Instruction: Generate impression based on findings.

Input: The sagittal images include inferior endplate of T11 vertebral body. Grade I retrolisthesis of L1 on L2. Otherwise the alignment of the lumbar spine is grossly within normal limits. There is very mild wedging of the T12 vertebral body, which may be physiologic. There is no evidence of acute fracture or subluxation. There are multilevel degenerative changes with multilevel disc height loss, worst at the L1-L2 level with fatty endplate changes. Prior images are partially available for comparison, but there appears to be some progression since 2011. The conus terminates at the L1 level and is normal in signal.T12/L1: Mild disc bulge and facet arthropathy without significant spinal canal stenosis. Mild right neural foraminal narrowing. No significant left neural foraminal narrowing.L1/2: Posterior osteophyte and disc bulge with a prominent left lateral recess and foraminal component and facet arthropathy with moderate to severe left neural foraminal narrowing which may be impinging on the exiting left L1 nerve root. There is minimal right neural foraminal narrowing. Mild spinal canal stenosis. L2/3: Right central disc protrusion and facet arthropathy with mild spinal spinal canal stenosis and also moderate right neural foraminal narrowing. No significant left neural foraminal narrowing.L3/4: Broad-based disc bulge, facet arthropathy, and ligamentum flavum thickening with moderate spinal canal stenosis and mild right and mild to moderate left bilateral neural foraminal narrowing.L4/5: Diffuse disc bulge, facet arthropathy, and ligamentum flavum thickening with mild to moderate spinal canal stenosis, moderate right greater than left neural foraminal narrowing.L5/S1:Minimal disc bulge with bilateral moderate neural foraminal narrowing. No significant spinal canal stenosis.

Output: Multilevel degenerative changes throughout the lumbar spine. There is moderate spinal canal stenosis at L3-L4 and mild to moderate at L4-L5. Multilevel neural foraminal stenosis as above.


Instruction: Generate impression based on findings.

Input: Back pain. There are focal depressions in the inferior endplate of T12 and the superior endplate of L1, where there is also high T2 signal in the adjacent bone marrow suggestive of edema, as well as moderate loss of T12-L1 disc space height. There is no significant spinal canal or neural foramen stenosis. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The paravertebral soft tissues are unremarkable.

Output: Intravertebral disc herniation at T12-L1 with associated reactive changes in the adjacent bone marrow, but no evidence of significant spinal canal or neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: There is leftward deviation of the infundibulum and rounded enlargement of the right aspect of the pituitary gland measuring up to 8 mm in height without a clearly defined hypoenhancing mass. Normal T1 hyperintensity of the neurohypophysis is preserved. The optic chiasm, cavernous sinuses and intracranial portions of the optic nerves are normal in appearance. There multiple patchy foci of T2 hyperintensity within the partially imaged brain.

Output: 1.Asymmetric enlargement of the right aspect of the pituitary gland measuring up to 8 mm. No discrete hypoenhancing lesion is seen however finding may represent a pituitary microadenoma. No significant suprasellar extension or mass effect on the optic chiasm. 2.Patchy foci of T2 hyperintensity within the partially imaged brain are compatible with history of demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 24 years Female (DOB:8/25/1992)Reason: seizure evaluation - presurgical assessment History: intractable epilepsy, right fronto-temporalPROVIDER/ATTENDING NAME: NAOUM P ISSA JAMES X TAO The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 13 x 8 mm axial dimension focus of diffusion restriction in the splenium of the corpus callosum which is bright on FLAIR and slightly hypointense on T1 imaging.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 some mucosal thickening along the floor of the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a somewhat nonspecific lesion within the splenium of the corpus callosum which is suspicious for (but not conclusive for) subacute infarction. Other differential considerations include inflammatory reaction due to other cause (viral infection metabolic) and trauma. Please correlate with clinical symptoms.


Instruction: Generate impression based on findings.

Input: There is a 7 x 8 mm mass within the inferior fourth ventricle centered at the obex that demonstrates slightly different signal characteristics than the adjacent brain parenchyma and does not have the appearance of choroid plexus. There is no evidence of intracranial hemorrhage or acute infarct. There is a single nonspecific punctate focus of T2 hyperintensity within the left periventricular white matter that likely represents age-related white matter changes. The ventricles are somewhat prominent, out of proportion to the degree of mild volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a prominent cisterna magna. There is a retention cyst within the left maxillary sinus. The midline structures and craniocervical junction are within normal limits.

Output: 8 mm mass centered at the obex, in the context of mild ventriculomegaly, is very suggestive of subependymoma with other etiologies such as ependymoma or a choroid plexus lesion also possible. Postcontrast sequences are recommended for further characterization.This finding was called by Dr. Michael Rozenfeld to Dr. Andrea Dellaria on 5/9/2015 12:35 PM.


Instruction: Generate impression based on findings.

Input: Progressive leg weakness; evaluation for targeted muscle biopsy Due to technical factors including metallic susceptibility artifact related to the patient's left dynamic hip screw device, the images are of markedly suboptimal quality and nondiagnostic for the stated indication of localizing site for muscle biopsy in the left vastus lateralis. This study was reviewed by the radiology resident on call and terminated prior to completion of the study.There is diffusely abnormal signal involving the bones and soft tissues of the visualized lower extremities. We are uncertain to what extent this relates to technical artifact versus the patient's underlying condition. There appear to be bilateral knee joint effusions, as well as testicular hydroceles.

Output: Nondiagnostic exam as detailed above. The patient will not be charged for the study. Attempts to have the patient return for additional images were unsuccessful due to patient refusal.


Instruction: Generate impression based on findings.

Input: 79-year-old female with endometrial cancer and continued uterine bleeding. Evaluate status of disease. PELVIS:UTERUS, ADNEXA: Increased distention of the endometrial canal, which now demonstrates a blood-fluid level. The endometrial canal measures up to 9.4 x 6.8 cm (axial series 8 image 17), prior 1.9 x 2 cm. The known lobulated endometrial mass has increased in size and measures 7.1 cm in length (sagittal series 6 image 34), prior 5.3 cm. The lesion extends into the endocervical canal and into the upper vagina. The lesion is in close contact with the sigmoid colon (axial series 8 image 21), however no definite evidence for serosal invasion.Multiple uterine fibroids are again noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval enlargement of known endometrial mass.


Instruction: Generate impression based on findings.

Input: 23-year-old male with malignant neoplasm of the base of tongue/oral cavity, status post chemoradiation therapy. There has been interval decrease in extent of an infiltrative mass in the posterior right tongue, now appearing less defined with less intense enhancement and T2 hyperintense abnormality. In AP dimension it measures 19 mm (series 1802 image 47), previously 20 mm, although it appears significantly decreased in transverse and craniocaudal bulk, with more irregular margins making measurement difficult. Redemonstrated are posttreatment findings including partial right glossectomy and neck dissection. There is no evidence of significant lymphadenopathy in the imaged portions of the neck. The remaining salivary glands and thyroid are unremarkable. The osseous structures appear to be intact. The imaged intracranial structures are stable. There is a small amount of fluid in bilateral mastoid air cells, unchanged.

Output: There has been interval decrease in extent of an infiltrative mass in the posterior right tongue, now appearing less defined with less intense enhancement and T2 hyperintense abnormality. In AP dimension it measures 19 mm (previously 20 mm), although it appears significantly decreased in transverse and craniocaudal bulk, with more irregular margins making measurement difficult. There is no clinically significant lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 34 years, Male, Reason: s/p TBI in 2002. Now with behavior changes History: mood instability, anger out burst. Several sequences are motion degraded. There are multiple scattered foci of susceptibility related to hemosiderin in the brain at the gray-white junction as well as at the cortical surface consistent with traumatic brain injury. Chronic hemosiderin deposition is relatively more prominent along the surface of the left inferior frontal and left temporal lobes as well as the superior parietal lobules. There is extensive encephalomalacia involving the left anterior temporal lobe as well as the left temporal lobe laterally along the left middle and inferior temporal gyri. There is also encephalomalacia involving the left superior parietal lobule. There is also small area of gliosis evident involving the right superior parietal lobule also likely related to prior trauma. Linear T2 signal abnormality with surrounding gliosis involving the right superior frontal gyrus may be related to prior ventriculostomy or ICP monitoring device.There is no intracranial mass or mass effect. No acute infarct. No extra-axial collections. No midline shift or herniation. There are areas of ex vacuo dilatation of the lateral ventricles. There is also multifocal thinning of the corpus callosum which may be related to Wallerian degeneration and/or traumatic injury. No hydrocephalus. There is polypoid mucosal thickening involving the bilateral maxillary sinuses. Evidence of prior left frontotemporal craniotomy.

Output: Multifocal encephalomalacia and chronic hemorrhage consistent with chronic traumatic brain injury. Findings are relatively more prominent in the left temporal and left parietal lobes as described above.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of vaginal cancer. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: There is air within the bladder.LYMPH NODES: Shotty inguinal lymph nodes are decreased from prior.BOWEL, MESENTERY: There is tethering of the sigmoid colon to the vaginal cuff. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Vaginal mass has significantly decreased in size. Irregular mucosal thickening and mild enhancement of the right lateral vagina extending into the posterior aspect of the bladder (image 299 of series 1004). There is also improved appearance of parametrial invasion. There is air within the vaginal cuff.Ventral abdominal surgical scar.

Output: Interval significant decrease in size of right vaginal mass. Given the bladder involvement and air within the bladder, in the absence of recent instrumention, a vesicovaginal fistula is suspected.


Instruction: Generate impression based on findings.

Input: 62-year-old man with intermittent right leg numbness and weakness in the right L4 or 5 distribution when sitting in a cramped position. There are five lumbar type vertebral bodies present. There is minimal anterolisthesis of L5 on S1 and loss of disc height at this level; otherwise, the vertebral body and disk heights are well-maintained. The conus medullaris terminates at L1. At L4-5, there is bilateral facet joint hypertrophy and ligamentum flavum thickening resulting in mild bilateral neural foraminal narrowing, but no significant compromise to spinal canal. At L5-S1, there is degenerative disc disease with fatty endplate bone marrow signal alterations and mild facet arthropathy resulting in moderate right and severe left neural foraminal narrowing, but no significant compromise to the spinal canal. While the entire kidneys are not included in the field of view, the imaged portions appear extensively replaced with cysts. There is atrophy of the paraspinous muscles.

Output: 1.Degenerative spondylosis with mild bilateral neural foraminal narrowing at L4-L5 and moderate right and severe neural foraminal narrowing at L5-S1, but no significant spinal canal stenosis.2.The imaged portions of the kidneys appear replaced with cysts, which may represent polycystic kidney disease or other form or renal disease. Dedicated renal imaging is recommended for further evaluation if outside studies are unavailable for comparison.


Instruction: Generate impression based on findings.

Input: Male 68 years old Reason: evaluate for thigh myositis for biopsy. History: proximal muscle weakness, concern for polymyositis or dermatomyositis. RIGHT FEMUR:Musculature: There is widespread edema-type signal of the musculature of the right thigh as seen on fat saturation T2 weighted images with most pronounced involvement of the vastus intermedius and adductor magnus muscles. There is relative sparing of the semitendinosus muscle and gracilis. The vastus medialis, lateralis and rectus femoris distally are also relatively spared. There is also moderate fatty atrophy of the semimembranosus muscle.Bone marrow: The marrow signal intensity of the femur is within normal limits. Additional findings: Small knee joint effusion. Small bilateral hydroceles.LEFT FEMUR:Musculature: There is widespread edema-type signal of the musculature of the left thigh as seen on fat saturation T2 weighted images with most pronounced involvement of the rectus femoris proximally and adductor magnus. There is relative sparing of the vastus lateralis and intermedius as well as the distal vastus medialis and rectus femoris. There is moderate fatty atrophy of the semimembranosus as well as moderate fatty atrophy of the mid rectus femoris.Bone marrow: The marrow signal intensity of the femur is within normal limits.Additional findings: Small knee joint effusion. Small bilateral hydroceles.

Output: Findings consistent with polymyositis as described above.


Instruction: Generate impression based on findings.

Input: Ms. Gagnon is a 59-year-old female with biopsy-proven IDC/DCIS of the right breast, spanning approximately 7.3 cm on prior MRI. She is currently undergoing neoadjuvant chemotherapy. She presents today for repeat MRI to assess for imaging evaluation to treatment response. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST: There has been an interval decrease in size of biopsy-proven heterogeneously enhancing mass in the right upper outer breast, posterior depth, now measuring 2.1 x 1.5 x 1.8 cm, previously measuring 2.8 x 2.3 x 2.4 cm (AP x LR x CC). There continues to be a thin fat plane between thismass and pectoralis muscle on T2 weighted images, and there is no pectoral enhancement, suggesting no invasion into the muscle. There continues to be segmental nonmass enhancement extending anteriorly from the mass in the right upper outer breast, measuring approximately 5.0 x 1.6 cm, previously measuring 5.1 x 1.7 cm. However, this non-mass enhancement has decreased in overall enhancement intensity and pattern. Overall measurement including mass and non mass enhancement is 6.6 x 2.3 cm, compared to 7.3 x 2.8 cm.LEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.A vascular port overlies the left upper chest wall.

Output: (1) Decreasing size of index malignancy in the right upper outer breast with residual total enhancement measuring 6.6 cm in the AP dimension (compared to 7.3 cm).(2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 40-year-old male with left-sided abdominal pain. Patient with outside CT showing possible thickening of the jejunum. Evaluate small bowel thickening. ABDOMEN:LIVER, BILIARY TRACT: Multiple subcentimeter T2 hyperintense foci without evidence of contrast enhancement compatible with simple cysts. 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: Proximal jejunal loops are underdistended and demonstrate mild contrast enhancement (series 11, image 533) which is likely secondary to underdistentionBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild jejunal mucosal enhancement likely secondary to underdistention.


Instruction: Generate impression based on findings.

Input: 56-year-old female with medial knee pain MENISCI: There is a flap of meniscal tissue flipped anteriorly, situated adjacent to the anterior horn of the medial meniscus, consistent with a displaced tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Mild chondromalacia along the medial patella extending to the median eminence without full thickness cartilage defect visualized. There is also mild thinning of the medial tibial femoral compartment articular cartilage without full thickness defect.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. Medial meniscus tear with meniscal flap displaced anterior to the anterior horn of the medial meniscus.2. Moderate joint effusion and mild chondromalacia as described above.


Instruction: Generate impression based on findings.

Input: 30-year-old male. Pain with wrist extension. Evaluate for tendinitis. Left wrist: LIGAMENTS: Grossly intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Grossly intact.TENDONS: Normal signal intensity and morphology of the wrist tendons without evidence of tendinopathy or tenosynovitis.BONES: Small cyst in the lunate, likely degenerative in etiology. ADDITIONAL

Output: 1. No evidence of tendinopathy or tenosynovitis.2. Small cysts in the lunate, likely degenerative in etiology.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: No significant abnormality noted. There is increased signal intensity within the peripheral fibers of the posterior horn of the medial meniscus which is thought to represent vascularity.ARTICULAR CARTILAGE AND BONE: There is heterogeneity of the articular cartilage of the medial and lateral compartments but otherwise there is no evidence of full-thickness cartilage defect.There is heterogeneity and areas of near full-thickness to full-thickness loss of articular cartilage of the patellofemoral compartment particularly within the lateral patellar facet. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: The Insall Salvati ratio is borderline elevated at 1.4. The femoral trochlea appears subjectively shallow. The TT to TG distance is normal at 1.5 cm and there is a mild amount of nonspecific increased signal within the superolateral portion of Hoffa's fat pad.ADDITIONAL

Output: Moderate articular cartilage loss and heterogeneity of the patellofemoral compartment with areas of near full-thickness to full-thickness loss of the lateral patellar facet.


Instruction: Generate impression based on findings.

Input: Reason: Patient w/ prostate cancer w/ diffuse weakness, inability to ambulate, bladder/bowel incontinence, please eval for cord compression History: As above There is extensive multilevel cervical spondylosis with disc osteophyte formation most severe at C3/4 level with cord impingement and edema. There is marrow edema from C3 to C7, better assessed on dedicated cervical spine exam. There are chronic compression deformities of T5 and T6 without marrow edema or spinal canal stenosis. There is also mild compression deformity of the T12. There is multilevel lumbar spondylosis with spinal canal narrowing, better assessed on dedicated lumbar spine exam. There is no definite metastatic disease of the spine.

Output: 1.There is extensive multilevel cervical and lumbar spondylosis, better assessed on dedicated exams. 2.No definite metastatic disease of the spine.


Instruction: Generate impression based on findings.

Input: Right shoulder immobility. Inflamed and enlarged area between cervical spine and R shoulder) Patient's body habitus and poor signal on the axial T2 fat saturated sequences through the supraclavicular region limit assessment of the supraclavicular region. However no obvious mass is apparent. No mass is seen involving the cervical paraspinous soft tissues on the cervical spine sequences.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. 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: There is a disc osteophyte complex with moderate spinal canal stenosis at this level. No cord signal abnormality. There is mild to moderate bilateral right worse than left neural foraminal stenosis related to uncovertebral hypertrophy and mild facet arthropathy.C4-5: There is a disc osteophyte complex with moderate spinal canal stenosis at this level. There is moderate right neural foraminal stenosis and mild left neural foraminal stenosis.C5-6: There is a disc osteophyte complex and mild ligamentum flavum thickening which contribute to moderate spinal canal stenosis. There is mild right and moderate left neural foraminal stenosis.C6-7: Small disc osteophyte complex and ligamentum flavum thickening with mild spinal canal narrowing. There is minimal narrowing of the left neural foramen. Right neural foramen is patent. C7-T1: No significant compromise to the spinal canal or right neural foramen. There is mild left neural foraminal narrowing.Disc bulge at T2-T3 is partially imaged without spinal canal stenosis. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Patient's body habitus and poor signal on the axial T2 and postgadolinium sequences through the supraclavicular region limit assessment of the supraclavicular region on this cervical spine MRI study. However no obvious mass is apparent. If clinically indicated targeted ultrasound of this region can be considered. Please also refer to separate report for findings in the shoulder.2. There are degenerative changes throughout the cervical spine including moderate spinal canal stenosis at the C3-C4, C4-C5, and C5-C6 levels. No cord signal abnormality. Neural foraminal narrowing is also seen at multiple levels as detailed above.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, left ptosis, cutaneous neurofibromas, plexiform neurofibroma . Brain: There is left sphenoid wing dysplasia with a defect in the left lateral orbital wall and associated expansion and protrusion of the middle cranial fossa into the left orbit, prominence of the extra-axial cerebrospinal fluid spaces overlying the left temporal lobe, and 5 mm of midline shift towards the left. There are punctate foci of high T2 signal in the subcortical white matter of the inferior left frontal lobe and midbrain posterior to the left red nucleus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The optic chiasm appears to be intact. The ventricles are not dilated. There appears to be an anomalous and enlarged proximal right opthalmic artery, which projects into the right sphenoid sinus. Orbits: There is an infiltrative heterogeneously enhancing mass in the left eyelid with apparent extension into the lacrimal gland and superior extraconal region, which measures approximately 10 x 35 mm in cross-section. In addition, there is diffuse enhancement measuring up to 2 mm in thickness along the lateral extraconal region of the left orbit, extending posteriorly to the orbital apex and into the superior orbital fissure. There are several additional nodular enhancing lesions in the skin and subcutaneous tissues of the left lateral periorbital and temporal regions, as well as overlying the left masseter muscle and parotid gland. There is left proptosis, compression of the left optic nerve, and deformity of the lateral rectus muscle associated with the sphenoid wing dysplasia and protruding intracranial contents, but no discernible tumor within the optic nerve. In addition, there is enlargement of the left globe diffuse, compatible with buphthalmos. The right orbit appears unremarkable. There is a subcentimeter enhancing focus in the right sublingual space.

Output: 1. A left eyelid plexiform neurofibroma measures up to approximately 35 mm and appears to infiltrate the lacrimal gland and superior extraconal space and what may represent additional tumor measuring up to 2 mm in thickness along the lateral extraconal region of the left orbit extending posteriorly to the orbital apex and into the superior orbital fissure.2. Several other left facial and scalp lesions are compatible with peripheral nerve sheath tumors as well.3. Left sphenoid wing dysplasia with proptosis associated with expansion of the middle cranial fossa and prominence of the subarachnoid spaces.4. Mild left buphthalmos.5. Apparent anomalous and enlarged proximal right opthalmic artery, which projects into the right sphenoid sinus and may in part represent vascular dysplasia, possibly with fusiform aneurysm. Dedicated angiographic imaging may be useful for further evaluation.6. A subcentimeter enhancing lesion in the right sublingual space may represent a neurofibroma.7. Nonspecific punctate foci of high T2 signal in the subcortical white matter of the inferior left frontal lobe and midbrain posterior to the left red nucleus may represent stigmata of neurofibromatosis type 1, such as "FASI".8. During the study the patient experienced a mild contrast reaction manifested by cough, pruritis, and nasal congestion, but no shortness of breath and symptoms resolved in few minutes. No treatment was administered. The patient was discharged in stable condition and instructed to seek medical care should symptoms recur.


Instruction: Generate impression based on findings.

Input: Male, 23 years old, with history of neurocytoma and imaging findings of progressive disease. Functional MRI assessment of the motor strips is requested for presurgical planning. It should be noted that the margins of the patient's midline cingulate region tumor show evidence of hemosiderin staining as do several of the adjacent cerebral sulci. The resultant magnetic susceptibility is not believed to affect the quality of the functional data.Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. In particular, motor activation of the foot resides posterior and superior to the upper margin of the tumor. Language SMA activation as revealed by the verb generation paradigm resides within the superior frontal gyrus directly above but removed from the tumor.

Output: Successful functional MRI for sensorimotor cortical mapping. Motor activation of the foot maps posterior and superior to the patient's midline tumor. Language SMA activity is also seen directly superior to the tumor.


Instruction: Generate impression based on findings.

Input: Migraines/headaches. Evaluate for structural lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland 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 acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: No. New onset of aphasia. Rule out bleed or mass. Examination demonstrates a mass within the posterior fossa with minimal amount of hemorrhage or calcification. There is surrounding vasogenic edema and mass effect on the fourth ventricle and minimally on the quadrigeminal plate. No evidence of hydrocephalus is detected. Further follow-up with an MRI examination is recommended. The mass measures approximately 26.2 mm x 41.This examination is otherwise unremarkable.

Output: Mass within the left cerebellum with minimal possible hemorrhage or calcification. Further follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: AMS. Evaluate for acute CVA. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. Parenchymal volume loss is again seen with prominence of the ventricles and sulci. There is encephalomalacia of the right inferior parietal lobule which is unchanged. There is no midline shift. The basal cisterns are patent. There is no edema or mass effect. There are patchy areas of T2/Flair signal abnormalities in the subcortical and the periventricular white matter, which are nonspecific, but most likely consistent with chronic small vessel ischemic changes. There is mucosal thickening of the left maxillary sinus. Again seen is a bony anomaly in the medial wall of the right maxillary sinus which may reflect osseous deficiency or sinus expansion which may be either congenital or surgical in nature. There is mild mucosal thickening of the sphenoid sinuses. A small amount of high T2 signal intensity is seen in the left frontal sinus. There is a minimal partial opacification of the left mastoid air cells.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Right parietal encephalomalacia chronic in nature.3.Findings compatible with mild-moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: 3T scanner, CCM protocol, QSM, permeability History: Known CCM yearly surveillance About 12.5 mm (measured on the axial T2 weighted image the longest diameter) sized right postcentral gyrus cavernous malformation is seen with the surrounding hemosiderin deposition unchanged since prior scan. On post Gad enhanced image, especially posterior aspect of the lesion shows some enhancement which is unchanged since prior scan. Punctate susceptibility lesion on the right thalamus is also seen, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection, 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 and mastoid air cells are clear.

Output: 1. Right postcentral gyrus cavernous malformation is again seen, unchanged in terms of maximum diameter, MR characteristics and findings since prior scan.2. Susceptibility lesion on the right thalamus is again see, unchanged since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are left breast ultrasound dated 4/4/2011, left diagnostic mammogram dated 4/4/2011, and MRI breast dated 4/13/2011 performed at Northwestern Graylake. LEFT DIAGNOSTIC MAMMOGRAM (4/4/2011): Two standard views of the left breast and 2 spot compression views were obtained. The breast parenchyma is heterogeneously dense. The breast tissue in the left upper inner quadrant appears slightly more conspicuous on recent mammogram dated 2/19/2015LEFT BREAST ULTRASOUND (4/4/2011): A cyst was seen in the 12 o'clock position of the left breast that measures 4 mm.BREAST MRI (4/13/2011): There is no significant interval change compared to mammogram dated 12/22/2014.

Output: Slightly more conspicuous breast parenchyma the left upper inner quadrant compared to examination in 2011 without interval change from breast MRI dated 4/13/2011 and 12/22/2014. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Radiculopathy, cervical region [M54.12], Reason for Study: ^Reason: Assess for canal and/or foraminal stenosis History: Radiculopathic pain RUE C7 distribution There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. C5-C6: broad based central and slightly eccentric toward right side focal bulging of disc which abuts thecal sac, no neuroforaminal narrowing or spinal stenosis. C6-C7: broad based central diffuse bulging of disc which abuts thecal sac, no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multilevel disc bulges, at the level of C45, C56 and C67 as described above.2. Otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: Presented with confabulations. History of alcohol abuse. The patient was sedated with irregular breathing and movement during the examination. The exam was not completed as the patient become combative. There are no axial T1 and diffusion weighted images.There are a few punctate subcortical and mild periventricular cerebral white-matter T2/FLAIR hyperintensities. Accounting for coaptation involving the anterior aspect of the right lateral ventricle, the ventricles and the other CSF-containing spaces are globally enlarged reflecting moderate cerebral and cerebellar volume loss. There is no midline shift or brain herniation. The major intracranial vascular flow voids are preserved. There is no intracranial hemorrhage.There is trace maxillary mucosal thickening. The other paranasal sinuses are clear. There is also trace T2-hyperintensity within the mastoid air cells.T2-hyperintensity along the nasopharyngeal vault which may represent secretions but is not completely assessed. The clivus shows near complete loss of the expected fatty signal with prominent somewhat geographic appearing T1 hypointensity, with sparing of its lower part. The floor of the sella appears to be maintained. Similar loss of marrow fatty signal is present in the included cervical spine. The calvarial marrow has a more normal appearance. These findings may reflect hypercellular marrow due to chronic medical illnesses but the geographic involvement in the clivus is atypical.

Output: 1.Incomplete, limited examination.2.Moderate generalized brain volume loss. Mild cerebral white-matter signal abnormality, probably reflective of microvascular ischemia.3.Loss of the normal fatty signal in the clivus and included upper cervical spine may reflect red marrow reconversion or infiltration in the absence of primary malignancy, although the geographic pattern of involvement in the clivus is atypical. Head CT scan may better characterize the clival abnormality.


Instruction: Generate impression based on findings.

Input: History of HCC status post TACE/RFA ablation. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.The segment 5 ablation cavity measures approximately 3.8 x 1.5 cm (series 10, image 233), compared to 4.3 x 1.9 cm previously. There is adjacent perfusional anomaly but no discrete lesion.The segment 6 ablation cavity measures 2.2 x 3.0 cm (series 10, image 244), compared to 3.0 x 3.7 cm previously.No evidence of residual or recurrent disease.No new suspicious liver lesion. No biliary ductal dilatation. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mildly atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhosis with two right hepatic lobe ablation cavities without evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Saddle distribution pain and paresthesia. There is 50% anterior/central vertebral body height loss at L2 associated with minimal, if any, adjacent marrow edema. There is no retropulsion or extraosseous soft tissue component. The vertebral bodies are preserved in height otherwise and there is no suspicious marrow edema. Mild type I degenerative signal is present subjacent to the endplates of L5-S1 anteriorly. There is severe disc height loss at L3-L4, L4-5 and L5-S1. Sagittal alignment is notable for straightening in addition to minimal anterior subluxation of L1 relative to L2 and L2 relative to L3 and posterior subluxation of L3 over L4. The spinal canal is severely narrowed at L2-L3 as described below with redundant cauda equina roots cranial to the stenosis level. The conus medullaris tip lies at L1-L2 level. The conus has a normal morphology and signal. There are well-circumscribed, homogeneously T2-hyperintense, T1-hypointense renal lesions, the largest of which is an exophytic lesion arising from the inferior pole of the left kidney that measures up to 5.2 cm. These are likely cysts but are not completely assessed. At T10-T11, there is central/left paracentral disc protrusion and mild facet arthropathy but no significant spinal canal or neural foraminal stenosis. At T11-T12, there is a small central disc protrusion and mild facet arthropathy but no significant spinal canal or neural foraminal stenosis. At T12-L1, there is a tiny left paracentral disc protrusion as well as moderate facet arthropathy and ligamentum flavum thickening but no significant spinal canal or neural foraminal stenosis. At L1-L2, the subluxation-associated disc uncovering/bulge and severe bilateral facet arthropathy result in moderate central and left paracentral spinal canal stenosis. There is minimal, if any, left-sided neural foraminal stenosis. At L2-L3, the subluxation-associated disc uncovering along with disc bulging and severe bilateral facet arthropathy and ligamenta flava thickening result in severe spinal canal stenosis. There is moderate-to-severe left and moderate right medial neural foraminal stenoses. A small, heterogeneously T2-hyperintense lesion related to the right facet is probably a synovial cyst. At L3-L4, disc osteophyte complex and moderate bilateral facet arthropathy result in stenosis of the right subarticular recess and mild central spinal canal stenosis. There is also severe right and moderate left neural foraminal stenoses that are most pronounced medially. A large right lateral osteophyte also touches the right L3 nerve root. At L4-L5 and L5-S1: There is no significant central spinal canal stenosis, but there is severe left and moderate-to-severe right neural foraminal stenoses caused by the facet arthropathy and the disc/osteophyte. The lateral osteophytes at L5-S1 contact the respective extraforaminal segments of the L5 nerve roots.

Output: 1.A compression fracture of L1 likely represents a chronic insufficiency fracture. 2.Multilevel degenerative lumbar spondylolysis with spinal canal stenosis that is severe at L2-L3 and moderate at L1-L2, as well as bilateral neural foraminal stenoses that are most pronounced at L4-L5 and L5-S1.3.Multiple renal cysts are not completely assessed on this examination. A renal ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 43 years old. Reason: Mild Thyromegaly exam. No Nodules Palpated. RIGHT LOBE MEASUREMENTS: 1.6 x 2.4 x 5.0 cm.LEFT LOBE MEASUREMENTS: 1.7 x 2.4 x 4.8 cm.ISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Homogeneous echotexture, without focal lesion.LEFT LOBE: Homogeneous echotexture, without focal lesion.ISTHMUS: Homogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 2 lymph node measures 0.8 x 0.3 x 1.0 cm.OTHER: No significant abnormality noted.

Output: No thyroid nodules identified.


Instruction: Generate impression based on findings.

Input: Right sided Parkinsonism. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of significant spinal canal stenosis or spinal cord lesions.


Instruction: Generate impression based on findings.

Input: Right-sided sciatica pain, evaluate for evidence of spinal stenosis and degree of degenerative disc disease. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening; alignment in the lumbar spine is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen with particular disc height loss at the L4-L5 and L5-S1 levels with vacuum phenomena as well as edematous marrow signal changes involving the L5 and S1 endplates. Additional details as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge eccentric to the right without significant spinal canal stenosis. There is mild right neural foraminal narrowing as well as contact of the disc with the extraforaminal right L2 nerve root. Left neural foramen is patent. Bilateral facet arthropathy, with distention of the right facet joint.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is disc bulge eccentric to the left as well as facet arthropathy, worse on the left than the right. There is no significant spinal canal or right neural foraminal stenosis. There is moderate left neural foraminal stenosis.L5-S1: Disc bulge and moderate bilateral facet arthropathy. No significant spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine without significant spinal canal stenosis at any level. There is mild right L2-L3 and moderate right L5-S1 neural foraminal stenosis as well as moderate left L4-L5 and left L5-S1 neural foraminal stenosis. Additional details as above.2. Endplate degenerative changes are worse at the L4-5 and L5-S1 levels. There is also facet arthropathy at L2-L3, L4-L5, and L5-S1 levels, which may also be contributing to back pain.


Instruction: Generate impression based on findings.

Input: Ms. Johnican is a 43 year old female with known left breast cancer status post neoadjuvant chemotherapy and disease positive left axillary lymph node. Personal history of benign left breast biopsies for tubular adenoma and fibroadenoma and benign right axillary lymph node biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left superior breast, at site of known malignancy, there is revisualization of an irregular enhancing mass measuring 2.3 x 1.7 x 1.9 cm (AP x ML x SI), previously measuring 2.1 x 2.3 x 2.1 cm. Biopsy marker clip is located centrally within this malignancy. There is associated minimal skin dimpling seen anteriorly.Biopsy-proven tubular adenoma and biopsy-proven fibroadenoma of the left breast measure 1.5 x 1.0 x 1.2 cm and 0.8 cm respectively, not significantly changed in size and appearance when compared to prior examination.RIGHT BREAST:There is no abnormal enhancement seen in the right breast.AXILLA: There has been an interval decrease in size of previously enlarged left axillary lymph nodes, two of which contain biopsy marker clips. The two biopsied left axillary lymph nodes now measure 1.7 x 0.7 cm and 1.1 x 0.5 cm respectively. Previously enlarged right axillary lymph nodes have also decreased in size when compared to prior examination, the larger one of which contains a Hydromark biopsy clip.

Output: (1) Interval decrease in size of left breast index malignancy and left axillary lymph nodes.(2) No MR evidence of malignancy in the right breast.(3) Stable biopsy-proven tubular adenoma and fibroadenoma of the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Acute ischemic stroke. Signs and symptoms: Right leg weakness. Nonenhanced brain MRI:Examination demonstrates a 10 x 10 mm focus of restricted diffusion in the left cerebellum consistent with an acute nonhemorrhagic stroke. A tiny linear restricted diffusion is also noted in the right posterior cerebellum as well highly suggestive of a small acute stroke.Additionally there is a large left mid to posterior temporal and occipital as well as left pontine and multiple tiny right occipital foci of restricted diffusion as well consistent with acute ischemic stroke in the distribution of the left PCA.There is no evidence of hemorrhagic changes with the findings.Additionally examination demonstrated a large chronic left posterior frontal and parietal ischemic stroke without evidence of hemorrhagic changes. There is ex vacuo dilatation of left lateral ventricle secondary to chronic strokes and mild effacement of adjacent cortical sulci to the left temporal-occipital acute stroke.Examination also demonstrates moderate degree of chronic small vessel ischemic strokes.Prominence of cortical sulci and dilatation of supratentorial ventricular system consistent with underlying parenchymal volume loss.The signal voids of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.Large acute nonhemorrhagic ischemic stroke in left temporal / occipital and left thalamus. Small foci of acute ischemic stroke in bilateral cerebellum (L>R) is also noted as detailed above.2.Chronic nonhemorrhagic small vessel ischemic strokes and a large chronic left MCA territory posterior frontal/parietal cortical stroke as mentioned.3.Prominence of cortical sulci and supratentorial ventricular system consistent with underlying parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: As demonstrated previously, the cerebellar tonsils have a somewhat pointed configuration with the right tonsil extending 8 mm inferior to the foramen magnum and the left tonsil extends 3 mm inferior to the foramen magnum. As before, biphasic CSF flow is demonstrated posteriorly at the level of the cerebellar tonsils and foramen magnum.Redemonstrated is a large intramedullary septated fluid cavity that begins at the cervico-medullary junction which begins to taper at the T7-T8 level before terminating at the T9-T10 level. It is unchanged in size, again measuring up to 8 x 10 mm at the T4 level. There is surrounding patchy high T2 signal in the spinal cord which appears unchanged. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or foraminal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1.Stable Chiari malformation.2.Unchanged syringomyelia extending from the craniocervical junction to the T9-10 level.


Instruction: Generate impression based on findings.

Input: 62-year-old male with cirrhosis on heparin drip, supratherapeutic. Now with hemoglobin drop. Concern for hematoma and liver. Per medical record, history of cirrhosis (HCV, EtOH, HCC) s/p transplant in 2009 c/b relapsed HCV, portal vein thrombosis, grade III esophageal varices and grade I gastric variceal bleed with emergent TIPS in May 2015. Multiple sequences are limited by dielectric artifact secondary to the patient's ascites.ABDOMEN:LUNG BASES: Small bilateral pleural effusions with bilateral lower lobe atelectasis.LIVER, BILIARY TRACT: 11.0 x 8.7 x 8.7 cm lobulated septated mass in the right hepatic lobe, with homogeneous internal low T1 signal, internal high T2 signal, and mild peripheral enhancement without internal enhancement. This is similar to the prior CT on 7/4/2015, though new since 5/21/2015. Geographic regions of high T2 signal in the posterior right hepatic lobe are compatible with fibrosis and steatosis, also seen on prior CTs. There is biliary ductal dilation in the posterior right hepatic lobe, possibly secondary to compression by the aforementioned mass. The TIPS is again seen, in similar configuration to prior studies.SPLEEN: Splenomegaly with siderotic nodules.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: Moderate amount of ascites, similar to the prior CT, though increased since the prior MRI in 2014. Anasarca.

Output: 11 cm lobulated septated mass in the right hepatic lobe without internal enhancement and questionable rim enhancement. This appearance is nonspecific though abscess and hematoma should be considered.


Instruction: Generate impression based on findings.

Input: 53-year-old female with history of neoplasm of the endometrium. Evaluate.Pathology results 7/16/2015 of endometrial biopsy demonstrating endometrial carcinoma. PELVIS:UTERUS, ADNEXA: Large T1 and T2 heterogeneous uterine mass measuring 14 x 10 cm (series 601, image 57), not significantly changed. Additionally, there is a multiseptated large fluid containing mass which appears to arise from the left adnexa. This mass demonstrates components which are T2 hyperintense and T1 hypointense compatible with fluid. Additionally, there are small components which are T1 hyperintense and T2 hypointense consistent with blood products. This lesion measures approximately 14 x 9 cm (series 601, image 43). The septations demonstrate contrast enhancement. This mass was retrospectively seen on the February 2015 CT and appears to have mildly increased in size.The normal right ovary is suggested on series 601, image 50.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent pelvic sidewall and external iliac lymph nodes bilaterally are unchanged compared to the previous CT examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large heterogeneous uterine mass is not significantly changed.2.Multiseptated large complex fluid containing mass favored to arise from the left adnexa as detailed above, may be related to patient's known large endometrial malignancy versus separate ovarian primary neoplasm.3.Bilateral pelvic sidewall and external iliac lymph nodes are unchanged compared to the recent CT examination.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: in resection cavity from prior tumor History: tumor resection Post stereotaxic biopsy follow up for the recurrent left cerebellar hemisphere tumor.Gross size, MR signal intensities and enhancing pattern of the left cerebellar lesion do not show any significant interval change.There is linear biopsy track demonstrating blood products from the posterior aspect of the lesion through the mesial aspect of the left cerebellar hemisphere.The degree of surrounding edema and mass effects do not show any significant interval change. The 4th ventricle shows mass effects especially left lateral aspect, however, there is no evidence of hydrocephalus. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post biopsy status of the recurrent left cerebellar mass through the midline occipital craniectomy site. 2. Postoperative no unusual finding, specifically no interval change of the gross size of the mass and the extent of surrounding edema and mass effects since prior scan.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:10/2/1946)Reason: Stroke work up in setting of new onset seizure History: Shaking of L side and unrespnosive, L gaze deviationPROVIDER/ATTENDING NAME: TAO W XIE TAO W XIE MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia present along the right superior frontal gyrus and right cingulate gyrus. There is some diffusion restriction is present along portions of the right cingulate gyrus and right superior frontal gyrus.In general the brainstem and cerebellum are relatively small. There are some patchy T2 and FLAIR signal hyperintensities within the pons.There are submillimeter punctate foci of T2 and FLAIR signal hyperintensity in the thalami. On susceptibility weighted imaging there are punctate foci of signal hypointensity within the thalami bilaterally which correspond to the T2 and FLAIR signal abnormalities.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The calcifications present along the falx.MRA brain:The MRA exam is mildly degraded due to motion artifact.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right A1 segment is larger than the left A1 segment. The right anterior cerebral artery becomes attenuated at the level of the A2 segment and does not opacify along the A4 and A5 segments.There is no evidence for intracranial aneurysm .The anterior communicating artery is identified and is medium sized. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is encephalomalacia present along the medial aspect of the right frontal lobe involving right superior frontal gyrus and right cingulate gyrus which is associated with some foci of diffusion restriction suggesting a superimposed subacute or acute infarct.2.There is attenuation of the right anterior cerebral artery along the right A2 and A3 segments with suspected occlusion more distally.3.Periventricular and subcortical white matter lesions of a mild degree as well as patchy lesions in the pons are nonspecific. At this age they are most likely vascular related. 4.There is atrophy of the pons and cerebellum.5.A couple microhemorrhages in the thalami are present in isolation these are somewhat nonspecific. They could be hypertensive in origin based on location.6.The MR angiogram is somewhat degraded due to some mild motion artifact which may obscure some subtle or small abnormalities .


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with a lesion in the right centrum semiovale. A round, T2 hyperintense nonenhancing lesion is redemonstrated within the right centrum semiovale measuring up to 15 mm in diameter. There has been no significant interval change in size or morphology of this lesion.No additional focal lesions are seen. No areas of edema or mass effect are detected. Diffusion-weighted images are within normal limits. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. The ventricles are normal in size and morphology.

Output: There has been no interval change in the size or morphology of a lesion previously identified in the right centrum semiovale. The differential remains broad and would include low-grade brain tumor, demyelination, and sequela of prior inflammation.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with multiple myeloma and new onset back pain. Cervical:A grade 1 retrolisthesis of C5 relative to C6 is seen. Alignment is otherwise unremarkable. Vertebral body heights are preserved. No pathologic marrow signal change or enhancement is detected. The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic cord or leptomeningeal enhancement is seen.C2-3: Facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C3-4: Left sided facet hypertrophy. Posterior disc-osteophyte complex formation eccentric to the left foraminal region. No significant spinal canal stenosis. Moderate to severe left and mild right foraminal narrowing. C4-5: Left greater than right facet hypertrophy. Left ligamentum flavum thickening. Minimal posterior disc-osteophyte complex formation. Mild narrowing of the left aspect of the spinal canal. Moderate to severe bilateral foraminal narrowing.C5-6: Left facet hypertrophy. Posterior disc-osteophyte complex formation and disc uncovering. Mild generalized spinal canal narrowing. Severe bilateral foraminal narrowing. C6-7: Left greater than right facet hypertrophy. Mild posterior disc-osteophyte complex formation asymmetric to the right foraminal zone. No significant spinal canal stenosis. Moderate to severe right foraminal narrowing. C7-T1: Right greater than left facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. Thoracic:Marrow signal characteristics are diffusely heterogeneous but there are no edema-inducing lesions and no evidence of any pathologic marrow enhancement.The thoracic kyphosis is mildly exaggerated likely due to mild anterior wedging from T4 through T9. Overall, vertebral body heights are preserved.The visualized spinal cord illustrates normal signal intensity throughout. No pathologic cord or leptomeningeal enhancement is seen. No epidural abnormalities are detected.At T2-3, a central disc protrusion minimally impinges upon the spinal cord but causes no significant spinal canal or foraminal stenosis.At T7-8, a moderately sized right paracentral disc protrusion slightly flattens the ventral spinal cord but causes no significant generalized spinal canal or foraminal stenosis.Lumbar:Marrow signal characteristics are diffusely and mildly heterogeneous. In addition, within the anterior aspect of the L1 vertebral body, there is a 6 mm well-circumscribed focus of enhancing marrow replacement. Vertebral body height and morphology are preserved. Trace anterolisthesis of L3 relative to L4 and L4 relative to L5 is seen. Elsewhere alignment is anatomic.The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic cord or leptomeningeal enhancement is suspected. No epidural abnormalities are seen.T12-L1: Minimal facet hypertrophy. Minimal bulging disc. No significant spinal canal or foraminal stenosis.L1-2: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet hypertrophy. Mild laterally bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Moderate facet hypertrophy. Mild disc bulging and disc uncovering. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy. Mild disc bulging and disc uncovering. No significant spinal canal stenosis. No significant foraminal narrowing. L5-S1: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: 1.A single 6 cm focus of enhancing marrow replacement is seen within the L1 vertebral body which, although nonspecific, could represent an isolated site of myelomatous disease.2.Elsewhere no definite myelomatous lesions are seen.3.Relatively modest degenerative findings are seen. No areas of high-grade spinal canal stenosis are suspected. Significant neuroforaminal narrowing is, however, noted at multiple cervical levels.


Instruction: Generate impression based on findings.

Input: Reason: evaluate nodules on dorsum of L hand History: painful nodules on ulnar dorsum of L hand x 3 months, no trauma Note is made of 2 skin markers overlying the dorsal aspect of hand and wrist. Underlying these markers are 2 prominent superficial veins. There is decreased signal intensity centrally within the aforementioned prominent vessel along the dorsal aspect of the fifth metacarpal which may represent a small central thrombus. Otherwise no masses are identified. The imaged musculature of the wrist and hand is normal in appearance. No bone marrow signal abnormality is identified.

Output: Slightly prominent superficial veins along the dorsum of the hand. There is central low intensity within the prominent superificial vein along the dorsal aspect of the fifth metacarpal which is nonspecific but may represent superficial venous thrombosis. This could be further evaluated with ultrasound examination with Doppler interrogation if clinically warrented.


Instruction: Generate impression based on findings.

Input: 62-year-old female with urinary diagnosed prostate cancer PELVIS:PROSTATE:Prostate Size: 5.1 x 3.1 x 2.6 cm.Peripheral Zone: There is a 5 mm T2 hypointense focus with associated restricted diffusion in the left mid gland peripheral zone. There is a subtle T2 hypointense focus in the right mid gland peripheral zone with subtle corresponding restricted diffusion. Additional round/linear T2 hypointense foci bilaterally are nonspecific. There is associated T1 hyperintense foci in the left peripheral zone compatible with hemorrhage/post biopsy changes. Central Gland: Mild degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Not present.BLADDER: No significant abnormality noted.LYMPH NODES: Elongated bilateral external iliac/pelvic wall lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suspicious 5 mm focus in the left mid gland peripheral zone as described.2.Subtle 3 mm focus in the right mid gland peripheral zone as above.


Instruction: Generate impression based on findings.

Input: Thoracic spine:Thoracic alignment is grossly anatomic. There is a mild superior endplate compression deformity of the T8 vertebral body without increased STIR signal, which also appears present on a prior thoracic spine radiograph. Otherwise vertebral body heights and disc spaces are preserved. Marrow signal intensity is benign throughout. T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates minimal posterior disc bulge without canal stenosis. Facet hypertrophy contributes to moderate left and mild right neural foraminal stenosis. T3/4 demonstrates a small central disc protrusion with slight anterior flattening of the cord, but no cord signal abnormality or significant canal stenosis. There is facet hypertrophy without neural foraminal stenosis. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates a left paramedian disc protrusion which effaces the thecal sac and impinges on the left aspect of the spinal cord without underlying spinal cord signal abnormality. T6/7 demonstrates a small left paramedian disc bulge which causes minimal flattening on the left aspect of the spinal cord without underlying spinal cord signal abnormality. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates a small central disc protrusion and left posterior disc bulge which causes mild flattening of the left aspect of the spinal cord without underlying spinal cord signal abnormality.T9/10 demonstrates a small bilateral paracentral disc protrusion without spinal canal stenosis. T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates a mild left paracentral disc protrusion without spinal canal stenosis. T12/L1 demonstrates central disc extrusion extending 6 mm into the spinal canal and above and below the disc level over a craniocaudal distance of 3.0 cm. There is mild spinal canal stenosis at this level. There is mild ligamentum flavum and facet hypertrophy.There is a disc-osteophyte complex at C6/C7 without significant spinal canal stenosis. A single sagittal survey image of the cervical spine also demonstrates additional spondylytic changes of the cervical spine; if the patient has clinical symptoms that can be correlated to the cervical spine, then dedicated imaging can be considered. There is a left simple renal cyst. Lumbar spine:There is a leftward lumbar curve centered at L1/L2. There is trace retrolisthesis of L1 on L2, L2 on L3, and L3 on L4. There is trace anterolisthesis of L4 on L5 and L5 on S1. There is severe degenerative disc disease involving L1/L2 and L2/L3 with edema type signal within the vertebral bodies of L2 and L3, which is likely degenerative in etiology. A T1 and T2 hyperintense signal lesion within the L4 vertebral body likely represents a hemangioma. The conus is normal in signal and morphology and terminates at an appropriate level. L1/2: There is an asymmetric disc bulge to the right with minimal spinal canal stenosis and severe right and moderate left neural foraminal stenosis. There is moderate right lateral recess stenosis. L2/3: There is mild diffuse disc bulge which is also eccentric to the right and ligamentum flavum thickening with mild spinal canal stenosis and severe right and moderate left neural foraminal stenosis. There is moderate right lateral recess stenosis. L3/4: Posterior disc bulge and ligamentum flavum thickening contribute to moderate to severe spinal canal stenosis and moderate right and severe left neural foraminal stenosis. There is severe left lateral recess stenosis.L4/5: Posterior disc bulge and ligamentum flavum thickening contribute to moderate to severe spinal canal stenosis and mild to moderate right and moderate left neural foraminal stenosis. There is moderate bilateral lateral recess stenosis. L5/S1: Posterior disc bulge, ligamentum flavum thickening, and bilateral facet hypertrophy contribute to moderate spinal canal stenosis, mild right neural foraminal stenosis, and mild to moderate left neural foraminal stenosis.

Output: 1. Multilevel degenerative changes of the thoracic spine with disc protrusion at T5/T6 with cord impingement, disc extrusion at T12/L1 with mild canal stenosis, and additional findings as described above. Chronic compression deformity of the T8 vertebral body.2. Multilevel degenerative changes of the lumbar spine with moderate to severe canal stenosis at L3/L4 and L4/L5, multilevel moderate to severe neural foraminal stenosis, and multilevel moderate to severe lateral recess stenosis as described above. 3. A single sagittal survey image of the cervical spine also demonstrates additional spondylytic changes of the cervical spine; if the patient has clinical symptoms that can be correlated to this distribution, then dedicated imaging can be considered.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: please do dr javed MS protocol, compare to prior. History: progression MS Brain MRIThere are multiple FLAIR high signal intensities on bilateral periventricular white matter, including bilateral trigone area. These findings are nonspecific, however, considering the patient clinical history, these findings also are compatible with demyelinating disease such as multiple sclerosis.Comparing to prior scan performed outside institution, although the signal intensity of those lesions are slightly different, the number and distribution of FLAIR high signal intensity lesions appear to be unchanged.There is an no evidence of abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Lumbar MRIFor the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation. Focal annular tear with minimal bulging of disc which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multifocal white matter FLAIR high signal intensity lesions which are consistent with demyelinating disease such as multiple sclerosis, unchanged since prior scan.2. Focal annular tear with disc desiccation at the level of L4-5 otherwise unremarkable lumbar spine MRI.


Instruction: Generate impression based on findings.

Input: There is no new restricted diffusion.There is again prominence of the subarachnoid spaces and ventricles. The subdural collection on the right continues to extend along the frontal parietal lobes but has decreased in size. It previously measured 8 mm in thickness on prior MR, and now measures 4 mm at a similar level along the frontal lobe. Overall, the extra-axial space on the right appears similar to the prior CT, although direct comparison is difficult given the differences in exam technique and inability to differentiate subarachnoid from subdural space on CT.On the left there is an 12 mm crescentic collection containing T1 and T2 isointense material posteriorly as well as a component that is mildly bright on T1 and bright on T2 more superficially and anteriorly indicating blood products of different ages. There is a probable septation with susceptibility artifact along it as well as some susceptibility artifact dependently. When compared to the previous CT, inferring the size based on the subarachnoid vessels, the collection appears similar although it is slightly increased in thickness when compared to the previous MRI where it measured 10 mm in thickness.There are tracts of susceptibility artifact along the temporal and parietal lobes bilaterally in the locations of the previous subdural drains. In addition, there are small foci of susceptibility artifact for example along the right occipital horn and in the basal ganglia on the right.The ventricles and sulci are stable in size. The basal cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The left middle ear and mastoid air cells were previously opacified but have now cleared. Myelination is appropriate for the patient's age.

Output: Persistent bilateral subdural hematomas appear stable compared to the recent CT. When compared to the prior MRI the collection on the left has increased in thickness. There is evidence of septation and interval blood products. The subdural on the right is smaller compared to the previous MRI.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with altered mental status, unsteady gait, urinary incontinence. Cervical:Alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow replacement or pathologic marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic parenchymal or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: Unremarkable. C3-4: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C4-5: Unremarkable. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild to moderate right and mild left foraminal narrowing. C7-T1: Unremarkable. Thoracic:Slight exaggeration of the typical kyphosis is seen in the upper thoracic spine but alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic parenchymal or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.The intervertebral discs are preserved. No disc herniation, spinal canal stenosis or significant foraminal narrowing is detected.Incidental note is made of pleural thickening and/or fluid on the right.Lumbar:There is a slight kyphotic angulation centered at L1-2, but otherwise, alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or pathologic marrow enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No abnormal intrathecal enhancement is seen. No epidural abnormalities are suspected.L1-2: Loss of disc height and T2 signal. No significant spinal canal or foraminal stenosis. L2-3: Unremarkable. L3-4: Unremarkable. L4-5: Very mild disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing. L5-S1: Mild facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.No evidence of cord compression or any significant compromise of the spinal canal or neural foramina.2.No spinal cord or nerve root abnormalities.3.Mild degenerative findings as above.


Instruction: Generate impression based on findings.

Input: Reason: hx of bladder cancer s/p cystectomy with neobladder, evaluate for mets History: see above ABDOMEN:LIVER, BILIARY TRACT: Unchanged subcentimeter hepatic cysts. No new suspicious lesions or pathologic enhancement. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys enhance homogeneously. No focal obstructing ureter mass.RETROPERITONEUM, LYMPH NODES: No abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Status post cystectomy and neobladder creation. No suspicious lesions to suggest recurrence.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen inflammatory changes centered in the left labial soft tissues have resolved. No evidence of fistula on the current exam.OTHER: No significant abnormality noted.

Output: No specific evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Hand, foot, and tongue movement mapped to their expected locations along the pre- and post-central gyri. Language related activity is left dominant and is best demonstrated during the sentence completion task. Regions of activation corresponding to the expected locations of Broca's and Wernicke's areas are seen in the inferior left frontal gyrus and the superior left temporal gyrus respectively.

Output: 1. Left dominant language function.2. Normal location of hand, foot, and tongue sensorimotor function bilaterally.


Instruction: Generate impression based on findings.

Input: 46-year-old female with screening detected amorphous calcifications in the right upper-outer quadrant for which stereotactic biopsy is recommended. Patient presents for a breast MRI before biopsy as part of the research study. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally. No abnormal enhancement noted in the right upper-outer quadrant corresponding to the cluster of calcifications. A benign round subcentimeter enhancing lesion most likely represents a benign intramammary lymph node identified on the T2-weighted sequence.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 24-year-old male with history of tumor resection presents with headache; evaluate for subarachnoid hemorrhage There is a periaqueductal mass, with lymphoplasmacytic histology, that shows interval enlargement from the previous CT on 9/11/2008 now measuring 33 x 30 mm (image 12, series 2) as compared to the previous measurement of 23 x 20 mm. However, there is no significant change compared to the MRI study on 10/12/2009. Again seen is a right ventriculostomy tube that extends to the body of the right lateral ventricle.There is no evidence of intracranial hemorrhage or acute hydrocephalus. The ventricles and basal cisterns are normal in size and configuration.Postsurgical changes from a right frontal craniotomy are again noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Periaqueductal mass whose pathology is suggestive of lymphoplasmocytic neoplasmventriculostomy as described above. No acute intracranial hemorrhage or hydrocephalus.


Instruction: Generate impression based on findings.

Input: MRI brain:There is an area of restricted diffusion in the periventricular coronal radiata extending to the right basal ganglia consistent with acute ischemic infarct. There is a small focus of restricted diffusion in the right pons also relate to acute stroke.There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. Additional scattered old infarcts are seen mostly in the left cerebral cortex in the frontal and parietal lobe. There is mild global parenchymal volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is minimal opacification of the right more than left mastoid air cells. MRA head: The intracranial internal carotid arteries are normal in course and caliber. The right A1 segment is hypoplastic. Otherwise anterior cerebral is is normal in course and caliber. There is a right P-comm artery. The proximal middle cerebral artery is unremarkable. There is paucity of more distal branches of the right middle cerebral artery. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. MRA neck: MRA of the neck is significantly degraded due to patient motion and is virtually a nondiagnostic exam.

Output: 1. Restricted diffusion in the right periventricular corona radiata extending to the right basal ganglia consistent with acute ischemic stroke. Additional punctate focus of acute ischemia in the right pons.2. Moderate chronic small vessel ischemic disease. Multiple chronic left cortical infarcts and lacunar infarct in the right basal ganglia.3. Paucity of right distal MCA branches, otherwise no significant stenosis or aneurysm in the proximal intracranial anterior or posterior circulation.4. Poor quality MRA neck which is nondiagnostic.


Instruction: Generate impression based on findings.

Input: Female; 52 years old. Reason: Evaluation of pancreatic cystic structure seen on ultrasound, also please make sure liver imaging is Cirrhosis protocol History: see above ABDOMEN:LUNG BASES: Cardiomegaly.LIVER, BILIARY TRACT: Ill-defined subcapsular segment two lesion (series 1304/102) and smaller subcapsular lesion in the posterior right hepatic lobe (series 1304/102) best seen on portal venous and delayed phase images are nonspecific. No abnormal arterial enhancement or restricted diffusion. These lesions may be related to perfusional changes.Gallbladder sludge and/or small stones. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesions. No pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Prominent left extrarenal pelvis noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Midgut malrotation without evidence of volvulus or obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal ascites.

Output: 1. Nonspecific hepatic lesions without abnormal arterial enhancement or restricted diffusion may be related to perfusional changes.2. No focal pancreatic lesions.3. Midgut malrotation without evidence of volvulus or obstruction.4. Ascites.


Instruction: Generate impression based on findings.

Input: 51-year-old male with question of chondromalacia. MENISCI: The posterior horn of the medial meniscus is partially obscured from metallic artifact secondary to prior surgery. There appears to be blunting of the free edge of the posterior medial meniscus, but we cannot determine to what degree this represents tearing versus artifactual distortion. There is globular increased signal within the posterior horn and body of the medial meniscus suggesting intrasubstance degeneration. There is also mild intrasubstance degeneration of the lateral meniscus, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is mild superficial fraying of the articular cartilage of the patella. The articular cartilage of the femoral trochlea appears intact. Portions of the articular cartilage of the femoral condyles are obscured by metallic susceptibility artifact, but we see no fluid filled defects.LIGAMENTS: The patient has undergone ACL reconstruction. The graft appears intact. A band of low signal intensity posterior to the graft likely represents native ACL. The PCL, MCL, and LCL complex appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Evaluation of the menisci and articular cartilage is slightly limited by numerous foci of susceptibility artifact. There is blunting of the free edge of the posterior horn of the medial meniscus but we are uncertain the degree of which this represents tearing versus deformity from metallic susceptibility artifact.2. Mild degeneration of the articular cartilage of the patella.


Instruction: Generate impression based on findings.

Input: Numbness in hands and feet. There is trace prominence of the cervical spinal cord central canal. The spinal cord otherwise appears unremarkable. The vertebral column alignment is mildly straightened in the sagittal plane. There is a small eccentric left posterior disc-osteophyte complex at C5-6 without significant spinal canal stenosis. There is no evidence of mass lesions within the spinal canal. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Trace prominence of the cervical spinal cord central canal. The spinal cord otherwise appears unremarkable. 2. Small eccentric left posterior disc-osteophyte complex at C5-6 without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is relatively well-demarcated, nonenhancing, T2/FLAIR hyperintense region of cortical and subcortical thickening within the right parietal precuneus. The lesion measures approximately 12 or 13 mm in maximal dimension. There is little if any associated mass effect.There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. Incidental note is made of a right frontal developmental venous anomaly. There is no midline shift or herniation. The major cerebral flow voids are intact. There is dependent fluid in the sphenoid sinus and patchy fluid in the right mastoid air cells.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRV Brain: The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.

Output: 1.Cortical and subcortical signal abnormality and thickening in the right parietal precuneus. The differential diagnosis for this finding is broad and would include a focal dysplasia, low-grade neoplasm or simply seizure related edema. An isolated lesion of PRES or vasculitis would be somewhat unusual but still possible. An infectious or inflammatory etiology would also warrant consideration.2.Normal MRA and MRV of the brain.


Instruction: Generate impression based on findings.

Input: L4 lytic lesion. please provide biopsy Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Following the procedures no significant hematomas was identified.

Output: L4vertebral bone biopsy under CT guidance. A total of nine samples were delivered to surgical pathology for analysis.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:3/7/1975)Reason: 3 t scanner ccm protocol qsm/permialbility History: s/p resection of pontine cavernomaPROVIDER/ATTENDING NAME: ISSAM A. AWAD SURGEON W/ SCHED UCMC There is redemonstration of a mass centered in the right pons associated with a developmental venous anomaly. This mass is surrounded by signal loss peripherally and T1 and T2 signal hyperintensity and a popcorn-like appearance centrally. On T1 imaging it measures 14 mm in diameter. It is unchanged in size compared with previous exam. However, the intrinsic signal characteristics have changed there is more signal loss peripherally and the smaller T2 hyperintense component. The T2 hyperintense component measures 3 mm on the current exam and measured 10 mm on the prior exam. The patient status post right temporal bone surgery.There are subdural effusion present in the posterior fossa which was also present on the prior exam and does not appear to have changed substantially.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the left maxillary sinus. There is partial opacification of the left frontal sinus and anterior ethmoid air cells. This was also present on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The patient is undergone recent surgery for a pontine cerebral cavernous malformation. The inner component of the cerebral cavernous malformation is decreased in size. The adjacent hemosiderin deposition the course has not changed. A follow-up exam would help further assess this. This lesion associated with a developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.L1-L2: There is no significant spinal canal or neural foraminal narrowing.L2-L3: There is mild disc desiccation, loss of disc height, and a mild disc bulge without spinal canal or neural foramen stenosis. L3-L4: There is mild disc desiccation, loss of disc height, and a mild disc bulge with a superimposed right lateral recess and foraminal zone disc extrusion. These findings result in mild spinal canal stenosis, moderate right, and mild left neural foramen stenosis.L4-L5: There is a minimal disc bulge that results in mild bilateral neural foramen narrowing.L5-S1: There is no significant spinal canal or neural foraminal narrowing.

Output: 1.At L3-L4 there is a mild disc bulge with a superimposed right lateral recess and foraminal disc extrusion that results in mild spinal canal stenosis, as well as moderate right, and mild left neural foramen stenosis. Please correlate for right L3 and L4 radiculopathy. 2.Additional mild degenerative changes at L2-L3 and L4-L5 as detailed above.


Instruction: Generate impression based on findings.

Input: History of multiple endocrine neoplasia 1a with pancreatic lesions. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal lesion, biliary ductal dilatation or vascular abnormality. Status post cholecystectomy. No extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates fatty atrophy with focal fat in the pancreatic head but is otherwise normal in morphology and signal intensity. The main pancreatic duct is normal in caliber.The very subtle T2 hyperintense lesion in the pancreatic tail measures 8 mm (series 5/17), not significantly changed from the prior study where it measured 9 mm.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: Partially imaged left basilar peripheral wedge-shaped signal intensity compatible with atelectasis/scarring as seen on 3/7/2015 CT.

Output: Stable pancreatic tail subcentimeter lesion likely corresponding to the patient's previously sampled neuroendocrine tumor.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Posterior osteophyte disc complex, left uncinate hypertrophy, and left facet hypertrophy. There is severe left neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and left facet hypertrophy. There is moderate left neural foraminal stenosis.C5/6: Posterior osteophyte disc complex eccentric to the left causing anterior left hemicord flattening, as well as associated left hemicord T2 hyperintensity of myelomalacia. There is also bilateral uncinate hypertrophy and slight ligamentum flavum thickening. There is mild central canal stenosis, although more moderate focally leftward, as well as moderate to severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex causes anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is mild-to-moderate central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C3/4: Severe left neural foraminal stenosis.2.C4/5: Moderate left neural foraminal stenosis.3.C5/6: Left hemicord T2 hyperintensity of myelomalacia. There is mild central canal stenosis, although more moderate focally leftward, as well as moderate to severe bilateral neural foraminal stenosis.4.C6/7: Mild-to-moderate central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 56-year-old male who presents for renal cell cancer surveillance monitoring. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology without evidence of a focal lesion or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Again noted is several enhancing soft tissue nodules in the dorsal lateral retroperitoneal space.The largest nodule measures 3.0 x 1.4 cm (series 1002, image 437), previously remeasured as 3.0 x 1.4 cm.Another discrete nodule more inferiorly measures 0.8 cm (series 1002, image 362), unchanged.Additional discrete perisplenic implant on the left lateral transversalis fascia is unchanged (series 1002, image 552).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a new rim-enhancing lesion anterior to the spleen in left upper abdomen (series 1002, image 527).BONES, SOFT TISSUES: In the lower left lateral abdominal wall musculature, there is a 1.8 x 1.0 cm enhancing nodule (series 1002, image 162) not significantly changed.OTHER: No significant abnormality noted.

Output: 1.Status post left nephrectomy with enhancing soft tissue nodularity in the left retroperitoneum suspicious for residual/recurrent disease, which is not significantly changed.2.Additional nonspecific enhancing soft tissue nodule in the left lateral abdominal wall musculature is not significantly changed and may represent another site of metastatic disease.3.New mesenteric rim-enhancing lesion anterior to the spleen highly suspicious for necrotic metastatic focus.4.Near complete resolution of enhancing lesion in the left gluteal maximus muscle, likely prior site of inflammation.


Instruction: Generate impression based on findings.

Input: Otalgia/sensorineural hearing loss, bilateral. The optic nerves are mildly abnormal in appearance and small crowded in constitution most consistent with a diagnosis of "pseudopapilledema." There is possible deficiency of bone overlying the bilateral superior semicircular canals. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The cochleas, vestibules, and endolymphatic ducts appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a pineal gland cyst that measures up to 9 mm. There is a prominent retrocerebellar cerebrospinal fluid space. There is mild concavity of the superior aspect of the pituitary gland. There are partially-imaged borderline prominent upper cervical lymph nodes.

Output: 1. Possible deficiency of bone overlying the bilateral superior semicircular canals. A temporal bone CT may be useful for further evaluation of dehiscence if clinically warranted. 2. A pineal gland cyst measures up to 9 mm, which likely represent benign cystic degeneration, although incompletely characterized in this exam. 3. Nonspecific mild concavity of the superior aspect of the pituitary gland, which could represent a manifestation of pseudotumor cerebri in the appropriate clinical setting.4. Nonspecific partially-imaged borderline prominent upper cervical lymph nodes.