Instruction: Generate impression based on findings.

Input: 56-year-old male with history of prostate cancer. Evaluate for high risk features.Pathology report:Prostate, right base; needle biopsy: High grade prostatic intraepithelial neoplasia (PIN) with adjacent atypical glands suspicious for carcinoma.Prostate, left base; needle biopsy: High grade prostatic intraepithelial neoplasia (PIN). Prostate, right mid; needle biopsy: Prostatic adenocarcinoma, Gleason score 6 (3+3), less than 1.0 mm focus.Prostate, right mid lateral; needle biopsy: High grade prostatic intraepithelial neoplasia (PIN). PELVIS:PROSTATE:Prostate Size: 4.8 x 2.8 x 4.0 centimetersPeripheral Zone: Scattered foci of T1 hyperintensity most compatible with hemorrhage from previous biopsy. Abnormal T2 hypointensity with corresponding low signal on ADC in the following regions concerning for adenocarcinoma:Right apex measuring 1.2 x 0.8 cm (series 1001, image 12). This lesion is amenable to MRI guided biopsy.Left mid gland measuring 0.7 x 0.6 cm (series 1001, image 15).Additionally, there is an ill-defined subcentimeter right mid gland lesion (series 1001, image 18) which may represent hypoplasia versus adenocarcinoma.Central Gland: Central gland is heterogeneous in appearance consistent with benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two suspicious foci in the right apex and left mid gland concerning for adenocarcinoma. The right apex lesion is amenable to MRI guided biopsy. 2.Right mid gland ill-defined focus may represent stromal hyperplasia versus adenocarcinoma. 3.No evidence of seminal vesicle or extracapsular extension.


Instruction: Generate impression based on findings.

Input: 60-year-old female with right knee traumatic injury/twisting w/persistent pain, instability x 3 months. MENISCI: Best seen on the coronal sequences is replacement of the body of the lateral meniscus with increased signal intensity indicating a near complete or complete radial tear. There is additional attenuation and signal abnormality within the posterior horn of the lateral meniscus compatible with additional complex tearing. There is a bandlike fragment of low signal intensity adjacent to the anterior cruciate ligament which may represent a displaced meniscal fragment. The anterior horn of the lateral meniscus appears intact.There is blunting of the free edge of the posterior horn of the medial meniscus indicating a partial thickness radial tear with increased signal intensity extending from the tear along the undersurface of the posterior horn indicating additional fraying. There is increased signal intensity and fragmentation of the anterior horn of the medial meniscus at its root indicating degeneration and tearing. The body of the medial meniscus appears slightly small but is otherwise intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss along the posterior aspect of the lateral tibial plateau and near full-thickness cartilage loss along the posterior aspect of the lateral femoral condyle adjacent to the torn meniscus. There are also small lateral compartment osteophytes. The articular cartilage of the medial and patellofemoral compartments appears relatively normal accounting for the patient's age.LIGAMENTS: There is mild high signal intensity within the anterior cruciate ligament which may reflect mild degeneration but we see no tear. The posterior cruciate ligament, medial collateral ligament and lateral collateral ligament appear intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Medial and lateral meniscal tears as described above.2.Osteoarthritic changes affecting the lateral compartment.3.Baker's cyst.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with esophageal ulceration and bone exposure. Again seen is a defect or ulceration of the right posterior hypopharyngeal mucosa spanning the C4 and C5 levels. Pooling fluid and/or inflamed supraglottic mucosa partially fills the defect. The defect extends up to the anterior margin of the vertebral bodies.The mucosa and paravertebral soft tissues adjacent to the defect are edematous and enhancing. However, no discrete or rim-enhancing fluid collections are identified. As on the prior examination, the marrow of the C4 and to a lesser degree the C5 vertebrae is slightly T1 hypointense. However, there is no STIR signal abnormality within the marrow or intervening disc spaces. Postcontrast images demonstrate relatively heterogeneous enhancement throughout the cervical marrow which may reflect the effects of prior radiotherapy. Again seen is evidence of right IJ vein thrombosis.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. The visualized spinal cord shows normal signal intensity and morphology. No epidural lesions are suspected. Relatively mild disc osteophyte formation is seen through the cervical region. No areas of high-grade spinal canal or foraminal stenosis are observed.

Output: An ulceration is redemonstrated along the right posterior hypopharyngeal wall at the C4 and C5 levels. Although the adjacent supraglottic mucosa and paravertebral soft tissues are edematous, no evidence of abscess is seen. There is mild T1 signal abnormality within the marrow of the C4 and C5 vertebrae. However, the complete absence of any pathologic STIR signal to suggest edema in the marrow space or discs would argue against osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: prostate cancer History: see aboveBiopsy 4/15/2016; right base Gleason 6, left mid Gleason 6, left base Gleason 6, left apex Gleason 6. PELVIS:PROSTATE:Prostate Size: 4.7 x 2.8 x 3.4 cm Peripheral Zone: Focus (6mm) of low T2 low ADC signal without associated enhancement right mid prostate anteriorly (801/13). No associated perfusion abnormalitya.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Smaller free fluid is present within the pelvis

Output: 1.6mm lesion in the right mid prostate.2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: BRAIN MRI:There are foci of restricted diffusion in the right thalamus, left globus pallidus, and there is left aspect of the pons. These corresponds to the increased T2 and FLAIR signal in the same location.Nonspecific periventricular white matter punctate foci of high signal is seen in T2 and FLAIR, representing small vessel chronic ischemic disease.There are multiple pontine lacunar infarcts, mostly hemorrhagic.Chronic small vessel disease is seen in the left basal ganglia.There are cerebellar linear high signal in T2 and FLAIR in both hemisphere due to chronic infarction with encephalomalacia, seen in the left hemisphere more than the right cerebellar hemisphere.Ventricular size is normal with no evidence of mass effect or edema. No definite evidence of bleed.There is near complete opacification of the left maxillary sinus.BRAIN MRA:There is narrowing of the left internal carotid artery of moderate degree in the precavernous segment. This report clinically. The left internal carotid artery is patent. Irregular diffuse narrowing of the left MCA is seen consistent with atherosclerotic disease.The right internal carotid artery demonstrates mild stenosis of the precavernous and of the cavernous segment. The right MCA is patent. Both anterior cerebral arteries are patent.There is hypoplastic right A1 segment which is a normal variant. No evidence of occlusion in the anterior circulation.There is mild vascular linear impression and atherosclerotic ectasia of the basilar artery. Mild atherosclerotic irregularities of the posterior cerebral arteries seen. The posterior cerebral arteries are patent with no evidence of occlusion.

Output: 1. Diffusion restriction in the pons, right thalamus, and the left globus pallidus, representing acute ischemia.2. Extensive vertebro-basilar circulation chronic ischemic disease as detailed. 3. Chronic ischemic disease is seen in the midbrain, periventricular white matter, and the basal ganglia and chronic bilateral cerebellar(L>R) chronic ischemic strokes


Instruction: Generate impression based on findings.

Input: Clinical question: Walking trouble, right leg weakness per history. Signs and symptoms: Spastic in legs and significant sensation loss. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse patchy foci of flair and T2 hyperintensity primarily in the periventricular and to a lesser degree subcortical as well as bilateral basal ganglia, left thalamus and pons without associated susceptibility signal changes. Considering patient's stated age of 76 findings are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.The slight prominence of ventricular system as well as the cortical sulci although may be at the upper limits of normal possibly show mild underlying parenchymal volume loss is suspected.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells as well as calvarium and soft tissues of the scalp.Nonenhanced cervical MRI:There is generalized smaller size of the spinal canal which is suspected to represent a congenital anatomical variation.There is mild to moderate degenerative changes of cervical spine however with normal alignment. Mild straightening of cervical lordosis is noted.Foramen Magnum demonstrate mild hypertrophy changes of posterior elements and ligamentous hypertrophy and including the posterior longitudinal ligament. Findings results in mild spinal stenosis at this level.C2 -- C3 demonstrate mild degenerative changes, mild central spinal stenosis and no neural foraminal compromise.C3 -- C4 demonstrate moderate loss of disk height, shallow centrally located osteophyte which results in slight flattening and deformity of the ventral aspect of the cord. There is mild central spinal stenosis and moderate right neural foraminal compromise.C4 -- C5 demonstrate mild disk disease with loss of disk height, broad-based central disk protrusion which in combination with moderate ligamentum flavum hypertrophy and congenitally small canal results in significant flattening deformity of the cord and central spinal stenosis. There is significant right and moderate left neural foraminal compromise at this level also. On sagittal T2 series there is suggestion of very subtle increased T2 signal intensity of the cord which could represent edema or myelomalacia.C5 -- C6 demonstrate minimal degenerative changes of the disk and facets as well as ligamentum flavum which in combination with congenitally narrow canal results in mild to moderate central spinal stenosis and moderate left and mild right neural foraminal compromise.C6 -- C7 demonstrate mild disk disease with loss of disk height shallow broad based bulge of disk and mild hypertrophic changes of posterior elements. There is resultant mild central spinal stenosis and mild bilateral neural foraminal compromise.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine through T3 are unremarkable.

Output: 1.Nonenhanced head brain MRI demonstrates no acute intracranial process. Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed. Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.2.Non-enhanced MRI of the cervical spine demonstrate generalized uniform smaller than expected caliber of the spinal canal suggestive of a congenital anatomical variation. Degenerative changes of cervical spine in combination with congenitally small canal results in multilevel central spinal stenosis and multilevel bilateral neural foraminal compromise (some significantly) as detailed per level. Spinal stenosis is most severe at C4 -- C5 and with resultant significant flattening deformity of the cord. There is suspected T2 hyperintensity of the cord at this level which could represent an cord edema on or myelomalacia. Please see detailed report above.


Instruction: Generate impression based on findings.

Input: 47 year old female with pain and right third digit proximal nailbed suspected glomus tumor. The patient returned for additional imaging of the DIP joint of the middle finger using a microscopy coil. The patient while not be charged for these images.A marker was placed along the ulnar aspect of the PIP joint. Best seen on the axial proton density fat saturated images is a small focus of increased signal intensity along the dorsal and ulnar aspect of the PIP joint that measures 2 mm in the transverse dimension and approximately 4 mm in the longitudinal dimension corresponding to the focus of enhancement seen on the prior study. The small focus of signal abnormality lies immediately volar to the ulnar collateral ligament. The ligament itself, however, can be traced on these images from the head of the middle phalanx to the base of the distal phalanx and appears to be intact. The remaining visualized bone and soft tissue structures are unremarkable.

Output: Small nodular focus of abnormal signal intensity corresponding to enhancement seen on the initial study. While it is conceivable that this could represent a glomus tumor, it remains nonspecific and could represent a synovitis arising from the joint.


Instruction: Generate impression based on findings.

Input: Female 22 years old Reason: evaluate for ACL tear or other ligament injury History: pain, swelling after feeling a "pop" during ultimate frisbee practice. MENISCI: There is complex tearing of the anterior horn, body and posterior horn of the lateral meniscus consisting of a predominantly horizontal component which extends to the superior articular surface. There is a globular focus of intermediate signal within the posterior horn which may reflect degeneration. Heterogeneous signal abnormality lateral to the body in the lateral gutter likely represents debris but a small flap tear cannot be completely excluded.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tearing of the entire lateral meniscus as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Possible. Signs and symptoms: Fall Nonenhanced CT of brain:There is no evidence of acute post traumatic intracranial findings.Findings consistent with minimal small vessel disease of indeterminate age is noted.Cortical sulci, ventricular system and CSF cisterns remain within normal for patient of stated age of 87. Large vessel intracranial calcification of carotid and vertebral arteries are noted.Limited view of paranasal sinuses and mastoid air cells are unremarkable.Gadolinium demonstrate a large area of low attenuation within the marrow space in the right frontal lobe with suspected area also thinning of the inner cortex of right frontal bone. There is no associated epidural component with this finding. Findings could represent fibrous dysplasia however less likely possibility of a metastatic lesion cannot be entirely ruled out. There are no additional foci of abnormality of calvarium. This finding can be further evaluated either by a nuclear medicine study or a dedicated MRI of brain with enhancement.

Output: 1. No evidence of post traumatic findings of intracranial space or the calvarium.2.Findings consistent with minimal small vessel disease of indeterminate age.3.Large area of lytic change involving the right frontal bone which may represent fibrous dysplasia and less likely possibility of a metastatic lesion cannot be entirely ruled out. Follow up with neck medicine bone scan or an MRI of brain with enhancement is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Syrinx, evaluate for changes, history of Chiari decompression. Signs and symptoms: As above. Nonenhanced brain MRI:Examination demonstrate postoperative changes all Chiari decompression. There is inferior prolapse of the content of posterior fossa into the expanded subarachnoid space at the level of the compression. This appearance is identical to prior exam.Prominence of the supratentorial ventricular system and with maintained midline remains identical to prior exam. There is normal signal intensity of cerebral cortex and with normal myelination pattern. There is no detectable signal abnormality in the brain parenchyma. Compared to prior exam there is no evidence of any new findings.Nonenhanced MRI of cervical spine:Examination demonstrates an expansile syrinx of cervical cord without appreciable change since prior exam. Expansion of syrinx is largest at C6 and C7 disk level which is similar to prior exam. At this level also there is a central and immediate left median small disk protrusion with results in effacement of the ventral subarachnoid space and mild indentation of the cord similar to prior study.A faint focus of T2 hyperintensity superiorly at the level cervicomedullary junction of the cord remains similar to prior exam.The alignment the vertebral column is anatomical. This examination demonstrate no evidence of any new finding since prior study from 2014.CSF flow study demonstrate presence of biphasic flow with the foramen magnum anteriorly however similar to prior exam it demonstrate attenuation at the level of the tip of dens. Biphasic flow through the fourth ventricle and the aqueduct is identified.PC flow posteriorly through the foramen magnum is attenuated however present.Nonenhanced thoracic MRI:Examination demonstrates extension of significantly expanded syrinx of cervical cord into the thoracic cord and terminating at approximately mid L1 level. This finding remains identical to prior exam. The expanded syrinx in the cervical and thoracic region significantly occupies the subarachnoid space.There is normal signal intensity and anatomical alignment of the column. No detectable abnormality of the vertebral column.

Output: 1.Nonenhanced brain MRI demonstrate no evidence of acute or new finding since prior exam. Prolapse of the posterior fossa contents into the expanded subarachnoid space at the level of the craniectomy similar to prior exam. Stable postoperative changes of Chiari decompression and prominence of supratentorial ventricular system similar to prior study.2.Nonenhanced MRI of cervical and thoracic spine demonstrate a severely expanded syrinx of the cervical and thoracic cord spanning from mid C3 to lower L1 level without change. CSF flow study demonstrate presence of biphasic CSF flow anteriorly through the foramen magnum however with attenuation at the level of the tip of the dens similar to prior exam. Biphasic flow through the posterior aspect the foramen magnum is present however attenuated similar to prior study. Biphasic flow is also detected through the fourth ventricle and the aqueduct.3.A small central disk protrusion at C6 -- C7 with effacement of ventral subarachnoid space and subtle indentation of cord similar to prior exam.


Instruction: Generate impression based on findings.

Input: Severe left arm pain and weakness, evaluate for radiculopathy. Hx of SLE Examination is limited by motion artifact. There is straightening of the cervical lordosis which may be positional. The vertebral bodies are aligned and the vertebral body heights are maintained. Multilevel anterior osteophyte formation is demonstrated, most prominent at C5 level. No worrisome focal marrow signal is identified. The intervertebral disc spaces are grossly maintained. There is developmental narrowing of the cervical spinal canal. The spinal cord is suboptimally evaluated secondary to motion artifact.C2-C3: There is hypertrophy of the ligamentum flavum, however otherwise no significant abnormality is appreciated.C3-C4: There is hypertrophy of the ligamentum flavum with small posterior disc osteophyte complex formation causing moderate central spinal and bilateral neuroforaminal stenosis.C4-C5: There is a small posterior disc osteophyte complex with hypertrophy of the ligamentum flavum and uncovertebral joints resulting in mild to moderate spinal canal and moderate bilateral neuroforaminal stenosis.C5-C6: Posterior disc osteophyte formation and hypertrophy of the ligamentum flavum result in moderate to severe left and moderate right neuroforaminal stenosis as well as mild to moderate central spinal stenosis.C6-C7: There is a posterior disc osteophyte complex with hypertrophy ligamentum flavum causing mild spinal canal stenosis without significant neuroforaminal stenosis.C7-T1: No significant disc herniation or neuroforaminal stenosis is noted at this level.

Output: Limited examination secondary to artifact demonstrates multilevel spondylosis of the cervical spine with multilevel at least moderate grade central spinal stenosis predominantly on the basis of developmental narrowing.


Instruction: Generate impression based on findings.

Input: Obsessive-compulsive disorder [F42], Reason for Study: ^Reason: surveillance History: ocd There is no evidence of acute ischemic or new hemorrhagic lesion on this scan.Redemonstration of prior laser ablation foci on bilateral internal capsule anterior limb just lateral aspect of lateral ventricle frontal horns. Those foci show central low signal intensity with surrounding high signal intensity rim, no change in terms of MR characteristics. The size of right side focus remains stable but that of the left appears to be slightly smaller than before and changed its shape from round to elliptical. Bilateral frontal lobes' laser ablation lead tracks are seen with some susceptibility artifacts indicating lead tract blood products, no change since prior scan.On post enhanced image, the left focus still shows evidence of enhancement, however, the extent of the enhancement appears to be much lessen than prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Interval decrease in size of left laser ablation focus as well as decrease extent of enhancement comparing to prior scan.3. Stable right side ablation focus in terms of size and MR characteristics.4. No change in bilateral lead track blood products.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with cervical myelopathy. Image quality is slightly degraded by motion artifact. Within this limitation the following observations are made.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is suspected.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: Facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Intimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C4-5: Unremarkable. C5-6: Left greater than right facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C6-7: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation with a left paracentral extrusion which just barely contacts the cord but causes no significant cord deformation. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. C7-T1: Unremarkable.

Output: Relatively mild degenerative disease is seen in the cervical spine. No areas of high-grade spinal canal stenosis are detected. There is a left paracentral disc extrusion at C6-7 which may barely contact the cord but causes no significant cord deformation. Moderate foraminal narrowing is seen on the left at C3-4.


Instruction: Generate impression based on findings.

Input: Scapholunate pain. Contrast is noted within the midcarpal joint. No contrast is seen extending into the radiocarpal joint to indicate either a scapholunate or lunotriquetral ligament tear. There is a 1cm collection of fluid signal intensity volar to the radial styloid immediately superficial to the attachments of the long radiolunate and radioscaphocapitate ligaments that I suspect represent a ganglion, but could conceivably reflect degeneration or partial thickness tearing of the underlying extrinsic ligaments.There is heterogeneity of signal of the medial fibers of the articular disk of the triangular fibrocartilage complex at and near its ulnar styloid attachment suggestive of degenerative tearing. Mild edema type signal within the adjacent ulnar styloid is likely reactive in etiology. Furthermore, there is a small linear focus of increased signal intensity partially traversing the articular disk near its radial attachment that I suspect represents a tear.There is fluid within the sheaths of the extensor digitorum tendons that could conceivably represent mild tenosynovitis but but may simply be due to injection of lidocaine during the arthrogram portion of the procedure. The tendons are otherwise unremarkable.

Output: 1.No evidence of scapholunate ligament tear.2.Findings suggestive of tearing of the articular disk of the triangular fibrocartilage.3.Small collection of fluid signal intensity volar to the radial styloid may represent a ganglion.


Instruction: Generate impression based on findings.

Input: Meningioma resection surveillance. There are postoperative findings related to right parafalcine meningioma resection with unchanged encephalomalacia in the underlying right parietal lobe. However, there is interval increase in size of a nodular enhancement in the surgical bed along the right aspect of the posterior superior sagittal sinus, which measures 16 x 18 mm in axial cross-section, previously 12 x 13 mm. The tumor protrudes in to the subgaleal space through th calvarial defect. There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged patchy nonspecific scattered cerebral white matter T2 hyperintensity beyond the region of the surgical bed. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are bilateral lens implants. There are persistent secretions in the left frontal sinus.

Output: Postoperative findings related to right parafalcine meningioma resection with interval increase in size of residual tumor.


Instruction: Generate impression based on findings.

Input: Spinal stenosis lumbar region. Neurogenic claudication. Idiopathic scoliosis and kyphoscoliosis. There is straightening of lumbar lordosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is moderate narrowing of the L2-L3 through L4-L5 discs with disc desiccation. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is increased dorsal epidural fat throughout the lumbar spine contributing to spinal stenosis. Multilevel degenerative changes are seen, as described below. L1-L2: There is left far lateral disc protrusion which is similar compared to the previous exam. No definite foraminal stenosis. No central spinal canal stenosis.L2-L3: There is eccentric left disc bulge causing partial narrowing of the left neural foramen. There is right paracentral disc bulge indenting the thecal sac anteriorly. Mild to moderate central canal stenosis is evident. There is facet arthropathy and ligamentum flavum thickening.L3-L4: Severe endplate degenerative changes are present. There is diffuse disc bulge slightly prominent to the right side causing mild to moderate right foraminal narrowing and mild to moderate left foraminal narrowing. There is moderate central spinal canal stenosis at this level. These findings are likely progressed compared to the previous exam. There is facet arthropathy and ligamentum flavum thickening.L4-L5: Severe endplate degenerative changes are present. Prominent left disc bulge is noted. There is mild central spinal canal stenosis. There is facet arthropathy and ligamentum flavum thickening. Lateral recess narrowing is again noted greater on the left.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. There is facet arthropathy and ligamentum flavum thickening.Paraspinous soft tissues are within normal limits.Rounded T2 hyperintensities are noted in the bilateral kidneys which are nonspecific but most likely represent cysts.

Output: 1.Multilevel lumbar spondylotic changes with findings most conspicuous and minimally progressed at L3-L4 resulting in moderate central spinal canal stenosis as well as mild to moderate left and mild right foraminal stenosis.2.Rounded T2 hyperintense areas in the bilateral kidneys statistically representing cysts. Ultrasound of the abdomen can be obtained if further indicated.


Instruction: Generate impression based on findings.

Input: 26 years Male (DOB:2/16/1989)Reason: disc herniation change? History: left radic, pre-opPROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is redemonstration of a T2 hyperintense lesion in T11 vertebral body measuring 11 x 16 mm sagittal dimensions which measured 11 x 16 mm on the prior exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is a left lateral recess broad-based disc protrusion present at this level which is unchanged since the prior exam. It partially effaces the fat at the left lateral recess and it encroaches on the nerve roots of the left lateral recess. There is some loss of disc space height at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is redemonstration and no change in the left lateral recess disc protrusion at L4-5. It encroaches on the nerve roots of the left lateral recess.2.The T11 vertebral body lesion present which is stable since the prior exam. It has atypical MR signal intensity features for hemangioma but may still represent a hemangioma. It is however nonspecific.


Instruction: Generate impression based on findings.

Input: History of tibial plateau fracture status post ORIF and removal. Evaluate for medial meniscus tear. MENISCI: Medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is a partial-thickness focal fissure of the medial aspect of the medial tibial plateau articular cartilage adjacent to the tibial spine. Otherwise, the articular cartilage of the remaining compartments appears intact.The tibial plateau and tibial tuberosity fractures have healed with pin tracks from prior orthopedic hardware.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Small cartilage defect of the medial tibial plateau.


Instruction: Generate impression based on findings.

Input: Reason: Abnormal DRE with elevated PSA 10.3. No reported biopsy results. History: Abnormal DRE with elevated PSA 10.3. No reported biopsy results. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.7 x 4.1 cm.Peripheral Zone: There is a large lesion extending from the left peripheral zone at the base, mid gland and apex which is dark on T2/ADC with early enhancement, suspicious for prostate adenocarcinoma. This lesion measures approximately 2.4 x 1.4 cm in the mid gland (1201/13). There is irregularity in the adjacent capsule with spiculation on postcontrast images in the left mid gland and apex suggesting extracapsular extension.Central Gland: BPH nodulesSeminal Vesicles: No evidence of seminal vesicle involvement.Extracapsular Extension: There is irregularity along the adjacent left lateral aspect of the capsule in the mid gland and base with spiculations and postcontrast images suggesting extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter perirectal lymph node is nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large peripheral zone lesion within the left base, mid gland and apex, suspicious for prostate adenocarcinoma.2.Findings suggestive of extracapsular extension.3.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status, unspecified Unspecified cord compressionDiagnosis Edits: Clinical question: cord edema extending in the thoracic spine MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots.There is centrally and high signal present within the spinal cord which is more prevalent in the upper thoracic spinal cord in the lower thoracic spinal cord. There is associated mild enlargement of the thoracic spinal cord.There are small bilateral pleural effusions present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild anterior subluxation of L5 on S1 there is endplate reactive changes present with some elevated T1 signal along the endplates at left half of the vertebral bodies suggesting that this is chronic. There is moderate facet hypertrophy present at this level. There is some loss of disc space height and disc desiccation. At L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate facet hypertrophy present at this level. There is mild anterior subluxation of L4 and L5. There is partial effacement of the fat at the lateral recess bilaterally at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level. There is loss of disc space height and some endplate reactive change present at this level. The endplate reactive changes are present which have high signal on T1 suggesting that this is chronic.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and some endplate reactive change present at this level. The endplate reactive changes are present which have high signal on T1 suggesting that this is chronic.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is subtle elevated T2 signal present diffusely within the perivertebral musculature.

Output: 1.There is diffuse thoracic spinal cord swelling due to central cord abnormality involving spinal cord gray matter which extends down from the lesion identified in the cervical spinal cord. Differential considerations may include ischemia as well as inflammatory/infectious etiologies.2.There are multilevel degenerative changes present in lumbar spine with mild to moderate spinal stenosis at L4-5.3.Small pleural effusions4.There is subtle elevated T2 signal present diffusely within the perivertebral musculature. This is a nonspecific finding. This could be inflammatory or reactive to denervation. It is of unclear significance.


Instruction: Generate impression based on findings.

Input: Optic papillitis left eye, evaluate for multiple sclerosis and papillitis. ORBITS: There is mild asymmetric enlargement, increased T2 signal, and increased enhancement involving the intraorbital and intracanalicular portions of the left optic nerve. There is flattening of the left posterior globe. There is also mild associated restricted diffusion involving the intraorbital portion of the left optic nerve and occluding the optic nerve head. There is elevation of the left optic nerve head.There is also an ill-defined appearance of the right distal optic nerve head with questionable flattening of the optic disc without associated increased enhancement or abnormal signal. No intraorbital masses are identified. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a normal variant cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. Trace mucosal thickening is present within the paranasal sinuses. There is a small mucous retention cyst within the right maxillary sinus. Mild, homogeneously decreased T1 signal within the bone marrow most likely reflects normal red marrow in patient of this age.

Output: 1.Findings compatible with left optic neuritis.2.Additional findings raising the possibility of early right optic neuritis, recommend clinical correlation.3.No acute intracranial abnormality or evidence of cerebral demyelinating disease.


Instruction: Generate impression based on findings.

Input: 33-year-old female with pain, evaluate for AVN of the knee MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears within normal limits.There is extensive red marrow replacement sparing only the epiphyses of the distal femur and proximal tibia. Partially visualized heterogeneous signal abnormalities in the distal diaphysis of the femur and proximal diaphysis of the tibia likely represent bone infarcts.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps tendon and patellar tendons are intact.ADDITIONAL

Output: . Extensive red marrow replacement sparing the epiphyses and likely bone infarcts in the tibial and femoral diaphyses, as described above.


Instruction: Generate impression based on findings.

Input: 54 years, Male, early onset Alzheimer's dementia. No restricted diffusion to suggest acute ischemia. There are numerous foci of susceptibility artifact of variable sizes throughout both cerebral hemispheres, predominantly at the gray-white matter junctions, which are compatible with chronic microhemorrhages. There is also curvilinear susceptibility signal along the left parieto-occipital sulci, compatible with superficial siderosis. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is a small area of encephalomalacia in the mesial right temporal lobe medial to the temporal horn (image 14 on axial series) Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes. Major intracranial vascular flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct or other acute intracranial abnormality.2. Numerous chronic lobar microhemorrhages of varying sizes in both cerebral hemispheres and left parieto-occipital siderosis probably indicatinga prior hemorrhagic event. This could be seen with amyloid deposition with resultant angiopathy.3. Nonspecific abnormal T2 signal in the periventricular and subcortical white matter to a degree greater than expected for patient age and could also be related to amyloid angiopathy versus chronic small vessel ischemic changes. Correlation with cerebrovascular risk factors is suggested.4. Small area of encephalomalacia in the mesial right temporal lobe likely related to a small chronic infarct.


Instruction: Generate impression based on findings.

Input: 64-year-old female with nausea/abdominal pain. Evaluate for mass or blockage. ABDOMEN:LIVER, BILIARY TRACT: Post surgical changes from hepaticojejunostomy. Scattered arterially hyperenhancing peripheral foci of the liver are not present on the venous and delayed phases and are most consistent with perfusional variants. No suspicious lesions are identified. SPLEEN: The spleen is at the upper limits of normal in size measuring 13 cm in length.PANCREAS: Postsurgical changes from a Whipple procedure. The residual pancreatic tail again demonstrates bulbous enlargement with decreased T1-weighted signal intensity. There is increased size of the infiltrative soft tissue lesion involving the distal pancreatic body with dilatation of the pancreatic duct proximally and distally. This lesion extends posteriorly to compress the splenic vein and anteriorly to the posterior wall of the stomach. This lesion measures 3.1 x 2.7 cm (series 1405 image 244) and is at the level of the splenic hilum. There is interval development of gastric collateral vessels. Mildly enlarged regional lymph nodes are also seen. A unilocular cystic lesion in the pancreatic tail has slightly increased in size measuring 1.4 x 1.4 cm (series 301 image 29) (prior 1.2 x 1 cm).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged peripancreatic retroperitoneal lymph nodes.BOWEL, MESENTERY: Status post distal gastrectomy with gastrojejunostomy. No evidence for bowel obstruction or ascites.BONES, SOFT TISSUES: Findings compatible with a benign osseous hemangioma of the L4 vertebral body (series 201 image 18), unchanged.OTHER: No significant abnormality noted.

Output: 1. More pronounced appearance of an infiltrative lesion involving the distal pancreatic body with persistent dilatation of the proximal and distal pancreatic duct. This lesion compresses the splenic vein with new gastric collateral vessels and regional lymphadenopathy. Further evaluation with endoscopic ultrasound is suggested.2. Unilocular cyst of the pancreatic tail has slightly increased in the interval.


Instruction: Generate impression based on findings.

Input: Diagnosis: Facial weaknessClinical question: rule out stroke MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, 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.Incidental note is made of partial empty sella.MRA brain: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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact and small in caliber. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.No evidence for acute cerebral infarction4.No evidence for intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: Female, 44 years old, with multiple sclerosis and right-sided hemiballismus status post deep brain stimulator placement. Evaluate for interval changes. Please note that axial FLAIR images were inadvertently omitted from this examination. Arrangements will be made for the patient to return to complete the axial FLAIR sequence.A left-sided deep brain stimulator is in stable position with its tip terminating within the left basal ganglia.Ill-defined periventricular FLAIR hyperintensity is again seen with numerous superimposed more focal or cavitary lesions. The overall quantity and distribution of these lesions does not appear to have changed significantly. As before, a clustering of such lesions is seen within the left cerebellum also appearing similar to prior. All of these more focal lesions demonstrate marked T1 hypointensity. No edema or mass effect is detected. Thinning of the corpus callosum and generalized parenchymal volume loss appear similar to prior. No pathologic enhancement is seen. A developmental venous anomaly is redemonstrated in the right cerebellum.Paranasal sinus mucosal thickening is evident.

Output: 1.Stable positioning of the left-sided deep brain stimulator lead.2.Redemonstration of extensive parenchymal lesions compatible with multiple sclerosis showing no definite or significant interval change.


Instruction: Generate impression based on findings.

Input: 15-year-old female. Patient with lymphangioma retroperitoneum. Needs follow-up MRI in two months. On Inderal 40 mg BID. Need to assess for shrinkage of mass. The fluid filled mass with multiple septations located posterior to the superior gastric body, anterior to the upper pole of the left kidney, and medial to the spleen consistent with stated history of lymphangioma. It is not significantly changed in size at 6 x 7 x 5 cm. The mass is again seen to insinuate itself into the pancreatic body and tail with fine frond-like projections.The liver and spleen are normal in appearance. No biliary ductal dilatation. The kidneys are normal in appearance. No hydronephrosis.

Output: Retroperitoneal lymphangioma without significant interval change in size.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:5/4/1975)Reason: hx choroid plexus pap. Preop planning for tumor History: dizziness/ h/aPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI There is a mass centered in the left cerebellar medullary angle cistern and foramen of Luschka measuring 30 x 24 mm in axial dimensions. It enhances heterogeneously. It has heterogeneous signal on T2 imaging are predominantly hyperintense to gray matter. It has not changed substantially when compared to the prior exam. There is associated mass effect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Left foramen of Luschka mass is compatible with choroid plexus papilloma. Please note that this exam was performed for the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. PELVIS:PROSTATE:Prostate Size: 2.5 x 4.0 x 4.9 cmPeripheral Zone: The peripheral zone appears scarred.There is a 7 x 6 mm focus of T2 weighted hypointensity in the right apex with associated restricted diffusion. Multiple ill-defined foci of T2 weighted hypointensity in the left apex and right mid gland without significant associated restricted diffusion are noted.Central Gland: No significant abnormality.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular invasion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.7 mm right transition zone apex lesion may represent a site of prostatic adenocarcinoma. No evidence of seminal vesicle invasion or extracapsular extension.2.Multiple nonspecific foci of T2 weighted hypointensity in the left apex and right mid gland peripheral zones are also noted.


Instruction: Generate impression based on findings.

Input: Clinical question: 39-year-old male status post MVA with pain in the lower lumbar spine with numbness. Evaluate. Signs and symptoms: Left leg numbness. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column however with straightening of lumbar lordosis which could be positional.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild hypertrophic changes of the facets and ligamentum flavum and unremarkable otherwise.L3-L4 demonstrate mild disc disease and mild loss of disc height, mild bilateral ligamentum flavum hypertrophy, mild bilateral facet disease and bilateral facet effusion. No spinal stenosis or neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum level and hypertrophy and mild bilateral facet effusion. There is a shallow broad-based disc/osteophyte complex on the right which in combination with hypertrophic changes of posterior elements results in moderate right neural foraminal compromise and no central spinal stenosis.L5-S1 demonstrate mild disc disease, mild bilateral facet and ligamentum flavum degenerative changes creating bilateral facet effusion. There is a central and leftward broad-based disc protrusion with subtle mass effect on the thecal sac with resultant left lateral recess compromise. No spinal stenosis however mild neural foraminal compromise.

Output: 1.At L4-5 there is evidence of degenerative changes of the spine and a right-sided disc-osteophyte complex with resultant mild right neural foraminal compromise.2.At L5-S1 there is mild degenerative changes and including a central and left lateral disc protrusion resulting in left lateral recess compromise as detailed.3.Mild degenerative changes at other levels as detailed.4.Unremarkable perispinal soft tissues.


Instruction: Generate impression based on findings.

Input: Reason: left knee medial meniscus tear History: left knee pain MENISCI: There is blunting and deformity of the posterior horn of the medial meniscus indicating a complex tear with a large horizontal component which extends to the body of the meniscus. There is globular increased signal abnormality within the body of the lateral meniscus indicating intrasubstance degeneration. Some of the signal extends to the tibial articular surface of the free edge of the meniscus indicating degenerative tearing, involving the body of the meniscus. ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing portion of the medial tibiofemoral compartment with underlying degenerative subchondral signal abnormality. There is subjective thinning of the articular cartilage of the lateral tibiofemoral compartment. There is a full-thickness articular cartilage defect along the lateral facet of the patella. There is a full-thickness articular cartilage defect along the median eminence of the patella and medial facet of the patella, centrally. There is superficial fraying of the articular cartilage of the femoral trochlea. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above. Degeneration/degenerative tearing of the lateral meniscus.2. Osteoarthritis of the left knee with full-thickness articular cartilage degeneration/defects as described above.3. Small joint effusion. 4. Borderline tibial tubercle to trochlear groove distance. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 65-year-old male with cerebellum dysfunction and recent fall There is a focus of hypodensity involving the right precentral gyrus white and gray matter corresponding to the area of restricted diffusion seen on prior MRI and likely represents an evolving subacute infarct. Subtle hyperdensity is seen along the precentral gyrus cortex which may represent laminar necrosis versus punctate petechial hemorrhage.A few hypoattenuating foci are seen in the periventricular region which is nonspecific but may represent small vessel ischemic disease of indeterminate age. There is no mass-effect, midline shift or edema. The ventricles and basal cisterns are normal in size and configuration.Minimal soft tissue swelling seen overlying the right parieto-occipital region without underlying fracture. The calvaria and skull base are radiographically normal. Partial opacification of the left maxillary sinus containing high density material which may represent inspissated mucus versus fungal sinusitis, grossly unchanged. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Findings consistent with an evolving right precentral gyrus subacute infarct as seen on the prior MRI. CT is insensitive for the early diagnosis of acute nonhemorrhagic infarct. MRI brain can be considered if clinically indicated.2. Redemonstration of left maxillary sinus sinusitis containing high density material which may represent inspissated mucus versus fungal sinusitis.


Instruction: Generate impression based on findings.

Input: There is rightward convexity of the mid lumbar spine with apex of the curvature at L2. Vertebral body heights are unchanged. There is stable grade 1 retrolisthesis of L2 over L3 and L4 over L5. There has been mild progression of multilevel disc narrowing, moderate to severe in degree. There is multilevel disc desiccation. Severe multilevel degenerative changes of the lumbar spine is again demonstrated, with endplate irregularity and endplate marrow signal changes. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.Multilevel degenerative changes are seen, as described below:At T9-T10: On sagittal images, minimal disc bulge is seen. There is mild stenosis of the central canal. There is ligamentum flavum thickening.At T10-T11: On sagittal images, there is no definite abnormality.At T11-T12: On sagittal images, there is mild disc bulge. There is significant ligamentum flavum thickening. There is mild stenosis of the spinal canal.At T12-L1: There is a mild ventrolateral disc protrusion. There is ligamentum flavum-thickening. No foraminal narrowing or spinal canal stenosis.At L1-L2: This is a left far lateral disc osteophyte complex. There is mild left foraminal stenosis. There is moderate spinal canal stenosis. There is ligamentum flavum thickening and facet joint hypertrophy. No change from previous.At L2-L3: There is uncovering of the disc. There is narrowing of the lateral recesses and moderate left foraminal stenosis at this level. There is mild right foraminal stenosis. There is mild spinal canal stenosis. There is facet joint arthropathy.At L3-L4: There is posterior osteophyte disc complex causing moderate bilateral foraminal stenosis. There is moderate spinal canal stenosis. There is ligamentum flavum thickening and facet arthropathy. At L4-L5: There is uncovering of the disc with superimposed disc bulge with superimposed right foraminal/far lateral protrusion. There is moderate to severe right foraminal stenosis and moderate left foraminal stenosis. There is moderate spinal canal stenosis. There is ligamentum flavum thickening. There is facet arthropathy which has progressed in the interim trace facet joint effusions. At L5-S1: There is disc bulge causing moderate foraminal narrowing on the right and mild foraminal narrowing on the left. There is ligamentum flavum thickening and facet arthropathy. There is moderate spinal canal stenosis improved from previous.Tiny T2 hyperintense focus is seen in the posterior cortex of the left kidney, likely a small cyst. The left adrenal gland is minimally prominent and unchanged from previous. There is layering T2 hypointense debris in the dependent portion of the gallbladder. Paraspinous soft tissues are within normal limits.

Output: 1. Very minimal progression of multilevel severe degenerative changes of the lumbar spine, with findings most prominent at L4-L5 with moderate-severe right foraminal stenosis and moderate left foraminal stenosis. There has been interval progression in the facet arthropathy at this level.2. Moderate spinal canal stenosis at various levels, slightly improved at L5-S1.3. Minimal layering debris within the gallbladder which may represent stones or sludge. Further evaluation with ultrasound may be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop study. Findings and symptoms: Preop imaging. Pre and post enhanced Stealth brain MRI:Examination is performed utilizing the stone protocol and is not a true diagnostic test.There are also no prior exams for comparison.Examination demonstrates a well-demarcated round extra-axial with T2 hypointense signal intensity and with diffuse enhancement in the left anterior and inferior frontal abutting the inner table of the skull as well as the falx. The mass measures maximum of 39 x 48 x 53 mm in size and consistent with a meningioma. There is surrounding vasogenic edema and constellation of findings results in significant mass effect on the left frontal horn of lateral ventricle and deviation of midline to the right of approximately 3 mm. This mass is inseparable from the very small caliber anterior aspect of superior sagittal sinus. Assessment for involvement of sinus cannot be made on this exam. Follow-up with dedicated imaging is recommended for further assessment if clinically desired.Ventricular system remains within normal size and the third ventricle is in midline. Cortical sulci and CSF spaces are unremarkable.

Output: Extra-axial dural based left anterior/inferior frontal mass highly suggestive of a meningioma and measuring at 39 x 48 x 53 mm size.


Instruction: Generate impression based on findings.

Input: Critical question: Evaluate for spinal cord/nerve root impingement given lumbar disk disease and worsening of symptoms. Signs and symptoms: Left leg weakness. Nonenhanced lumbar MRI:T12 -- L1 is unremarkable.L1 -- L2 demonstrate mild hypertrophic changes of the ligamentum flavum and unremarkable otherwise.L2 -- L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. Widening of the left fossa the space containing fluid signal intensity suggestive of inflammatory change or synovitis. No spinal stenosis however mild bilateral neural foraminal compromise is present.L4 -- L5 demonstrate moderate disk disease and loss of disk height, extensive hypertrophic changes of articulating facets and to a lesser degree of the ligamentum flavum. Constellation of changes result in grade 1 antral listhesis however without spinal stenosis. Mild bilateral neural foraminal compromise is present. There is increased T2 signal intensity within the annulus of the disk on the left (sagittal T2/T2 stir images 6 through 9) and consistent with an annular fissure.L5 -- S1 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis however mild bilateral (left greater than right) neural foraminal compromise are present.

Output: 1.Moderate changes at the L4 -- L5 with resultant grade 1 anterolisthesis however without central spinal stenosis is noted. There is evidence of an annular fissure at this level as detailed.2.Moderate changes at L5 -- S1 without spinal stenosis.3.Unremarkable exam at the other levels.


Instruction: Generate impression based on findings.

Input: Clinical question: 17 year old male with sickle cell disease, concern for microvascular disease seen on CT. Evaluate for microvascular disease. Acute ischemia.Signs and Symptoms: Microvascular disease seen on CT MRI of the brainNo diffusion weighted abnormalities are appreciated.Punctate lesions which are hyperintense on T2 and FLAIR MRI are present in the left centrum semiovale and to a lesser degree right centrum semiovale.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. Mastoid air cells appear to be a hypoplastic The visualized portions of the orbits are intact.Incidental note is made of marked bilateral nasopharyngeal adenoidal hypertrophy.There is diffuse marrow replacement present.MRA brain: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. In general the intracranial vasculature is fairly patulous.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally with medium-sized P1 segments. The vertebral arteries are similar in size.

Output: 1.There are some punctate periventricular white matter lesions present bilaterally more on the left than the right side which are nonspecific. They could be vascular related. The location is along the watershed distribution. This could be microembolic though they could also be related to hypoperfusion2.There is no evidence for intracranial cerebrovascular occlusive disease.3.Marked bilateral nasopharyngeal adenoidal hypertrophy. There is a nonspecific finding.4.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: This is a 5-year-old male with a history of Dandy-Walker malformation with P. with a VP shunt who presents with behavioral changes. Please evaluate ventricles and for shunt malformation. Changes consistent with Dandy-Walker malformation with large posterior fossa cyst which is continuous with the fourth ventricle. The VP shunt catheter is located in the posterior fossa within the fourth ventricle. When compared to the prior MRI in 2007 there are no changes in the size of the posterior fossa cyst. There is no significant ventricular prominence. There is an interval slight decrease in the frontal horns of the lateral ventricles.There is no evidence of intracranial hemorrhage, mass or edema.

Output: 1. Dandy-Walker malformation with VP shunt catheter located in the posterior fossa cyst.2. There are no changes in the size of the posterior fossa cyst. 3. No significant ventricular prominence.


Instruction: Generate impression based on findings.

Input: Left elbow pain. Left wrist pain. Left elbow: There is a mildly displaced fracture of the coronoid process of the ulna as seen on the recent MRI examination. Additional poorly defined foci of mineralization are seen along the posterior aspect of the radiocapitellar articulation. Elevation of the distal anterior fat pad along the distal humerus indicates joint effusion/hemarthrosis.Left wrist: There is a 3 to 4 mm density in the soft tissues volar to the radial styloid which I suspect represents a mildly displaced fracture through the tip of the styloid.

Output: Fractures of the coronoid process of the ulna and the tip of the radial styloid.


Instruction: Generate impression based on findings.

Input: 76 years, Male, left upper extremity numbness and tingling, history of previous CVA. No restricted diffusion to suggest acute ischemia is definitively appreciated. There is subtle punctate focus of diffusion hyperintensity involving the left parietal subcortical region, axial diffusion images 259, without corresponding T2/FLAIR hyperintensity and may be artifactual. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size for age.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease and similar to prior study from 10/18/2007. Brain parenchyma is otherwise unremarkable for age. Paranasal sinuses and mastoid air cells are clear. Bilateral lens implants. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. No definite evidence of acute infarct. Subtle punctate focus of diffusion hyperintensity in the left parietal lobe may be artifactual.2. Mild chronic small vessel ischemic changes which are similar to prior study from 10/18/2007.


Instruction: Generate impression based on findings.

Input: 34 years Male (DOB:4/7/1982)Reason: eval t spine, prior mass History: left chest pain at t7 dermatomePROVIDER/ATTENDING NAME: DAVID M. LIEBOVITZ REEM H JAN The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is redemonstration of a posterior epidural enhancing lesion measuring 36 x 6 mm sagittal dimensions which is slightly eccentric towards the left. It displaces the spinal cord anteriorly nearly effaces the spinal fluid adjacent to it has not changed substantially compared to the January exam. It extends from T7-8 to T8-9. There is a central disc protrusion at T7-8 which in combination with the posterior epidural lesion and narrows the spinal canal further radial mild degree of spinal stenosis. The lesion extends towards the left T8-9 neural foramen..

Output: There is redemonstration of a posterior epidural spinal lesion which remains stable compared to the previous exam. It is associated with a mild degree of spinal stenosis and some encroachment of left-sided exiting nerve roots at T8-9. Differential considerations include epidural hemangioma, neurofibroma, meningioma, neurinoma.


Instruction: Generate impression based on findings.

Input: Grade II glioma status post treatment. There are postoperative findings related to right frontal craniotomy. There is unchanged confluent T2 hyperintensity in along the margins of the right frontal lobe resection cavity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. In particular, there is no elevated perfusion or enhancement within the treatment bed. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Stable post-treatment findings in the right frontal lobe region, without evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Female 48 years old Reason: hx of cervical cancer s/p chemoRT, now with abnormal uptake on PET History: none PELVIS:UTERUS, ADNEXA: Soft tissue mass involving the posterior aspect of the cervix extending into the mesorectal fascia posteriorly measures 4.6 x 2.3 cm. Previously, 5.5 x 3.7 cm. The lesion shows some enhancement. The abnormal uptake on PET correlates to the soft tissue mass approximately the 3:00 o'clock position. The upper vagina is thickened.BLADDER: No significant abnormality noted.LYMPH NODES: Small pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic ascites.

Output: 1.Decrease in the soft tissue mass involving the posterior cervix and left upper vagina. The area of abnormal FDG uptake correlates to the 3:00 o'clock position of this mass.


Instruction: Generate impression based on findings.

Input: Right thumb injury six weeks ago now with pain overlying dorsum of the IP joint and possible foreign body seen on x-ray. The density seen on recent radiographs along the dorsal surface of the diaphysis of the proximal phalanx corresponds to plaque-like nonenhancing low signal intensity on this MRI study. This abnormal low signal intensity appears to contact to the cortex both proximally and distally, with subjacent relatively high signal intensity between it and the underlying cortical bone. While it is possible that this could represent a foreign body, its margins are relatively poorly defined and it does not have the typical geometric appearance of a foreign body. I favor focal posttraumatic periosteal reaction, perhaps with a small subperiosteal hematoma. Of note, the adjacent cortex itself appears intact, and the signal intensity of the medullary bone of the proximal phalanx is normal. Additional abnormal signal intensity extends through the soft tissues dorsal to the proximal phalanx to the skin surface that is isointense to skeletal muscle on T1-weighted images, heterogeneously hyperintense on T2-weighted images, and shows enhancement following gadolinium administration, indicating inflammation. I see no rim-enhancing fluid collection to suggest an abscess. The extensor tendon is bowed dorsally by the underlying cortically-based mass/periostitis, and its fibers dorsal to the mid diaphysis of the proximal phalanx are indistinct suggesting at least partial if not full-thickness tearing of the tendon. The flexor pollicis longus appears normal. The collateral ligaments of the interphalangeal joint appears intact. A small focus of high signal intensity separates the dorsal fibers of the ulnar collateral ligament of the first metacarpophalangeal joint from the base of the proximal phalanx, but this finding is of questionable significance, as the volar fibers of the ligament appear to attach in normal fashion to the bone.

Output: 1.Density along the dorsal margin of the proximal phalanx of the thumb seen on recent radiographs is favored to represent periosteal reaction/heterotopic ossification over foreign body.2.Soft tissue inflammation dorsal to the proximal phalanx with tear of the extensor tendon and other findings as above.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Cervical spine MRI:There is straightening the cervical spine which is likely positional. 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. There is no abnormal enhancement.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Posterior osteophyte disc complex causing slight anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is mild central and moderate bilateral neural foraminal stenosis.C6/7: Mild posterior osteophyte disc complex and slight ligamentum flavum thickening. There are no significant stenoses.C7/T1: Unremarkable

Output: 1.Negative contrast enhanced brain MRI.2.C5/6: Mild central and moderate bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 15-year-old female with knee pain after sports. Evaluate for fracture. MENISCI: There is increased linear T2 signal in the posterior horn of the lateral meniscus extending to both articular surfaces (series 5, image 21) compatible with a tear. Additionally, there is diffusely increased signal within the posterior horn of the lateral meniscus as well as fluid tracking within the meniscus compatible with maceration. There is increased signal without evidence of extension to the articular surfaces in the anterior horn of the lateral meniscus compatible with degeneration.The medial meniscus is normal in signal and morphology.ARTICULAR CARTILAGE AND BONE: There is increased T2 signal within the femoral condyles, posterior tibial plateau, as well as the fibular head compatible with contusions with probable underlying microtrabecular fractures.LIGAMENTS: The anterior cruciate ligament is increased in signal and thickened in morphology compatible with a tear. Posterior cruciate ligament and the collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Torn anterior cruciate ligament.2.Macerated posterior horn of the lateral meniscus with evidence of a tear.3.Degeneration of the anterior horn of the lateral meniscus.4.Multiple osseous contusions with probable underlying microtrabecular fractures.5.Moderate-sized knee joint effusion.


Instruction: Generate impression based on findings.

Input: 51-year-old female with chronic elbow pain LIGAMENTS: The collateral ligaments appear intact.TENDONS: The flexor and extensor tendons are intact without associated signal abnormality.ARTICULAR SURFACES AND BONE: The bone marrow signal is within normal limits. The articular surface is grossly within normal limits.SURROUNDING STRUCTURES: The biceps and triceps tendons are intact.ADDITIONAL

Output: No specific findings to account for the patient's chronic elbow pain.


Instruction: Generate impression based on findings.

Input: Low back pain and right L5 radiculopathy. There is perhaps slight disc bulging and facet hypertrophy at L4-5 and L5-S1 with slight narrowing of the neural foramina bilaterally, but no significant spinal canal stenosis. There is no significant spinal canal or neural foraminal narrowing at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is no evidence of tumors. The paravertebral soft tissues are unremarkable.

Output: Perhaps slight disc bulging and facet hypertrophy at L4-5 and L5-S1 with slight narrowing of the neural foramina bilaterally, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 59 years Female (DOB:5/27/1956)Reason: epilepsy workup, please evaluate for subtle contrast enhancing lesions, hippocampal sclerosis etc History: 59yof with 3d of florid UTI symptoms presenting after a first-ever grand mal seizurePROVIDER/ATTENDING NAME: MICHAEL A WARD ADIL J JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several FLAIR and T2 hyperintense punctate foci subcortical white matter of the frontal lobes and left temporal lobe. There are a few punctate foci of signal hyperintensity on T2 and FLAIR MR images in the brainstem.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are subcortical and brainstem punctate lesions present which are nonspecific. Most likely these are vascular related.2.No intracranial mass lesions are appreciated.


Instruction: Generate impression based on findings.

Input: 37 year old female with left knee pain, 8 weeks status post lateral meniscus repair. Evaluate for retear of the lateral meniscus, limited ROM. MENISCI: There is branching signal within the posterior horn and posterior aspect of the body of the lateral meniscus which extends to the femoral and tibial articular surface as well as the peripheral fibers of the meniscus compatible with a complex tear, appearing similar to the prior study. Although it is impossible for us to exclude a re-tear, this particular tear is of intermediate signal intensity and does not contain fluid, arguing against a retear. Best seen on sagittal image 26 of series 4 and sagittal image 27 of series 6, however, is a small focus of increased signal intensity within the undersurface fibers of the body of the meniscus that is situated slightly more anterior than the aforementioned tear and was not clearly evident on the prior study. There is also a vertically oriented linear band of high signal intensity traversing the body of the lateral meniscus as seen on image 19 of series 8 at the red-white zone that was also not clearly seen on the prior study. These findings are suggestive of a new tear of the body of the lateral meniscus. There is mild intrasubstance degeneration in the anterior horn of the lateral meniscus but no definite tear is evident. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defects. We see no bone contusions.LIGAMENTS: The patient is status post ACL reconstruction. The graft appears intact. There is intermediate signal intensity along the anterior margin of the graft which may represent synovitis or fibrosis, but is of questionable current clinical significance. The PCL, MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings suggestive of a new tear of the body of the lateral meniscus as described above.2. Postoperative changes of a prior ACL reconstruction as described above.


Instruction: Generate impression based on findings.

Input: Male 55 years old with Hx of new onset left arm weakness with extensor predominance and hand numbness, please evaluate for infarcts Mild periventricular and subcortical T2/FLAIR hyperintensities suggestive of chronic small vessel ischemic changes, several of which demonstrate focal volume loss within the bilateral frontal periventricular white matter, basal ganglia, and right pons. Some of these lesions are also associated with susceptibility, indicative of chronic microhemorrhages, and appear similar to prior exam. There is no evidence of acute intracranial hemorrhage, mass, or restricted diffusion to suggest ischemia. Stable mild global parenchymal volume loss. The ventricles and basal cisterns are patent. There is no midline shift or herniation. The major cerebral flow voids are intact. Right maxillary retention cyst appearing stable from prior exam. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute infarct or intracranial mass effect.2. Chronic small vessel ischemic disease with multiple chronic lacunar infarcts within the bilateral periventricular white matter, basal ganglia, and right pons appear similar to prior. Scattered chronic microhemorrhages also appear similar to prior.


Instruction: Generate impression based on findings.

Input: 75 years Female (DOB:3/27/1941)Reason: extensive stage small cell lung cancer History: extensive stage small cell lung cancerPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No evidence for brain metastases.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Unresponsive. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of cerebral white matter T2 hyperintensity. The brainstem, cerebellum, 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild scattered foci of cerebral white matter T2 hyperintensity are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 71 year old male with history of recent pericardial effusion diagnosis by echocardiography without associated symptoms, referred for cardiac MRI for additional evaluation. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 74%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 136 ml (normal range 142+/-34), the LV end systolic volume index is 17 ml/m2 (normal range 25+/-9), the LVESV is 35 ml (normal range 47+/-19). There is hypokinesis of the most apical segments. There is eccentric hypertrophy in a pattern of apical hypertrophy. The hypertrophy also extends to the mid lateral wall, but is clearly not concentric, with maximal wall thickness of 18mm in the mid to apical lateral wall. There is patchy late gadolinium enhancement im multiple myocardial segments. The apex and distal-mid lateral are most heavily involved, but there is also mild enhancement of the the mid anterior and inferior wall. It is not subendocardial and is not consistent with previous myocardial infarction. This pattern would suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The gadolinium pattern in the hypertrophied areas likely represents scarring, but the involvement outside the most hypertrophied segments suggests either a more mild hypertrophic process in these segments, or a super imposed infiltrative disorder. The native T1 myocardial relaxation time is elevated between 1100-1200ms. There is no myocardial iron overload. There is [no]LV thrombus. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 146 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is chordal SAM noted with at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a moderate-large circumferential pericardial effusion which predominantly posterior, overlying the left atrium and ventricle. There is no evidence of abnormal septal motion with respiratory variation, nor is there evidence for right atrial or right ventricular collapse. The maximal width of the effusion is 2.5cm posteriorly.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is eccentric hypertrophy in a pattern of apical hypertrophy. The hypertrophy also extends to the mid lateral wall, but is clearly not concentric, with maximal wall thickness of 18mm in the mid to apical lateral wall. There is patchy late gadolinium enhancement im multiple myocardial segments. The apex and distal-mid lateral are most heavily involved, but there is also mild enhancement of the the mid anterior and inferior wall. It is not subendocardial and is not consistent with previous myocardial infarction. This pattern would suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The gadolinium pattern in the hypertrophied areas likely represents scarring, but the involvement outside the most hypertrophied segments suggests either a more mild hypertrophic process in these segments, or a super imposed infiltrative disorder.2. Chordal SAM is noted with at least mild regurgitation. 3. Normal size RV with normal systolic function (EF 52%).4. Marked biatrial enlargement.5. Large pericardial effusion which is circumferential, but predominantly posterior overlying the left ventricle (maximal depth of 2.5cm). There is no definitive associated pericardial inflammation. There is no evidence for overt hemodynamic compromise due to the effusion.


Instruction: Generate impression based on findings.

Input: Left frontal mass with edema. Rule-out metastatic lesion. A non-infused CT examination of brain from St. Catherine Hospital dated 2 -- 18 -- 08 is submitted for interpretation. Patient's name is confirmed on the images.Large area of vasogenic edema in the left frontal lobe with mass effect on the frontal horn and possible extension of edema into the corpus callosum is noted. Within the area of edema a necrotic appearing tumor in the loculated fashion measuring approximately 32 by 19 mm in transaxial dimension.This is highly suspected of the tumor and can be further evaluated with a dedicated MRI.No hemorrhage or hydrocephalus is detected.

Output: Necrotic left frontal lobe tumor with extensive surrounding vasogenic edema


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for new stroke/metastases/other lesions that may trigger seizure. Signs and symptoms: New onset of seizures, old right MCA stroke, colon cancer. Pre and post enhanced brain MRI:Limited exam due to significant motion artifact.No acute intracranial process and negative diffusion weighted series.Examination demonstrates extensive right hemispheric encephalomalacia consistent with a large right MCA territory. Findings results in ex vacuo dilatation of right lateral ventricle and widening of cortical sulci. Additionally study demonstrates fairly extensive periventricular confluent foci of FLAIR hyperintensity consistent with extensive chronic small vessel ischemic strokes. There is evidence of right sided biliary and degeneration. Images through posterior fossa demonstrate multiple foci of FLAIR hyperintensity in the pons suggestive of chronic lacunar infarcts.There is no detectable abnormal enhancement of brain parenchyma or the leptomeninges to suggest metastatic disease.Calvarium demonstrates normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells demonstrate normal pneumatization signal patterns.Nonenhanced brain MRA:Examination demonstrates patent and unremarkable bilateral internal carotid arteries. Unremarkable bilateral anterior cerebral arteries. Unremarkable left middle cerebral artery and its branches. Patent right middle cerebral artery however with paucity of distal branches compared to the left representing changes from patient's known large chronic right MCA territory stroke.Pre and post enhanced neck MRA:The visualized aortic arch is unremarkable.The origins of major vessels are all patent and unremarkable.Brachiocephalic and bilateral subclavian are patent and unremarkable.Bilateral vertebral arteries are patent and unremarkable.Bilateral common carotid arteries are patent and unremarkable.There is mild atherosclerotic disease at the origin of right internal carotid artery without significant stenosis and unremarkable otherwise.There is a short segmental moderate stenosis at the origin of left internal carotid artery due to a short segment of atherosclerotic plaque and unremarkable otherwise.

Output: 1.Brain MRI is exam due to extensive motion artifact. No evidence of an acute intracranial process and no detectable metastases lesions. Large chronic right MCA territory ischemic stroke, extensive chronic small vessel ischemic disease including chronic lacunar infarcts as detailed. Stable significant parenchymal volume loss with ex vacuo dilatation of the supratentorial ventricular system and cortical sulci.2.Nonenhanced brain MRA demonstrates patency of all intracranial major branches however with paucity of distal branches of right MCA.3.MRA of neck demonstrate a short segmental moderate vascular stenosis at the origin of the left internal carotid artery, mild atherosclerotic disease at the origin of the right internal carotid artery and unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 41-year-old female with cystic lesion of the pituitary gland. A previously demonstrated cystic focus in the right pituitary gland has significantly decreased in size, although there is now a more conspicuous, noncystic, hypoenhancing component best visualized within the midline superior anterior pituitary lobe measuring 5 mm transverse x 3 mm craniocaudal x 4 mm AP. The pituitary gland is otherwise not particularly enlarged. The optic apparatus and cavernous sinuses are intact without involvement. There are unchanged mild punctate foci of high T2 signal in the visualized aspects of the cerebral white matter.

Output: A previously demonstrated cystic focus in the right pituitary gland has significantly decreased in size, although there is now a more conspicuous, noncystic, hypoenhancing component best visualized within the midline superior anterior pituitary lobe measuring 5 mm transverse x 3 mm craniocaudal x 4 mm AP most likely representing a microadenoma


Instruction: Generate impression based on findings.

Input: Left lower extremity radiculopathy. Evaluate for L5-S1 stenosis. There has been interval spinal fusion at L4-L5 level via posterior rods and screws and an intervertebral disc space device. The vertebral column alignment is near-anatomic. The vertebral body heights are preserved. There is intervertebral disc desiccation at L3-L4, L4-L5 and L5-S1. There is also facet hypertrophy and ligamentum flavum thickening at various levels. At L3-L4, there is mild left foraminal disc protrusion resulting in mild encroachment at the left lateral recess and left neural foramen. At L4-L5, there is no significant residual spinal canal or neural foraminal narrowing. The disc protrusion superimposed upon a mild disc bulge at L5-S1 appears to have decreased in size, but there is persistent bilateral neural foraminal stenosis, primarily due to facet hypertrophy, and there is no significant spinal canal. The spinal cord displays normal signal and morphology.

Output: 1. Interval spinal fusion at L4-L5, without evidence of significant spinal canal or neural foraminal stenosis at this level. 2. Apparent decrease in size of the disc protrusion at L5-S1, but persistent bilateral neural foraminal stenosis primarily due to facet hypertrophy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate bilateral angiomyolipomas RIGHT KIDNEY: The right kidney measures 8.7 cm in length. There is no evidence of hydronephrosis. There is a echogenic upper pole nodule measuring 1.2 cm in diameter. This is compatible with an angiomyolipoma. The previously described questionable lower pole angiomyolipoma identified on MRI is probably still present but difficult to characterize on ultrasound given body habitus.LEFT KIDNEY: The left kidney measures 9.6 cm in length. Numerous echogenic nodules are noted which are nonspecific but compatible with angiomyolipomas. The largest is exophytic at the lower pole measuring 3.2 x 3.1 x 2.5 cm.BLADDER:: No significant abnormalities noted. Bladder is well-distended and grossly normal in contour

Output: Multiple bilateral echogenic renal nodules which are nonspecific but compatible with angiomyolipomas. These are amenable to embolization if desired clinically.


Instruction: Generate impression based on findings.

Input: 68 years Male (DOB:11/24/1947)Reason: eval for vessel occlusion History: right hemiparesisPROVIDER/ATTENDING NAME: NAVNEET CHEEMA CHRISTOPHER M GOMEZ MRI of the brainThere is a focus of diffusion restriction present along the posterior limb of the left internal capsule.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of confluent periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate T2 and FLAIR hyperintense foci are present in the basal ganglia, thalami and brainstem.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is some marrow replacement along the odontoid tip.MRA brain:There is a 5 mm fusiform aneurysm present along the basilar artery at the origin of the left anterior inferior cerebellar artery which encompasses the left anterior inferior cerebellar artery origin.There is a posterior left laterally directed 4 mm wide neck aneurysm present at the basilar artery between the levels of the anterior inferior cerebellar artery and the superior cerebellar artery.There is a 2 mm infundibulum present at the origin of the right posterior communicating arteryAntegrade 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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small in diameter. The posterior communicating arteries are not well visualized. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is 80% stenosis stenosis along the proximal third of the cervical segment of the left vertebral artery

Output: 1.Acute lacunar infarct along the posterior limb of the left internal capsule. 2.There are 2 aneurysms present along the basilar artery. One is 5 mm and fusiform and at the level of the left anterior-inferior cerebellar artery were it incorporates the origin of the left anterior inferior cerebellar artery. The other is wide necked and between the levels of the superior cerebellar artery and anterior inferior cerebellar artery measuring 4 mm diameter. In addition there is a 2 mm infundibulum at the origin of the right posterior communicating artery.3.There is an 80% stenosis along the course of the left vertebral artery.4.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 5.Multiple punctate lesions in the basal ganglia, thalami and brainstem are likely related to prior vascular events.6.There appears to be marrow replacement along the odontoid tip. It is not clear based on this exam whether it represents sclerosis or an infiltrating lesion. A CT of the cervical spine may be of benefit to further evaluate this.7.At the time of dictation an alphanumeric page was sent to Dr. Fintel.