Instruction: Generate impression based on findings.

Input: 67-year-old male patient with infected left foot ulcer. Evaluate osteomyelitis. There is feathery low T1 and increased T2 signal within the posterior aspect of the calcaneus which is highly suspicious for osteomyelitis. No definite enhancement is identified within the bone on post-contrast imaging. There is a defect within the overlying soft tissues of the heel with edema type signal within the surrounding soft tissues. No discrete drainable fluid collection is identified.Degenerative changes otherwise affect the midfoot and tibiotalar joint. The Achilles tendon appears thickened suggesting tendinosis. The remaining tendinous and ligamentous structures are grossly intact.

Output: 1. Findings highly suspicious for osteomyelitis of the posterior calcaneus. 2. Achilles tendinopathy.


Instruction: Generate impression based on findings.

Input: Bleeding after robotic supracervical hysterectomy. History of stress urinary incontinence anddysfunctional uterine bleeding s/p hysterectomy and bilateral salpingectomy. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Small nabothian cervical cysts. The paracervical soft tissues are unremarkable. 2.9 x 2.7 cm right and 2.2 x 2.2 cm left adnexal lesions which are hyperintense on T1-weighted imaging and demonstrate shadowing on T2-weighted imaging compatible with endometriomas, appearing similar in size to CT dated 12/18/2015.BLADDER: No significant abnormality noted.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: No specific findings to account for the patient's bleeding. Bilateral adnexal probable endometriomas.


Instruction: Generate impression based on findings.

Input: Reason: ascending cholangitis? History: GNR sepsis, fever, tachycardia, pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. 1.2 cm right hepatic T2 hyperintensity corresponds to ill-defined hypodense lesion seen on prior CT (701/27). No new lesion was identified to correspond to left hepatic hypodensity seen previously.Gallbladder is mildly dilated containing sludge. No evidence of cholelithiasis or choledocholithiasis. Common bile duct measures 7 mm, likely within normal limits for ageSPLEEN: No significant abnormality noted.PANCREAS: Dilated main pancreatic duct with diffuse atrophy, suggestive of chronic pancreatitis.. Multiple dilated tubular structures in the pancreatic head are favored to represent dilated side branches.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintensities, likely cystsRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Concentric bowel wall thickening in the cecum appears grossly similar to the prior CT.BONES, SOFT TISSUES: Diffuse anasarca.OTHER: Moderate ascites.

Output: 1.Exam was terminated due to patient discomfort and postcontrast images were not obtained.2.No evidence of ascending cholangitis.3.Findings of chronic pancreatitis.4.Cirrhotic liver morphology with right hepatic T2 hyperintensity which is nonspecific without intravenous contrast.5.Moderate abdominal ascites.6.Diffuse circumferential cecal wall thickening is nonspecific but appears similar to the prior exam, possibly a portal colopathy or nonspecific colitis.


Instruction: Generate impression based on findings.

Input: T2 hyperintense, T1 isointense lesion is seen in the anterior C2 vertebral body measuring approximately 9 mm. While nonspecific, this is favored to be benign in etiology and may represent an atypical hemangioma.Alignment is normal. The marrow signal is benign. No acute fracture or subluxation identified. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: No disc height loss or disc bulge. No neural foraminal or spinal canal stenosis.C3/4: No disc height loss or disc bulge. No neural foraminal or spinal canal stenosis.C4/5: No disc height loss or disc bulge. No neural foraminal or spinal canal stenosis.C5/6: No disc height loss or disc bulge. No neural foraminal or spinal canal stenosis.C6/7: No disc height loss or disc bulge. No neural foraminal or spinal canal stenosis.C7/T1: No disc height loss or disc bulge. No neural foraminal or spinal canal stenosis.

Output: 1.Nonspecific C2 vertebral body lesion is favored to represent an atypical hemangioma, however comparison to outside hospital imaging and/or CT of the cervical spine would be helpful for further characterization.2.No acute fracture or subluxation. No neural foraminal or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 27 year old female with rectal cancer. Evaluate disease status. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules are stable in size and number, the largest measures 1.5 x 1.5 cm (image 53, series #4).MEDIASTINUM AND HILA: No evidence of adenopathy. CHEST WALL: The right-sided venous port terminates within the right atrium. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: A fibroid projects from the uterine fundus, better visualized on MRI 8/31/09.BLADDER: No significant abnormality noted.LYMPH NODES: 4.5 x 8.1 cm left adnexal mass lesion (image 169, series #3) likely conglomerate adenopathy with ovary. Complex cystic mass in the right adnexa is stable on the current examination.BOWEL, MESENTERY: Ill-defined rectal thickening remains.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites.

Output: 1. Stable adnexal masses. 2. Stable pulmonary metastases.


Instruction: Generate impression based on findings.

Input: T11 right pedicle and transverse process lesion is not perform CT-guided biopsy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the disk space and adjacent osseous structures. Following needle removal images obtained demonstrate no complications .

Output: T11 right transvere process and pedicle biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Low back pain, sciatica Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge slightly eccentric to the left with minimal contact of the left descending L5 nerve root and minimal left neural foraminal narrowing. Otherwise no spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: There is central disc protrusion with contact of the descending S1 nerve roots. Mild central spinal canal stenosis. Neural foramina are patent. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild lumbar spine degenerative changes including central disc protrusion at the L5-S1 level with contact of the S1 nerve roots as well as minimal L4-L5 disc bulge. No high-grade spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Incomplete partition type 1 on CT: right sensorineural hearing loss. Internal Auditory Canal: The right cochlea is bulbous and there is deficiency of the modiolus and interscalar septations and communicates widely with the dysplastic vestibule. In addition, the semicircular canal bone island is diminutive with dysmorphic semicircular canals. There also appears to be mild thinning of the cochlear nerve caliber, but the vestibular nerves are intact. The left cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The left inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. A few scattered foci of cerebral white matter T2 hyperintensity may represent slightly prominent perivascular spaces. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening.

Output: 1. Findings compatible with right side incomplete partition type 1 and what appears to be mild cochlear nerve deficiency.2. The intracranial structures are otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for metastatic lesions History: pelvic lucencies on xray Note is made of innumerable foci of enhancement with associated decreased signal abnormality T1-weighted images and increased signal abnormality on fluid sensitive sequences affecting all of the bones of the pelvis, as well as multiple lesions within the proximal femora, bilaterally, and the imaged lower lumbar spine, consistent with metastatic disease. The largest lesion is situated within the right sacral wing. There is associated enhancing increased signal abnormality within the adductor musculature on the right likely representing soft tissue extension of disease. Note is made of a fat-containing right inguinal hernia. Mild osteoarthritis affects the hips. There is fatty infiltration of the musculature of the pelvis.

Output: Diffuse osseous metastatic disease involving the imaged bones of the pelvis and proximal appendicular skeleton.


Instruction: Generate impression based on findings.

Input: 48 year-old male with history of ventricular tachycardia and previous ablations. Send for evaluation for scar. Has an ICD Left VentricleThe left ventricle is mildly to moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 32%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 227 ml (normal range 142+/-34), the LV end systolic volume index is 76 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 132 g (normal range 164+/-36). There is an aneurysm at the basal inferior and infero-lateral walls. There is septal dyssynergy. There is transmural late gadolinium enhancement extending from base to middle segments of the inferior and infero-lateral walls, corresponding to the area of previously described LV aneurysm. This finding is consistent with a prior myocardial infarction. This portion of the myocardium is not viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 34%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 179 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 117 ml (normal range 54+/-17).Right AtriumThe right atrium is not well seen due to pacemaker artifact.Aortic ValveThe aortic valve is not well seen due to pacemaker artifact.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve is not well seen.Tricuspid ValveThe tricuspid valve is not well seen due to pacemaker artifact.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is not well seen due to pacemaker artifact.Pulmonary VeinsThe right superior pulmonary vein is not well seen. The remaining three 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 FindingsLarge pacemaker artifact covering the right side of the chest. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Large pacemaker artifact covering the right side of the chest. 2. The left ventricle is mildly to moderately dilated with moderately reduced systolic function, the LVEF is 32%.3. A basal inferior/inferolateral aneurysm is noted with thinning of the myocardial wall. 4. There is transmural late gadolinium enhancement extending from base to middle segments of the inferior and infero-lateral walls, corresponding to the area of the described LV aneurysm. This finding is consistent with a prior myocardial infarction. This portion of the myocardium is not viable. 5. The right ventricle is normal in size with moderately reduced systolic function, the RVEF is 34%.


Instruction: Generate impression based on findings.

Input: History of ileocolonic Crohn's disease, recent hospitalization with obstructive symptoms ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Distended stomach. There is a distal small bowel loop in the right hemiabdomen with long segment narrowing and surrounding fibrofatty proliferation, unchanged. Angulated loops of small bowel with evidence of adhesions in the right lower quadrant. There is no abnormal wall enhancement or thickening to suggest active small bowel inflammation. No evidence of bowel obstruction.BONES, SOFT TISSUES: Postoperative changes in the anterior abdominal wall.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Chronic changes without evidence of active small bowel inflammation. No evidence of bowel obstruction.


Instruction: Generate impression based on findings.

Input: Female 68 years old Reason: HCC screening History: cirrhosis from AIH. ABDOMEN:LIVER, BILIARY TRACT: Nodularity along the hepatic contour and prominence of the hepatic fissures consistent with chronic liver disease. No suspicious liver lesion. No intra or extrahepatic biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintensities within the kidneys are consistent with renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticular disease. T2 hyperintense lesion in the region of the third part of duodenum. Low signal at the anteromedial aspect likely represents air, suggesting that this is a duodenal diverticulum however a direct connection to the duodenum is difficult to identify. BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology without focal suspicious lesion. 2.Cystic lesion in the region of the third part of duodenum may represent a diverticulum. This could be confirmed with post contrast CT abdomen.


Instruction: Generate impression based on findings.

Input: Cognitive impairment, prior CVA. There is chronic encephalomalacia in the left precentral gyrus and left occipital lobe. There is also scattered mild cerebral white matter T2 hyperintensity, which likely represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is an unchanged mass in the deep lobe of the left parotid gland that measures up to approximately 25 mm.

Output: 1. Chronic infarcts in the left precentral gyrus and left occipital lobe. 2. Probable chronic small vessel ischemic disease.3. Unchanged mass in the deep lobe of the left parotid gland, which may represent a pleomorphic adenoma.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left-sided craniotomy for STA-MCA bypass. There are expected postsurgical changes including small extra-axial fluid collection along the left cerebral hemisphere as well as small amount of pneumocephalus. There are multiple new small foci of restricted diffusion scattered in the left frontal lobe consistent with acute infarcts and new since previous MRI dated 10/22/2015. There is a relatively larger area of restricted diffusion along the left temporal lobe surface compatible with cytotoxic edema/infarct and may be likely related to retraction.There are increased areas of T1 hyperintensities in the left frontal and temporal lobe compatible with cortical laminar necrosis. Again seen are patchy and scattered high FLAIR signal intensity lesions in the bilateral periventricular and subcortical white matter, particularly in the left cerebral hemisphere, related to chronic ischemia. There are multiple lacunar infarcts in the bilateral basal ganglia.The ventricles are unchanged from prior. There is volume loss involving cerebellar hemispheres left more than right as seen before. There is no mass effect, midline shift or herniation. The midline structures and craniocervical junction are within normal limits.MRA head: Evidence of recent left-sided a STA-MCA bypass with focus of susceptibility at the bypass site. There is redemonstration of a chronic occlusion of the left internal carotid artery which is reconstituted at the level of the left supraclinoid ICA. There is atheromatous plaque involving cavernous and supraclinoid internal carotid arteries. There is moderate stenosis of the right supraclinoid ICA. There is mildly diminished flow-related signal involving the left MCA compared to the right MCA with prior CTA also demonstrating mildly reduced caliber of the left MCA compared to the right MCA. Anterior cerebral arteries are patent. Again seen is a 2.5 mm right anterior communicating artery aneurysm better seen on recent CTA. There is also approximately 5 mm outpouching along the right lateral cavernous internal carotid artery. Atherosclerotic disease is also evident involving the posterior circulation with mild multifocal stenosis affecting the distal vertebral, basilar artery and posterior cerebral arteries.

Output: 1. Postoperative findings related to left STA-MCA bypass. There is susceptibility artifact at the bypass site and CTA may be helpful if clinically warranted. There are multiple new foci of acute infarct in the left cerebral hemisphere. There is a relatively larger focus of restricted diffusion/infarct involving the left temporal lobe surface which may be related to retraction.2. Redemonstration of chronic occlusion of the left ICA with reconstitution in its supraclinoid segment. The left MCA demonstrates mildly diminished flow-related signal as compared to the right. There is moderate stenosis involving the right cavernous internal carotid artery.3. 2.5 anterior communicating artery aneurysm as well as a 5 mm right cavernous ICA aneurysm as seen on recent angiogram.4. Multiple prior infarcts, particularly in the left cerebral hemisphere.


Instruction: Generate impression based on findings.

Input: Cervicalgia [M54.2] / Dorsalgia, unspecified [M54.9], Reason for Study: There are diffuse bulging of discs at the level of C34 and C45 without evidence of spinal canal stenosis or neural foraminal stenosis. Other cervical disc levels appear to be normal. Intervertebral discs of lumbar spine appear to be normal.There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1-L2 disc level.The paraspinal soft tissues and musculature are unremarkable.

Output: 1. Disc bulging at the level of C34 and C45 without evidence of spinal canal stenosis or neural foraminal stenosis.2. Otherwise unremarkable cervical and lumbar spine MRIs.


Instruction: Generate impression based on findings.

Input: Reason: ? Disk herniation History: back pain with radiation to right lower abdomen 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 compressed grossly intact.At T12-L1 there is a large right paramedian disk extrusion present with disk material extruding behind the T12 vertebral body along its entire length. There is associated compression of the thecal sac and the conus medullaris. The extruded disk material is heterogeneous in signal characteristics. There is loss of disk space height and endplate reactive change at this level as well as signal change in the adjacent vertebral bodies. There is associated encroachment of the right-sided exiting nerve roots within the neural foramen at this level.At L5-S1 there is a diffuse disk bulge present associated with facet and ligamentum flavum hypertrophy and partial effacement of the fat at the lateral recesses. There is partial effacement of the fat surrounding the exiting nerve roots with mild encroachment of the exiting nerve roots. There is facet and ligamentum flavum hypertrophy present bilaterally. Overall there is mild to moderate spinal stenosis at this level.At L4-5 there is a diffuse disk bulge present associated with facet and ligamentum flavum hypertrophy and effacement of the fat at the lateral recesses. There is effacement of the fat surrounding the left exiting nerve roots with encroachment of the left exiting nerve roots. Overall there is moderate spinal stenosis at this level.At L3-4 there is a diffuse disk bulge present associated with facet and ligamentum flavum hypertrophy and effacement of the fat at the lateral recesses. There is partial effacement of the fat surrounding the exiting nerve roots with mild encroachment of the exiting nerve roots. Overall there is mild spinal stenosis at this level.At L2-3 there is a diffuse disk bulge present associated with facet and ligamentum flavum hypertrophy and partial effacement of the fat at the lateral recesses. There is partial effacement of the fat surrounding the exiting nerve roots with mild encroachment of the exiting nerve roots. Overall there is mild spinal stenosis at this level.At L1-2 there is a diffuse disk bulge present associated with facet and ligamentum flavum hypertrophy and partial effacement of the fat at the lateral recesses. There is partial effacement of the fat surrounding the exiting nerve roots with mild encroachment of the exiting nerve roots. There is a Schmorl's node at this level with adjacent inflammatory changes.There are cysts present along the kidneys bilaterally measuring up to 12mm diameter.

Output: 1.There is a large disk extrusion present at T12-L1 which compresses the conus medullaris. The disk itself appears to have a more cystic appearing component behind the T12 vertebra. There are adjacent inflammatory changes. There is associated encroachment of the right-sided exiting nerve roots within the neural foramen at this level. 2.There are degenerative changes present in the lumbar spine with a moderate to severe degree of spinal stenosis at L4-5 and milder degrees of spinal stenosis at L3-4 and L5-S1.3.There is encroachment of exiting nerve roots within the neural foramina at multiple levels which are appear worse on the left side at L4-5. 4.Findings were discussed with Dr Adam Cifu at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Cystic lesion deep to left SCM. There is a well-defined mass in the left neck deep to the sternocleidomastoid muscle that measures up to 5 cm. The lesion demonstrates high T1 and low T2 signal and has smooth, thin peripheral enhancement. There are no flow voids or signs of phleboliths within the lesion. The cervical lymph nodes are not particularly enlarged. The thyroid and salivary glands are unremarkable. There is a left maxillary sinus retention cyst. The imaged intracranial structures and orbits are unremarkable. The osseous structures appear to be intact.

Output: A well-defined cystic lesion deep to the left sternocleidomastoid muscle inferior to the level of the mandibular angle, which measures up to 5 cm, may represent a second branchial cleft cyst.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with acute ischemic stroke. Evaluate vascular patency. Also with right-sided pain and weakness. MRA brain:Image quality is limited by motion artifact. There may be mild vascular narrowing through the cavernous ICAs. No obvious high-grade vascular stenosis or occlusion is detected intracranially. No large aneurysms are seen. The ACOM artery is moderately sized and unremarkable. The PCOM arteries are moderately sized and unremarkable.MRA neck:Image quality is limited by motion artifact. The origins of the great vessels are not well seen though no significant stenosis is suspected. No significant stenosis is suspected at the carotid bifurcations by NASCET criteria. The cervical ICAs appear to be patent though they are not well assessed due to artifact. The vertebral arteries appear to be largely patent though there are portions of each which are not well visualized, possibly due to artifact.Cervical spine:Image quality is limited by motion artifact. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or concerning marrow replacement is seen.The visualized spinal cord is normal in signal and morphology. No epidural abnormality is suspected.Please note that there is a misregistration between the actual level of the axial slices and the level represented by the scout line on sagittal images. Specifically, the axial images are registering one disc level higher on the sagittal images than they are in reality. C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation, asymmetric to the right. No spinal canal stenosis. No foraminal narrowing. C5-6: Moderate posterior disc-osteophyte complex formation resulting in mild spinal canal stenosis. No significant foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.MRA imaging of the intracranial vessels and the neck is compromised by motion artifact. Within this limitation, no definite causative stenosis or occlusion is seen to account for the patient's ischemic lesions.2.Overall mild degenerative disc disease is seen. C5-6 is the most significantly affected level where there is a mild spinal canal stenosis. 3.Please note that there is a misregistration between the actual level of the axial slices and the level represented by the scout line on sagittal images. Care should therefore be taken when cross-referencing the axial images to the sagittal images.


Instruction: Generate impression based on findings.

Input: Optic nerve gliomas, 24 months off chemotherapy Orbits: There is no significant interval change in the peripherally-enhancing right orbital segment optic nerve glioma with a central cystic component, which measures up to 7 mm in diameter. The other orbital contents are otherwise unremarkable. Brain: T2/FLAIR hyperintense cystic lesion along the right optic tract extending inferiorly into the right medial temporal lobe measures approximately 12 x 12 x 13 mm previously approximately 9 x 9 x 7 mm. There is also interval development of peripheral enhancement. Findings suspicious for progression.There is no significant interval change in the non-enhancing T2 hyperintense lesion centered within the left optic chiasm and hypothalamus that measures approximately 10 x 14 mm. T2/FLAIR hyperintensity along the lateral aspects of the thalami is not significantly changed. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: Compared to 10/9/2015, there has been interval development of enhancement as well as mild increase in size of lesion along the right optic tract which extends into the right medial temporal lobe, findings consistent with glioma progression. Remainder of the bilateral optic pathway gliomas are unchanged.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with ataxia. There are extensive supratentorial and infratentorial T2 hyperintense lesions in the cerebral white matter, which appear similar as on the prior exam, accounting for differences in technique. There are also T2 hyperintense lesions in the imaged portions of the cervical spine. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Extensive supratentorial and infratentorial demyelinating lesions appear similar as on the prior exam, accounting for differences in technique.


Instruction: Generate impression based on findings.

Input: 80 year-old male status post excision of right shoulder chondrosarcoma There is no evidence of soft tissue mass or abnormal enhancement to indicate tumor recurrence about the shoulder. Patchy T2 bright foci of signal in the proximal humerus likely represent areas of bone infarction.New full thickness tear of the distal supraspinatus tendon at its insertion with extension of fluid into the subacromial subdeltoid bursa. No significant tendon retraction or muscular atrophy. There is also tendinosis and partial thickness tearing of the distal infraspinatus tendon. The rotator cuff is otherwise intact. The biceps tendon is normally situated within the bicipital groove. The suprascapular notch and spinoglenoid notch appear normal. There is moderate acromioclavicular joint osteoarthritis as well as fluid in the AC joint. Glenohumeral alignment is within normal limits.

Output: 1. No evidence of tumor recurrence or metastasis about the shoulder.2. Full-thickness supraspinatus tear at its insertion without significant retraction.


Instruction: Generate impression based on findings.

Input: Neck pain, evaluate for ligamentous injury, stenosis, or cord impingement. There is severe motion degradation on all sequences which renders this exam nondiagnostic. Patient could not cooperate for the study despite the provided sedation medications.

Output: Examination of the cervical spine is severely motion degraded and non-diagnostic.


Instruction: Generate impression based on findings.

Input: 58-year-old female with splenomegaly. History of polycythemia that transformed to myelofibrosis. Patient on protocol 15-1306 and it needs measurements of the spleen. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. Subcentimeter cyst of hepatic segment 8, unchanged.SPLEEN: Marked splenomegaly measuring 23 cm in length (prior 21.5 cm). The previously described subcentimeter T2 hyperintense foci of the mid spleen are unchanged (series 501 images 43, 45).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: Stable T2 hyperintense foci of the L2, L3 vertebral bodies, left hemisacrum (coronal series 401 images 37, 38, 40) and right iliac bone (coronal series 901 image 37). These foci are favored to represent osseous hemangiomas.OTHER: No significant abnormality noted.

Output: Splenomegaly measuring 23 cm in length (prior 21.5 cm).


Instruction: Generate impression based on findings.

Input: 47 year old man with history of significant alcohol abuse and 2 months of worsening heart failure symptoms, found to have a severely reduced LV EF with no obstructive coronary disease. He was referred for cardiac MRI to evaluate for evidence of nonischemic cardiomyopathy etiologies. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 11%, the LV end diastolic volume index is 292 ml/m2 (normal range: 74+/-15), the LVEDV is 658 ml (normal range 142+/-34), the LV end systolic volume index is 260 ml/m2 (normal range 25+/-9), the LVESV is 586 ml (normal range 47+/-19), the LV mass index is 106 g/m2 (normal range 85+/-15), and the LV mass is 239 g (normal range 164+/-36). The wall motion is globally hypokinetic with regional variation, notably inferior wall akinesis, septal akinesis, mid-distal lateral wall akinesis, mid-distal anterior wall akinesis. No intracardiac thrombus was identified. There are two globular foci of late gadolinium enhacement in the basal and distal inferolateral wall; while these findings can be suggestive of a possible embolic phenomenon, these abnormalities are disproportionate to the associated wall motion. There is linear epicardial late gadolinium enhancement in the anteroseptum, mid anterior and anterolateral wall. The constellation of findings are highly suggestive of a component of post-viral myocarditis, perhaps superimposed on an underlying cardiomyopathy due to alcohol abuse.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 196 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 112 ml (normal range 54+/-17).Right AtriumThe right atrium is normal sized.Aortic ValveThe aortic valve is mildly thickened, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve demonstrates malcoaptation and there is mild associated mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trace pericardial effusion.Extracardiac FindingsTrace left pleural effusion. Wedge shaped focus favoring infarct in the superomedial spleen. Focal rounded area of high signal in the right lower lobe, which could represent possible nodule vs. artifact. If there is no previous outside chest CT imaging to compare, a dedicated low dose chest CT should be considered if clinically indicated.

Output: 1. Severely dilated left ventricle with severely reduced function (EF 11%). No intracardiac thrombus was identified. Patchy late gadolinium enhancement involving the epicardial antero septum, mid-distal anterior and anterolateral wall, and two additional globular foci in the basal and distal inferolateral wall. Taken together, these findings are highly suggestive of a component of post-viral myocarditis, perhaps superimposed on an underlying cardiomyopathy due to alcohol abuse. 2. Normal sized right ventricle with preserved systolic function.3. Wedge shaped infarct in the superomedial spleen.4. Focus of high signal in the posterior segment right lower lobe which could represent nodule versus artifact; further imaging with low dose CT thorax should be considered in absence of recent outside comparison CT for comparison. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Recent shingles outbreak, bilateral burning lower extremity pain. The conus medullaris or lower spinal cord are unremarkable. There is no evidence of enhancing lesions. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is degenerative spondylosis in the lower lumbar spine with facet hypertrophy and effusions, as well as mild disc space and bulging with bilateral neural foraminal narrowing at L4-5 and L5-S1, but no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: No evidence of lower spinal cord or cauda equina lesions.


Instruction: Generate impression based on findings.

Input: 13-year-old male with pain, muscle wasting, evaluate for progression of lesions Foci of T2 signal abnormality affecting bilateral iliac crests are less intense than on the prior exam. Extension into the adjacent gluteus musculature is no longer noted. Additional foci T2 signal abnormality adjacent to the left and right SI joints, and ischia are also decreased compared with the prior exam. There is mild associated enhancement of these lesions. No new foci of signal abnormality are identified. Both hip joints appear normal for the patient's age. The soft tissues and musculature are normal.

Output: Interval improvement in multifocal marrow signal abnormality as described above. No new lesions.


Instruction: Generate impression based on findings.

Input: Male, 51 years old, with increased lower extremity reflexes, and fluctuating abnormality the brain of uncertain etiology, in the context of lung cancer. C-spine:Image quality is degraded by motion artifact but diagnostic information is still obtained.Alignment is anatomic. Vertebral body morphology is unremarkable. A focus of T2 hyperintensity within the C7 vertebral body is nonspecific.Given the limitations as above, no definite spinal cord abnormality is seen.C2-3: Minimal posterior disk osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing.C3-4: Posterior disk osteophyte formation with a superimposed central extrusion and no significant cord impingement or generalized spinal canal stenosis. Mild/moderate left foraminal narrowing. C4-5: Unremarkable. C5-6: Minimal left paracentral protrusion. No significant spinal cord impingement or spinal canal stenosis. Mild left foraminal narrowing. C6-7: Unremarkable. C7-T1: Minimal posterior disk osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing.T-spine:Alignment is anatomic. Vertebral body morphology is within normal limits. Small T2 hyperintense foci within the T4 and T7 vertebral bodies are nonspecific. Ill-defined T2 hyperintensity within the right anterior aspect of the T9 vertebral body is of uncertain significance.Visualized spinal cord shows normal morphology and signal characteristics allowing for motion artifact.A right upper lobe lung mass is seen.L-spine:Transitional morphology of the L5 vertebral body is seen. The lumbar vertebrae otherwise show normal morphology. A small T2 hyperintense focus within the L3 vertebral body is nonspecific.The visualized conus and cauda equina are unremarkable given the limitations of motion degradation.At L4-5, a disk bulge is present, asymmetric to the left, with resultant moderate narrowing of the spinal canal. Both neural foramina show mild to moderate narrowing.The remaining lumbar intervertebral disks are preserved with no additional areas of spinal canal or neuroforaminal stenosis.MRS:On limited anatomic images of the brain, T2 hyperintensity and edema has progressed within the left paramedian parietal lobe, affecting the cingulate gyrus as well as the splenium and part of the body of the corpus callosum.Single voxel spectroscopic assessment of this abnormal tissue was performed, along with contralateral normal appearing tissue, at multiple TEs. Cho, Cr and NAA peaks are proportionately decreased relative to normal, as is myoinositol, a glial cell marker. Notable lipid peaks are evident on short TE sequences, but no significant lactate is seen.

Output: 1. Relatively mild degenerative findings in the spine which would not adequately account for the patient's symptoms.2. Scattered areas of signal abnormality are seen within the spinal vertebrae as described above. These lesions are nonspecific and largely nonaggressive in appearance. Given the patient's history, and without the benefit of IV contrast, the possibility of metastatic disease cannot be entirely excluded, though it is not highly suspected at this point.3. Limited anatomic imaging of the brain shows progression of a lesion involving the paramedian left parietal lobe as well as the corpus callosum. Spectroscopic assessment of this lesion reveals a fairly proportionate reduction in the major brain metabolic peaks, indicating loss of both neural and glial elements. The presence of lipid is compatible with cellular degeneration. Absence of lactate would argue against a primary ischemic etiology. Overall, the spectroscopic pattern is most suggestive of a non-neoplastic inflammatory, metabolic or autoimmune phenomenon. An infectious or post infectious process may be considered, as well as a paraneoplastic encephalitis.


Instruction: Generate impression based on findings.

Input: Male; 79 years old. Reason: ileitis demonstrated on previous CAT scan and SBFT (9/2013). Crohn's ? acute ? History: asymptomatic ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple loops of mid to distal ileum (at least 30cm) in the right hemiabdomen demonstrate mild circumferential wall thickening and increased enhancement, compatible with active inflammation and most likely secondary to inflammatory bowel disease. The degree of inflammation is less than prior CT. There is sparing of the terminal ileum. No bowel obstruction. No free fluid. Multiple duodenal diverticula, similar to prior CT.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with active inflammation of multiple mid to distal ileal loops, most likely secondary to inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Reason: Sinus cancer compare to last CT. Measure 1) Soft tissue mass in left nasal cavity, 2) soft tissue mass R. orbit medial rectus muscle, 3) Soft tissue L. orbit, 4) left level 2 lymph node, 5) right level 2 lymph node, 6) 2nd right level 2 lymph node. History: post 2 cycles of therapy. Neck CT:There is interval progression of abnormal soft tissue centered within the left nasal cavity which displaces the nasal septum to the right and abuts the left maxillary antrum. The soft tissue abnormality measures 4.3 x 2.8 cm (series 80280, image 25) compared to prior measurement of 4.1 x 2.2 cm in extent (image 17, series 80288). There is increased tumor filling the left nasal cavity causing increased obliteration of the nasal cavity, and further extension into the left maxillary antrum causing increased trapped secretion within the left maxillary sinus.The soft tissue mass erodes through the lamina papyracea to invade both extraconal orbital spaces. Soft tissue within the right orbit is inseparable from the medial rectus muscle and measures 4.1 x 1.3 cm (series 8034, image 10) compared to prior measurement of 3.8 x 1.6 cm (image 13, series 4) on the prior exam. Soft tissue within the left orbit displaces the medial rectus muscle medially and probably also involves the muscle directly. It measures 2.7 x 1.7 cm compared to prior measurement of 3.0 x 1.4 cm (image 13, series 4) on the prior exam. The slight differences in measurements may be related to differences in sampling.Abnormal soft tissue fills both orbital apices. There is evidence of impingement of the optic nerves bilaterally. Small foci of erosion within the superior orbital walls bilaterally are unchanged. Tumor extends through these cranial defects, particularly on the left where there is evidence of intracranial involvement, better seen on the patient's prior MRI. Soft tissue invasion with bone erosion involves the sphenoid sinuses as well as the sella, foveae ethmoidalis and cribriform plate, similar to the prior examination. Soft tissue invasion of the left sphenopalatine foramen, pterygopalatine fossa and pterygomaxillary fissure appears similar to the prior exam.Postsurgical change involving the anterior aspect of the right maxillary bone is again seen. The patient has undergone right partial maxillectomy, antrostomy and ethmoidectomy. Mucosal thickening within the remaining right maxillary sinus appears similar to the prior exam.Reference lymph node measurements are as follows:Left level 2 (image 8034, series 39): 1.1 cm in short axis, compared to 1.2 cm previously. Right level 2 (image 41, series 8034): 1.3 cm in short axis, compared to 1.2 cm previously.Right level 2 (image 43, series 8034): 1.1 cm in short axis, compared to similar measurement previously.Scattered additional pathological cervical lymph nodes are again seen. There is irregular right level 5 node which demonstrates increased infiltration of surrounding fat and is suggestive of progression of lymphadenopathy with extracapsular extension. There is increased soft tissue stranding and fat reticulation, which may be related to post-treatment effect.The epiglottis, valleculae, piriform sinuses, glottis and suglottic airway are normal.The parotid and submandibular glands, as well as the thyroid, are unremarkable. The cervical vessels are patent. The lung apices show no significant abnormality. Sclerosis within the C5 and C6 vertebral bodies, suspicious for metastatic disease, is unchanged.

Output: 1.Interval progression of left nasal cavity mass with extension into the left maxillary sinus and cribriform plate.2.Soft tissue mass invasion of the extraconal orbital spaces unchanged. There is extension into orbital apices causing optic nerve impingement.3.Extensive skull base invasion appears similar to the prior examination.4.Stable size of numerous pathological cervical lymph nodes with reference measurements as above. However, a right level 5 node demonstrates increased infiltration of surrounding fat and is suggestive of progression of lymphadenopathy with extracapsular extension. 5.Stable bony sclerotic lesions suggestive of metastatic disease in the cervical spine.


Instruction: Generate impression based on findings.

Input: 73-year-old male with intrahepatic bile duct carcinoma ABDOMEN:LIVER, BILIARY TRACT: Status post left hepatectomy and portoenterostomy. Percutaneous biliary drain is noted. A bile duct stent is noted. Mild to moderate intrahepatic biliary ductal dilatation converges to the level of the stent. No mass is evident. Susceptibility defect from a metallic clip in segment 5/6. Status post cholecystectomy.The vasculature is patent. Enhancing mesenteric nodule measuring 7 mm along the right abdominal wall.SPLEEN: No significant abnormality noted.PANCREAS: Pancreaticojejunostomy. The main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mildly prominent right cardiophrenic lymph nodes. Scattered subcentimeter peripancreatic/porta hepatis lymph nodes.BOWEL, MESENTERY: Small bowel caliber is within normal limits without evidence of obstruction. The appendix is well visualized and within normal limits.BONES, SOFT TISSUES: Midline ventral wall defect with fluid signal in the subcutaneous tissue, likely post surgical.OTHER: No significant abnormality noted.

Output: 1.Mild to moderate intrahepatic biliary ductal dilatation converging to the level of the stent. No mass is evident. 2.Enhancing mesenteric nodule measuring 7 mm along the right abdominal wall. Findings may represent a lymph node although mesenteric carcinomatosis cannot be entirely excluded. Attention on follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: T4aN2cM0 oral tongue cancer infiltrating the floor of mouth treated with CRT completed 10/2014. There are post-treatment findings in the upper aerodigestive tract, including margin right mandibulectomy. There is mild patchy enhancement in the right dorsal hemitongue, but no evidence of measurable tumor in the oral cavity. There is no significant cervical lymphadenopathy by size criteria. The airways are patent. The thyroid and salivary glands are unchanged. The major vessels of the neck are patent. There are mild emphysematous changes in the lung apices. There is degenerative cervical spondylosis without high-grade spinal canal stenosis. There is staphylomatous deformity of the left globe.

Output: Post-treatment findings without evidence of measurable tumor recurrence or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified nature of brain [239.6], Reason for Study: ^Reason: pre-op, for biopsy on 6/23' please do thin cut T2 and thin cut T1 post-contrast axials only History: R thalamic lesion The imaging was performed with stealth protocol with fiducial markers attached.Again there is a multilobulated right basal ganglia mass extends toward right side midbrain. The mass shows extensive enhancement enhancement and shows low signal intensity on T2 weighted image with extensive surrounding edema.Above findings do not show any significant interval change since prior scan.Differential diagnosis remains unchanged including primary CNS lymphoma, primary malignant glioma and metastasis.No change of chronic ischemic infarct with encephalomalacia seen on the left cerebellar hemisphere.No change of underlying minimal to moderate nonspecific small vessel ischemic disease.The paranasal sinuses and mastoid air cells are clear.

Output: Pre and post contrast enhanced MRI scan weight preop localization purposes with fiducial markers attached.Otherwise no interval change of right basal ganglia mass extends toward right midbrain with mass effect since prior scan.


Instruction: Generate impression based on findings.

Input: Neck pain Alignment is anatomic without subluxation. The marrow signal is benign. Vertebral body heights are maintained. The cervicomedullary junction is normal. Spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. No intraspinal hematoma or mass. The visualized paraspinal contents are unremarkable. Major cervical vasculatures with normal flow voids. Mild multilevel degenerative disease. C1/2: No significant spinal canal stenosis or foraminal narrowing.C2/3: No significant spinal canal stenosis or foraminal narrowing. C3/4: Mild disc osteophyte complex without significant spinal canal stenosis. No significant foraminal narrowing.C4/5: Mild disc osteophyte complex with mild spinal canal stenosis. Uncovertebral arthropathy resulting in moderate bilateral foraminal narrowing.C5/6: Mild disc osteophyte complex with mild spinal canal stenosis. Uncovertebral arthropathy resulting in severe left and moderate right foraminal narrowing.C6/7: Mild to moderate disc osteophyte complex with mild-to-moderate spinal canal stenosis. Uncovertebral arthropathy resulting in severe left and moderate right foraminal narrowing.C7/T1: No significant spinal canal stenosis or foraminal narrowing.

Output: Multilevel degenerative spondylosis most severe at C6-7 level with mild-to-moderate spinal canal stenosis and severe left and moderate right foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, history of Crohn's disease, history of breast cancer in 2005, now with recurrence in the axillary nodes, a right upper lung nodule positive on PET, and increased signal in the pituitary. Assess for pituitary adenoma versus metastasis. Along the right aspect of the sella, and involving the right cavernous sinus, there is an ill-defined region of soft tissue thickening which is asymmetric relative to the left sella and cavernous sinus (see key images). This tissue correlates with the region of hypermetabolic activity seen on prior PET scan.The visualized pituitary gland is within which can be normal for age. No additional pituitary sellar or suprasellar lesions are seen.

Output: A region of soft tissue thickening is evident involving the right aspect of the sella and the right cavernous sinus. This does correlate with an area of hypermetabolic activity seen on prior PET scan. Without the benefit of IV contrast, no further characterization can be made. The differential diagnosis therefore remains broad and would include metastatic disease, a primary pituitary neoplasm, an incidental cavernous sinus meningioma, as well as an inflammatory/granulomatous process.


Instruction: Generate impression based on findings.

Input: Neck mass. 37-year-old male. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and mastoid air cells are unremarkable.Images through the neck demonstrates a low-density mass with extensive internal vascular enhancement in left neck immediately posterior to the left carotid bifurcation. There is anterior displacement of distal left common carotid, proximal left internal and external carotid arteries. The mass measures 72 mm in cranial cephalad access and 42-mm x 38 0.7-mm in its axial dimension. On axial images a tapered cephalad extension of this mass reaches the anterior aspect of body of C1 vertebrae. Prior MRI examination demonstrated intense enhancement of this tumor however the enhancement on the CT examination is very patchy and not solid as it was noted on MRI. This mass demonstrates a very well demarcated margin and with no evidence of any edematous changes of adjacent fascia planes. There is significant mass-effect and lateral displacement of the left internal internal jugular which at the level of maximum compression is almost nondetectable. There is no evidence of encasement of the left carotid by this mass. Left internal jugular home for her superior and inferior to this tumor remains open.The differential for this tumor remains and is a chemodectoma, a schwannoma or a metastatic lymph node.A small right submandibular lymph node measuring 12 mm times 15-mm in transaxial dimension is present. This shows no enhancement or necrosis. Multiple smaller scattered nonenhancing and not a pathologic nodes are also noted.There is symmetrical prominence collecting tonsils with no enhancement or necrosis. Limited images of the apices of the lungs are negative for pathology.Limited images of the mediastinum are also negative. 70 cc of Omnipaque 350 was utilized for the above study.

Output: 1. Large well-demarcated low-density mass with patchy internal vascular enhancement in the left neck. Finding is believed to represent a schwannoma, additional possibility of chemodectoma, metastatic lesion cannot be entirely ruled out.2.Small additional nonenhancing and nonpathologic lymph nodes as detailed.3.Prominent adenoids and collecting tonsils with no abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:9/6/1972)Reason: seizure protocol. 3T MRI with thin cut. History: Seizure since age 16. No previous work up available.PROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU The CSF spaces are appropriate for the patient's stated age with no midline shift. The hippocampi appear symmetric.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.

Output: No abnormal mass lesions are appreciated within the brain parenchyma to explain patient's seizures. MRI of the brain appears to be within normal limits.


Instruction: Generate impression based on findings.

Input: Papillary adenocarcinoma of the distal tuft of the ring finger, outside excision with positive margins performed October 2016. The examination is significantly limited by motion artifact.Within these limits, there is no abnormal mass or enhancement identified within the distal phalanx of the ring finger. There is a tiny focus of low signal intensity on both T1 and T2 sequences along the dorsal and radial aspect of the distal tuft and along the nailbed best appreciated on series 19 image 4 and series 20 image 10. This focus does not enhance following contrast and may represent an area of mineralization, scarring, or susceptibility artifact from prior surgery.The marrow signal of the ring finger, specifically the distal phalanx, appears normal. The remaining soft tissues of the ring finger also appear normal.

Output: Motion degraded exam. Within these limits, there is no abnormal mass or enhancement identified within the distal phalanx of the ring finger. There is a tiny focus of low signal intensity in the distal tuft along the nailbed which may represent an area of mineralization, scarring, or susceptibility from prior surgery but correlation with radiographs and physical exam is recommended.


Instruction: Generate impression based on findings.

Input: New onset HA, visual disturbance. Brain MRI: A small focus of enhancement is noted just inferior to the right caudate head which also demonstrates susceptibility abnormality. There is no surrounding hypointensity on T2/FLAIR to suggest edema. There is also no evidence of restricted diffusion. Constellation of above findings suggest possibility of cavernous malformation. Differential diagnosis include cavernous malformation with associated capillary telangiectasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable.Orbits MRI:No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.Brain MRA:The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.Neck MRA:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion. There is a left dominant vertebral artery. The C6 level of the right vertebral artery shows crossing of venous structure and overlapped deep cervical artery which created an artifactual narrowing of that segment on MIP reformat image. There is no evidence of stenosis or occlusion.

Output: 1.Small enhancing lesion just inferior to the right caudate head with associated susceptibility abnormality but without restricted diffusion. Differential considerations include cavernous malformation or cavernous malformation associated with capillary telangiectasia. Additional less likely considerations are subacute lacunar infarct or hemorrhage as well as metastasis. Mild mucosal thickening is noted of the left sphenoid sinus which is nonspecific. 2.No significant sterile occlusive disease or aneurysm involving the intracranial and extracranial craniofacial vasculature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Li-fraumeni syndrome screening CHEST:CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver parenchyma is homogeneous. No suspicious mass is identified.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is mild pelvicalyceal dilatation of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: 50 years, Female, rapidly progressive consolidative decline. Assess for CJD. There is significant restricted diffusion involving the right caudate head and anterior putamen and to a subtle degree involving the left caudate head and anterior putamen. There are also scattered areas of subtle cortical restricted diffusion particularly in the right cerebral hemisphere. There is T2 hyperintensity involving the right caudate head and anterior putamen and to a milder degree on the left.No evidence of infarct, hemorrhage, intracranial mass, or mass effect. Brain parenchymal volume is within normal limits. No hydrocephalus or extra-axial collections. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Areas of restricted diffusion and T2 hyperintensity in the basal ganglia and cortex, right greater than left. Appearance and distribution of these findings is highly suspicious for Creutzfeldt-Jakob disease.


Instruction: Generate impression based on findings.

Input: Male 75 years old Reason: knee pain History: knee pain MENISCI: There is an undersurface horizontal cleavage tear of the posterior horn of the medial meniscus. No evidence of lateral meniscus tear.ARTICULAR CARTILAGE AND BONE: There is slight thinning of the hyaline cartilage of the medial femoral condyle without focal defect identified.LIGAMENTS: No significant abnormality noted.EXTENSOR MECHANISM: There is partial thickness tearing of the quadriceps tendon with delamination of the deep fibers but without complete retraction or evidence of patella Baja. The patellar tendon is intact.ADDITIONAL

Output: 1. Partial-thickness tear of the quadriceps tendon as described above.2. Horizontal cleavage tear of the posterior horn of the medial meniscus as described above.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: BRAIN: There is T1 hyperintense subdural fluid posterior to the cerebellum, along the tentorium, and along the falx cerebri posteriorly, as well as subpial T1 hyperintense fluid within multiple frontal and parietal sulci compatible with subacute hemorrhage. There is corresponding decreased diffusion in some of these regions which is likely artifactual secondary to the hemorrhage. There are however additional foci of decreased diffusion within cortices adjacent to a falcine subdural hemorrhage that likely represents compression ischemia. In addition, there are foci of decreased diffusion in the corpus collosum and right peri-atrial white matter that are compatible with traumatic axonal injury. Within the midline there is an approximately 19 x 12 mm focus of susceptibility effect and fluid fluid level compatible with intra-falcine hematoma. It essentially unchanged in size allowing for differences in technique. There is adjacent T2 hyperintensity compatible with vasogenic edema within the surrounding bilateral white matter. Along both frontal convexities there are T2 hyperintense subdural fluid collections that are new since the prior exam and measure up to 5 mm on the left and 3-mm on the right. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the bilateral mastoid air cells and developing paranasal sinuses.CERVICAL SPINE: There is thin T1 hyperintense T2 hypointense fluid measuring up to 1 mm within the subdural space anterior to the medulla and ventral to the spinal cord at the C1-C4 levels. In addition, there is T1 and T2 hyperintense fluid along the dorsal epidural space extending from the T1 level inferiorly to at least the T7 level and below the level of this exam. It also extends superiorly, wrapping around the cord up to the C6 level. There is no cord signal abnormality or spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1.Essentially unchanged intracranial subdural and subpial hemorrhage as well as a large interhemispheric hematoma with adjacent edema.2.Foci of compression ischemia adjacent to the interhemispheric hematoma. 3.Small foci of diffusion restriction most compatible with traumatic axonal injury within the corpus callosum and right peri-atrial white matter. 4.New subdural post-traumatic effusions along the bilateral frontal convexities. 5.Epidural and subdural hematomas within the cervical and upper thoracic spinal canal, extending below the level of this exam. There is no cord signal abnormality, cord compression, or significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 65-year-old female with weight loss, hyperbilirubinemia. Past medical history of metastatic pancreatic cancer with liver metastases. Concern for cholangitis. Elevated AST/ALT. Please characterize pancreatic primary, liver metastases, and biliary tree. Rule out obstruction. Exam limitations include extensive patient motion artifact and susceptibility artifact at the level of the central pancreas.ABDOMEN:LIVER, BILIARY TRACT: Marked hepatomegaly measuring 30 cm in craniocaudal length. The hepatic parenchyma demonstrates innumerable near confluent small lesions of abnormal signal intensity compatible with the history of hepatic metastatic disease. There is narrowing of the hepatic veins and portal veins. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Extensive cystic changes of the pancreatic body and tail, which is favored to represent pancreatic ductal and sidebranch dilatation. These findings extend to the proximal pancreatic body, however a discrete lesion is not clearly identified within the limitations of this exam. The proximal aspect of the SMA demonstrates a normal surrounding fat plane, however there is limited visualization of the midportion SMA due to motion artifact and susceptibility artifact.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal and upper abdominal lymphadenopathy is seen. For reference, there is a 1.9 x 1.5 cm left paraaortic lymph node (series 401 image 24).There are separate origins of the common hepatic artery and splenic artery from the aorta, normal variant. An IVC filter is noted.BOWEL, MESENTERY: Mild ascites.BONES, SOFT TISSUES: Multilevel degenerative changes of the spine.OTHER: Small right pleural effusion.

Output: 1.Extensive cystic changes of the pancreatic body and tail, which is favored to represent pancreatic ductal and sidebranch dilatation. These findings extend to the proximal pancreatic body. However, extensive motion and regional susceptibility artifacts limit the ability to accurately delineate the presumed pancreatic body mass lesion, and CT is recommended for more accurate staging. There is evidence of metastatic hepatic and nodal disease.2.Marked hepatomegaly measuring 30 cm in length. Extensive near confluent hepatic lesions compatible with history of metastases. No intra or extrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Reason: eval for L knee meniscus vs patellofemoral pathology History: L knee medial and lateral joint line pain, + patellar apprehension MENISCI: There is globular increased signal intensity throughout the anterior horn and body of the lateral meniscus indicating severe intrasubstance degeneration. There is extension of mucoid material into the adjacent soft tissues with parameniscal cyst formation. Additionally, however, there is linear signal extending both vertically through the anterior horn of the meniscus and horizontally to the femoral articular surface indicating superimposed complex tearing. Additional intrasubstance degeneration affects the posterior horn of the lateral meniscus and there is perhaps a tiny undersurface tear in the peripheral fibers near the attachment of the ligament of Wrisberg. There is minimal intrasubstance signal of the medial meniscus of doubtful clinical significance, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage defects. The bone marrow signal intensity is within normal limits.LIGAMENTS: The ACL appears thinned, but appears intact. The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall Salvati ratio is within normal limits.ADDITIONAL

Output: Complex tear of the lateral meniscus with extensive underlying mucoid degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male 54 years old status post OLT 6/15 for ETOH cirrhosis and HCC. Elevated liver tests but no rejection on liver biopsy. Evaluate for lesions and assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: Stable postsurgical changes related to liver transplant, cholecystectomy and hepaticojejunostomy. There is wedged shaped enhancement within hepatic segments 7/8 on the arterial phase which normalizes on later phases of contrast consistent with transient hepatic intensity difference (THID). The hepatic artery, particularly at expected level of the common hepatic artery, is not well assessed due to significant susceptibility artifact related to prior surgery. However intrahepatic arterial enhancement is suggested. The hepatic and portal veins are patent in appearance.There is new mild right-sided intrahepatic biliary ductal dilatation with multiple filling defects consistent with stones in the common duct and located proximal to an area of apparent luminal narrowing at the expected level of the confluence and appearing to proximal to the biliary-enteric anastomosis (no evidence of left-sided intrahepatic biliary ductal dilatation, which would be expected in the setting of stricture involving the biliary-enteric surgical anastomosis). The narrowing extends over a distance of 9 mm although this may be undermeasured on this exam. As the intrahepatic biliary ductal dilatation is only on the right, findings are favored to represent a nonanastomotic stricture.SPLEEN: The spleen measures 13 cm in craniocaudal dimension.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: Gynecomastia. A tiny posterolateral left chest wall cyst is of uncertain significance. Diastases of the rectus abdominis muscles is unchanged.OTHER: No significant abnormality noted.

Output: 1. Status post liver transplant. No suspicious hepatic lesion.2. New mild right-sided intrahepatic biliary ductal dilatation and choledocholithiasis. Just distal or inferior to level of stones is a suspected nonanastomotic (favored due to the absence of biliary ductal dilatation on left side) stricture, measuring approximately 9 mm in length. Considering constellation of findings, underlying stricture may have resulted in proximal biliary stasis which in turn led to stone formation. Please refer to discussion above. 3. The hepatic artery, particularly at expected level of the common hepatic artery, is not well assessed due to significant susceptibility artifact related to prior surgery. However intrahepatic arterial enhancement is suggested. Hepatic arterial anatomy may be evaluated with CTA in the future if clinically indicated. The hepatic and portal veins are patent in appearance. 4. Wedged shaped enhancement within hepatic segments 7/8 on the arterial phase which normalizes on later phases of contrast consistent with transient hepatic intensity difference (THID).


Instruction: Generate impression based on findings.

Input: Weakness deconditioning. Suspicion for MCA infarct. MRI BRAIN: There is mild diffuse global volume loss. The gray-white matter differentiation is preserved. There are a few scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are unchanged. There is mineralization of the bilateral globus pallidus. There is no evidence for acute intracranial hemorrhage. No midline shift or mass effect is appreciated.MRA BRAIN: The intracranial carotids and vertebrobasilar arteries are grossly patent, however additional examination is nondiagnostic due to extensive motion artifact.

Output: 1. No acute infarct.2. Stable mild white matter changes likely related to chronic microvascular ischemic disease.3. The intracranial carotids and vertebrobasilar arteries are grossly patent, however detailed evaluation is nondiagnostic due to extensive motion artifact.


Instruction: Generate impression based on findings.

Input: 74-year-old woman with left shoulder pain. ROTATOR CUFF: There are several small tears of the supraspinatus at its insertion, without evidence of retraction or full-thickness tears. The rotator cuff and shoulder musculature are otherwise normal. Small subchondral cysts are seen within the humeral head.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. The labrum is grossly normal.BICEPS TENDON: The tendon of the long head of the biceps is in its groove. ADDITIONAL

Output: Several partial tears of the supraspinatus at its insertion. Large joint effusion.


Instruction: Generate impression based on findings.

Input: Status post tumor resection. There are postoperative findings related to a right-sided craniotomy for resection of a right parietal lobe mass. There is pneumocephalus and slightly increased small fluid collection with blood products subjacent to the craniotomy site as well as within the resection cavity. There is nodular focus of T1 hyperintensity along the inferior aspect of the resection cavity may represent blood products. No definite evidence of residual tumor is appreciated at this location. There is extensive associated vasogenic edema extending anteriorly into the basal ganglia, medially into the left parietal lobe along the splenium and inferiorly into the right temporal lobe. There is partial effacement of the right lateral ventricle with a 9 mm right to left midline shift, previously measuring 7 mm. There is slight decrease in the prominence of the left lateral ventricle. There is a 5 mm enhancing nodule involving the right occipital lobe. There is a 5 mm enhancing nodule involving the posterior aspect of the left superior frontal gyrus. There is restricted diffusion compatible with infarct involving the right posterior cerebral artery territory including the right occipital lobe and extending into the posterior para hippocampal gyrus. Restricted diffusion is also noted within the right pons consistent with infarct. The capillary gyrus.

Output: 1. Postoperative findings related to right-sided craniotomy for right parietal lobe tumor resection. No definite evidence of residual tumor within this location is appreciated. 2. There remains extensive surrounding vasogenic edema with improved right to left midline shift of 9 mm, previously 7 mm. 3. Acute infarct involving the right posterior cerebral artery territory including the right occipital lobe, right posterior aspect of the parahippocampal gyrus, and the right paramedian pons. Finding may have been the result of previously seen uncal herniation.4. 5 mm enhancing nodule in the left frontal lobe involving the posterior aspect of the superior frontal gyrus and a 5 mm enhancing nodule in the right occipital lobe involving the lingual gyrus are consistent with additional metastatic lesions.Dr. Ali discussed findings with Dr.Wallace (NSY) at 1330 hrs on 5/24/2015.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 47 years Female (DOB:5/20/1968)Reason: please do dr Javed MS protocol and compare to prior History: progression MSPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular white matter lesions present some which are perpendicularly oriented to the lateral ventricles. Additionally there are some subcortical white matter lesions present as well. These lesions are hyperintense on T2 and FLAIR MRI . There is a T2 and FLAIR hyperintense lesion present in the right precentral gyrus which is not readily appreciated on the prior exam.There is redemonstration of a T2 and FLAIR hyperintense lesion within the anterior aspect of the medulla on the left and another one along the left cerebral peduncle.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is redemonstration of multiple patchy T2 hyperintense lesions within the cervical spinal cord. There are unchanged compared to the prior exam. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present this levelAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge associated with endplate and bilateral uncovertebral osteophytes at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. Some loss of disc space height this desiccation and endplate reactive changes associated with a disc bulge, endplate osteophytes and uncovertebral osteophytes at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is redemonstration of multiple white matter lesions in the subcortical and periventricular white matter as well as in the brainstem. When compared to the previous exam most lesions are stable. There appears to be a new lesion in the right precentral gyrus. Lack of contrast enhancement generally implies nonacute plaque formation. These are compatible with patient's diagnosis of multiple sclerosis.2.There is redemonstration of significant change of multiple lesions throughout the cervical spinal cord. These are compatible with patient's diagnosis of multiple sclerosis.3.There are degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots. Worst levels appear to be C5-6 and C6-7.


Instruction: Generate impression based on findings.

Input: 42 year old male with stage I seminoma, evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Areas of loss of signal within the liver on out of phase images consistent with diffuse hepatic steatosis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts are identified within the kidneys bilaterally. Additional smaller subcentimeter foci of fluid signal intensity are identified within the kidneys, which are too small to characterize but likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: Prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged adenopathy, nonspecific right external iliac lymph node, measuring 9 x 6 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneous bone marrow signal abnormality in the femoral head/neck junction likely represents residual islands of red marrow.

Output: 1. No convincing evidence of metastatic disease.2. Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Male, 83 years old, with right lower extremity radicular pain. Alignment is anatomic, allowing for mild straightening of the lumbar lordosis. Vertebral body heights are preserved. There is degenerative endplate signal abnormality at L4-5. Elsewhere, the marrow signal characteristics are unremarkable. The visualized spinal cord, conus and cauda equina are within normal limits.L1-2: Central annular fissure without protrusion. No significant spinal canal or neuroforaminal stenosis. L2-3: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Loss of disc height and disc bulging. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Loss of disc height and disc bulging. Prominence of the epidural fat. No significant spinal canal stenosis. Mild to moderate foraminal narrowing.

Output: Disc degeneration at L4-5 results in a mild spinal canal stenosis and moderate bilateral foraminal narrowing.Disc degeneration at L5-S1 results in only mild spinal canal narrowing and mild bilateral foraminal narrowing.


Instruction: Generate impression based on findings.

Input: History of base of tongue cancer. Status post chemo/RT finishing 8 -- 12 -- 2004 CT of the soft tissues of the neck.Images through the skull base and cavernous sinuses demonstrate prominence of the lateral ventricles stable since prior study. New since prior examination is erosive changes of the posterior aspect of dens and body of C2 vertebrae. There is also associated soft tissue thickening and enhancement along the ventral aspect of the spinal canal at this level. This soft tissue also appears to extend between the dens and inferior tip of the clivus. The finding is concerning for metastatic disease and a follow-up with an MRI examination is recommended. There is slight compromise of the AP diameter of thecal sac at this level due to epidural soft tissue mass which causes slight flattening and posterior displacement of the cord and borderline central spinal stenosis of 7.5 mid. These findings are best appreciated on the reformatted sagittal images and also axial post infusion image 28 through 32.No evidence of recurrence of tumor at the level of base of tongue is detected. There is also no evidence of any pathologic adenopathy in the neck. No evidence of any additional osseous abnormality is detected. Extensive degenerative changes of cervical spine are noted. Limited images through the apices of the lungs demonstrate apical scarring. No evidence of metastatic nodules within the lung or limited view of mediastinum is detected.CT of brain with infusion:Visualization of ventral epidural soft tissue at the level of foramen magnum as detailed above.No evidence of hemorrhage, edema, mass effect or midline shift. Prominent supratentorial ventricular system remains stable since prior study. Normal density of brain parenchyma and no evidence of abnormal enhancement.The above new findings where discussed with Dr. Nwizu, Tobenna with pager number 2703 at the time of interpretation.70 cc of Omnipaque was utilized for this exam.

Output: 1.Stable CT of brain with infusion.2.Erosive changes along the dorsal aspect of C2 vertebral body with extra osseous enhancing soft tissue as detailed. Follow-up with a dedicated MRI of cervical spine is recommended to rule out metastatic lesions.3.No evidence of recurrence of tumor at the tongue base or any pathologic adenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Female 11 years old; with neuroblastoma, evaluate for disease progression History: hip pain ACETABULAR LABRUM: Normal in appearance.ARTICULAR CARTILAGE AND BONE: No fracture or malalignment. SOFT TISSUES: No enhancing soft tissue or osseous lesions evident. Normal symmetric musculature. No significant pelvic lymphadenopathy. The known left retroperitoneal mass is not included in the field-of-view. ADDITIONAL

Output: 1.Left adnexal cyst. 2.No osseous or soft tissue abnormality in the left hip or pelvis. 3.Please refer to concomitant lumbar spine MRI from the same date for other findings. Findings discussed with Dr. Susan Cohn on 12/29/15 at 09:55.


Instruction: Generate impression based on findings.

Input: Male, 38 years old, with paresthesias and history of multiple sclerosis. Evaluate for progression. Numerous juxtacortical, periventricular, corpus callosum and brainstem T2 hyperintense lesions are redemonstrated. These appear similar in size, number and distribution when compared to the prior examination. Several of these lesions, two along the left lateral ventricle and one along the right lateral ventricle, demonstrate marked T1 hypointensity. Other lesions demonstrate mildly to moderately reduced T1 signal. The T1 characteristics of these lesions do not appear to have significantly changed.Brain parenchymal morphology is otherwise unremarkable. No mass effect or edema is suspected. Brain volume appears to be preserved. The ventricles are normal in size and morphology. No abnormal extra-axial collections are detected.

Output: No significant interval change in the size, number or imaging characteristics of numerous lesions compatible with multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer initial staging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of T2 hyperintensity in the cerebral white matter bilaterally. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases. Mild scattered foci of T2 hyperintensity in the cerebral white matter bilaterally are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female 57 years old Reason: Brachytherapy planning History: Brachytherapy planning UTERUS, ADNEXA: Patient's known cervical cancer mass is now significantly smaller and measures 3 x 2.1 cm on image #26, series #401. Again noted is the parametrial extension bilaterally.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Significant interval decrease in the size of the patient's known cervical mass.


Instruction: Generate impression based on findings.

Input: 30-year-old woman with history of epigastric pain, right upper quadrant tenderness, nausea, and vomiting. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. There is hyperenhancement surrounding the gallbladder fossa but no suspicious focal hepatic lesion. The gallbladder is distended and contains small stones. There is a small amount of pericholecystic fluid and gallbladder wall edema. Additionally, the common bile duct measures up to 13 mm in diameter (5/56) with an 8 mm round filling defect at the ampulla (5/46).SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is nondilated and the parenchyma appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.8 mm stone at the ampulla with resultant extra and intrahepatic biliary ductal dilatation.2.Acute cholecystitis.


Instruction: Generate impression based on findings.

Input: Reason: cervical radiculopathy History: neck pain radiating into posterior left shoulder The cervical vertebral bodies are appropriate in overall alignment and height. There is a small syrinx present within the spinal cord at the C6 vertebral body level.At C2-3 there is a large right paramedian disk extrusion which compresses the right half of the thecal sac and the right hemicord. Overall there is a moderate degree of spinal stenosis at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a mild degenerative change is present at this levelAt C4-5 there is a diffuse disk bulge present associated with endplate and uncovertebral osteophytes and mild narrowing of the spinal canal and mild narrowing of the right neural foramen. Overall is a mild appearance the isthmus is normal.At C5-6 there is a left paramedian disk extrusion which compresses the left half of the thecal sac and left hemicord. There is associated endplate and uncovertebral osteophytes at this level. Overall there is a moderate degree of spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is some disk desiccation at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Incidental note is made of partial empty sella.

Output: 1.There is a large disk extrusion at C2-3 which compresses the right hemicord and crates spinal stenosis.2.There is a large disk extrusion at C5-6 which compresses the left hemicord and creates spinal stenosis.3.There are degenerative changes present in the cervical spine associated with a encroachment of the right-sided exiting nerve roots at C4-5 and mild spinal stenosis at C4-5


Instruction: Generate impression based on findings.

Input: History of pineal mass for follow-up. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The pineal gland is normal in size and morphology. There may be a punctate pineal cyst. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Unremarkable appearance of the pineal gland. Recommend correlation with prior outside studies.2. No evidence of intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 19 year old male with lateral knee pain. MENISCI: The medial meniscus appears intact. There is a linear branching signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface consistent with a complex tear including a horizontal and longitudinal component which extends to involve the body and anterior horn of the meniscus in a horizontal fashion.ARTICULAR CARTILAGE AND BONE: There is increased bone marrow signal abnormality within the lateral aspect of the tibial plateau consistent with a bone contusion. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tearing of the lateral meniscus and bone contusion of the tibial plateau as described above.2. Small joint effusion.3. Increased signal abnormality within the muscle belly of the popliteus, suggesting a muscle strain.


Instruction: Generate impression based on findings.

Input: Re-evaluate vestibular schwannoma. There is a homogeneously enhancing mass within the left internal auditory canal that protrudes slightly into the left cerebellopontine angle cistern, measuring up to 13 mm in length. The left inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is mild fluid within the left mastoid air cells and middle ears also appear unremarkable. The right temporal bone structures are unremarkable.

Output: Unchanged left vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: Male, 39 years old, with neurofibromatosis type I and subcutaneous tumors. Please evaluate the subcutaneous tumor at the base of the skull below occiput. No large mass is evident in the suboccipital soft tissues of the upper neck. There are, however, several small nodules within the suboccipital subcutaneous tissues, including one just to the left midline which measures 10 x 5 mm. Mild artifact is seen in the soft tissues in this general area likely represented prior surgery.Thickening and nodularity along the left hard palate is redemonstrated without significant interval change. Numerous scattered small cutaneous nodules are seen in the neck and upper chest without significant change. A cluster of nodules in the left supraclavicular region is also redemonstrated without significant change.Mucosal thickening in the right maxillary sinus is redemonstrated. The aerodigestive mucosa is otherwise unremarkable. No concerning lesions of the major salivary glands or thyroid are seen.

Output: 1.No large lesions are seen in the suboccipital soft tissues of the upper neck. A few scattered small subcutaneous nodules potentially representing neurofibromas are demonstrated including one just to the left of midline which measures no more than 1 cm.2.A left hard palate soft tissue nodule is unchanged. Scattered numerous small cutaneous nodules are also redemonstrated through the neck and upper chest without significant change.