Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified congenital anomaly of spinal cordClinical question: eval for possible lumbar infectionSigns and Symptoms: incision drainage Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height.There thecal sac and spinal canal are large. There is a syrinx in the distal spinal cord. It previously measured 1.5x3.5 mm axial dimensions. This is enlarged since the prior exam. It now measures 3x5mm axial dimensions. The spinal cord is tethered and adheres to the posterior aspect of the spinal canal. There is a fluid collection with fluid-fluid levels redemonstrated in the perivertebral space surrounding spinous processes at the L3,L4 and L5 vertebral levels. It has ring enhancement with a thicker wall on the current exam. It previously measured 118x33 mm sagittal dimensions and now measures 71x18 mm sagittal dimensions. There is associated patchy enhancement in the adjacent musculature which was also previously present and some loculations. It is contiguous with the thecal sac at the laminectomy sites at the L5 level. There is some associated enhancement of the distal tethered cord and adjacent thecal sac which was also previously present.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Since the prior exam the syrinx has enlarged.2.Since the prior exam the posterior perivertebral fluid collection has decreased in size and appears more organized. The possibility of infection cannot be excluded.3.Tethered cord with cord ending in the sacrum status post surgery.


Instruction: Generate impression based on findings.

Input: 48-year-old female with family history of breast cancer, positive BRAC1 mutation presents for high-risk screening. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. Biopsy clip artifact is again noted in the right posterior central breast.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Female 70 years old Reason: smoldering myeloma History: lesions on xray, evaluate for lytic bone disease Right humerus: Somewhat mottled appearance of the bone marrow, but no discrete lesions to suggest myelomatous deposits.Left humerus: There are 2 small foci of T1 hypointense signal in the proximal/mid diaphysis, suspicious for myelomatous deposits (images 12 and 13, series 4). There is corresponding T2 heterogeneous bone marrow signal. Fluid is noted in the subdeltoid bursa.

Output: Lesions in the left humerus suspicious for myelomatous deposits. No discrete lesions in the right humerus.


Instruction: Generate impression based on findings.

Input: History of sarcoidosis and cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Dysmorphic liver morphology is unchanged. No focal suspicious lesion or biliary ductal dilatation.The hepatic artery and portal vein appear patent. The hepatic veins are not visualized, unchanged.Normally distended gallbladder. There may be a small gallstone near the gallbladder neck (series 7/33).SPLEEN: The spleen measures 12.4 cm in length, with several punctate lesions best seen on portal venous phase, may correspond to patient's known sarcoidosis. Perisplenic collateral vessel formation. The splenic vein is patent.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged dysmorphic hepatic morphology without a suspicious lesion. Nonvisualization of the hepatic veins, unchanged.2.Splenomegaly and punctate splenic lesions, may correspond to patient's known sarcoidosis.


Instruction: Generate impression based on findings.

Input: Status post Chiari decompression with increasing leg pain/stiffness. Brain: There are postoperative findings related Chiari decompression with improved configuration of inferior cerebellum and CSF flow across the neo-foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the region of the cerebellar tonsil with punctate susceptibility effect, which may be attributable to tonsillectomy. The brain parenchyma otherwise 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. There is mucosal thickening in the maxillary sinuses.Spine: The spinal cord now displays normal signal and morphology, without syringomyelia. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related Chiari decompression with improved configuration of inferior cerebellum and CSF flow across the neo-foramen magnum. 2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Neck pain with headaches Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is reversal of cervical lordosis with apex at C4-C5. There is minimal anterolisthesis of C3 on C4 and minimal retrolisthesis of C4 on C5, C5 on C6, and C6 on C7. Bone marrow signal is within normal limits. There is mild generalized facet arthropathy.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Small central disc protrusion. No significant compromise to the spinal canal or neural foramina.C3-4: Mild narrowing of the spinal canal which is predominantly developmental. Minimal narrowing of the left neural foramen related to uncovertebral hypertrophy and mild facet arthropathy. Neural foramina are otherwise patent.C4-5: Moderate to severe disc height loss with disc osteophyte complex and mild ligamentum flavum thickening contributing to mild to moderate spinal canal stenosis. There is mild narrowing of the neural foramina, left relatively greater than right.C5-6: Moderate to severe disc height loss. Small disc osteophyte complex and ligamentum flavum thickening. There is mild to moderate spinal canal stenosis. There is mild to moderate narrowing of the bilateral neural foramina related to uncovertebral hypertrophy.C6-7: Moderate to severe disc height loss. Small disc osteophyte complex with mild spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at the C4-C5 and C5-C6 levels and to a milder degree at the C6-C7 and C3-C4 levels.2. Multilevel neural foraminal stenosis, relatively worse at the C5-C6 level where there is mild to moderate stenosis bilaterally.3. Reversal of cervical lordosis with apex at the C4-C5 level.


Instruction: Generate impression based on findings.

Input: Patient with worsening confusion and headaches. History of metastatic renal cell cancer with brain metastases. Undergoing whole brain radiation. Rule out bleed, edema, increased intracranial pressure. Nonenhanced CT of brain:Examination demonstrate a slightly high density mass in the basal cistern measuring 13 mm x 16.6-mm in transaxial dimension. There is evidence of edema in the hypothalamic and bilateral basal ganglia. Considering patient's provided clinical history of malignancy this finding could represent a metastatic focus. Further follow-up with an MRI is recommended to exclude other lesions in this location.Shunted lateral ventricles with complete collapse of right lateral ventricle and normal appearing third ventricle and left lateral ventricle.Foci of encephalomalacia in the right frontal lobe under a right frontal craniectomy may represent site of prior surgical intervention for removal of tumor. There is no evidence of hemorrhage or midline shift.Calvarium demonstrates right high convexity frontal craniotomy and is otherwise negative.Limited view of paranasal sinuses and mastoid air cells are unremarkable. Limited view of orbits are negative.

Output: 1.High density mass in the basal cistern/hypothalamic region with surrounding edema highly concerning for metastatic lesion considering provided history of renal cell cancer.2.No evidence of any additional metastatic foci and no evidence of midline shift or hydrocephalus.3.High convexity right posterior frontal encephalomalacia under a right frontal craniectomy.4.Calvarium, paranasal sinuses and mastoid air cells are intact.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of HCV cirrhosis/HCC, pre-liver transplant candidate, please evaluate for metastases LUNGS AND PLEURA: Moderate size right pleural effusion.No evidence of pulmonary edema or pulmonary masses.Mild scarring at the left lung base.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Mild cardiac enlargement with valvular calcification and mild/moderate coronary calcification.Mild cardiac enlargement. No significant pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Contour abnormality of the liver compatible with cirrhosis.Marked splenomegaly.Recently demonstrated intrahepatic lesions on an MRI exam cannot be evaluated without intravenous contrast.

Output: Moderate-sized right pleural effusion. No pulmonary lesions identified.


Instruction: Generate impression based on findings.

Input: Stage IVb lung adenocarcinoma with progressive headache and anxiety-related memory deficits surveillance for brain metastases. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal nonspecific cerebral white matter T2 hyperintense foci. There are subcentimeter right choroid fissure cysts. 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.

Output: Incidental right subcentimeter right choroid fissure cysts. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: History of bilateral lower extremity ulcerations, evaluate for osteomyelitis. MR images of the right tibia/fibula are provided. Postsurgical changes of prior ACL graft are partially visualized. A skin marker is present along the medial ankle at the site of patient's soft tissue ulcer with underlying soft tissue edema and abnormally increased soft tissue enhancement. In the underlying medial tibia just proximal to the tibiotalar joint, there is loss of cortex (series 1601, image 15) with underlying bone marrow signal abnormality and increased enhancement compatible with osteomyelitis. The area of osseous signal abnormality on the T2 images measures approximately 3.0 x 1.5 cm in the axial plane. The remaining visualized bone marrow signal is grossly within normal limits. Aside from a soft tissue edema in the medial ankle, the visualized soft tissues are otherwise grossly unremarkable.MR images of the left tibia/fibula demonstrate a skin marker along the lateral aspect of the distal leg representing site of patient's soft tissue ulcer. Subjacent to the marker, there is mild soft tissue swelling and increased soft tissue enhancement without underlying cortical or bone marrow signal abnormalities to suggest osteomyelitis. The remaining bone marrow signal intensity is within normal limits. The remaining soft tissues are otherwise grossly unremarkable.

Output: 1.Findings compatible with osteomyelitis involving the medial aspect of the right distal tibia.2.No evidence of osteomyelitis in the left tibia/fibula.


Instruction: Generate impression based on findings.

Input: 73-year-old female with abdominal pain with CT findings and serum markers concerning for cholangiocarcinoma. ABDOMEN:LUNG BASES: Small right and trace left pleural effusions with underlying bibasilar subsegmental atelectasis, partially visualized.LIVER, BILIARY TRACT: Numerous T2 hyperintense lesions with restricted diffusion and perilesional enhancement throughout the liver with dominant, confluent lesion in the right hepatic lobe, unchanged since prior exam and compatible with metastases. There is suggestion of increased enhancement on delayed phase images, which could be seen with cholangiocarcinoma, but there are no other specific findings to suggest this etiology. Moreover, the large burden of disease makes evaluation for a specific etiology difficult.Cholelithiasis. Scattered, isolated intrahepatic ducts in both lobes of the liver are mildly dilated due to obstruction from the above-described lesions. Hepatic and portal veins are patent. Mild perihepatic ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Redemonstration of prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffuse hepatic metastases, for which cholangiocarcinoma is a possibility. Again, biopsy is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 82 years Female (DOB:11/28/1933)Reason: assess for etiology of bleed, HTN vs. CAA vs. Mets (h/o breast CA) History: bleedPROVIDER/ATTENDING NAME: AGNIESZKA A ARDELT RAYMOND A ROOS MRI of the brainNo diffusion weighted abnormalities are appreciated.. Patchy T2 and FLAIR hyperintense foci are present in the thalami and basal ganglia as well as the brainstem.On susceptibility imaging there are multiple small foci of signal loss present in the thalami to a lesser degree basal ganglia and internal capsules and in the upper brainstem as well as some of the subcortical white matter in the frontal, parietal and temporal lobes and also scattered in the cerebellar hemispheres.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cyst in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is extracranial origin of the left posterior inferior cerebellar artery. There is triplication of the anterior cerebral artery. Anterior communicating artery appears to be incompletely. The posterior communicating arteries are not readily appreciated. The left vertebral artery slightly smaller than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.There is no evidence for acute ischemic cerebral infarction.3.There are multiple microhemorrhages scattered throughout the brain parenchyma a somewhat favor thalami and internal capsules and upper brainstem but are present throughout the cerebellum and to lesser subcortical white matter. This pattern is suggestive of hypertensive microhemorrhages however superimposed process may be present.4.Patchy lesions in the brainstem and thalami basal ganglia are likely vascular related at this age.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Male 10 years old Reason: evaluate scoliosis History: scoliosisVIEWS: Thoracolumbar spine AP (1 view) 3/24/2016 at 1321 Dextrorotoscoliosis of the thoracic spine measures 17 degrees. Levorotoscoliosis of the thoracolumbar spine measures 28 degrees. No segmentation anomalies. Moderate stool burden throughout the colon.

Output: Dextrorotoscoliosis of the thoracic spine and levorotoscoliosis of the thoracolumbar spine as detailed above.


Instruction: Generate impression based on findings.

Input: Disorientation, unspecified [R41.0], Reason for Study: ^Reason: 26M with hx of PRES, now with intermittent confusion, r/o PRES and venous thrombosis History: intermittent confusion and decreased visual acuity Brain MRINo evidence of acute ischemic or hemorrhagic lesion on scan. 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. 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. There is an accessory salivary gland anterior aspect of the right parotid gland which is partially visualized.MR venogramMotion artifacts degraded image quality.3D phase contrast MRV and 2-D phase contrast MR venogram were performed.Major dural sinuses including superior sagittal sinus, bilateral transverse sinuses, bilateral sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus were visualized. No evidence of major dural sinus or venous drainage pathway occlusion.

Output: 1. Normal brain MRI.2. No evidence of venous sinus or major venous drainage occlusion or thrombosis.


Instruction: Generate impression based on findings.

Input: Reason: h/o epilepsy s/p laser ablation History: surveillance The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a abnormal signal in the left hippocampus (including had and tail) on flair and T2 weighted images which extends towards the left amygdala. There is no associated contrast enhancement. Compared to prior exams the signal in the left hippocampus is more heterogeneous. There is new T2 and flair signal hyperintensity in the adjacent left parahippocampal gyrus was not present on the exams from a year ago which displays a small amount of contrast enhancement. There is a small susceptibility effect present at the left hippocampus which was not present on prior exams. There is a associated mild enlargement of the temporal horn of the left lateral ventricle indicating adjacent volume loss due to ex vacuo effect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Incidental note is made of a developmental venous anomaly in the left cerebellar hemisphere.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings compatible with post treatment change involving the left hippocampus and now left parahippocampal gyrus.


Instruction: Generate impression based on findings.

Input: History of primary CNS lymphoma status post 4 cycles of MTR. There are postoperative findings related to transfrontal biopsy, including extra-axial T1 hyperintensity and susceptibility compatible with chronic blood products. There is interval decrease in size of patchy areas of high T2 signal in the left periventricular white matter. There are otherwise unchanged scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The midline structures and craniocervical junction are within normal limits. There is global parenchymal volume loss. Otherwise, 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 unchanged.

Output: Numerous scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter may represent chronic small vessel ischemic disease. Otherwise, left periventricular signal abnormality at the site of the treated CNS lymphoma has subsided, although assessment is limited by the lack of intravenous contrast.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question:? Bleed or mass effect. Signs and symptoms: Seizure Nonenhanced CT of brain:The images through the anterior aspect of the temporal lobes demonstrate a subtle area of low attenuation in the left anterior temporal lobe. This is within the white matter and mid no distinct involvement of cortex. There is also extensive beam hardening artifact secondary to bone. Recommend follow-up exam with an MRI for better evaluation. The finding could represent edema from an inflammatory process (viral encephalitis), masse, venous thrombosis or other causes. I cannot be entirely certain if this finding is not an artifact or represent a focal area of encephalomalacia of unknown etiology. Considering provided clinical history of seizure further MR is recommended.The density and morphology of brain is otherwise entirely within normal limits. The cortical sulci, ventricular system and all CSF cisterns as well as gray -- white matter differentiation is preserved. The density of intracranial venous sinuses show no definitive abnormality.Calvarium, limited real paranasal sinuses, orbits and mastoid air cells are unremarkable.

Output: 1.Subtle suspected area of edema in the white matter of the left anterior temporal lobe as detailed above. Follow-up wirth and MRI is recommended if patient's symptoms persist. Please see above comments as for etiology.2.this examination is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 57 year old female with history of right breast invasive ductal carcinoma status post mastectomy in 2007 presents for screening examination. Patient is currently on aromatase inhibitor. No current breast related complaints. Positive family history of breast carcinoma in her sister at age 48. There is heterogeneous amount of fibroglandular tissue in left breast. Postsurgical changes are present consistent with right mastectomy. No abnormal enhancement is seen in the left breast and right chest wall.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Altered mental status and unsteady gait x 3 days. Rule out ICH, CVA. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there is strong clinical concern for acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 42 year-old female with a history of pituitary adenoma presents with with weight loss, shortness of breath, and heaviness of the neck and upper chest CT HEAD:There is no evidence of intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. Limited view of the sella turcica and pituitary gland is unremarkable. The pituitary gland is normal in size. There are sclerotic changes in the sphenoid bone most consistent with postsurgical changes. It should be noted that a dedicated MRI is preferred for evaluating interval changes in pituitary lesions. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells and paranasal sinuses are within normal limits.CT NECK:The thyroid gland, parotid gland, and submandibular glands are within normal limits. The visualized orbits are within normal limits. The visualized paranasal sinuses and mastoid air cells are clear. Bilateral lung apex micronodules. There are small scattered cervical lymph nodes normal in size and shape, which are not enlarged by CT criteria. The major vessels are patent.Mild degenerative disk disease affects the cervical spine. There is preservation of the normal cervical lordosis. There is no evidence of acute fracture or malalignment. The prevertebral soft tissues are within normal limits.

Output: 1. No acute intracranial abnormality. Limited view of the sella turcica and pituitary gland is unremarkable. There are sclerotic changes in the sphenoid bone most consistent with postsurgical changes. It should be noted that a dedicated MRI is preferred for evaluating interval changes in pituitary lesions. 2. No evidence of focal neck mass or other radiographic finding to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 60 years Female Reason: vertigo. Hx breast CA. History: vertigo. Provider Name: RIMAS V. LUKAS RIMAS V. LUKAS BRAINThe CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for intracranial cerebrovascular occlusive disease.3.No evidence for internal auditory canal mass.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with left-sided stroke presenting with slowed response, concern for worsening mental status. Barely detectable diffusion restriction is seen corresponding to the areas of hypoattenuation noted on prior CTA involving the left insula, opercular tissues and inferior parietal lobule. No significant edema, mass effect or volume loss is evident as of yet. Trace scattered sulcal FLAIR hyperintensity within the infarct region may reflect vascular engorgement or slow flow.Scattered small foci of cortical and white matter T2 hyperintensity are seen which may reflect prior episodes of ischemia. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Several scattered foci of susceptibility are seen which may reflect chronic microhemorrhage. The ventricles are normal in size and morphology.

Output: 1.Diffusion restriction corresponding to the known left MCA infarct is barely detectable suggesting a subacute time course. 2.No evidence of associated edema, mass effect or significant tissue loss is detected.3.No other acute findings are seen to account for the patient's apparent worsening mental status.


Instruction: Generate impression based on findings.

Input: 61 year old with history of cardiac arrest presenting for evaluation prior to ICD implantation. Left VentricleThe left ventricle is mildly enlarged with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 207 ml (normal range 109+/-23), the LV end systolic volume index is 44 ml/m2 (normal range 18+/-5), the LVESV is 94 ml (normal range 31+/-10), the LV mass index is 54 g/m2 (normal range 67+/-11), and the LV mass is 114 g (normal range 114+/-24). There is a regional wall motion abnormality in the basal inferior-inferolateral wall, further, there is a moderate-size area of transmural late gadolinium enhancement in the same area suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is additionally evidence of increased T2-signal in the basal inferolateral wall, seen on the SSFP images. These findings are most consistent with recent myocardial infarction in the territory of a obtuse marginal artery or posterolateral artery. There is mild left ventricular hypertrophy. Left AtriumThe left atrium is mildly enlarged.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 178 ml (normal range 110+/-24), the RV end systolic volume index is 46 ml/m2 (normal range 22+/-8), and the RVESV is 97 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The descending thoracic aorta is mildly dilated (36mm); there is additionally evidence of a small penetrating aortic ulcer in the mid-portion of the descending thoracic aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThyroid enlargement is noted. There are trivial bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is mildly enlarged with low normal systolic function (LVEF 54%). There is a regional wall motion abnormality in the basal inferior-inferolateral wall, with an area of moderate-sized area of transmural LGE in a pattern most consistent with a recent myocardial infarction. 2. Right ventricle is normal in size with mildly reduced systolic function (RVEF 46%). 3. The descending thoracic aorta is mildly dilated (36mm) and has a small penetrating aortic ulcer in the mid-portion.4. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: pannus History: inflammation c spine The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk desiccation presentThere is mild thickening of the cruciate ligaments which is nonspecific. There is heterogeneous signal on T1 and T2 imaging along the right lateral mass of C1.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. There is mild anterior subluxation of C2 on C3 associated with some facet hypertrophy predominantly on the left side. There are left-sided uncovertebral osteophytes present at this level which mildly narrow the left neural foramen.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. There is mild anterior subluxation of C7 on T1.The vertebral artery flow voids appear to be intact.

Output: 1.The right lateral mass of C1 is somewhat heterogeneous and irregular. This is nonspecific. It is possible that this is related to degenerative change. A CT of the cervical spine may be helpful in further evaluating if clinically appropriate.2.There are some minor degenerative changes present in the cervical spine without significant compromise of spinal canal or exiting nerve roots.3.Some images are degraded by patient motion which may obscure more subtle anomalies can


Instruction: Generate impression based on findings.

Input: Reason: stroke History: facial weakness1/16/195462 yearsMale MRI of the brainNo diffusion weighted abnormalities are appreciated.There are small subdural effusions present in the posterior fossa and to lesser degree supratentorial brain which is probably related to some degree of volume loss.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is mild narrowing along the proximal right vertebral artery.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree (several) are nonspecific. At this age they are most likely vascular related and likely of little clinical significance.3.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:8/18/1960)Reason: leptomeningeal disease , History: seizures , AMSPROVIDER/ATTENDING NAME: EHTASHAM G KHATTAK WENDY STOCK The lateral and third ventricles are mildly dilated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The dural sleeves are mildly ectatic.

Output: 1.The ventricles are mildly dilated. In isolation this is non-specific. An underlying cause is not identified on this exam.2.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.


Instruction: Generate impression based on findings.

Input: 62 year-old female with nausea, vomiting, and dizziness. Evaluate for bleed.IMAGE ACQUISITION: Nonenhanced CT of the head and MRI of the brain dated 8/20/11 There is a rounded focus of hyperattenuation in the left pons, correlating with the site of abnormality seen on recent MRI. There is no midline shift or hydrocephalus.Mild hypoattenuation in the periventricular and subcortical white matter is most consistent with small vessel ischemic disease. No skull fracture is evident. Visualized paranasal sinuses are grossly clear.Postsurgical changes are again seen with left temporo-occipital encephalomalacia, unchanged.

Output: Rounded focus of hyperattenuation in the left pons correlating with site of abnormality seen on MRI. This most likely represents a hemorrhagic metastases. A subsequent MRI was ordered.


Instruction: Generate impression based on findings.

Input: Nausea with vomiting [787.01], Reason for Study: ^Reason: headaches, history of cervical cancer History: headaches No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with medically intractable right temporal lobe epilepsy. Functional MRI requested for surgical planning. Sensorimotor cortical activation of the hands and face maps as expected along the pre- and post-central gyri. Reliable sensorimotor cortical activation of the feet could not be achieved. Passive visual stimulation results in cortical activation along the bilateral calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the verb generation and sentence completion paradigms. Language is left dominant. Broca's area activity is identified in its customary location of the left inferior frontal gyrus, primarily pars triangularis. Two candidate foci for Wernicke's area activity are seen in slightly atypical locations including the left supramarginal gyrus and the left middle temporal gyrus. A very small focus of activity is also demonstrated in the left superior temporal sulcus which is the more common location for Wernicke's area.

Output: Technically successful functional MRI. The sensorimotor and primary visual cortices are well delineated. Language is left dominant. Broca's area activity is identified in its customary location. Two candidate foci for Wernicke's area activity are seen in slightly atypical locations as above.


Instruction: Generate impression based on findings.

Input: Reason: R patellar tendinosis vs. Patellar chondral lesion History: Right knee pain. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small focus of edema superiorly and centrally within Hoffa's fat pad, which is nonspecific.ADDITIONAL

Output: No patellar chondral lesion is evident. There is a small focus of edema type signal in Hoffa's fat pad which is of questionable clinical significance. We otherwise see no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Male, 4 years old, with behavior and speech changes over the last few months. History of cisterna magna with increased ventricular size. Prominence of the extracerebral CSF spaces seen on the prior examination has resolved, including in the posterior fossa, indicating that the prior findings likely represented benign prominence of the extra-axial spaces of infancy. The lateral and third ventricles do, however, remain mildly prominent, though this is improved relative to the prior examination.No evidence of restricted diffusion, edema, mass effect or focal parenchymal signal abnormality is seen. No migrational anomalies or structural defects are identified. There is a 4 mm left temporal choroid plexus or choroidal fissure cyst. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The pituitary region is unremarkable. The corpus callosum is fully formed and intact. The brainstem and cerebellum are unremarkable. The pattern of white matter myelination is appropriate.

Output: Prominence of the extracerebral CSF spaces seen in the prior examination, including that thought to represent a magna cisterna magna, have essentially resolved. These findings therefore likely represented benign prominence of the extra-axial spaces of infancy.Slight prominence of the ventricular system does persist. This could reflect normal anatomic variation or mild white matter volume loss. No definite focal parenchymal lesions are seen.


Instruction: Generate impression based on findings.

Input: Urinary incontinence, decreased bladder capacity, thick-walled bladder, detrusor sphincter dyssynergia. The conus medullaris is located at the L1-2 level and appears to translate anteriorly with supine positioning. The inferior spinal cord signal is intact and there is no evidence of fibrofatty filum terminale. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The inferior spinal cord and cauda equina nerve roots appear unremarkable. The paravertebral soft tissues are unremarkable.

Output: No evidence of lumbar spine anomalies.


Instruction: Generate impression based on findings.

Input: Bulbar weakness, facial weakness. Possible brainstem lesion. No evidence of acute ischemic or hemorrhagic lesion.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 paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Multiple staring episodes per week. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. In particular, the hippocampi appear to be intact and there is no evidence of heterotopia. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No discernible seizure foci.


Instruction: Generate impression based on findings.

Input: Weakness, neck pain, evaluate for cord compression. There is an approximately 5.2 x 4.3 x 5.7 cm enhancing mass involving the posterior and right lateral elements of C3-C6. A portion of the mass extends into the epidural space and compresses the posterior cervical spinal cord. Anteriorly at C5-C6, the spinal cord is compressed against a large posterior disc osteophyte complex and there is high T2 signal in the spinal cord in this region. Additionally, there is a 4.0 x 4.4 x 7.1 cm mildly enhancing mass in the posterior mediastinum involving the esophagus. More inferiorly there appears to be a partially imaged mass and/or hiatal hernia. There is enhancement involving the C5 and C6 vertebral bodies. The thoracic spinal cord is unremarkable and there are no tumors in the thoracic or lumbar vertebrae. There is no spondylolisthesis or significant loss of vertebral body height. There are a few minimal posterior disc-osteophyte complexes in the thoracic spine and there is incompletely characterized degenerative spondylosis in the lower lumbar spine.

Output: 1. A large mass involving the posterior and right lateral elements of C3-C6 with epidural extension and associated compression of the spinal cord with edema in conjunction with a prominent disc-osteophyte complex at C5-6. The tumor appears to also involve the C5 and C6 vertebral bodies and may represent metastatic disease.2. A bulky mass involving the mid esophagus and posterior mediastinum, as well as partially imaged mass and/or hiatal hernia may represent the primary tumor and/or additional metastatic disease. Dedicated chest CT or PET may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 50 years, Male, gait disturbance and hyperreflexic. Evaluate for brain lesion. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage, intracranial mass or mass-effect. There is sulcal and ventricular prominence, compatible with moderate generalized parenchymal volume loss, greater than expected for age. There is no hydrocephalus.Several foci of T2 hyperintensity are seen in the bilateral subcortical and periventricular white matter. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement is identified. Normal flow-voids are present within the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.Several foci of T2 hyperintensity within the bilateral subcortical and periventricular white matter are nonspecific, and statistically most likely represent chronic small vessel disease. However, other differential considerations include migraine sequela, infectious/inflammatory etiology, trauma or demyelinating disease.2.Moderate generalized parenchymal volume loss, greater than expected for age.


Instruction: Generate impression based on findings.

Input: 28-year-old female with history of recent nasopharyngeal cancer status post chemo/RT. Please eval extent of disease. CT of soft tissues of the neck with infusion.Images through the skull base demonstrates a slight prominence of the left cavernous sinus compared to the right and also there are sclerotic changes of the sphenoid bone on the left side. Subtle erosive changes of the pterygoid bone on the left, specifically the medial leaf of the pterygoid bone is noted. combination of the above findings are highly suspected of possible extension of tumor into the skull base and the left cavernous sinus. These findings were present on the prior study. Further evaluation with an MRI examination is recommended.Chronic inflammatory sinus disease of the sphenoid sinus is also present which was also noted on the prior exam and demonstrates no interval change. There is complete opacification of bilateral mastoid air cells and middle ear cavities. These findings on the left were present on the prior study however the findings on the right are new since prior exam.In comparison to prior exam there is significant interval reduction in the size of previously noted left high nasopharyngeal tumor. On the current exam some subtle soft tissue swelling with edematous changes and without definitive enhancement is still is present. This finding extends anteriorly into the posterior choana of the left nasal cavity.No evidence of any pathologic adenopathy neck is detected.Limited images of the apices of the lungs are unremarkable. No additional areas of bony erosion or metastatic lesions is detected.CT of brain with infusion.No evidence of metastatic lesion of the brain parenchyma or the meninges is detected. The bony density of calvarium is unremarkable with the exception of findings described on the left side of the sphenoid bone/pterygoid adjacent to the patient's known tumor.

Output: 1.Significant reduction in the size of patient's known high left nasopharyngeal cancer with no definite measurable tumor on the current study.2.Erosive and sclerotic changes of the skull base involving the left pterygoid bone and left aspect of the body of sphenoid bone as detailed.3.The bony changes as well is a slight prominence of the cavernous sinus on the left raises the possibility of extension of tumor into the skull base and cavernous sinus. Further follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 25 years, Male, status post craniotomy for right cerebellar mass. Additional history per chart: history of medulloblastoma status post resection April 2007 followed by chemotherapy and radiation treatment, presented recently with cerebellar mass Compared to 3/30/2016, interval postsurgical changes related to resection of previously seen right cerebellar mass are seen. No residual tumor is definitively appreciated. There are areas of intrinsic T1 shortening and susceptibility related to blood products without definite enhancement. Postoperative changes include fluid in the right cerebellar resection cavity and adjacent to the craniotomy site. No large fluid collections or significant mass effect is demonstrated. Small areas of restricted diffusion are evident along the posterior margin of the resection cavity related to blood products and cytotoxic edema. No large infarct, hemorrhage, or new mass effect is evident. Vasogenic edema in the right cerebellar hemisphere is mildly improved. There is improvement in mass effect in the posterior fossa including deformity of the fourth ventricle and effacement of the right ambient cistern. Ventricles are not significantly changed in size and demonstrate no evidence of hydrocephalus. Scattered punctate foci of susceptibility in the brain are again seen and presumably related to prior radiation. Remainder of the brain demonstrates no abnormal parenchymal or meningeal enhancement or parenchymal signal abnormality.

Output: Interval postsurgical changes of resection of right cerebellar mass. No residual tumor is definitively appreciated.


Instruction: Generate impression based on findings.

Input: 72-year-old patient with left breast cancer status post neoadjuvant treatment chemotherapy with MRI showing some response, status post seed localization to help guide surgery. Patient status post surgery. Orthogonal digital specimen radiographs revealed the mass, localization seed, and clip to be within the specimen. Dense breast tissue as well as calcifications are noted at the periphery of the specimen, specifically posteriorly. The breast surgeon will excise additional tissue posteriorly; this additional excised tissue will not be imaged.

Output: Mass, localization seed, and clip within the specimen as above. The breast surgeon will excise additional tissue posteriorly; this additional excised tissue will not be imaged.


Instruction: Generate impression based on findings.

Input: Reason: Possible LT ligament tear, possible TFCC tear History: ulnar sided wrist pain LIGAMENTS: We see no contrast extending across the scapholunate or triquetral ligaments to indicate a complete tear. Focal increased signal intensity involving the membranous portion of the scapholunate ligament near its insertion on the scaphoid could represent a partial tear, but this is equivocal. The lunotriquetral ligament appears normal.TRIANGULAR FIBROCARTILAGE COMPLEX: We see no gadolinium traversing the articular disc of the triangular fibrocartilage or entering the distal radioulnar joint to indicate a full-thickness tear. Mild heterogeneity of the articular disc suggests mild degeneration. Contrast extends from the ulnar side of the radiocarpal joint proximally along the medial margin of the distal ulna volar to the extensor carpi ulnaris tendon, perhaps representing a perforation/disruption of the capsule, but this is of questionable clinical significance.TENDONS: The tendons appear normal.BONES: We see no fracture or malalignment.ADDITIONAL

Output: Extension of contrast from the radiocarpal joint along the medial aspect of the ulna may represent a perforation of the medial capsular structures of the wrist. This is of uncertain clinical significance and there are no findings of a lunotriquetral tear. Other findings as above.


Instruction: Generate impression based on findings.

Input: History of multiple cystic lesions throughout the pancreas thought to be IPMNs, follow-up. ABDOMEN:LIVER, BILIARY TRACT: Decreased hepatic parenchymal signal on out of phase images is compatible with diffuse hepatic steatosis. No suspicious focal hepatic lesions are identified. Again seen is a right portal venous branch thrombosis with multiple reconstituted collaterals that extend adjacent to the left portal vein. The main portal vein is patent, however, the portal splenic confluence is narrowed, similar to prior exam. There is no biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Innumerable cystic lesions are seen throughout an atrophic pancreas, similar to prior exam. Some of these lesions appear to connect to the pancreatic duct, most suggestive of IPMNs. No significant enhancing nodularity or diffusion restriction within these cysts to indicate malignancy. The reference pancreatic tail lesion is 1.6 x 1.3 cm (series 6, image 48), unchanged. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The previously described right sacral insufficiency fracture is not included in the field-of-view.OTHER: Right lower lobe pulmonary nodularity, similar to prior.

Output: Innumerable pancreatic cystic lesions most suggestive of IPMNs are not significantly changed. No specific evidence of malignancy.


Instruction: Generate impression based on findings.

Input: Evaluate adenoma size change: worsening headache. There is interval decrease in size of the lesion within the sella, which measures up to 3 mm in craniocaudal dimension, previously 7mm. The lesion now appears T1 hypointense and does not display enhancement. There is no mass effect upon the cavernous sinuses or optic apparatus. The infundibulum remains slightly deviated to the right.

Output: Interval decrease in size of the treated pituitary adenoma with evolution of the signal characteristics.


Instruction: Generate impression based on findings.

Input: History of meningioma and status post resection of pituitary macroadenoma on 2/5/2016. Pituitary: There are postsurgical findings of a pituitary macroadenoma resection. Again seen is a well-circumscribed midline contrast-enhancing lesion measuring up to 12 mm appearing unchanged from the prior study. A smaller, more posterior component along the medial aspect of the left cavernous sinus also appears unchanged. Pituitary infundibular deviation to the right is unchanged. Enhancement involving the right lateral aspect of the sella likely represents residual normal pituitary tissue. While the larger residual mass still has suprasellar extension, there continues to be no significant mass effect. There is unchanged inferior displacement and thinning of the floor of the third ventricle and the optic chiasm.Brain: There are two enhancing, broad-based extra-axial masses along the left superior frontal convexity that are unchanged in size as compared to the prior study. Again seen is hyperostosis of the calvarium adjacent to the larger lesion. There is no significant mass effect upon the underlying brain parenchyma. There are a few scattered foci of nonspecific cerebral white matter T2 hyperintensity. There is no evidence of acute infarct. There is diffuse cerebral volume loss. There is no midline shift or herniation. There is right scleral buckle and bilateral lens implants. The paranasal sinuses are unremarkable.

Output: 1. Stable postoperative findings in the pituitary region.2. Stable convexity meningiomas.


Instruction: Generate impression based on findings.

Input: Reason: eval for HCC History: Hepatic lobe lesion on CT. History of lymphoma ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Cholelithiasis without evidence of cholecystitis. Mild periportal edema. There is ill-defined, confluent progressive enhancement within the left hepatic lobe and segment 4 of the right hepatic lobe with corresponding increased T2/DWI signal. There is no washout or focal suspicious lesions. Hypoattenuating lesion seen on the prior CT does not demonstrate arterial enhancement.SPLEEN: Enhancing focus within the spleen, likely a hemangiomaPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged portacaval node measuring 2.2 x 1.0 cm (12/109).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology with an ill-defined region of progressive enhancement. This likely represents fibrosis, however diffusely infiltrating lymphoma cannot be excluded. PET/CT may be helpful for further evaluation.


Instruction: Generate impression based on findings.

Input: 51-year-old female with pain at the greater trochanter and left sacroiliac joint. Results with lateral hip pain for months. Although this examination was not protocoled for detailed evaluation of the acetabular labrum, there is heterogeneity of the superior labrum indicating degeneration/tearing. No fluid-filled tear is evident. No bone marrow signal abnormality is identified. The femoroacetabular joint alignment is anatomic. There is a small amount of fluid within the joint without evidence of a large effusion. There is no signal abnormality about the left sacroiliac joint as clinically questioned. No erosions are evident. There is a small amount of nonspecific peritrochanteric inflammation which is not necessarily of any clinical significance (image 17; series 9). Moderate to severe degenerative disc disease affects the lower lumbar spine.

Output: 1. Mild to moderate osteoarthritis of the left hip with degeneration/tearing of the acetabular labrum.2. Small amount of nonspecific peritrochanteric inflammation which is not necessarily of any clinical significance. No focal fluid collection to suggest a bursitis is identified. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with drainage from the lower back status post L3-L5 XLIF with percutaneous screws. Findings are seen compatible with posterior instrumented fusion from L3 through L5 and interbody fusion at L3-4 and L4-5. Instrumentation is better assessed on prior CT.Several small rim-enhancing fluid collections are identified within the posterior subcutaneous soft tissues of the operative region. For example, irregularly marginated collections are evident to the left of midline at L4 and to both sides of midline at L5. These collections range in size from 1 to 2 cm in diameter but they are thin.Several rim-enhancing fluid collections are also evident within the bilateral psoas muscles beginning at the L3 level and continuing down to L5. The adjacent psoas musculature is edematous. The largest collection is on the left and measures 20 x 15 x 13 mm.No evidence of any epidural fluid collection is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits.Anterolisthesis of L3 relative to L4 seen on the preoperative examination has been corrected. Sagittal alignment is grossly anatomic. Vertebral body heights are preserved. No marrow signal abnormalities are observed which could not be attributable to the recent surgical instrumentation. No definite pathologic marrow enhancement is seen.L1-2: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Marked facet arthropathy with progressive facet effusions. Ligamentum flavum thickening. Improved disc bulging. Improved mild generalized spinal canal stenosis. The left lateral recess remains narrowed. Severe left foraminal narrowing, unchanged. L4-5: Marked facet arthropathy with improvement in facet effusions. Ligamentum flavum thickening. Mild bulging disc, improved. Mild spinal canal stenosis, improved. Moderate to severe right foraminal narrowing, unchanged. L5-S1: Facet arthropathy. Minimal bulging disc. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes.

Output: 1.Findings are seen compatible with recent posterior instrumented fusion from L3 through L5 as well as interbody fusion at L3-4 and L4-5.2.Small rim enhancing fluid collections are evident within the posterior soft tissues of the operative region. In addition, there are several small fluid collections within the bilateral psoas muscles measuring up to 2 cm in diameter with adjacent edema. Collectively, these findings are concerning for infected collections, though postoperative seroma with granulation tissue could also present similarly.3.No evidence of any epidural fluid collection or significant compromise of the spinal canal is seen.4.Multilevel degenerative findings are seen, improved at some levels secondary to surgery, with details as above.


Instruction: Generate impression based on findings.

Input: There is stable grade 1 anterolisthesis of L4 on L5. The vertebral body heights are maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. No abnormal postcontrast enhancement is identified.T12-L1: Mild hypertrophic degenerative changes of the ligamentum flavum and posterior facets are demonstrated at this level. Otherwise, no significant abnormalities appreciated at this level. Specifically there is no evidence for disc herniation, neuroforaminal stenosis, or spinal canal stenosis.L1-L2: Mild hypertrophic degenerative changes of the ligamentum flavum and posterior facets are demonstrated at this level. Otherwise, no significant abnormalities appreciated at this level. Specifically there is no evidence for disc herniation, neuroforaminal stenosis, or spinal canal stenosis.L2-L3: Mild hypertrophic degenerative changes of the ligamentum flavum and posterior facets are demonstrated at this level. Otherwise, no significant abnormalities appreciated at this level. Specifically there is no evidence for disc herniation, neuroforaminal stenosis, or spinal canal stenosis.L3-L4: There is intervertebral disc desiccation and a diffuse disc bulge with bilateral ligamentum flavum and facet hypertrophic degenerative changes resulting in mild bilateral neuroforaminal stenosis and mild central spinal stenosis.L4-L5: There is only a small residual low T1 and T2 signal focus posterior to the L4 vertebral body in the epidural space without mass effect, possibly related to scarring. The previously seen lesion in this area likely related to a sequestered disc and is no longer visualized. There is moderate degenerative disc disease and loss of disc height with significant bilateral facet and ligamentum flavum degenerative change and resultant grade one anterolisthesis of L4 over L5. There is moderate left and mild to moderate right neuroforaminal stenosis as well as mild to moderate central spinal stenosis.L5-S1: There is a diffuse disc bulge with superimposed central disc protrusion abutting the bilateral S1 nerve roots. An enhancing small right para-median annular fissure is again visualized. There is mild to moderate left neural foraminal narrowing without right neuroforaminal stenosis or spinal canal stenosis. Moderate hypertrophic degenerative changes of the posterior facets and ligamentum flavum are seen as well.Several lobulated cystic nonenhancing pelvic structures are visualized, possibly relating to ovarian cysts.

Output: 1. The previously identified low central lesion at the anterior L4 ventral epidural space is no longer visualized and may have related to a sequestered disc fragment which has now resorbed, with only minimal ill-defined residual low signal in this area without mass effect, possibly related to scarring.2. Additional degenerative changes of the lumbar spine with associated grade 1 anterolisthesis of L4 over L5 appear similar to prior examination.3. Several lobulated cystic nonenhancing pelvic structures are visualized, possibly relating to ovarian cysts.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out aneurysm, intracranial hemorrhage. Signs and symptoms: Headaches. CTA of intracranial circulation:140 cc of Omnipaque 350 was administered for this exam.3-D reformatted images were obtained utilizing an independent workstation.Vertebral/basilar system.Normal appearing bilateral intracranial vertebral arteries, bilateral pica branches, basilar artery, superior cerebellar arteries and posterior cerebral. No vascular abnormality in particular no aneurysm is identified as clinically is questioned. There is anatomical variation of proximal basilar artery fenestration.Right internal carotid.The distal cervical portion of right internal carotid artery, internal carotid artery across the skull base and the supraclinoid portion of right internal carotid artery remain within normal limits. There is no posterior communicating artery visible. There is anatomical variation of hypoplastic right A1. Right middle cerebral artery and its branches are unremarkable.Left internal carotid.There is patent normal appearing left internal carotid artery in its distal cervical portion and across the skull base. Normal-appearing supraclinoid left internal carotid artery. Nonvisualization of a left posterior communicating artery is an anatomical variation.There is a dominant left A1 supplying both A2 segments of the anterior cerebral arteries. There is no evidence of any aneurysm all anterior cerebral arteries, left middle cerebral artery or the supraclinoid left internal carotid artery. Incidental note is made of a slightly enlarged (compare to the right) left superior ophthalmic vein. There is high density of the left superior ophthalmic vein posteriorly in the retro-orbital space. The more anterior portion of the left superior ophthalmic vein demonstrate low density compared to its more posterior portion.. The exact etiology of this discrepancy in density is not clear. The hypodensity of the left superior ophthalmic vein posteriorly in the left retro-orbital space may present thrombus or contrast within a vessel. Please correlate with physical exam and patient symptomatology. This lesion can be further evaluated with an MRI exam if clinically is warranted.Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, cisterns cisterns and gray -- white matter differentiation remains within normal.An extra-axial dural based densely calcified lesion in high convexity right frontal lobe may represent a dural plaque or a very small heavily calcified meningioma. This finding was present on prior exam and is unchanged.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are unremarkable. Limited real paranasal sinuses demonstrate extensive opacification of right maxillary sinus.

Output: 1.No CTA of intracranial circulation for aneurysm as clinically is questioned. Fenestration of proximal basilar artery is noted.2.Slightly prominent left superior ophthalmic vein. Higher density of this vein in its more posterior portion in the retro-orbital space may represent clot or contrast. Please correlate with clinical findings, symptomatology and physical exam. If there is a concern and patient is symptomatic recommend an MRI examination.3.Stable unremarkable non-infused head CT. Stable small high convexity right frontal calcified dural based lesion measuring 8 times 6-mm in size since prior study. Right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: Chest pain. Evaluate for dissection. LUNGS AND PLEURA: No focal consolidation or pleural effusion. MEDIASTINUM AND HILA: Image quality is limited by artifact overlying the aorta on 3D MRA and contrast enhanced MRA sequences, making detailed evaluation of the aorta difficult. There is no convincing focal evidence of aortic dissection. The right innominate and left common carotid arteries arise from a common trunk from the aorta. Caliber of the great vessels is normal. Heart size is upper limits of normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No convincing evidence of aortic dissection with the limitations detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial abscess. Signs and symptoms: High WBC in CSF. Pre-and post-enhanced brain MRI:Diffusion weighted images are unremarkable.Examination of a straight extensive postoperative changes a wide left suboccipital craniectomy and grid placement of a mesh at the level of the craniectomy site. Large CSF signal intensity extra-axial collection in the posterior fossa on the left with several mass effect on the fourth ventricle demonstrate no change in its size and overall mass effect. The fourth ventricle also remains in stable since prior exam. Approximately 8.5 mm herniation of cerebellar tonsils through the foramen magnum is fairly similar to prior exam.Examination however demonstrate significant interval increased in pseudomeningocele at the surgical site since prior study. This finding demonstrate no mass effect on the intracranial content. In largest transaxial dimensions of this collection is approximately at 64 x 66 -mm.Extensive pulsation artifact from this collection precludes precise assessment for detection of abnormal enhancement. Within this limitation however there is a very thin linear enhancement along the anterior aspect of extra-axial CSF collection intracranially. This appearance is within expected post operative change. There is also no detectable T2/flair hyperintensity of cerebella at the site to suggest presence of an infectious process/abscess. There is no convincing evidence of leptomeningeal or intraparenchymal enhancement. There is enhancement of the soft tissues or suboccipital region surrounding the pseudomeningocele which is also within expected postop change. The enhancement is less conspicuous since prior study. This observation could represent internal improvement or be as result of significant flattening and displacement of the surrounding soft tissues due to interval increased expansion of pseudomeningocele.

Output: 1.Negative diffusion weighted images.2.Extensive postoperative changes of a wide left suboccipital craniectomy with stable intracranial postoperative changes and without convincing evidence of an infectious process/abscess formation as detailed.3.Significant interval increased pseudomeningocele posterior to the craniectomy site as detailed. Mild enhancement of surrounding soft tissues are expected postop changes. No convincing evidence of an abscess formation.


Instruction: Generate impression based on findings.

Input: Ms. Victor is a 51-year-old female with a personal history of triple positive right breast cancer (DCIS with microinvasive carcinoma) and metastatic disease in the right axillary lymph node. She presents for MRI breast reevaluation after chemotherapy treatment. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is no residual abnormal enhancement seen in the right breast, which previously measured 7.1 x 8.4 x 11.0 cm (AP x LR x CC).LEFT BREAST:There is no abnormal enhancement see in the left breast. AXILLA:Metastatic right axillary lymph node with centrally located biopsy marker clip now measures 1.1 cm in maximal dimension, previously measuring 1.9 cm. This lymph node has returned to a more benign morphology. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: (1) Complete interval resolution of previously seen diffuse non-mass enhancement in the right breast. Interval decrease in size of metastatic right axillary lymph node.(2) No MRI evidence of malignancy in the left breast.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 12 years Male (DOB:7/28/2004)Reason: h/o sickle cell disease, rule out CVA History: acute chest syndrome requiring intubation, developed altered mental status prior to intubatinoPROVIDER/ATTENDING NAME: DIANA LILY MITCHELL CATHERINE A. HUMIKOWSKI MRI of the brainThere are multiple foci of signal loss and susceptibility weighted imaging in the corpus callosum as well as subcortical white matter which were not evident on the prior exam. The largest one appears to be in the left parietal lobe subcortical white matter where it is also visible on routine imaging. Additional moderate-sized bones associated with the FLAIR signal hyperintensity are present in the subcortical white matter of the frontal and parietal lobes as well as the temporal lobes and occipital lobes.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. The visualized portions of the mastoid air cells are opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Although the distal internal vasculature appears somewhat attenuated this is nonspecific finding there is no convincing specific vessel occlusion or stenosis appreciated.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The cerebellar tonsils remain approximate 5 mm below the level of foramen magnum and are unchanged since the prior exam.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There are numerous microhemorrhages scattered throughout subcortical white matter and the corpus callosum. Most of these are only seen on susceptibility weighted imaging. There is evidence that some of these are subacute in nature. These were not present on the prior exam from 2014. Although the cause is uncertain possibilities may include vasculopathy of sickle cell disease or a vasculitis associated with sickle cell disease. Findings were reported to Dr Tara Calhoun at the time of this interpretation.2.No evidence for cerebrovascular occlusive disease. 3.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Urothelial cancer with known right ischial metastasis There is a destructive lesion with questionable nondisplaced pathologic fracture centered within the right ischium. The lesion measures 5 x 2.5 cm in the transverse dimension and 6.5 cm in the craniocaudal dimension. The mass penetrates the cortex in multiple areas and there is mild edema and enhancement of the adjacent soft tissues. Edema and enhancement extends anteriorly to partially involve the inferior pubic ramus which may reflect marrow extension of tumor. Several small rounded foci of abnormal signal intensity and enhancement are noted within the ischium just superior to the main lesion, likely representing additional areas of disease. There are no additional abnormal foci or enhancement within the bones of the pelvis.The hamstring origin appears intact. Severe degenerative disc disease affects L5-S1. There is a tiny rim enhancing elongated fluid collection lateral to the left iliotibial band which may be the result of prior trauma or intervention but is not necessarily of any current clinical significance.Again seen is an enlarged residual distal ureter on the right containing both fluid and intermediate signal intensity. This is of uncertain etiology or significance but the possibility of residual malignancy is not excluded; however this correlates to similar findings on comparison CT exams. An elongated right iliac lymph node is also noted comparable to that seen on prior CT as well. There is prostatomegaly.

Output: Destructive right ischial lesion with other findings described above.


Instruction: Generate impression based on findings.

Input: 52-year-old female with cervical stenosis, preop planning for cervical fusion,Evaluate for cervical instability. There is grade 1 retrolisthesis of C6 which persists on flexion and extension views. There is severe degenerative disc disease at C5-C6 and C6-C7 with moderate degenerative disc disease at C7-T1. There is multilevel facet joint arthropathy. There is anterior wedging of C5 and C6 resulting in loss of the normal cervical lordosis on neutral views. No evidence of instability on flexion and extension views.

Output: Severe degenerative changes without evidence of cervical instability.


Instruction: Generate impression based on findings.

Input: 42 year old with strong family history of breast cancer. Family history of breast carcinoma in her sister (diagnosed at age 36), two aunts (diagnosed at age 40), and a cousin. Family history of ovarian cancer diagnosed in two aunts. BRCA mutation. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 23-year-old male with recurrent right shoulder dislocation. Assess for glenoid anterior fracture.IMAGE ACQUISITIONS: CT of the right shoulder without contrast. Coronal oblique and sagittal oblique reformats were obtained. 3-D reconstructions were performed on an independent workstation. There is deficiency of the anterior/inferior glenoid as seen on the prior MRI examination. This results in loss of articulating surface along the inferior aspect of the glenoid. We are uncertain whether this is congenital or due to long-standing trauma (i.e., repeated anterior dislocations). Currently, the margins of the glenoid are corticated.There is a curvilinear focus of calcification along the anterior/inferior margin of the glenoid. This measures just over 1 cm in greatest dimension. This may represent an old adherent fracture fragment or capsular calcification.Currently, the glenohumeral joint alignment is within normal limits. However, there is flattening of the postero-lateral humeral head, indicating Hill-Sachs deformity from prior dislocation.The bones are otherwise within normal limits. The soft tissues are within normal limits given the limitations of CT relative to MRI.

Output: Deficiency of the anterior/inferior glenoid which may be congenital or due to repeated anterior dislocations.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:1/28/1965)Reason: concern for brain metastases History: lung cancer, concern for brain metsPROVIDER/ATTENDING NAME: EVERETT E. VOKES EVERETT E. VOKES The CSF spaces are appropriate for the patient's stated age with no midline shift. Much of the imaging is degraded due to patient motion which may obscure more subtle abnormalities.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 diffuse marrow replacement present.

Output: 1.The extent of visualization there is no brain metastasis appreciated. Some of the imaging is degraded due to patient motion which may obscure more subtle abnormalities.2.There is diffuse marrow replacement present. This is a nonspecific finding. This could be seen with anemia, lymphoproliferative disorder, myeloproliferative disorder, chronic disease. It is nonspecific


Instruction: Generate impression based on findings.

Input: There is a solitary punctate focus of susceptibility hypointensity within the posterior aspect of the right frontal horn, likely sequela of remote microhemorrhage versus mineralization within the choroid.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 acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is present within right mastoid air cells. The left mastoid air cells and bilateral middle ear cavities are clear.. There is no abnormal enhancement within the brain.

Output: 1.There is a solitary punctate focus of susceptibility hypointensity within the posterior aspect of the right frontal horn, likely sequela of remote microhemorrhage versus mineralization within the choroid.2.Fluid is present within right mastoid air cells.


Instruction: Generate impression based on findings.

Input: Male, 77 years old, with refractory left sciatica. A trace retrolisthesis of L5 relative to L4 and S1 is seen. Spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is observed.The visualized spinal cord, conus and nerve roots of the cauda equina are intact.Loss of disc T2 signal is seen at L4-5 and L5-S1. The discs demonstrate relative preservation of height. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Minimal laterally bulging disc. No significant spinal canal or foraminal stenosis. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Minimal laterally bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc asymmetric to the right foraminal zone. Mild spinal canal stenosis. Moderate bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing.

Output: Relatively mild degenerative findings are seen which result in a mild spinal canal stenosis at L4-5, mild bilateral foraminal narrowing at L4-5, and moderate to severe bilateral foraminal narrowing at L5-S1.


Instruction: Generate impression based on findings.

Input: Male, 31 years old, with backache. Assess for herniated disk. Five fully lumbar type vertebral bodies are present. The S1 vertebral body demonstrates a transitional morphology.Vertebral body morphology is within normal limits. No pathologic marrow replacement or evidence of marrow edema is seen. No abnormal marrow enhancement is detected.The visualized spinal cord, conus and cauda equina are within normal limits. No pathologic intrathecal enhancement is seen.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L4-5: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L5-S1: Moderate facet hypertrophy. Mild bulging disk. Left subarticular/foraminal protrusion. Mild effacement the left lateral recess. Moderate to severe left neuroforaminal narrowing. The right neural foramen is patent.

Output: 1.A left subarticular/foraminal disk protrusion is evident at L5 S1. This finding, along with moderate facet hypertrophy, results in moderate to severe narrowing of the left neural foramen at this level. No significant generalized spinal canal stenosis is seen.2.Mild degenerative findings at additional levels as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Chiari, tethered cord, new symptoms, please do be CSF flow study and tethered cord protocol. Signs and symptoms: Headache and back pain. Nonenhanced lumbar MRI:Comparison of lumbar sagittal T2 weighted images in supine and prone position demonstrate noticeable anterior movement of the lower thoracic cord and conus and proximal cauda equina.There is a moderately expansile syrinx of the lower most visualized thoracic cord and conus (from T10 inferiorly) and without appreciable change since prior study. There is no detectable signal abnormality of the cauda equina. There is termination of the cord at lower L1 level.There is normal signal intensity, anatomical morphology and the alignment of the vertebral column. No evidence of a spinal canal or neural foraminal compromise. Unremarkable paraspinal soft tissues.Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates expected postoperative changes of Chiari decompression with resultant expansion of the subarachnoid space.There is normal anatomical development of the brain and with normal signal intensity on all MRI sequences otherwise.Unremarkable CT cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.CSF flow study:The inferior pole of the cerebellar tonsil demonstrate a pointed deformity projecting inferiorly and inseparable from the dura at the surgical site which is best appreciated on sagittal T1 weighted images as well as 3-D fiesta sequence. This finding is highly suspected for a focus of adhesion.There is no detectable abnormality at the level of the quadrigeminal plate and the aqueduct.CSF flow study demonstrate presence biphasic flow anteriorly through the foramen magnum without evidence of compromise. The biphasic pulsation of CSF posterior to the cord appears to abruptly terminate at the level of cerebellar tonsils and without detectable flow posterior to the tonsils. Very subtle fro through the inferior fourth ventricle is dictated.

Output: 1.Nonenhanced MRI of the lumbar spine demonstrate noticeable anterior movement of the lower thoracic cord, conus and proximal cauda equina on prone sagittal T2 weighted images compared to supine series. No tethered cord. There is termination of cord at lower L1 level. No detectable signal abnormality of the cauda equina. Lower most visualized thoracic cord from T10 inferiorly demonstrate moderately expansile syrinx without interval change since prior study.2.Nonenhanced MRI of brain demonstrate post operative changes of Chiari decompression with expected expansion of subarachnoid space as detailed. Unremarkable intracranial content otherwise. There is pointed deformity of the inferior pole of the cerebellar tonsil projecting inferiorly and inseparable from the surgical site which is suspected for adhesion. CSF flow study demonstrate presence of biphasic flow anteriorly through the foramen magnum. The biphasic pulsation of CSF posteriorly terminates at the level of cerebellar tonsils. Subtle biphasic flow in the inferior aspect of the fourth ventricle is detected.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for progression; stenosis History: neck pain; paresthesias The cervical vertebral bodies are appropriate in overall alignment and height. There is some signal change within the upper thoracic spinal cord and lower cervical spine spinal cord which was also present on the prior exam. It predominantly involves the central portion of the spinal cord.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. There is a disk bulge present at this level associated with small uncovertebral osteophytes.At C5-6 there is no significant compromise to the spinal canal. There is a minor disk bulge present at this level associated with some small endplate and uncovertebral osteophytes and some narrowing of the neural foramina bilaterally with mild encroachment of the exiting nerve roots. Overall there is no significant change when compared to prior exam.At C6-7 there is no significant compromise to the spinal canal . There is a minor disk bulge present at this level associated with some small endplate and uncovertebral osteophytes.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Single changes within the central portion of the lower cervical spinal cord and upper thoracic spinal cord are stable when compared to the prior exam.2.There some mild degenerative changes present in the cervical spine without significant compromise of the spinal canal or exiting nerve roots. There only mild encroachment of the exiting nerve roots at C5-6 due to degenerative changes.


Instruction: Generate impression based on findings.

Input: Prostate cancer status post surgery with elevating PSA. 8/19/2015 0.41 PELVIS:PROSTATE: Status post prostatectomy.BLADDER: There is asymmetric dorsal bladder wall soft tissue thickening (series 1001/21) which demonstrates postcontrast enhancement and is suspicious for local tumor recurrence extending from the cystourethral junction (series 502 image 89). The lesion measures 2.6 x 0.5 x 2.2 cm.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings suspicious for tumor recurrence involving the right dorsal bladder wall extending from the cystourethral junction.


Instruction: Generate impression based on findings.

Input: Male, 43 years old, with recurrent nasopharyngeal cancer, just completing induction chemotherapy. Restaging exam. Infiltrative enhancing tumor centered on the upper left carotid space is again seen. As before, this lesion infiltrates through the left hypoglossal canal with mild encroachment on the left cerebellar medullary angle, as well as into the left jugular foramen. The size and overall appearance of this lesion have not significantly changed from the prior examination. The lesion measures approximately 30 mm x 24 mm, previously 30 mm x 25 mm. Loss of the flow void at the level of the left sigmoid sinus is seen likely indicating lack of flow or very slow flow.Thickening of the left nasopharyngeal mucosa is again seen with effacement of of the left fossa of Rosenmuller, not significantly changed. No discrete masslike lesion is seen. Marrow replacement and enhancement within the clivus is unchanged.The brain parenchyma shows normal morphology and signal characteristics. No evidence of edema or mass effect is seen. No pathologic parenchymal or leptomeningeal enhancement is identified. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.The left carotid space tumor which infiltrates through the hypoglossal canal and jugular foramen shows no significant interval change in size or morphology.2.Effacement of the left fossa of Rosenmuller and marrow replacement with enhancement in the clivus are stable findings as well.3.No evidence of any brain parenchymal metastatic disease is seen.


Instruction: Generate impression based on findings.

Input: Asymmetric patellar reflexes with decreased reflexes over left patella. Lumbar radiculopathy. Right leg pain. Please note there is variant lumbosacral anatomy and for the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. As numbered there appears to be hypoplastic ribs associated with L1. Vertebral body heights are normal. There is grade 1 anterolisthesis of L4 and L5. Alignment is otherwise maintained. Bone marrow signal is benign. Conus is in normal position. There are multilevel degenerative changes with disc desiccation from L2-L3 to L5-S1 with minimal loss of height. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disc bulge without significant spinal canal or neural foraminal stenosis.L3-L4: There is mild disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening. There is no significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis. L4-L5: There is bilateral facet arthropathy and grade 1 anterolisthesis. There is disc uncovering and minimal bulge. There is minimal central spinal canal narrowing. There is mild to moderate right and moderate to severe left neural foraminal stenosis where there may be impingement of the left exiting L4 nerve root. L5-S1: There is disc bulge and advanced bilateral facet arthropathy. There is severe right and moderate left neural foraminal stenosis. There is partial effacement of the right lateral recess. No significance central canal stenosis.Postcontrast sequences demonstrate enhancement associated with the left L4-L5 and L5-S1 facet arthropathy most likely on a degenerative basis. There is enhancement of the left foraminal L4 and right L5 nerve roots which is most likely related to the proximal stenoses. There is also mild enhancement involving the cauda equina nerve roots/dorsal dural surface at the L4-L5 level which are of uncertain significance but may be related to the adjacent L4-L5 facet arthropathy, spinal stenosis--although it is relatively mild, or less likely a separate inflammatory process.

Output: 1. Degenerative changes in the lumbar spine, particularly at the L4-L5 and L5-S1 levels. There is grade 1 L4-L5 anterolisthesis. There is up to moderate to severe neural foraminal stenosis on the left at L4-L5 and on the right at L5-S1 where there may be impingement of the left L4 and right L5 exiting nerve roots. Additional levels as above.2. There is enhancement involving and surrounding the left L4 foraminal nerve root as well as the right L5 nerve root which is most likely on a degenerative/compressive basis. There is also subtle enhancement involving the cauda equina nerve roots at the L4-L5 level which may be on a degenerative basis/reactive process; a separate inflammatory process involving the cauda equina nerve roots is felt to be less likely but not entirely excluded. 3. Please note comment regarding lumbosacral vertebral numbering above.