interval surgical removal of a large craniotomy flap in the left temporal -- parietal and frontal as described.2.Negative changes of the posterior edge of craniectomy site is a new finding since prior exam.3.Extensive residual vasogenic edema and or combination of edema and encephalomalacia in the left hemisphere.4.No evidence of intracranial hemorrhage or midline shift.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with history of neck sarcoma, status post resection. Assess for recurrence. Mild post-treatment findings are evident in the left supraclavicular fossa. A T2 hyperintense, enhancing, 11 x 6 mm focus in the operative bed, along the anterior margin of the anterior scalene muscle, is unchanged and non-specific.No additional mass lesion or pathologic adenopathy is seen. The neck soft tissues are otherwise unremarkable allowing for obscuration of part of the oral cavity by artifact from dental hardware. Bone marrow signal is within normal limits.

Output: A small focus of signal hyperintensity and enhancement in the left supraclavicular operative bed is unchanged and non-specific. No additional new or concerning findings are seen to suggest recurrent disease.


Instruction: Generate impression based on findings.

Input: 18 years Female (DOB:6/2/1998)Reason: 3 t scanner History: pre op image ingPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is a 28 x 30 mm axial dimension heterogeneous mass with surrounding low signal compatible with hemosiderin and a popcorn-like appearance located along the right precentral gyrus laterally. It was also present on the prior exam is not changed substantially.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: A right precentral gyrus mass most likely represents a cerebral cavernous malformation. It is unchanged since the previous exam. Please note this exam was performed for the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: There has been interval left C2-3 laminotomy, left C3-4 hemilaminectomy as well as left C7-T1 and T1-2 laminotomies. There is associated paraspinal soft tissue edema. A surgical drain terminates in the left paraspinal musculature at the level of C2.There has been significant interval improvement in the size of the fluid collection involving the ventral epidural space throughout the cervical and visualized upper thoracic spine. Residual fluid collection for example measures 4 mm in the AP dimension at C2-3 and 7 mm in thickness at C7, previously 9 mm at both levels. Peripheral enhancement is again evident compatible with residual fluid/abscess. The degree of spinal canal stenosis and mass effect on the spinal cord has significantly improved. There is residual spinal canal stenosis and mass effect on the spinal cord, which is up to a mild to moderate degree in the lower cervical spine. No cord signal abnormality. Minimal multilevel degenerative changes. Vertebral body heights in the cervical spine are maintained. No suspicious osseous lesions. No findings to suggest discitis-osteomyelitis in the cervical spine.

Output: Interval drainage and decrease in size of ventral epidural abscess and improvement in mass effect on the cervical and partially imaged upper thoracic cord. Residual collection as described above.


Instruction: Generate impression based on findings.

Input: Brain mass mortise arthritic. 59-year-old female. The brainstem appears enlarged. Comparing to the recent MRI there is redemonstration of a been expansile mass within the brainstem involving the pons and the right cerebellar peduncle as well as the medulla.The CSF spaces are appropriate for the patient's stated age with no midline shift. The fourth ventricle is mildly distortedNo intracranial hemorrhage is identified. 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 no evidence for acute intracranial hemorrhage.2.The brainstem appears enlarged. There is a been expansile mass within the brainstem involving the pons and the right cerebellar peduncle as well as the medulla better imaged on the recent MRI from 2/5 /10. There is no obvious change.


Instruction: Generate impression based on findings.

Input: 77-year-old female patient with HCV cirrhosis and intermittent abdominal pain. ABDOMEN:LUNG BASES: There is a loculated pleural effusion in the right lung. Recommend dedicated chest radiograph or CT. Susceptibility artifact from median sternotomy hardware noted.LIVER, BILIARY TRACT: Cirrhotic liver morphology. No suspicious arterial enhancing lesions seen. Mildly enlarged perihepatic and periportal lymphadenopathy appears similar compared to prior examination. Hepatic vasculature is patent.Status post cholecystectomy. Mild intrahepatic biliary ductal dilatation, stable. Common bile duct is normal in size and stable compared to prior.SPLEEN: Multiple lesions with blooming artifact in the spleen may represent cirrhotic nodules. Spleen is upper limit of normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Residual punctate focus of T2 hyperintense signal in the inferior left adrenal gland from prior hemorrhage. Persistent nodularity of the left adrenal gland appears similar compared to prior examination.KIDNEYS, URETERS: Bilateral renal cysts are stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Cardiomegaly.

Output: 1.Cirrhotic liver morphology without suspicious lesion identified. Stable mild intrahepatic biliary ductal dilatation.2.Loculated right pleural effusion. Suggest dedicated imaging of chest as indicated.3.Stable appearance of left adrenal gland from prior hemorrhage.


Instruction: Generate impression based on findings.

Input: Clinical question: Migraine and episode suspicious of a seizure. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates normal anatomical development of brain parenchyma without evidence of congenital anomaly.The signal intensity of brain parenchyma remains within normal in all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces and brain myelination.No detectable abnormal parenchymal, leptomeningeal or calvarial enhancement on post enhanced series.The signal voids of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses is within normal and mid normal pattern of enhancement.Unremarkable images through the orbits including axial fat sat post enhanced studies. Extensive chronic maxillary sinusitis and minimally of other paranasal sinuses are noted. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: Unremarkable pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Female, 9 years old, history of medulloblastoma status post chemotherapy. Brain:Findings are redemonstrated compatible with prior tumor resection from the cerebellum. A small hemosiderin stained resection cavity within the inferior aspect of the cerebellum is unchanged in size and morphology. Mild T2 hyperintensity within the parenchyma surrounding the cavity is stable. No evidence of pathologic enhancement is seen within or around the treatment bed.Supratentorially, no concerning parenchymal signal abnormality or pathologic enhancement is detected. No evidence of edema or mass effect is seen. No abnormal extra-axial collections are noted. The fourth ventricle remains chronically dilated while the remainder of the ventricular system is within normal limits.Spine:The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic intramedullary or leptomeningeal enhancement is seen. No evidence of any intraspinal mass is noted.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. Marrow signal characteristics are predominately fatty compatible with prior radiation. Otherwise, no concerning marrow replacement, edema or pathologic marrow enhancement is seen.

Output: 1. Stable findings related to prior surgery and treatment within the posterior fossa. No evidence to suggest recurrent disease is seen.2. No evidence of metastatic disease in the spine.


Instruction: Generate impression based on findings.

Input: Examination is mildly motion degraded. There is a unchanged ovoid area of FLAIR hyperintensity and mild T1 hypointensity in the left supramarginal subcortical white matter. No new lesion is definitively appreciated. No abnormal enhancement is appreciated. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. No extra-axial fluid collection is identified. Visualized extracranial soft tissues are unremarkable.

Output: No new lesions in the brain to suggest progression of known demyelinating disease. No abnormal enhancement. Brain parenchymal volume is preserved.


Instruction: Generate impression based on findings.

Input: 27-year-old female with lateral left ankle pain. Evaluate for peroneal tendinitis. TENDONS: There is focal signal abnormality within the subcutaneous fat superficial to the peroneus longus tendon as it courses along the body of the calcaneus. This finding is nonspecific but suggestive of mild inflammation. The peroneal tendons themselves appear normal and we see no tenosynovitis. The Achilles tendon, extensor tendons, and remaining flexor tendons are unremarkable.LIGAMENTS: The lateral collateral ligament complex and distal tibiofibular syndesmotic complex are within normal limits. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: The bone marrow signal and articular cartilage are within normal limits. No osteochondral defect is identified.ADDITIONAL

Output: Mild nonspecific inflammation of the subcutaneous fat superficial to the peroneus longus tendon as it courses along the body of the calcaneus. The tendons themselves appear normal.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: Eval extent of strokeSigns and Symptoms: RLE weakness, Wernicke's aphasia The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small (6mm) focus of diffusion restriction along the left superior temporal gyrus. There is a signal hyperintensity present in an adjacent MCA distal M2 segment branch. There is lower signal in the adjacent venous structures including transmedullary veins and a cortical vein.There are several punctate foci of susceptibility effect present in the thalami and basal ganglia with a couple additional foci in the cerebellar hemispheres.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are punctate T2/FLAIR foci of signal hyperintensity present in the external capsules. An irregular focus of T2 signal hyperintensity and FLAIR hyperintensity is present in the pons. A few similar foci are present in the basal ganglia and thalami.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities in the right ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is a small focus of infarction along the left superior temporal gyrus which could in part explain the patient's symptoms of Wernicke's aphasia. There are findings which suggest that there may very well be an occluded m2 branch responsible for this (image 100 series #401) associated with signs suggestive of local hypoxia.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Old lacunar infarcts are present in the basal ganglia, thalami and brainstem4.A few microhemorrhages in the thalami, basal ganglia and cerebellum are present which could relate to hypertension.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate pancreatic cyst History: cirrhosis with pancreatic cysts ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. T2 hyperintense subcentimeter lesion likely a small cyst at the dome of the liver. No suspicious hepatic lesions.SPLEEN: Small splenule.PANCREAS: No ductal dilatation. Multiple small cystic foci adjacent to the main pancreatic duct could represent small side branch IPMNs or dilated side branches, grossly unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter T2 hyperintensities are too small to characterize, likely small cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable examination.


Instruction: Generate impression based on findings.

Input: 80 year-old male with history of thyroid cancer status post thyroidectomy. Restaging of disease. Limited evaluation due to lack of contrast. MRI may be considered for further evaluation as clinically warranted.BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. Sinus disease affects the ethmoid sinuses bilaterally.Skull base:Small nodules in the neck cannot be ruled out due to lack of contrast. MRI may be considered for further evaluation as clinically warranted.Fascial planes appear intact without evidence of architectural distortion or abnormal mass. The airways are patent.

Output: Limited evaluation due to lack of contrast without evidence of gross abnormality. MRI can be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: History of C1-C2 schwannoma, status post resection Again seen are postoperative changes of laminectomy and tumor resection at the C1-C2 level. No discrete enhancing lesion is appreciated to suggest residual or recurrent tumor, although preoperative images would be helpful if available. There is small focus of T2 hyperintensity involving the cervical cord at the right lateral C2 level, much smaller than 5/15/2007 and compatible with myelomalacia. Cervical cord is otherwise unremarkable.Degenerative changes are again seen in the cervical spine. There is minimal retrolisthesis of C3 on C4 and mild anterolisthesis at C4-C5 to T1-2 similar to prior There are small disc osteophyte complexes throughout the cervical spine without significant spinal canal stenosis at any level. There is mild right C3-C4 and moderate left C4-C5 and left C5-C6 neural foraminal narrowing similar to prior. Prominent facet arthropathy on the left at C4-C5 noted. Vertebral body heights are normal. Bone marrow signal is benign. Paraspinous soft tissues demonstrate remote postsurgical changes but are otherwise unremarkable.

Output: 1. No findings to suggest tumor recurrence.2. Punctate T2 hyperintensity in the cervical cord at the right lateral C2 level compatible with myelomalacia and much smaller/evolved since 5/15/2007.3. Degenerative changes in the cervical spine appear similar to prior without significant spinal canal stenosis at any level. Neural foraminal narrowing as above.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to resection of a right vestibular schwannoma. There is an unchanged subcentimeter focus of enhancement within the superior aspect of the right internal auditory canal as well as unchanged thin linear enhancement along the posterior aspect of the right internal auditory canal. There is unchanged clumping of the right cranial nerve 7 and 8 complex. The left internal auditory canal is unremarkable. The bilateral inner ear structures are unremarkable. Partially imaged remainder of the brain demonstrates no intracranial mass or mass effect. Mild scattered paranasal sinus opacification similar to prior.

Output: Continued stable appearance of small enhancing focus in the right superior internal auditory canal, which may represent a small focus of residual tumor versus granulation tissue.


Instruction: Generate impression based on findings.

Input: 45-year-old female with history of left IDC/ILC treated with lumpectomy and sentinel lymph node biopsy in December 2014, followed by chemotherapy and radiation therapy. History of benign stereotactic biopsy in 2012. There is No family history of breast cancer. No current breast complaints. Three standard views of both breasts with additional spot magnification views of the lumpectomy were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense (BiRADS Density Category C), which may obscure small masses, unchanged in pattern and distribution. Post lumpectomy changes are reidentified in the left central outer breast including postsurgical architectural distortion and surgical clips within the lumpectomy bed. Diffuse left breast skin thickening likely reflects post radiation changes. Surgical clips project over the left axilla compatible with sentinel lymph node biopsy.Redemonstrated right upper outer biopsy clip marker from prior stereotactic biopsy in 2012. Previously reported right upper outer partially circumscribed partially obscured masses, confirmed simple cysts on prior MRI of 2014, are no longer visualized and have likely involuted. Stable central small calcified oil cyst.No new dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Ms. Jackson is a 51 year old female with a personal history of left breast lumpectomy and sentinel lymph node biopsy in December 2014 for IDC treated with chemotherapy at Trinity hospital. She presents today for ultrasound evaluation of axillary lymph nodes status post treatment. Upon physical exam of the left axilla, no discrete masses are appreciated. Surgical scars are identified on the skin.Targeted ultrasound of the left axilla demonstrates two normal appearing lymph nodes in the left axilla, adjacent to the surgical scar. These two lymph nodes measure 1.5 x 0.9 x 1.2 cm and 1.4 x 0.5 x 1.3 cm, respectively. There is normal hilar vascular flow with uniform cortical thickness. These correlate with the two benign-appearing lymph nodes identified on the recent MRI.

Output: Benign appearance of two left axillary lymph nodes. No sonographic evidence of malignancy. Patient should continue to follow up with her surgical care team as clinically warranted.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of renal cyst. RIGHT KIDNEY: Kidney measures 12.7 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass. Inferior pole simple cyst measuring up to 3.1 cm appearing similar to prior examinations.LEFT KIDNEY: Kidney measures 10.6 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: The bladder appears unremarkable.

Output: Simple right renal cyst.


Instruction: Generate impression based on findings.

Input: Diagnosis: Testicular hypofunctionClinical question: ? Pituitary mass lesionSigns and Symptoms: Hypogonadotrophic hypogonadism MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.Incidental note is made of partial empty sella.

Output: 1.There is partial into sella present but no intrinsic lesion within the territory gland to suggest pituitary adenoma.2.No intracranial mass lesions are appreciated within the brain parenchyma.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with low back pain and some radiating symptoms. Trace anterolisthesis of L4 relative to L5 is seen. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved.Endplate edema is seen posteriorly at L3-4 in association with a disc extrusion at this level which may be partly intraosseous. Further details are discussed below. Mild endplate edema is seen at L2-3. No evidence of concerning marrow replacement is detected.The distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Loss of disc height and mild disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy with small facet effusions. Disc bulging with a superimposed central and right paracentral superiorly directed extrusion. The extrusion encroaches upon the posterior inferior corner of the L3 vertebral body and may therefore be partly intraosseous. There is a severe associated spinal canal stenosis with effacement of CSF and crowding of the cauda equina. The left neural foramen is mildly narrowed. L4-5: Facet arthropathy with bilateral facet effusions. Disc bulging. A moderate spinal canal narrowing is seen mostly due to facet arthropathy. Mild right foraminal narrowing. L5-S1: Facet arthropathy right worse than left. The intervertebral disc is preserved. No significant spinal canal or foraminal stenosis.

Output: Multilevel degenerative findings are seen. L3-4 is the most severely affected level where facet arthropathy and a disc extrusion contribute to produce a severe spinal canal stenosis. Elsewhere, no high-grade spinal canal or foraminal stenosis is seen.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for compression. Signs and symptoms: Upper extremity weakness. Non-enhanced total spine MRI:Examination demonstrate normal anatomic alignment and signal intensity which column.There is no evidence of spinal canal compromise or stenosis at any level.There is normal signal intensity and caliber all cord, conus and cauda equina.No detectable paraspinal soft tissue abnormality on this limited exam.

Output: No evidence of cord compression.


Instruction: Generate impression based on findings.

Input: Left parotid mass. PER EPIC note: In 8/2016 possibly related to travel to Mexico, the patient acutely developed left neck pain and swelling associated with a mass. She underwent CT and ultrasound guided biopsy and drainage. The biopsy was negative for malignancy. On 10/2016, she underwent a thyroid ultrasound which demonstrated bilateral thyroid nodules. She underwent a CT after the FNA and aspiration on 11/2016 which demonstrated a 1.4 cm lesion in the left parotid gland suggestive of an intra-parotid LN and 1.7 cm left thyroid nodule. There is an intrinsically T1 hyperintense, peripherally enhancing mass in the left parotid gland that involves both the superficial and deep portions of the gland and measures up to 12 x 30 mm in axial section. Portions of the tumor appear to be somewhat ill-defined. There are mildly prominent lymph nodes in the superficial left submandibular gland, measuring up to 6 x 10 mm in axial section. There are also mildly prominent left level 2A lymph nodes, measuring up to 9 x 12 mm in axial section. The right parotid gland and bilateral submandibular gland are unremarkable. There is mild diffuse prominence of the tongue base. There is a partially imaged left thyroid nodule. The imaged intracranial structures, paranasal sinuses, and orbits are unremarkable. There is degenerative cervical spondylosis with a posterior disc osteophyte that abuts the spinal cord at C5-6.

Output: 1. A mass in the left parotid gland that involves both the superficial and deep portions of the gland and measures up to 30 mm and mildly prominent regional lymph nodes may represent reactive lymphadenopathy based on the prior FNA results, although neoplasm is a differential consideration based on imaging. 2. Partially imaged left thyroid nodule. Please refer to the prior thyroid ultrasound report for additional details.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55], Reason for Study: ^Reason: syncope History: syncope with stool incontinence There is no evidence of acute ischemic or hemorrhagic lesion.There are few scattered T2/FLAIR high signal intensity lesions on periventricular white matter which indicate nonspecific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Localized opacification of the left mastoid air cell is again seen, unchanged since prior scan.

Output: 1. Few scattered FLAIR/T2 high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Postoperative changes are seen again seen from previous high right frontal parietal convexity craniotomy with underlying areas of encephalomalacia. There is a similar abnormal irregular contour to the clival margins especially inferiorly consistent with erosive changes, progressed since the prior MRI. There is mild overlying soft tissue thickening of the nasopharyngeal region without enhancement. There is a similar pattern of heterogeneous enhancement along the left sphenoid sinus.The ventricles and sulci are prominent, consistent with mild-moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are multiple scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. Similar pattern of patchy FLAIR hyperintensities also seen within the pons bilaterally. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. T1 hyperintense mucus retention cysts are identified in the posterior left ethmoid region. There is mild mucosal thickening in the maxillary sinuses with evidence of prior endoscopic sinus surgery. There is residual opacification along the right ethmoid cavity, with history of prior ethmoidectomy.

Output: 1. No acute abnormality. Stable pattern of abnormal FLAIR hyperintense foci within the white matter and brainstem , which are nonspecific but may relate to chronic small vessel ischemic changes.2. Grossly stable regular appearance of the heterogeneous clivus with mild overlying soft tissue prominence along the nasopharynx and enhancement along the left sphenoid sinus region, which again may be related to Rosai Dorfman disease.


Instruction: Generate impression based on findings.

Input: 66 years Female (DOB:1/21/1950)Reason: low back pain leg pain History: low back pain leg panPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Five lumbar type vertebral bodies are presumed to be present. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present. There is mild anterior subluxation of L4 and L5 and the superior endplate compression at L2 with approximately 25% loss of vertebral body height.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present this level associated with moderate facet hypertrophy. Relative to the prior exam this has not changed substantially.At L4-5 there is loss of disc space height, disc desiccation as well as a diffuse disc bulge associated with marked bilateral facet and ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level as well as some mild crowding of the nerve roots within the thecal sac. There is mild anterior subluxation of L4 and L5. These findings were present on the prior exam but have not changed significantly. The patient status post left hemilaminectomy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge as well as some mild facet and ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a small cyst present in the right kidney measuring 6 mm in diameter and another along the left kidney measuring 5 mm in diameter. These are stable and compared to the prior exam.

Output: 1.There are degenerative changes present lumbar spine worse at L4-5 where there is moderate spinal stenosis and mild subluxation and status post hemilaminectomy. This is stable compared to prior exam.2.There is a benign-appearing chronic compression fracture at L2 which is also stable compared to the prior exam..


Instruction: Generate impression based on findings.

Input: 28 year-old female with fibromatosis status post chemotherapy and preparing for surgery/XRT. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: 1.2-cm hypodense lesion in segment two of the liver may represent hemangioma, unchanged from MRI 1/7/09SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The left kidney continues to demonstrate abnormal infiltrative low density throughout, greatest in the upper pole, with some areas of fat density. Dilatation of the left renal collecting system and ureter extends to the proximal third of the ureter, where ill-defined soft tissue obstructs the ureter, unchanged.Upper pole calculus in the left.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mass in the presacral space as slightly increased in size, measuring 5.8 x 5.0 cm (series 2; image 116), previously 5.4 x 4.7 cm. Another lesion extends into the left perirectal region and ischiorectal fossa, involving the left lateral pelvic side wall and invading the ipsilateral obturator internus muscle. It measures approximately 7.6 x 5.0 cm (series 3; image 124), previously 7.0 x 4.7 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Continued mild increase in size of the known fibrous masses.Unchanged appearance of the left kidney, compatible with xanthogranulomatous pyelonephritis


Instruction: Generate impression based on findings.

Input: Lower back pain. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a small broad-based disk protrusion at this level and mild ligamentum flavum hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There is no significant compromise to lumbar spinal canal or neural foramina. There are only mild degenerative changes present worse at L4-5 as detailed above.


Instruction: Generate impression based on findings.

Input: 69-year-old female with suspicious cluster of calcifications in the right breast presents for research MRI (Alan Penn study). There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, there is a focal non-mass enhancement, measuring 10 x 7 x 11 mm (AP x LR x CC), at posterior 2:00 position, corresponding the area of suspicious calcifications.In addition, there is a small enhancing mass, measuring 7 x 7 x 10 mm, at posterior 10:00 position in the right breast.No abnormal enhancement is seen in left breast. Axillary lymph nodes are mildly large bilaterally, but there is no uniquely enlarged lymph nodes in either axillary region.

Output: 1. Suspicious non-mass enhancement in the right breast at posterior 2:00 position, corresponding the area of suspicious calcifications on the recent mammogram. Stereotactic biopsy was performed for the calcifications later today.2. A small enhancing mass in the right breast at posterior 10:00 position. Ultrasound-guided biopsy was performed for this mass later today. 3. No MRI evidence of malignancy in left breast. 4. No abnormal lymph nodes in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI evident stigmata of neurofibromatosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Two weeks post partum with headache. Signs and symptoms: Sudden onset of headache. Pre-and post-enhanced pituitary MRI:Examination demonstrates normal signal intensity and size of pituitary gland and with normal homogeneous pattern of enhancement. Pituitary stalk is in midline and normal pattern of enhancement.Hypothalamic region including suprasellar visual complex of the straight normal signal intensity and without abnormal enhancement.Unremarkable bilateral cavernous carotids and with normal pattern of enhancement.Unremarkable sphenoid sinus and skull base.Pre-and post-enhanced MRV:Examination demonstrate no convincing evidence of signal abnormality of the intracranial venous sinuses.Post-enhanced images demonstrate normal enhancement and size of the superior sagittal sinus, a dominant large right transverse and sigmoid sinus as well as right jugular bulb and proximal right internal jugular vein. Normal visualization of bilateral thalamostriate veins, internal cerebral veins, vein of Galen and straight sinus as well as the confluence of sinuses. There is a uniformly very small size caliber of the right transverse sinus, right sigmoid sinus, right jugular bulb and right proximal internal jugular which is believed to represent a normal anatomical variation. This can be further assessed with a CTV exam if clinically concerned for thrombosed sinus persist. There is no asymmetry in visualized bilateral cerebral cortical veins. Negative diffusion weighted series. The anatomical morphology and the signal intensity of brain parenchymal remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable susceptibility signal abnormality is noted.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal limits and with normal pattern of enhancement.

Output: 1.Negative pre-and post enhanced pituitary MRI.2.Negative pre-and post enhanced MRV. There is anatomical variation all uniformly small and hypoplastic left transverse and sigmoid sinuses as well smaller size of the left jugular bulb and proximal left internal jugular. If clinical concern for thrombosed sinus persist further assessment with CTV is recommended.


Instruction: Generate impression based on findings.

Input: 60-year-old female with supraglottic larynx cancer. Initial staging scan. LUNGS AND PLEURA: Peribronchial thickening and right basilar mild reticular nodular pattern compatible with aspiration bronchiolitis. Scattered micronodules largest of which measures 3 mm, (image 62, series 5) too small to characterize. Mild bilateral apical emphysema.MEDIASTINUM AND HILA: Tracheostomy tube in appropriate position. Mediastinal lymph nodes are not enlarged by CT criteria. Debris in the right mainstem bronchus. Elongated right thyroid lobe extends inferiorly to the right of the trachea and contains cystic areas, nonspecific by CT. Small adjacent lymph nodes (2R) just below this area, image 18. Mild inflammatory change of the proximal intrathoracic esophagus. 1cm right hilar lymph node image 57 could be reactive.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Left adrenal nodule is measuring 7 x 12 mm, (image 23, series 3) is too small to characterize but does not contain measurable fat, atypical for an adenoma. This may be further evaluated with MRI.

Output: 1. Bronchiolitis pattern compatible with aspiration.2. No conclusive evidence of metastatic disease, however several small 2R lymph nodes are ill defined and enhance. Short term CT or PET follow up suggested to rule out nodal metastases.3. Indeterminate left adrenal nodule as above may be evaluated with in and out of phase MRI if it would affect clinical management of the patient.4. Probable radiation esophagitis of the proximal intrathoracic segment.


Instruction: Generate impression based on findings.

Input: 65-year-old female with a transient receptive aphasia. LE hemisphere TIA vs stroke. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered small foci of periventricular and subcortical white matter T2/flair hyperintensities which are nonspecific but are likely related to small vessel ischemic disease. There is evidence of a multiple small chronic left cerebellar infarcts. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: There is scattered atherosclerotic disease involving the intracranial arteries, probably including the laceral portion of the left internal carotid artery, left greater than right cavernous ICA segments, and M2/M3 segments of the left MCA although the quality of the exam is suboptimal for full assessment. The left A1 segment is mildly hypoplastic but the anterior cerebral arteries are otherwise patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: The exam is limited by motion, especially in the upper chest region. There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is probably moderate atherosclerotic narrowing of the proximal left common carotid artery. The common carotid arteries and cervical internal carotid arteries are otherwise normal in course and caliber. Analysis of the proximal vertebral arteries limited secondary to motion but the origin of the vertebral arteries otherwise appear grossly patent.

Output: 1.No evidence of acute intracranial hemorrhage or infarct.2.Scattered likely chronic small vessel ischemic disease.3.Diffuse scattered atherosclerotic disease in the neck and brain as described above but no high-grade or occlusive stenosis.


Instruction: Generate impression based on findings.

Input: 43-year-old male with a presentation of right sided C5 radiculopathy symptoms clinically (right shoulder pain for approximately 2 weeks time with radiation from superior aspect of shoulder down the arm to hand and fingers). Evaluate for abnormalities of the cervical spine. The craniovertebral junction appears within normal limits. There is slight reversal of the cervical lordotic curvature. There is mild degenerative height loss involving the C5 and C6 vertebral bodies as well as multilevel disc height loss most prominently involving the C4-5 and C5-6 levels. There is heterogeneity of the bone marrow corresponding with the degenerative changes. However, no focal worrisome bone marrow signal abnormality is visualized. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.Interspace observations:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild left greater than right facet and uncovertebral hypertrophy without significant compromise to the spinal canal. Mild left foraminal narrowing.C4-5: Prominent disc osteophyte complex with a right foraminal focal component which along with facet hypertrophy contributes to severe right and moderate left neural foraminal narrowing. There is also mild spinal canal stenosis.C5-6: Right greater than left disc osteophyte complex with facet hypertrophy which contribute to moderate left and mild right neuroforaminal narrowing. There is no spinal canal stenosis. C6-7: Mild facet and uncovertebral hypertrophy without significant compromise to the spinal canal and only mild left foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: Multilevel spondylotic changes most prominent at the right C4-5 level where there is a right foraminal disc protrusion which causes severe right neural foraminal stenosis. There is mild spinal canal stenosis at this level as well.


Instruction: Generate impression based on findings.

Input: There are findings related to left temporal craniotomy, including fluid and swelling of the overlying scalp and periorbital tissues. There has been interval resection of previously demonstrated cavernous malformation in the left temporal lobe. There is an area of intrinsic high T1 signal intensity and corresponding susceptibility effect in the resection bed in the left temporal lobe consistent with hemorrhage. There are also residual areas of curvilinear susceptibility effect along the margins of the resection cavity that correspond to preoperative hemosiderin deposits. There is no evidence of acute territorial infarction. The ventricles and sulci are within normal limits in size and configuration. There is no midline shift.

Output: Status post recent gross total resection of a left temporal lobe cavernous malformation with residual areas of hemosiderin staining along the periphery of the resection cavity. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: ? mass compressing trachea History: see CXR, CT chest. Limited examination without contrast. LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Within the anterior mediastinum between the trachea and left common carotid and subclavian arteries, there is a lobulated collection that measures 3.6 x 3.1 x 4.6 cm (AP x TR x oblique CC; series 16 image 39, series 15 image 9), which demonstrates homogeneous T2 slightly hyperintense signal and T1 hyperintense signal compatible with proteinaceous material or blood products. Associated tracheal deviation and narrowing. There is possibly connection anterolaterally with the brachiocephalic artery (series 11 image 31). Thin hypointense rim correlates with thin peripheral calcification seen on CT. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Limited examination without intravenous contrast. 3.6 x 3.1 x 3.6 cm proteinaceous lobulated collection in the anterior mediastinum may represent a postsurgical collection such as seroma, hematoma, or lymphocele from prior parathyroid removal. Without contrast, a thrombosed aneurysm/pseudoaneurysm of the brachiocephalic artery cannot be excluded.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:7/13/1961)Reason: rule out stroke History: R side weakness, facial droopPROVIDER/ATTENDING NAME: IRA J BLUMEN CHRISTOPHER M GOMEZ MRI of the brainThere is a focus of diffusion restriction measuring 7 x 5 mm axial dimensions located at the posterior limb of the left internal capsule. This associated with T2 and FLAIR signal hyperintensity.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain: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 posterior communicating arteries are medium-sized. The vertebral arteries are similar in size.The left posterior inferior cerebellar artery has extracranial origin

Output: 1.There is an acute lacunar infarct present along the posterior limb of the left internal capsule.2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: There is a CSF intensity structure within the right hemisphere with white matter borders demonstrating mild gliosis, contiguous with the adjacent right lateral ventricle.The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is present within both mastoid air cells and middle ear cavities. There is no abnormal enhancement within the brain.

Output: There is a CSF intensity structure within the right hemisphere with white matter borders demonstrating mild gliosis, contiguous with the adjacent right lateral ventricle. These findings provide MRI evidence for a porencephalic cyst with associated ex vacuo dilatation of the adjacent right lateral ventricle.


Instruction: Generate impression based on findings.

Input: Reason: 61 y/o man w/ ptosis of the left eyelid for the past 2 mo and weight loss. MRI Brain:There are innumerable scattered subcortical and periventricular white matter T2/FLAIR hyperintense foci, indicating chronic small vessel ischemic disease. The cerebral sulci and ventricles are prominent bilaterally, indicating mild global volume loss. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There are two retention cysts within the right maxillary sinus. There is no abnormal enhancement within the brain. MRI Orbit:This exam is partially limited by motion artifact. The globes are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact. There is a subtle lobulated irregularity of the left posterior globe, likely representing staphyloma. The right globe is elongated in the AP dimension, which likely relates to myopia.MRI Cervical Spine:There is heterogeneous marrow signal, which is nonspecific. There is multilevel narrowing of intervertebral discs. There is C3 on C4 retrolisthesis by 4 mm. There is C4 on C5 anterolisthesis by 4 mm. There is trace anterolisthesis of C7 on T1 and of T1 on T2. Cervical spinal cord signal intensity and morphology are normal throughout. C2-3: There is no evidence of significant neural foraminal or central canal stenosis.C3-4: There is disc osteophyte complex and uncovering of the intervertebral disc, resulting in moderate central canal stenosis, moderate to severe left foraminal stenosis, and moderate right foraminal stenosis. There is uncovertebral joint hypertrophy at this level.C4-5: There is disc osteophyte complex with uncovering of the disc and ligamentum flavum thickening, resulting in moderate central canal stenosis, moderate to severe right foraminal stenosis, and moderate left foraminal stenosis.C5-6: There is disc osteophyte complex, resulting in mild central canal stenosis and moderate left greater than right foraminal stenosis. There is uncovertebral joint hypertrophy at this level.C6-7: There is disc osteophyte complex resulting in moderate to severe right foraminal stenosis and moderate left foraminal stenosis. There is uncovertebral joint hypertrophy at this level. There is no evidence of significant central canal stenosis.C7-T1: There is disc osteophyte complex with uncovering of the disc. There is moderate bilateral foraminal stenosis and uncovertebral joint hypertrophy at this level.T1-T2: On sagittal images, there is a disc bulge with moderate right foraminal stenosis and mild left foraminal stenosis at this level.T2-T3 and T3-T4: On sagittal images, there is disc bulge and mild left foraminal stenosis at this level.MRI Soft Tissue Neck:The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. No lymphadenopathy is noted. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable.

Output: 1. Innumerable small hyperintense foci on FLAIR images, likely representing chronic small vessel ischemic disease, however other etiologies are not excluded.2. Irregularity of the left posterior globe, likely representing staphyloma. 3. Multilevel degenerative changes of the cervical spine, with up to moderate to severe foraminal stenosis and moderate central canal stenosis at the levels described above.4. MR neck is unremarkable.


Instruction: Generate impression based on findings.

Input: Female; 45 years old. Reason: progression of disk herniation History: paresthesias and weakness in L5 dermatome/myotome Grade 1 retrolisthesis of L5 on S1 is again noted, unchanged in extent. Fatty degenerative endplate changes at L4 and L5 are stable. The conus is normal in signal and morphology and terminates at an appropriate level.L1/2: No evidence of neuroforaminal or central canal stenosis, unchanged.L2/3: No evidence of neuroforaminal or central canal stenosis, unchanged.L3/4: Mild ligamentum flavum and facet hypertrophy. No evidence of neuroforaminal or central canal stenosis. These findings are unchanged.L4/5: The disc demonstrates moderately reduced T2 signal with mild loss of disk height. Superimposed on the previously demonstrated moderate disc bulge with slight extrusion upwards is a new right paracentral disc protrusion causing marked right lateral recess stenosis. Mild facet joint hypertrophy and minimal bilateral neural foraminal narrowing is unchanged.L5/S1: The disc demonstrates moderately reduced T2 signal. There is progressive thickening of ventral epidural fat resulting in thecal sac narrowing, but the nerve roots are not crowded. There is a mild disk bulge minimally effacing the ventral CSF space without significant central canal stenosis. Mild facet joint hypertrophy. Mild right greater than left neuroforaminal narrowing. Mild thickening of the ligamentum flavum. These findings are unchanged.

Output: At L4/5 there is a new right paracentral disc protrusion causing marked right lateral recess stenosis. Degenerative changes elsewhere are stable in appearance and described in detail above.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, status post seizure with left head deviation and convulsions. A clustering of small T2 hyperintense foci are evident within the inferior right precentral gyrus, involving predominantly the subcortical white matter. The gray matter overlying the affected region blends to some degree with the lesion and, as a result, is somewhat distorted in appearance. On thin section T1-weighted imaging, the lesion or lesions have a somewhat linear or curvilinear morphology suggesting vessels, or a perivascular distribution, or potentially even radial migration lines.No significant associated mass effect is detected. No diffusion restriction or significant susceptibility effect is noted. Elsewhere, brain parenchymal morphology is within normal limits. There are a small number of additional scattered foci of T2 hyperintensity in the cerebral hemispheres which are nonspecific. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is normal in size and morphology. A subcentimeter nasopharyngeal cyst is detected incidentally. Bone marrow signal characteristics are unremarkable. Mild inflammation of the paranasal sinus mucosa is demonstrated.

Output: A lesion is detected in the right inferior precentral gyrus corresponding to the face/head region of the motor homunculus. The lesion is incompletely characterized without contrast, and as such, the patient should return to receive postcontrast imaging.Given the limited evaluation, the differential diagnosis would include gliosis from some prior insult or injury, a congenital migrational anomaly, or potentially an underlying vascular lesion. A neoplastic etiology is not highly suspected, but postcontrast imaging will help in this regard.


Instruction: Generate impression based on findings.

Input: Male, 63 years old. Right knee pain. Rule out medial meniscal tear. MENISCI: There is globular signal abnormality within the posterior horn of the lateral meniscus without clear linear signal which may represent intrasubstance degeneration. The anterior horn of the lateral meniscus appears intact. There is a complex tear of the body of the medial meniscus extending into the posterior horn with mild extrusion. The anterior horn of the medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema presumably due to contusion predominantly within the medial femoral condyle and also within the femoral and tibial metaphyses. There is signal abnormality within the articular cartilage of the medial femoral condyle with underlying osseous changes. There is also a focal defects within the articular cartilage of the anterior femur.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complex tear of the medial meniscus with additional degenerative changes above.


Instruction: Generate impression based on findings.

Input: 7 years, Male, one grand mal seizure and staring spell. History of right-sided head trauma. Evaluate for etiology of seizure There is no evidence of cortical dysplasia, gray matter heterotopia, hippocampal abnormality, intracranial mass, or other findings to suggest seizure focus. No evidence of hemorrhage or traumatic encephalomalacia. No evidence of ischemia. No intracranial mass effect, midline shift, or herniation. Ventricles and sulci are within normal limits. Posterior fossa structures are unremarkable. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild scattered paranasal sinus opacification throughout the paranasal sinuses. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: Brain MRI appears within normal limits. No findings to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: 47-year-old female with left hip pain. 3 views of the left hip demonstrate moderate osteoarthritic changes, slightly progressed since the prior study from 5/19/2014. Single AP view of the pelvis again demonstrates moderate osteoarthritis of the left hip as well as mild osteoarthritis involving the right hip. Mild sclerosis along the left SI joint is likely degenerative in etiology. Mild degenerative changes are also noted in the lower lumbar spine.

Output: Osteoarthritis as described above.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: lesion on CT History: Lefts sided weakness Brain MRIMultifocal brain parenchymal lesions with high signal intensity on T2/FLAIR images were seen involving right superior frontal gyrus-pre central gyrus junction, left centrum semiovale, right parietal lobe posterior aspect of cingulate gyrus, right occipital gyrus, and left middle cerebellar peduncle. In particular, the right superior frontal gyrus - pre central gyrus junctional lesion shows peripheral enhancement indicating active inflammation. There is no evidence of acute ischemic or hemorrhagic lesion.Constellation of above findings indicate possible demyelinating disease such as multiple sclerosis. About 5mm cerebellar tonsilar ectopia through the foramen magnum.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain pre and post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Multifocal bihemispheric, supra and infra tentorial location, various sized brain parenchymal lesions showing high signal intensity on T2/FLAIR images with a Gad enhancing lesion indicating possible demyelinating disease such as multiple sclerosis.2. No evidence of acute ischemic or hemorrhagic lesion.3. Normal brain MRV.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis: pain and numbness. There appears to be faint T2 hyperintensity in the mid thoracic spinal cord, with perhaps mild volume loss. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis. However, there is an unchanged T2 hyperintense lesion in the right S2-3 neural foramen that measures 15 mm in width. There is also a punctate perineural cyst in the incompletely imaged right C6-7 neural foramen. The paravertebral soft tissues are unremarkable.

Output: 1. Apparent faint T2 hyperintensity in the mid thoracic spinal cord, with perhaps mild volume loss may represent a chronic demyelinating lesion. 2. An unchanged T2 hyperintense lesion in the right S2-3 neural foramen is incompletely characterized without intravenous contrast, but likely represents a perineural cyst.


Instruction: Generate impression based on findings.

Input: 60 year old male. Bilateral decubitus ulcers. Presenting with AMS. Evaluate for underlying osteomyelitis. Images are variably degraded by motion artifact, limiting evaluation.PELVIS: Mild edema in the subcutaneous fat and gluteus maximus of the right buttock (series 401, image 17). Marrow signal intensity of the pelvis is within normal limits. No evidence of osteomyelitis. Mild degenerative changes of the lumbar spine with multilevel disk bulges and posterior element hypertrophy. Mild osteoarthritis of the bilateral hips.Post-surgical changes in the sigmoid colon. Nonspecific mildly enlarged external iliac lymph node that is 1.3 x 1.4 cm (series 301, image 21). Prominent bilateral inguinal lymph nodes, likely reactive.

Output: 1. Mild edema in the soft tissues of the right buttock. No underlying osteomyelitis.2. Mildly enlarged right external iliac lymph node, nonspecific.


Instruction: Generate impression based on findings.

Input: Evaluate for stroke. Altered mental status, aphasia and worsening of arm weakness. Non-enhanced CT of brain:Images through posterior fossa are unremarkable.Images through the supratentorial brain parenchyma demonstrates very subtle low attenuation of the left frontal cortex with subtle effacement of cortical sulci. This is highly suspect of an acute stroke in follow-up with an MRI is recommended. There is no evidence of hemorrhage. Previously noted old strokes are again identified.No evidence of hydrocephalus or midline shift.

Output: 1.Highly suspected acute nonhemorrhagic cortical stroke of the left frontal lobe with subtle effacement of cortical sulci. Follow-up with an MRI is recommended. 2.Old strokes are identified with no change.3.Above findings were relayed to Dr. Paul Bergl # 2554 utilizing paging tool device on PACS system.


Instruction: Generate impression based on findings.

Input: 14-year-old male with history of knee pain with swelling and instability. Evaluate for ACL tear. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is increased edema type signal abnormality within the anterior aspect of the tibial epiphysis. There is 6 mm of broad based cortical depression about the anterior aspect of the lateral tibial plateau. There is also edema type signal abnormality within the femoral epiphysis, medial greater than lateral.There is periosteal reaction noted about the lateral aspect of the distal femur with a small amount of subperiosteal increased T1/T2 signal abnormality. Within the posterolateral femoral physis there is a focus of increased signal intensity (best seen on image 8 of series 1001 and image 15 of series 901).LIGAMENTS: There is increased signal abnormality and thickening of the ACL, although the fibers are intact. There is intermediate signal intensity involving the lateral collateral ligament complex with a small amount of adjacent fluid. The PCL and MCL are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1. 6 mm broad base depression of the anterior aspect of the lateral tibial plateau with underlying diffuse bone marrow edema involving the anterior aspect of the tibial epiphysis.2. Small fracture within the posterolateral distal femoral physis with hematoma extending cranially resulting in a small subperiosteal hematoma and subsequent periostitis.3. Partial ACL tear.4. Mild sprain of the LCL. 5. Bone marrow edema about the femoral epiphysis.


Instruction: Generate impression based on findings.

Input: Clinical question: Please evaluate lesion. Concern for CNS lymphoma. Signs and symptoms: Headaches, nausea and vomiting, history of lymphoma. Pre-and postcontrast CT of brain:Examination demonstrate an enhancing mass wave a small area of internal necrosis measuring 25.5-mm x 22 0.2-mm in the inferior right frontal lobe. There is evidence of surrounding vasogenic edema. Very minimal midline shift at the level of floor of anterior cranial fossa.A is a provided clinical date of findings is believed to represent CNS lymphoma. This finding was not present on prior MRI examination from 2007.Small punctate focus of high density measuring approximately 3 mm times 2-mm in deep right frontal periventricular white matter is noted. Finding may represent calcification although its small size makes precise evaluation difficult and the possibility of a small hemorrhage cannot be entirely ruled out although this latter possibility is considered less likely.This examination is otherwise unremarkable.Calvarium, mastoid air cells and limited view of paranasal sinuses are unremarkable.90 cc of Omnipaque 350 is administered for above study.

Output: 1.Enhancing mass in the inferior aspect of right frontal lobe with surrounding vasogenic edema may represent recurrence of CNS lymphoma.2.Small focus of calcification measuring approximately 3 mm in deep periventricular white matter of right frontal lobe of uncertain significance.3.Unremarkable study otherwise.