Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: ams, history of malignancy, history of embolic strokes The CSF spaces are appropriate for the patient's stated age with no midline shift. A focus of encephalomalacia is redemonstrated in the posterior aspect of the right temporal lobe extending into the adjacent occipital lobe.Another focus of encephalomalacia is present along the medial and inferior aspect of the left cerebellar hemisphere. This was also present on the previous examThere are some small cortically based foci of diffusion weighted signal hyperintensity located at the focus of encephalomalacia in the right posterior temporal lobe additionally there are punctate foci of signal hyperintensity on the diffusion-weighted imaging in the centrum semiovale bilaterally in the left middle frontal gyrus and in the left precuneus. These are associated with low signal on ADC maps.There is a moderate degree of periventricular and subcortical confluent and punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are several punctate foci of susceptibility effect in the subcortical white matter as well as in the thalami bilaterally and the brainstem and to a lesser degree cerebellar hemispheres and basal ganglia. They're more densely populated in the thalami.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.There is redemonstration of a lipoma along the frontal scalp tissues just anterior to the coronal suture.

Output: 1.There are multiple punctate foci of diffusion restriction suggesting punctate infarctions scattered in the supratentorial brain as detailed above. This could potentially represent a mild shower of emboli2.Redemonstration of foci of encephalomalacia centered in the right parietal lobe and inferior semilunar lobule of the left cerebellar hemisphere3.Multiple microhemorrhages are present in a distribution which includes dominantly brainstem and thalami but also elsewhere is suspicious for hypertensive cause 4.Periventricular and subcortical white matter changes of a moderate to marked degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Clinical question: rule out central lesionSigns and Symptoms: LUE weakness, increase reflexes in LLE, numbness in LUEAcute myeloid leukemia. Acute myelogenous leukemia. MRI brain: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 demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this levelAt C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height, endplate reactive changes, diffuse disc bulge and bilateral uncovertebral osteophytes at this level associated with some narrowing of the neural foramina right worse than left with some encroachment of the right-sided exiting nerve roots within the neural foramen.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Brachial plexus:The subclavian arteries and veins are identified and are intact. Nerve roots from the cervical spine can be followed. Within the region of the left brachial plexus no mass lesions are appreciated.There is asymmetric T2 signal hyperintensity involving the left brachial plexus and surrounding soft tissues and muscles of the scapula. There is no obvious asymmetric enhancement to the left side.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There are some degenerative changes present in the cervical spine with encroachment of the nerve roots within the right neural foramen at C5-6.3.No brachial plexus mass is appreciated to explain the patient's symptoms.4.There is asymmetric signal in the tissues surrounding the left brachial plexus. I suspect this is artifactual related to inhomogenous fat suppression. There is no obvious thickening of the plexus appreciated. A subtle infiltration or early stages of plexopathy may be overlooked.


Instruction: Generate impression based on findings.

Input: 49-year-old female patient with known right breast invasive ductal carcinoma. Patient is status post bilateral mastectomies with bilateral silicone implants 8/2012 for IDC and DCIS. MRI detected abnormal enhancement in the right breast, subsequently biopsied and found to be invasive ductal carcinoma. Patient is status post neoadjuvant chemotherapy therapy. Status post bilateral mastectomies with bilateral silicone implants.Again seen is a focus of nonmass enhancement in the 6:00 position of the right reconstructed breast abutting the skin in implant which currently measures 2.2 x 0.6 x 0.3 cm (ML X AP X SI), previously 2.5 x 0.7 x 0.4 cm. There is moderate interval decrease in degree of enhancement of this focus compared to prior. A clip is noted within this focus of abnormal enhancement.Again seen is an enhancing intramammary lymph node that measures 6 mm, unchanged and benign in morphology.

Output: 1.Minimal interval decrease in size of nonmass enhancement in the 6:00 position of the right breast between the implant and the skin. Additionally, there is moderate interval decrease in intensity of enhancement of the above mentioned area. 2.No new foci of abnormal enhancement identified.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:12/15/1950)Reason: lumbar radiculopathy History: lumbar radiculopathyPROVIDER/ATTENDING NAME: RICHARD W KANG RICHARD W KANG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and some endplate reactive changes as well as disc desiccation at this level associated with a diffuse disc bulge and mild facet hypertrophy. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is a diffuse disc bulge and a superimposed left paramedian disc extrusion which disc extrusion impresses on the thecal sac and effaces the spinal fluid within the thecal sac at this level. Some disc material extends behind the adjacent endplates. Overall there is moderate to marked spinal stenosis at this level. There is effacement of the fat at the left lateral recess at this level. There are some mild facet and ligamentum flavum hypertrophy at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a diffuse disc bulge at this level. There are endplate reactive changes at this level which are high signal on T1 and T2 and suppresses on the inversion recovery images. These are chronic endplate reactive changes.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a disc bulge as well as some endplate reactive changes which are high signal on T1 and suppresses on the STIR images indicating they are chronic.At L1-2 there is no significant compromise to spinal canal or neural foramina. There are Schmorl's nodes present at this level.

Output: 1.There are multilevel degenerative changes present in the lumbar spine which are worse at L4-5 where there is moderate to severe spinal stenosis as a result of a left paramedian disc extrusion .


Instruction: Generate impression based on findings.

Input: 53 year-old woman with history of pain, evaluate for meniscal tear. MENISCI: There is a horizontal cleavage tear involving the posterior horn of the medial meniscus. The anterior horn of the medial meniscus appears intact.There is a horizontal cleavage tear involving the posterior horn of the lateral meniscus. Additionally, there are small parameniscal cysts. The anterior horn of the lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal appears normal. The articular cartilage of the patellofemoral and tibiofemoral compartments appears intact.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Tears of the posterior horn of the medial meniscus and posterior horn of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: 77-year-old man with known stroke, has clonus on the left side Examination is severely motion degraded. Vertebral body heights are normal. There is grade 1 anterolisthesis of C4 on C5, C5 on C6, and C6 on C7. Degenerative changes are seen including small disc osteophyte complexes and ligamentum flavum thickening. Mild to moderate spinal canal stenosis is suspected at the C4-C5 and C5-C6 levels. Up to moderate neural foraminal stenosis is also suspected at multiple levels poorly evaluated. Examination is inadequate to assess for cord signal abnormality.

Output: Severely motion degraded exam demonstrating mild to moderate multilevel degenerative changes. Mild to moderate spinal canal stenosis is suspected at the C4-C5 and C5-C6 levels. No evidence of frank cord compression or cord mass within the limitations of the study. Examination is inadequate to assess for cord signal abnormality. Consider repeat examination with sedation if there is significant suspicion for cervical cord pathology.


Instruction: Generate impression based on findings.

Input: There are post-surgical findings related to Chiari decompression. There remains a residual extradural CSF intensity fluid collection that tracks less inferiorly than previous exam, but measures up to 5 mm in thickness and is partly septated. The inferior cerebellum displays an unchanged configuration. There still appears to be narrow biphasic cerebrospinal fluid flow anteriorly across the neo-foramen magnum, but somewhat blunted cerebrospinal fluid flow posteriorly. The vertebral body heights and alignment are unchanged. There is no evidence of syringohydromyelia. The bone marrow signal is unremarkable. There is a posterior disc-osteophyte complex at C5-6 and ligamentum flavum thickening that results in spinal canal stenosis, which appears to have progressed from previous exam. However, there is no definite abnormal signal within the spinal cord parenchyma.

Output: 1.Post-surgical findings related to related to Chiari decompression with a small residual pseudomeningocele. 2.No evidence of cervical syringohydromyelia.3.Increase in the degree of spinal canal stenosis at the C5-6 level related to a disc-osteophyte complex and ligamentum flavum thickening without definite associated spinal cord signal abnormality. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Assess for spondylolisthesis. There is borderline grade 2 anterolisthesis of L4 on L5. Otherwise the lumbar spine is unremarkable with vertebral body heights and intervertebral spaces preserved. Components of bilateral hip arthroplasties are incompletely visualized.

Output: Orbital line grade 2 anterolisthesis of L4 on L5.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for CVA. Signs and symptoms: Aphagia. Unenhanced head CT:The examination demonstrates very subtle subcortical and periventricular low attenuation which are suspected for mild small vessel ischemic disease of indeterminate age. These findings were noted on prior MRI examination from 6 -- 23 -- 10.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. High density extra axial lesion measuring approximately 18 times 15 mm in transaxial dimension is noted along the superiorly surface of tentorium on the left is consistent with patient's known meningioma. There is no appreciable interval change since prior exam. There is no evidence of surrounding vasogenic edema.

Output: 1.No detectable acute intracranial findings.2.Minimal small vessel ischemic disease of indeterminate age.3.Stable left sided subtemporal meningioma.


Instruction: Generate impression based on findings.

Input: Prostate cancer.Rise in PSA to 6.62 ng/mL. Transrectal ultrasound and biopsy, adenocarcinoma, Gleason score 6 (3+3) , involving 2/12 cores: left lateral base- 4% of a 5mm core and right medial base - 29% of a 5mm core. PELVIS:PROSTATE:Prostate Size: 4.8 x 3.0 cm.Peripheral Zone: Lesion at the right base demonstrating hypointense T2 and ADC signal measures at least 6 x 6 mm (image 18 series 801) and may represent patient's known prostatic adenocarcinoma. This lesion abuts the capsule though, and while no clear extracapsular extension is seen, this cannot be entirely excluded. No other definite lesion is identified.Central Gland: Multiple well-defined nodules demonstrate benign morphology without suspicious characteristics.Seminal Vesicles: No evidence of seminal vesicle invasion. Seminal vesicles appear atrophic.Extracapsular Extension: While no clear extracapsular extension is seen, the lesion above abuts the capsule and therefore extracapsular extension cannot be entirely excluded.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral pelvic sidewall lymph nodes measure approximately 8 mm in short axis. No pathologically enlarged lymph nodes are present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lesion in the right base as described above, suspicious for known prostatic adenocarcinoma. Extracapsular extension cannot be entirely excluded. No evidence of seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: There is a small T2 hyperintesity in the right occiptal cortex that is T1 hypointense, with blooming centrally on the gradient echo which may represent prior small infarct with hemorrhagic products. Cerebral cavernous malformation is felt to be less likely. 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. There is partial opacification of the left maxillary sinus. The right mastoid air cells are opacified. The The remaining paranasal sinuses are clear. There is no abnormal enhancement within the brain. There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions, arteriovenous malformations, or aneurysms are identified.

Output: 1.There is a small T2 hyperintesity in the right occiptal cortex that is T1 hypointense, with blooming centrally on the gradient echo which may represent prior small infarct with hemorrhagic products. Cerebral cavernous malformation is felt to be less likely.2.Normal MRA of the brain.


Instruction: Generate impression based on findings.

Input: Female 55 years old with locking, catching, and right knee pain. Assess for medial meniscus tear. MENISCI: There is globular increased signal within the posterior horn of the medial meniscus indicating intrasubstance degeneration. Additionally, the posterior horn of the medial meniscus appears to terminate medial to its expected root attachment indicating a root tear. There is medial extrusion of the body of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate to severe degeneration of the articular cartilage of the medial compartment with areas of full-thickness cartilage loss along the medial femoral condyle. There is edema-type signal within the medial femoral condyle and medial tibial plateau which is likely degenerative. There is moderate degeneration and near full-thickness fissuring of the medial facet of the trochlea and moderate degeneration of the articular cartilage of the lateral tibial plateau along the lateral tibial spine with a full-thickness cleft.LIGAMENTS: The cruciate and collateral ligaments are intact. Edema along the medial collateral ligament is likely associated with the aforementioned medial compartment pathology but could conceivably represent an MCL sprain in the correct clinical setting. EXTENSOR MECHANISM: The extensor mechanism is intact. There is mild nonspecific edema in the prepatellar soft tissues.ADDITIONAL

Output: 1. Degeneration and posterior root tear of the medial meniscus.2. Tricompartmental cartilage degeneration most severely affecting the medial compartment.3. Moderate joint effusion and other findings as above.


Instruction: Generate impression based on findings.

Input: Female 64 years old; Reason: H/o AL amyloidosis with history of bone involvement. Monitor for progression of bone lesions. A circumscribed ovoid lesion in the left ilium is unchanged in size measuring 3.8 x 2.0 cm (series 5, image 14) with unchanged signal characteristics. The lesion in the proximal femoral diaphysis is unchanged measuring 1.3 AP x 1.5 cm CC. Small predominantly-subcentimeter foci in the bilateral proximal femoral diaphyses and left posterior sacral wing are also similar to prior. No definite new lesions are identified.No fracture or dislocation is identified. No significant marrow edema is identified. Mild osteoarthritis affects the bilateral hips.There is no muscular fatty atrophy or edema. The visualized pelvic organs are unremarkable.

Output: Stable osseous lesions in the pelvis.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, history of coccygeal/sacral chordoma status post resection. Surveillance scan. The previously demonstrated postsurgical changes are minimally included on this examination and this region is better assessed on the accompanying pelvic MRI.Fatty signal within the S2 and S3 vertebral bodies is again seen similar to prior compatible with focal fat or hemangiomas. No evidence of suspicious T2 hyperintensity or pathologic enhancement is seen at these levels.Elsewhere in the lumbar spine, no pathologic marrow signal alteration or enhancement is seen. Vertebral body height and morphology is normal. The visualized spinal cord, conus and cauda equina are unremarkable. Conus medullaris terminates at the L1-2 level.L1-2: No significant disc disease. No spinal canal or neural foramina stenosis.L2-3: No significant disc disease. No spinal canal or neural foramina stenosis.L3-4: Disc abnormality has improved with minimal residual disc bulge and increased conspicuity of central annular fissure. No significant spinal canal stenosis. No significant neural foraminal narrowing. L4-5: Mild disc bulge, which has slightly worsened, indenting the ventral thecal sac. Left dorsal annular fissure is now only barely seen on this examination. Mild bilateral foraminal narrowing.L5-S1: Left paracentral disc protrusion has decreased in size decreased posterior displacement of the descending left S1 nerve root. No significant central canal stenosis or neural foraminal stenosis. There is now a left paracentral annular fissure.Mild facet arthropathy in the lumbar spine. Paraspinous soft tissues are unremarkable.

Output: 1. Postsurgical changes in the sacrococcygeal region are almost completely excluded from this examination. No evidence of residual or recurrent tumor is seen. Please see separate report from accompanying pelvic MRI.2. Mild degenerative changes in the lumbar spine as described above with fluctuating disease, including improvement especially of the disc protrusion at L5-S1 and associated mass effect on the left S1 nerve root.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with low back and bilateral leg pain. Alignment is anatomic. Vertebral body heights are preserved. The L5 vertebral body and the sacrum are relatively fatty replaced with a more heterogeneous mottled appearance of the remaining lumbar vertebral body levels. However, no evidence of marrow edema is seen. The visualized spinal cord, conus and cauda equina are unremarkable.T11-12: Ligamentum flavum thickening and facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.T12-L1: Unremarkable.L1-2: Moderate left and mild right facet hypertrophy with ligamentum flavum thickening. Mild bulging disc. No significant spinal canal stenosis. Severe left and mild right foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Small left ligamentum flavum cyst which slightly indents the left dorsal thecal sac. No significant spinal canal or neuroforaminal stenosis. L4-5: Moderate facet hypertrophy. Small left ligamentum flavum cyst causing no significant deformation of the thecal sac. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Bulging disc with a small right paracentral and foraminal protrusion. No significant spinal canal stenosis. Moderate to severe right and moderate left foraminal narrowing.

Output: 1.No significant or high-grade spinal canal stenosis is seen.2.Posterior element hypertrophy at L1-2 causes a severe left and mild right foraminal narrowing.3.Posterior element hypertrophy and disc disease at L5-S1 causes a moderate to severe right and moderate left foraminal narrowing.4.Marrow signal characteristics are somewhat mottled and heterogeneous except at the L5 level and in the sacrum where the marrow is more uniformly fatty replaced. The etiology of this finding is uncertain, but no evidence of marrow edema is seen to suggest an active pathologic process.


Instruction: Generate impression based on findings.

Input: Note is made of a minimally displaced fracture of the ulnar styloid. No intra-articular contrast is identified within the distal radial ulnar joint or midcarpal joint. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute 14 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the left wrist for subsequent MRI arthrogram examination. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: Shoulder pain and limited range of motion There is flattening and fragmentation of the humeral head medially as seen on recent radiographs which could reflect the sequela of avascular necrosis or neuropathic arthropathy. There is distention of the joint with heterogeneous fluid signal intensity which likely reflects a combination of synovitis and debris. Degenerative cysts are noted within the underlying humeral head.GLENOHUMERAL JOINT AND GLENOID LABRUM: Subchondral cysts are noted within the glenoid which are likely degenerative. There is diffuse degeneration and tearing of the labrum, which is most severe posteriorly.ROTATOR CUFF: Despite the deformity of the humeral head, the rotator cuff itself appears intact as does the rotator cuff musculature.SUPRASPINATUS OUTLET: There is deformity of the distal clavicle indicating a chronic fracture with no definite bony bridging evident. A trace amount of fluid is noted within the subacromial-subdeltoid bursa. The coracoacromial ligament is thickened perhaps the result of prior trauma.BICEPS TENDON: The tendon of the long head of the biceps is intact.

Output: Flattening and fragmentation of the humeral head with distention of the glenohumeral joint with heterogeneous signal intensity which likely reflects a combination of debris and synovitis. These findings may be the result of avascular necrosis or neuropathic arthropathy, however the rotator cuff is intact. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate spinal anatomy for possible fusion. Signs and symptoms: Pain and weakness. Non-enhanced CT of lumbar spine:Examination redemonstrates destructive changes of the L1 vertebral body with collapse of more than 50% of one. There is fragmentation of the body of L1 vertebrae with expansion into the spinal canal posteriorly. These findings are similar to what was noted on prior MRI of lumbar spine. There is compromise of the AP diameter of thecal sac secondary to retropulsion of fragments into the canal. There is widening of the articulating facets space between T12 -- L1 and L1 -- L2 levels.There is evidence of minimal lytic changes of the inferior endplate of T12 vertebrae as well. This is result of patient's known diskitis/osteomyelitis. The T12 vertebral body and its pedicles are otherwise unremarkable.Very advanced degenerative disk disease throughout the rest of the lumbar spine with significant loss of disk height and sclerotic changes of the adjacent endplates as well as vacuum phenomenon. The alignment of vertebral column is otherwise unremarkable. There is no evidence of any abnormality of the pedicles of the lumbar spine except for partial involvement of pedicles of L1 with technique changes. Very extensive hypertrophic changes of articulating facets bilaterally are noted throughout the lumbar spine. Multilevel mild neural foramina compromise secondary to degenerative changes are suspected.Nonenhanced CT of thoracic spine:A small leak change along the inferior endplate of T12 is consistent with patient's known osteomyelitis/diskitis noted on multiple prior MRI exams. The density of vertebral column in the thoracic spine is otherwise unremarkable. There is no evidence of sclerotic or lytic changes of the rest of thoracic spine. Could the exception of hypertrophic changes no additional abnormality of the facets or the pedicles are detected.The alignment the vertebral column is within normal limits.Mild-to-moderate degenerative disk disease and hypertrophic changes of posterior elements throughout the thoracic spine is noted.

Output: 1.Lytic/destructive changes of L1 vertebrae with retropulsion of fracture body of L1 into the spinal canal and resultant central spinal stenosis. There is also lytic changes involving the anterior aspect of L1 pedicles bilaterally which is also result the patient's osteomyelitis.2.Extensive degenerative changes of lumbar spine of both disks and posterior elements and with multilevel neural frontal compromise as detailed. There is no evidence of any bony defect in the rest of lumber spine other than L1 level.3.Degenerative changes of disk and posterior elements in thoracic spine. Minimal lytic changes of the inferior endplate of T12 related to patient's known osteomyelitis. Unremarkable CT of thoracic spine otherwise.


Instruction: Generate impression based on findings.

Input: Other musculoskeletal symptoms referable to limbs(729.89) [729.89] / Moyamoya disease [437.5] / Facial weakness [781.94], Reason for Study: ^Reason: evaluate for new stroke History: moyamoya pt with new r face and L arm weakness, bowel/bladder incontinence Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are multifocal tissue losses, encephalomalacia include bilateral frontal lobes, left parietal lobe, left temporal lobe, left occipital lobe and left insular with ex vacuo change of the left lateral ventricle.There are multiple small signal voids around suprasellar cistern, ambient cistern, interpeduncular cistern and quadrigeminal cistern indicating small collateral vessels, Moya Moya vessels.Comparing to prior scan performed on July 2007, there are no significant interval difference in terms of the extent of encephalomalacia, the degree of Moya Moya vessels and the degree of ex vacuo change of the left lateral ventricle.The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no MR evidence of normal inflow enhancement on bilateral distal ICAs especially from the level of bilateral ophthalmic arteries. Bilateral MCAs' M1 segments are not visualized as well as bilateral ACA A1 segments. The right ACA appears to be reconstituted at the level of the corpus callosum genus portion. Bilateral ICAs were visualized, although small in diameter, upto the level of the proximal cavernous sinus segment.The vertebral basilar system appears to be normal in diameter. However, there are numerous small flow related enhancements on cisterns spaces especially quadrigeminal, ambient, interpeduncular, and suprasellar cisterns. In addition, there are numerous small flow related enhancements on bilateral midbrain, pons and basal ganglia indicating collateral vessels (Moya Moya vessels). No significant interval change since prior scan.No evidence of intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate severely narrowed but still patent bilateral extracranial ICAs especially from CCA bifurcations.Right vertebral artery appears to be smaller and somewhat luminal irregularity. This finding most likely represent congenital hypoplasia. The left vertebral artery appears to be normal.Bilateral CCAs are slightly smaller in diameter without focal stenosis.Bilateral subclavian arteries are normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Multifocal chronic ischemic infarction with encephalomalacia as described above, no change since prior scan.3. Severe stenosis of bilateral ICAs from the level of CCA bifurcation to the level of proximal cavernous sinus segment then appear to be completely occluded. No change since prior scan. 4. Vertebrobasilar system appears to be normal with the right vertebral artery is hypoplastic.5. Numerous development of MoyaMoya vessels as described above, no change of its extent and degree since prior exam.


Instruction: Generate impression based on findings.

Input: Reason: Right Shoulder Lipoma except tender to touch, r/o other etiology History: mass, tender to touch, mobile ROTATOR CUFF: There is a partial-thickness articular surface tear of the distal fibers of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 3 mm in the AP dimension. There is no significant retraction. There is also partial thickness undersurface tearing of the subscapularis at the level of its insertion on the lesser tuberosity. There is no significant retraction. The supraspinatus muscle and tendon appear intact. There is mild intermediate signal intensity within the supraspinatus indicating mild tendinosis. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Minimal osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Findings suggestive of a lipoma along the anterolateral aspect of the right shoulder without evidence of an enhancing mass lesion.2. Partial-thickness undersurface tear of the rotator cuff without evidence of a full-thickness tear or retraction.


Instruction: Generate impression based on findings.

Input: 64-year-old woman with history metastatic carcinoid, please restage. ABDOMEN:LIVER, BILIARY TRACT: The resection cavity in segment 4/5 of the liver (series 301, image 26) is unchanged in size measuring 2.4 x 1.8 cm, previously 2.4 x 1.8 cm.Multiple scattered hyperintense foci on diffusion weighted images, consistent with metastasis, appear similar in size and distribution compared to the prior study when accounting for differences in technique but increased in number compared to the prior study dated back to 2009. The reference right posterior liver lesion (series 301, image 28) measures 7 mm, previously 7 mm. The previously described segment 7/8 lesion which demonstrates washout on delayed contrast-enhanced sequences (series 901, image 32) measures 1.0 x 1.2, previously 1.0 x 1.2 cm. No definite new lesions are identified.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Fat-containing lesion in the inferior left kidney likely represents an angiomyolipoma given loss of signal on fat suppressed imaging and is unchanged from the prior study. T2 hyperintense nonenhancing lesions are seen in the right kidney consistent with simple cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of prior hemicolectomy. Otherwise, no significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in liver lesions suspicious for metastases, see discussion above.2.No interval change in the liver resection cavity.


Instruction: Generate impression based on findings.

Input: 71-year-old male with history of thoracic soft tissue mass. Additional clinical history of prior radiology requisitions indicates myeloma and prostate cancer.IMAGE ACQUISITIONS: CT of the thoracic and lumbar spine was performed without the administration of IV contrast. On this nonenhanced CT examination, there is no gross soft tissue abnormality to suggest a mass. The paraspinal soft tissues appear normal. However, this type of examination is not optimal for detection of soft tissue masses, and if there is continued clinical concern, MRI is recommended for a better evaluation of the soft tissues.Within the thoracic spine, there are diffuse bone changes of myeloma. There is kyphosis at the level of the severe compression fracture of the T5 vertebral body. Severe compression deformity of the T12 vertebral body is also present. T11 is status post vertebroplasty. More mild compression deformities are seen at the T7, T8 and T 11 levels.Within the lung bases, there is patchy opacity with air bronchograms which could be infectious in etiology.LUMBAR SPINE

Output: 1. No definite soft tissue mass. If there is continued concern for soft tissue mass, MRI is recommended for a more sensitive evaluation.2. Extensive changes within the bony spine consistent with the history of myeloma. Numerous compression fractures throughout the thoracolumbar spine.3. Opacity within the lungs which could represent pneumonia.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to remote left parietal lobe tumor biopsy. There is an ill-defined, heterogenously enhancing lesion centered in the left parietal lobe with areas of susceptibility effect and surrounding vasogenic edema and extension towards the ependymal surface that appears to have slightly expanded, measuring 28 x 45 mm in axial cross-section, previously 25 x 44 mm. There is unchanged midline shift to the right of 3 mm. There is interval increase in size of an enhancing right cerebellar hemisphere lesion, now measuring up to 15 mm, previously 9 mm. There is a newly apparent ring-enhancing lesion in the left postcentral gyrus that measures up to 5 mm. There is no evidence of acute infarction. The skull and extracranial structures appear unchanged.

Output: 1. Slight interval expansion of the lesion centered in the left parietal lobe with extensive surrounding vasogenic edema and/or gliosis that may represent metastasis and/or radiation necrosis.2. Increase in size of a right cerebellar hemisphere metastasis.3. New subcentimeter left postcentral gyrus metastasis.


Instruction: Generate impression based on findings.

Input: Female 51 years old; Reason: Right knee pain after fall. Assess for intra-articular pathology. History: Pain, swelling and difficulty bearing weight Please note that metallic artifact from the prior ACL repair limits evaluation of the proximal tibia. MENISCI: No significant abnormality noted. The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is marked loss of cartilage along the patellar undersurface, with fissuring at the apex. A subcentimeter focal partial-thickness defect is present in the articular cartilage of the medial femoral condyle. Mild degenerative-type signal is present in the lateral tibiofemoral compartment cartilage, without fluid-filled cartilage defect.Mild depression of the posterior aspect of the lateral tibial plateau with mild underlying bone marrow edema is compatible with a compression deformity. LIGAMENTS: Post-surgical changes of an ACL graft are noted; however, the mid-portion of the reconstructed ACL is not seen, likely representing a tear. The PCL is intact. The collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings compatible with an ACL graft tear.2. Mild to moderate cartilage degeneration, most prominent at the undersurface of the patella, as above.3. Mild compression deformity of the lateral tibial plateau.


Instruction: Generate impression based on findings.

Input: Distended optic nerve sheaths are seen with mild bulging of the optic nerve heads particularly on the right compatible with papilledema. No abnormal mass within the orbits is appreciated. Evidence of left-sided intraocular lens replacement. Left maxillary mucus retention cyst and minimal mucosal thickening in the ethmoid sinuses. No convincing signal abnormality within the optic nerves themselves is appreciated. There is enhancement surrounding the optic nerve sheaths bilaterally without discrete mass.Partially imaged brain again demonstrates Ommaya catheter with tip in the lateral aspect of the lateral ventricle. CSF signal intensity collection surrounding the catheter appears similar with surrounding vasogenic edema. Moderate ventriculomegaly appears similar. T2/FLAIR hyperintensity in the periventricular white matter also appears similar. Partially empty sella is noted which can be normal variant.CERVICAL SPINE

Output: 1. MRI of the orbits demonstrates bulging of the optic nerve heads suspected to represent papilledema. There is enhancement surrounding the optic nerve sheaths bilaterally which is nonspecific and may be related to perineuritis, possibly from treatment-related change or perhaps related to known leptomeningeal disease. No edema within the optic nerves. No discrete orbital masses.2. Limited evaluation of the brain again demonstrates dilatation of the ventricular system. Although some of this is related to volume loss, mild communicating hydrocephalus is suspected.3. Diffuse abnormal leptomeningeal enhancement involving the cauda equina nerve roots and surface of the lower thoracic cord. This finding is similar to prior and compatible with history of leptomeningeal disease. No evidence of epidural tumor or masses. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer with bony metastases, status post chemo, evaluate disease a status. Signs and symptoms: Lung cancer. Nonenhanced head CT:Patient refused injection of contrast after partial externalization of contrast from the first trial.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Periventricular and subcortical low attenuation of bihemispheric white matter is suspected for mild small vessel ischemic disease of indeterminate age. No evidence of the mass on these non-infused study.Recommend either repeat CT exam with intravenous contrast or an enhanced MRI to exclude possibility of small metastatic disease.Calvarium is intact. Limited view of orbits are unremarkable.Lasted vessels limited cavities are pneumatized are unremarkable.Extensive chronic sinus disease of right maxillary sinus, minimally left maxillary sinus and minimally of bilateral ethmoid sinuses and the frontal signs.

Output: 1.No evidence of metastatic disease to the brain or the calvarium on these non-infused study.2.Minimal small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Cervical spine: Compared to 1/24/2015, there is evidence of progression of osseous metastatic disease with multiple new new lesions involving all levels in the cervical spine. Relatively largest lesion measures 1 cm involving the C3 vertebral body and not present previously. Vertebral body heights are maintained. Unchanged exaggerated cervical lordosis and minimal anterolisthesis of C4 on C5, C5 on C6 and minimal retrolisthesis of C6 on C7. Mild degenerative changes are also again seen in the cervical spine including multilevel facet arthropathy and small disc osteophyte complexes at the C5-C6 and C6-C7 levels as well as ligamentum flavum thickening. There is no significant spinal canal or neural foraminal stenosis in the cervical spine. There is no evidence of pathologic compression fractures. No evidence of epidural tumor.Thoracic spine: Sagittal post gadolinium images were not obtained and there is motion degradation on several sequences. Interval progression of osseous metastatic disease is seen with multiple new thoracic vertebral bodies demonstrating more diffuse infiltrative low T1 signal such as T3, T5, T7, T8 with intervening vertebral bodies at T4 and T6 again demonstrating abnormal marrow signal. Evidence of extension into the posterior elements again noted. No new pathologic compression fractures with maintained vertebral body heights. No thoracic cord signal abnormality or evidence of mass effect on the on the thoracic cord. There is slightly exaggerated thoracic kyphotic curvature as seen before.Lumbar spine: There is motion degradation on several sequences limiting evaluation for subtle abnormalities. Interval progression of osseous metastatic disease is seen with multiple new lumbar vertebral bodies demonstrating infiltrative low T1 marrow signal such as L2, L4, L5, S1, and S3. Alignment is maintained. No pathologic compression fractures. There is epidural tumor extending from T12 to L2 which has progressed in the interval. There is near circumferential epidural tumor at the L1 level measuring approximately 6 mm in thickness ventrally with mild spinal canal stenosis at this level. Conus tip is at the lower L1 level. Tumor infiltration and expansile appearance of the pedicle also results in moderate right-sided neural foraminal stenosis at the right L1-L2 level. Mild progression of paraspinous soft tissue tumor extension also noted at the right L1 level. No significant spinal canal stenosis more inferiorly. There are mild multilevel degenerative changes without high-grade spinal canal or neural foraminal stenosis at any level. Multiple new metastatic lesions throughout the visualized pelvis also noted.

Output: 1. Compared to 1/24/2015, there is evidence of progression of diffuse osseous metastatic disease with multiple new lesions involving the cervical, thoracic, and lumbar spine and visualized pelvis. 2. No evidence of pathologic compression fractures. No evidence of cord or cauda equina compression. There is interval increase in epidural tumor from the T12-L2 levels with now mild spinal canal stenosis (at the level of the conus) related to near circumferential epidural tumor at the L1 level. L1-L2 neural foraminal narrowing related to epidural tumor also appears slightly worse.3. Please note sagittal post gadolinium images of the thoracic spine were not obtained which may detect small epidural tumor in the thoracic spine. Patient may return for this sequence at no charge if clinically indicated. This would however be likely not associated with high grade spinal canal stenosis in the thoracic spine based on the other available thoracic sequences.


Instruction: Generate impression based on findings.

Input: 15-year-old female with right knee pain after basketball injury. MENISCI: There is blunting of the posterior lateral meniscus, indicative of a small tear. The medial meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: There is loss of the articular cartilage along the posterior lateral femoral condyle, as well as an underlying bone contusion of the lateral femoral condyle. A second bony contusion is present in the lateral aspect of the patella.LIGAMENTS: The medial and lateral collateral ligament complexes are intact and within normal limits. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Tear of the posterior lateral meniscus with mild blunting.2.Loss of cartilage along the posterior lateral femoral condyle adjacent to the meniscal tear.3.Bony contusions of the posterior lateral femoral condyle and the lateral aspect of the patella.


Instruction: Generate impression based on findings.

Input: Concussion followed by vomiting and suggestion of complex partial seizure. There is artifact related to the left external ear or retroauricular region that is most pronounced on diffusion and susceptibility-weighted imaging. Accounting for that, there is no evidence of intracranial hemorrhage, mass, or acute infarct. Myelination is appropriate for age. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain, abnormal LFTs, cholestasis, concern for choledocholithiasis ABDOMEN:LIVER, BILIARY TRACT: Areas of alternating stricture and dilatation involving intrahepatic biliary system similar in configuration to prior study and extent. Again seen more focal stricturing near confluence of right and left hepatic ducts. Degree of ductal dilatation in periphery of liver mildly increased. For example, hypointense subcentimeter focus seen in hepatic segment 2/3 on image 46 series 1002 likely portion of dilated intrahepatic bile duct, measures 6 mm. Common bile duct normal in size, configuration similar to earlier study. No intraluminal signal void seen to suggest choledocholithiasis. No suspicious liver lesion delineated.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Areas of alternating stricture and dilatation involving intrahepatic biliary system similar in configuration to prior study and extent. Again seen more focal stricturing near confluence of right and left hepatic ducts. Degree of ductal dilatation in periphery of liver mildly increased. Findings compatible with primary sclerosing cholangitis.


Instruction: Generate impression based on findings.

Input: 54-year-old male with bilateral knee pain. MENISCI:Left Knee: Linear increased signal is noted in the posterior horn of the left medial meniscus, extending to the articular surface. Findings are compatible with a radial tear but there is also a vertical component (series 601, image 21). The anterior horn of the left medial meniscus and both horns of the left lateral meniscus are unremarkable.Right Knee: Subtle increased signal in the posterior horn of the right medial meniscus, suggestive of a partial undersurface tear. The anterior horn of the right medial meniscus is unremarkable. Myxoid degeneration is noted in the anterior horn of the right lateral meniscus, which is otherwise unremarkable.ARTICULAR CARTILAGE AND BONE: Left Knee: No significant abnormality noted.Right Knee: Lobulated, T2-hyperintense lesion in the distal femoral metaphysis is compatible with a benign enchondroma. No significant bone marrow edema. Normal tricompartmental articular cartilage.LIGAMENTS: No significant abnormality noted in either knee. EXTENSOR MECHANISM: No significant abnormality noted in either knee.ADDITIONAL

Output: 1.Radial tear with vertical component in the posterior horn of the left medial meniscus.2.Findings suggestive of a partial undersurface tear in the posterior horn of the right medial meniscus.


Instruction: Generate impression based on findings.

Input: Female, 12 years old, with headache, weakness and pain in the extremities. History of MVA. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The brainstem and cerebellum are unremarkable with no evidence of tonsillar herniation.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation of the brain with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 75-year-old female patient with worsening right low back pain in past 3-4 months. Severe degenerative disc disease is noted throughout the lumbar spine with vacuum disc phenomenon at T12/L1, L1/L2, L4/L5, and L5/S1. There is a dextrorotoscoliosis and a slight anterolisthesis of L5 on S1. There is heavy atherosclerotic calcification of the abdominal aorta and its branches.

Output: Severe degenerative disc disease of the lumbar spine.


Instruction: Generate impression based on findings.

Input: Reason: Research study History: new prostate cancerSlawomir Urgacz is a 64Yrs man who has had his PSA followed for several years which was reportedly 4-5 range for some time. 10/2015 it rose to 9.1. It was repeated 3/2016 and found to have decreased yet still elevated to 6.1. This prompted a PNBx on 5/2016 which demonstrated Gleason 3+4 with 2 cores positive, details below. He is reportedly T1c.3+4: L apex (5%)3+3: L mid lat (25%) PELVIS:PROSTATE:Prostate Size: 5.2 x 3.1 x 4.7 cmPeripheral Zone: No suspicious lesions are evident.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: No significant abnormality noted.

Output: No suspicious lesions are evident. No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: There is a 1.1 x 0.9 cm ill-defined rounded non-enhancing lesion of T2 hyperintensity along the left cerebellar folia that has decreased in size and prominence. There is persistent but minimal mass effect along the gray white matter junction. There are additional nonspecific foci of subcortical T2 hyperintensity in the bilateral paramedian parietal regions at the convexity.There are findings related to an acute - early subacute large parenchymal hematoma within the left occipital lobe with surrounding vasogenic edema that results in unchanged mass effect on the local sulci, the left atrium and left occipital horn, as well as a 3-mm rightward midline shift. The size of the hematoma is unchanged, measuring 4.5 x 2.9 cm. There is no intraventricular hemorrhage and the ventricles are unchanged in size. There is thin enhancement along the left tentorium that likely represents reactive dural thickening, possibly due to trace subdural blood products seen in this area previously. There is essentially unchanged FLAIR signal hyperintensity throughout multiple frontal and parietal sulci bilaterally, right greater than left with minimal associated susceptibility effect, corresponding to areas of sulcal hyperattenuation on CT. There are unchanged additional scattered areas of sulcal FLAIR hyperintensity elsewhere without susceptibility effect which may relate to artifactual signal from sedation/oxygenation.There is no evidence of acute infarct. The major cerebral flow voids are intact. There is a moderate-sized air-fluid level within the right maxillary sinus. There is mucosal thickening within the sphenoid sinuses.

Output: 1.A rounded area of abnormal signal in the left cerebellum with mild mass effect appears smaller and less prominent on today's exam and does not enhance. The differential diagnosis primarily includes infectious/inflammatory etiologies such as a focal cerebellitis, demyelinating disease, and less likely ischemic etiologies. 2.Left occipital acute parenchymal hematoma is unchanged in size with unchanged mass effect and minimal midline shift.3.Mild grossly unchanged subarachnoid hemorrhage over the bilateral frontal and parietal lobes.4.Unchanged nonspecific subcortical FLAIR hyperintensity in the bilateral paramedian parietal lobes may represent additional subarachnoid hemorrhage or sedation artifact.5.Moderate sized air-fluid level within the right maxillary sinus. Please correlate clinically for acute sinusitis.


Instruction: Generate impression based on findings.

Input: New back pain. Thoracic spine: At the T7 and T8 vertebral bodies, there are changes of previous augmented vertebroplasty, where central vertebral body height loss remain not significantly changed nor the minimal T8 retropulsion. The compression fracture along the anterior inferior endplate of T6 is unchanged but there are anterior and central compression fractures at T9, T11 and T12, which are new since October 2015 though without associated marrow edema. There is unchanged focal fat in the left T5 lamina. There is mildly exaggerated kyphosis from the multilevel compression fractures. Multilevel disc desiccation is present. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The distal arch/proximal descending aorta is prominent and there is a small left pleural effusion. The paravertebral soft tissues are unremarkable.Lumbar spine: New central compression fractures involve all the lumbar vertebral bodies, which is most pronounced at L2 with up to 50% height loss in addition to fluid subjacent to the superior endplate and adjacent marrow edema, as well as linear hypointense signal in the posterior aspect of the vertebral body. Mild marrow edema is present superiorly at L1, L3 and L4. Sagittal alignment remains anatomic. There is no retropulsion or osseous expansion. Multilevel degenerative disc disease is not significantly changed and results in shallow ventral indentations of the thecal sac but no significant spinal canal stenosis. Facet arthropathy contributes to mild bilateral neural foraminal stenoses in the mid/lower lumbar spine, most pronounced on the left at L3-L4 and on the right at L4-L5 levels, where it is moderate. The conus medullaris displays normal signal and morphology with its tip lying at upper L2 level. The paraspinal muscles are atrophic. The paravertebral soft tissues are unremarkable otherwise.

Output: 1.Thoracic spine: New insufficiency compression fractures are present at T9, T11 and T12 without marrow edema, marrow replacement or retropulsion. T6-T8 compression fractures are unchanged since October 2015 except for changes of augmented vertebroplasty at T7 and T8. No thoracic spinal canal stenosis or cord abnormality. Incidental small left pleural effusion.2.Lumbar spine: New, since October 2015, insufficiency compression fractures at L1-L5, most pronounced at L2, where there is also fluid subjacent to the superior endplate, which may reflect unstable endplate fragment. There is mild marrow edema at the other levels but no retropulsion or osseous expansion. Multilevel degenerative disease has not changed, causing neural foraminal stenoses most on the left at L3-4 and on the right at L4-L5, but no significant spinal canal stenosis. Unremarkable conus medullaris.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [340], Reason for Study: ^Reason: please do dr javed MS protocol and compare to prior History: progression MS There are multifocal scattered various sized high signal intensity lesions on FLAIR images including right precentral gyrus, corpus callosum body, left trigone area, left internal capsule posterior limb, and right temporo-occipital white matter.There is one lesion on the right middle frontal gyrus which is a new lesion comparing to prior scan. There is no evidence of contrast enhancement on any of lesions seen on FLAIR images.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Grossly unchanged the size and number of white matter high signal intensity lesions on FLAIR images as described above except one new lesion at the right middle frontal gyrus.2. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [225.2], Reason for Study: ^Reason: eval post-op tumor resection History: eval for residual tumor There is evidence of right frontal parietal craniotomy indicating postoperative status including overlying scalp swelling, minimal localized fluid collections and air.Previously seen right frontoparietal extra-axial (overlying on the central sulcus) has been removed with blood products on surgical bed. There is no evidence of enhancing lesion on the meninges, nor overlying skull especially inner table.Although due to subacute surgical bed blood products, minimally enhancing lesion which can suggest residual tumor cannot be excluded, there is no definitive evidence of residual tumor on the scan.Extensive parenchymal edema on the area of surgery is still seen.Minimal deformity of the right lateral ventricle due to mass effect is still seen, no change since prior scan. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Postoperative changes of right frontoparietal extra-axial mass with overlying skull inner table involvement including local surgical bed blood products, no MR evidence of residual tumor on neither meninges no overlying skull inner table.2. No change of local brain edema with mild effacement of right lateral ventricle.3. No evidence of acute ischemic lesion.


Instruction: Generate impression based on findings.

Input: Tremors, hypertension, delay. Patient with history of ependymoma. Brain: Compared to CT head dated 4/19/2016, there has been increase in size of the lateral and third ventricles and increase in periventricular FLAIR hyperintensity compatible with transependymal flow related to obstructive hydrocephalus. A left frontal approach ventriculostomy catheter terminates at the foramen of Monro, unchanged. Additional prior bilateral catheter tracts are noted with chronic blood products.Again seen are postsurgical changes of right occipital craniotomy related to partial tumor resection. The right occipital approach catheter traversing the right CP angle cystic lesion is unchanged in position. The cystic component at the right cerebellopontine angle is unchanged in its posterior aspect measuring 16 x 13 mm in the axial plane, although there is some decrease in the more anterior cystic component lateral to the pons in the region of the catheter tip when compared to 3/18/2016. There is mild increase in however cystic expansion along the posterior and left lateral aspect of the mass which continues as an expanded foramen of Luschka. The overall enhancing posterior fossa mass does not demonstrate significant change in size measuring approximately 45 x 50 mm, in the axial plane mass and approximately 40 mm in the craniocaudal dimension. Extension into the right upper aspect of the cervical spine is again seen to the C1-C2 level. Slight differences in enhancement are favored to be related to technique. Extensive FLAIR hyperintensity in the posterior fossa is also not significantly changed. Mass effect on the cerebellum and brainstem with leftward deviation is not significantly changed. Foci of susceptibility are again seen related to calcification within the tumor as seen on recent CT. Unchanged small pineal cyst. Diffuse paranasal sinus opacification and bilateral mastoid air cell opacification is increased since 4/19/2016.Spine: There is expansile T1 hypointensity and T2 hyperintensity involving most of the cervical cord which appears contiguous with the central canal, extending inferiorly to the C7 level, which is new since prior spine MRI from 9/9/2015. Signal abnormality measures up to 7 x 10 mm in the axial plane at the C4 level. More recent dedicated spine imaging is not available, although there is some suggestion of abnormal signal in the partially imaged upper cervical cord on recent brain MRI studies.No abnormal medullary or leptomeningeal enhancement is appreciated to suggest drop metastases in the spine. Visualized osseous structures in the spine are unremarkable.There is fibrofatty infiltration of the filum terminale measuring less than 2 mm. Conus terminates normally at the upper L2 level.

Output: 1. Interval increase in size of the ventricular system consistent with development of hydrocephalus. There is associated evidence of transependymal CSF flow. Left frontal ventriculostomy catheter appears unchanged in position.2. Overall size of the posterior fossa ependymoma is not significantly changed. Compared to prior studies dating back to 3/18/2016, there is slight decrease in size of the of the cystic component involving the anterior aspect of the cerebellopontine angle cistern. There is mild increase in cystic/fourth ventricular expansion dorsal and along the left lateral aspect of the mass, which is contiguous with the left foramen of Luschka.3. No evidence of drop metastasis in the spine. 4. Abnormal expansile T2 signal is seen throughout the central cervical cord, which is contiguous with the central canal and extends to the C7 level, likely representing a syrinx. This finding is new since prior complete spine MRI from 9/9/2015. More recent dedicated spine imaging is not available, although there is some suggestion of abnormal signal involving at least the partially imaged upper cervical cord on recent brain MRI studies.5. Fibrofatty infiltration of the filum terminale. Conus terminates normally at the upper L2 level without clear imaging evidence of cord tethering.Dr. Ali discussed findings of hydrocephalus with Dr. Retondo-Rudkinsky at 1600 hrs on 5/6/2016.


Instruction: Generate impression based on findings.

Input: Mild motion abnormality and limits evaluation.Brain: The hippocampi are symmetric in size with normal signal characteristics and preserved internal architecture. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Pituitary: The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. There is an apparent area of hypoenhancement in the left aspect of the pituitary which is favored to represent artifact due to volume averaging. No definite evidence of pituitary micro or macroadenoma. The cavernous sinuses are intact bilaterally.

Output: 1. Apparent area of hypoenhancement in the left aspect of the pituitary which is favored to represent artifact due to volume averaging. No definite evidence of pituitary micro or macroadenoma. 2. Otherwise unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: 61-year-old African-American female with PVD, clots, no not withdrawing to pain left upper extremity. Signs and symptoms: Left upper extremity weakness. Nonenhanced brain MRI:There is no evidence of an acute intracranial process and in particular no evidence of acute ischemic stroke detected.There are patchy foci of flair hyperintensity in the subcortical and minimally ventricular white matter of cerebral hemispheres which are nonspecific however in proper clinical setting could represent mild chronic small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.The signal void of major intracranial arterial branches are identified.Calvarium is intact. There is a focus of subgaleal hemorrhage and in right posterior temporal region measuring maximum of 1.8-mm in thickness. Unremarkable images through the orbits, paranasal sinuses. Extensive opacification of bilateral mastoid air cells.

Output: 1.No acute ischemic stroke.2.Findings suggestive of mild age indeterminate small vessel ischemic disease.3.Tiny focus of subgaleal hemorrhage in the left posterior temporal.4.Extensive bilateral mastoid air cell opacification.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with headaches, and cough syncope, progressing. Most sequences are at least moderately degraded by motion artifact. Within these limitations, the following observations are made.No definite parenchymal signal abnormality, edema or mass effect is detected. No large areas of abnormal parenchymal or extra-axial enhancement are observed.No significant intracranial hemorrhage or abnormal extra-axial fluid is suspected. The ventricular system is normal in size and morphology.

Output: Image quality is degraded by motion artifact. Within this limitation, no definite intracranial findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Brain MRI: A region of restricted diffusion is noted in the left MCA distribution within the left angular gyrus, left dorsal insular cortex and left superior temporal gyrus and measures 5.0 x 5.1 cm. The region demonstrates susceptibility abnormalities indicating petechial hemorrhages. Mild mass effect is noted but no midline shift or herniation. Additional mild scattered periventricular and subcortical white matter hypointensities likely represent chronic small vessel ischemic disease.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Small right maxillary mucous retention cyst. The paranasal sinuses and mastoid air cells are clear. Brain MRA:The M1 segment of the left MCA is patent. However, within the M2 segment of the left MCA and beyond is moderate to severe stenosis of multiple branches which most likely includes branches leading to the infarcted region. An acute occlusion of these vessels is highly suspected. There is also mild atherosclerotic involvement of the right middle cerebral and bilateral anterior cerebral arteries but no significant flow-limiting stenosis. The intracranial portions of the internal carotid arteries are patent without significant steno-occlusive disease. The focal loss of signal in the petrous internal carotid arteries is artifactual. There is antegrade flow within the vertebrobasilar system. There is a normal variant hypoplastic P1 segment of the right PCA. No steno-occlusive disease, dissection or aneurysm.

Output: 1.Acute MCA distribution infarct involving the left parieto-temporal region with a component of petechial hemorrhage. There is mild mass effect but no midline shift or herniation.2.Moderate to severe stenosis of many M2 segment branches of the left MCA which most likely includes branches leading to the infarcted region. An acute occlusion of these vessels is highly suspected. 3.Mild chronic small vessel ischemic changes as well as mild atherosclerotic disease elsewhere intracranially as described above.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There are patchy areas of T2 FLAIR hyperintensities in the subcortical and the periventricular white matter and in the pons, which are nonspecific, but most consistent with chronic small vessel ischemic changes. There is a small chronic infarct involving the left precentral gyrus that was seen in the previous study of 5/12/2015. Ventricular size is normal. No midline shift. The basal cisterns are patent. No evidence for acute intracranial hemorrhage, mass effect, or edema.Incidentally noted small lipoma in the left periorbital scalp.MRI C-SPINE: Examination is moderately motion degraded. There is a minimal retrolisthesis/dorsal angulation at the C5-C6 level. There is significant loss of disc height at the C5-C6 level with endplate fatty marrow signal changes. Motion limits evaluation for cord signal abnormality, however no definite cord signal abnormality is appreciated.C2-C3: No evidence of spinal canal or foraminal compromise.C3-C4: No evidence of spinal canal or neural foraminal compromise.C4-C5: No spinal or neural foraminal compromise. C5-C6: There is disc osteophyte complex with effacement of the ventral thecal sac. There is uncovertebral hypertrophy with associated mild to moderate bilateral neural foraminal narrowing.C6-C7: There is no spinal or neural foraminal compromise.The visualized portion of the thoracic spine demonstrates disc bulge of the disc space T3-T4.C7-T1: There is no spinal canal foraminal compromise.MRA BRAIN:There study is motion degraded.There is a hypoplastic left A1 segment with fetal origin of the left PCA and nonvisualization of the left P1 segment. There is mild atherosclerotic narrowing involving the left cavernous and supraclinoid internal carotid arteries without evidence of high-grade stenosis in the anterior or posterior circulations. Patent bilateral posterior communicating arteries. The right vertebral artery is small beyond the PICA origin.

Output: 1. Brain MRI demonstrates no evidence of acute infarct, mass effect, or edema. Mild chronic small vessel ischemic changes and small left precentral gyrus infarct again seen.2. Evaluation of the cervical spine again demonstrates degenerative changes at the C5-C6 level with mild to moderate degree of spinal canal stenosis. Cord signal abnormality is not well evaluated given the motion degradation; however no definite cord signal abnormality is appreciated. There is mild to moderate bilateral neural foraminal stenosis at this level.3. MRA is slightly motion degraded. There is mild atherosclerotic narrowing of the left cavernous and supraclinoid internal carotid arteries. No high-grade stenosis in the intracranial anterior or posterior circulation.


Instruction: Generate impression based on findings.

Input: Shoulder pain. Evaluate for rotator cuff tear or biceps tear. ROTATOR CUFF: There is increased signal intensity replacing the distal infraspinatus tendon at its insertion on the greater tuberosity suggesting full thickness tear. The abnormal signal intensity appears to extend through the entire thickness of the tendon and involves the majority of the tendon in the AP dimension indicating a near complete or complete tear. There also appears to be delamination of the undersurface fibers that are retracted by approximately 1 cm. There is mild edema in the underlying greater tuberosity. There is mild fatty atrophy along the myotendinous junction of the infraspinatus. The aforementioned tearing appears to extend into the posterior fibers of the supraspinatus with additional interstitial tearing involving the distal 1.5 cm of the supraspinatus. The supraspinatus muscle appears intact. Teres muscle and tendon muscle are intact. The subscapularis muscle and tendon are intact. SUPRASPINATUS OUTLET: There is mild to moderate osteoarthritis at the acromioclavicular joint. We see no frank fluid in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. The glenoid labrum appears normal given the limitations of a non-arthrogram study. There is no joint effusion. BICEPS TENDON: The tendon of the long head of the biceps appears normal given the limitations of a non-arthrogram study.

Output: 1.Full thickness insertional tear of the infraspinatus with mild retraction and extension into the supraspinatus as above. 2.Acromioclavicular joint osteoarthritis3.Normal-appearing biceps tendon without tear.


Instruction: Generate impression based on findings.

Input: Ms.Tara Schlitz, 32 years old, submitted outside study for review. She initially presented to outside facility for a palpable concern in the left breast.Images performed at Advocate Christ Medical Center submitted for review: Diagnostic ultrasound of both breasts 12/8/2015Ultrasound-guided biopsy of left breast 12/17/2015Postprocedure mammogram 2/17/2015MRI breast 12/24/2015Images submitted for comparison:None Mammogram 12/8/2015: As per other side report, bilateral diagnostic mammogram was performed but not submitted for review at the time of this dictation.Both Breast Ultrasound 12/8/2015 : Static ultrasound images are submitted for interpretation.Left breast:In the left breast, 1:00 position, 6 cm from the nipple, at the site labeled as palpable area, there is a 1.9 x 1.3 x 1 cm hypoechoic, oval mass with internal and peripheral flow. In addition, 2 normal-appearing lymph nodes are noted in the left axilla.Right breast:Normal breast tissue is noted on the images labeled as right breast 12:00, 3:00, 6:00, 9:00 and 12:00 retroareolar region. No suspicious lymph node is noted on the image labeled as right breast axilla.Ultrasound-Guided Biopsy Of The Left Breast Breast 12/17/2015: Previously identified mass in the left breast 1:00 position was the target for the biopsy. Targeting appeared appropriate.Left Unilateral Post Procedure Mammogram (10/19/2015): An approximately 11 mm mass is noted in the left upper outer breast, far posterior depth, in close proximity of the pectoralis muscle. A biopsy marking clip is seen approximately 3 mm slightly medial and inferior to the mass.MRI BREAST 12/24/2015:Multisequence and multiplanar MRI of both breasts with and without IV contrast were performed as outside MRI protocol.The breasts are composed of extreme breast tissue. There is minimal background parenchymal enhancement bilaterally. In the left breast, 1:00 position, 6 cm from the nipple, there is an enhancing mass measuring 17 x 14 x 16 mm (AP X LR X SI). A susceptibility artifact from the biopsy clip is noted in the medial and inferior aspect of this enhancing mass. This is compatible with the known history of biopsy-proven malignancy. The lesion abuts the pectoralis muscle without abnormal enhancement of the pectoralis muscle. Postbiopsy changes are noted in vicinity of this biopsy-proven cancer. No additional suspicious enhancement is noted in either breast. Visualized axillary lymph nodes are unremarkable.Per Outside Pathology:A. Left breast breast lesion, 1:00 position; ultrasound guided core needle biopsy:- Invasive ductal carcinoma, grade 3

Output: 1. Biopsy-proven 17 mm unifocal cancer in the posterior left breast without chest wall involvement.2. No abnormal finding in the right breast.3. Unremarkable axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Altered mental status. Nonenhanced head CT:There is no detectable intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white differentiation remains within normal.Calvarium is intact. Paranasal sinuses and mastoid air cells are unremarkable. Limited views of the orbits demonstrate thickening of the extraocular musculature on the left and crowding of the retro-orbital space. There is also suspected increased density of the retro-orbital fat. Correlate weighted physical exam. Recommend enhanced MRI or dedicated CT of orbit with enhancement.

Output: 1.No evidence of intracranial abnormality.2.Apparent thickening of the extraocular musculature on the left side with crowding of the retro-orbital space and poor visualization of retro-orbital fat. Recommend dedicated MRI or CT of orbits.


Instruction: Generate impression based on findings.

Input: 54 years Female (DOB: 8/20/1961)Reason: encephalopathy, hx of cutaneous abscess History: as abovePROVIDER NAME: AGNIESZKA ANNA ARDELT AGNIESZKA ANNA ARDELT MRI brain: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 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 mucosal thickening throughout the paranasal sinuses are status post nasal intubation. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment. There is mild superior endplate compression present at T10. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal lesions are identified in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level. There is mild to moderate facet hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level. There is mild facet ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.There are mild degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or exiting nerve roots.3.There is no compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 47-year-old female with breast cancer. Evaluate for metastases. MRI Cord compression assessment:With the benefit of full spine imaging, we identified 11 rib-bearing vertebral bodies which may change some vertebral body levels relative to prior exams. There is diffuse marrow replacement of many of the vertebral bodies within the spine, particularly involving the T6, L1, L3, L4 and L5 vertebral bodies, compatible with osseous metastases. There is evidence of kyphoplasty material at L1, L4 and L5. A compression deformity is again seen at L4 with some retropulsion of the fracture fragments as well as extensive epidural involvement of tumor which is unchanged compared to the recent previous CT. This causes severe compression on the thecal sac at this level. However there is no compromise to the spinal cord which terminates at the L1 level. The epidural spread of tumor posterior to the L1, L4 and L5 levels are described in detail on the dedicated MRI lumbar spine detail below. There is no definite evidence of intradural or leptomeningeal disease. Also noted on the sagittal imaging is a soft tissue mass involving the sternum compatible with metastatic disease as well as questionable soft tissue prominence around the great vessels in the mediastinum.MRI Lumbar Spine: Redemonstrated are areas diffuse bone marrow replacement, especially involving the L1, L3, L4, and L5 vertebral bodies consistent with metastatic disease. There is also involvement of the posterior elements at these levels. Some of the signal abnormality in the L1, L3, and L5 vertebral bodies is secondary to kyphoplasty material better seen on the recent lumbar spine CT. There is up to 70% height loss involving the L4 vertebral body consistent with pathologic fracture. There is minimal height loss involving the L5 vertebral body. Minimal osseous retropulsion is evident at the L1, L4, and L5 levels.L1-L2: There is diffuse marrow replacement and pathologic enhancement of the L1 vertebral body indicating metastatic disease but the vertebral body height is preserved. There is a mild degree of epidural extension which mildly effaces the ventral thecal sac but there is no significant central canal or neural foraminal stenosis.L2-3: There is no significant compromise to the neuroforamina or central canal.L3-4: There is almost complete involvement of the L3 vertebral body with tumor although the vertebral body height is within normal limits. There is evidence of epidural spread especially involving the right lateral recess and the right neural foramen with likely compromise of the neural foramen. There is moderate central spinal canal stenosis. The left neural foramen is not significantly narrowed. There is tumor extension into the right posterior spinal musculature at the L3-4 level.L4-5: There is complete marrow replacement of L4 indicating metastatic disease as well as severe compression deformity as described in the recent lumbar CT and which is unchanged. There is extensive paraspinal and epidural tumor which is circumferential within the spinal canal around the thecal sac. This causes severe spinal canal stenosis with impingement of the cauda equina and probable infiltration of the neural foramina to some degree. Also contributing at this level to the neural foraminal stenosis is facet degeneration. Anterior to the L4 vertebral body are several pathologic aortocaval lymph nodes. L5-S1: Diffuse involvement of the L5 vertebral body with tumor is seen as well as evidence of kyphoplasty. There is facet arthropathy which predominantly is the cause of neural foraminal narrowing bilaterally although a small amount of tumor could also be involved. There is no significant central spinal canal compromise at this level.There is significant marrow replacement involving the visualized bilateral iliac bones indicating evidence of tumor with increased extraosseous extension anteriorly along the left iliac wing invading the adjacent subcutaneous tissue, intra-abdominal space, and probably the left psoas muscle to some degree.MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.With the benefit of full spine imaging, we identified 11 rib-bearing vertebral bodies which may change vertebral body numbering relative to the previous exam. 2.Findings compatible with widespread osseous metastatic disease especially involving the vertebral bodies of T6, L1, L3, 4, and L5. 3.Epidural spread of tumor especially involves the L4 level where there is circumferential involvement of the spinal canal and which causes severe spinal canal stenosis at this level. Anterior epidural spread of disease mildly narrows the L1 central canal level and moderately narrows the L5 central canal.4.Metastatic lesions involve the sternum and sacroiliac region, specifically the left iliac wing where there extraosseous extension anteriorly which invades the adjacent subcutaneous tissue, intra-abdominal space, and probably the left psoas muscle to some degree.5.Unchanged compression fracture of the L4 vertebral body.6.No evidence of intracranial disease.


Instruction: Generate impression based on findings.

Input: Reason: assess for pathologic History: hearing loss. Left-sided sensorineural hearing loss. 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. A cavum septum pellucidum and vergae are noted. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.The internal auditory canals appear normal without evidence of mass. The facial, cochlear and vestibular nerves are identified bilaterally and appear within normal limits. The apical and middle turns of the cochlea are not well differentiated as seen on CT of the same day. The vestibule and semicircular canals are symmetric bilaterally. vestibular aqueducts are better evaluated on CT of the same day. No fluid is evident within the mastoid air cells.

Output: 1.Normal-appearing facial, cochlear and vestibular nerves.2.Apical and middle turns of the cochlea are not well differentiated and mildly dysplastic bilaterally. For further details, please see temporal bone CT performed on the same day.


Instruction: Generate impression based on findings.

Input: Hereditary hemorrhagic telangiectasia [I78.0] / Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: 3T scanner, please evaluate for AVMs, HHT, and evaluate known aneurysm (please compare to outside images uploaded to PACS) Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. There is a retention cyst on the right maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate left Pcom origin infundibulum which demonstrated patent left Pcom artery and smooth luminal bulge at the right Pcom area. The bulge at the right Pcom area is measured about 0.8mm x 2.6mm which most likely represent right Pcom infundibulum. Comparing to prior scan performed at outside hospital, there is no significant interval change.Otherwise bilateral ICAs, MCAs and ACAs appear to be normal. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of abnormal enhancement. No acute ischemic or hemorrhagic lesion.2. Right Pcom area luminal bulging most likely represent infundibulum, the left pcom origin infundibulum. No change since prior scan.3. No evidence of intracranial arterial aneurysm. No evidence of unusual vascularity or evidence of arteriovenous shunt.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of ESRD, diabetes, hypertension left meningioma status post resection in 2005. New mental status changes Postoperative changes of left frontal -- parietal craniotomy for removal of meningioma is again demonstrated. Residual vasogenic edema/encephalomalacia remains stable since prior study.No evidence of any new area of hemorrhage or edema is detected. No evidence of hydrocephalus.Further evaluation with an MRI is recommended to determine recurrence or residual tumor.

Output: Stable exam since prior study.


Instruction: Generate impression based on findings.

Input: History of renal cancer. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology and size without a focal suspicious lesion. Stable punctate benign hepatic cysts. Cholelithiasis within a normally distended gallbladder. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Mild fatty atrophy without a focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of tumor recurrence in the nephrectomy bed. No local regional lymphadenopathy. The right adrenal gland is unremarkable.Postsurgical changes from a left partial nephrectomy of the lateral interpolar region. No evidence of recurrence in the surgical bed. Stable small left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Susceptibility artifact from lymph node dissection in the retroperitoneum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes from right nephrectomy and partial left nephrectomy without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for disc disease, osteoarthritis, spinal stenosis. Signs and symptoms: Low back pain, left-sided sciatica and paresthesia. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column. T12-L1 is unremarkable.L1-L2 and L2-L3 demonstrate mild hypertrophic changes of the ligamentum flavum and minimal facet disease and unremarkable otherwise.L3-L4 demonstrate moderate bilateral ligamentum flavum hypertrophy, mild facet and disc disease however without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate moderate bilateral ligamentum flavum hypertrophy and mild facet disease which includes mild left facet effusion. No spinal stenosis or neural foraminal compromise.L5-S1 demonstrate mild degenerative disc disease and loss of disc height, a left lateral and far lateral broad-based disc protrusion resulting in significant left neural foraminal compromise and no central spinal stenosis. Right neural foramen remains patent.Limited view appears spinal soft tissues are unremarkable.

Output: 1.L5-S1 demonstrate a left lateral and far lateral broad-based disc protrusion resulting in significant left neural foraminal compromise.2.Mild degenerative changes at other levels as detailed.3.No spinal stenosis or neural foraminal compromise at other levels.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the knee.