Instruction: Generate impression based on findings.

Input: Reason: eval for sacroiliitis, inflammatory back pain There is no evidence of fracture or malalignment. Tiny osteophyte along the right SI joint but no fluid or enhancement within the SI joint to indicate sacroiliitis. There is benign-appearing cortically based lesion in the proximal right femur, which is incompletely imaged on this study, but of doubtful clinical significance and likely correlates with lucent lesion seen on CT from 7/20/2010. Otherwise bone marrow signal intensity is normal.There is small amount of fluid in the bilateral hip joints, which is normal. We see no synovitis. The muscles are within normal limits.Enlarged prostate is noted.

Output: Minimal osteoarthritis of the right SI joint, but no evidence of sacroiliitis. Other findings as above.


Instruction: Generate impression based on findings.

Input: 49-year-old female patient with low back pain, L5-S1. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is a grade 1 retrolisthesis of L5 on S1 with severe degenerative disc disease at this level. There is also disc narrowing and dessication at L3/L4 and L4/L5. There is underlying mid to distal lumbar developmental narrowing of the spinal canal due to short pedicles and dorsal epidural fat. Multilevel degenerative changes are 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: Minimal posterior disc bulge, ligamentum flavum thickening, and facet hypertrophy contribute to minimal bilateral neural foraminal stenosis and mild central canal stenosis. There is a small central annular fissure.L4-L5: There is a small central annular fissure with a shallow central disc protrusion, ligamentum flavum thickening, and facet hypertrophy which contributes to mild bilateral neural foraminal stenosis. No spinal canal stenosis.L5-S1: Grade 1 retrolisthesis of L5 on S1 with disc uncovering and superimposed mild posterior disc bulge contributes to moderate to severe bilateral neural foraminal stenosis. No significant spinal canal stenosis. There is a left far lateral annular fissure. There is nodularity of the left partially imaged adrenal gland.

Output: 1. Grade 1 retrolisthesis of L5 on S1 with severe degenerative disc disease and moderate to severe bilateral neural foraminal stenosis at this level. Other findings including multilevel annular fissures as described above.2. Nodularity of the partially imaged left adrenal gland. Dedicated imaging may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: Left arm and left numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a subcentimeter nonspecific focus of T2 hyperintensity in the left anterior insular subcortical white matter, which may represent a prominent perivascular space with CSF flow. The brain parenchyma and pituitary gland appear otherwise unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Reason: 81 yo female with hx of IPMN s/p distal pancreatectomy and splenectomy in 2010; please evaluate for any abnormalities and or recurrence History: IPMN. ABDOMEN:LIVER, BILIARY TRACT: Nonvisualization of the main portal vein with cavernous transformation, unchanged. No suspicious focal hepatic lesion.Status post cholecystectomy. No intrahepatic or extra hepatic biliary ductal dilatation.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. Previously seen multiple T2 hyperintense pancreatic lesions along the pancreatectomy margin are no longer visualized. Stable 3 mm T2 hyperintense focus in the uncinate. No new lesions. No pancreatic duct dilatation. Stable linear nonenhancing focus in the mid pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts, some of which are hemorrhagic, again 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.Previously seen multiple cystic lesions in the distal pancreas along the pancreatectomy margin are no longer visualized. No new lesions.2.Stable portal vein thrombosis with cavernous transformation.


Instruction: Generate impression based on findings.

Input: 48 year old female with vulvar cancer, chest pain, troponinemia without epicardial coronary artery disease on coronary angiogram, pericardial effusion referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 68 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 121 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation times are elevated (1160 ms). There is mild diffuse high T2 signal involving the myocardium suggesting edema.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 145 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 64 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve not completely assessed. Grossly no significant 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 small pericardial effusion. There is mild enhancement of the pericardium with late gadolinium enhancement imaging and high signal on T2-STIR imaging. There is no evidence of pericardial constriction noted. Extracardiac FindingsThere is a moderate sized left pleural effusion and small sized right pleural effusion. There is mild compressive atelectasis of the left lung. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Findings as above correlating with acute pericarditis with trace pericardial effusion but evidence of constrictive physiology.2. The pre-contrast native myocardial T1 relaxation times are elevated (1160 ms) and there is mild high T2 signal likely representing mild myocardial edema. 3. The left ventricle is normal size and systolic function (LVEF 55%).4. The right ventricle is normal size and systolic function (RVEF 56%).5. There is a moderate sized left pleural effusion and small sized right pleural effusion.


Instruction: Generate impression based on findings.

Input: 64 years, Female, brain lesion cord lesion. Per chart, patient has progressive left lower extremity weakness. BRAIN

Output: 1. Brain MRI demonstrates no evidence of infarct, intracranial mass, or mass effect. There is evidence of mild chronic small vessel ischemic disease.2. No abnormal signal within the spinal cord. No significant stenosis in the cervical, thoracic, or lumbar spine. 3. Mild degenerative changes in the spine. There is mild to moderate right C5-C6 neural foraminal stenosis. There is also mild neural foraminal stenosis at L3-L4, L4-L5, and L5-S1 as described above.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with history of metastatic lung adenocarcinoma, surveillance scan. Two subcentimeter foci of enhancement seen previously within the right postcentral gyrus, and a third within the left superior frontal gyrus, are no longer evident. Mild associated T2 hyperintensity has also resolved in these locations.No evidence of any new enhancing or nonenhancing intracranial lesion is seen. Ill-defined periventricular T2 hyperintensity is again seen compatible with prior therapy. No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected.There is no evidence of any significant intracranial hemorrhage or abnormal extra axial fluid. The ventricular system is normal in size.

Output: 1.Interval resolution of subcentimeter lesions seen in the right post central gyrus and left superior frontal gyrus.2.No new intracranial lesions are evident.


Instruction: Generate impression based on findings.

Input: Female, 27 years old, with new onset seizure. As on the prior examination, numerous small foci of susceptibility are evident predominantly within the corpus callosum, and to a lesser degree, in the periventricular white matter. Accounting for differences in image quality related to 3T technique on the present exam, there does not appear to have been a significant increase in the number or size of these lesions.The above-mentioned lesions are associated with neither edema nor mass effect. No evidence of restricted diffusion is seen. No acute intracranial hemorrhage is demonstrated. No pathologic parenchymal or extra-axial enhancement is detected. The ventricles are normal in size and morphology.

Output: Redemonstrated are multiple small foci of microhemorrhage within the corpus callosum and, to a lesser degree, in the periventricular white matter. The nature of these findings is uncertain, but they are in any event chronic. No new or acute intracranial abnormalities are detected to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of uncertain behavior of brain, unspecified Unspecified convulsionsClinical question: residual pilocytic astrocytoma after a subtotal resection, No follow up since 2012, evaluate for changesSigns and Symptoms: tumor, follow up , yearly Since the prior exam and heterogeneously enhancing mass located at the right pontomedullary junction associated with a septated multicystic component has increased in size. The enhancing component currently measures 47 x 30 mm coronal dimensions and previously measured 33 x 25 mm in coronal dimensions. The enhancing component that has enlarged most as the more superior aspect of the patient's neoplasm which bulges into the fourth ventricle. The combined cystic and solid component currently measures 55 x 51 mm axial dimensions and previously measured 41 x 31 mm axial dimensions. The cystic component has enlarged since the prior exam is along the more lateral aspect of neoplasm. The mass bulges further into the fourth ventricle relative to the prior exam. There is redemonstration of ventriculomegaly with enlargement of the temporal horns of the lateral ventricles. Biventricular diameter on coronal imaging at the level of foramen of Monro is currently approximately 67 mm and previously was approximately 69 mm. Third ventricular diameter remains at 17 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since prior exam, a posterior fossa neoplasm which is consistent with the patient's diagnosis of pilocytic astrocytoma and is centered at the right half of the pontomedullary junction has enlarged.2.Since the prior exam ventriculomegaly has mildly regressed.


Instruction: Generate impression based on findings.

Input: Grade 2 olfactory esthesioneuroblastoma treated with recent radiation/chemo/surgery. Face: There are interval post-operative findings related to right medial maxillectomy and right anterior and posterior ethmoidectomy. There is moderate mucosal thickening in the right maxillary sinus, ethmoid, and frontal sinuses. There is a small area of relative T2 hypointensity and hypoenhancement in the right superior anterior ethmoid surgical bed, but otherwise no evidence of gross residual tumor in the rest of the sinonasal region. There is leftward nasal septal deviation. There are findings related to right dacryocystorhinostomy, but the orbits are otherwise grossly intact. There is a subcentimeter Thornwaldt or nasopharyngeal retention cyst.Brain: There is no evidence of intracranial extension of tumor. There is a prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable and there is no evidence of acute infection or abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Interval sinonasal surgery with a small area in the right superior anterior ethmoid surgical bed that has features that resemble the original tumor, which may therefore represent a small amount treated tumor versus cauterized tissue amidst moderate right sinonasal mucosal inflammation, but otherwise no evidence of gross residual tumor in the rest of the sinonasal region.2. No evidence of intracranial tumor.


Instruction: Generate impression based on findings.

Input: Pituitary cyst surveillance. There is no significant interval change in the nonenhancing low T1 and high T2 signal lesion centered in the left posterior pituitary that measures up to approximately 5 mm. The infundibulum and posterior pituitary bright spot is intact. There is no mass effect upon the optic apparatus. The cavernous sinuses are intact.

Output: No significant interval change in the cystic lesion centered in the left posterior pituitary that measures up to approximately 5 mm.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for labral tear History: anterior hip pain ACETABULAR LABRUM: Small anterior superior labral tear with associated paralabral cyst.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small anterior superior labral tear with associated paralabral cyst.


Instruction: Generate impression based on findings.

Input: Low back pain, radiculopathy 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. Mild bilateral facet arthropathy.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.L4-L5: Disc desiccation without significant loss of height. There is moderate facet arthropathy bilaterally, particularly on the right. There is minimal bilateral neural foraminal narrowing. No significant spinal canal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Paraspinous soft tissues are within normal limits. There is a 2.9 cm cystic structure which is partially visualized and presumably and an adnexal cyst. Degenerative changes at the sacroiliac joints also noted.

Output: 1. Mild degenerative changes in the lumbar spine with minimal bilateral neural foraminal narrowing at L4-L5. Otherwise no significant spinal canal or neural foraminal stenosis at any level.2. Multilevel facet arthropathy, relatively worse at L4-L5 which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: 33-year-old male. Abdominal pain in left upper quadrant modified with food and alcohol. Perform gadolinium and secretin to rule out pancreas disease. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic mass. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Normal signal intensity and morphology of the pancreas with no focal lesions. No pancreatic ductal dilatation. Appropriate physiologic response of the pancreas to secretin. Pancreatic duct is normal in morphology.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: Unremarkable MRCP of the pancreas. No evidence of acute or chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: 62-year-old male with weight loss, acute swelling, fluid testicles. PSA 4.9 (7/2/2016), 3.67 (1/12/2015). Biopsy 8/25/2016 Gleason 6. PELVIS:PROSTATE:Prostate Size: 5.2 x 5.8 x 2.9 cm.Peripheral Zone: There is diffuse T1 hyperintense signal throughout the peripheral zone consistent with hemorrhage. No dominant lesion is identified to suggest malignancy.Central Gland: Moderate degree benign prostatic hypertrophy.Seminal Vesicles: Asymmetric appearance of the seminal vesicles with loss of T2 signal on the left.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Large left hydrocele.OTHER: No significant abnormality noted.

Output: 1.Significantly limited examination due to diffuse hemorrhage throughout the peripheral zone. No dominant lesion is identified to suggest malignancy.2.Large left hydrocele.


Instruction: Generate impression based on findings.

Input: 15-year-old female with injury after basketball game. Evaluate for injury. MENISCI: Branching high signal is present within in the posterior horn of the medial meniscus, which extends to both articular surfaces compatible with complex meniscal tear. The anterior horn of the medial meniscus as well as the anterior and posterior horns of the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is increased T2 signal in the lateral femoral condyle compatible with edema, with associated high signal in the underlying femoral condylar articular surface suggesting articular cartilage tearing.LIGAMENTS: There is a complete tear of the anterior cruciate ligament. The posterior cruciate ligament is intact. The lateral collateral and medial collateral ligament complexes are intact. EXTENSOR MECHANISM: High signal is evident within the medial and lateral patellar retinaculum consistent with edema. The extensor mechanism is intact.ADDITIONAL

Output: 1.Complete tear of the anterior cruciate ligament with associated marrow edema in the lateral femoral condyles.2.Complex tear of the posterior horn of the medial meniscus.3.Edema affecting the medial and lateral patellar retinaculum.4.Moderate/large joint effusion.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of NF1. BONE MARROW: No significant abnormality noted.SOFT TISSUES: Plexiform neurofibroma extending from the bilateral lumbosacral spine through the left femur are again seen. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Extensive plexiform neurofibromas of the lumbosacral spine and left anteromedial femur, similar to prior.


Instruction: Generate impression based on findings.

Input: 7-year-old male with history of tuberous sclerosis. Evaluate for renal angiomyolipoma. ABDOMEN:LIVER, BILIARY TRACT: The liver is within normal limits.SPLEEN: The spleen is normal in appearance.PANCREAS: The pancreas is normal in appearance.ADRENAL GLANDS: No significant adrenal abnormality.KIDNEYS, URETERS: No hydronephrosis, hydroureter, masses or abnormal enhancement.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal abnormality.BOWEL, MESENTERY: No small bowel obstruction or significant abnormality.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No angiomyolipomas or additional significant abnormality.


Instruction: Generate impression based on findings.

Input: 56-year-old man with lower back pain. History of lumbar fusion at outside hospital in 2013. Again seen are posterior spinal fixation rods with bilateral pedicle screws in the L3, L4, L5 and S1 vertebral bodies. Hardware loosening, described on recent MRI and CT studies, is not appreciated radiographically. There is no evidence of instability on flexion and extension views.

Output: No evidence of lumbar spinal instability.


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: chronic ACL tear, 6 months of left knee pain evaluate for meniscus tear, chondral injury History: left knee pain. MENISCI: There is a partial thickness radial tear of the posterior horn of the medial meniscus best seen on image 10 of series 4. There is additional intrasubstance signal within the posterior horn of the medial meniscus that appears to extend from the free edge of the meniscus to the periphery, likely representing additional horizontal tearing. There is intrasubstance degeneration of the body of the medial meniscus, and the anterior horn of the medial meniscus appears intact. Increased signal intensity within the posterior horn of the lateral meniscus likely simply represents the interface with the meniscofemoral ligament of Wrisberg. We see no definite lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There is partial thickness degeneration of the articular cartilage of the medial femoral condyle just above the site of the aforementioned radial tear of the posterior horn of the medial meniscus. There also appears to be focal thinning of the subjacent articular cartilage of the medial tibial plateau. There is moderate thinning of the articular cartilage of the patella along both its medial and lateral facets, with subchondral cyst formation in the far medial aspect of the patella. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Medial meniscal tear as described above.2.Partial-thickness cartilage degeneration as described above.3.Normal appearing ligaments.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: demoid tumor; colon cancer History: palpable RUQ mass 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: Again noted multiple enhancing lesions in the anterior abdominal wall predominantly on the right side but also on the left side. They have significantly decreased in size compared to previous MRI. An index lesion in the right upper lobe measures 4.2 x 4.4 cm on image #404, series #1104. An index lesion in the left anterior abdominal wall measures 1.9 cm in diameter image #354, series #1104. There are also multiple enhancing tracts likely secondary to previous laparoscopic surgery.Postsurgical changes secondary to recent surgery in the anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:No evidence of pelvic mass or free fluid.

Output: 1. Postsurgical changes in the anterior abdominal wall.2.Enhancing residual masses in the anterior abdominal wall on both sides.


Instruction: Generate impression based on findings.

Input: 23-year-old female with 10-cm pelvic mass on outside CT. Interpretation of outside exam requested. ABDOMEN:LUNG BASES: Single right lower lobe micronodular on image one of 89. No other abnormalities in the lung bases. Small hiatal hernia is noted.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Unremarkable.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild prominence of the left renal collecting system. No evidence of stone.RETROPERITONEUM, LYMPH NODES: Please see below.BOWEL, MESENTERY: Thickening of the lateral gastric wall extending towards the GE junction. Ill-defined soft tissue density between the greater curvature of the stomach and spleen measuring 3.5 x 1.3 cm. Etiology of this soft tissue mass is unknown and may be related to gastric wall thickening. No abnormality of the small bowel. Colon is unremarkable except for mass-effect as is mentioned below.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Uterus and adnexa are displaced by and abut the 10-cm mass that will be described further below.BLADDER: Bladder is distended and displaced by the pelvic mass.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mass effect on the rectum, displacing it to the right of the pelvic mass. No evidence of bowel obstruction. No evidence of invasion into bowel, as the fat planes between the mass and bowel are preserved.BONES, SOFT TISSUES: No significant abnormality noted. Specifically, no involvement of the pelvic bones or sacrum by the pelvic mass.OTHER: 10-cm pelvic mass which has centrally low density likely due to necrosis. It is most likely that the mass arises from the posterior wall of the vagina (better appreciated on the companion MRI study) as the adjacent pelvic bones as well as the uterus and adnexa are not clearly contiguous with the mass (this is also better seen on the outside MR images).

Output: 1. 10-cm pelvic mass which has mass-effect on the rectum, bladder and adnexa. We favor a sarcoma with origin of this lesion likely the posterior wall of the vagina (this is better appreciated on the companion MRI). 2. Soft tissue density adjacent to the splenic hilum and gastric wall thickening as described above . Upper endoscopy is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: History of cervical cancer. PELVIS:UTERUS, ADNEXA: Mildly heterogeneous appearance of the uterus is noted. No significant endometrial cavity dilatation. Unremarkable adnexa.There is abnormal dilatation, heterogeneous intermediate T2-weighted signal and restricted diffusion at the level of the cervix compatible with patient's known cervical cancer measuring up to 5.7 x 3.4 cm which appears to extend slightly cranially towards the internal os but not extending to the myometrium/endometrial canal. On sagittal images the right lateral margin of the cervix is ill-defined (series 601/28), suspicious for parametrial tumor involvement. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate volume of fluid within the pelvis. No peritoneal surface nodularity or restricted diffusion is identified.Colonic wall thickening which may be treatment related. BONES, SOFT TISSUES: Marked anasarca. Muscle fatty atrophy.OTHER: No significant abnormality noted.

Output: Limited nonenhanced study re-demonstrates the cervical mass with suspected parametrial tumoral extension. The mass cannot be reliably compared to prior studies due to modality differences. The extent of signal abnormality is grossly similar to the PET/CT appearance.


Instruction: Generate impression based on findings.

Input: Other symptoms and signs involving cognitive functions and awareness [R41.89], Reason for Study: ^Reason: eval for stroke, lesion History: facial droop, drooling, unrespsonsive x 10 minutes Brain MRINo evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.Scattered multifocal bilateral periventricular white matter T2/FLAIR high signal intensity lesions indicate nonspecific small vessel ischemic disease.Scattered several susceptibility lesions on bilateral hemispheres indicate possible chronic microhemorrhages or mineralizations.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Retention cyst on the right maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate ectatic changes with tortuosity of the distal intracranial ICAs indicate atherosclerotic changes. However, there is no significant luminal stenosis (more than 50%). There is no evidence of intracranial aneurysm.Distal left vertebral artery is hypoplastic.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Nonspecific small vessel ischemic disease.3. Atherosclerotic changes of intracranial arterial system without significant luminal stenosis.


Instruction: Generate impression based on findings.

Input: 71 year old male with history of fall with neck pain. Please evaluate. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.There is grade I retrolisthesis of C5 on C6 of approximately 5 mm that appears unchanged from the prior MRI 3/3/2009. In addition, there are destructive changes of the endplates at C5-C6 that is also unchanged; these findings are compatible with a chronic, non-progressive destructive process.Disk bulge noted at C3-C4; unchanged from previous MRI.No acute fracture. The remainder of the spine is in normal alignment.

Output: 1. Stable destructive process at C5-C6; there are no findings to suggest acute or progressive process.2. No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: This exam was terminated prior to completion due to the patient reported chest pain and a rapid response being called. The MRA head was performed along with only the sagittal T1 and diffusion brain sequences.BRAIN: There are foci of restricted diffusion within the lateral thalami, larger on the right.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber with a fetal origin of both posterior cerebral arteries and a dominant left vertebral artery. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.Very limited brain MRI demonstrating bilateral acute infarcts within the lateral thalami, larger on the right. Completion of the brain MRI is suggested. 2.No evidence of flow-limiting stenosis or aneurysm within the head.


Instruction: Generate impression based on findings.

Input: Ms. Beal is a 48-year-old female with strong family history of breast cancer. Family history of breast cancer in her mother x4 times. Personal history of bilateral benign breast biopsies (left breast 2:00-fibroadenoma). She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Scattered cysts are identified in both breasts. There is re-identification of a previously biopsied left breast fibroadenoma in the left lateral breast with faint associated enhancement, appearing unchanged in size and appearance when compared to prior MRI examinationsThere is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: MRI findings: Extensive areas of restricted diffusion in the bilateral medial temporal lobes, right more than the left occipital lobe, left more than the right cerebellum, midbrain and pons compatible with acute infarction. There is T2 hyperintensity and encephalomalacia in the left inferior cerebellum, left occipital lobe and pons compatible with chronic infarcts. There is mild periventricular white matter hyperintensity related to chronic small vessel ischemic disease. No evidence of susceptibility foci are evident.There is mild global parenchymal volume loss. No evidence of mass effect or midline shift. The basal cisterns remain patent. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. MRA head findings: Please note this is motion degraded exam as well as technically limited. The intracranial internal carotid arteries are normal in course and caliber. The anterior and middle cerebral arteries show flow related signal with some wall irregularity but without hemodynamically significant stenosis or occlusion. The left vertebral artery is not opacified. The right vertebral artery is diminutive beyond the proximal V4 segment. The basilar artery is not visualized. The posterior cerebral arteries are also not visualized. Bilateral PCOM arteries appear to be present but they do not apparently compensate for the vertebrobasilar abnormalities.MRA neck findings: The common carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion. There is some narrowing at the carotid bifurcations but without high-grade stenosis or occlusion.Bilateral vertebral arteries are poorly visualized which may be technical or could be related to atherosclerotic disease.

Output: 1. Extensive areas of acute infarction involving the bilateral medial temporal lobes, right more than the left occipital lobe, left more than the right cerebellum, midbrain and pons.2. Lack of flow in the vertebrobasilar circulation compatible with severe stenosis or occlusion.3. No significant vaso-occlusive disease in the anterior circulation.Above findings were discussed with Dr Warnecke at 10:30 hours on 12/21/2015.


Instruction: Generate impression based on findings.

Input: Reason: eval microfrx healing History: pain MENISCI: There is blunting and deformity of the posterior horn of the medial meniscus which likely represents a combination of postsurgical changes from prior partial meniscectomy, degeneration, and prior tearing, appearing similar to the prior study. No fluid-filled defect is identified to suggest a new tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the lateral compartment appears intact. There is near full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle posteriorly above the posterior horn of the meniscus with underlying subchondral signal abnormality. There is near full-thickness articular cartilage degeneration along the lateral facet of the patella which may have progressed slightly when compared to the prior exam. There is low signal intensity material identified along the lateral facet of the patella likely representing fibrocartilage related to prior microfracture, appearing similar to the prior study. There is subchondral edema in the surrounding area.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is a subcentimeter focus of fluid signal intensity along the posterior aspect of the PCL which may represent mucoid degeneration versus ganglion formation.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Blunting and deformity of the posterior horn of the medial meniscus, appearing similar to the prior study, likely representing a combination of postsurgical changes from prior partial meniscectomy, degeneration, and prior tearing. No new fluid-filled tear is identified.2. Slight interval progression of articular cartilage degeneration affecting the patellofemoral articulation with postsurgical changes consistent with the stated history of prior microfracture.


Instruction: Generate impression based on findings.

Input: Bilateral leg weakness, evaluate for cord compression. Please note because of discomfort, patient could not be positioned in the conventional manner within the scanner, and as a result image quality is significantly degraded. Examination in the cervical region is of very poor quality. The ventral epidural space in the cervical region shows fairly uniform moderate T1 intensity signal with corresponding dark signal on STIR sequence. Compared to recent prior CTA of the neck this appears to reflect a combination of ligamentous thickening and perhaps some venous engorgement with the possibility of an acute epidural process considered less likely based on this limited evaluation.There is narrowing of the cervical spinal canal particularly at C5-C6 and C6-C7. There is probable myelomalacia of the cord at this level which was also present previously.Within the constraints of degraded examination, no evidence of cord compression is evident in the thoracic region.The evaluation of the lumbar region is again of poor quality due to multiple factors, particularly orthopedic instrument related artifact. There is evidence of previous surgery in the lumbosacral spine with orthopedic instruments significantly obscuring a large part of the spine. As seen previously, there is disc or ossific material projecting posteriorly into the spinal canal at L2-3 level which causes significant spinal canal narrowing and probable impingement of the cauda equina. Similar findings were seen on the prior exam. There appears to be marrow space edema involving L2 and L3. In addition, the L3 vertebral body seems to have lost height relative to the prior exam.In the right paraspinal soft tissues including the musculature, extensive edema and abnormal signal is noted. In particular the right psoas muscle is very edematous and contains a 16 mm focus of low T2 and high T1 signal which could represent hemorrhage. There is a lesser degree of paraspinal soft tissue involvement on the left side.

Output: 1. Thickening of the ventral epidural tissues in the cervical spine is felt to most likely reflect ligamentous thickening and/or venous engorgement based on comparison with a recent prior CTA. An acute epidural process is considered less likely. Dedicated C-spine MRI imaging can be considered if the patient can be made comfortable or with anesthesiology assistance.2. No cord compression in the thoracic region.3. Postsurgical findings in the lumbar spine including posterior fusion which significantly limit the evaluation. As in previous exam a high-grade canal stenosis at L2-3 is seen with disc or bony material projecting into the spinal canal appearing similar to the previous exam.4. There is severe edema in the right paraspinal musculature and soft tissues in the lumbar region, right more than left. There appears to be a small fluid collection within the edematous right psoas muscle which may reflect hemorrhage. In addition there is edema involving the L2 and L3 vertebral bodies with suspected further loss of height of the L3 vertebral body. These findings raise the possibility of an infectious process such as osteomyelitis. Further evaluation with dedicated abdomen and pelvis imaging is suggested for further evaluation. Given difficulties with MRI tolerance, CT would be appropriate for this patient.Findings were discussed with Dr. Jacobson by Dr. Kumar at 15:13 hours on 11/6/2015.


Instruction: Generate impression based on findings.

Input: This limited surgical planning exam redemonstrates a T2 hyperintense 17 x 18 mm lesion within the left pars opercularis. There are a few scattered unchanged punctate foci of T2 hyperintensity throughout the supratentorial white matter that are most compatible with mild chronic small vessel ischemic disease.

Output: Pretreatment MRI redemonstrates an unchanged lesion within the left pars opercularis likely representing low-grade glial neoplasm.


Instruction: Generate impression based on findings.

Input: Thoracic or lumbosacral neuritis or radiculitis, RLE pain. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 9mm cyst along the left renal parenchyma. Smaller cysts are present in the right kidney.

Output: No compromise to lumbar spinal canal or neural foramina. There are no significant degenerative changes in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:11/9/1952)Reason: Deduce etiology of chronic lumbar region back pain History: Chronic pain with ambulationPROVIDER/ATTENDING NAME: DIANE L. ALTKORN DIANE L. ALTKORN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation presentAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a moderate bilateral facet hypertrophy at this level. There is mild narrowing of the neural foramina and 2 mm anterior subluxation of L5 on S1. There is disc desiccation at this level.At L4-5 there is a moderate bilateral facet hypertrophy at this level. There is mild narrowing of the neural foramina and 2 mm anterior subluxation of L5 on S1. There is partial effacement of the fat surrounding the right-sided exiting nerve roots at this level. There is some partial effacement of the fat at the left lateral recess at this level with some mild encroachment of the nerve roots at the left lateral recess.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge and mild ligamentum flavum hypertrophy at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 10 mm cyst along the right kidney.

Output: There are degenerative changes present in the lumbar spine mainly in the form of facet hypertrophy and to a lesser degree disc bulges worse at L4-5 and L5-S1. There is some mild encroachment of the nerve roots of the left lateral recess and right neural foramen at L4-5 related to the degenerative changes associated with some mild narrowing of the spinal canal.


Instruction: Generate impression based on findings.

Input: A 45 year old female with history of hypertension, breast cancer after chemotherapy (including doxorubicin) and radiotherapy. An echocardiography showed decreased left ventricular systolic function. Because of chest pain, the patient was referred to stress cardiac MRI for further evaluation.MEDICATIONS: clonazepam, lisinopril, metoprolol, tamoxifen, venlafaxine, zolpidem First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 30 g/m2, and the LV mass is 73 g. There are no regional wall motion abnormalities present.No thrombus is present.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 62 ml/m2 (normal range 69+/-14), the RVEDV is 153 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThe patient is status post right lumpectomy 2012 with radiation and chemotherapy. There is a T2 iso to hypodense lesion within the right breast measuring 1.9 x 2.4 cm (301/14) that correlates to the likely coil cyst within the lumpectomy bed, as described on the recent mammogram. Dedicated imaging of this lesion was not performed. The breasts are not included in their entirety within the field-of-view.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 56%).4. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 31 years, Male, with Dandy-Walker variant, hydrocephalus, pituitary tumor, and headaches. Question any change in the pituitary tumor or the ventricles.. The bilateral lateral ventricles and third ventricles are collapsed and not appreciably changed since CT dated 1/27/2016. Left parietal VP shunt catheter is in place with unchanged position of the ventriculostomy catheter with its tip near the foramen of Monro. There is unchanged FLAIR hyperintensity in the left periatrial region compatible with gliosis, probably related to the ventriculostomy catheter. Linear FLAIR hyperintensity involving the left frontal periventricular white matter is also likely related to prior ventriculostomy tract. Focal thinning involving the anterior callosal body with susceptibility/chronic blood products also remains unchanged and corresponds to tract of ventriculostomy catheter seen on 3/22/2009.No evidence of acute ischemia or hemorrhage. No extra-axial collections. There is diffuse thickening of the calvarium which may be related to chronic shunting. Unchanged posterior fossa findings including a retrocerebellar arachnoid cyst which is associated with superior bowing of the tentorium, anterior displacement of the cerebellum, and mild scalloping of the occipital bone. This finding remains unchanged dating back to 7/22/2009.Dedicated images of the pituitary gland demonstrate unchanged appearance of the pituitary gland without definite evidence of pituitary micro or macroadenoma. There is slight heterogeneity of the posterior aspect of the pituitary gland with subcentimeter focus of T2 hyperintensity and enhancement which may represent a pars intermedia cyst and unchanged. Normal T1 shortening involving the neurohypophysis is not clearly seen which is nonspecific. Bilateral cavernous sinuses are unremarkable. Infundibulum is unremarkable. Optic chiasm and nerves are unremarkable.

Output: 1. Shunted ventricular system remains decompressed and unchanged since CT head dated 1/27/2016.2. Posterior fossa findings including a retrocerebellar arachnoid cyst with local mass effect remains unchanged dating back to 7/22/2009.3. Unchanged appearance of the pituitary gland without definite evidence of micro- or macroadenoma. Tiny nonenhancing area in the posterior pituitary gland remains unchanged and may represent a pars intermedia cyst. No associated mass effect.


Instruction: Generate impression based on findings.

Input: There is asymmetric volume loss within the left temporal lobe as well as less so throughout the entire left cerebral hemisphere. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small focus of T2 hyperintensity within the left paramedian cerebellum which likely represents chronic ischemia. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Asymmetric volume loss of the left cerebral hemisphere most prominent in the left temporal lobe may be seen in the clinical setting of semantic dementia.


Instruction: Generate impression based on findings.

Input: Newly diagnosed squamous cell carcinoma of the cervix presents for staging. PELVIS:UTERUS, ADNEXA: The uterus measures 8.8 x 4.4 cm in the sagittal plane. The endometrial cavity/canal is normal in signal intensity and thickness. The inner myometrium/junctional zone measures up to 9 mm with poorly defined margins but no cystic or hemorrhagic foci. Several large nabothian cysts.The left and right ovary are normal in morphology and size, measuring 2.9 x 1.8 and 2.4 x 1.8 cm, respectively, containing numerous follicles.There appears to be circumferential relatively poor enhancement of the cervix without a discrete nodule or mass. No evidence of invasion into the endometrium, invasion into the vaginal canal or parametrial extension. 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 discrete cervical lesion is identified.Findings raising possibility of mild diffuse adenomyomatosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out ischemic lesion. Signs and symptoms: Left hemiparesis. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no evidence of acute ischemic stroke.Ectopia of cerebellar tonsils of approximately 5 mm with subtle deformity of cerebellar tonsils.There are several punctate foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter and with normal morphology and signal intensity of brain parenchyma otherwise on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses appear normal.Images through the orbits, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial process.2.Mild ectopia of cerebellar tonsils of approximately 5 mm with subtle deformity of cerebellar tonsils.3.Few scattered mostly bilateral frontal subcortical and periventricular foci of FLAIR hyperintensity are nonspecific however in proper clinical setting could represent chronic changes of mild small vessel ischemic strokes.4.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Clinical question: History of pituitary adenoma status post resection. Signs and symptoms: Surveillance scan. Again seen is previously debulked, enhancing sellar mass consistent with known pituitary macroadenoma. Compared to 7/16/2014, there appears to be minimal interval increase in size, measuring approximately 37 x 36 x 26 mm in the AP, transverse, and craniocaudal dimensions, previously 30 x 34 x 24 mm. Signal features are similar to prior with slight change in size of cystic areas. As seen before, anterior extension results in obliteration of the sphenoid sinus. Superiorly, there is no significant suprasellar extension and no mass effect on the optic chiasm. Mild tenting of the optic chiasm is again noted consistent with postsurgical change. Infundibulum is rightward deviated, similar to prior. Lateral extension on the left into the left cavernous sinus with partial encasement of the left cavernous internal carotid artery is again seen without narrowing of the left ICA caliber.Limited evaluation of the remainder of the brain again demonstrates enlargement of the lateral ventricles, particularly the right frontal horn, stable to minimally decreased in size in the interval. Scattered foci of T2 hyperintensity in the white matter also again seen and may represent small vessel ischemic changes.

Output: 1. Compared to 7/16/2014, there is minimal interval increase in size of the sellar mass consistent with known pituitary macroadenoma as detailed above. There is no mass effect on the optic chiasm.2. Ventriculomegaly is again seen and stable to minimally improved compared to prior.


Instruction: Generate impression based on findings.

Input: 30 year-old female with multifocal giant cell tumor. Now with right-sided chest wall pain. Evaluate for thoracic spine or rib lesions. Nonenhanced CT of thoracic spine:Axial 3-mm images of entire thoracic spine with zero degree angulation of the gantry were obtained. Sagittal and coronal 2-D reformatted images were obtained.Examination demonstrates normal density and alignment of vertebral column. There is no detectable lytic or sclerotic lesions of the vertebral column. No definite acute abnormality of perispinal soft tissues is identified. Very minimal degenerative disk disease throughout the thoracic spine is present. No evidence of central spinal stenosis or definitive neural foramina compromise on this exam is detected. Recommend follow-up with an MRI examination.Limited view of the proximal thoracic ribs are negative for any osseous abnormalities.

Output: Negative nonenhanced CT of thoracic spine. Follow-up with dedicated MRI of thoracic spine likely more helpful for detecting the cause of patient's right sided chest wall pain.


Instruction: Generate impression based on findings.

Input: Female, 83 years old, with worsening back pain and gait abnormality, and right leg weakness. History of back surgery. Findings compatible with prior surgery are again seen at the L4-5 level where evidence of right-sided laminectomy and facetectomy is demonstrated.The lumbar lordosis is straightened similar to prior. A trace anterolisthesis of L4 relative to L5 has slightly progressed.Vertebral body marrow signal is mildly heterogeneous which likely represents a combination of inhomogeneous fat and superimposed degenerative endplate signal change.Degenerative disc disease has progressed at L4-5 with further loss of disc height. The remaining disc levels appear similar to the prior exam. Level specific findings are as follows below.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed by level below.T12-L1: Facet hypertrophy. Minimal bulging disc. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte, increased in size. Minimal bulging disc. Prominence of the epidural fat. Slight narrowing of the thecal sac without change. Mild left foraminal narrowing without change. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte, increased in size. Mild bulging disc. Mild generalized narrowing of the spinal canal without change. Mild left foraminal narrowing without change. L4-5: Advanced left facet hypertrophy. Postoperative findings at the level of the right facet. Left anterior disc osteophyte slightly increased. Disc bulging and disc uncovering. Mild to moderate generalized spinal canal narrowing with medial displacement of the left-sided cauda equina nerve roots. Moderate right and severe left foraminal narrowing. No significant interval changes. L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: 1.Postoperative findings compatible with right-sided laminectomy and facetectomy at L4-5.2.Progressive disc degeneration at L4-5 with further loss of disc height. The combination of disc degeneration and posterior element hypertrophy results in a mild to moderate generalized spinal canal narrowing asymmetric to the left without significant interval change. The L4-5 neural foramina are both significantly narrowed but without noticeable interval change.3.Degenerative findings at other levels are relatively mild and unchanged with the exception of multilevel anterior osteophytosis which has progressed but which does not affect the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [228.02], Reason for Study: ^Reason: 3T Scanner, CCM Protocol History: Abnormality noted on prior MRI; CCM vs. AVM, please evaluate and compare with priori images Brain MRIRe-demonstration of right cingulate gyrus anterior aspect signal void just above the level of caudate head. The lesion does not show associated edema, nor high signal intensity on T1 weighted image.On Gad enhanced image, there is prominent vascular structure extending from the lesion to the adjacent cortex.There is another linear enhancing structure on the left frontal lobe middle frontal gyrus. These two white matter linear enhancing structure are likely representing developmental venous anomaly (DVA).And the signal void lesion on the right cingulate gyrus likely represent cavernous malformation. The size and MR characteristics of the lesion do not show any interval change since prior exam.There is prominent enhancement on the right side angular gyrus which could represent prominent vein of Labbe or associated small DVA.There focal signal void on the left frontal lobe medial orbital gyrus (series 1202, image 14/28), however, this lesion was not seen on the original gradient echo images, thus the reconstructed images likely represent volume averaging artifact.  The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Right cingulate gyrus cavernous malformation with associated developmental venous anomaly. Another developmental venous anomaly on the left frontal lobe and possible DVA on the right angular gyrus. No change since prior exam.2. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Intractable headaches and vertigo, new onset. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There appears to be a small amount of fluid within the right mastoid air cells.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute cerebral infarction.2. No evidence of inner ear or retrocochlear lesions.3. Apparent nonspecific small amount of fluid within the right mastoid air cells.


Instruction: Generate impression based on findings.

Input: BRCA 1 mutation, needs screening MRI in comparison to prior exams. The patient is currently breast-feeding There is heterogeneous amount of fibroglandular tissue in both breasts.Marked patchy parenchymal enhancement is noted bilaterally consistent with lactational changes.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Limited examination given the lactational changes in both breast. Within these limitations, no MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Compression of brain [G93.5] / Low back pain [M54.5], Reason for Study: ^Reason: Chiari malformation with back pain and headaches, follow up with CSF flow study History: Chiari malformation and back pain23 years Female (DOB:11/6/1993)Reason: chiChiarilformation with back pain and headaches, follow up with CSF flow study History: Chiari malformation and back painPROVIDER/ATTENDING NAME: DAVID M. FRIM SERVICES ANCILLARY Complete Spine MRIRedemonstration of Chiari I malformation (downward displacement of cerebellar tonsils) are seen, unchanged since prior scan.There is no evidence of syringomyelia.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. 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 L1-2. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues and musculature are unremarkable.2D Phase Contrast MRA for CSF flowBidBidirectionalF flows across the foramen magnum seen both anterior and posterior aspect of upper cervical cord and cervicomedullary junction. In addition, subtle bidbidirectionalF flow is seen through the foramen Magendie.Comparing to prior scan, there is no significant interval change though this exam is not quantitative.

Output: 1. Unchanged Chiari 1 malformation since prior scan.2. No evidence of syringomyelia3. Unchanged bidirectional CSF flow across the foramen magnum both anterior and posterior aspect of upper cervical spine and cervicomedullary junction as well as foramen Magendie.


Instruction: Generate impression based on findings.

Input: Altered mental status, multiple myeloma. The images are degraded by patient motion. There is a mass centred within the clivus with extension into the left cavernous sinus. There is no gross mass effect upon the pons. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits and scalp soft tissues are grossly unremarkable. There is mild right maxillary and bilateral sphenoid sinus mucosal thickening and fluid in the left maxillary sinus.

Output: 1. A lesion in the central skull base with extension into the left cavernous sinus is likely related to multiple myeloma, but assessment of the previously demonstrated epidural extension is limited by patient motion and the lack of intravenous contrast.2. No evidence of acute intracranial hemorrhage or acute infarct.3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: 73-year-old male with left shoulder pain, evaluate for tendon injury ROTATOR CUFF: There is a fluid signal intensity within the distal supraspinatus tendon at its insertion on the greater tuberosity. This tear disrupts the bursal surface fibers, but appears to spare the articular surface fibers. There is 5 mm retraction of the bursal surface fibers. Overall, the tear involves at least 50% of the tendon thickness and is approximately 1.5 cm in the AP dimension. It appears to propagate posteriorly as an interstitial tear of the anterior insertional fibers of the infraspinatus tendon. The majority of the infraspinatus tendon, however, appears intact. There is minimal fatty infiltration along the myotendinous junction of the supraspinatus and infraspinatus, but otherwise the muscles appear normal. The teres minor tendon and muscle appears normal. The subscapularis tendon and muscles are within normal limits.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is perhaps a small 7 mm ossicle along the anterior aspect of the acromion process. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small amount of fluid in the glenohumeral joint, but no effusion. The superior labrum is attenuated, likely representing chronic degenerative tearing. Inferiorly, the labrum is within normal limits for age. Mild osteoarthritis affects the glenohumeral joint.BICEPS TENDON: The biceps tendon and long head of the biceps appears normal. ADDITIONAL

Output: Insertional bursal surface tear of the supraspinatus tendon, and other findings as described above.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact. There is mildly restricted diffusion within the peri-rolandic and occipital cortex bilaterally. There is no evidence of intracranial hemorrhage or mass. There are scattered mild foci of T2 hyperintensity within the supratentorial white matter without restricted diffusion. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is fluid within the mastoid air cells.

Output: 1.Mild bilateral perirolandic and occipital cortical acute ischemia compatible with hypoxic injury.2.Mild chronic small vessel ischemic disease. 3.Non-specific bilateral mastoid air cell fluid.


Instruction: Generate impression based on findings.

Input: Male, 86 years old, with Bell's palsy, dysfunction of cranial nerves V1, V2, CN7 and CN6 on the right. Scattered foci of T2 hyperintensity are evident within the periventricular white matter and the pons. No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. On postcontrast images, no evidence of any pathologic parenchymal enhancement is seen.Scattered small foci of susceptibility are evident through the brain compatible with chronic microhemorrhage. No evidence of significant or acute intracranial hemorrhage. No abnormal extra-axial collections are detected. Ventricles and sulci are prominent compatible with diffuse volume loss. Prominence of the perivascular spaces is seen.There may be mild enhancement of the distal cisternal portion of the right trigeminal nerve. The other cisternal cranial nerves including the seventh nerves within the IACs are unremarkable.Very subtle asymmetric expansion of the right cavernous sinus is seen. This is felt to reflect the presence of abnormal soft tissue within the sinus which demonstrates a slightly different pattern of enhancement from the remainder of the cavernous sinus (see image 34 series 26, and image 33 series 27). This tissue can also be appreciated on precontrast T1-weighted images (image 41 series 17) and on diffusion-weighted images (image 371 series 18). This tissue occupies predominantly the upper aspect of the cavernous sinus with sparing of Meckel's cave, though it does abut the right ICA with possible mild vascular narrowing. This soft tissue thickening extends anteriorly and superiorly, nearly to the level of the orbital apex. In addition, V2 is seen to be thickened as it passes through the foramen rotundum into the pterygopalatine fossa (image 31 series 27). No specific lesions in the facial soft tissues are seen. An area of thickening or adherent secretions is seen within the left maxillary sinus, and at the left frontoethmoidal recess. No masses or cervical adenopathy are appreciated in the neck. On limited views of the cervical spine, multilevel spondylosis is appreciated most severely affecting the C5-6 level where there may be a mild spinal canal stenosis.

Output: An abnormal soft tissue process is suspected within the upper aspect of the right cavernous sinus. This abnormality, although subtle, can be visualized on both pre- and postcontrast images and on diffusion-weighted images. The distal cisternal right trigeminal nerve enhances mildly which may be related to this process. The right V2 branch is thickened as it passes through the foramen rotundum. Meckel's cave and V3 appear to be spared.The differential diagnosis for these findings would include a cavernous sinus meningioma or nerve sheath tumor, as well as an infiltrative neoplastic process such as lymphoma or perineural tumor spread, or an infiltrative nonneoplastic inflammatory or granulomatous process.Findings compatible with chronic small vessel ischemic disease of the brain are seen. No significant or acute brain parenchymal lesions are appreciated.


Instruction: Generate impression based on findings.

Input: Ms. King is a 39 year old female with personal history of BRCA2 mutation and strong family history of breast cancer including her mother (diagnosed at the age of 44) and maternal grandmother (diagnosed at the age of 63). There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarctionDiagnosis: Other malaise and fatigueClinical question: r/o acute processSigns and Symptoms: weakness MRI of the brainThere is diffusion restriction along the right MCA territory predominantly involving patchy areas along the right inferior and middle frontal gyri as well as the insular cortex. There are small foci of diffusion restriction along the right temporal lobe.There is subtle FLAIR signal hyperintensity in these areas of diffusion restriction.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, left middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The right MCA flow voids are not readily recognized.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, left middle and posterior cerebral arteries. There is a high grade stenosis at the distal right m1 segment involving superior and inferior divisions.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the PCA bilaterally with a tiny right p1 segment and a small left p1 segment. The LVA is larger than the RVA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The origins of the vertebral arteries are tortuous.

Output: 1.Near complete occlusion of the right m1 segment of the MCA at the bifurcation and distal m1 segment with evidence for slow antegrade flow "outline sign" at the proximal right superior and inferior divisions.2.Acute cerebral infarction involving predominantly the right middle and inferior frontal gyri as well as the right insular cortex with associated smaller foci of infarction in the right temporal lobe.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for stenosis at the carotid bifurcation.


Instruction: Generate impression based on findings.

Input: 83 years Male (DOB:6/26/1932)Reason: cause of seizure History: seizurePROVIDER/ATTENDING NAME: DAVID A HARTER JOHN P KRESS There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are a few punctate foci of signal hyperintensity on T2 and FLAIR imaging located in the brainstem thalami and external capsules.The lateral ventricles are fairly large. The biventricular diameter is approximately 47 mm on axial imaging. On coronal imaging at the level of the foramen of Monro biventricular diameter is 47 mm. The temporal horns of the lateral ventricles are large. The third ventricle measures approximately 12 mm diameter. The fourth ventricle also appears fairly large.No foci of diffusion restriction are appreciated intracranially.Is a focus of susceptibility effect present in the right thalamus medially and another one in the left cerebellar hemisphere.Much of the imaging is degraded by patient motion.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions in the brainstem, thalami and external capsules are likely vascular related.3.There are microhemorrhages present. Underlying cause is not clear. The locations could suggest hypertension but this is nonspecific. Only a couple right identified4.There is ventriculomegaly present. The possibility of normal pressure hydrocephalus cannot be excluded.5.Exam is moderately degraded due to patient motion which would obscure more subtle abnormalities


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Confusion, seizures. Nonenhanced head CT:Images through posterior fossa are unremarkable and stable since prior study. Previously noted acute hematoma in the right occipital lobe is again identified in the definitive interval change in its density or measurements. Mildly dilated supratentorial ventricular system likely result of parenchymal volume loss remain stable. Small amount of blood in the dependent portion of occipital horn of the lateral ventricle is noted. There is slight increase in the amount of blood in the left occipital horn likely result profunda precipitation of blood within the ventricle. Small amount of blood in the subarachnoid space also is noted and stable.Advanced periventricular and subcortical low attenuation of white matter is suspected for extensive small vessel ischemic stroke of indeterminate age. This findings were present on multiple prior CT and MRI exams and if no appreciable change.

Output: Stable constellation of intracranial findings of right occipital lobe hematoma and its minimal surrounding vasogenic edema, mildly dilated supratentorial ventricular system and extensive small vessel disease.


Instruction: Generate impression based on findings.

Input: 45-year-old male patient with history of osteomyelitis status post right second toe amputation.New wound, edema. Evaluate for osteomyelitis. There is soft tissue ulceration along the ball of the foot with extensive signal abnormality in the underlying subcutaneous soft tissues. Additionally, there is diffuse edema throughout the soft tissues of the foot.As seen on the radiographs, there is dorsal dislocation of the proximal phalanx of the great toe relative to the first metatarsal. There is a small rim-enhancing fluid collection immediately plantar to the head of the first metatarsal. There is erosion of the plantar and medial aspects of the head of the first metatarsal surrounding a small intramedullary focus of near fluid signal intensity. Although there is little enhancement of the medullary bone, these findings are suggestive of chronic osteomyelitis and a small intramedullary abscess. There is proximal displacement of the sesamoid bones with surface irregularity and signal abnormality of the lateral sesamoid likely reflecting chronic osteomyelitis. Mild signal abnormality within the lateral aspect of the base of the proximal phalanx may be related to chronic osteomyelitis or reactive osteitis. Signal intensity of the distal phalanx appears normal.The patient is status post amputation of the second toe. There is a sinus tract extending from the plantar surface of the ball of foot to what remains of the head of the second metatarsal. Small rim-enhancing fluid collections surround the second metatarsal head and probably communicate with the aforementioned sinus. There is abnormal signal intensity and enhancement involving the head and diaphysis of the second metatarsal indicating osteomyelitis.As seen on radiographs, there is deformity of the head of the third metatarsal and signal abnormality compatible with chronic osteomyelitis. There is signal abnormality within the proximal phalanx of the third toe compatible with chronic osteomyelitis. Signal intensity within the middle and distal phalanges are within normal limits. There is also a small enhancing fluid collection adjacent to the head of the third metatarsal.Abnormal signal intensity and enhancement involving the head, neck, and diaphysis of the fourth metatarsal is compatible with osteomyelitis. The phalanges of the fourth toe appear normal.There is a tiny focus of edema type signal in the head of the fifth toe metatarsal which is favored to be arthritic in etiology over osteomyelitis. The phalanges of the fifth toe are within normal limits. There is also a small rim-enhancing fluid collection (4-5 mm) immediately adjacent to the lateral aspect of the base of the fifth metatarsal with surrounding inflammation. A 6-7 mm collection of fluid signal intensity dorsal to the base of the fifth metatarsal may represent a synovial cyst or ganglion.Degenerative arthritic changes affect the bones of the midfoot. There is thickening of the plantar fascia. The flexor hallucis longus tendon is also abnormally thickened likely due to a chronic full-thickness tear and becomes inseparable from the plantar fascia beneath the first metatarsal likely representing chronic scarring. There is also enhancement surrounding the flexor tendons near the first metatarsal neck suggestive of tenosynovitis. Distal to this, the tendons are not visualized and may be torn.

Output: Soft tissue ulceration with multifocal osteomyelitis and other findings as described above.These findings were discussed with M. Jacobs via telephone at 0959 hrs.


Instruction: Generate impression based on findings.

Input: 54-year-old female with reportedly newly diagnosed HCC, evaluate extent of disease/cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Mildly cirrhotic liver morphology.There is a lesion within the inferior aspect of segment 6 measuring 5.7 x 7.4 cm which is hyperintense on DWI and T2 and hypointense on T1-weighted images. Following contrast administration no definite hyperenhancement on arterial phase images is evident. Progressive delayed enhancement is suggested within the lesion, may reflect underlying fibrous composition. This lesion is hypointense on delayed phase images. A branch of the right portal vein leading to the lesion is thrombosed.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: Multiple enlarged portacaval nodes measuring 3.1 x 1.8 cm (13/38) and 3.8 x 2.5 cm (13/49)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Basilar pulmonary opacities.

Output: Outside exam read:1.Cirrhotic liver morphology with large segment 6 lesion. There is no definite hyperenhancement on arterial phase images (which would favor a hepatocellular carcinoma). Cholangiocarcinoma is favored given apparent progressive delayed enhancement within lesion, however remaining among differential considerations are an atypical hepatocellular carcinoma or hypovascular metastatic disease.2.Thrombosis of a branch of the right portal vein.3.Enlarged portacaval lymph nodes.


Instruction: Generate impression based on findings.

Input: 40-year-old male with complex renal cyst on MRA. Evaluate the renal cyst. ABDOMEN:LIVER, BILIARY TRACT: There is a segment 7 intermediate T2 signal lesion measuring approximately 2.2 x 2.5 cm with avid arterial enhancement which persists; this lesion most compatible with FNH.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS:RIGHT KIDNEY:Right exophytic, well encapsulated lesion anteriorly (series 4, image 15) which demonstrates T1 and T2 heterogeneous signal with probable low level contrast enhancement. This lesion measures 2.7 x 2.3 cm. This is suspicious for renal cell carcinoma.Right inferior pole subcentimeter T2 hyperintense focus with thin septations which likely enhance (series 4, image 28).Right posterior T2 hyperintense focus with mildly enhancing thin septations (series 4, image 18), compatible with a complex cyst.Additional subcentimeter T2 hyperintense nonenhancing foci compatible with cysts.LEFT KIDNEY: Left mid pole T2 hyperintense subcentimeter focus with questionable enhancement (series 4, image 12). This lesion is too small to characterize.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.Right renal exophytic lesion anteriorly suspicious for renal cell carcinoma. Differential considerations include papillary over chromophobe.2.There are 2 complex cysts on the right and one complex cyst on the left as detailed above. Attention on follow-up is recommended.3.Segment 7 hepatic FNH.


Instruction: Generate impression based on findings.

Input: 44-year-old male with new onset seizure. Evaluate for stroke, edema. There is an area of hypodensity in the right frontal subcortical region that may represent edema or encephalomalacia. This could be related to old ischemic change. However, an MRI is recommended for further evaluation. The ventricles and sulci are mildly prominent, which may represent volume loss considering the patient's age. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right frontal subcortical hypodensity may represent edema or encephalomalacia. This could be related to old ischemic change. However, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Left knee pain, questioning iliotibial band syndrome or patellofemoral stress syndrome MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is abnormal marrow edema within the patella with areas of near full-thickness to full-thickness articular cartilage loss particularly affecting the lateral facet. The articular cartilage of the medial and tibial compartments is relatively preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Articular cartilage loss affecting the undersurface of the patella with areas of near full-thickness to full-thickness loss affecting the lateral patellar facet associated with likely reactive marrow edema within the patella. The remaining knee otherwise appears normal.


Instruction: Generate impression based on findings.

Input: Right-sided cervical radiculopathy. Motion artifact degrades the exam quality despite several repeat sequences. Axial T2* sequences are nondiagnostic due to technical factors.The cervical vertebral bodies are appropriate in overall alignment and height. There is mild desiccation of the intervertebral discs, with mild-moderate loss of disc height at C5-6. Disc heights are otherwise preserved. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to spinal canal or neural foramina.At C3-4 there is a trace disc bulge with superimposed mild left paracentral/foraminal posterior osteophyte disc complex and left uncovertebral arthropathy. This results in indentation of the left ventral thecal sac and moderate left neuroforaminal stenosis.At C4-5 there is mild left facet and uncovertebral arthropathy resulting in mild left neuroforaminal stenosis. There is no significant spinal canal stenosis.At C5-6 there is diffuse posterior osteophyte disc complex with left paracentral prominence. There may be resultant severe right and moderate-severe left neuroforaminal stenosis, but this is not well assessed secondary to motion artifact. There is no significant spinal canal stenosis.At C6-7 there is mild disc bulge with right paracentral/foraminal disc protrusion, left foraminal disc-osteophyte complex, and mild bilateral facet and uncovertebral arthropathy. These findings result in right greater than left moderate to severe neuroforaminal stenosis. There is no significant spinal canal stenosis.At C7-T1 there is focal right mid-foraminal disc-osteophyte complex with mild right neuroforaminal stenosis. There is no significant spinal canal stenosis.The vertebral artery flow voids appear to be intact.

Output: Motion degraded exam. Moderate scattered spondylotic changes, with up to moderate-severe right greater than left neuroforaminal stenosis at C6-7 and C5-6, with focal right paracentral/foraminal disc protrusion at C6-7.


Instruction: Generate impression based on findings.

Input: 46 or old female with multiple myeloma. Evaluate for bone lesions. SKULL: Two views of the skull show no discrete myelomatous lesions. Small lucencies are likely vascular in etiology.CERVICAL SPINE: Two views of the cervical spine show no discrete myelomatous lesions.THORACIC SPINE: Single view of the thoracic spine shows no discrete myelomatous lesions. LUMBAR SPINE: Two views of the lumbar spine show no discrete myelomatous lesions.RIBS: Single view of the ribs shows no discrete myelomatous lesions.PELVIS: Single view of the pelvis is limited by overlying bowel gas, though we see no discrete myelomatous lesion.UPPER EXTREMITY: Two views of the bilateral humeri and single view of the bilateral forearms show no discrete myelomatous lesion.LOWER EXTREMITY: Two views of the bilateral femurs and a single view of the bilateral tibia/fibula show no discrete myelomatous lesions.

Output: No discrete myelomatous lesions.


Instruction: Generate impression based on findings.

Input: Memory loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is prominent hypointensity in the bilateral basal ganglia. There is mild scattered cerebral white matter T2 hyperintensity. There are also a few scattered punctate foci of intraparenchymal susceptibility effect. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild scattered cerebral white matter T2 hyperintensity are nonspecific, but may represent chronic small vessel ischemic disease3. Prominent hypointensity in the bilateral basal ganglia may represent a neurodegenerative process versus age-related mineral deposition. 4. Mild diffuse cerebral volume loss.5. A few scattered punctate foci of intraparenchymal susceptibility effect may represent chronic microhemorrhages.


Instruction: Generate impression based on findings.

Input: There is residual subcortical T2 hyperintensity within the occipital lobes bilaterally. There are a few punctate foci of susceptibility effect in the bilateral parietal and occipital lobes as well. There are also unchanged scattered punctate cerebral white matter T2 hyperintensities and a focal defect in the right aspect of the body of the corpus callosum. There is an unchanged configuration of the ventricular system, with prominence of the lateral ventricles, particularly posteriorly, with associated diminished periventricular white matter volume. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The hippocampi are symmetric without abnormal signal. There is no midline shift. There are unchanged minimally low-lying cerebellar tonsils. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the ethmoid sinuses.

Output: 1. Residual stigmata of previous posterior reversible encephalopathy syndrome are unchanged.2. Mild probable chronic small vessel ischemic disease without evidence of acute infarction.3. Unchanged ventriculomegaly with what appears to be colpocephaly.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for etiology of altered mental status (metastases, CVA). Signs and symptoms cord altered mental status No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Extensive patchy periventricular and subcortical areas of low attenuation are nonspecific however likelihood of advanced small vessel disease should be considered. No evidence of cortical abnormality. Cortical sulci and ventricular system as well as the CSF cisterns are within normal range for patient's stated age.This examination cannot exclude metastatic lesion to the brain or leptomeninges without the benefit of contrast infusion. Further follow-up with an MRI is recommended. There is however no definitive evidence of metastatic disease on this non-infused study. Calvarial, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Findings highly suspected off small vessel disease of indeterminate age.2.Limited value examination for dictation of metastatic disease due to lack of contrast. Follow-up with an MRI is recommended.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: 59 year old female with a prominent pancreatic duct and intrahepatic ductal dilation. Presents with epigastric pain, nausea and vomiting. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No evidence of significant intra- or extra-hepatic biliary ductal dilation. No focal mass lesion identified within the liver. SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is mildly atrophic, intrinsic T1 signal of pancreas within normal limits. There is mild dilation of the main pancreatic duct measuring up to 6 mm in diameter, appearing similar to the findings on recent CT examinations. There is a normal exocrine response to secretin augmentation. However, the main pancreatic duct does not distend in response to secretin administration. This finding is nonspecific but is suggestive of chronic duct dysfunction. No definite pancreatic lesion delineated. A benign ductal stricture is also a differential consideration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of prior gastrojejunostomy. BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Dilation of the main pancreatic duct with associated diminished response to secretin augmentation which may reflect chronic duct dysfunction. There is no focal obstructing masslesion identified, however, a benign stricture proximal to the confluence of the common trunk is not entirely excluded. Correlation with ERCP could be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a 1.0 x 1.1 cm T1 hypointense and T2 hyperintense focus within the body of the C2 vertebral body. There are minimal posterior disc-osteophyte complexes at multiple levels, but no significant spinal canal or neural foraminal stenoses. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Minimal degenerative changes of the cervical spine without significant spinal canal or neural foraminal stenosis. No spinal cord signal abnormality.2. A lesion in the C2 body is likely benign. However, further evaluation with radiograph or CT may be useful. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 76-year-old female with right shoulder pain and difficulty raising the right arm. Rule out rotator cuff injury. Patient motion artifact limits examination.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus at the level of its insertion on the greater tuberosity with minimal retraction, measuring approximately 12 mm in AP dimension. There is thickening and intermediate signal abnormality affecting the supraspinatus tendon indicating moderate tendinosis. There is mild fatty infiltration/atrophy of the supraspinatus.There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is fatty infiltration of the infraspinatus at the level of the myotendinous junction. The infraspinatus muscle and tendon otherwise appear intact. The teres minor and subscapularis muscles and tendons appear intact. There is thickening and intermediate signal intensity within the subscapularis indicating a combination of tendinosis and redundancy of the tendon, given the lack of external rotation of the humeral head on this examination.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint with inferior osteophyte formation off the acromion process and clavicle resulting in slight impression of the superior fibers of the supraspinatus. There is a small amount of fluid within the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the glenoid labrum, the labrum appears intact.BICEPS TENDON: There is thickening and intermediate signal abnormality affecting the extra articular portion of the tendon of the long head of the biceps indicating moderate tendinosis. There is longitudinal split tearing of the extra-articular portion of the long head of the biceps tendon. The intra-articular portion of the long head of the biceps is also thickened with increased signal abnormality suggesting moderate tendinosis. There is a subcentimeter focus of low signal abnormality within the tendon sheath of the long head of the biceps, along the anterior aspect of the humeral metadiaphysis, which may represent a loose body. Circumferential fluid within the tendon sheath of the long head of the biceps may reflect fluid extension from the glenohumeral joint versus a tenosynovitis. ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus tendon and interstitial tearing of the infraspinatus as described above. Rotator cuff tendinosis as described above.2. Longitudinal split tear of the long head of the biceps tendon.3. Small glenohumeral joint effusion and other findings as described above.