Instruction: Generate impression based on findings.

Input: Patient has right hip ulcer. X-ray shows degenerative changes, recommended MRI for better evaluation. Esophageal cancer. There is a soft tissue ulcer that extends through the posterolateral subcutaneous fat of the right upper thigh to the iliotibial band at the level of the greater trochanter. A small amount of fluid and enhancement is seen immediately deep to the iliotibial band and superficial to the trochanter, but I see no signal abnormality within the marrow of the trochanter itself to indicate osteomyelitis. A small amount of edema is seen within the posterolateral fibers of the vastus lateralis muscle proximally at its origin. Chronic-appearing enthesopathic spurs are noted projecting from the greater trochanter. I see no focal lesions to suggest metastatic disease to the bones of the hip. Mild osteoarthritis affects the right hip joint. I see no joint effusion or synovitis. Mild osteoarthritis also affects the left hip as seen on the large field-of-view images. Degenerative disc disease affects the visualized lower lumbar spine. The sacroiliac joints are within normal limits for age. There is mild reticulation of the subcutaneous fat posteriorly perhaps reflecting mild edema, nonspecific. The remaining visualized soft tissues are unremarkable.

Output: Soft tissue ulcer without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. Subsequently, 1 cc of Kenalog (40 mm) was injected intra-articularly. The needle was then withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 24 seconds.

Output: Successful fluoroscopically guided injection of gadolinium into the left hip for MRI arthrogram as well as intra-articular injection of Kenalog.


Instruction: Generate impression based on findings.

Input: 70 years Male (DOB:3/7/1946)Reason: Ill-defined lytic lesion in the transverse process of L3 via CT scan suspicious for indolent metastases, hx of ex-pleomorphic adenocarcinoma completed CRT 9/16/16 History: Ill-defined lytic lesion in the transverse process of L3 via CT scan suspicious for indolent metastases, hx of ex-pleomorphic adenocarcinoma completed CRT 9/16/16PROVIDER/ATTENDING NAME: ALISON M MONGE SERVICES ANCILLARY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment . The conus medullaris on sagittal imaging is grossly intact. There is 25% loss of vertebral body height at L1 and 40% loss of vertebral body height at T12. There is no associated T2 signal hyperintensity with these anterior compression fractures. In addition the sacrum appears unusually angulated and has a somewhat heterogeneous signal within it with a lacelike pattern of enhancement.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level. There is bilateral facet hypertrophy present at this level. There is some mild displacement of the nerve root at the right lateral recess at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy at this level.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.No abnormal mass lesions are appreciated in the lumbar spine.There is a cyst present along the left kidney which measures 16 x 23 mm in axial dimensions. It is cortically based.

Output: 1.There are compression fractures present at T12 and L1 which appear to be chronic.2.Findings suggest longstanding fracture injury to the sacrum.3.There is no convincing evidence for bone metastases to the lumbar spine including the transverse processes.


Instruction: Generate impression based on findings.

Input: 55-year-old female with lupus status post CVA x 2, hypotensive and unresponsive with distended abdomen. Concern for intracranial process and acute abdomen. There is no evidence of intracranial hemorrhage, mass or edema. No evidence of acute cortical stroke, however, if there is clinical concern for acute stroke an MRI may be considered. Increased density within the left globe may be due to hemorrhage.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.

Output: 1. No evidence of acute cortical stroke, however, if there is clinical concern for acute stroke an MRI may be considered.2. Increased density within the left globe may be due to hemorrhage.


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB:2/13/1978)Reason: 38F AML/ALL, recent R MCA stroke (11/19) s/p TPA/thrombectomy, now with blurred vision and HA and CT head with evolving R MCA ischemia. eval for new foci of ischemia vs evolution of old stroke History: 38F AML/ALL, recent R MCA stroke (11/19) s/p TPA/thrombectomy, now with blurred vision and HA and CT head with evolving R MCA ischemia. eval for new foci of ischemia vs evolution of old strPROVIDER/ATTENDING NAME: CHRISTOPHER K. DAUGHERTY Brain MRIThere are redemonstration of scattered restricted diffusion involving right frontal lobe, insular cortex caudate head and right temporal lobe. These lesions suggest evolving right MCA territory subacute ischemic stroke without evidence of hemorrhagic conversion.Comparing to prior MRI, the extent of the restricted diffusion appears to be similar.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. In particular, there is no evidence of focal filling defect which was seen on prior CT angiogram.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Evolving right MCA subacute ischemic stroke without evidence of hemorrhagic conversion. 2. No evidence of new acute ischemic or hemorrhagic lesion.3. Normal brain and neck MRA.


Instruction: Generate impression based on findings.

Input: Female 36 years old Reason: likely FDP tendon laceration of right ring finger LIGAMENTS: No significant abnormality noted.TENDONS: Flexor digitorum profundus muscle and tendon appears unremarkable in the ring finger. Additional muscles and tendons appear unremarkable. BONES: Bone marrow signal is within normal limits.ADDITIONAL

Output: Flexor digitorum profundus appears within normal limits. Overall unremarkable examination.


Instruction: Generate impression based on findings.

Input: 52-year-old female with worsening headaches. Evaluate for progression; Chiari. The patient also has sciatic nerve pain. Evaluate for stenosis.Additional EMR Data: History of Chiari malformation, HTN, impaired glucose tolerance, HLD, and ?h/o MS (off of Betaseron since 2006 given nonspecific MRI sxs, not clear diagnosis) who presents for f/u. Brain MRI:Limited exam secondary to patient motion. Nonspecific hyperintense FLAIR foci are again seen predominantly in the subcortical white matter of the bilateral cerebral hemispheres and there are at least a few more foci compared to the previous exam predominantly in the frontal lobes within the subcortical white matter.On the current exam there is moderate crowding of the foramen magnum and the cerebellar tonsils extend at most 4 mm below the foramen magnum which is at the upper limits of normal. In addition the cerebellar tonsils have a more rounded configuration compared to the previous exam and this is suspected to be in part related to changes in head position compared to the previous exam, as there is decreased extension of the neck. There is relatively decreased CSF flow posteriorly at the level of the foramen magnum just distal to the caudal tip of the tonsils but there is biphasic flow detected through the cerebral aqueduct, fourth ventricle and outflow tracts.There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.L-spine MRI:There is transitional lumbosacral anatomy with sacralization of the L5 vertebral body, four non-rib bearing lumbar vertebral bodies and twelve rib-bearing vertebrae. For the purposes of this exam, the last fully formed disc is at L4-5 with a rudimentary disc at the L5-S1 level.There is slightly exaggerated lordosis of the lumbar spine and stable grade 1 degenerative anterolisthesis of L4 on L5. There is also disk narrowing and dessication at L4-5. There is also a developmentally narrowed lower lumbar spinal canal due to short pedicles and prominent dorsal epidural fat. The vertebral body heights are preserved. The marrow is heterogeneous, although unchanged compared to the prior exam. The conus is normal in signal and morphology and terminates at the mid-L2 level.Again seen is uncovering of the L4-5 disc with a superimposed mild disc bulge and moderate to severe facet arthropathy which contribute to mild-moderate right and moderate-severe left neuroforaminal narrowing and at least moderate spinal canal stenosis but this is not significantly changed.Small right mid-kidney cyst is again noted. The paravertebral soft tissues are unremarkable.

Output: 1.Slight interval progression of the predominantly subcortical FLAIR hyperintense foci which remain nonspecific.2.Persistent moderate crowding of the foramen magnum with now normal cerebellar tonsil morphology and positioning, likely in part related to change in the patient's head position. Current imaging does not meet the criteria for Chiari malformation. Biphasic flow of CSF through this level, although there is relatively decreased flow dorsally just caudal to the tonsils. Correlate clinically.3.Transitional lumbosacral anatomy as noted above. If surgery is to be contemplated, recommend correlation with imaging of the entire spine. 4.Unchanged appearance of the focal degenerative disease at the L4-5 level with moderate-severe left neuroforaminal narrowing and moderate spinal canal stenosis at this level, with underlying developmental narrowing of the canal.


Instruction: Generate impression based on findings.

Input: There is hematoma involving the right psoas muscle measuring 5.5 x 4.2-cm in AP and transverse dimensions and extending from mid L3 level to the pelvis outside the field of view.Interval progression of multilevel degenerative spondylosis with worsening loss of disk height and linear T1 and T2 hypointensity, presumably vacuum phenomenon. Minimal anterolisthesis of L4 over L5 vertebral body. Advanced multilevel facet arthropathy, worse at lower lumbar spine. No evidence of fracture. There are Modic type II changes at multiple vertebral body endplates. Otherwise marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. Bilateral renal cysts are noted. Lipoma involving the right posterior paraspinous musculature again seen.Multilevel degenerative changes, individual levels as below:L1/2: Posterior disk bulge. Mild facet hypertrophy. Epidural lipomatosis with mild bilateral foraminal narrowing. Mild spinal canal stenosis.L2/3: Posterior disk bulge. Mild to moderate loss of disk height. Facet arthropathy with ligamentum flavum hypertrophy. Epidural lipomatosis with near complete obliteration of the right neuroforamina and minimal left neural foraminal narrowing. Mild to moderate central canal stenosis.L3/4: Rightward eccentric posterior disk bulge. Mild to moderate loss of disk height. Advanced facet arthropathy with ligamentum flavum hypertrophy. Severe right and mild left neural foraminal narrowing. There is also mild central canal stenosis.L4/5: Rightward eccentric posterior disk bulge. Mild loss of disk height. Advanced facet arthropathy with ligamentum flavum hypertrophy. Moderate right and severe left neural foraminal narrowing. There is also mild to moderate central canal stenosis.L5/S1: Leftward eccentric posterior disk bulge with moderate to severe loss of disk height. There are also large anterior osteophytes at L5 and S1 vertebral bodies. Moderate left neural foraminal narrowing. No significant right neuroforaminal or spinal canal stenosis.

Output: 1.Hematoma involving the right psoas muscle extending from mid L3 level inferiorly into the pelvis outside the field of view.2.Interval progression of multilevel degenerative changes in the lumbar spine as detailed above. There is severe right L2-3, right L3-4, and left L4-5 foraminal narrowing with additional levels as above. There is mild to moderate spinal canal stenosis at L2-3 and L4-5.Findings discussed with Dr. Dionne Blackman on 4/3/2015, 4:30PM


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for growth of grade ll oligodendroglioma. Signs and symptoms: Grade ll oligodendroglioma. Evaluate for growth. Pre-and post-enhanced brain MRI:Examination redemonstrates a large focus of flair hyperintensity involving the periventricular white matter of left mid temporal lobe and extending posteriorly to surround the trigone of the left lateral ventricle. Internal foci of susceptibility in this region and underlying parenchymal volume loss and ex vacuo dilatation of the trigone of left lateral ventricle remains similar to prior exam. Findings are consistent with post treatment/surgical changes of patient's known left hemispheric oligodendroglioma. Similar to prior exam there is evidence of T1 hyperintensity within the surgical site and along the left aspect of the splenium of corpus callosum consistent with mineralization. There is a very thin linear enhancement along the anterior aspect of this focus of mineralization within the surgical cavity which also remains identical to prior study. Mild periventricular white matter flair hyperintensity of the right hemisphere similar to prior the study and likely treatment related changes.There is no convincing evidence of residual or recurrence of tumor. Further follow-up is recommended.Expected postoperative changes of left frontal parietal craniotomy similar to prior study.

Output: 1.Stable postoperative and treatment changes of left hemispheric oligodendroglioma without convincing evidence of residual or recurrence of tumor.2.Further follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out CVA. Signs and symptoms: Slurred speech and facial tube. Nonenhanced CT of brain:Findings consistent with extensive small vessel disease of indeterminate age is noted. There is no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. No evidence of acute cortical stroke is detected. Prominence of cortical sulci and ventricular system is concerning for underlying volume loss. Follow-up with an MRI is recommended.Calvarium, visualized paranasal sinuses, mastoid air cells and middle cavities are unremarkable.

Output: 1.Small vessel disease of indeterminate age.2.No evidence of acute cortical stroke or hemorrhage.3.Calvarium, paranasal sinuses and mastoid air cells are pneumatized and unremarkable.


Instruction: Generate impression based on findings.

Input: 45 years, Female, Reason: cause of LFT abnormalities History: markedly elevated alk phos, elevated AST/ALT. Severely limited study due to patient motion and large body habitus.ABDOMEN:LUNG BASES: Cardiomegaly.LIVER, BILIARY TRACT: Gallbladder is contracted with wall thickening which is nonspecific. Hepatomegaly. No focal hepatic lesions. Common bile duct appears normal. SPLEEN: Borderline enlarged spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace perihepatic ascites.

Output: 1.Limited study due to motion and body habitus.2.Hepatomegaly without focal liver lesions.3.Contracted gallbladder with nonspecific wall thickening which is likely due to volume overload.4.Trace perihepatic ascites.


Instruction: Generate impression based on findings.

Input: Female 76 years old Reason: HCC s/p TACE RFA, f/u History: HCV cirrhosis, HCC ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates fibrosis and cirrhotic morphology with nodular contour and prominence of the hepatic fissures. The ablation cavity in the left hepatic lobe has enlarged and contains central hemorrhage consistent with recent ablation. This measures 1.9 x 3.0 cm (16, image 29). No residual arterially enhancing focus is identified. No new foci of arterial enhancement or washout are identified.Patent hepatic vasculature.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing T2 hyperintensity at the lower pole of the right kidney consistent with renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Splenic vein occlusion. Multiple upper abdominal collateral vessels.

Output: 1.Status post TACE RFA. No residual arterial enhancement in this region. No new suspicious lesions identified.


Instruction: Generate impression based on findings.

Input: Plantar foot mass There is a mass within the plantar soft tissues of the foot beneath the first metatarsal that appears to arise of the medial band of plantar fascia. It is predominantly isointense to skeletal muscle on T1, containing scattered foci of low signal intensity, and slightly hyperintense to skeletal muscle on T2WI, which also demonstrate scattered foci of low signal intensity. There is diffuse enhancement of the mass following contrast administration and it measures 2.5 x 1 cm in the transverse dimensions and approximately 3 cm in the longitudinal dimension. This is most compatible with plantar fibromatosis. An additional tiny focus of enhancement is noted along the plantar margin of the flexor digitorum brevis muscle, which could conceivably represent an additional small focus of fibromatosis.There is nonspecific edema within the dorsal subcutaneous tissues of the foot. Mild to moderate osteoarthritis affects the first MTP and TMT joints. There is additional mild osteoarthritis of the navicular-medial cuneiform articulation. There is mild enhancement and edema along the tendon sheath of the flexor digitorum longus suggesting mild tenosynovitis.

Output: MRI features of plantar fibromatosis with other findings described above.


Instruction: Generate impression based on findings.

Input: History of pancreatitis and ulcerative colitis presenting with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology without a focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Normal pancreatic morphology, signal intensity and enhancement. Normal pancreatic duct caliber.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: No specific findings to account for the patient's mid-abdominal pain.


Instruction: Generate impression based on findings.

Input: Low back pain with suspected CSF leak. Dural enhancement in the brain and cervical spine. 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. No fluid collections are seen in the lumbar spine or paraspinous soft tissues.Mild multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disk desiccation and mild bulge. No spinal canal or neural foraminal stenosis.L4-L5: There is disk desiccation, mild bulge and a Schmorl's node involving the superior endplate of right L5. There is no significant spinal canal stenosis or neural foraminal stenosis. Bilateral facet arthropathy.L5-S1: There is disk desiccation, mild bulge, and bilateral facet arthropathy. There is no significant spinal canal or right foramina narrowing. There is mild left neural foramina stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. No fluid collections are seen in the lumbar spine or paraspinous soft tissues to suggest site of CSF leak. If there is continued suspicion for CSF leak and intracranial hypotension, consider myelogram for further evaluation.2. Mild degenerative changes as detailed above.


Instruction: Generate impression based on findings.

Input: Chronic loss of balance and right facial droop. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal scattered nonspecific cerebral white matter T2 hyperintensity bilaterally. Apparent high T1 signal on the high resolution post-contrast images along the right lateral wall of the fourth ventricle corresponds to venous sinus pulsation artifact. 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 intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Facial nerve disorder. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. A contrast enhanced exam may be more sensitive to subtle lesions than a non-contrast exam.


Instruction: Generate impression based on findings.

Input: Reason: Right femur pain, evaluate for cause History: pain There is increased signal intensity along the myotendinous junction, centrally, within the rectus femoris at the level of the mid to distal femoral diaphysis compatible with a strain as well as a small but elongated intramuscular hematoma. The distal quadriceps tendon appears intact. The origin of the rectus femoris is not included on the field-of-view of the study, but we see no edema within the muscle proximally to suggest a proximal injury. The remainder of the imaged musculature of the right thigh is normal in appearance. The signal intensity of the femoral diaphysis is normal. The head of the femur as well as the distal articular surface of the femur are not included in their entirety on the field-of-view of this study.

Output: Myotendinous strain injury of the rectus femoris with small intramuscular hematoma.


Instruction: Generate impression based on findings.

Input: There is a punctate focus of diffusion hyperintensity in the right inferior parietal periventricular white matter with T2 hyperintensity which is new since remote MRI from 5/14/2007. There is isointense corresponding ADC signal.Again seen is evidence of extensive chronic small vessel ischemic disease with patchy T2/FLAIR hyperintensities in the periventricular and subcortical white matter as well as in the pons, minimally progressed in the interval. Again seen are areas of encephalomalacia involving the left temporo-occipital lobe. Lacunar infarct involving the left frontal corona radiata is unchanged. Confluent FLAIR hyperintensity in the right frontal corona radiata and centrum semiovale is also similar to prior. There is small infarct involving the right cerebellar hemisphere which appears chronic but is new since prior study from 2007.There is linear area of encephalomalacia with susceptibility involving the right basal ganglia and internal capsule consistent with prior hemorrhagic infarct. In addition, punctate susceptibility signal is again seen in the left basal ganglia as well as associated with the left temporo-occipital infarct compatible with chronic blood products. There is evidence of Wallerian degeneration with volume loss along the right corticospinal tract. There is volume loss with enlarged ventricles and sulci, slightly progressed since the previous study. There is no midline shift. Basal cisterns are patent. No evidence of herniation.There is opacification of the right sphenoid sinus. Evidence of intraocular lens replacement.

Output: 1. Punctate focus of diffusion hyperintensity in the right inferior parietal periventricular white matter which is suspected to represent a tiny subacute infarct.2. Evidence of advanced chronic small vessel ischemic disease which has minimally progressed since prior study from 2007. Again seen are multiple chronic infarcts including at the left temporal-occipital lobe junction and right basal ganglia/internal capsule. Small right cerebellar lacunar infarct appears chronic but new since prior study from 2007. Please see additional details above.


Instruction: Generate impression based on findings.

Input: BRAIN:There is no diffusion abnormality. There is cystic encephalomalacia in the superior left frontal gyrus that extends posteriorly into the left parietal lobe, as well in the left occipital and posteromedial temporal lobes, corresponding with previously seen infarcts in the left ACA, PCA, and to lesser degree MCA territories. There is associated volume loss and ex vacuo dilatation of the left supratentorial ventricular system.There is expected evolution of intraparenchymal hemorrhage in the left basal ganglia with a rim of susceptibility artifact and encephalomalacia, overall decreased in size compared to prior. There is a punctate focus of susceptibility artifact in the right basal ganglia, unchanged. There is a punctate focus of susceptibility in the genu of the left internal capsule, possibly seen on prior examination and better seen on the current study.There is associated volume loss of the corpus callosum as well as the left cerebral peduncle, consistent with Wallerian degeneration. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.MRA:Please note that the prior MRA was technically degraded, therefore comparison is not possible. There is signal within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions, arteriovenous malformations, or aneurysms are identified.

Output: 1.Evolution of multiple prior infarcts as described above with resultant encephalomalacia and expected evolution of left basal ganglia hemorrhage.2.MRA without significant stenosis in the anterior or posterior circulation. Note that the prior MRA was technically degraded and direct comparison is not possible.


Instruction: Generate impression based on findings.

Input: 77 years, Male, Reason: hx of large pseudocyst. CT 1/21/15 with disruption of PD where AXIOS stent placed. Please eval History: na. ABDOMEN:LUNG BASES: Right basilar opacity is unchanged.LIVER, BILIARY TRACT: Left hepatic subcentimeter cyst. Status post cholecystectomy.Common bile duct is mildly dilated to 8 mm with smooth tapering at its distal aspect. There is mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a peripancreatic collection measuring 1.7 x 1.1 cm which is decreased from 2.6 x 1.3 cm previously. AXIOS stent entering the pancreatic collection produces local artifact in this region of the pancreas. The pancreatic duct within the distal tail appears to communicate with the peripancreatic lesion (16/5 and 2001/48), indicating disruption of the duct. There is a long segment, subjacent to the stent, in which the pancreatic duct is not well visualized. The pancreatic duct within the head and neck appears normal.Diffusion restriction within the pancreatic tail suggests inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter T2 hyperintensities likely represent cysts.RETROPERITONEUM, LYMPH NODES: IVC filter. Mild amount of mural thrombus in the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Peripancreatic fluid collection is decreased in size from the prior exam. The main pancreatic duct within the tail appears to communicate with this collection, indicating disruption. The pancreatic duct within the body subjacent to the stent is not well visualized, either due to artifact or disruption.2.Diffusion restriction within the tail of the pancreas suggests inflammation and is likely related to recent episode of pancreatitis.3.Right lower lobe pulmonary opacity may represent consolidation, however neoplasm is also considered, particularly given its persistence. Recommend either short term follow-up or PET-CT.


Instruction: Generate impression based on findings.

Input: 68-year-old male patient with history of prostate cancer status post prostatectomy. Assess for residual prostate and lymphadenopathy. PELVIS:PROSTATE:The prostate is absent with post-surgical sequela of a prostatectomy within the prostate bed. No residual prostatic tissue is identified. BLADDER: No significant abnormality noted.LYMPH NODES: A 2.3 x 3.2 cm cystic structure on the right and a 2.7 x 2.5 cm cystic structure on the left adjacent to the external iliac vasculature are compatible with lymphoceles. No lymphadenopathy is identified. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat-containing right inguinal hernia.

Output: 1. Post-surgical changes of a prostatectomy without evidence of residual prostatic tissue.2. Bilateral pelvic lymphoceles. No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 54-year-old male with history of pancreatic cancer, coagulopathy, and liver failure presents with headache, altered mental status, left eye pain with unreactive dilated pupil There is a well demarcated, hyperattenuating sellar mass (image 9, series 2) which is consistent with a pituitary macroadenoma. There also appears to be a separate additional expansile mass in the sella (image 8, series 2) eroding the left posterior clinate and dorsum sella with minimal expansion into the left cerebello-pontine angle and significant extension into the left cavernous sinus with associated lateral expansion of the cavernous sinus. The mass shows hyperattenuation along the periphery with a hypoattenuating center. Although this second mass likely represents extension of the pituitary macroadenoma, an MRI is recommended for further evaluation and to exclude aneurysm. These masses are unlikely to represent metastases. There is no evidence of intracranial hemorrhage. The orbits appear within normal limits.The ventricles and basal cisterns are normal in size and configuration. With the exception of the dorsal sella and posterior clinate, the remaining calvaria and skull base are radiographically normal. A left maxillary retention cyst is noted. The other visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Sellar masses with posterior and left lateral cavernous sinus extension as described above. These masses likely represent pituitary macroadenomas, MRI is recommended for further characterization and to exclude the diagnosis of aneurysm.Left maxillary retention cyst.


Instruction: Generate impression based on findings.

Input: Evaluate for tethered cord, Chiari malformation, syringomyelia: increased reflexes, multiple location of pain, and headaches. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The cerebellar tonsils are not low-lying.

Output: No evidence of Chiari malformation, syringohydromyelia, or mass lesions within the cervical and thoracic spinal canal. The lumbar spine was not imaged, but is planned for a later date.


Instruction: Generate impression based on findings.

Input: 38-year-old male patient with alcohol hepatitis with intra-abdominal bleed status post prior embolization, now with persistent leukocytosis. Evaluate for abscess. Several sequences are degraded by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring 22 cm in the craniocaudal dimension. Within limitations of motion degradation, there is no new T2 hyperintense/diffusion restricted collection within the liver to suggest a new intrahepatic fluid collection. Previously demonstrated large geographic area of signal abnormality involving the left hepatic lobe and extending into the right hepatic lobe is less clearly delineated on this examination secondary to extensive motion artifact. However, the extent of this region of signal abnormality and enhancement characteristics appear grossly similar to the prior examination.There is a persistent focus of signal void within the middle hepatic vein centrally suggesting nonocclusive thrombus. Furthermore, there is the suggestion of signal void within the anterior branch of the right portal vein which could represent thrombus. The left portal vein is narrowed. The main portal vein appears patent.There is no intra or extra hepatic biliary ductal dilatation. The gallbladder wall is mildly thickened which is nonspecific in setting of ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is large volume abdominal ascites. There is an evolving hematoma within the left hemiabdomen which is causing displacement of the bowel to the right and mild peritoneal enhancement. Small left pleural effusion.

Output: 1.Within limitations of the study, no new hepatic lesion is identified to suggest an infected fluid collection.2.Large geographic region of signal abnormality within the liver predominately in the distribution of the left portal vein may be perfusional in etiology and sequela of partial occlusion of the left portal vein as it is narrowed. Furthermore, there is probable non-occlusive thrombus within the middle hepatic vein centrally and the anterior branch of the right portal vein.3.Large volume ascites with evolving hematoma in the left hemiabdomen and non-specific peritoneal enhancement; superimposed infection is not excluded. 4.Small left pleural effusion.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis and lupus presenting with worsening left-sided weakness and gait instability. Assess for new lesions. Redemonstration of multiple foci of periventricular and subcortical white matter with increased T2 signal compatible with the history of multiple sclerosis. There are no new lesions identified. No lesional enhancement is noted on the postcontrast images. T1 hypointensity associated with multiple lesions again seen. Brain parenchymal volume is grossly preserved. No acute ischemia. There is no evidence of intracranial hemorrhage. No intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. Calvarium and extracranial soft tissues are within normal limits.

Output: 1. Multiple supratentorial and infratentorial white matter lesions compatible with the history of multiple sclerosis. No new lesions are identified. No lesions with enhancement to suggest active demyelination. 2. No evidence of acute ischemia, hemorrhage, or intracranial mass effect.


Instruction: Generate impression based on findings.

Input: Resection of hard palate polymorphous low-grade adenocarcinoma (PLGA) on 2/4/2016 with negative margins. There is a defect in the right hard palate with what likely represents scar tissue in the surgical bed due to low T2 signal, but no convincing evidence of gross tumor. There is no evidence of significant lymphadenopathy in the neck. The major salivary glands are unremarkable. The thyroid gland is also unremarkable. The sinonasal cavities are intact. There is a narrow cervical spinal canal with disc-osteophyte complexes that impinge upon the spinal cord at multiple levels. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Post-treatment findings in the right hard palate without evidence of gross tumor recurrence.2. No evidence of significant lymphadenopathy in the neck. 3. Narrow cervical spinal canal with disc-osteophyte complexes that impinge upon the spinal cord at multiple levels.


Instruction: Generate impression based on findings.

Input: Male, 80 years old, with rim enhancing lesion in the left thalamus, and additional lesion in the splenium of the corpus callosum. S/p biposy of the thalamic lesion without tissue diagnosis and no growth of organisms. S/p empiric trials of antibiotics without improvement. A masslike enhancing lesion is evident spanning the left thalamus and midbrain measuring up to 32 x 25 x 27 mm (tv x ap x cc). The lesion shows thick irregular peripheral enhancement with a heterogeneously non-enhancing, susceptibility rimmed central cavity. Parts of the solid enhancing portion of the lesion show mild diffusion restriction, while the central component is non-restricted. On review of the patient's prior imaging, this lesion has fluctuated in size becoming larger (6/2/15), then smaller (7/7/15), then larger again (7/23/15). These changes may reflect alterations in the medication and steroid regimen, so correlation with the medication administration record is suggested. On the present exam, the lesion continues to increase in size and is larger now than on any prior exam. The lesion extends further into the left cerebral peduncle and midbrain, with moderate deformation of the brainstem and slight midline shift to the right.Also noted in relation to the above lesion is a subtle leptomeningeal enhancement of the surface of the left cerebral peduncle. Infiltrative enhancement is also seen along the left optic tract. These findings were not clearly appreciated on prior exams and may therefore be new.A heterogeneous but largely solidly enhancing lesion is also present involving the central and left splenium. Mild internal susceptibility is seen, along with mild questionable restricted diffusion. As with the larger thalamic lesion, the splenial lesion has also fluctuated in size over prior exams, but continues to grow on the present study.Single and multivoxel spectroscopy was performed on both the above described lesions. Strong lipid resonances are seen in the central cavity of the thalamic lesion, but also in the solid enhancing portions of both the thalamic and splenial lesions. Multivoxel spectroscopy reveals gradually increasing choline and decreasing NAA resonances with approach to the solid enhancing portion of the thalamic lesion. It is important to note that elevated choline is seen even in the normal appearing tissue surrounding the lesion. At its peak, the choline resonance in the solid portion of the thalamic lesion is elevated 4 times relative to distant normal tissue. No evidence of any amino acid peaks (marker of bacterial abscess) is seen, nor of any prominent peaks between 3.8 and 3.6 ppm which are reported in the literature to reflect trehalose, a marker of fungal infection.Sequelae of left frontal approach biopsy are seen. A few scattered non specific foci of T2 hyperintensity are seen in the cerebral hemispheres. No other lesions are seen. The ventricles are not dilated. Progressive mass effect is seen on the left lateral ventricle.

Output: A thickly rim enhancing lesion with central cavitation in the left thalamus is evident. This lesion has fluctuated in size over prior exams, perhaps related to the medication and steroid regimen, but continues to grow and has reached its largest size on the present study. Subtle leptomeningeal enhancement of the left cerebral peduncle, and infiltrative enhancement along the left optic tract, seem to be new findings as well. A similar but smaller lesion in the splenium also continues to increase in size.Spectroscopic assessment of both lesions shows the presence of lipid in the central cavity of the thalamic lesion (expected for necrotic tissue), but also in the solid portions of both lesions. Furthermore, the solid portions show significantly elevated choline, reaching 4x normal in the thalamic lesion. Choline elevation, in fact, is seen not only within the lesion, but also in the surrounding normal appearing parenchyma, with gradual return to normal choline levels as distance from the lesion increases suggesting a diffusely infiltrative process. The combination of infiltrative increased choline and increased lipid in the solid portions of the tumor is rather suggestive of lymphoma. While it is true that rim enhancing lymphoma is an entity more commonly seen in the immunocompromised patient, this patient's age may imply some degree of baseline immunosuppression which could account for the enhancement pattern. If not lymphoma, the elevated choline would in general suggest a highly proliferative process, and as such, higher grade glioma would also need to be considered. The possibility of infection, while considered somewhat less likely, should not be dismissed. The imaging and spectroscopic features seem to exclude a typical pyogenic infection. However, atypical infections, including tubercular and fungal, would be reasonable considerations.


Instruction: Generate impression based on findings.

Input: 62-year-old female with family history of breast cancer in mother (diagnosed at age 50), sister (diagnosed at the age of 40), and a paternal cousin. She is of an Ashkenazi Jewish heritage. Short-term (6 months) follow up MRI is performed. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A 9 mm enhancing mass at posterior 10:00 position and a 5 mm enhancing focus at anterior 11:00 position are unchanged in the right breast. In the left breast, two parallel linear enhancing areas at anterior 6:00 are unchanged.No abnormal enhancement is seen in either breast. No abnormal 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: Metastatic breast cancer, evaluate for leptomeningeal metastasis in lumbosacral spine/cauda equina. Five lumbar type vertebral bodies are presumed to be present. There is evidence of diffuse osseous metastatic disease with particular areas of low T1 signal and marrow replacement identified involving the T12, L1, L5, S1, S2, and S3 vertebral levels. Areas of sclerosis are seen involving the T12 and L1 vertebral bodies in the recent chest/upper abdominal CT studies. There is mild loss of height involving the T12 (also seen on prior CT) as well as the L5 vertebral bodies consistent with pathologic fracture. There is mild anterolisthesis of L4 on L5.There is evidence of epidural tumor extending from L4-L5 to the S3 levels. Axial images are severely motion degraded. There appears to be up to moderate spinal canal stenosis related to the epidural tumor from L5 to the S3 levels.Individual levels as below: T12-L1: No significant spinal canal stenosis. Sagittal images demonstrate mild to moderate right and minimal left neural neural foramina narrowing related to tumor involving the posterior elements at T12 extending into the neural foramina.L1-L2: No spinal canal or neural foraminal stenosis.L2-L3: No spinal canal or neural foraminal stenosis.L3-L4: No spinal canal or neural foraminal stenosis.L4-L5: There is moderate spinal canal stenosis related to mild anterolisthesis, disk bulge, ligamentum flavum thickening, and facet arthropathy. There is minimal component of epidural tumor contributing to stenosis at the inferior aspect of this level. No significant neural foraminal stenosis. Advanced facet arthropathy.L5-S1: There is a right central and paracentral disk protrusion which effaces the lateral recess. There is also facet arthropathy and ligamentum flavum thickening. Degenerative changes and epidural tumor result in mild to moderate central spinal canal narrowing. There is also moderate bilateral neural foraminal stenosis, worse on the right than the left related to combination of degenerative disease and epidural tumor. Moderate facet arthropathy.Motion degradation limits evaluation. However there is extensive tumor infiltration involving the sacrum and iliac bones worse on the right than the left. There is mild encroachment into the bilateral S1-S2 neural foramina.

Output: 1. There is evidence of diffuse osseous metastatic disease involving the lumbar spine, visualized lower thoracic spine, and pelvis. There is relatively greater involvement from the L5 to S3 levels with epidural tumor as described above resulting in up to moderate spinal canal stenosis. Epidural tumor in the spinal canal appears relatively worst at the S2 level near the expected level of the termination of the thecal sac. Abnormal enhancement within the lumbosacral spinal canal appears mostly if not all epidural. Severe motion degradation on the axial images significantly limits evaluation however, no definite evidence of leptomeningeal disease is demonstrated.2. Moderate narrowing of the L5-S1 neural foramina related to epidural tumor and to a lesser degree the S1-S2, and T12-L1 neural foramina. 3. Moderate spinal canal stenosis at L4-L5 which appears predominantly on a degenerative basis. Advanced facet arthropathy and grade 1 anterolisthesis noted at this level. 4. Mild pathologic compression fractures at T12 and L5.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with multiple sclerosis. Evaluate for progression. Brain:Multiple scattered T2 hyperintense lesions are seen within the periventricular and subcortical white matter. Some of these are oriented radially with respect to the ventricles. The brainstem and cerebellum are relatively preserved. On comparison with the prior examination, no significant interval change in size or number of lesions is seen.No enhancing lesions are demonstrated. No evidence of significant local generalized edema is seen. No findings to suggest intracranial hemorrhage or any other abnormal extra axial fluid collection is detected. The ventricles are normal in size and morphology.C-spine:A T2 hyperintense lesion is evident within the dorsal cord at C2 with no corresponding pathologic enhancement demonstrated. Within the limitations of motion degradation, no definite additional spinal cord lesions are seen.There is a reversal of the cervical lordosis centered at C5-6. A trace anterolisthesis of C4 relative to C5 is noted. A trace retrolisthesis of C6 relative to C7 is noted. Vertebral body height and morphology are unremarkable.The visualized spinal cord is unremarkable except as discussed above. No pathologic cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.Disc degeneration is seen most notably at C6-7 and to a lesser degree at C5-6. Additional level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Right facet arthropathy. No spinal canal stenosis. Moderate right foraminal narrowing. C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation asymmetric to the left. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C7-T1: Left facet arthropathy. No significant spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Multiple lesions are redemonstrated in the brain compatible with demyelinating disease. There has been no significant interval change in lesion size or number. No enhancing lesions are identified.2.A lesion is evident within the ventral spinal cord at C2 with no associated enhancement. There is no prior examination for comparison.3.Level disc degeneration is seen. No high-grade spinal canal stenosis is noted. However, scattered mild to moderate foraminal narrowing is demonstrated.


Instruction: Generate impression based on findings.

Input: Male, 48 years old, with history of multiple myeloma and brain metastases, left optic nerve infiltration, status post three cycles of HD methotrexate and proton beam therapy, currently at subacute rehabilitation facility. Brain:Since the prior examination, a right frontal approach ventricular catheter has been placed with its tip in the right lateral ventricle. Minimal evidence of prior endoscopic intervention is also seen.Significant interval improvement is seen in the degree of left frontal edema arising from the previously demonstrated enhancing lesion. Only a small amount of residual T2 signal abnormality and susceptibility effect are seen, and there is no longer any mass effect. Without the benefit of contrast, the size of any residual enhancing component cannot be assessed, though the lesion in its entirety does appear to be significantly smaller. The pineal region mass has also substantially improved such that it is no longer discretely identifiable.No new areas of parenchymal signal abnormality are seen. No abnormal extra-axial fluid collections are detected. Mild interval brain parenchymal volume loss is seen when compared to the prior examination. The ventricles are consequently slightly larger than on prior but they are not dilated. Without the benefit of contrast, abnormalities of the optic apparatus are not adequately assessed. However, no gross optic nerve lesions are seen.Cervical spine:A subcentimeter focus of STIR hyperintensity is unchanged within the C4 vertebral body. No new marrow space lesions are seen. Spinal alignment is anatomic and the vertebral body heights are preserved. The spinal cord demonstrates normal signal intensity and morphology throughout. No focal cord lesions are seen. No epidural abnormalities are suspected. The intervertebral discs are preserved with no areas of high-grade spinal canal or foraminal stenosis.Only the sagittal T1-weighted images of the thoracic spine were able to be acquired. Given this very limited examination, no gross marrow space lesions are seen.

Output: 1.Significant interval reduction in the size of the previously seen left frontal lobe lesion with much reduced edema and mass effect.2.Complete or near complete resolution of the previously seen pineal region tumor.3.Given the limitations of a noncontrast examination, no gross abnormalities of the optic apparatus are seen.4.No definite myelomatous lesions are detected in the cervical spine.


Instruction: Generate impression based on findings.

Input: The heterogeneously enhancing, well circumscribed ovoid mass extending from the T4-5 to the T5-6 level measures 4.7 x 3.1 x 3.4 cm, not significantly changed when measured similarly. There is no evidence of extension into the spinal canal. The lumbar spine is in normal alignment, with a normal lumbar lordosis. There are central endplate depressions from T11 to L1 and mild anterior wedging of the L1 vertebral body are stable. The vertebral body and disc heights are otherwise well-maintained. The T10 hemangioma is unchanged, as are two well-defined areas of low T1 and T2 signal in the T7 vertebral body with subtle enhancement. The spinal cord signal is normal throughout. There is no significant disc bulge, herniation, spinal canal, or foraminal stenosis within the thoracic spine. There is a small right renal probable cyst only apparent on the localizer images.

Output: 1. Stable size and appearance of the right thoracic paraspinous mass most compatible with a peripheral nerve sheath tumor.2. Unchanged hemangioma in the T10 vertebra and enhancing lesions in the T7 and T9 vertebral bodies, which may represent atypical hemangiomas. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The examination is limited by motion artifact. There is scattered periventricular white matter and pontine T2 hyperintensity and a small lacunar infarction in the left basal ganglia and corona radiata, but no evidence of acute infarction. There is no midline shift or mass effect. There is diffuse prominence of the cortical sulci in proportion to the ventricles consistent with mild global volume loss. There is a persistent cavum septum pellucidum and vergae. There is an enlarged partially empty sella. There is no abnormal enhancement. There is a fluid level in the right maxilla sinus and there is mild mucosal thickening of the ethmoid sinus. There is a small left maxillary retention cyst.

Output: 1. Sequela of chronic microvascular ischemic change and lacunar infarct in the left basal ganglia and corona radiata without evidence for acute infarction.2. Right maxillary sinus air-fluid level and mucosal thickening of the ethmoid air cells suggest acute sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Severe neck stiffness (less than 20 degrees in any direction x1 month). History of Hepatocellular carcinoma. There is an enhancing lesion in the dens and a portions of the C2 body anteriorly. There is diffuse heterogeneous bone marrow signal from C3 through C7 with endplate irregularities and small disc-osteophyte complexes that appear to mildly indent the spinal cord. The vertebral body heights appear to be grossly preserved, however. There is no evidence of significant lymphadenopathy in the neck. The salivary glands are unremarkable. There is a T1 and T2 hyperintense nodule in the left thyroid gland that measures up to 7 mm. There are T1 hyperintense secretions in the right sphenoid sinus. There is a small amount of fluid in the left mastoid air cells. The imaged portions of the intracranial structures and orbits are unremarkable.

Output: 1. A lesion in the dens and a portions of the C2 body anteriorly likely represents metastatic disease. 2. Diffuse heterogeneous bone marrow signal from C3 through C7 is likely degenerative in nature, with endplate irregularities and small disc-osteophyte complexes that appear to mildly indent the spinal cord. 3. A small nodule in the left thyroid gland likely represents a colloid cyst.


Instruction: Generate impression based on findings.

Input: Male 56 years old. Reason: s/p fall 3 wks ago with pelvic fx on MRI; assess for healing. History: improving pain A single AP view of the pelvis shows a nondisplaced fracture of the inferior ramus of the right pubic bone. The fracture line is indistinct which may represent some healing. Additional obturator ring fractures seen on prior MRI are not clearly visualized on the current study.There is disruption of the right first sacral arcuate line corresponding to the nondisplaced sacral ring fracture on MRI.Mild osteoarthritis affects both hips. There is degenerative disk disease of the lumbar spine.

Output: Pelvic fractures as described above, some of which are not well seen on this radiograph compared to the previous MRI.


Instruction: Generate impression based on findings.

Input: Evaluate for retrocochlear pathology: asymmetric SNHL, left worse than right; tinnitus and dizziness. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: 75-year-old male with history of colon cancer, metastatic to the liver. Patient status post liver resection now with elevated alkaline phosphatase. Evaluate for etiology. ABDOMEN:LUNG BASES: Bilateral small pleural effusions with the right decreased in size compared to previous examination.LIVER, BILIARY TRACT: Postoperative changes of right hepatectomy. There is thrombus in the hepatic vein in the medial hepatic segment 4A/4B. The thrombus occludes the segment 4 hepatic vein; this is due to narrowing at the confluence of the veins near the dome. This causes perfusion changes in segment 4 of the liver. The segment 2 vein is also narrowed but patent. The IVC is narrowed at the intrahepatic portion. Additionally, there is a fluid collection near the resection margin measuring 3.8 x 1.2 cm (series 6, image 22). Right subdiaphragmatic drain is present.No significant change in T2 hyperintense segment 4 lesion consistent with a cyst measuring 1.3 x 1.3 cm (series 6, image 29), previously measuring 1.5 x 1.2 cm. An additional smaller T2 hyperintense lesion in segment 2 of the liver consistent with a cyst is stable (series 6, image 30).SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is atrophic but otherwise appears normal.ADRENAL GLANDS: Adrenal glands are normal in size and morphology bilaterally.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Visualized bowel is moderately distended measuring up to 3.5 cm with transition point likely in the right lower quadrant. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Thrombus in the hepatic vein in the medial hepatic segment 4A/4B.2.Segment 2 vein is also narrowed but patent.3.Fluid collection near the resection margin measuring up to 3.8 cm.4.Postoperative changes of right hepatectomy without suspicious hepatic lesions. 5.Findings consistent with small bowel obstruction.6.Bilateral small pleural effusions.Findings relayed to Dr. Xue over the phone at approximately 5:05 PM.


Instruction: Generate impression based on findings.

Input: Altered mental status, multiple myeloma. The images are degraded by patient motion. There is a mass centered 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: History of metastatic carcinoid tumor. Interval follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: There is redemonstration of multiple T2 hyperintense enhancing lesions throughout the liver. Accounting for differences in technique, the majority of the lesions appear slightly smaller compared to prior. The reference segment 7 lesion measures 2.1 x 1.5 cm (series 8 image 22), previously 2.1 x 1.9 cm. No new lesions are identified.There is stable prominence of the common bile duct measuring 11 mm, previously 12 mm. No obvious stricture or mass lesion.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum without pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst and additional bilateral T2 bright foci which are too small to characterize but also likely represent additional cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slight interval decrease in size of multiple hepatic metastatic lesions compatible with treatment response. No new lesions are identified.2.Stable mild dilatation of the common bile duct.


Instruction: Generate impression based on findings.

Input: Recent recurrent small bowel obstruction. Evaluate for extent of Crohn's disease. 6/13/2014 biopsy showed mildly active chronic enteritis of the ileum. 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: The small bowel is adequately distended with oral contrast.There are long segments of fixed narrowing, indicating strictures, involving the small bowel in the right hemiabdomen including the terminal ileum and distal small bowel with associated fibrofatty perforation, mild circumferential wall thickening, restricted diffusion and postcontrast enhancement. These are not completely contiguous compatible with at least 3 skip lesions. There is moderate prestenotic/upstream small bowel dilatation, however these are not flow limiting strictures as there is oral contrast in the right colon. The lesion of the terminal ileum involves approximately 9 cm. More proximally there is a lesion measuring approximately 15 cm.There is mild angulation of the small bowel in the right lower quadrant towards the mesentery suggesting non-obstructive adhesive inflammatory changes.Also note is made of a pedunculated polypoid lesion in the distal small bowel measuring 1 cm (series 15/28), compatible with an inflammatory polyp.No free fluid or loculated fluid collection. No specific findings of sinus tract or fistula formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal skips lesions of acute inflammatory changes of the distal small bowel superimposed on moderate length nonflow-limiting chronic strictures. There is upstream/prestenotic dilatation of the small bowel, consistent with partial obstruction (fluid seen distally in colon). The total length of disease involvement is at least 24 cm.At least one presumed inflammatory polyp in the distal small bowel, measuring up to 1 cm.


Instruction: Generate impression based on findings.

Input: 69-year-old female with pain and buckling. Evaluate for internal derangement. MENISCI: There is branching intermediate signal intensity within the anterior horn of the lateral meniscus extending to both the tibial and femoral articular surfaces indicating a complex tear with underlying meniscal degeneration. There is blunting of the free edge of the body of the meniscus likely representing extension of this tear. There is also increased signal intensity within the inner fibers of the posterior horn of the lateral meniscus, near its root, which may represent degeneration and free edge fraying/tearing. There is mild increased signal intensity within the medial meniscus suggesting intrasubstance degeneration, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is moderate to severe degeneration of the articular cartilage of the patellofemoral joint with areas along the patella completely devoid of articular cartilage and associated with degenerative subchondral signal abnormality. There is relatively mild cartilage degeneration affecting the tibiofemoral articulation. There is mild tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Complex tear of the lateral meniscus, predominantly involving the anterior horn.2. Osteoarthritis with cartilage degeneration most severely affecting the patella.3. Small joint effusion.4. Nonspecific edema within the soft tissues anterior to the patella.


Instruction: Generate impression based on findings.

Input: There is a pineal region mass that results in mass effect upon the midbrain tectum, aqueduct, and superior vermis. The mass enhances and demonstrates mild diffusion restriction compatible with high cellularity and measures 36 x 28 x 26 mm in the AP by transverse by CC dimensions (series 1202 image 39 and series 401 image 13). There are central punctate foci of susceptibility effect corresponding to calcification on recent CT. There is significant dilatation of the lateral and third ventricles unchanged from the recent CT. There is periventricular T2 hyperintensity compatible with subependymal CSF flow secondary to hydrocephalus. There is no definitely suprasellar mass, although the infundibulum is foreshortened due to the bulging third ventricular floor.There is no evidence of intracranial hemorrhage acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Large enhancing pineal region mass with central calcifications and resultant obstructive hydrocephalus secondary to mass effect upon the aqueduct, with transependymal edema. While the appearance is most suggestive of a germ cell tumor, other pineal neoplasms remain with the differential.


Instruction: Generate impression based on findings.

Input: History of HCV and EtOH cirrhosis, outside CT with hypodense lesions in liver. Evaluation is significantly limited by motion.ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with diffuse nodularity and reticular increased T2 signal suggestive of fibrosis. In segment 2, there are 2 lesions corresponding to the hypodense lesions seen on recent CT. The first lesion measures 1.7 x 1.7 cm and the second lesion measures 1.7 x 1.6 cm (series 5, image 7). Both lesions demonstrate mildly hyperintense T2 signal and hypointense T1 signal. The lesions do not demonstrate definite arterial enhancement, though this is limited by motion. The signal characteristics are suggestive of regenerative nodules. There is possibly a third similar lesion within segment 2 with similar signal characteristics. There is an additional lesion within the posterior aspect of the right hepatic lobe (series 8, image 18) with similar signal characteristics. A few additional smaller nodules throughout the liver are too small to characterize. The portal venous system appears patent. Evaluation of the hepatic arteries and veins is limited by motion. No biliary ductal dilatation.SPLEEN: Massive splenomegaly with spleen measuring up to 2.6 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is mild prominence of the right renal pelvis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild ascites.

Output: 1.Examination limited by patient motion.2.Cirrhotic liver with massive splenomegaly and mild ascites.3.Multiple hepatic lesions suggestive of cirrhosis related nodules without definite benign or malignant features, corresponding to the previous CT findings, although evaluation is somewhat limited by motion. Continued attention to these lesions on follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Pain after injury Left ring finger: Mild soft tissue swelling surrounds the index finger particularly at the level of the PIP joint. There is no fracture or dislocation.Right wrist: The fracture described on prior MRI is not appreciated on these radiographs. There is mild diffuse soft tissue swelling of the wrist.

Output: Mild soft tissue swelling of the right wrist and left ring finger without radiographic evidence of fracture.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis and lower extremity weakness. Brain: There are multiple supratentorial and infratentorial T2 hyperintense lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Spine: There are diffuse patchy T2 hyperintense lesions within the cervical spinal cord, which are not significantly changed. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are prominent posterior disc-osteophyte complexes at T5-6, T6-7, and T9-10, which indent the spinal cord. The thoracic spinal cord signal otherwise appears unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No significant interval change of the demyelinating lesions in the brain.2. No significant interval change of the demyelinating lesions in the spinal cord.3. Prominent posterior disc-osteophyte complexes at T5-6, T6-7, and T9-10, which indent the spinal cord.


Instruction: Generate impression based on findings.

Input: There is a 10 mm AP x 12 mm transverse x 14 mm lesion within the anteromedial right temporal lobe which is heterogeneously yet primarily T2 hyperintense surrounded by a rim of multisequence hypointensity. This is associated with elevated susceptibility hypointensity, yet does not exhibit perilesional edema. Additionally, along its anteromedial aspect there is an associated developmental venous anomaly. There are no other lesions identified on susceptibility imaging.A large developmental venous anomaly is noted involving the right cerebellar hemisphere. There is no associated lesion demonstrating susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.MRI findings consistent with a right temporal lobe cavernous malformation with associated developmental venous anomaly. There is no perilesional edema.2.A large developmental venous anomaly is noted involving the right cerebellar hemisphere. There is no associated lesion demonstrating susceptibility abnormality.


Instruction: Generate impression based on findings.

Input: 31-year-old male. Clinical question to be answered: Intracranial hemorrhage. Signs and symptoms: Acute cysts left ear. Changes consistent with patient's history of pituitary adenoma with enlarged sella are again identified with no interval change since prior exam. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. This examination remains a stable since prior study. Exclude residual pituitary tumor an MRI examination with infusion is the appropriate study.Mastoid air cells and middle ear cavities are unremarkable. Limited view of paranasal sinuses are unremarkable.

Output: No areas of interval change since prior examination from 6 -- 28 -- 2009.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:5/6/1964)Reason: lumbar radiculopathy vs. MS History: R leg weaknessReferring Attending: RICHARD W KANG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild facet hypertrophy at this level.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.The uterus appears fairly large with multiple signal void type lesions.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.The uterus appears be fairly large with multiple signal void the lesions. One possibility is this represents fibroids. The uterus however is not included in its entirety on this exam and is not adequately evaluated. Please correlate with patient's clinical history and other studies.


Instruction: Generate impression based on findings.

Input: History of liver mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. There is a 3.5 x 3.1 cm lesion which appears to be exophytic from the posterior aspect of segment 2. The lesion is mildly hypointense on T1 weighted images and mildly hyperintense on T2-weighted images. On postcontrast images the lesion demonstrates subtle peripheral discontinuous nodular enhancement which progressively increases centrally on more delayed images. The lesion does not fully fill in on the sequences obtained. The lesion demonstrates mass effect on the lesser curvature of the stomach.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: Note is made of a linear signal void within the abdominal aorta on some of the imaging sequences, likely represents an artifact.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 3.5 cm exophytic lesion from segment 2 of the liver with imaging characteristics most suggestive of a hemangioma, with some atypical features: T2 mild hyperintensity and incomplete central contrast filling. A 6 month follow-up examination to confirm stability is recommended.


Instruction: Generate impression based on findings.

Input: 65 year old male with a history of multiple arrhythmias including non-sustained ventricular tachycardia and frequent PVCs, supraventricular tachycardia, and paroxysmal atrial fibrillation who is referred for cardiac MRI for further evaluation.MEDICATIONS: Atenolol and Aspirin. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Dark rim artifact is noted at stress and rest. Viability/ Myocardial ScarThere is evidence of mid-myocardial late gadolinium enhancement in the basal inferior and inferolateral, basal anteroseptum, and apical right ventricular insertion site. These patterns are not typical for prior myocardial infarction and suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is moderately dilated with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 244 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 117 ml (normal range 47+/-19), the LV mass index is 34 g/m2, and the LV mass is 66 g. There is global hypokinesis. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 128 ml/m2 (normal range 82+/-16), the RVEDV is 245 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 109 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.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 obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. 3. The left ventricle is moderately dilated with low normal systolic function (LVEF 52%) and evidence of myocardial fibrosis, inflammation, or infiltration as described above. 4. The right ventricle is mildly dilated with normal systolic function (RVEF 56%).5. Severe biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari malformation, back pain. There is a relatively small posterior fossa and there is platybasia with a somewhat hypoplastic clivus. There are low-lying, pointed cerebellar tonsils that extend nearly 20 mm inferior to the foramen magnum, resulting in marked impendence to cerebrospinal fluid flow in the craniocervical junction region and mass-effect upon the cervicomedullary tissues. There is mild prominence of the upper cervical spinal cord central canal. The rest of the spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are mild disc bulges in the lumbar spine, but no significant spinal canal or neural foraminal stenoses. The paravertebral soft tissues are unremarkable.

Output: 1. Dysmorphic posterior skull base as low-lying, pointed cerebellar tonsils that extend nearly 20 mm inferior to the foramen magnum, resulting in marked impendence to cerebrospinal fluid flow in the craniocervical junction region2. Apparent mild upper cervical spinal cord syrinx.


Instruction: Generate impression based on findings.

Input: There is a left frontal and parietal hemispheric extra-axial fluid collection which has slightly hyperintense T1 signal with respect to CSF and T2/FLAIR hyperintense signal measuring up to 5 mm in maximal thickness on coronal T2 image 12. There is mild mass effect on the regional gyri and sulci but there is no significant midline shift or herniation. There is no acute infarct. There is no suspicious intracranial enhancement. The ventricles are unchanged with persistent dilatation of the fourth ventricle. There is moderate to severe global volume loss.There are unchanged remote postoperative signs related to suboccipital craniotomy with minimal T2 signal abnormality adjacent to the fourth ventricle. There are scattered foci of susceptibility effect in the right anterior temporal lobe, left parietal/temporal lobe, left cerebellar hemisphere, and at the postoperative site.There is moderate opacification of the bilateral mastoid air cells, new from prior exam. There are new small bilateral sphenoid sinus air fluid levels.

Output: 1.Thin left frontal and parietal hemispheric subacute subdural hematoma measuring up to 5 mm in maximal thickness with minimal localized mass-effect and no midline shift.2.No evidence of recurrent tumor.3.Nonspecific fluid opacification of mastoid air cells bilaterally as well as small air-fluid level in the right sphenoid sinus. Please correlate clinically.Findings were discussed with resident Dr. Warren Alperstein by Dr. Uppuluri over the telephone at 12:14 p.m. today.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 52 years old Reason: puncture wound 2/2 bite, r/o infection vs. fracture History: animal bite There is swelling of the soft tissues of the index finger. We see no fracture. There is a 1 mm round lucency in the base of the distal phalanx of the index finger, which appears to have thin sclerotic margins and is favored to represent a degenerative cyst. However, if there is strong clinical concern for penetration of bone and/or osteomyelitis, MRI may be considered for further evaluation. Osteoarthritis affects the interphalangeal joints.

Output: 1.Soft tissue swelling without fracture.2.Round lucency in the base of the distal phalanx of the index finger likely represents a degenerative cyst. However, if there is strong clinical concern for penetration of bone and/or osteomyelitis, MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with spastic legs, worse on the right. Evaluate for lesions that could represent multiple sclerosis. There is a trace retrolisthesis of C5 relative to C6. Otherwise, sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits.Degenerative endplate signal abnormality is seen at C5-6 and C6-7. A small subchondral cystic focus is also likely present superiorly at C6. No worrisome marrow replacement is identified.The visualized spinal cord shows normal signal intensity and morphology. No focal lesions are seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Loss of disc height with disc osteophyte formation. Effacement of the ventral thecal sac without significant generalized canal stenosis. Mild bilateral foraminal narrowing. C6-7: Loss of disc height with minimal disc osteophyte formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.No spinal cord lesions are seen to suggest demyelinating disease or any other specific pathologic process.2.Degenerative disc disease is evident at C5-6 and C6-7 but there is no significant generalized spinal canal stenosis and only mild associated foraminal narrowing.


Instruction: Generate impression based on findings.

Input: 57-year-old male with history of complex ischiorectal fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter lower pelvic and external iliac nodes.BOWEL, MESENTERY: Again seen is a complex fistula with multiple branching sinus tracts arising from the 1:00 position of the lower rectum. There is a moderate amount of fibrosis around the origin of the fistula. The first branch terminates on the skin surface of the midline gluteal cleft. The sinus tract then branches into anterior and posterior components. The anterior components heads towards the scrotum. The posterior component courses to the skin surface at the right gluteal cleft. The tracts are wider and more prominent when compared to prior.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Worsening complex ischiorectal fistula as above.


Instruction: Generate impression based on findings.

Input: History of right IJ (treated in 2014) and left IJ stenosis (untreated), now with generalized weakness and poorly controlled hypertension. There is a new subcentimeter T2 hyperintense lesion in the left thalamus without convincing restricted diffusion. Multiple cerebral white matter T2 hyperintense lesions are otherwise unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mild mucosal thickening in the maxillary sinuses. There are prominent scalp veins.

Output: 1. A new subcentimeter T2 hyperintense lesion in the left thalamus without convincing restricted diffusion may represent a late subacute infarct. Otherwise, the probable chronic small vessel ischemic white matter disease and lacunar infarcts appear unchanged.2. Prominent scalp veins may be related to jugular vein stenosis.


Instruction: Generate impression based on findings.

Input: Slurred speech [R47.81], Reason for Study: ^Reason: stroke workup History: dysarthria Brain MRIThere are scattered multiple diffusion restriction on the left precentral gyrus indicating acute ischemic infarct. There is no evidence of hemorrhagic transformation.There are also increased FLAIR/T2 high signal intensity lesion with tissue loss on the right inferior parietal lobule, in particular supra marginal gyrus as well as left cerebellar hemisphere indicate chronic ischemic infarct with encephalomalacia.Scattered and somewhat patchy T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left vertebral artery and is with left PICA.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Left vertebral artery appears to be hypoplastic.

Output: 1. Acute ischemic infarct without evidence of hemorrhagic transformation on the left MCA territory, left frontal lobe precentral gyrus.2. Chronic ischemic infarct with encephalomalacia on the right MCA territory, inferior parietal lobule as well as left cerebellar hemisphere. 3. Nonspecific small vessel ischemic disease.4. No evidence of luminal stenosis, major vessel occlusion on post intra and extra cranial arterial system.5. No evidence of intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Rule out intracranial hemorrhage. Signs and symptoms: Altered mental status and headaches. Heavy large vessel intracranial vascular calcification of vertebral arteries and carotids are noted. Large area of vasogenic edema in the right temporal lobe with extension into right parietal is noted. There is associated mass effect and midline shift to approximately 7 mm. no evidence of hemorrhage is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Follow-up exam but a dedicated MRI examination is highly recommended. This finding is concerning for malignancy or possibly an infectious process.

Output: Significant right-sided vasogenic edema with associated mass effect as detailed. Follow-up exam with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 59 years Male (DOB:10/26/1956)Reason: Pt is a 59 y/o male with met prostate cancer, now with worsening back, hip, and leg pain, evaluate for progression of disease, attention to L5 lesion History: back, hip leg pain, L5 lesionReferring Attending: RUSSELL Z SZMULEWITZ 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. No abnormal enhancing lesions are appreciated in the lumbar spine. There is a 16 x 12 mm enhancing focus present within the superior aspect of the L5 vertebral body eccentric towards the left side it is contiguous with the adjacent disc in the adjacent endplates appears to be disrupted it can also be identified on the CT scan from 6/2/2015.There is a 18 x 16 mm sagittal dimension enhancing focus was a cystic central component located within the inferior aspect of the L1 vertebral body which is left of center. This was not evident on the CT scan from 6/2/2015.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with mild posterior subluxation of L5 on S1 and some partial effacement of the fat at the lateral recess bilaterally. There is some mild facet hypertrophic changes present at this level. Some disc material extends into the right neural foramen at this level and mildly encroaches on the right-sided exiting nerve roots.At L4-5 there is a diffuse disc bulge present associated loss of disc space height and disc desiccation and moderate bilateral facet and ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level. There is triangulation of the thecal sac. Overall there is a mild to moderate spinal stenosis at this level. There are subchondral cysts along the facet joints at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Findings are concerning for retroperitoneal lymphadenopathy especially at the L4 and L3 vertebral body levels

Output: 1.There is an L1 vertebral body lesion present. The possibility this represents metastatic disease cannot be excluded.2.There is an L5 vertebral body lesion present which has a general appearance of a Schmorl's node and has been present on a prior CT scan from last year.3.Findings are concerning for retroperitoneal lymphadenopathy. Please correlate with CT of the abdomen findings4.There are multilevel degenerative changes present in the lumbar spine with mild to moderate spinal stenosis at L4-5 where there is some encroachment of the nerve roots at the lateral recess is as well as mild encroachment of the right-sided exiting nerve roots at L5-S1


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB:5/20/1965)Reason: back pain History: back painPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present this level associated disc desiccation and loss of disc space height. There is some partial effacement of the fat at the lateral recess bilaterally at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation as well as a disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation as well as a disc bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are some degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Right-sided weakness. Non-enhanced CT brain:The examination is suboptimal due to fact that patient was unable to lie flat for study. The images are noisy and evaluation for subtle findings is not possible. Within this limitation however no definitive evidence of any abnormality is identified. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Recommend repeat CT or an MRI of brain if concern for stroke persist.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: Suboptimal exam due to difficulty positioning the patient within the gantry properly. No gross abnormalities detected. Follow up with repeat CT exam or an MRI is recommended if clinical concern for stroke persist.