Instruction: Generate impression based on findings.

Input: ovarian cancer. mullerian duct. evaluate for metastases. 22 years old female. The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine. The known lesions in the cervical spine identified on MRI exam from a couple days ago are not detected on the CT scan.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.

Output: 1.No fractures are identified in the cervical spine.2.The patient's metastases cannot be detected on the CT of the cervical spine.


Instruction: Generate impression based on findings.

Input: Reason: labral tear? stress fracture? History: hip pain ACETABULAR LABRUM: A tear is present in anterosuperior labral, with contrast material filling the labral defect.ARTICULAR CARTILAGE AND BONE: No articular cartilaginous defect is identified.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Findings compatible with a tear through the anterosuperior labrum.


Instruction: Generate impression based on findings.

Input: Evaluate for developmental anomaly underlying lipoma of the midline forehead associated with overlapping capillary malformations. There is a subcentimeter fat-signal lesion in the midline of the frontal scalp. There is no evidence of intracranial extension. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable.

Output: A subcentimeter lipomatous lesion in the midline of the frontal scalp, without evidence of intracranial extension or intracranial anomalies, is compatible with a lipoma.


Instruction: Generate impression based on findings.

Input: Reason: ? medial meniscus tear History: catching/pain MENISCI: Menisci are intact.ARTICULAR CARTILAGE AND BONE: There a 2 foci of near full-thickness fissuring along the lateral patellar facet. The articular cartilage along the medial patellar facet, trochlea and medial and lateral compartments is intact.LIGAMENTS: The ACL and PCL are intact. There are 2 subcentimeter cysts at the ACL insertion. The medial and lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.No evidence of meniscal tear.2.Near full-thickness fissuring along the articular cartilage of the lateral facet of the patella.3.Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for cervical stenosis/myelopathy. Signs and symptoms: History of cervical laminectomy in 2006. Nonenhanced cervical MRI:Examination redemonstrated multilevel posterior laminectomy from C3 through C6 with resultant expansion of thecal sac and no evidence of central spinal stenosis at any level.Examination also redemonstrates a short segmental patchy foci of T2 hyperintensity decreased cord caliber consistent with myelomalacia at C4 level without interval change since prior exam.Foramen magnum is unremarkable.C2 -- C3 demonstrate moderate disk disease and loss of disk height, no central spinal stenosis and bilateral neural foraminal compromise without appreciable change since prior exam.C3 -- C4 demonstrate advanced disk disease with near complete loss of disk height, grade 1 retrolisthesis and no central spinal stenosis. Severe right and moderate left neural foraminal compromise without change since prior exam.C4 -- C5 demonstrate advanced disk disease, significant loss of disk height and suspected partial fusion at the disk level. Significant bilateral neural foraminal compromise and no central spinal stenosis. No appreciable interval change since prior exam.C5 -- C6 demonstrate advanced disk disease significant bilateral neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate moderate disk disease and loss of disk height, significant right and moderate left neural foraminal compromise and no central spinal stenosis. No appreciable interval change since prior exam.C7 -- T1 demonstrate advanced disk disease, mild to moderate bilateral ligamentum flavum hypertrophy, no convincing evidence of central spinal stenosis all of her significant bilateral neural foraminal compromise is noted. There is no appreciable interval change since prior exam.Similar to prior exam there is mild reversal of cervical lordosis centered at C6 level.

Output: 1.Postoperative changes of multilevel laminectomies from C3 through C6 without change since prior exam.2.No evidence of central spinal stenosis at any level and similar to prior exam.3.Short segmental myelomalacia and decreased cord caliber at C4 similar to prior exam.4.Multilevel bilateral neural foraminal compromise (some significantly) as detailed and without appreciable interval change since prior study.


Instruction: Generate impression based on findings.

Input: 63-year-old with a strong family history of breast cancer. Mild parenchymal enhancement is noted bilaterally. Mild fibroglandular tissue is present. No abnormal enhancement is seen in either breast. Stable benign intramammary lymph nodes are again noted. A benign oil cyst is noted in the left medial breast. This was also present on the prior mammogram.No abnormal axillary lymph nodes are identified in either axillary region.Several high T2 hepatic cysts are present.

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


Instruction: Generate impression based on findings.

Input: Chiari malformation, abnormal increased growth. Pituitary: There is a non-enhancing, intrinsically T1 hyperintense lesion located between the adenohypophysis and neurohypophysis that measures up to 9 mm. The infundibulum is intact. The optic apparatus and cavernous sinuses are intact. The imaged portions of the brain parenchyma are unremarkable.Complete Spine: The cerebellar tonsils are not low-lying. The spinal cord displays normal signal and morphology. 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 a right sacral perineural cyst that measures up to 17 mm. There is no significant spinal canal stenosis. There is The paravertebral soft tissues are unremarkable.

Output: 1. Findings compatible with a subcentimeter Rathke cleft cyst.2. No evidence of Chiari malformations of spinal cord lesions.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Right temporal mass. Assess extent of resection. There are findings related to the recent right temporal craniotomy for resection of a left temporal mass. There is residual abnormal enhancement along the posterior and medial surgical margins, measuring up to 8 mm in thickness. The surgical cavity contains filled with heterogeneous fluid and gas. The associated extensive surrounding vasogenic edema with associated partial ventricular effacement and 6 mm midline shift are unchanged. There is mild diffusion restriction along the surgical margin. Otherwise, there is no acute territorial infarct. There is an area of susceptibility effect within the right temporal lobe posterior to the surgical cavity that measures up to approximately 25 mm. The 10 mm enhancing focus in the anterior right temporal lobe is unchanged. There are bilateral lens implants.

Output: 1. Recent right temporal craniotomy for resection of a left temporal mass, with residual tumor along the posterior and medial surgical margins, measuring up to 8 mm in thickness, and extensive surrounding tumor infiltration and/or edema. 2. A smaller lesion in the anterior right temporal lobe likely represents additional tumor.3. Intraparenchymal hemorrhage within the right temporal lobe posterior to the surgical cavity that measures up to approximately 25 mm appears unchanged, accounting for differences in technique.


Instruction: Generate impression based on findings.

Input: Reason: transverse myelitis please eval for brain involvement History: TM new onset The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a vague signal hyperintensity on T2 and flair MRI along the middle cerebellar peduncles bilaterally (right more than left) and left midbrain . There is not associated contrast enhancement and no associated micro-hemorrhage.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses there is partial opacification of the right maxillary sinus with an air-fluid level in the right maxillary sinus. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: 1.Vague signal hyperintensity in the middle cerebellar peduncles (right more than left) and left midbrain is a nonspecific finding. It could relate demyelination or other inflammatory process such as a viral illness or other inflammatory process.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Air-fluid level in the right maxillary sinus is non-specific but could relate to acute sinusitis.


Instruction: Generate impression based on findings.

Input: 27-year-old female with pain and clicking after fall. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is edema within the medial lateral condyle which may be secondary to contusion. There is slight heterogeneity of the articular cartilage along the undersurface of the patella. The remaining articular cartilage appears intact.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Bone marrow edema within the medial lateral condyle which may be secondary to direct contusion. No evidence of meniscal injury, ligamentous injury, or loose body.


Instruction: Generate impression based on findings.

Input: Reason: extend to mid femur; Run as pelvis bone study, patient with hx of T12 paraplegia as child, s/p multiple debridement, with open wound probing to wound along lateral right hip, any sign of new abscess? Extent of osteo or sequestra? History: possible acute on chronic osteo The patient has undergone disarticulation of the right hip. There is a defect traversing the soft tissues from the skin posteriorly to the top of the remaining femur containing fluid and gas. Tracts of fluid extend anteriorly from this defect along the medial and lateral margins of the proximal femur and also superiorly along the proximal end of the remaining femur, where there is additional gas density. There is abnormal signal intensity and enhancement within the proximal femur indicating osteomyelitis. Fluid also extends medially toward a chronically deformed ischium which also shows focal signal abnormality compatible with osteomyelitis. There is extensive inflammation of the surrounding soft tissues.Additionally, there is a large heterogeneous rim-enhancing fluid collection measuring 15.8 x 7.4 x 9.4 cm, more anteriorly within the thigh, extending from the proximal femur laterally to the deformed right pubic bone medially, subjacent to the femoral vessels, compatible with abscess formation. There is abnormal signal intensity within the superior and inferior pubic rami of the right pubic bone compatible with osteomyelitis. This abscess does not clearly communicate with the posterior wound; however, there is a band of intermediate signal intensity extending to the skin surface, anteriorly, that presumably represents sinus tract formation. Once again there is extensive inflammation within the adjacent soft tissues. Additionally, portions of the right femoral vein are not well visualized along the anterior aspect of the abscess suggesting compression.There is chronic appearing deformity of the right iliac wing with signal abnormality that may reflect the sequela of acute on chronic infection. Evaluation of the sacrum is limited by metallic susceptibility artifact related to the patient's orthopedic hardware. Additional ulcerations are identified along the posterolateral aspect of the left hip. One of these ulcerations appears to extend to the level of the greater trochanter of the left femur, but we see no specific imaging features of osteomyelitis affecting the greater trochanter on the left. There is an additional sinus tract which extends inferiorly from the ischial tuberosity to the skin surface with associated deformity and abnormal signal intensity within the left ischium likely representing a combination of acute and chronic osteomyelitis. There is profound atrophy of the musculature of the pelvis and upper thighs. Note is made of a left lower quadrant colostomy. There is a Foley catheter in place within the bladder. Although this examination was not protocoled for detailed evaluation of the pelvic viscera, the bladder wall appears thickened which may represent a cystitis. Note is made of right inguinal and obturator lymphadenopathy which may be reactive.Incompletely imaged on this study is an approximately 3.5 cm mass of low signal intensity just proximal to the aortic bifurcation that likely represents an aneurysm and can be further evaluated with CT angiography.

Output: 1. Extensive soft tissue ulceration as well as a large abscess anteriorly within the proximal right thigh with osteomyelitis of the remaining proximal femur and bones of the pelvis as described above.2. 3.5 cm mass of low signal intensity proximal to the aortic bifurcation likely represents aneurysm formation and can be further evaluated with CT angiography.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: 26-year-old male with leukemia and. Acute intracranial hemorrhage, evaluate for progression. Signs and symptoms: Acute intracranial hemorrhage. Unenhanced head CT:Examination demonstrate a small acute hematoma in the cortex of the right frontal lobe measuring 8.2 x 4 0.9-mm in size similar to prior MRI exam. Very subtle surrounding vasogenic edema is present.A second smaller left paramedian high convexity frontal hematoma measuring 6 x 4.4-mm in size and very minimal surrounding edema is also similar to prior exam.There is no evidence of any additional foci of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The ventricular system remains within normal limits and midline is maintained.A small arachnoid cyst at the level of pineal cistern is also similar to prior MRI exam finding.

Output: 1.Stable size and minimal surrounding edema of bilateral frontal parenchymal hematomas when compared with prior MRI exam.2.No evidence of any additional new findings since prior studies.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: No significant abnormality noted. Menisci appear intact and well anchored posteriorlyARTICULAR CARTILAGE AND BONE: Cartilaginous surfaces are entirely intact and homogeneous without focal defects. Marrow signal unremarkable, however a discrete focal cyst like abnormalities observed in the posterior femoral metaphysis along the medial aspect. This cystic changes discrete with a suspected sclerotic margin representing a suspected benign-appearing cortical defect.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Suspected benign cortical cyst in the distal femoral metaphysis laterally


Instruction: Generate impression based on findings.

Input: A 69 year old female asymptomatic who had a routine echocardiography which showed a left atrial mass. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with nromal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 74 ml/m2 (normal range: 65+/-11), the LVEDV is 126 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 46 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 63 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. A mass attached to the inter-atrial septum was noted with the following characteristics: short peduncle, some mobility, mildly heterogeneous, hyperintensive in T1 and T2 images, no fat component, same enhancement that suggest mild perfusion. The mass is not invading structures around it. The size is 22:15 mm. The anterior leaflet of the mitral valve contact the mass during systole. Based on location and statistic, the most common diagnosis is myxoma. Other tumors with perfusion cannot be ruled out. The T1 hyperintensity seen might be explained by a component of hemorrhage. Right VentricleThe right ventricle is normal in size . The overall RV ejection fraction is 55%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size with normal systolic function. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with nromal systolic function, the LVEF is 64%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size , the RVEF is is 55%. 3. A mass attached to the inter-atrial septum was noted with the following characteristics: short peduncle, some mobility, mildly heterogeneous, hyperintensive in T1 and T2 images, no fat component, same enhancement that suggest mild perfusion. The mass is not invading structures around it. The size is 22 x 15 mm. The anterior leaflet of the mitral valve contact the mass during systole. Based on location and statistic, the most common diagnosis is myxoma. Other tumors with perfusion cannot be ruled out. The T1 hyperintensity seen might be explained by a component of hemorrhage. 4. The left atrium is normal in size. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49-year-old man with history of hepatitis C and NASH. ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged and cirrhotic in morphology with nodular contour and widened fissures. No evidence of steatosis on in and out of phase imaging. No enhancing focal hepatic lesion identified. Please note that the inferior pole of the liver was imaged only in delayed phase.The gallbladder is distended with sludge but normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly without signal abnormality or focal lesion.PANCREAS: Small area of interdigitating fat within the body of the pancreas (1700/70), the pancreas is otherwise unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple renal cysts noted, otherwise no significant abnormality.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: Cirrhotic liver and splenomegaly without focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of unspecified ovary Disorder of brain, unspecifiedClinical question: 45yo female with ovarian cancer and nonspecific brain lesion seen on PET, recommended f/u MRI to further characterizeSigns and Symptoms: brain lesion on PET There is a mass measuring 19 x 23 mm sagittal dimensions and 17 x 17 mm axial dimensions located along the right occipital pole. It is associated with foci of susceptibility effect as well as a vasogenic pattern of edema.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses with more mucosal thickening in the right maxillary sinus compared to the left.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: A hemorrhagic mass in the right occipital lobe is suspicious for metastatic disease.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, new onset ataxia. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The pituitary gland is within normal limits. The corpus callosum is fully formed and intact. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable. The pattern of white matter myelination is appropriate for age.Bone marrow signal characteristics are within normal limits. Paranasal sinus inflammation is detected.

Output: Unremarkable evaluation of the brain.


Instruction: Generate impression based on findings.

Input: Low back pain and sciatica. Splenectomy and hysterectomy. There is disc space narrowing and dessication along with a central disc protrusion and mild facet and ligamentum flavum hypertrophy at L5-S1 that results in compression of the descending S1 nerve roots, right greater than left, but no significant neural foramen compromise. There is no significant disc bulge or herniation at the other lumbar vertebral levels. The vertebral column alignment is within normal limits. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The imaged portions of the spinal cord display normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis at L5-S1 with a disc protrusion that results in compression of the descending S1 nerve roots, right greater than left.


Instruction: Generate impression based on findings.

Input: 79 year old woman with history of severe coronary calcification on CT, HTN, HL and an abnormal nuclear stress test who was referred for vasodilator stress cardiac MRI for further evaluation.MEDICATIONS: rosuvastatin, nebivolol, lisinopril, amlodipine First Pass PerfusionNo evidence of ischemia.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 59 ml/m2 (normal range: 65+/-11), the LVEDV is 95 ml (normal range 109+/-23), the LV end systolic volume index is 51 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 76 g. There are no regional wall motion abnormalities present.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is mildly thickened and opens widely.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation. Dedicated evaluation was not performed.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a rounded low-intensity signal focus at the last slice at the inferior field of view on axial images (301/1) measuring 9 x 9 mm. In the absence of outside imaging, recommend a CT thorax for further evaluation, to exclude pulmonary nodule. Mild levoscoliosis of the thoracolumbar spine.

Output: 1. No evidence of ischemia or myocardial infarct.2. Normal LV size and systolic function (LVEF 64%).3. Normal RV size and systolic function (RVEF 56%).4. A rounded focus is noted at the right costophrenic sulcus, incompletely imaged. If outside comparison imaging is not available, further evaluation with a CT thorax is recommended to exclude a pulmonary nodule.


Instruction: Generate impression based on findings.

Input: Right sciatica. Rule out disc disease. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The cord signal intensity is within normal limits. The conus medullaris on sagittal imaging is grossly intact. There are mild degenerative changes of the visualized lower thoracic spine.T12-L1 through L3-4: Mild degenerative changes are noted but there is no significant compromise to spinal canal or neural foramina.L4-5: There is a large broad based disc protrusion across the ventral thecal sac greater on the right as well as mild facet degenerative changes and severe ligamentum flavum hypertrophy. These constellation of findings causes moderate to severe central spinal canal stenosis and severe right neural foraminal stenosis as well as severe right lateral recess compromise. There is also mild to moderate left neuroforaminal stenosis. Increased STIR signal within the L4-5 disc as well as the adjacent endplates are noted greater along the inferior endplate. Given the abnormal signal intensity within the disc, follow-up MRI with contrast is recommended to rule out discitis.L5-S1: Mild degenerative disease and moderate facet degenerative changes but no significant compromise to spinal canal or neural foramina. A small synovial cyst is noted projecting posteriorly from the right articular facet measuring 6 x 9 mm.Note is made of severe renal atrophy.

Output: 1.Large broad base disc protrusion at the L4-5 level, facet degenerative changes and advanced ligamentum flavum hypertrophy causes moderate to severe central canal stenosis, severe right neuroforaminal and right lateral recess compromise.2.Increased T2/STIR intensity within the L4-5 disc as well as within the adjacent vertebral body endplates is likely degenerative but follow-up contrast MRI imaging is recommended to rule out the possibility of discitis.


Instruction: Generate impression based on findings.

Input: 17-year-old male with hypothyroidism. Evaluate for thyroid nodules.EXAMINATION: Sonogram thyroid 11/21/2016 3:30 Evaluation is limited secondary to patient positioning, unable to extend neck.RIGHT LOBE MEASUREMENTS: 3.5 cm x 1.1 cm x 0.8 cmLEFT LOBE MEASUREMENTS: 1.2 cm x 0.7 cm, unable to obtain a longitudinal measurement secondary to the above limitations and size of the left thyroid lobe.ISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Demonstrates homogeneous echotexture with no discrete nodules are identified.LEFT LOBE: The left thyroid lobe is asymmetrically smaller compared to the right. No discrete nodules are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited evaluation as above.The left thyroid lobe is asymmetrically smaller compared to the right. No discrete nodules identified.


Instruction: Generate impression based on findings.

Input: Reason: eval lumbar stenosis History: LBP, radiating bilateral pain into buttocks Alignment is anatomic. No abnormal marrow signal. Vertebral body heights are maintained. Multilevel disc desiccation without significant disc space loss. No abnormal signal within the distal cord or conus which ends at L1-L2. Small terminal ventricle.T12-L1: No spinal or neuroforaminal stenosis.L1-L2: No spinal or neuroforaminal stenosis.L2-L3: Minimal diffuse disc bulge. No spinal or neuroforaminal stenosis.L3-L4: Mild diffuse disc bulge. Ligamentum flavum hypertrophy. Bilateral facet arthropathy and effusions. Mild narrowing of the central canal but no significant crowding of the cauda equina. No neuroforaminal stenosis. Overall similar to prior exam.L4-L5: Diffuse disc bulge. Ligamentum flavum hypertrophy, particularly on the left. Bilateral facet arthropathy and effusions. Mild effacement of the ventral thecal sac, however there is no significant canal stenosis. Mild right neuroforaminal stenosis. No left neuroforaminal stenosis. Overall similar to prior exam.L5-S1: Diffuse disc bulge. No spinal canal stenosis. No neural foraminal stenosis. Overall similar to prior exam.Small bilateral renal cysts.

Output: Mild narrowing of the central canal at L3-L4 but no significant crowding of the cauda equina. Overall unchanged from prior exam.


Instruction: Generate impression based on findings.

Input: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus [G40.219], Reason for Study: ^Reason: epilepsy History: seizures There is laser ablation probe inserted through the right occipital burr hole and the tip is located at the right mesial temporal lobe, hippocampus head.MRI with contrast enhancement shows tubular shaped enhancing cavity around the inserted probe indicating tissue with ablated area.There are linear enhancing lesions on the right temporal and occipital lobes indicating prior tracks of previously inserted probes through the right temporal and occipital burr holes. Sulcal effacement of the lateral aspect of the right temporal lobe are seen indicating postoperative changes.The ventricles, sulci and cisterns are unremarkable.

Output: 1. Right occipital burr hole approached laser ablation probe located at the right hippocampal head.2. Post enhancement scan shows tubular enhancement around the tip of the probe indicating post ablation changes.3. Additional linear to tubular enhancing areas around the temporal and occipital lobes indicate prior probe insertion track. No postoperative unusual finding.


Instruction: Generate impression based on findings.

Input: Left patella excision and knee reconstruction in April 2016 for malignant giant cell tumor, restaging Again seen are surgical changes of the knee including patellar resection and soft tissue reconstruction. The medial head of the gastrocnemius has been transposed as a flap along the anteromedial aspect of the proximal tibia. This graft is contiguous with a reconstructed extensor mechanism which can be traced to its insertion on the tibial tuberosity distally and the quadriceps tendon proximally. The reconstructed tendon appears thickened with heterogeneous increased signal on short TE sequences, which may represent degeneration or tendinosis but this appears similar to the prior examination and there is no evidence of a full-thickness tear.There is mild thickening and enhancement of the skin of the knee. Additionally, there is bandlike enhancing tissue traversing the subcutaneous fat of the knee which likely represents scarring. Heterogeneous enhancement of the reconstructed extensor tendon is noted with additional amorphous enhancement anterior to the biceps femoris muscle. Although it is impossible to exclude small tumoral deposits, this changes appears improved from the prior examination and likely represent scarring as there is no dominant focus of nodular enhancement to confirm recurrence.Metallic susceptibility artifact is seen along the anterior tibial tuberosity. There is a moderate-sized joint effusion with mild enhancement of the synovium indicating synovitis. The underlying bone marrow is of normal signal. There is diffuse edema of the subcutaneous fat which also appears improved from the prior exam.Although not tailored for the evaluation of the internal structures of the knee, the menisci and collateral ligaments appear intact.

Output: Redemonstration of surgical changes relating to soft tissue reconstruction of the knee. Again seen is amorphous enhancement of the surrounding soft tissues but this has decreased from the prior examination and likely represents improving inflammation. Again, there is no dominant nodular focus of enhancement to suggest residual or recurrent disease although small tumoral deposits cannot entirely be excluded.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with headaches, history of pituitary lesion, six month follow-up. A heterogeneous, slightly hypoenhancing and perhaps partially cystic/necrotic mass is evident within the right aspect of the sella. The lesion measures up to 19 mm TV, 15 mm CC, and 15 mm AP. Measurements are inclusive of a portion of the lesion which appears to involve the right cavernous sinus. The lesion projects superiorly into the suprasellar cistern and may just contact the optic apparatus. It appears that the native pituitary gland drapes along the left aspect of the tumor. The pituitary stalk likewise deviates to the left of the lesion.The brain demonstrates normal morphology. A few scattered T2 hyperintense lesions are seen in the periventricular white matter, a nonspecific finding. No restricted diffusion is evident. No edema or mass effect is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology. No pathologic intracranial enhancement is seen.

Output: 1.A masslike lesion is evident involving the right aspect of the sella and the right cavernous sinus with slight encroachment on the suprasellar cistern. The lesion is favored to represent a macroadenoma.2.No other significant lesions are evident in the brain.


Instruction: Generate impression based on findings.

Input: 57 year old with metastatic kidney cancer. Pretreatment evaluation for progression. Postoperative changes in the right frontal lobe with dural thickening and bony destruction is unchanged from prior CT and probably represents dural metastasis when correlated with the prior MRI. Additional lesion in the greater wing of the right sphenoid appears unchanged.The ventricles and basal cisterns are unchanged in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No interval change of renal cell metastases to the brain.


Instruction: Generate impression based on findings.

Input: Male 53 years old; Reason: known osteomyelitis in R foot, now septic with unclear source. Red, painful leg. RIGHT FOOT: The patient is status post amputation of the fourth ray through the fourth metatarsal, and status post amputation of the distal half of the fifth metatarsal. There are associated soft tissue changes including scarring and foci of metallic susceptibility artifact. Soft tissue defect at the lateral aspect of the forefoot near the site of the fifth metatarsal amputation with underlying signal abnormality in the soft tissues possibly represents a combination of scarring and inflammation. No discrete fluid collection is seen to suggest abscess. No marrow signal abnormality is seen to confirm osteomyelitis. Edema is present in the dorsal soft tissues of the foot. Mild edema and atrophy of the plantar musculature of the foot is noted. There are foci of metallic susceptibility artifact in the plantar soft tissues beneath the first metatarsal neck, which limit evaluation of the surrounding structures.RIGHT TIBIA/FIBULA: There is edema within the subcutaneous fat. Mild signal abnormality in the musculature likely represents a combination of atrophy and edema. No fluid collection is seen to suggest abscess. The bone marrow signal is normal. No findings are seen to confirm osteomyelitis. A knee joint effusion is seen, though incompletely imaged on this exam. Similar findings are noted in the contralateral leg on the large FOV series.

Output: Postoperative and soft tissue inflammatory changes, as described above. No findings to suggest osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: History of dilated pancreatic duct. No pancreas mass. 1 year surveillance per last MRI recommendations. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. Several subcentimeter hepatic cysts are again noted. The hepatic vasculature appears patent.There is no intrahepatic biliary ductal dilatation. The common bile duct measures up to 7 mm without an obstructing stone or discrete lesion. It tapers smoothly at the major ampulla. The gallbladder is within normal limits without cholelithiasis. SPLEEN: The spleen is normal in size and signal intensity without a discrete lesion.PANCREAS: The pancreas is normal in morphology signal intensity and enhancement. The main pancreatic duct remains minimally prominent, however it is better visualized today extending all the way into the pancreatic tail without evidence of stricture. The main pancreatic duct appears to drain at the major ampulla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Bilateral renal cysts. Intrinsically T1 weighted hyperintense lesion in the right superior pole demonstrates no enhancement on subtraction images and is compatible with a proteinaceous/hemorrhagic cyst. No suspicious renal lesions.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.Stable nonenhancing lesion in the right kidney compatible with a hemorrhagic/proteinaceous cyst.2.No evidence of pancreatic duct stricture as previously questioned.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There is extensive, mainly confluent and periventricular, bilateral cerebral white matter T2 hyperintensity with areas of associated T1 hypointensity. There are also a small areas of T2 hyperintensity in the medial left middle cerebellar peduncle and medial left cerebellar hemisphere white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. 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: Extensive white matter disease related to multiple sclerosis with associated cerebral volume loss, but no evidence of acute inflammatory lesions.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: R MCA History: Left sided weakness. Brain MRIRestricted diffusion on the right insular, right frontal lobe, right temporal lobe anterior aspect, right globus pallidus, right internal capsule posterior limb, and right cerebral peduncle indicating acute ischemic stroke. There are surrounding edema with mass effects with effacement of the right lateral ventricle. There is no evidence of midline shift.Posterior aspect of the ischemic stroke lesion shows curvilinear susceptibility artifacts on Gradient echo images which likely represent cortical veins which were displaced due to local mass effects instead of hemorrhagic conversion. There is no evidence of hemorrhagic conversion. There are multifocal encephalomalacia at the right temporo-occipital lobe and left centrum semiovale indicating chronic stroke. The cranial-cervical junction are normal. Mucosal thickenings on the right maxillary sinus and ethmoid sinus.Opacifications on the right mastoid air cells.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate near total occlusion of the right MCA proximal M1 segment with minimal forward flow through a very tiny vascular structure which most likely represent anterior temporal branch. There are multifocal luminal narrowings on bilateral PCA P1 segments and left MCA M2 segment indicating atherosclerosis.There is no evidence of intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate luminal irregularities especially on the right extracranial ICA without evidence of luminal stenosis indicating possible fibromuscular dysplasia. Bilateral vertebral artery ostia appear to show mild to moderate (less than 50%) luminal stenosis. However, there is no evidence of significant (more than 50%) luminal narrowing on bilateral CCAs, and left extracranial ICA. Bilateral cervical vertebral arteries appear to be within normal limits. Bilateral subclavian arteries appear to be normal.

Output: 1. Right MCA territorial acute ischemic infarction involving right frontal lobe, right frontal operculum, right anterior temporal lobe, right insular, right basal ganglia, and right cerebral peduncle without evidence of hemorrhagic conversion.2. Near total occlusion of the right MCA at the proximal M1 segment with evidence of intracranial atherosclerosis.3. Multifocal chronic encephalomalacia at the right temporo-occipital lobe and left centrum semiovale.4. Irregular right extracranial ICA lumen indicating possible fibromuscular dysplasia.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with brain lesion, examination for surgical planning. A T2 hyperintense masslike lesion with a thin T2 hypointense rim is evident situated within the left postcentral gyrus. The lesion measures 23 x 16 mm in the axial plane. The lesion expands the postcentral gyrus with mild local mass effect. FLAIR hyperintensity suggesting edema surrounds the lesion and spreads medially towards the paracentral lobule and inferiorly to involve the parietal lobe and a small portion of the posterior frontal lobe.Numerous scattered small T2 hyperintense lesions, and ill-defined periventricular hyperintensity, may reflect the sequelae of microvascular ischemia. No abnormal extra-axial collections are seen. The ventricles are normal in size morphology.

Output: Limited imaging for surgical planning purposes demonstrates a masslike lesion within the left postcentral gyrus.


Instruction: Generate impression based on findings.

Input: Clinical question: 59-year-old male with an NSCLC with adrenal, liver, pelvis metastases, need MRI of brain for complete workup. Signs and symptoms: NSCLC. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a tiny focus of FLAIR hyperintensity in the subcortical white matter of left frontal lobe, small focus of FLAIR hyperintensity in the genuine of corpus callosum and a punctate focus of similar signal change in the white matter of left posterior temporal lobe, punctate foci in the left cerebellum and pons. Findings are nonspecific, nonhemorrhagic, nonenhancing. Considering patient's stated age differentials of mild chronic small vessel ischemic strokes or demyelinating disease should be considered. The overall anatomical morphology of the brain as well as its signal intensity remains otherwise within normal on all MRI sequences and without detectable abnormal enhancement to suggest metastatic disease.Calvarium and soft tissues of the scalp demonstrate normal signal intensity and without abnormal enhancement.Images through the orbits demonstrate a chronic blowout fracture of the left lamina papyracea and unremarkable otherwise.On paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No evidence of metastatic disease.2.Negative diffusion-weighted series and findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.


Instruction: Generate impression based on findings.

Input: 49-year-old female with a history of a low-grade salivary gland duct carcinoma of the right nasopharynx status post radiation therapy. There is redemonstration of polypoid enhancing mucosal lesion along the right nasopharyngeal mucosa, which has not significantly changed in size or appearance. The lesion measures approximately up to 13 mm. Otherwise, there is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass effect, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the maxillary sinuses. A left globe prosthesis is present. The skull and scalp soft tissues are grossly unremarkable.

Output: 1. No significant change in treated right nasopharyngeal tumor.2. No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (3/31/15, 4/6/15, 10/9/15, 11/2/15), ultrasound images of right breast (10/12/15), images from ultrasound guided biopsy and postprocedural right mammographic images (11/2/2015), breast MRI (11/10/2015), ultrasound images of right breast (11/12/2015), images from stereotactic needle biopsy of right breast and postprocedural right mammographic images (11/19/2015) performed at Presence St. Joseph Medical Center. For comparison, digital mammographic images (1/11/14) are available. DIGITAL MAMMOGRAPHIC IMAGES (3/31/15, 4/6/15, 10/9/15, 11/2/15): The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution.In the right breast at lateral aspect around 9:00 position, there are pleomorphic calcifications, including fine linear type with a developing focal asymmetry. The calcifications are extending segmentally in discontiguous fashion, measuring 60 x 40 mm (AP x LR). The focal asymmetry is present at posterior aspect of these calcifications, measuring 11 mm. There is another asymmetry seen best on CC view at medial anterior aspect of the right breast measuring 7 mm.A circumscribed oval mass with multiple coarse benign-appearing calcifications is present at 12:00 position in the right breast, likely a fibroadenoma.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/12/15):Ill-defined hypoechoic mass measuring 7 x 9 mm at 9:00 position with echogenic rim is detected, corresponding to the focal asymmetry seen on the mammogram at posterior aspect of the segmentally distributed calcifications.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/2/2015):Ultrasound guided biopsy was performed for the mass at 9:00 position with an appropriate needle placement. Postprocedural mammograms demonstrate a marker clip (Hydromark) at the site of the focal asymmetry at 9:00 position in the right breast.Per outside radiology report, the result was malignant.BREAST MRI (11/10/2015):The study was performed with a protocol outlined in the outside report.There are 2 enhancing masses in the right breast, one at 9:00 position measuring 19 x 13 x 12 mm (AP x LR x CC), and the other at 3:00 position measuring 14 x 21 x 11 mm. The one at 9:00 position is proven carcinoma and the marker clip is present at the anterior aspect of this mass. Non-mass enhancement is present between the two masses, measuring 49 x 71 x 20 mm.No abnormal enhancement is seen in the left breast.No abnormal lymph nodes are present in either axilla.ULTRASOUND IMAGES OF RIGHT BREAST (11/12/2015):The study was performed as second look ultrasound to look for a correlate of MR detected mass at 3:00 position in the right breast. No sonographic correlate was detected in this study.IMAGES FROM STEREOTACTIC NEEDLE BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/19/2015):Stereotactic biopsy was performed for the asymmetry best seen on CC view at medial right breast, because the asymmetry is likely correlating to the MR detected mass at 3:00 position. Postprocedural mammograms demonstrate a marker clip at upper inner aspect of the right breast, near the site of the enhancing mass seen on the MRI. Distance between 2 clips is 135 mm on CC view.Per outside radiology report, the biopsy result was malignant; invasive ductal carcinoma.

Output: 1. Biopsy proven carcinoma in the right breast, 2 sites; one at 9:00 position and the other at 3:00 position. Mammograms demonstrate suspicious calcifications segmentally at lateral right breast and MRI demonstrates extensive non-mass enhancement between the two malignant masses in the right breast.2. No mammographic or MR evidence of malignancy in the left breast.3. No MR evidence of abnormal lymph nodes in either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Lumbosacral spondylosis without myelopathy. Evaluate for lumbar stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Rounded areas of T1 and T2 hyperintensity involving L4, L2 and T11 vertebral bodies demonstrating dropout of signal on the STIR are in keeping with benign etiology such as hemangioma or focal fat. Multilevel degenerative changes are seen with endplate irregularity involving L2-L3 levels and Schmorl's nodes noted adjacent to the endplate at several levels. There is disc desiccation at multiple levels with scattered disc narrowing more pronounced at L2-L3 level.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc bulge with right-sided prominence is seen abutting the descending right L3 nerve root. There is mild right neural foraminal stenosis. No central canal stenosis. A lobulated hyperintense T2 lesion seen arising at the level of left L2-L3 facet joint and projecting dorsally most likely represents a synovial cyst.L3-L4: There is diffuse bulging of the disc with right-sided prominence causing moderate right foraminal stenosis and mild left foraminal stenosis. Mild central canal stenosis is seen at this level. There is facet hypertrophy and ligamentum flavum hypertrophy.L4-L5: There is disc bulging underlying a right foraminal protrusion causing severe right foraminal stenosis. There is moderate left foraminal stenosis. There is narrowing of the left lateral recess and moderate central canal stenosis. There are changes of facet arthropathy and ligament flavum hypertrophy.L5-S1: There is disc bulge along with superimposed disc protrusion causing right moderate foraminal stenosis. There is moderate facet arthropathy and ligamentum flavum hypertrophy at this level. There is effusion in the right facet joint. A tiny cystic structure is seen in the region of the right neural foramen likely abutting the exiting L5 nerve root, which may represent a nerve root sleeve cyst or synovial cyst. Mild indentation of the right thecal sac is noted.The right psoas muscle is smaller compared to the left. Otherwise, paraspinal soft tissues are unremarkable.There are rounded T2 hyperintense lesion in the bilateral kidneys measuring 4.2 x 4.2 cm on the right side and about 4.4 x 3.9 cm on the left side most likely cysts.

Output: 1. Multilevel moderate degenerative changes most pronounced at L4-L5 level with severe right foraminal stenosis and moderate central canal stenosis.2. Small cystic structure, likely a synovial cyst or perhaps a nerve root sleeve cyst, abutting the exiting right L5 root at the L5-S1 level.3. Rounded T2 hyperintense lesions in the bilateral kidneys, most likely cysts. Follow up ultrasound could be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: Female; 54 years old. Reason: Evaluate for cholangiocarcinoma History: PSC, elevated CA 19-9 and prior concern for Klatskin point lesion. LIVER, BILIARY TRACT: Multifocal areas of dilatation and stricturing are again noted in the intra and extrahepatic bile ducts, compatible with the patient's known primary sclerosing cholangitis with stable overall configuration. Stricture of the proximal common hepatic duct includes Klatskin's point and measures 1.5 cm in length, unchanged (series 3, image 63). Mild stricturing of the distal common bile duct is also similar to prior MRI and measures 3.1 cm in length (series 3, image 64). No definite intraductal lesions are noted. Stable small right liver cyst. No suspicious hepatic lesions. SPLEEN: No significant abnormality noted.PANCREAS: Scattered subcentimeter cystic lesions adjacent to the pancreatic duct may represent sidebranch IPMNs (intraductal papillary mucinous neoplasm, series 3 image 56). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts. 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: Overall stable appearance of primary sclerosing cholangitis as described above. No new intraductal masses or suspicious liver lesions.


Instruction: Generate impression based on findings.

Input: 67 years Male (DOB:7/26/1948)Reason: history of lumbar fracture compare to previous MRI History: low back painReferring Attending: JAVAD HEKMATPANAH Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. There is a well formed disc at S1-S2.There is a compression fracture present at L5 with approximately 30% loss of vertebral body height. It is unchanged since prior examAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge at this level as well as disc desiccation. There is moderate facet hypertrophy at this level. There is narrowing of the neural foramina bilaterally with mild encroachment of the exiting nerve roots within the neural foramina.At L4-5 there is a disc bulge at this associated with mild facet hypertrophy. The left neural foramen is mild encroachment of the left recess and partial effacement of fat at the left lateral recess. There is encroachment of the nerve roots of the left lateral recess at this level. There is narrowing of neural foramina bilaterally at this level. The exiting nerve roots are surrounded by fat within the 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. There is a Schmorl's node present at this level associated with endplate reactive changes which are bright on T1.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a well formed disc at S1-S2. We assume L5 to be the compressed vertebral body.2.There is a stable compression fracture 5 which has generally a benign appearance.3.There are degenerative changes present in the lumbar spine with encroachment of nerve roots at the left lateral recess at L4-5.


Instruction: Generate impression based on findings.

Input: There is slight reversal of normal cervical curvature. There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Discogenic reactive endplate changes are evident at C4/5 and C5/6.C1/2: Ligament thickening partially effaces the anterior CSF, however without cord abutment and no resulting stenosis.C2/3: Trace anterolisthesis C2 on C3 and moderate bilateral facet hypertrophy. There is moderate bilateral neural foraminal stenosis.C3/4: Trace anterolisthesis C3 on C4, posterior osteophyte disc complex, and severe bilateral facet hypertrophy. There is severe left and moderate to severe right neural foraminal stenosis.C4/5: Trace retrolisthesis C4 on C5, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and mild bilateral facet hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C6/7: Trace anterolisthesis C6 on C7, posterior osteophyte disc complex, and moderate bilateral facet hypertrophy. There are no significant stenoses.C7/T1: Trace anterolisthesis C7 on T1 and moderate bilateral facet hypertrophy. There are no significant stenoses.Facet hypertrophy is also noted involving the levels of the upper thoracic spine which encroach bilateral neural foramina, especially notable on the right at T2/3 where there is also trace 1 anterolisthesis of T2 on T3.

Output: 1.C2/3: Moderate bilateral neural foraminal stenosis.2.C3/4: Severe left and moderate to severe right neural foraminal stenosis.3.C4/5: Mild central and severe bilateral neural foraminal stenosis.4.C5/6: Mild central and severe bilateral neural foraminal stenosis.5.Facet hypertrophy is also noted involving the levels of the upper thoracic spine which encroach bilateral neural foramina, especially notable on the right at T2/3 where there is also trace 1 anterolisthesis of T2 on T3.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with bilateral lower extremity weakness. No evidence of acute cord compression is seen. Please note that artifact prevents accurate assessment of spinal cord signal characteristics. There is a mild scoliotic curvature to the spine. Vertebral body heights are preserved. Mild disc degeneration is evident in the cervical spine with more advanced degeneration in the lumbar spine particularly at L4-5. There is likely mild to moderate spinal canal stenosis and foraminal narrowing at this level.

Output: 1.No acute cord compression.2.Lumbar spine degenerative disease can be further assessed non-emergently with dedicated imaging if clinically warranted.


Instruction: Generate impression based on findings.

Input: Female, 11 years old, with history of craniopharyngioma, follow-up examination after proton therapy. The heterogeneous, enhancing, cystic and solid lesion centered on the suprasellar cistern has decreased in size from the prior examination. For example, on axial images, the lesion measures 38 x 35 mm, previously 40 x 40 mm. The signal characteristics of the constituents cysts have also changed with a reduction in the quantity of T1 hyperintense material which may have represented hemorrhagic, proteinaceous or mucoid fluid.Mass effect on the adjacent structures does persist, particularly the optic apparatus, the proximal circle of Willis vessels, and the cerebral peduncles. The major intracranial flow voids remain visible. The lateral ventricles are slightly prominent but unchanged from the prior examination. No additional parenchymal lesions are seen. Sequelae of prior right frontal craniotomy are noted.

Output: Interval decrease in size of the suprasellar craniopharyngioma.


Instruction: Generate impression based on findings.

Input: Vertebral body heights and alignment are preserved. The bone marrow signal is benign. There is no evidence of fracture or subluxation. The cervical and upper thoracic cord are normal in caliber and signal. The cervicomedullary junction is normal. The cerebellar tonsils and visualized portion of the posterior fossa are unremarkable. There is a benign appearing osseous protuberance measuring 12 mm arising posteriorly from the right inferior articulating facet of C5. The visualized paraspinal structures are normal.C1/2: The atlantoaxial interval appears normal and there is no significant abnormality noted.C2/3: There is no spinal canal or neural foraminal stenosis.C3/4: There is no significant spinal canal or neural foraminal stenosis.C4/5: There is no significant spinal canal or neural foraminal stenosis.C5/6: There is a mild disc bulge with minimal effacement of the anterior subarachnoid space. There is no significant spinal canal or neural foraminal stenosis.C6/7: There is a mild disc bulge with minimal effacement of the anterior subarachnoid space. There is no significant spinal canal or neural foraminal stenosis.C7/T1: There is no significant spinal canal or neural foraminal stenosis.

Output: 1.Minimal degenerative changes without significant spinal canal or neural foraminal stenosis at any level.2.Small bony protuberance incidentally seen arising posteriorly from the right inferior facet of C5 which is compatible with an osteochondroma.


Instruction: Generate impression based on findings.

Input: 63 year old male. History of pseudocyst and pancreatic necrosis status post 1 cystogastrostomy and 2 cystoduodenostomy stent placements. Cystogastrostomy drain has since been removed. ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips. Mild central intrahepatic and extrahepatic biliary ductal dilatation with smooth tapered narrowing in the pancreatic segment, likely due to a benign stricture. No suspicious hepatic mass. Patent hepatic vasculature.SPLEEN: No focal splenic lesion. Chronic thrombosis of the splenic vein with collateral vessels.PANCREAS: Marked atrophy and associated decreased T1 signal intensity of the pancreatic neck, body, and tail with relative sparing of the head, consistent with chronic pancreatitis. The main pancreatic duct is mildly tortuous and has an irregular contour from the neck to tail without significant dilatation, likely from multifocal strictures. Multiple hypoattenuating foci noted on prior CT corresponding to cystic foci scattered throughout the pancreas, greatest in number within the tail where they are clustered, likely represent dilated sidebranch ducts related to chronic pancreatitis.The 1.5 cm small cystic lesion in the pancreatic head seen on prior CT is favored to represent a dilated sidebranch duct and not a pseudocyst.No appreciable increase in ductal caliber after secretin administration.No pseudocyst or significant fluid collection is identified. Cystoduodenostomy stents are not well visualized due to technique.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: Findings consistent with chronic pancreatitis with relative sparing of the head. Multiple cystic foci scattered throughout the pancreas, greatest in number in the tail, likely represent dilated sidebranch ducts due to multifocal stricturing of the main pancreatic duct. No pseudocyst or significant fluid collection is identified.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is thin T1 and T2/FLAIR hyperintense fluid signal along the right anterior inferior frontal lobe, and along the left occipital lobe. These collections measure no more than 2 to 3 mm in thickness and exerts no significant mass effect upon the adjacent brain parenchyma. There is no evidence of mass, or acute infarct. The brain parenchyma and pituitary gland otherwise appear unremarkable. No pathologic enhancement is seen. 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 a small residual right periorbital hematoma.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. Small P-comm arteries are present. There may be a small fenestration of the vertebrobasilar junction which is a normal variant. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. There is no evidence of stenosis or occlusion. The origins of the vertebral arteries are patent. However, the V2 and V3 segments are not well assessed bilaterally secondary to field-of-view limitations.

Output: 1. Trace subdural hemorrhage along the right frontal and left occipital lobes without significant mass effect on the adjacent brain parenchyma. No subarachnoid hemorrhage is identified on this examination.2. The vasculature in the brain and neck are patent without evidence of flow limiting stenosis, aneurysm or vascular malformation. Please note, however, that the V2 and V3 segments of the vertebral arteries are not well visualized due to field of view limitations.


Instruction: Generate impression based on findings.

Input: Low back pain with right greater than left radicular symptoms. History of liver cancer with L4 lesion on CT. For the purposes of numbering the most inferior rib-bearing vertebra is labeled T12. There is transitional anatomy with partial sacralization of the L5 vertebral body.There is abnormal T1 hypointensity involving the right lateral aspect of the L3 vertebral body with associated T2/STIR hyperintensity and enhancement, highly suspicious for metastasis. Lesion measures approximately 3.7 x 3.8 x 2.8 cm in the AP, transverse, and craniocaudal dimensions There is minimal involvement of the adjacent right paravertebral soft tissues. Posterior cortex of the vertebral body remains intact. Abnormal signal extending into the posterior elements is favored to represent edema. No evidence of epidural tumor or leptomeningeal disease.There are multiple small Schmorl's nodes throughout the visualized spine. There is mild loss of height involving the L2 vertebral body related to Schmorl's noted as well as a broader depression of the superior endplate compatible with a chronic compression fracture. Mild superior endplate deformity is also evident at the right aspect of the L1 vertebral body. These findings are unchanged since CT from 7/28/2014. No findings to suggest an acute compression fracture. Enhancement involving the superior endplate of L2 is favored to be related to the Schmorl's node. No additional metastatic lesions are definitively appreciated.There is mild developmental narrowing of the lumbar spine with superimposed degenerative changes as described below: L1-L2: Minimal disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy contribute to mild spinal canal narrowing. Neural foramina are patent.L2-L3: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening with associated mild to moderate spinal canal narrowing. Neural foramina are patent.L3-L4: Disc bulge, ligamentum flavum thickening, and advanced facet arthropathy contribute to moderate to severe spinal canal stenosis. There is moderate right and mild to moderate left neural foraminal stenosis.L4-L5: Disc bulge, advanced facet arthropathy, ligamentum flavum thickening contribute to moderate spinal canal stenosis. There is mild to moderate bilateral, left slightly worse than right, neural foraminal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.

Output: 1. Enhancing lesion involving the right aspect of the L4 vertebral body is most consistent with metastatic disease and demonstrates enlargement on CT studies from 2/29/2016 and 5/23/2016. No associated epidural tumor or pathologic compression fracture. No additional metastatic lesions are definitively appreciated.2. Advanced degenerative changes in the lumbar spine including moderate to severe L3-L4 and moderate L4-L5 spinal canal stenosis. There is also neural foraminal narrowing at multiple levels as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: History of skull base neuroendocrine tumors status post cyber knife treatment 8 -- 2014. Signs and symptoms: Surveillance scan. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination re-demonstrate a very large irregular enhancing mass consistent with patient's known meningioma. The epicenter tumor appears to be in the left cavernous sinus with resultant significant expansion of the sinus by the mass. Medially the tumor extends into the sphenoid sinus and sella and traverses the midline abutting the right cavernous sinus. Posterior there is extensive erosive changes of clivus and dorsum sella with significant bulge of tumor into the prepontine cistern and left superior cerebellopontine angle cistern. There is subtle mass effect, flattening and posterior displacement of the pons and in the basilar artery. The left Meckel's cave is entirely effaced secondary to tumor extension. Laterally there is expansion of cavernous sinus and with loculated appearance of the left lateral margin of tumor highly suspected of extension through the dura Very subtle flair hyperintensity of the displaced left temporal lobe suspicious for small focus of edema. Anteriorly the tumor extends into the posterior left ethmoid air cells as well as left orbital apex. There is decreased caliber and irregularity of the left cavernous carotid secondary to tumor encasement. Inferiorly tumor extends into the left pterygoids and into the enlarged left foramen ovale. Superiorly the tumor extends into the left subfrontal region with subtle elevation of left frontal lobe however without detectable parenchymal edema. There is also extension of tumor into the basal cistern and is in contact with the chiasm without significant mass effect. The tumor however is inseparable from the left optic nerve and encases the left supraclinoid internal carotid..There is also extension of tumor posteriorly along the petroclinoid ligament and with erosive changes of the apex of the left petrous bone. The very irregular shape of tumor makes precise comparison with prior exam difficult. Also prior exam is from an outside institution and without SPGR reformatted thin images which hinders precise comparison. Within this limitation however all measurements of tumor indicate slight interval increased size and extent since prior exam from 3 -- 19 -- 14. The largest transaxial dimensions of tumor are at 51 x 49-mm.Mild to moderate chronic small vessel ischemic stroke are present and without significant change.

Output: 1.A large invasive left sided meningioma in the left cavernous sinus, left Meckel's cave, left middle cranial fossa, left posterior ethmoid, sella turcica/basal cistern, prepontine cistern, left upper cerebellopontine angle, left petrous apex, left superior orbital fissure, left orbital apex and the left foramen ovale is again identified. Although very difficult to measure due to the irregular shape of tumor and difference in technique of two studies, all acquired measurements demonstrate subtle interval increased size of tumor since prior outside institution MRI exam from Cook County Hospital dated 3 -- 19 -- 14.2.There is irregularity and decreased caliber of the left cavernous carotid secondary to tumor encasement.3.In the basal cistern the tumor is in contact with the chiasm and inseparable from the left cisternal portion of optic nerve and encases the left supraclinoid internal carotid.4.Diffusion weighted images are negative and mild to moderate findings of chronic non-hemorrhagic small vessel ischemic stroke are noted.


Instruction: Generate impression based on findings.

Input: Female; 77 years old. Reason: history of pancreatic cyst 5mm, family history of panc cancer History: see above ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Status post cholecystectomy. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: 5-mm round T2 hyperintense lesion in the uncinate process (series 7/20) with probable connection to a side branch pancreatic duct (series 10/70), most likely a side branch IPMN. No mural nodularity or suspicious enhancement. At least two similar but smaller lesions in the pancreatic body and tail are seen on MRCP images, which are most likely additional sidebranch IPMN's (series 11/4).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 2.8 x 2.1 cm round mass within the duodenal bulb which is homogeneously T1 hyperintense mass and demonstrates loss of signal on T2 fat saturation sequences, most compatible with duodenal lipoma (series 4/21). No evidence of gastric outlet obstruction. Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple small sidebranch IPMN's.2.Duodenal lipoma.


Instruction: Generate impression based on findings.

Input: 70 year-old female with history of weakness and sensory deficits. Evaluate for CIDP vs. ALS vs. MND. Cervical spine:The cranial-cervical junction is normal. There is straightening of the normal cervical lordosis. The cervical spine alignment is anatomic. Vertebral body heights are preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. There is diffuse disc desiccation at all cervical levels. No abnormal enhancement is observed within the spinal cord.There is a dense atherosclerotic plaque at the carotid bifurcations bilaterally resulting in a 70-80% stenosis on the left and 50-60% on the right. The visualized portions of the distal internal carotid artery are unremarkable. Additionally, there is an abnormal appearance of the right internal jugular vein with a potential plaque resulting in significant luminal narrowing. The left internal jugular vein is not well visualized.Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is a mild disc bulge. No significant neuroforaminal or spinal canal stenosis.C3-C4: There is a moderate disc bulge with anterior osteophyte formation. No significant neuroforaminal or spinal canal stenosis.C4-C5: There is a moderate disc bulge with anterior osteophyte formation. There is mild neuroforaminal narrowing on the left. No significant spinal canal stenosis.C5-C6: There is a mild disc bulge. No significant neuroforaminal or spinal canal stenosis.C6-C7: There is a mild disc bulge. No neuroforaminal narrowing or spinal stenosis. C7-T1: The disc is unremarkable. No neuroforaminal narrowing or spinal stenosis. Thoracic spine:There is a normal thoracic kyphosis. The spine alignment is anatomic. Vertebral body heights are preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable. No abnormal enhancement is observed within the spinal cord.

Output: 1. The cervical and thoracic spinal cord appear normal with no evidence of ALS, CIDP, or MND as clinically queried.2. Dense atherosclerotic plaques at the carotid bifurcations bilaterally resulting in 70-80% stenosis on the left and 50-60% stenosis on the right. Additionally, the right internal jugular has an abnormal appearance with possible stenosis/plaque resulting in significant luminal narrowing. A CT angiogram with delayed phase is recommended for further evaluation.3. Degenerative arthritic changes of the cervical spine, worse at the C4-5 level, as described above.


Instruction: Generate impression based on findings.

Input: 39 year-old female with painless jaundice. Rule out pancreatic mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without cholecystitis. Several small gallstones are present in the neck of the gallbladder. Infiltrative changes in the periportal fat and lymphadenopathy in the hepatic hilum. There is extensive periportal edema. These infiltrative findings surround the superior mesenteric artery and vein, confluence and main portal vein, possibly representing infiltrative neoplasm. The hepatic vasculature is patent. No biliary duct dilatation.SPLEEN: No significant abnormality notedPANCREAS: There is an area of ill-defined hypoenhancement in the pancreatic head seen on axial image 40/161 of series 4, which could represent a primary pancreatic neoplasm. For further evaluation with contrast-enhanced MRI and M.R.C.P. may be helpful, if indicated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large right upper pole simple benign cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Ill-defined hypodensity in pancreatic head with associated fat infiltration and lymphadenopathy in the hepatic hilum. Periportal edema. Findings may be due to pancreatic neoplasm. Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: Brain: There are postoperative findings related to Chiari decompression. There are foci of deformity of the posteroinferior aspect of the cerebellum, with tenting towards the overlying dura. There is a retroflexed dens with associated narrowing of the column of cerebrospinal fluid flow across the anterior neo-foramen magnum. Cerebrospinal fluid flow across the posterior neo-foramen magnum appears to be intact. There is no evidence of acute infarction or hemorrhage. There is mild scattered paranasal sinus mucosal thickening.Spine: There has been interval decrease in size of the thoracic syrinx, which now measures up to 1 mm in width, previously 6 mm. The vertebral bone marrow signal is within the normal limits. There is lack of the usual cervical lordosis, but no spondylolisthesis. There is normal alignment of the lumbar vertebral bodies. The vertebral bone marrow signal appears unremarkable. The conus medullaris is located at the level of L1. The filum terminale appears unremarkable. There is no evidence of spinal canal or neural foraminal stenosis. The paraspinal soft tissues are unremarkable.

Output: 1. Postoperative findings related to Chiari decompression. A retroflexed dens is associated narrowing of the column of cerebrospinal fluid flow across the anterior neo-foramen magnum and tenting of cerebellar tissue towards the overlying dura may indicate adhesion formation. 2. Marked interval decrease in size of the thoracic syrinx.


Instruction: Generate impression based on findings.

Input: 29 year old female with atrial flutter and atrial fibrillation with recent stroke referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 59 ml (normal range 31+/-10), the LV mass index is 29 g/m2 (normal range 67+/-11), and the LV mass is 51 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native myocardial pre-contrast T1 relaxation times are within normal limits (~1000 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 82 ml/m2 (normal range 69+/-14), the RVEDV is 146 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 63 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall nodular enhancing foci within the breasts, likely fibroadenomas given patient's age and multifocality. 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. The left ventricle is mildly dilated with normal systolic function (LVEF 60%). 2. The right ventricle is normal in size with normal systolic function (LVEF 57%). 3. All four pulmonary veins drain normally into the left atrium.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 2-year-old male with history of syncope and falls. Please amount of The density and morphology brain parenchyma remains within normal limits. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Prominence of lateral ventricles (left greater than right) is noted. Further evaluation with an MRI examination is recommended to evaluate the cause of this discrepancy in the size of lateral ventricles which CT may not be able to determine.Calvarial, mastoid air cells and limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial process.2.Expansion of left lateral ventricle although may be anatomical variation it is concerning for underlying parenchymal volume loss of left hemisphere and should be further evaluated with an MRI examination.


Instruction: Generate impression based on findings.

Input: Male 30 years old Reason: left and right knee avn History: left and right knee pain. MENISCI: The menisci are normal in signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: There is abnormal signal intensity with surrounding edema within the majority of the lateral femoral condyle consistent with AVN, extending to the subchondral bone plate. There is slight depression of the weight-bearing portion of the articular surface with a thin band of underlying signal abnormality consistent with a subchondral fracture. There is mild thinning and increased signal intensity of the overlying cartilage suggestive of mild degeneration but we see no full-thickness fluid-filled defect. AVN also affects the medial femoral condyle posteriorly but there is no evidence of subchondral fracture, articular surface collapse, or overlying cartilage abnormality. There is a small focus of osteonecrosis in the medial tibial condyle which does not contact the articular surface. There is mild increased signal intensity within the articular cartilage of the lateral facet of the patella, suggestive of mild chondromalacia/degeneration.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Osteonecrosis as described above.


Instruction: Generate impression based on findings.

Input: There is a right cerebral convexity subdural hematoma that measures up to 5 mm in thickness. It is mainly hyperintense on T1 and T2 with components that are hyperintense on T1 and hypointense on T2 weighted imaging. There is also a thinner subdural hematoma within the posterior fossa dorsal to the cerebellum and a thin left posterior suptratentorial subdural hematoma. There are also multiple foci of susceptibility effect over the cerebral convexities within sulci superiorly as well as within the superior vermis compatible with subarachnoid hemosiderin deposition. There is cortical and parenchymal decreased diffusion within the right and possibly left occipital lobes, bilateral parietal lobes, right greater than left, and minimally within the bilateral frontal lobes as well as prominent diffusion restriction within the splenium. There is no evidence of mass. The myelination pattern is appropriate for age. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is minimal fluid within the mastoid air cells and right middle ear. The midline structures and craniocervical junction are within normal limits.

Output: 1.Bilateral subdural hematomas without midline shift with components of different ages of blood as well as components of subarachnoid blood. 2.Multiple patchy foci of supratentorial cortical and parenchymal decreased diffusion may represent traumatic axonal injury or anoxic injury and are not in an arterial distribution.


Instruction: Generate impression based on findings.

Input: Reason: evaluate peroneal tendons History: pain TENDONS: There appears to be anomalous anatomy of the peroneal tendons. The peroneus brevis tendon courses distally with the majority of its fibers appearing to insert on the retrotrochlear eminence of the calcaneus, as one would expect from a peroneus quartus, although we see no separate peroneus quartus muscle belly. The peroneus longus tendon appears unusually large, but seems to have a normal course beneath the cuboidal tunnel. There is mild increased signal intensity within the peroneus longus tendon posterior to the distal fibula, suggesting tendinosis, and as the tendon courses beneath the fibular tip, there is mild surface irregularity which we expect represents mild partial-thickness longitudinal tearing. There is a small amount of fluid around the peroneus longus tendon beneath the fibular tip as well. A thin low signal intensity structure extending proximally from the base of the fifth metatarsal may represent a hypoplastic peroneus brevis tendon, which may arise either from the aforementioned peroneus longus or the anomalous tendon inserting on the retrocochlear eminence. The remaining tendons appear intact. Note is made of the posterior tibialis tendon inserting onto a type II accessory navicular.LIGAMENTS: The anterior talofibular ligament margins are slightly irregular and the ligament appears thinned on the T1-weighted images, likely reflecting old injury. The calcaneofibular ligament demonstrates mild increased signal intensity, perhaps representing prior sprain, otherwise the ligament appears intact. The anterior and posterior tibiofibular ligaments are within normal limits. The distal tibiofibular syndesmotic complex is intact. The visualized deltoid ligament appears intact.ARTICULAR SURFACES AND BONE: We see no osteochondral defect. There is a small amount of fluid in the tibiotalar joint, but no large effusion. ADDITIONAL

Output: 1.Variant peroneal anatomy as described above.2.Enlargement and increased signal intensity of the peroneus longus suggests mild tendinosis, and mild irregularity of its surface may reflect partial thickness longitudinal tearing.3.Findings suggestive of previous injury to the anterior talofibular ligament and other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Cervical spondylosis with radicular symptoms; any change from last MRI?. Signs and symptoms: Cervical spondylosis with radicular symptoms. Nonenhanced cervical MRI:The examination redemonstrates extensive degenerative changes of cervical spine which appears to primarily involve the disks. There is resultant mild reversal of cervical lordosis centered at C4-C5 disk level. This appearance is similar to the prior study.Foramen magnum is unremarkable.C2 -- C3 demonstrate mild bilateral (right greater than left) facet hypertrophic changes with resultant mild right neural foraminal compromise. No change since prior exam.C3 -- C4 demonstrate moderate disk disease and loss of disk height, moderate right and mild left facet hypertrophic changes and shallow broad based bulging disk. Constellation of changes results in significant right neural foraminal compromise and moderate to significant on the left as well as mild central spinal stenosis. Findings demonstrate no significant change since prior exam. C4 -- C5 demonstrate advanced disk disease with significant loss of disk height, asymmetric significant left facet hypertrophic changes. There is a broad based disk and osteophyte complex extending from right paramedian to far laterally on the left. There is interval increased size of this finding since prior exam.Above changes results in flattening and posterior displacement of the cord, moderate central spinal stenosis and significant left neural foraminal compromise.C5 -- C6 demonstrate advanced disk disease and loss of disk height and no significant facet or ligamentum flavum hypertrophy. Shallow hypertrophic spur results in partial effacement of ventral subarachnoid space and a subtle flattening deformity of the cord and mild central spinal stenosis. There is no significant change in the extent of finding since prior study.C6 -- C7 demonstrate advanced disk degeneration with significant loss of disk height. Mild right facet hypertrophy changes an unremarkable left. Ventral hypertrophic spur results in partial effacement of the ventral subarachnoid space and subtle flattening of the cord however without central spinal stenosis. Mild bilateral neural foraminal compromise. No significant change since prior exam.C7 -- T1 demonstrate mild disk disease and loss of disk height. Mild bilateral ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.As was noted on prior exam there is a small syrinx of cervical cord which demonstrate no interval change since prior exam. The largest has axial dimension of the syrinx at C5 measures at 3.9 x 3.1-mm which is nearly identical to prior exam. The syrinx similar to prior exam demonstrate two small segments of expansion one centered at C5 as measured above and a smaller one at C6 -- C7 disk level similar to prior study.Nonenhanced thoracic MRI:Significant sclerosis of the thoracolumbar region is noted. There are no coronal images precise assessment of the degree or extent of the sclerosis.Severe scoliosis precludes precise assessment of the spine however within this limitation there is no evidence of central spinal stenosis at any level.The signal intensity and caliber of thoracic cord remains within normal.Scoliotic changes results in left neural foraminal compromise at T7 -- T8. There is also asymmetric left-sided facet hypertrophic changes with facet effusion T7 -- T8 level.There is significant left neural foraminal compromise at T8 -- T9 secondary to asymmetric left facet hypertrophic changes. Extensive postoperative changes of prior posterior fusion and placement of metallic hardware extends from T11 inferiorly to the lumber spine and beyond the field of the exam. There is no spinal stenosis at the visualized levels of surgery.

Output: 1.Nonenhanced MRI of the cervical spine demonstrate extensive degenerative changes of disks and to lesser degree of the posterior elements throughout the cervical spine with resultant reversal of cervical lordosis as detailed. There is progression of degenerative changes at C4 -- C5 since prior exam. Changes at this level results in central spinal stenosis and neural foraminal compromise. Degenerative changes at other levels however without significant central spinal stenosis as detailed and without significant change. Two small foci of syrinx at C5 and at C6 -- C7 disk levels remain similar to prior exam measuring maximum of 3.9 x 2.1-mm at C5 level.2.Nonenhanced MRI of thoracic spine demonstrate significant sclerosis of thoracolumbar region as was noted on prior plain radiographs. No pulmonary lesions acquired. There is no evidence of central spinal stenosis at any level. There is normal signal intensity and caliber of thoracic cord. Neural foraminal compromise in an asymmetric fashion secondary to asymmetric hypertrophic changes as result of the scoliosis as detailed per level above.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:10/2/1975)Reason: stroke History: slurred speechPROVIDER/ATTENDING NAME: JAMES AHN MRI of the brainThere are 10 to 15 T2 and FLAIR hyperintense punctate foci along subcortical white matter of the right and left parietal lobes and several more in the frontal lobe subcortical white matter.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. There is fetal origin of the right PCA with a hypoplastic p1 segment. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Punctate lesions in the subcortical white matter of the parietal lobes and to a lesser degree frontal lobes are present which are nonspecific. They are unusual for this age. It could be vascular related


Instruction: Generate impression based on findings.

Input: Evaluate for left parietooccipital headaches. There is a linear depression of the skin in the left frontoparietal region. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There area a few scattered punctate foci of T2 hyperintensity in the cerebral white matter bilaterally. There is mineralization of the bilateral basal ganglia. 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, and mastoid air cells are grossly unremarkable. There is minimal fluid within a right ethmoid air cell. There is cosmetic filler material in the bilateral nasolabial fold regions.

Output: 1. A linear depression of the skin in the left frontoparietal region may be due to extrinsic compression or secondary to trauma perhaps. Direct inspection may help elucidate this further. 2. A few scattered punctate foci of T2 hyperintensity in the cerebral white matter bilaterally are nonspecific, but may represent chronic small vessel ischemia. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.