Instruction: Generate impression based on findings.

Input: 48-year-old female with brain edema and brain metastases undergoing preoperative planning for possible left crani for largest mass resection. Limited sequences were obtained for the purposes of treatment planning. Redemonstrated are multiple enhancing brain lesions with associated surrounding edema, some of which abut the dural surface. The largest is again seen in the left frontal lobe just deep to the superior frontal sulcus which measures 2.9 x 2.4 cm (series 301, image 142). There is some susceptibility abnormality indicating intratumoral hemorrhage. The associated vasogenic edema is marked and causes 1 cm of focal rightward subfalcine herniation. A second relatively large lesion adjacent to the floor the left middle cranial fossa is more heterogeneously enhancing and has more susceptibility abnormality indicating more intratumoral hemorrhage. This lesion also has associated adjacent vasogenic edema, with complete effacement of the left temporal horn. The associated mass-effect results in asymmetric widening of the left ambient cistern and minimal medial displacement of the left uncus. Midline shift to the right measures 6 mm. There is also partial effacement of the remaining left lateral ventricle and third ventricle is not visualized. The right lateral ventricle is slitlike.Other smaller lesions are present in the right parieto-occipital region, posteromedial right temporal lobe in the periatrial location, and the left cerebellar hemisphere. Smaller lesions are seen in the medial right brachium pontis as well. Even smaller lesions are suggested scattered along the gray-white junction diffusely.There is lobulated mucosal thickening within the maxillary sinuses bilaterally. Partially empty sella is suggested. There there are no enhancing lesions involving the calvarium.

Output: Examination for treatment planning. Multiple supratentorial and infratentorial enhancing lesions are consistent with metastatic disease. The largest is in the left frontal lobe with extensive associated vasogenic edema. There is 6 mm rightward midline shift and findings of early uncal herniation.


Instruction: Generate impression based on findings.

Input: 58 year-old female with liver mass on CT examination. ABDOMEN:LIVER, BILIARY TRACT: Note is made of multiple subcentimeter fluid signal intensity foci in the liver, which are most consistent with simple cyst. The no enhancing mass lesions are identified. No suspicious enhancing mass lesions are identified. No evidence of intra or extrahepatic biliary ductal dilation. SPLEEN: Subcentimeter splenule. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple hepatic simple cysts, without evidence of a suspicious hepatic mass lesion, as clinically questioned. Of note, the comparison images from the outside institution CT did not show the entire liver.


Instruction: Generate impression based on findings.

Input: 78-year-old female with ankle pain. Rule out right ankle neoplasm. TENDONS: There is a small amount of fluid within the tendon sheath of the posterior tibialis which may represent extension of fluid from the tibiotalar joint. LIGAMENTS: The ligaments appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified.ADDITIONAL

Output: Soft tissue swelling/subcutaneous edema along the medial aspect of the ankle.


Instruction: Generate impression based on findings.

Input: Systemic lupus erythematosus with altered mental status and seizures. Assess for lupus cerebritis. There is a gyriform area of restricted diffusion, susceptibility artifact, and peripheral enhancement in the right frontal lobe with surrounding vasogenic edema. The lesion is associated with peripheral contrast enhancement that measures up to 25 mm. There is a similar appearing lesion involving the left basal ganglia that measures up to 15 mm. There are also areas of T2 hyperintensity and swelling involving the bilateral thalami, right basal ganglia, and right midbrain. In addition, there are patchy areas of restricted diffusion and T2 hyperintensity without associated enhancement in the bilateral corona radiata and centrum semiovale. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a partially-empty sella. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter right maxillary alveolar cystic lesion, which may represent a periapical or globulomaxillary cyst.

Output: Multifocal cerebral and midbrain lesions associated with areas of hemorrhage, peripheral enhancement, as well as surrounding vasogenic edema may represent acute and subacute infarcts related to lupus vasculitis. Septic emboli from endocarditis (Libman-Sacks) or other infectious process, such as Hurst disease (acute hemorrhagic leukoencephalitis), are alternative considerations in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: History of ovarian cancer presenting with a palpable inguinal mass. PELVIS:UTERUS, ADNEXA: The uterus contains numerous fibroids. The largest is arising from the left aspect of the fundus in a subserosal location. There is redemonstration of a submucosal nodule along the posterior aspect of the endometrial canal (series 801 image 26). This remains indeterminate in appearance but could represent a submucosal fibroid, but a polyp is an additional consideration.The left ovary is surgically absent. There is redemonstration of a left hydrosalpinx which is perhaps slightly smaller when compared to prior.There are 2 focal cystic structures one in the left adnexa (series 801 image 21) the other in the presacral soft tissues (series 801 image 1) which given the patient's operative history likely reflect peritoneal inclusion cysts.Right ovary is normal in size containing several small follicles. The dominant cyst has crenulated peripheral enhancement compatible with a corpus luteum.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is loculated fluid within the right inguinal canal without associated enhancement or nodularity. This appears similar to outside hospital CT from 11/19/2013. This presumably correlates with the patient's palpable inguinal mass.OTHER: Moderate volume of free fluid within the pelvis which is slightly decreased when compared to prior.

Output: 1.Loculated fluid in the right inguinal canal without associated nodularity or enhancement appears similar to prior CT from 11/19/2013 and presumably correlates with the patient's reported palpable inguinal mass.2.Multiple pelvic findings presumably related to prior surgery including absence of the left ovary and presence of left hydrosalpinx and simple cysts which presumably reflect peritoneal inclusion cysts (large dominant cyst seen on prior MRI improved in size).3.Indeterminate submucosal lesion in the lower uterine canal which may reflect a submucosal fibroid or endometrial polyp. Malignancy is considered less likely given the stability but correlation with patient's history recommended and tissue sampling should be pursued as clinically indicated.4.Multiple uterine fibroids.


Instruction: Generate impression based on findings.

Input: Female 50 years old; Reason: history metastatic renal cancer. presumed RT induced esophageal ulcer, with esophageal stent, assess for cancer progression History: epigastric pain CHEST:LUNGS AND PLEURA: Interval development of a small left pleural effusion.MEDIASTINUM AND HILA: Reference left para-aortic lymph node measures 1.2 x 0 .9 cm, previously 1.3 x 1.3 cm (image 687/series 2102). CHEST WALL: Surgical changes above the xiphoid process.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are postsurgical changes in the caudate. The reference poorly enhancing lesion within the right hepatic lobe measures 1.0 cm, previously 0.8 cm (image 533; series 2103), suspicious for metastatic disease. There is mild intrahepatic biliary ductal dilatation, unchanged. The hepatic and portal veins are patent.SPLEEN: The spleen is absent.PANCREAS: The pancreatic body and tail are severely atrophic. This is possibly due to radiation. Pancreatic duct is mildly prominent but not dilated, unchanged.ADRENAL GLANDS: Right adrenal gland is unremarkable. Left adrenal gland has been resected.KIDNEYS, URETERS: Status post left nephrectomy. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: There postsurgical changes near the gastroesophageal junction. There is interval development of gastrohepatic lymphadenopathy (image 102: Series 2201).BOWEL, MESENTERY: Again seen is diffuse circumferential wall thickening of the distal esophagus near the GE junction. There is also thickening of the gastroesophageal junction, unchanged. This is in the region of prior nodal tumor. There is focal soft tissue thickening involving the gastric wall near the fundus about the gastroesophageal junction measuring 2.5 x 2.4 cm, previously 2.3 x 2.1 cm (image 593 series 2201). BONES, SOFT TISSUES: Postsurgical changes in the intra-abdominal wall and chest wall.OTHER: No upper abdominal fluid collections.

Output: 1.Persistent diffuse distal esophageal wall thickening with a soft tissue nodule in the adjacent gastric wall. This is located in the site of prior nodal disease and may represent recurrent disease.2.Persistent right hepatic lobe lesion.3.Persistent periaortic lymphadenopathy with interval development of gastrohepatic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: History of L4-L5 discectomy with recurrent back and right leg pain. Evaluate for herniation. Signs and symptoms: Right leg pain, back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.There is unremarkable signal intensity of the vertebral column.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate moderate bilateral ligamentum flavum hypertrophy and mild facet disease without significant degenerative disc disease. No neural foraminal compromise however mild central spinal stenosis is suspected. This finding demonstrate no significant change since prior exam.L4-L5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral (L> R) facet hypertrophic changes are noted. There is a large right lateral broad-based disc protrusion with resultant mass effect on the thecal sac, moderate central spinal stenosis and significant right lateral recess compromise. There is interval progression of findings since prior study. There is mild compromise of right neural foramina also secondary to hypertrophic changes. There is evidence of a small right sided surgical laminotomy at this level.L5-S1 is unremarkable.Unremarkable. Spinal soft tissues.

Output: 1.At L4-L5 there is a right lateral disc protrusion with resultant moderate central spinal stenosis and significant right lateral recess compromise. There is interval progression of findings since prior MRI exam from an outside institution.2.At L4-L5 mild degenerative changes results in mild central spinal stenosis similar to prior.3.Unremarkable images at other levels. Please review detailed report per level above.


Instruction: Generate impression based on findings.

Input: 63 years, Female, Reason: 63 yo female has a small body of pancreas mass with mural nodule. Pt noted on OSH imaging to have renal artery aneurysms. Pt needs secretin stimulating MRCP to evaluate pancreas lesion. History: abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Common bile duct is prominent measuring up to 1.2 cm proximally, however no choledocholithiasis, stricture or mass is evident. There is mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There are multiple outpouchings from the pancreatic duct including a 1.4-cm outpouching in the pancreatic head and a 1.3-cm outpouching in the pancreatic body, both of which appear to communicate with main pancreatic duct. There are multiple smaller subcentimeter outpouchings along the course of the duct. There is a blunted response upon secretin administration. No enhancing pancreatic lesions are evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Saccular left renal artery aneurysm measuring 2.4 x 1.9 cm (10/11).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.Multiple small outpouchings along the course of the pancreatic duct likely represent side branch IPMNs.2.Saccular left renal artery aneurysm measuring up to 2.4 cm.


Instruction: Generate impression based on findings.

Input: Recent surgery for a right frontal lobe anaplastic oligodendroglioma (WHO grade III). There are recent postoperative findings related to subtotal right frontal tumor resection with a small amount of hemorrhage in the region of the surgical cavity and along the right lateral ventricle choroid plexus and overlying extradural fluid collections that measure up to 7 mm in width. There is residual heterogeneously enhancing tumor along the posterior and superior margins that measures up to 20 mm in thickness. There is also a small amount of enhancement along the anterior medial margin. There appear to be small areas of restricted diffusion along the surgical margin, which may be related to the effects of blood products, but no acute territorial infarct. There is persistent extensive surrounding vasogenic edema and up to approximately 10 mm of midline shift to the left, as well as subfalcine herniation and partial effacement of the right lateral ventricle. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Recent postoperative findings related to subtotal right frontal tumor resection with evidence of residual tumor along the surgical margins, particularly posteriorly and superiorly, as well as persistent extensive vasogenic edema and approximately 10 mm of midline shift.


Instruction: Generate impression based on findings.

Input: Left temporal mass. Right hemiparesis. History of left cavernous sinus meningoma; status post radiation in the mid 1990s at Ingles. BRAIN MRI:The heterogeneous mass involving the left middle cranial fossa is probably extra-axial but invaginating or invading into the left temporal lobe from inferiorly. The mass shows intense but heterogeneous contrast enhancement, especially in its anterior part. It contains blood products, especially in its posterior part with associated susceptibility artifact and peripheral deep T2-hypointensity. This component within the left middle fossa measures maximally 6.1 cm anteroposteriorly and 3.1 cm craniocaudally (image #22 of series #16). In transverse, it measures 3.8 cm as on image #22 of series #10. T1 shortening as well as small fluid levels are noted associated with the left temporal intraparenchymal hemorrhage. There is relatively remarkable hyperintense T2 signal that extends to involve the left temporal, parietal and posterior frontal white-matter, including the external and extreme capsules as well as the posterior limb of the internal capsule. The T2 signal abnormality is compatible with vasogenic edema, although component of this may represent chronic post treatment change. This is also associated with mass-effect compressing the left lateral ventricle and causing mild midline shift.There is a separate tiny focus of susceptibility effect in the left temporal lobe posterior to this mass which may reflect blood product or calcification. There is minimal blood in the occipital horn of the left lateral ventricle, probably as an extension from the hemorrhage associated with a mass in the left middle cranial fossa.The mass is associated with an infiltrative contrast-enhancing mass that involves the left cavernous sinus, left petroclival ligament, sella turcica and also extends along the dorsal aspect of the clivus. Osseous changes including sclerosis/hyperostosis are better appreciated on recent CT. The mass also reaches very close to the left foramen ovale though not definitively through it. Involvement of the left cavernous sinus is associated with encasement and narrowing of the cavernous segment of the left internal carotid artery. There is also involvement of the left Meckel's cave with encasement of the left trigeminal nerve. The left optic canal is involved but there is no definite optic nerve atrophy or abnormal contrast enhancement. There is also no intraorbital extension. There is involvement of the left superior and inferior orbital fissures as well as foramen rotundum. Posteriorly there is also minimal mass-effect on the left anterolateral aspect of the inferior mid brain/upper pons.The remainder of the brain is notable for nonspecific scattered T2-hyperintense foci involving the frontoparietal white-matter. There is also mild periventricular T2-hyperintensity. There is no associated brain parenchymal diffusion restriction. There is no separate contrast enhancing brain lesion. Besides the mass-effect closed by the above-described mass, there is overall mild expansion of the CSF-containing spaces, reflecting mild global brain volume loss.There is a small retention cyst in the inferior aspect of the right maxillary sinus. Other paranasal sinuses show trace mucosal thickening. There is no gross orbital abnormality besides the above described involvement of the left optic canal. Sclerotic focus involving the left lateral mass of C1 is better seen on CT.CRANIAL MRA:Accounting for the above described mild narrowing of the cavernous (C2) segment in addition to the distal petrous (C2 and C3) segments of the left internal carotid artery by the mass, there is displacement of the left middle cerebral artery sylvian branches by the mass-effect. Otherwise, there is no significant stenosis or asymmetry of flow-related signal of the major intracranial arteries. There is no aneurysm. Of note, the right vertebral artery is dominant.CRANIAL MRV:Left cavernous sinus is invaded as mentioned above. The dural venous sinuses are otherwise patent. The internal cerebral veins are patent as well.

Output: 1.Overall findings are consistent with a large left petroclival meningioma with invasion of the cavernous sinus as well as suggestion of intraparenchymal invasion into the left temporal lobe. There is evidence of recent intraparenchymal hemorrhage within the left temporal lobe likely related to the tumor with extensive surrounding vasogenic edema. Minimal intraventricular blood products are also noted.2.There is extensive mass effect on the left trigeminal nerve and its branches. Tumor extends to left orbital apex including involvement of the optic canal. There is also minimal mass effect on the left aspect of the pons.3.Besides mild compression of the left internal carotid artery and displacement of the sylvian branches of the left middle cerebral artery, the intracranial MRA is unremarkable.4.MR venogram shows patent dural venous sinuses, aside from the left cavernous sinus mentioned above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiple cerebral cavernous malformations. The surgical cavity in the posterior right temporal lobe is unchanged nor is the susceptibility effect along the surgical margin or the minimal adjacent parenchymal T2-hyperintensity. The lobulated T2-hyperintense lesion involving the left frontal lobe, which shows susceptibility effect, is unchanged since January 2016 though minimally increased compared to the March 2015 examination. The multiple other cerebral and cerebellar foci of susceptibility effect were also present previously. There is no mass-effect, midline shift or abnormal intracranial contrast enhancement. The ventricles are unchanged. The major intracranial vascular flow voids are otherwise preserved.There is mucosal thickening in the left ethmoid sinuses. The orbits are grossly unremarkable. Postoperative changes are present around the right parieto-occipital-temporal craniotomy.

Output: 1.Unchanged right posterior temporal postoperative findings.2.Multiple cerebral and cerebellar cavernous malformations are unchanged since January 2016. However, the left frontal T1-hyperintense cavernous malformation is slightly larger than in March 2015. No new focus of susceptibility effect to indicate the development of a new lesion.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with history of autoimmune encephalitis and new onset of headaches and worsening cognition, concern for flare of disease. No evidence of parenchymal diffusion restriction, T2 signal abnormality, edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is observed. Brain morphology is unremarkable. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. The ventricles are stable and normal in size.

Output: Unremarkable evaluation with no MRI evidence of a disease flare.


Instruction: Generate impression based on findings.

Input: Neck pain with radiation to the scapula. The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. Degenerative changes are specified by the intervertebral level as follows: C2-C3: No neuroforaminal narrowing or spinal stenosis. C3-C4: Tiny left paracentral disc protrusion, but no neuroforaminal narrowing or spinal stenosis. C4-C5: Facet arthropathy. Mild disc bulge. Mild to moderate left neural foraminal narrowing. No spinal canal stenosis. C5-C6: Facet arthropathy. Mild to moderate left neural foraminal narrowing. No spinal canal stenosis. C6-C7: Marked facet hypertrophy on the left with moderate to severe left neural foraminal narrowing. No spinal canal stenosis. C7-T1: No neuroforaminal narrowing or spinal stenosis.

Output: 1.Significant neural foraminal stenosis at C6-7 on the left.2.Otherwise, only mild degenerative disease is seen with no spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 54 years, Male, Reason: evaluate for cause of elevated transaminases in pt w AML s/p SCT History: elevated transaminases, fever and altered mental status. ABDOMEN:LUNG BASES: Small bilateral pleural effusions, right greater than left, unchanged.LIVER, BILIARY TRACT: Multiple small gallstones with mild gallbladder wall thickening. Diffuse low signal on in phase T1 and T2 images likely reflects iron deposition. A 0.9-cm (1304/314) enhancing lesion in the left hepatic lobe seen on venous and delayed phases with mild associated increased T2 signal.SPLEEN: Diffuse lobe signal on in phase T1 and T2 images likely reflects iron deposition.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered mesenteric edema.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis with gallbladder wall thickening may represent acute cholecystitis. Recommend ultrasound for further evaluation.2.Subcentimeter enhancing lesion is nonspecific and may represent flash filling hemangioma, although metastases may also appear similar.3.Iron deposition within the liver and spleen.


Instruction: Generate impression based on findings.

Input: Reason: cirrhosis with lesions seen in the liver and pancreas on outside imaging History: cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.SPLEEN: There is a 2.0 x 1.6 cm (4/28), cystic lesion in the region of the splenic hilum, about the pancreatic tail.PANCREAS: A 5 mm cyst in the pancreatic head without communication to the pancreatic duct is nonspecific but likely represents a sidebranch IPMN. There is a 2 mm cyst in the pancreatic body/tail which communicates with the main pancreatic duct which is nondilated, suggestive of a side branch IPMN. There is no definite communication between the pancreatic duct the splenic hilar cyst.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left-sided T2 hyperintensity, likely a cyst.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.Cirrhotic liver morphology without suspicious hepatic lesions.2.Small cysts within the pancreatic head and body measuring up to 5 mm and likely represent sidebranch IPMNs.3.Nonspecific cyst in the region of the splenic hilum and pancreatic tail may represent a splenic cyst or exophytic pancreatic cystic lesion.


Instruction: Generate impression based on findings.

Input: Reason: eval post chole syndrome History: RUQ pain, N/V LUNG BASES: Trace bilateral pleural effusions. Cardiomegaly partially visualized.ABDOMEN: Examination limited by motion on multiple sequences.LIVER, BILIARY TRACT: Hepatomegaly with the liver measuring 22 cm in craniocaudal dimension. No focal hepatic lesion. Punctate hepatic cysts. Postsurgical changes of a cholecystectomy. The common bile duct measures 5 mm, likely postsurgical in etiology. No intrahepatic biliary ductal dilatation within the limits of this examination.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: Mild ascites, not significantly changed.

Output: 1.Postsurgical changes of a cholecystectomy. Minimal extrahepatic biliary ductal dilatation, likely related to postsurgical etiology. No intrahepatic biliary ductal dilatation within the limits of this examination, which is suboptimal due to motion.2.Findings of mild fluid overload including cardiomegaly, pleural effusions, and ascites, unchanged.


Instruction: Generate impression based on findings.

Input: Chronic migraine without aura, without mention of intractable migraine without mention of status migrainosusClinical question: headaches since age 10 ? Any malformationsSigns and Symptoms: headaches 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 demonstrate air-fluid level in the right maxillary sinus and mucosal thickening in the right sphenoid sinus as well as right ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is an air-fluid level present in the right maxillary sinus. The possibility of ascites cannot be excluded. Please correlate patient's clinical history2.No evidence for intracranial mass lesion or other lesion within the brain parenchyma to explain patient's headaches.


Instruction: Generate impression based on findings.

Input: 77-year-old female with right facial droop and expressive aphasia status post code stroke, tPA given for presumed ischemic stroke. There are areas of restricted diffusion involving the left frontal lobe including the lateral aspect of the precentral gyrus and extending into the left insula and operculum. There is no intracranial hemorrhage, focal mass effect, midline shift, herniation, or extra-axial fluid collection.There is additional moderate periventricular and subcortical white matter hypoattenuation which is nonspecific. Additional small areas of probable prior infarct include the left occipital region and right thalamus.The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Acute infarct involving the left frontal lobe including the lateral aspect of the precentral gyrus and extending into the left insula and operculum.2.No evidence of intracranial hemorrhage or mass effect.3.Moderate chronic likely small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Sudden right sensorineural hearing loss. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear intact, without evidence of abnormal enhancement. The bilateral cranial nerve 7 and 8 complexes are also intact. The bilateral mastoid air cells and middle ears appear unremarkable. There are developmental venous anomalies in the right superior temporal lobe and right parietal lobe periventricular region with an adjacent areas of high T2 signal. There is diffuse prominent dural enhancement, which extends into the bilateral internal auditory canals. There is a right parasellar aneurysm clip. There is encephalomalacia in the right basal ganglia. There is partially-imaged nonspecific scattered cerebral white matter T2 hyperintensity. There is a partially-imaged ventricular catheter device. There area bilateral lens implants and staphylomatous deformity.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. Persistent diffuse prominent dural enhancement, which can be a manifestation of intracranial hypotension in the setting of ventricular shunting. 3. Stigmata of right parasellar aneurysm clipping and chronic right basal ganglia infarction.4. Developmental venous anomalies in the right superior temporal lobe and right parietal lobe periventricular region with an adjacent areas of high T2 signal, which may represent gliosis.


Instruction: Generate impression based on findings.

Input: Male, 76 years old, with cervical myelopathy and spondylosis, evaluate stenosis. Reversal of the cervical lordosis is again seen slightly more so than on prior. As before, there are trace stepwise retrolistheses of C3 on C4, C4 on C5, and C5 on C6. Extensive endplate degenerative signal abnormality is demonstrated with associated chronic degenerative loss of vertebral body height, similar to prior.Foci of STIR hyperintensity are evident within the cord at C4-5 and C6. These were not evident on the prior examination, perhaps due to differences in technique. No cord swelling is seen. Elsewhere, spinal cord signal abnormality is unremarkable.C2-3: Facet arthropathy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Mild spinal canal stenosis without cord impingement. No foraminal narrowing. No interval changes.C3-4: Facet arthropathy. Posterior disc-osteophyte complex formation. Moderate to severe spinal canal stenosis with some ventral cord flattening, stable to slightly improved. Moderate to severe bilateral foraminal narrowing. Except as above, no changes.C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation. Moderate to severe spinal canal stenosis with minimal ventral cord flattening, stable to slightly improved. Moderate to severe bilateral foraminal narrowing. Except as above, no changes. C5-6: Facet arthropathy. Ligamentum flavum thickening and posterior disc-osteophyte complex formation. Moderate to severe spinal canal stenosis with ventral cord flattening, stable to slightly improved. Moderate to severe bilateral foraminal narrowing. Except as above, no changes.C6-7: Facet arthropathy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Mild canal stenosis with slight cord deformation, stable to slightly improved. Moderate left and mild right foraminal narrowing. Except as above, no changes.C7-T1: Facet arthropathy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Moderate spinal canal stenosis without cord impingement, stable to slightly improved. Moderate left and mild right foraminal narrowing. Except as above, no changes.A pleural effusion is partially visualized on the left. A heterogeneous right thyroid nodule is also partially visualized but not significantly changed.

Output: Multilevel advanced disc and posterior element degeneration is seen resulting in spinal canal stenosis at multiple levels. The degree of stenosis appears to be somewhat improved relative to the prior examination which could reflect differences in neck positioning. Otherwise, no significant interval change is seen.Small areas of cord signal abnormality are detected at C4-5 and C5-6. While these were not clearly evident on the prior examination, it may be that they were present but unresolvable due to differences in technique. They are favored to represent myelomalacia related to chronic impingement.A left pleural effusion is partially visualized. Unless the etiology is already known, this finding should be further evaluated with dedicated chest imaging, at the very least chest radiographs.


Instruction: Generate impression based on findings.

Input: Cervical cancer. Abdominal and back pain. PELVIS:UTERUS, ADNEXA: There is a large cervical mass compatible with the patient's history of cervical cancer. This mass is predominantly circumferential with larger nodular components posteriorly. In total, the mass spans 6.7 cm AP x 5.0 cm LR x 8.5 cm CC. The mass extends superiorly into the uterus and inferiorly into the vagina. Anteriorly, the mass infiltrates the immediate surrounding soft tissues, including the bladder, with fistula to the urinary bladder identified. Posteriorly, the mass abuts the rectum, without definite invasion.BLADDER: Invasion of the posterior bladder by the after mentioned mass, as described above. Bilateral nephroureteral stents partially imaged.LYMPH NODES: Numerous pathologically enlarged bilateral inguinal, pelvic, and partially imaged para-aortic lymph nodes identified. A right pelvic lymph node measures 2.8 x 1.9 cm (series 1701, image 353).BOWEL, MESENTERY: The after mentioned mass abuts the rectum, without definite invasion. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Large cervical mass compatible with patient's known history of cervical cancer, with invasion of the bladder and fistula visualized.2. Extensive pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: orbital lymphoma follow up Brain MRILeft temporal small craniotomy site and skull base area shows minimal smooth dural enhancement which is likely represent postoperative in nature. Comparing to prior study, there is no significant interval change in terms of enhancement pattern and characteristics.Scalp, left temporalis muscle as well as left masticator space also show no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Bilateral mastoid air cells show fluid collections. There is fluid collection on the left frontal sinus indicating possible localized sinusitis. No change of partial empty sellar.Orbit MRI:There is no evidence of abnormal thickening or enhancement on extra ocular muscles.In particular, the right superior rectus muscle appears to be normal in size without showing evidence of abnormal enhancement.Other orbital contents appear to be unremarkable.

Output: 1. Stable minimal smooth enhancement of left temporal lobe and skull base dura indicating postoperative change since prior exam.2. No evidence of abnormal enhancement on scalp, temporalis muscle, left masticator space and right superior rectus muscle.3. Bilateral mastoid fluid collections and left frontal sinusitis.


Instruction: Generate impression based on findings.

Input: Patient is a 22 yr old female with history of AML with prior s/p anthracycline containing chemotherapy and stem cell transplant presenting for evaluation of left ventricular function. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62 %, the LV end diastolic volume index is 74 ml/m2 (normal range: 65+/-11), the LVEDV is 115 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52 %, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 62%)2. The right ventricle is normal in size and systolic function (RVEF 52%)3. No evidence for delayed enhancement.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: lumbar radiculopathySigns and Symptoms: right sciatica 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. There are some Tarlov's cysts present in the sacral spinal canalAt L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral facet hypertrophy and ligamentum flavum hypertrophy. There is fluid within the facet joints with some widening of the facet joints. The fat at the lateral recess is effaced bilaterally but worse on the right versus the left side. It is encroachment of the nerve roots at the lateral recesses sees worse on the right side than the left. There is mild narrowing of the neural foramina bilaterally with some mild encroachment of the right-sided exiting nerve roots within the neural foramina. There are some endplate reactive changes present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate bilateral facet and ligamentum flavum hypertrophy at this level. A small amount of fluid is present in the facet jointsAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild degree of facet and ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in lumbar spine worse at L5-S1 where there is encroachment of the nerve roots at the lateral recesses sees bilaterally but worse on the right side versus the left and also encroachment of the right-sided exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Headache with associated diplopia, evaluating for evidence of increased intracranial pressure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, 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: 28-year-old male with history of Crohn's disease and primary sclerosing cholangitis. Evaluate for dominant stricture. ABDOMEN:LIVER, BILIARY TRACT: Within this limited examination, there appears to have been interval decrease in size of the common bile duct, currently measuring 5 mm in diameter. Previously identified regions of narrowing and dilatation involving the intrahepatic ducts as well as irregularity of the distal common bile duct is not evaluated on this incomplete examination.SPLEEN: Multiple T2 hyperintense lesions with a complex T2 lesion in the anterior spleen are again 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: Ahaustral colon is again identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Incomplete examination as detailed in technique section.1.Within above limitation, there appears to have been interval decrease in size of the common bile duct. The intra and extrahepatic biliary strictures are not evaluated on this exam.2.Multiple T2 hyperintense splenic lesions with a complex lesion in anterior spleen are not significantly changed.3.Ahaustral colon consistent with inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: 6-year-old female with low back pain and mid spine tenderness, evaluate for fracture/degenerative changes Thoracic spine: There is focal kyphosis at T10-T11 with severe loss of disc height, compression fracture of T11 and compression of T10 with anterior wedging. This was partially visualized on the prior MRI, although progression cannot be adequately evaluated due to differences in technique. Mild degenerative changes affect the remaining thoracic spine with anterior osteophytes and multilevel degenerative disc disease.Lumbar spine: There is mild degenerative disc disease at L5-S1 with small anterior osteophytes. No acute fracture is evident.

Output: Focal kyphosis with compression fractures at T10-T11. These were present on the prior MRI, although progression cannot be excluded due to differences in technique and only partial visualization of the prior study.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are a few foci of T2 hyperintensity within the periventricular white matter, with similar appearing foci in the right cerebellar hemisphere, without associated mass effect restrict diffusion, or susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Opacification is noted within the frontal sinuses. Otherwise the paranasal sinuses and mastoid air cells are clear. Cervical spine MRI:There are no fractures. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Left facet hypertrophy causes trace anterolisthesis C2 and C3 as well as moderate left neural foraminal stenosis.C3/4: Grade 1 anterolisthesis C3 on C4, posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is cord deformation, moderate central stenosis, and severe bilateral neural foraminal stenosis.C4/5: Trace retrolisthesis C4 on C5, posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, slight ligamentum flavum thickening, bilateral uncinate hypertrophy. There is borderline central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild central, moderate to severe left neural foraminal and moderate right neural foraminal stenosis.C7/T1: Trace anterolisthesis T1 T2, asymmetric right-sided posterior osteophyte disc complex, and bilateral uncinate hypertrophy. There is mild right neural foraminal stenosis.There is a suggestion of T2 hyperintense signal within the cervical cord at the C4-C5 levels, as seen on sagittal STIR imaging, however which is not confirmed on axial T2 imaging. This may represent early myelomalacia.

Output: 1.Mild chronic small vessel ischemic disease of the brain. 2.C2/3: Moderate left neural foraminal stenosis.3.C3/4: Moderate central stenosis, and severe bilateral neural foraminal stenosis.4.C4/5: Mild central and severe bilateral neural foraminal stenosis.5.C5/6: Borderline central and severe bilateral neural foraminal stenosis.6.C6/7: Mild central, moderate to severe left neural foraminal and moderate right neural foraminal stenosis.7.C7/T1: Mild right neural foraminal stenosis.8.There is a suggestion of T2 hyperintense signal within the cervical cord at the C4-C5 levels, as seen on sagittal STIR imaging, however which is not confirmed on axial T2 imaging. This may represent early myelomalacia.


Instruction: Generate impression based on findings.

Input: 67 years, Female, parkinsonism with brisk reflexes. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Few scattered foci of susceptibility effect compatible with chronic microhemorrhages and nonspecific. Major flow-voids are preserved. There is mild cerebral and cerebellar parenchymal volume loss with slightly more prominent volume loss involving the superior cerebellar vermis, which is nonspecific. There is also mild inferior cerebellar vermis hypoplasia which can be normal developmental variant.Orbits and sella are grossly unremarkable. Mild scattered paranasal sinus opacification. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Disc osteophyte complex with effacement of the ventral thecal sac. No significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis. C6-7: Disc osteophyte complex and ligamentum flavum thickening contribute to mild spinal canal stenosis. Mild to moderate left and minimal right neural foraminal stenosis. Small perineural cysts. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No intracranial mass or mass effect. Mild chronic small vessel ischemic changes in the brain. 2. Mild parenchymal cerebral and cerebellar volume loss with slightly greater involvement of the superior cerebellar vermis which may relate to chronic alcohol use, for example. Cerebellar volume loss related to MSA-C may also be considered in the appropriate clinical setting.3. Mild degenerative changes in the cervical spine without cord signal abnormality or high-grade stenosis at any level. Additional details of the degenerative changes as above.


Instruction: Generate impression based on findings.

Input: Essential (primary) hypertension [I10], Reason for Study: ^Reason: ? Septic emboli History: right eye lid lag \T\ MSSA bacteremia No evidence of acute ischemic or hemorrhagic lesion.There are several susceptibility artifacts on bilateral hemisphere indicating either parenchymal calcification or chronic petechial hemorrhage.Bihemispheric periventricular white matter FLAIR/T2 high signal intensities indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Fluid signal intensity on the right mastoid air cell.Right eye shows high signal intensity of vitreous with retinal detachment indicating possible post surgical changes such as silicon oil injection. The left eye shows absence of normal lens signal indicating post cataract surgery.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Metastatic esophageal cancer on therapy now, complains of slow speech, fatigue and increased sleepiness and decreased alertness. Please evaluate CNS status. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter, which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening of the bilateral ethmoid and maxillary sinuses.

Output: 1. No evidence of intracranial metastatic disease. No acute infarct, intracranial mass or mass effect.2. Scattered foci of T2 hyperintensity within the periventricular and subcortical white matter, which are nonspecific, but likely represent chronic small vessel ischemic changes and/or treatment-related changes.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with history of renal transplant and disseminated nocardia, follow-up examination. The previously mentioned edema inducing lesions scattered throughout both cerebral hemispheres and the right cerebellum all remain evident and all show progressive surrounding T2 hyperintensity which suggests worsening edema and/or increasing lesion size. As before, most of these lesions demonstrate some degree of diffusion restriction.Several scattered new foci of T2 hyperintensity are seen which do not, however, show correlating restricted diffusion. For example, new lesions are evident within the left middle frontal gyrus, along the left lateral ventricular body, within the right thalamus, along the left occipital horn, and in the right middle temporal gyrus.Some of the above-mentioned lesions demonstrate minimal susceptibility effect, but otherwise, no significant intracranial hemorrhage is detected. No abnormal extra-axial fluid collections are seen. Redemonstrated is evidence of T2 hyperintensity within the dorsal medulla and pons of uncertain etiology. The ventricles are stable and normal in size.

Output: Numerous edema-inducing lesions are demonstrated within both cerebral hemispheres and cerebellum, all of which show progressive edema and/or frank increase in lesion size. Several new small foci of signal abnormality are also noted which, while nonspecific, may represent further progression of the presumed disseminated Nocardia infection.


Instruction: Generate impression based on findings.

Input: Female, 57 years old. Reason: ?hydrocephalus History: headache There is redemonstration of a right cerebellar mass with surrounding vasogenic edema and compression of the fourth ventricle. There is stable ventriculomegaly of the lateral ventricles. Slight herniation of the right cerebellar tonsil into the foramen magnum is again noted. No areas of hemorrhage are identified.The calvaria and skull base are radiographically normal. Skull lesion seen on recent bone scan is not visualized on this study. There is opacification of the mastoid air cells bilaterally, left greater than right.

Output: Right cerebellar mass with associated vasogenic edema and compression of the fourth ventricle and crowding of the foramen magnum is not significantly changed since the prior examination.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with bilateral lower extremity weakness status post partial corpectomy and fusion of T4. Evidence of laminectomy and spinal canal decompression is again seen at T4. Since the prior examination, further surgery has been performed with placement of posterior fusion instruments spanning from T3 through T5. It also appears that further debulking of the tumor expanded T4 pedicles has been performed.With the above interval surgical changes, further decompression of the spinal canal at the T4 level is seen. The spinal cord is no longer compressed and there is now a thin cushion of CSF at least dorsally along the cord which was not previously evident. The cord itself shows no evidence of convincing signal abnormality through the operative field.Elsewhere, the spinal cord is within normal limits and the spinal canal is free of significant encroachment. There remains some postoperative fluid in the posterior soft tissue resection bed at T4, but elsewhere, no concerning paraspinal or epidural collections are detected.As on the prior examination, patchy marrow replacement and pathologic enhancement is again seen with significant involvement of C7, T1, T4 and T9. The T4 and T9 vertebral bodies are mildly compressed, similar to prior. Smaller lesions are also evident at other vertebral body levels similar to prior.Although there is mild vertebral body tumor expansion towards the ventral epidural space at T9, this results in only minimal effacement of the thecal sac. The T9-10 neural foramina are at least moderately narrowed largely due to expansile tumor within the facet complexes.

Output: 1.Evidence of interval surgery with further decompression of the spinal canal at the T4 level and placement of posterior fusion instruments spanning from T3 through T5. The spinal canal at the T4 level has been further decompressed and the cord is no longer compressed or impinged.2.Extensive metastatic disease is redemonstrated at multiple additional vertebral body levels. No other significant or high-grade spinal canal stenosis is suspected.


Instruction: Generate impression based on findings.

Input: Left foot pain. Wine cooler fell on dorsum of foot 6 weeks ago. No bone marrow signal abnormality is identified. No discrete fracture line is seen. There is a vitamin E capsule overlying the medial aspect of the base of the first metatarsal presumably representing the patient's site of pain. The visualized flexor and extensor tendons appear intact. Mild degenerative changes affect the talonavicular articulation. There is a small amount of fluid within the talonavicular joint without evidence of a large effusion. The imaged musculature of the foot is normal in appearance.

Output: Osteoarthritis of the foot without evidence of acute fracture. Otherwise no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with left cervical radiculopathy. Spinal alignment is anatomic. Vertebral body heights are preserved. Mild degenerative endplate signal change is seen at C6-7. No areas of pathologic marrow replacement or marrow edema are detected.The visualized spinal cord is normal signal characteristics throughout. No epidural abnormalities are suspected.The spinal canal is congenitally slender. Additional level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. Mild spinal canal stenosis with slight deformation of the cord. No evidence of cord edema. Mild left foraminal narrowing. C4-5: Facet arthropathy. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C5-6: Left facet arthropathy. Posterior disc-osteophyte complex formation with a small left paracentral protrusion. Mild generalized spinal canal stenosis with slight deformation of the left ventral cord. No cord edema. Severe left and mild right foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation asymmetric to the left. Mild to moderate spinal canal narrowing. Moderate left and mild right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Multilevel disc degeneration is seen which, superimposed upon a congenitally slender spinal canal, does result in spinal canal stenosis at C3-4, C5-6 and C6-7.2.Severe foraminal narrowing is seen on the left at C5-6 with moderate foraminal narrowing on the left at C6-7.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with disorder of brain, unspecified, preoperative examination with contrast for Stealth. Extensive edema is evident within the right parietal lobe and minimally the occipital lobe. On precontrast T1-weighted images, the cortex of the right inferior parietal lobule is hyperintense compatible with recent prior contrast administration. On postcontrast images, the juxtacortical tissues in this area demonstrate superimposed intense rim enhancement which extends from the brain surface to the ventricular margin. There is a small satellite nodule of enhancement more superiorly along the postcentral sulcus on the right. The overall lesion is relatively wedge-shaped. Regional mass effect results in effacement of the right ventricular atrium and occipital horn. No evidence of herniation is seen. In the left parietal lobe, relatively mild edema is seen straddling the intraparietal sulcus. Multiple small areas of linear and/or ring enhancement are also seen in this location, all much smaller than the lesion on the right. No significant generalized mass effect is evident on the left. No additional enhancing lesions are seen. On comparison with the prior outside examination, the above described findings have not significantly changed. The lesions are, however, new when compared to a prior CT from 09/29/16.

Output: Bilateral parietal lesions are identified, right side more than left, showing cortical and juxtacortical ribbonlike enhancement. The affected cortex of the right inferior parietal lobule is slightly blurred but it does remain evident. The distribution and morphology of the lesions suggest a vascular process. Evolution of ischemic injury could account for some of the imaging features. However, there could also be a superimposed infectious component with septic embolic disease a distinct possibility. Lesion morphology is not entirely typical of a pyogenic agent, and as such, atypical and even fungal etiologies should be considered.


Instruction: Generate impression based on findings.

Input: 64-year-old male with history of elevated PSA. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.5 x 6.1 x 4.0 cmPeripheral Zone: There is T2 hypointense lesion in the left mid gland measuring 4 x 4 mm (series 901, image 14) with corresponding low ADC signal.Central Gland: Heterogeneous in appearance compatible with benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific subcentimeter left pelvic sidewall lymph node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suspicious left mid gland subcentimeter lesion.


Instruction: Generate impression based on findings.

Input: 57-year-old male patient with prior meningioma and craniotomy. Headaches. There are postsurgical changes of a left frontal craniotomy with underlying encephalomalacia of the left frontal lobe and to a lesser degree the anterior right frontal lobe, appearing similar to the prior study. There is a new region of extra-axial thickening and enhancement about the left frontal convexity along the posterior aspect of resection margin measuring approximately 9 mm in the craniocaudal dimension and 4.4 cm in the transverse dimension (image 11, series 1101). This extra-axial thickening causes mild mass effect on the underlying left frontal lobe without white matter edema. The remaining brain parenchyma is unremarkable. The ventricular system is stable in size. The basal cisterns are patent. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.

Output: 1. Post-surgical changes related to resection of a left frontal meningioma with frontal lobe encephalomalacia. 2. New left frontal convexity extra-axial thickening and enhancement about the posterior aspect of the posterior resection margin is concerning for recurrent disease.


Instruction: Generate impression based on findings.

Input: Reason: lumbar anterolisthesis at L4-L5 History: back and buttock pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disk desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is moderate degree of bilateral facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a marked degree of facet hypertrophy at this level associated with ligamentum flavum hypertrophy, loss of disk space height and disk desiccation. There is mild (2mm) anterior subluxation of L4 on L5 present. Overall there is a mild degree of spinal stenosis present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild to moderate degree of bilateral facet and ligamentum flavum hypertrophy present at this level associated with a disk bulge. Overall there is a mild degree of spinal stenosis at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is a mild disk bulge at this level and mild ligamentum flavum hypertrophy at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk desiccation and endplate reactive changes associated with a disk bulge at this level.

Output: 1.There are degenerative changes present in the lumbar spine worse at L4-5 and L3-4 without a significant compromise to the spinal canal or neural foramina. There is mild degree of spinal stenosis present at L3-4 and to L4-5.


Instruction: Generate impression based on findings.

Input: The two surgeries for pituitary tumor evaluate size and placement. 70 year old male. There is a 25 x 21 mm sagittal dimension mass centered in the pituitary fossa which on the 11/ 2008 MRI exam measured 22 x 20 millimeters paired on axial dimensions it measures 23 x 21 mm and axial dimensions and is unchanged since the prior CT paired it has suprasellar extension indenting itself into the optic chiasm.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells and demonstrates a minor opacities in the right mastoid air cells present on the previous exams as well.. The visualized portions of the orbits are intact.

Output: 1.Sellar and Suprasellar mass known to represent a macroadenoma. It appears slightly larger than the 11/5/08 MRI exam.2.


Instruction: Generate impression based on findings.

Input: There are are non-enhancing densely calcified globular and irregular extra-axial lesions along the planum sphenoidale and sella, as well as along the left petrous apex. There are also calcified globular lesions in the left temporal lobe and left basal ganglia, measuring up. In addition, there are patchy susceptibility effect and T1 hyperintensity diffusely within the bilateral lenticular nuclei. Furthermore, there are gyriform calcifications in the right temporal lobe. There are also scattered foci of susceptibility effect in the bilateral cerebral hemispheres. There are postoperative findings related to frontal craniotomy with encephalomalacia in the bilateral anterior frontal lobe with ex vacuo dilatation of the frontal horns of the bilateral lateral ventricles. There is also volume loss of the bilateral prechiasmatic optic nerves. There is diffuse cerebellar volume loss. There is a right frontal linear T2 high signal tracking to the right lateral ventricle related to a previous ventriculostomy tract. There is no evidence of acute infarction. There are no enhancing intracranial lesions.

Output: 1. Apparent postoperative findings related to remote frontal craniotomy with encephalomalacia and susceptibility effect corresponding to calcifications in the bilateral anterior frontal lobes, as well as atrophy of the bilateral optic nerves. 2. Densely calcified extra-axial lesions along the planum sphenoidale and sella, as well as along the left petrous apex, may represent dystrophic calcifications from prior hemorrhage or radiation therapy if this were indeed administered, versus calcifying pseudotumors of the neuraxis or related to treated neoplasm, perhaps originally a craniopharyngioma, for example. 3. Densely calcified globular lesions in the left temporal lobe and left basal ganglia, as well as multiple punctate scattered foci of susceptibility effect in the bilateral cerebral hemispheres may represent treated tumors, chronic hemorrhages, and/or cavernous malformations. 4. Patchy mineralization present diffusely within the bilateral lenticular nuclei may represent dystrophic calcifications related to treatment effects, such as mineralizing microangiopathy, or an underlying metabolic disorder.5. Gyriform calcifications in the right temporal lobe with underlying white matter hypoattenuation may represent sequela of prior trauma or infarction. 6. Diffuse cerebellar volume loss is likely related to anti-epileptic use.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:2/22/1942)Reason: new lung cancer diagnosis, initial staging History: n/aPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL There is susceptibility effect along the surface of the right frontal lobe representing siderosis. There is encephalomalacia involving the right inferior parietal lobule and the posterior aspect of the right temporal lobe and posterior lateral aspect of the right occipital lobe. There is associated ex vacuo effect along the right lateral ventricle.There are numerous serpiginous flow-voids centered in the right cerebellar hemisphere associated with a large draining vein. The serpiginous flow-voids encompasses an area measuring approximately 11 x 7 mm axial dimensions.The right middle cerebral artery is not readily identified. The left middle cerebral artery appears attenuated distal to the mid M1 segment. The left anterior cerebral artery appears attenuated proximally. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal right anterior and left posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Findings suggest fetal origin of the right posterior cerebral artery with a small right P1 segment and stenosis or occlusion at the p2 segment and a fairly large left posterior cerebral artery with a large left posterior communicating artery. Findings also suggest leptomeningeal collateral reconstitution of the left anterior cerebral artery.The visualized portions of the paranasal sinuses demonstrate small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are suggestive of occlusion of the right middle cerebral artery and high-grade stenoses along the proximal left anterior cerebral artery and stenosis along the left middle cerebral artery as well as stenosis or occlusion of the right posterior cerebral artery at the P2 segment. If clinically appropriate an MR angiogram or CT angiogram may be helpful to further evaluate this. Leptomeningeal reconstitution of the anterior cerebral artery territory and possibly left middle cerebral artery territory are suggestive of misery perfusion.2.Findings raise the question of small arteriovenous malformation versus developmental venous anomaly located in the right cerebellar hemisphere. An MRA or a CTA may be helpful to further evaluate this.3.There is encephalomalacia involving much of the right cerebral hemisphere predominantly along the right middle and posterior cerebral artery territories.4.Siderosis along the right frontal lobe implies prior subarachnoid hemorrhage.5.Findings were discussed with Dr Jyoti Patel at the time of this interpretation.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, with bilateral nonspontaneous nipple discharge and recent elevated prolactin levels. Assess for pituitary lesion. The pituitary gland is somewhat asymmetric in that the right aspect of the gland is larger than the left. However, without the benefit of contrast enhancement, no focal glandular lesions are seen. The pituitary infundibulum is at midline. The suprasellar cistern, visualized optic pathway and cavernous sinuses are within normal limits.

Output: Asymmetry of the pituitary gland is seen with the right side being somewhat larger than the left. The significance of this finding is uncertain, and this could in fact represent normal anatomic variation. Within the limitations of a noncontrast examination, no focal lesions are identified.


Instruction: Generate impression based on findings.

Input: Cervical spine: Examination is mildly motion degraded. Vertebral body heights in the cervical spine are normal. Alignment is normal. There is diffuse low T1 marrow signal without focal destructive lesions. No evidence of epidural tumor. No pathologic compression fractures. No cord signal abnormalityMild multilevel degenerative changes are seen with small disc osteophyte complexes from C2-C3 to the C6-C7 levels without significant spinal canal stenosis. No high-grade neural foraminal stenosis at any level.Thoracic spine:Diffuse low T1 marrow signal is again noted without focal destructive lesions. There are areas of T1 and T2 hyperintensity involving the left sided transverse processes in the mid and lower thoracic spine and were present previously and compatible with fatty change, possibly from prior left-sided radiation. The vertebral body heights and disc spaces are maintained. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. No significant spinal canal or neural foraminal stenosis. No evidence of compression fractures. No abnormal enhancement.Lumbar spine:The most inferior well-defined disc space is labeled L5-S1. Diffuse low T1 marrow signal again seen. There are multiple heterogeneously enhancing lesions involving the visualized pelvis. Prior lumbar spine MRI was without contrast limiting comparison. Vertebral body heights are normal without compression fractures. No discrete destructive lesions within the lumbar spine are appreciated. No abnormal epidural or leptomeningeal enhancement.Grade 2 anterolisthesis of L5 on S1 is again seen with evidence of osseous fusion posteriorly. Degenerative changes include disc desiccation at L4/5 and L5/S1 with mild disc height loss at L4/5 and moderate disc height loss at L5/S1. There is a small Schmorl's node involving the superior endplate of L5. Mild disc bulge and facet arthropathy at L4-L5 with facet effusions again seen. There is mild bilateral L5-S1 neural foraminal narrowing. Otherwise no significant spinal canal or neural foraminal stenosis in the lumbar spine.

Output: Diffuse low T1 marrow signal throughout the spine as well as multiple enhancing lesions within the pelvis are compatible with history of multiple myeloma. No evidence of pathologic compression fractures or discrete destructive lesions within the cervical, thoracic, or lumbar spine. No evidence of epidural tumor. No significant spinal canal stenosis at any level. Mild degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Right-sided weakness, sepsis. Human immunodeficiency virus. There is a deep right superior frontal sulcus with thickening and irregularity of the cortex and focal enlargement of the underlying right lateral ventricle, which appears to communicate with the sulcus through a very narrow channel. There also appear to be prominent perivesicular spaces in this region. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. 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: 1. No evidence of central nervous system lymphoma or toxoplasmosis. 2. Findings compatible with right frontal lobe schizencephaly.


Instruction: Generate impression based on findings.

Input: Lymphoma: vision changes. Brain MRI: There is further decrease in size and enhancement associated with the right lateral and central skull base tumor with extracranial and intracranial soft tissue components since April 2016. There is a right transfrontal ventricular catheter that terminates in the right lateral ventricle. There is mild T2 hyperintensity surrounding the catheter in the right frontal lobe. There is slight interval enlargement of the right lateral ventricle, which is otherwise narrower than the left lateral ventricle. There is no evidence of intraparenchymal tumors or acute infarction. There is no midline shift or herniation. There are persistent right mastoid effusions. There are persistent enhancing lesions within the bilateral mandibular condyles and left medial temporal bone.Brain MRV: There is a persistent filling defect in the right sigmoid sinus and jugular bulb. There is narrowing of the upper right internal jugular vein. The rest of the cerebral venous sinuses are intact.Orbit MR: There is decreased prominence of the optic nerve discs and dilatation of the optic nerve sheaths. The orbital contents are otherwise unremarkable bilaterally.

Output: 1. Slight interval increase in size of the shunted right lateral ventricle.2. Further decrease in size and enhancement associated with the right lateral and central skull base tumor with extracranial and intracranial soft tissue components, likely attributable to treatment effects. 3. Decreased prominence of the optic nerve discs and dilatation of the optic nerve sheaths since April 2016, likely indicating lower intracranial pressure. 4. Persistent thrombus in the right sigmoid sinus and jugular bulb. 5. Persistent enhancing lesions within the bilateral mandibular condyles and left medial temporal bone likely represent additional lymphoma deposits.


Instruction: Generate impression based on findings.

Input: 60 year-old female with pain and bloating. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 11-mm lesion in the medial aspect of the right upper pole with peripheral, eccentric enhancement is suspicious for a small renal cell carcinoma. Further evaluation with a dedicated renal protocol CT or MRI is recommended.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Large pelvic mass with solid and cystic components measuring 17 x 11 cm on image number 105, series number 3. This lesion likely arises from the left ovary. Right ovary cannot be differentiated from the large mass but is likely seen on image number 122 of series number 3 and slightly enlarged. Ovarian torsion cannot the exclude by imaging.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Large pelvic mass likely arising from the left ovary suspicious for a malignant ovarian neoplasm. Superimposed torsion cannot be excluded.Small right renal lesion with eccentric enhancement suspicious for renal cell carcinoma. Further evaluation with dedicated kidney protocol CT or MRI is recommended.


Instruction: Generate impression based on findings.

Input: Multiple foci of T2 hyperintense signal in the periventricular, deep and subcortical white matter, as well as in the corpus callosum appear similar to the prior exam. No new lesions are identified. There is no associated enhancement. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a subcentimeter probable Thornwaldt cyst. There is asymmetric fluid in the pneumatized left anterior clinoid process.

Output: No appreciable change in the intracranial demyelinating lesions, without associated enhancement.


Instruction: Generate impression based on findings.

Input: 64 year old female with new onset of left proptosis. Thyroid eye disease versus mass. The extraocular musculature remain within normal size and configuration. The retro-orbital fat remains within normal limits. There is a slight prominence of the right optic nerve at the site of its insertion to the right globe. No definitive evidence of enhancement in this region is detected. Review of prior MRI examination of brain without infusion from 2007 demonstrated similar finding with no interval change. The osseous structures of the orbits are unremarkable. There is prominence of bilateral superior ophthalmic veins. MRI examination of this patient from 8 -- 30 -- 2007 was reviewed which also demonstrated prominence of superior ophthalmic veins however no abnormality at the level of cavernous sinus was noted on that exam.The paranasal sinuses are well pneumatized are unremarkable with the exception of a small retention cyst in the dependent portion of right maxillary sinus. No abnormality at the level of the skull base is detected.

Output: 1.No evidence of Graves' ophthalmopathy or mass in the orbit as clinically is questioned.2.Prominence of bilateral superior ophthalmic veins which has remained stable since prior MRI examination of brain without and fusion from 8 -- 30 -- 2007.3.Prominence of right optic nerve immediately posterior to the globe no enhancement as detailed.4.Dedicated MRI examination of orbits and region of the sella with infusion is recommended for further evaluation of the above findings.


Instruction: Generate impression based on findings.

Input: Male; 70 years old. Reason: prostate cancer s/p surgery now with detectable PSA. evaluate for local recurrence History: none PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.BLADDER: Mild circumferential bladder wall thickening, suggestive of hypertrophy from chronic outlet obstruction.LYMPH NODES: Scattered subcentimeter bilateral inguinal lymph nodes, but no enlarged lymph nodes by size criteria.BONES, SOFT TISSUES: Pagetoid changes of the pelvic bones, right greater than left, similar to prior CT. No definite osseous metastatic disease.OTHER: No significant abnormality noted.

Output: No evidence of residual or recurrent disease. Consider bone scintigraphy for evaluation of osseous metastatic disease, which may be more sensitive.


Instruction: Generate impression based on findings.

Input: 85 year old patient with left pontine infarct in bilateral cerebellar lesions please evaluate patient has right hemiparesis and gaze deviation to the rightTechnique: Contiguous axial images of the brain. Subsequently high resolution contiguous axial images were obtained through the lower half of the head and neck and aortic arch during bolus injection of intravenous contrast. On the noncontrast head CT a hypodense focus corresponding to the MRI abnormality along the left cerebellar hemisphere measuring 25 x 15 mm axial dimensions is present and not clearly evident on the prior exam. Hypodense foci in the lower mid brain and upper pons predominant involving the left upper pons and lower midbrain were also not readily identified on the prior exam. There are punctate lesions present along the right posterior inferior cerebellar artery territory and to a lesser degree left posterior inferior cerebellar artery territory.There is opacification of both distal vertebral arteries along their cervical segments. The right vertebral artery is somewhat smaller than the left intracranially and along the cervical segment. The right posterior inferior cerebellar artery does display contrast enhancement as does the left, however, the right vertebral artery does not opacify distal to the posterior inferior cerebellar artery suggesting that it is likely either highly stenotic or occluded. The basilar artery, therefore fills from the left vertebral artery. There are some mural calcifications associated with luminal narrowing as the left vertebral artery enters the subarachnoid space. The left anterior inferior cerebellar artery is larger than its right counterpart. The basilar artery is highly attenuated distal to the AICA origins and suspected to be occluded below the level of the superior cerebellar arteries. The posterior communicating arteries are of similar in size to the P2 segments. The P1 segments are asymmetric right larger than left. The right P1 segment is about the same size as the posterior communicating artery on the right side the left one is smaller than the left P2 segment. It is and therefore considered that the superior cerebellar arteries fill from the anterior circulation as do the posterior cerebral arteries in this patient.There are atherosclerotic calcifications along the distal internal carotid arteries bilaterally. No significant stenosis is appreciated along the anterior or posterior cerebral arteries. The anterior communicating artery is identified and is relatively small compared to the A1 segments which are approximately equal in size. There are atherosclerotic calcifications present along the carotid bifurcations however on the basis of NASCETcriteria no significant stenosis is present along the carotid bifurcations. There is some mild narrowing of the left internal card artery just distal to its origin but approximately a 40%.The left vertebral artery is significantly narrowed at its origin with approximately an 80% stenosis along its cervical segment there are foci of narrowing along the mid cervical vertebral artery with approximately 60% stenosis at the C4-5 disk space level. View right vertebral artery is small and intracranially essentially only supplies the right posterior inferior cerebellar artery which is otherwise disconnected. There is some mild prominent muscular branch is present along the the tube in segment collateralization to the left occipital artery is unknown basis of this exam.The patient is intubated both endotracheally and nasogastric.Some atherosclerotic calcifications are present along the aorta and some of the branches. There is atherosclerotic in narrowing of the innominate artery by approximately 75%. There are degenerative changes present along the cervical spine at C6-7 with left sided neural foraminal narrowing, and c3-4 with right sided neural foraminal narrowing.

Output: 1.Subacute foci of infarction in the left cerebellar hemisphere more than the right as well is within the upper pons and lower midbrain left worse than right. No evidence for hemorrhagic conversion2.Occlusion or near occlusion of the right vertebral artery distal to the origin of the posterior inferior cerebellar artery.3.High-grade stenosis at the origin of the left vertebral artery with a tandem lesion along the mid cervical segment of the left vertebral artery and atherosclerotic in narrowing of the left internal artery as it enters the subarachnoid space. 4.There is occlusion or near occlusion of the basilar artery between the anterior inferior cerebellar artery and the superior cerebellar artery origins.5.The posterior communicating arteries are fairly large as described above. The anterior circulation appears to be the dominant supply for the posterior cerebral arteries as well is the superior cerebellar arteries. 6.High-grade stenosis (approximately 75%) of the innominate artery due to atherosclerotic narrowing7.Mild narrowing at the left internal carotid artery origin as described above. no significant stenosis at the carotid bifurcations on the basiss of NASCET criteria.8.If clinically appropriate, a more detailed assessment of the supply to the posterior circulation may be provided via conventional angiography to confirm or exclude complete occlusion of right vertebral artery and basilar artery and to provide a more accurate description of the percent of stenoses described above, assess circulation time and to identify any collateralization from the external circulation to the intracranial circulation - which cannot be identified on this exam.9.Degenerative changes are present in the cervical spine as indicacated above. Please correlate with clinical symptoms.


Instruction: Generate impression based on findings.

Input: There is no discrete white matter T2 hyperintense lesion. There are no discrete white matter lesions in the callosum or the posterior fossa. There is no suspicious or abnormal enhancement within the brain. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect, midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No discrete mass, abnormal enhancement or T2 white matter lesions identified.


Instruction: Generate impression based on findings.

Input: Reason: pt with left knee pain, no known injury, now with popping History: left knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears slightly thinned diffusely, without focal defect.LIGAMENTS: The anterior collateral and posterior collateral ligaments are within normal limits.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Essentially unremarkable appearance of the left knee.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with right leg pain. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Degenerative fatty endplate signal change is seen at L4-5. Degenerative edematous endplate signal change is seen at L5-S1.There is a very small focus of T2 hyperintensity within the left aspect of the conus which seems to show a degree of volume loss as well. The cauda equina nerve roots are unremarkable. No epidural abnormalities are suspected.L1-2: Loss of disc T2 signal with relatively preserved disc height. Small central annular fissure. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy. No significant spinal canal or foraminal stenosis. L3-4: Facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L4-5: Facet arthropathy. Loss of disc height with disc bulging. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. L5-S1: Facet arthropathy. Disc bulging with central disc protrusion. The protrusion may contact the descending bilateral S1 nerve roots. Spinal canal itself, however, is not significantly narrowed. The bilateral neural foramina are severely narrowed.

Output: 1.Relatively severe degenerative findings are seen at L5-S1 with disc bulging, a central disc protrusion and facet arthropathy. Although the spinal canal itself is not significantly narrowed, the L5-S1 neural foramina are significantly narrowed, and the descending S1 nerve roots may also be mildly impinged.2.Disc degeneration is also seen at L4-5 but without high-grade spinal canal or foraminal stenosis. The remaining levels are within normal limits or show only minimal degenerative disease.3.A small focus of T2 hyperintensity within the left aspect of the conus is of uncertain significance. The possibility of parenchymal volume loss at this level would suggest that the abnormality is chronic.


Instruction: Generate impression based on findings.

Input: Planning for stereotactic brain biopsy. Brain lesion. Enhanced head CT:75 cc of Omnipaque 350 was administered for this study.Enhanced axial 1 mm CT images of the entire brain were obtained for presurgical planning brain biopsy.Examination demonstrates diffuse lower density of bihemispheric white matter likely result of prior therapy. Multiple periventricular irregularly-shaped highly suspected calcific lesions similar to prior MRI examination from 8 -- 5 -- 11. There is suggestion of subtle enhancement of these lesions as well. There are no non-infused CT images for confirmation of calcification however the very high density of these lesions is highly suspected of calcification. Review of prior head CT from 5 -- 12 -- 08 demonstrated no calcification. Findings could represent posttreatment changes of patient's known lymphoma. Recommend non-infused head CT for further evaluation. When compared with prior recent MRI there is no appreciable change.

Output: Multiple irregularly-shaped and highly suspected calcific lesions similar to prior MRI. Subtle enhancement of these lesions is present in. Please see above comments.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: cervical cancer, needed for brachytherapy planning History: cervical cancer, MRI needed for brachy planning PELVIS:UTERUS, ADNEXA: Interval decreased size of peripherally enhancing, centrally necrotic cervical mass, which now measures up to 3.3 x 4.4 cm cm in greatest axial dimension (series 801/19), previously 4 x 5.4 cm. Again, the mass is seen arising from the cervix and extending into the left lower uterine segment. Decreased rectal and adjacent small bowel invasion. Bilateral vesicoureteral junction invasion is similar to prior study. BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decreased size of cervical mass as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for MS. Signs and symptoms: Assess for MS. Nonenhanced brain MRI:Negative diffusion weighted images.Sagittal images demonstrate herniation of cerebellar tonsils through the foramen magnum for approximately 7.5 mm and result in mild flattening deformity of the dorsal aspect of tarsal. No change since prior exam from an outside institution exam (Northwest community Hospital) dated 7-23-14.Examination demonstrates a single ill-defined small focus of subtle FLAIR hyperintensity in the left paramedian pons and without interval change since prior exam.Anatomical morphology and the signal intensity of brain parenchyma remains otherwise within normal on all MRI sequences. In particular there are no detectable lesions in the corpus callosum, subcortical or periventricular white matter or in the cerebellar peduncles.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are normal.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.Partial opacification of right chamber of the sphenoid sinus and unremarkable paranasal sinuses otherwise.

Output: 1.Negative diffusion weighted images.2.Herniation of cerebellar tonsils through the foramen magnum of approximately 7.5 mm with mild flattening deformity.3.Single ill-defined nonspecific focus of FLAIR hyperintensity in the left paramedian pons and unremarkable nonenhanced brain MRI otherwise and without evidence of demyelinating disease.4.No evidence of interval change since prior exam from 7-23-14.


Instruction: Generate impression based on findings.

Input: 38 year old with symptomatic bradycardia referred for cardiac structural evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement of the ventricles or atria.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 157 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. No abnormal enhancement of ventricles or atria.2. Normal biventricular function.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Back pain with urinary incontinence and scrotal tingling. Also, right lower extremity pain. A limited study of noncontrast-enhanced sagittal T1 and STIR sequences were obtained through the spine to rule out cord compression. There is no evidence of spinal cord or cauda equina compression. Apparent diffuse areas of high T2 signal along the spinal cord are likely artifactual. The tip of the conus lies at the L1 level. There is lumbarization of S1. The vertebral body heights are preserved. There is multilevel cervical and thoracic disc desiccation and shallow ventral indentations of the thecal sac, but no significant spinal canal stenosis. There is fluid in the right L5-S1 facet and STIR hyperintensity in the adjacent soft tissue. There is minimal fluid in the right L4-L5 facet. The vertebral bone marrow appears to be mildly heterogeneous, but without evidence of edema or focal tumors. The paravertebral soft tissues are unremarkable.

Output: 1.No evidence of spinal cord compression.2.Mild degenerative spondylosis in the cervical, thoracic, and lumbar spine.3.Apparent diffuse areas of high T2 signal along the spinal cord are likely artifactual.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a subcentimeter right choroid fissure cyst or prominent perivascular space. The brain parenchyma and pituitary gland otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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