Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate brain abscess, compare ventricular size; compared to previous scans. Signs and symptoms: Abscess. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates interval removal of a left frontal approach ventricular catheter since prior study. There is also significant interval decrease associated edematous changes along the course of catheter since prior study. Thick band of enhancement which was noted along the course of left frontal catheter has also significantly decreased and appears as a thin linear enhancement extending from the level of the left frontal burr hole to the left lateral ventricular wall. There is also evidence of linear susceptibility signal changes along this course renal catheter similar to prior exam and consistent with a small amount of hemorrhage.Examination also demonstrate a thin linear band of hemosiderin deposition with enhancement extending from right posterior parietal burr hole to the right lateral ventricle without change since prior study.There is no evidence of an abscess formation and no convincing evidence of leptomeningeal enhancement. No detectable abnormal enhancement of the ependyma lining the ventricular system. Ventricular system remains stable in size and with maintained midline.

Output: 1.No acute intracranial findings.2.Near complete resolution of edematous changes in the left frontal lobe surrounding the previously removed ventricular catheter since prior exam.3.Significant interval decreased size of enhancement along the course of already removed ventricular catheter in the left frontal lobe since prior study.4.Stable thin band of enhancement in the right posterior parietal at the site of previously removed catheter.5.No detectable intracranial abscess, abnormal enhancement of leptomeninges or the ependyma lining the ventricular system.6.Stable size of ventricular system and with maintained midline since prior exam.


Instruction: Generate impression based on findings.

Input: 92 year-old female with hypertensive urgency. Rule out CVA. There is no evidence of intracranial hemorrhage, mass or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. There is an old left basal ganglia lacunar infarct. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No definite evidence of acute intracranial abnormality. Small vessel ischemic disease and old lacunar infarct.


Instruction: Generate impression based on findings.

Input: 63-year-old male with altered mental status, assess for etiology. CVA, hemorrhage, mass.IMAGE ACQUISITION: Nonenhanced CT of the head. No acute intracranial abnormality is evident. Specifically, there is no evidence of intracranial hemorrhage, focal mass, edema, midline shift, or hydrocephalus. There is no CT evidence for acute territorial ischemia.Again demonstrated is extensive hypoattenuation in the supratentorial white matter, unchanged and most consistent with small vessel ischemic disease. Atherosclerotic vertebral and internal carotid arteries arteries are again noted.Persistent opacification of the bilateral mastoid air cells with soft tissue attenuation within the left external auditory canal, unchanged. Please refer to recent MRI of the internal auditory canal for additional details.

Output: 1. No acute intracranial abnormality.2. Unchanged small vessel ischemic disease of indeterminate age.3. Persistent opacification of the left mastoid air cells with soft tissue attenuation within the left external auditory canal. Please refer to recent MRI from 9/28/11 for additional information.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with headache, vertigo and dizziness, and hyperreflexia. Evaluate for structural lesions. Numerous scattered foci of periventricular and subcortical FLAIR hyperintensity are demonstrated without significant change in the quantity or distribution of these lesions. No evidence of edema or mass effect is seen. Diffusion-weighted images are within normal limits. No findings to suggest acute intracranial hemorrhage are detected. A small cystic structure splaying the internal cerebral veins is unchanged. No other abnormal extra-axial collections are seen and the ventricles are stable and normal in size.

Output: 1.Numerous scattered foci of FLAIR signal abnormality are again seen. Statistically, these most likely represent chronic microvascular ischemic disease.2.A small cystic structure splaying the internal cerebral veins is unchanged. This could represent a cyst of the cavum vellum interpositum or some other congenital or developmental benign cyst.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post robotic-assisted laparoscopic prostatectomy in 2008 complicated by biochemical recurrence. 3+4 disease in the right and left lateral posterior peripheral zone of the mid gland. PELVIS:PROSTATE: Status post prostatectomy.PROSTATECTOMY BED: No measurable disease in the prostatectomy bed or at the cystourethral anastomosis.BLADDER: No measurable disease at the cystourethral anastomosis.LYMPH NODES: No pathologically enlarged or morphologically suspicious pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific findings of local tumor recurrence or suspicious pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 65-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 5.1 x 5.4 x 4.5 cmPeripheral Zone: Dominant T2 hypointense lesion with corresponding ADC restriction and early enhancement in the right mid gland peripheral zone.Central Gland: Moderate to marked degree of benign prostatic hypertrophy. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: Mass effect from central gland hypertrophy.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right mid gland peripheral zone lesion as described above highly suspicious for prostate malignancy. This lesion is amenable for focal ablation.


Instruction: Generate impression based on findings.

Input: 30 year-old male with left flank pain. Rule out renal stone. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: There is a 2.6 x 4 cm mass which appears contiguous with the left adrenal at axial image 50/175. Numerous punctate calcifications are present in this mass. The mass attenuation measures 36 Hounsfield units average. Further characterization with dedicated adrenal MRI or CT examination would be helpful, if indicated.KIDNEYS, URETERS: No nephrolithiasis. Mild fat stranding surrounding the left kidney may be due to pyelonephritis or recent passage of stone. Right kidney is normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: L5 vertebral segment is sacralized on the left.OTHER: No significant abnormality noted

Output: Left adrenal mass with punctate calcifications. See above.No nephrolithiasis. Mild fat stranding surrounding the left kidney may be due to pyelonephritis or recent passage of stone. Right kidney is normal.L5 vertebral segment articulates with the sacrum on the left side and may be a source of back pain.


Instruction: Generate impression based on findings.

Input: There is a punctate focus of contrast enhancement with associated susceptibility hypointensity within the superior right cerebellum (series 1201 image 66, series 701 image 75). There are no definite other foci of enhancement. T2 hyperintense foci are present within the white matter without associated restricted diffusion, enhancement, or susceptibility abnormality. There is diffuse volume loss with a superimposed somewhat predominant right parietal lobe atrophy pattern. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered foci of sporadic mucosal thickening can be found and the paranasal sinuses. Fluid is noted in the dependent right mastoid air cells. The left mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There is a punctate focus of contrast enhancement with associated susceptibility hypointensity within the superior right cerebellum (series 1201 image 66, series 701 image 75) suspicious for a tiny hemorrhagic metastasis.2.Chronic small vessel ischemic disease.3.There is diffuse volume loss with a superimposed somewhat predominant right parietal lobe atrophy pattern.


Instruction: Generate impression based on findings.

Input: Reason: Rotator cuff tear? History: decreased ROM + drop sign ROTATOR CUFF: There is a near full-thickness to full-thickness tear of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 17 mm in the AP dimension. There is minimal retraction. There is increased signal abnormality within the muscle belly of the supraspinatus and infraspinatus as well as within the subscapularis to a lesser degree. There is partial thickness articular surface tearing of the anterior fibers of the infraspinatus as well. There is a partial-thickness articular surface tear of the subscapularis at the level of its insertion measuring approximately 5 mm in the craniocaudal dimension. The teres minor muscle and tendon appear intact. No masses or lesions are identified within the suprascapular notch.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid recess. Mild to moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and intermediate signal intensity within the superior and posterior glenoid labrum likely reflecting degeneration and degenerative tearing within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is thickening and intermediate signal intensity within the intra-articular portion of the long head of the biceps tendon indicating moderate tendinosis.ADDITIONAL

Output: 1. High-grade near full-thickness to full-thickness tear of the supraspinatus with minimal retraction as well as partial-thickness tearing of the anterior fibers of the infraspinatus and superior fibers of the subscapularis.2. Increased signal abnormality within the supraspinatus, infraspinatus and subscapularis muscle bellies is nonspecific but may reflect subacute denervation or perhaps Parsonage-Turner syndrome.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: Evaluate for ischemia History: Difficulty speaking Brain MRINo evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral Pcom arteries and Acom artery are patent. No aneurysm. No stenosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain and neck MRA


Instruction: Generate impression based on findings.

Input: Female, 40 years old, status post meningioma resection in 3/2014. 6 month follow-up exam. Sequelae of meningioma resection from the left middle cranial fossa are again seen. This includes a wide left fronto-parieto-temporal craniotomy, as well as craniectomy and cranioplasty of part of the squamous temporal bone. The resection cavity itself is unchanged with evidence of encephalomalacia in the anterior temporal lobe. Thin enhancement along the resection cavity margins, and dural enhancement along the craniotomy margins, are also unchanged. The left greater sphenoid wing remains expanded and mildly enhancing but this, too, is without significant change.The left greater sphenoid wing bows minimally in towards the orbital apex, but no significant orbital encroachment or involvement of the optic nerve canal is seen. The orbital soft tissues are within normal limits.Elsewhere, brain parenchymal morphology is unremarkable. No new pathologic enhancement is seen. No evidence of restricted diffusion is detected. Ventricles are stable and normal in size.

Output: 1.Redemonstration of postoperative findings related to resection of a large left middle cranial fossa meningioma. 2.No findings to suggest recurrent tumor.


Instruction: Generate impression based on findings.

Input: There has been prior anterior cervical fusion with diskectomy at C5, C6, and C7 including cortical screws within the vertebral bodies and bone plugs within C5/6 and C6/7.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild left neural foraminal and moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex with a small central midline protrusion component. There is also mild left uncinate hypertrophy. There are no significant stenoses.C5/6: Surgically decompressed level with endplate spurring resulting in moderate right neural foraminal stenosis.C6/7: Surgically decompressed level with endplate spurring resulting in moderate bilateral neural foraminal stenosis.C7/T1: Trace anterolisthesis C7 on T1, minimal posterior osteophyte disc complex and bilateral facet hypertrophy. There is mild left neural foraminal stenosis.Sagittal imaging at T2/3 suggest the presence of a bulge versus protrusion which abuts the cord causing slight flattening, however without significant resulting central stenosis.

Output: 1.C3/4: Mild left neural foraminal and moderate right neural foraminal stenosis.2.C5/6: Moderate right neural foraminal stenosis.3.C6/7: Moderate bilateral neural foraminal stenosis.4.C7/T1: Mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with dysphagia, dysphonia and weakness. Brain:No evidence of restricted diffusion is seen. Scattered patchy foci of T2 hyperintensity are demonstrated in the subcortical and periventricular white matter. No evidence of parenchymal edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. There is no evidence of intracranial hemorrhage or any other abnormal extra-axial fluid. Ventricular system is normal in size and morphology.C-spine:A mild reversal of the normal cervical lordosis is demonstrated. Spinal alignment is unremarkable.Vertebral body heights are preserved. Degenerative endplate signal alteration is seen, but there is no evidence of any concerning marrow replacement or significant marrow edema.The visualized spinal cord shows no evidence of any pathologic signal abnormality and is morphologically unremarkable.No evidence of any pathologic spinal or paraspinal enhancement is seen.C2-3: Left facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C3-4: Facet hypertrophy. Mild disc osteophyte formation. Mild spinal canal narrowing. No significant foraminal narrowing. C4-5: No significant spinal canal or foraminal narrowing. C5-6: Disc osteophyte formation. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. C6-7: Facet hypertrophy. Disc osteophyte formation. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: 1.No acute intracranial abnormality. Scattered small white matter lesions likely reflect chronic microvascular ischemic disease.2.Mild degenerative findings in the cervical spine without evidence of any high-grade spinal canal or neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: Soft tissue disorder, unspecified [M79.9], There is no evidence of acute ischemic or hemorrhagic lesion.Multiple variable sized FLAIR/T2 high signal intensity lesions on bilateral white matter including bilateral cerebral peduncles are again seen, grossly unchanged in terms of distribution, size and approximate number since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal bihemispheric white matter lesions as described above, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Right shoulder pain, melanoma Note that evaluation is limited by motion artifact within the patient's difficulty with tolerating the exam.ROTATOR CUFF: Mild increased signal is noted within the distal fibers of the supraspinatus reflecting tendinosis. There is no evidence of full-thickness rotator cuff tear.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is tearing of the anterior and anterior superior labrum. There is no joint effusion.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Limited examination secondary to motion artifact and patient's difficulty cooperating with the exam.2. Enlarging right scapular mass and subcutaneous nodule concerning for progression of disease.3. Tendinopathy of the supraspinatus tendon and degenerative tearing of the anterior/superior labrum.


Instruction: Generate impression based on findings.

Input: altered mental status, unspecified [R41.82] / Disorder of brain, unspecified [G93.9] / Vascular headache, not elsewhere classified [G44.1], Reason for Study: ^Reason: poorly differentiated urothelial bladder cancer presented with AMS , R/o leptomeningeal spread. This is a limited examination with post contrast examinations only were performed.There is about 3cm sized heterogeneously enhancing pre sacral mass lesion with central non enhancing portion which may represent metastatic lesion.There is no evidence of abnormal enhancement on spinal cord, thecal sac or vertebral bodies throughout. Lower lying spinal cord is again demonstrated associated with spina bifida of sacrum. There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The cord signal is normal. The conus medullaris terminates at the level of L5S1. There is evidence of tethered cord or spinal dysraphism. There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. About 3cm sized inhomogeneously enhancing right side pelvic mass likely represent metastatic lesion.2. Tethered cord with spina bifida of sacrum.3. No evidence of abnormal enhancement on spinal cord, thecal sac or vertebral body.


Instruction: Generate impression based on findings.

Input: Several sequences are motion greater. Given this caveat:Brain MRI:T2 hyperintensity is present throughout the white matter, confluent in several locations, without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. Gyriform susceptibility abnormality is noted within the right parietal lobe. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mild mucosal thickening is present within the left maxillary sinus, otherwise the paranasal sinuses are clear. Mild inflammatory changes are noted in bilateral mastoid air cells with a few containing fluid. There is no abnormal enhancement within the brain. Cervical spine MRI:The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.There has been multilevel laminectomy extending from C2 through C6.C2/3: There is moderate left facet hypertrophy with facet fusion as well as mild right facet hypertrophy. Additionally, there is mild posterior aspect disc complex eccentric to the left. There is no central or right neural foraminal stenosis, however there is moderate left neural foraminal stenosis.C3/4: Trace anterolisthesis C3 on C4, posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, very severe left facet hypertrophy, and severe right facet hypertrophy. There is moderate central and severe bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and very severe bilateral facet hypertrophy. There is associated focal cord atrophy with intrinsic T2 hyperintensity. There is mild to moderate central and severe bilateral neural foraminal stenosisC5/6: Minimal posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and severe bilateral facet hypertrophy with probable bilateral facet fusion. There is mild to moderate bilateral neural foraminal stenosis.C6/7: Minimal posterior osteophyte disc complex, bilateral facet hypertrophy, partial vertebral body fusion, and mild bilateral facet hypertrophy with facet fusion. There is moderate left neural foraminal stenosis.C7/T1: Trace anterolisthesis C7 on T1, minimal posterior osteophyte disc complex, and moderate bilateral facet hypertrophy. There is moderate bilateral neural foraminal stenosis.Multilevel facet hypertrophy is present in the visualized upper thoracic spine, encroaching the neural foramina, worse at T1/2 and T2/3.

Output: 1.Advanced chronic small vessel ischemic disease.2.Gyriform susceptibility abnormality within the right parietal lobe most likely represents hemosiderin sequela of remote small hemorrhagic cortical infarction.3.There has been multilevel laminectomy extending from C2 through C6.4.C2/3: Moderate left neural foraminal stenosis.5.C3/4: Moderate central and severe bilateral neural foraminal stenosis.6.C4/5: There is spondylitic-associated focal cord atrophy with intrinsic T2 hyperintensity as well as mild to moderate central and severe bilateral neural foraminal stenosis7.C5/6: Mild to moderate bilateral neural foraminal stenosis.8.C6/7: Moderate left neural foraminal stenosis.9.C7/T1: Moderate bilateral neural foraminal stenosis.10.Multilevel facet hypertrophy is present in the visualized upper thoracic spine, encroaching the neural foramina, worse at T1/2 and T2/3.


Instruction: Generate impression based on findings.

Input: Reason: Crohn's disease of colon. History: Rectal pain. Assess for perirectal fistula PELVIS:UTERUS, ADNEXA: Bilateral ovarian cysts, likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Severe inflammation of the imaged colon. No abnormal intrapelvic fluid collection to suggest abscess formation.BONES, SOFT TISSUES: There is horseshoe shaped perianal fistula from the distal anus at 5-6 o'clock extending superiorly to the gluteal cleft (series 12 image 55, series 14 image 450). No adjacent fluid collection.OTHER: No significant abnormality noted.

Output: 1.Perianal fistula as above.2.Severe inflammation of the imaged colon.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:8/29/1950)Reason: eval s/p corpectomy for tumor with fusion History: postopPROVIDER/ATTENDING NAME: EDWIN RAMOS The patient is status post T9 corpectomy and posterior fusion using pedicle screws at T7, T8, T10 and T11 with interconnecting rods. To the extent of visualization is no compromise to the spinal cord at this time. There is metal artifact which partially obscures visualization from T7-T11.There are couple cysts present in the left kidney.

Output: Status post corpectomy and fusion. To the extent of visualization there is no compromise to the thoracic spinal cord. Please note that the study is somewhat limited due to metal artifact from the hardware.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with history of vasculitis/arteritis and now with multifocal areas of restricted diffusion on MRI. Multiple new punctate foci of diffusion restriction are evident in the cerebral hemispheres, predominantly affecting the peripheral tissues at the convexities. The inferior lobes and the deep structures are spared. A large area of ill-defined FLAIR hyperintensity has also progressed in the left corona radiata with subtle corresponding DWI hyperintensity.A chronic hemosiderin stained lacunar infarct of the left basal ganglia is unchanged. Small T2 hyperintense foci in the right basal ganglia are also unchanged and favored to represent perivascular spaces versus lacunar infarcts. Minimal scattered foci of T2 hyperintensity are unchanged and nonspecific. No evidence of significant generalized mass effect is seen. No acute intracranial hemorrhage is detected. An 8 mm extra-axial enhancing lesion along the right cerebral dura is unchanged. Ex vacuo dilatation of the left lateral ventricle is again seen. Ventricular size and morphology are unchanged. A subcutaneous cyst is redemonstrated in the left parietal scalp.

Output: 1.Interval development of multiple small foci of acute ischemia involving primarily the peripheral tissues of the cerebral convexities.2.Progressive ill-defined T2 signal abnormality within the left corona radiata with questionable minimal diffusion restriction. This could reflect subacute to chronic ischemic injury as well.3.Chronic lacunar infarct of the left basal ganglia is unchanged.4.Small enhancing extra-axial lesion along the right cerebral dura is unchanged and may represent an incidental meningioma.


Instruction: Generate impression based on findings.

Input: Reason: please do Dr Javed MS protocol on 3 tesla and compare to prior History: numbness and fatigue. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple punctate subcortical and periventricular white matter lesions which are bright on T2 and flair MRI.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the maxillary sinuses and opacities scattered in the maxillary sinuses and ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.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. There is a small central disk protrusion present at this level. This is stable when compared to the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is re-demonstration and no change in the number or extent of the patient's white matter lesions in the brain.2.No convincing evidence for cervical spinal cord involvement at this time.3.A small central disk protrusion is present at C5-6 without any significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Scoliosis. There is marked thoracolumbar rotatory dextroscoliosis centered at T10. There is no evidence of vertebral segmentation anomalies or mass lesions associated with the spine. The vertebral body heights are intact. There is mild prominence of the central canal of the spinal cord in the cervical and thoracic regions. The spinal cord is deformed due to the scoliosis, but there is no significant spinal canal stenosis. The conus medullaris is situated at the L2 vertebral body level. The vertebral bone marrow signal is unremarkable. There is a small right pleural effusion.

Output: 1. Marked thoracolumbar rotatory dextroscoliosis centered at T10, but no evidence of vertebral segmentation anomalies or mass lesions associated with the spine. 2. Mild prominence of the central canal of the spinal cord in the cervical and thoracic regions. 3. Small right pleural effusion.


Instruction: Generate impression based on findings.

Input: 65 year old male status post cardiac transplant, referred for vasodilator stress CMRI to evaluate for transplant vasculopathy.MEDICATIONS: cellcept, fosamax, Lasix, Norvasc, Prograf, Sildenafil, Fenofibric Acid, Humolog, Januvia, Lovaza. First Pass PerfusionDuring hyperemia, no perfusion defects were present. 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 and systolic function. There is mild basal anteroseptal hypertrophy at end diastole, maximum thickness of 14mm. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 56 ml/m2 (normal range: 74+/-15), the LVEDV is 110 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 45 ml (normal range 47+/-19), the LV mass index is 64 g/m2, and the LV mass is 127 g. There are no regional wall motion abnormalities present. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Transplant morphology noted. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 71 ml/m2 (normal range 82+/-16), the RVEDV is 141 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17).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.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 FindingsEnlarge right and left axillary lymph nodes. Multiple enlarged mediastinal lymph nodes. In this clinical setting, post transplant lymphoproliferative disease is suspected. Further evaluation with thoracic CT is recommended.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 59%).4. Normal RV size and systolic function (RVEF 50%).5. Multiple enlarged axillary and mediastinal lymph nodes suggestive of post-transplant lymphoproliferative disorder. Further evaluation with thoracic CT is recommended. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: R/O Rupture History: Posterior tibial tendonitis . Pain. Inability to bear weight on right foot x2 years. Right ankle/midfoot:The anterior tendons appear intact. The flexor tendons appear intact. Specifically, the posterior tibialis tendon appears intact. There is a longitudinal split tear of the peroneus brevis at the level of the distal fibular tip, however, the tendon can be traced to the level of its insertion on the tuberosity of the fifth metatarsal. There is, however, linear fluid signal intensity within the tendon just proximal to the level of its insertion, indicating an additional interstitial tear. There is mild subcutaneous edema in the surrounding area. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact. There is a lobulated focus of fluid signal intensity along the dorsal aspect of the base of the fifth metatarsal which may represent ganglion formation. No osteochondral defect is identified. No bone marrow signal abnormality is seen.Right midfoot/forefoot:Mild osteoarthritis affects the first MTP joint including subchondral cyst formation within the first metatarsal head. There is heterogeneous signal abnormality along the dorsal aspect of the first metatarsal head which likely represents postsurgical change related to prior bunionectomy. There are skin markers in the adjacent area which presumably correspond to the patient's surgical scar, per the technologist note. No enhancing mass lesions are identified. No bone marrow signal abnormality is seen.

Output: Longitudinal split tear and interstitial tearing of the peroneus brevis as described above. The posterior tibialis tendon appears intact. Osteoarthritis and postsurgical changes affect the foot.


Instruction: Generate impression based on findings.

Input: H/o stroke. There is redemonstration of the bilateral ACA, MCA and PCA territory and right cerebellar with vermis strokes. In comparison with prior brain MRI, there appears more mass effect, causing effacement of the fourth, third and left lateral ventricles and prepontine cistern. There are also enlargement of the right lateral ventricle and more midline shift to the right. Postoperative change of a frontal craniotomy and residual suprasellar and sellar mass are re-identified. The right subdural fluid collection is not visualized. No new hemorrhage is detected.

Output: 1. Bilateral ACA, MCA and PCA territory and right cerebellar with vermis strokes with increased mass effect. 2. Interval development of hydrocephalus of the right lateral ventricle. 3. Stable postoperative change of a frontal craniotomy.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:1/31/1945)Reason: quadriplegia History: as abovePROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG MRI of the brainThere is a large area of diffusion restriction centered in the left parietal lobe with some extension into the postcentral gyrus, posterior aspect of the insular cortex, adjacent occipital lobe and posterior aspect of the left superior temporal gyrus. There is some associated mass effect on the left lateral ventricle and mild midline shift. On susceptibility imaging there is some gyral signal loss associated with this area restriction indicative of petechial blood.Focus of susceptibility effect is present in the left globus pallidus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening predominantly in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is elongation of the AP dimension of the eyes bilaterally associated with scleral any.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is hypoplastic. There is fetal origin of the posterior cerebral artery bilaterally with a medium sized left P1 segment and a hypoplastic right P1 segment. There is extracranial origin of the right and left posterior inferior cerebellar arteries. The vertebral arteries are similar in size.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is some straightening of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal. There is some disc desiccation and some right-sided uncovertebral osteophytes at this level with some mild encroachment of the right-sided exiting nerve roots.At C3-4 there is no significant compromise to the spinal canal. There are some endplate uncovertebral osteophytes at this level associated with a disc bulge and some left-sided facet hypertrophy. There is some mild encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. There is left-sided facet hypertrophy at this level.At C5-6 there is no significant compromise to the spinal canal . There are endplate uncovertebral osteophytes at this level associated with a disc bulge and narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes at this level associated with a disc bulge and narrowing of the neural foramina bilaterally. There is encroachment of the left-sided exiting nerve roots within the neural foramen at this level. There is a small central disc protrusion at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Subacute infarction predominantly involving the left parietal lobe but also involving portions of the left insular cortex, temporal lobe and occipital lobe. There is associated petechial blood.2.No evidence for intracranial cerebrovascular occlusive disease.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Staphylomas of the eyes5.There are multilevel degenerative changes present in the cervical spine with encroachment of exiting nerve roots within the neural foramina at multiple levels as detailed above predominantly including C5-6 bilaterally, left-sided exiting nerve roots at C3-4, left-sided exiting nerve roots at C6-7 and right-sided exiting nerve roots at C2-3.


Instruction: Generate impression based on findings.

Input: new onset headache No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 30% of luminal narrowing at the mid basilar artery. however, this is exactly overlapping with MRA acquisition slap. Therefore, this could represent an artifact. However, if there is any clinical suspicion on intracranial arterial stenosis, CT angiography can be considered for further evaluation.Otherwise bilateral ICAs, MCAs and ACAs appear to be normal. Specifically, there is no evidence of intracranial arterial aneurysm, other significant luminal stenosis or evidence suggesting arteriovenous malformation.

Output: 1. CLINICAL INFORMATION:disturbance of skin sensationCOMPARISON: None.TECHNIQUE: MRI brain without contrast and MRA brain without contrast were performed. FINDINGS:There is 13mm x 9mm x 5mm sized lesion with ectatic venous structure indicating arteriovenous malformation on the left middle posterior temporal gyrus possibly within the left lateral occipital sulcus. There is no associated hemorrhage or surrounding edema.No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate enlarged left MCA angular branch with vascular blushing on the left temporo occipital lobe area indicating AVM.Otherwise unremarkable brain MRA.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, dysarthria. No restricted diffusion is seen. An area of encephalomalacia within the posterior left frontal lobe is compatible with a chronic infarct. A few scattered foci of T2 hyperintensity are evident within the periventricular and subcortical white matter, likely representing chronic microvascular ischemic disease. Small chronic lacunar infarctions are suspected within the basal ganglia. A small chronic infarct of the left cerebellum is also seen.No significant intracranial hemorrhage is seen. No abnormal extra axial fluid collections are detected. There is no mass-effect or parenchymal edema. Ventricles are within normal limits. Imaging of the intracranial vasculature shows no evidence of significant stenosis or occlusion. There is likely moderate atherosclerosis of the cavernous ICAs. No aneurysms are detected within the limitations of technique.Imaging of the neck reveals a common origin of the brachiocephalic and left common carotid arteries. Mild atherosclerotic narrowing is evident at the carotid bifurcations without significant stenosis by NASCET criteria. The vertebral vessels are free of significant stenosis.

Output: 1. No definite acute intracranial abnormality including no evidence of acute ischemia.2. A lesion seen in the posterior left frontal lobe on prior CT most likely represents a chronic infarct.3. Scattered additional areas of chronic ischemic injury are seen.4. Dedicated vascular imaging shows no evidence of significant stenosis or occlusion in the head or neck.


Instruction: Generate impression based on findings.

Input: Follow-up of post op meningitis and possible sellar abscess after transphenoidal hypophysectomy.. There are postoperative findings related to transsphenoidal surgery. There is no residual fluid collection in the sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no residual abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is scattered paranasal sinus mucosal thickening, particularly in the sphenoid sinuses.

Output: No evidence of residual fluid collection in the sella or stigmata of meningitis.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, with dementia. Assess for the presence of brain volume loss consistent with Alzheimer's. No restricted diffusion is seen. Extensive patchy periventricular and subcortical T2 hyperintensity is seen, a nonspecific finding. No evidence of edema or mass effect is detected. The left cerebellar hemisphere is hypoplastic/dysplastic with associated underdevelopment of the bony left posterior fossa. No intracranial hemorrhage or any abnormal extra-axial fluid collection is suspected. The ventricular system is normal in size and morphology, with the exception of the fourth ventricle which is somewhat malformed due to the abnormality discussed above. No significant or specific pattern of parenchymal volume loss is detected on this study. Cervical orthopedic fusion hardware is partially seen.

Output: 1. No significant or specific pattern of parenchymal volume loss is detected on this study. 2. Patchy bilateral white matter lesions are nonspecific but may represent advanced chronic microvascular ischemic disease.3. Congenital hypoplasia/dysplasia of the left cerebellum.


Instruction: Generate impression based on findings.

Input: 69-year-old female with primary sclerosing cholangitis, right upper quadrant pain, discomfort, rising alkaline phosphatase. ABDOMEN:LIVER, BILIARY TRACT: Status post left hepatectomy and hepaticojejunostomy. Interval increase in mild to moderate biliary ductal dilation of the right hepatic lobe with narrowing at the level of the hepaticojejunostomy. Main portal vein is patent. No new stricture is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged left renal cyst.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.Interval increase in mild to moderate biliary ductal dilation of the right hepatic lobe.2.Narrowing of the bile ducts at the level of the hepaticojejunostomy without enhancing lesion at this level raises suspicion for an anastomotic stricture.


Instruction: Generate impression based on findings.

Input: Elevated prolactin with pituitary microadenoma treated with cabergoline. There is no evidence of a residual pituitary lesion. The adenohypophysis is not enlarged. There is an intact posterior pituitary bright spot. The pituitary stalk is intact. The optic apparatus and cavernous sinuses are unremarkable.

Output: No evidence of residual pituitary adenoma.


Instruction: Generate impression based on findings.

Input: 40 year-old male, evaluate for hamstring tear or piriformis syndrome The muscles and tendons about the hips are within normal limits. Specifically, the hamstrings and their origins at the ischial tuberosity appear normal. The femoral heads are appropriately situated within the acetabulae. The piriformis muscles are symmetric. The sciatic foramen appears unremarkable. The pelvic structures appear within normal limits for the patient's age. There is mild increased T2 signal in the anterosuperior acetabulum bilaterally, but please note that this exam was not protocoled for evaluation of the acetabular labrum.

Output: Unremarkable exam without specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Ulnar wrist pain LIGAMENTS: We see no contrast traversing the scapholunate or lunotriquetral ligaments to suggest the presence of a tear. There is also no contrast within the midcarpal joint.TRIANGULAR FIBROCARTILAGE COMPLEX: There is a poorly defined near-linear focus of increased signal intensity within the articular disc of the triangular fibrocartilage that we suspect corresponds to the contrast-filled perforation seen on the conventional arthrogram images. Only a scant amount of gadolinium is seen within the distal radioulnar joint and it is possible that this perforation is of no clinical significance.TENDONS: The extensor carpi ulnaris tendon is situated within the ulnar groove when imaged in the pronated position; however there is medial subluxation of the tendon from the groove when in supination. Small linear intrasubstance foci of increased signal intensity within the tendon that extend to the surface could represent small partial-thickness tears, but we see no fluid within the tendon sheath or edema and the surrounding soft tissues to suggest an acute injury; thus the clinical significance of these findings is uncertain.BONES: No significant abnormality noted.ADDITIONAL

Output: 1. Small, barely perceptible perforation of the articular disc of the triangular fibrocartilage which is of uncertain clinical significance.2. Subluxation of the extensor carpi ulnaris tendon from the ulnar groove on supination. Although there are perhaps small partial-thickness tears of the tendon, we see no fluid in the tendon sheath or surrounding soft tissue edema; thus the clinical significance of these findings is uncertain.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with known glioblastoma, on Avestin, now with speech difficulties, right-sided weakness. Rule out bleed. Signs and symptoms: Same Unenhanced head CT:Examination demonstrates no evidence of acute intracranial hemorrhage.Extensive low-attenuation of white matter of the left cerebral hemisphere and to a lesser degree of the right hemisphere is consistent with posttreatment changes as well as residual edema/encephalomalacia of patient's known tumor. There is no appreciable change when compared to prior MR. There is an irregularly shaped calcification of the proximal left frontal lobe at the site of previously noted susceptibility signals are prior MR. Dilated supratentorial ventricular system are essentially similar to prior study. There is no evidence of midline shift. Recommend further follow-up with an MRI exam.

Output: 1.No evidence of acute intracranial hemorrhage as clinically questioned.2.When compared with prior MRI constellation of intracranial findings of brain tumor, post therapy changes, ventriculomegaly remains essentially similar.3.Recommend follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of frontal lobeClinical question: Eval for recurrence of PXA s/p RT.Signs and Symptoms: PXA.Comments: Pt w/ PXA s/p complete resection and focal RT. | The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal craniotomy for left frontal lobe surgery. There is a small linear focus of enhancement present along the inferior medial aspect of the resection site which is stable compared to prior exam. There is also small focus of T1 signal hyperintensity adjacent to the frontal horn of left lateral ventricle. Perfusion imaging does not demonstrate any areas of trabecular vascularity. The signal characteristics of the apparent fluid within the resection cavity are slightly different from that of spinal fluid.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The patient is status post left frontal lobe surgery. The appearance of the resection site is stable compared to the prior exam. Small focus of enhancement at the surgical site remains stable. It is quite possible that it is related to postoperative effect.


Instruction: Generate impression based on findings.

Input: 28-year-old male presents with right shoulder pain. ROTATOR CUFF: The rotator cuff muscles and tendons appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. No fluid or gadolinium in the subdeltoid or subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. The labrum appears normal. A band of low signal intensity along the inferior margin of the glenoid may represent a prominent capsular fold. There is infiltration of gadolinium along the margins of the subscapularis which not uncommonly occurs with these injections.BICEPS TENDON: Long head of the biceps tendon is intact. ADDITIONAL

Output: No specific findings to account for the patient's right shoulder pain.


Instruction: Generate impression based on findings.

Input: Chronic nonalcoholic liver disease. Cirrhosis. Closed fracture of the lumbar spine with possible spinal cord injury. Urinary retention/incontinence, constipation and lower extremely weakness. Evaluate for cord compression. Five lumbar type vertebral bodies are presumed to be present. There is a T12 anterior wedge compression fracture with up to 50 percent loss of height and mild edema. A Schmorl's node is noted at this level. There is also a compression fracture at L2 with 30 percent loss of height and moderate edema. No significant osseous retropulsion. Remainder of the vertebral body heights are preserved. There is minimal retrolisthesis at L4-5. There is grade 1 anterolisthesis at L5-S1 with bilateral pars defects at L5. Bone marrow signal is benign. The conus medullaris is normal in position.There is moderate left and mild right neural foraminal stenosis at L5-S1. No significant spinal canal stenosis at any level to suggest compression of the cauda equina.

Output: 1.No evidence of cauda equina compression.2.Acute-appearing compression fracture at L2 with 30% loss of height. Subacute to chronic compression fracture involving the T12 vertebral body with up to 50% loss of height.3.Moderate left and mild right L5-S1 neural foraminal stenosis. Isthmic spondylolisthesis noted at L5-S1.


Instruction: Generate impression based on findings.

Input: Diffuse large B-cell lymphoma with cord compression. MRI prior to lumbar puncture and intrathecal chemotherapy.. There are multiple small enhancing lesions throughout the calvarium compatible with metastases. No intracranial mass or mass-effect is seen. No abnormal parenchymal or meningeal enhancement is seen. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preservedSella and orbits are grossly within normal limits. Mild mucosal thickening in the paranasal sinuses with small right maxillary mucous retention cyst. Mastoid air cells are clear.

Output: 1. No intracranial mass or mass effect to contraindicate lumbar puncture.2. Multiple small enhancing lesions throughout the calvarium consistent with osseous metastases.


Instruction: Generate impression based on findings.

Input: 49 year old with BRCA 1 mutation and strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few bilateral enhancing foci are stable. No abnormal lymph nodes are identified in either axillary region.Presumed thoracic syrinx again noted.

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


Instruction: Generate impression based on findings.

Input: Nasal mass, turbinate hypertrophy. There is a cystic lesion in the right nasolabial junction that measures 14 mm in diameter. There is narrowing of the inferior portion of the piriform aperture. The nasal turbinates are intact. The paranasal sinuses and nasopharynx are unremarkable. There is a partially empty sella. The orbits are unremarkable.

Output: 1. Findings compatible with a right nasolabial cyst that measures 14 mm in diameter. 2. Nonspecific partially empty sella.


Instruction: Generate impression based on findings.

Input: The spinal cord is of normal caliber and signal. The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. No abnormal enhancement.Partially imaged posterior fossa demonstrates a mega cisterna magna, which is a normal variantTHORACIC SPINE

Output: 1. No signal abnormalities in the spinal cord to suggest demyelinating disease. 2. Tiny right paracentral disc protrusion at the T6-T7 level which slightly deforms the right ventral aspect of the cord. There is no significant spinal canal or neural foraminal stenosis at any level in the cervical or thoracic spine.3. Patient had a mild contrast reaction to gadolinium and was transferred to the ED. Recommend premedication per department protocol with future postgadolinium studies.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with history of glioblastoma multiforme, currently on clinical trial with Temodar and investigational agent. Left cranial postoperative findings are redemonstrated. A 7 mm epidural collection subjacent to the craniotomy flap has not significantly changed from prior.A left temporal lobe resection cavity is similar in size and shape. Fluid in the cavity demonstrates an interval reduction in FLAIR hyperintensity suggesting resolution of proteinaceous contents.Since the prior examination, enhancing tissue with corresponding elevated rCBV within the anterior left temporal lobe has decreased in thickness. Associated edema and FLAIR hyperintensity in the surrounding tissue is also mildly improved.The above mentioned enhancing tissue is, however, contiguous with a growing nodule of enhancement along the anterior margin of the resection cavity which also demonstrates mild elevated rCBV. This tissue measures up to 20 x 16 mm, previously 11 x 4 mm. Ill-defined infiltrative enhancement extends posteriorly from this dominant nodule along the medial aspect of the cavity to the level of the left atrial margin, and these areas of enhancement also seem slightly more conspicuous.Generalized ill-defined periventricular white matter T2 hyperintensity is again seen similar to the prior examination. Ex vacuo dilatation of the left lateral ventricle is unchanged. The size and shape of the ventricular system is stable. Hypoplasia of the right cerebellum is also redemonstrated.

Output: A mixed pattern of disease response is seen. For example, enhancing tissue within the anterior left temporal lobe has decreased in thickness with a corresponding decrease in associated parenchymal edema. However, more posteriorly, along the margin of the left temporal resection cavity, a nodule of enhancing tissue with mild corresponding rCBV elevation has substantially increased in size.Partial resolution of inflammation within the left temporal lobe is suspected given partial clearing of the fluid within the resection cavity.


Instruction: Generate impression based on findings.

Input: Evaluate ventricular size. Normal pressure hydrocephalus. VP shunt now with increasing headaches. Nonenhanced head CT:Images through posterior fossa are unremarkable and unchanged since prior MRI exam from 2004.Images two supratentorial space demonstrate enlargement of all supratentorial ventricular system. This exam is compared with prior MRI study from 2004. A the transverse axis of the third ventricle on the current head CT measures 16.3-mm compared to prior measurement of 20.7-mm.The transverse measurements of bilateral frontal horns measures 35mm compare to prior measurements of 43.3 mm.There is a BSO a right-sided ventricular catheter with the tip of the catheter in the right frontal horn at the level of foramina of Monroe.Examination also demonstrate small low-density bilateral subdural collections in the frontal and parietal regions. The size of right frontal subdural measures 3.4-mm in thickness and the left frontal subdural measures 4.4-mm in thickness. These subdurals were not present on prior MRI exam from 2004.There is no detectable intraparenchymal hemorrhage or edema. The gray -- white matter differentiation remains within normal.

Output: 1.Smaller size of supratentorial ventricular system since prior MRI examination from 2004. There is however persistent enlargement of all supratentorial ventricular system. Right-sided ventricular catheter with the tip in the right frontal horn.2.No detectable parenchymal abnormality.3.Since 2004 are small bilateral frontal and parietal low-density subdural collections which measure 3.4mm in thickness in the right frontal region and 4.4 mm in the left frontal region.


Instruction: Generate impression based on findings.

Input: Other malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: Right medial temporal lobe and the right frontal mixed signal lesions, likely represent History: headaches There is about 5mm sized right fusiform gyrus multiple conglomerated T2 high signal lesion with surrounding hemosiderin deposition. There is also right insular subcortical white matter lesion with similar MR characteristics.In addition, there is a small susceptibility lesion on the posterior aspect of the right middle temporal gyrus. All three lesions do not show any evidence of surrounding edema.Regarding the right fusiform gyrus and right anterior insular lesions, the central T2 high signal intensity portion appears to be slightly smaller than before, however, surrounding hemosiderin deposition appears to be larger.The right posterior middle temporal gyrus lesion was not seen on prior scan. However, since there was no compatible sequence to that of current Gradient echo or CCM sequence, it is not clear if the lesion is a new one or was there before.There is no evidence of abnormal enhancement on this scan.Constellation of above findings indicate 3 cavernous malformations with interval evolution of 2 lesions and newly found one small lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Three cavernous malformations are demonstrated without evidence of surrounding edema or enhancement. 2. Both right fusiform gyrus and anterior aspect of the insular lesions show interval change of MR feature. In particular, decreased size of central T2 high signal intensity portion and increased extent of surrounding hemosiderin deposition since prior scan.3. Posterior aspect of the right middle temporal gyrus lesion is a new lesion found on this scan, however, due to difference in MR technique, the lesion could have been unfound from prior scan.4. No evidence of acute ischemic or hemorrhagic lesion on this scan. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Esophageal cancer. Evaluate for brain mets prior to starting new treatment. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with history of myeloma, presenting with neck spasms. Anterior instrumented fusion of C5-C7 has been performed with evidence of vertebral body osseous incorporation. Evidence of posterior instrumented fusion is also seen from the occiput down to C6.A severe compression deformity of the C3 vertebral body appears similar to that noted on prior CT with mild retropulsion. Some STIR signal abnormality is seen within the compressed vertebra and in the adjacent inferior C2 endplate. There may be mild enhancement in these areas as well. No paraspinal or epidural fluid collections are detected. The remaining vertebral bodies are free of pathologic marrow replacement or edema.The visualized spinal cord is free of definite focal signal abnormality. No epidural lesions are suspected.C2-3: Retropulsion and osteophytic spurring cause effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. The left neural foramen is moderately to severely narrowed. C3-4: Retropulsion and osteophytic spurring, with central focality, cause effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. Some degree of left foraminal narrowing is suspected. C4-5: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C5-6: Obliteration of the disc space. No spinal canal stenosis. Perhaps mild foraminal narrowing on the left. C6-7: Obliteration of the disc space. No spinal canal stenosis. Perhaps mild left foraminal narrowing. C7-T1: The intervertebral disc is preserved. No spinal canal or foraminal stenosis.

Output: 1.Postoperative findings compatible with both anterior and posterior instrumented cervical fusion.2.A severe compression deformity of the C3 vertebral body appears similar to that noted on prior CT. There are no definitive findings of active inflammation or infection at this level.3.Relatively mild disc degeneration is seen at those levels which are not fused. No areas of high-grade spinal canal stenosis are demonstrated. Moderate to severe foraminal narrowing is, however, seen on the left at C2-3.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for tenosynovitis of L wrist History: L wrist swelling and pain along extensor tendons A marker was placed along the dorsal aspect of the wrist. Deep to the marker, we see fluid surrounding the extensor digitorum tendons of compartment 4, compatible with the suspected clinical history of tenosynovitis. There is also mild increased signal intensity within the tendons themselves suggesting tendinosis/inflammation. There are multiple slips of the extensor pollicis longus, a normal anatomic variant. The remaining extensor tendons appear intact. The flexor tendons appear intact. There is a tiny focus of increased signal intensity within the dorsal fibers of the scapholunate ligament which may represent a small perforation of questionable significance. The ligament otherwise appears intact given the limitations of a non arthrogram study. The lunotriquetral ligament is not optimally visualized but we see no findings to suggest disruption. The triangular fibrocartilage complex appears intact within the limitations of a non arthrogram study. There is a suture line along the volar skin surface the wrist with low signal intensity within the underlying subcutaneous fat compatible with scarring. There is discontinuity of the flexor retinaculum compatible with carpal tunnel release. There is a small 6 mm lobulated collection of fluid signal intensity within the soft tissues dorsal to the scaphoid near the attachment of the dorsal intercarpal ligament which likely represents a small ganglion. Mild osteoarthritis affects the basilar joint. There is a small focus of edema type signal abnormality in the distal diaphysis of the first metacarpal of uncertain significance.

Output: Extensor digitorum tenosynovitis concentrated dorsal to the distal carpal row and other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with subarachnoid hemorrhage. Assess for spinal vascular lesion. Blood product is again seen collected along the ventral brainstem with extension down into the cervical region. The majority of this blood product is located at the level of the pons and medulla with only a small amount reaching into the cervical spine.The upper cervical cord is mildly displaced by this blood product but does not seem to be severely compressed. There may be very mild patchy T2 hyperintensity within the upper cord but this is equivocal and could simply be reactive to the adjacent blood product. No discrete lesions are seen at any point within the visualized spinal cord. On postcontrast images no clear enhancing lesions are demonstrated. At most, there may be mild pial enhancement in the brainstem and upper cord which is likely reactive. No tangle of vessels or vascular nidus is seen.Slight reversal of the normal cervical lordosis may be positional. Vertebral body morphology is within normal limits. Small enhancing lesions within the C5 and T1 and T2 vertebral bodies probably represent hemangiomas.C2-3: Mild facet hypertrophy. Otherwise unremarkable.C3-4: Mild posterior disk osteophyte complex. No significant spinal canal or neuroforaminal stenosis.C4-5: Mild posterior disk osteophyte formation with a superimposed left paracentral/foraminal disk protrusion. This protrusion mildly contacts the lateral spinal cord. No significant generalized spinal canal or neuroforaminal stenosis. C5-6: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. C6-7: Unremarkable. C7-T1: Unremarkable.

Output: 1. Redemonstration of subarachnoid blood products extending along the ventral brainstem from the level of the pons to the upper cervical cord.2. There may be mild ill-defined signal abnormality within the upper cervical cord, perhaps reactive to the adjacent blood product.3. No discrete or enhancing lesions are seen within the visualized spinal cord. No vascular lesions are suspected.4. Scattered mild degenerative disk findings with a disk protrusion at C4-5 mildly pinching upon the lateral aspect of the cord.


Instruction: Generate impression based on findings.

Input: 74-year-old female with history of Crohn's disease on infliximab. Evaluate for mucosal disease. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered bilateral subcentimeter renal T2 hyperintense foci without evidence of contrast enhancement, consistent with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a small duodenal diverticulum. Approximately 5 cm from the ileocecal valve, there is evidence of distal ileum wall thickening, edema, diffusion restriction, and enhancement spanning over approximately 18 cm. Proximal to this segment, there is an additional patulous segment measuring approximately 9 cm with evidence of wall thickening, submucosal edema, and enhancement consistent with mild acute on chronic inflammatory bowel disease. Colon is normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Approximately 5 cm from the ileocecal valve, there is evidence of distal ileum wall thickening, edema, diffusion restriction, and enhancement spanning over approximately 18 cm. Proximal to this segment, there is an additional patulous segment measuring approximately 9 cm with evidence of wall thickening, mild submucosal edema, and enhancement consistent with mild acute on chronic inflammatory bowel disease. The colon is normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings consistent with active inflammatory bowel disease involving long segments of the distal ileum as above.


Instruction: Generate impression based on findings.

Input: 54 year old female with altered mental status after craniotomy. Post-surgical changes related to bi-frontal craniotomy and and repair of right frontal encephalocele are seen, with pneumocephalus and subcutaneous emphysema consistent with recent procedure. Evidence of bilateral frontal sinus exenteration, with bone fragments and fluid present in expected locations of right and left frontal sinuses. Small amount of extra axial blood is seen in the surgical field overlying the anterior frontal lobes. Increased density overlying the anterior aspect of the superior sagittal sinus may represent blood, however, thrombosis of the sagittal sinus cannot be excluded (series 1, image 18). A small area of hypoattenuation in the right antero-inferior frontal lobe adjacent to surgical site is non-specific and may represent edema related to the surgery, however, focal infarction cannot be excluded.No evidence of intraparenchymal or subarachnoid hemorrhage. There is possibly a trace amount of subdural hemorrhage along the falx.There is crowding at the foramen of magnum related to cerebellar ectopia as seen on prior MRI.There is significant preseptal soft tissue swelling on the right, with associated mild infiltration of the extraconal and intraconal post-septal fat on the medial aspect of the right orbit as well as intraorbital gas superiorly. There is mild right proptosis and apparent stretching of the right optic nerve as well. The left preseptal and post septal soft tissues and intraorbital contents appear unremarkable. No evidence of mass or midline shift.Changes related to right ethmoidectomy and right maxillary antrostomy are seen, with persistent opacification of the partially visulized right maxillary sinus. There is persistent lateral deviation of the right maxillary sinus wall, with opacification and likely packing of the partially visualized right nasal cavity. The left maxillary sinus is partially opacified as well. Ethmoid air cells are opacified bilaterally. The mastoid air cells appear unremarkable. Sphenoid sinuses are partially opacified.

Output: 1.Postoperative changes in the anterior calvarium and floor of anterior cranial fossa, with a small amount of extra-axial blood in surgical field and expected pneumocephalus. There is a trace amount of subdural hemorrhage along the falx.2.Increased attenuation in area of anterior aspect of superior sagittal sinus is non-specific and can represent post-surgical changes or blood, however, dural venous sinus thrombosis cannot be excluded. Consider MRI braina and MRV for further evaluation if clinically indicated. 3.Hypoattenuation in antero-inferior aspect of right frontal lobe may be related to post-surgical edema, however, this is nonspecific and infarction in this location cannot be excluded. MRI may be helpful to further evaluate. 4.Soft tissue swelling in the right periorbital region, which also appears to involve post-septal soft tissues; this is concerning for orbital inflammation or infection. Follow-up is recommended; MRI with contrast may be helpful to further characterize.5.Postoperative changes in the right ethmoid air cells and partially visualized right maxillary sinus, with opacification of the maxillary sinuses, ethmoid air cells, and right nasal cavity.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of rotational trauma 4 weeks ago and pain. Evaluate for lateral meniscal tear. MENISCI: The medial meniscus is normal in signal and morphology. There is mild blunting of the free edge of the posterior horn and body of the lateral meniscus; there is no definite increased signal extending to the articular surfaces.ARTICULAR CARTILAGE AND BONE: Mildly increased T2 signal within the lateral femoral condyle and posteriolateral aspect of the lateral tibial plateau compatible with mild edema. Otherwise, no evidence of acute fracture. No evidence of articular cartilage defects.LIGAMENTS: Mildly increased T2 signal within the anterior cruciate ligament fibers which may represent a mild sprain; otherwise, the anterior and posterior cruciate ligaments are intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps mechanism is intact.ADDITIONAL

Output: 1.Blunting of the free edge and body of the posterior horn of lateral meniscus without discrete tear.2.Moderate size knee joint effusion.3.Mild osseous contusions involving the lateral femoral condyle and posteriolateral tibial plateau.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified site [191.9], Reason for Study: ^Reason: history of cervical astrocytoma s/p resection History: off therapy evaluation Redemonstration of ill-defined diffuse high signal intensity lesion on FLAIR and T2-weighted imaging on the mandibular and cervicomedullary junction intra-axial lesion, maximum diameter on sagittal scan was measured around 29.4 mm x 14 mm. The lesion does not show any gadolinium enhancement, nor does not show any evidence of hemorrhagic foci within the lesion. Approximate size of the mass and MR characteristics do not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Previously seen right maxillary sinus opacification has been cleared.C-spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.There is no evidence of degenerative changes of cervical spine.

Output: 1. Stable and no change in terms of size and MR characteristics of medullar and cervicomedullary junctional mass lesion since prior scan.2. Unremarkable C spine MRI.


Instruction: Generate impression based on findings.

Input: History of left renal exophytic lesion with possible mild increase in size in recent ultrasound. ABDOMEN:LIVER, BILIARY TRACT: Diffuse, mildly decreased signal intensity of the hepatic parenchyma on out of phase images suggestive of hepatic steatosis. No focal hepatic lesions are identified. The hepatic vasculature appears patent. The gallbladder appears within normal limits. No biliary ductal dilatation.SPLEEN: The spleen is upper limits of normal in size without suspicious focal lesions.PANCREAS: The pancreas demonstrates normal signal intensity and enhancement without suspicious focal lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Within the interpolar region of the right kidney, there is a subcentimeter cyst which lacks suspicious features and appears similar to recent ultrasound. There is an additional exophytic cyst arising from the left kidney interpolar region which measures approximately 9 x 11 x 11 mm and lacks suspicious features. No suspicious renal lesions are identified. The renal parenchyma enhances normally.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.Simple renal cysts without suspicious renal lesions.2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Muscle twitching, bands in CSF. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal diffuse periventricular white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: Nonspecific minimal diffuse periventricular white matter T2 hyperintensity, but no findings characteristic of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 26-year-old female with right knee pain. MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: The tricompartmental articular cartilage demonstrates normal thickness without focal defects. No bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal knee MRI without specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Tinnitus, congested feeling in head; paresthesias of legs. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are secretions in the pneumatized left petrous apex.

Output: 1. No evidence of intracranial demyelinating lesions, mass, or acute infarct. 2. Secretions in the pneumatized left petrous apex.


Instruction: Generate impression based on findings.

Input: History of hepatic and pancreatic cysts. Evaluate for progression. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There are multiple simple cysts throughout the liver. The largest lesion is a complex cystic lesion demonstrating internal debris and signal suggestive of prior hemorrhage, measuring approximately 12.5 x 11.5 cm (series 7/41), compared to 15.3 x 15.1 cm previously. On postcontrast subtraction images it demonstrates no internal enhancement. Again this may represent a complex cyst or biliary hamartoma. It causes mild local mass effect on the adjacent duodenum and common bile duct without evidence of obstruction.No biliary ductal dilatation. Contracted gallbladder. No suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic tail multiloculated cystic lesion measures 5.9 x 3.6 cm (series 7/31), compared to 6.0 x 3.1 cm previously. There is suggestion that it communicates with the main pancreatic duct which is normal in caliber. Otherwise the pancreatic parenchyma is unremarkable.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: Small umbilical fat-containing hernia and diastases of the rectus abdominis musculature.OTHER: No significant abnormality noted.

Output: 1.Multiple benign-appearing liver cysts are unchanged. Complex cyst versus giant biliary hamartoma demonstrates interval decrease in size.2.No significant change in the pancreatic tail cystic lesion likely communicating with a normal caliber main pancreatic duct and representing a side-branch IPMN versus less likely a serous cystadenoma. No suspicious post-contrast enhancement.


Instruction: Generate impression based on findings.

Input: 74-year-old female with right knee pain and buckling sensation, evaluate for ligamentous injury. MENISCI: The medial meniscus is intact. There is complex multidirectional tearing involving the body and posterior horn of the lateral meniscus (series 10, image 10).ARTICULAR CARTILAGE AND BONE: There is an approximately 10 x 6 mm focus of abnormally low T1 signal along the lateral tibial plateau (series 3, image 17) with overlying full-thickness loss of cartilage compatible with subchondral fracture. Bone marrow signal is otherwise unremarkable. There is an area of full-thickness cartilage loss involving the posterior aspect of the lateral femoral condyle (series 10, image 10) measuring approximately 1.7 cm in the anterior posterior dimension. There is corresponding full thickness cartilage loss involving the posterior aspect of the lateral tibial condyle. There is diffuse mild thinning of the patellofemoral cartilage.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex multidirectional tear involving the body and posterior horn of the lateral meniscus.2.Area of full-thickness cartilage loss in the lateral tibiofemoral compartment with associated lateral tibial plateau small subchondral fracture.


Instruction: Generate impression based on findings.

Input: 30-year-old male patient with severe left knee pain. Concern for avascular necrosis in a sickle cell patient. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intactLow marrow signal within the distal femoral and proximal tibial metadiaphyses is consistent with red marrow replacement. There is medullary high T1 and T2 signal within the distal femoral diaphysis, which extends proximally outside the field of view, which is consistent with infarcted bone. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Findings consistent with bone infarction within the femoral diaphysis. 2. Diffuse red marrow replacement consistent with sickle cell anemia.3. Intact structures within the knee.


Instruction: Generate impression based on findings.

Input: Neuropathy and weakness in fingers, evaluate for herniated disc. Neck pain, right arm pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is reversal of normal cervical lordosis with kyphotic angulation centered at the C5-C6 level. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is a kyphosis centered at this level along with a disc bulge which results in effacement of the ventral thecal sac and mild impression on the ventral aspect of the cord. Dorsal thecal sac is preserved with overall no significant spinal canal stenosis. Neural foramina are patent. No cord signal abnormality.C5-6: Mild disc bulge with small right foraminal disc protrusion. No significant compromise to the spinal canal or left neural foramen. Mild right neural foraminal narrowing.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. There is kyphosis of the cervical spine with apex at the C5-C6 level which in combination with a disc bulge at this level results in mild impression on the ventral aspect of the cervical cord. No significant spinal canal stenosis at this level overall or neural foraminal stenosis. No cord signal abnormality. 2. Small right foraminal disc protrusion at the C6-C7 level with mild narrowing of the right neural foramen.


Instruction: Generate impression based on findings.

Input: NSCLC. Brain mets. New gait difficulty and neck pain. Cervical Spine:Alignment is anatomic. Vertebral body height is preserved. Marrow signal shows no suspicious focality. There is mild height and T2 signal loss at C4-C5, C5-C6 and C6-C7 levels. The spinal canal is moderately narrowed at these levels as described below. The spinal cord shows normal signal. The included brain stem and cerebellum show no gross abnormality.C2-C3 and C3-C4: No spinal canal or neural foraminal narrowing.C4-C5: Small disc-osteophyte complex has a central disc protrusion that moderately narrows the spinal canal and appears worse in the interval. There is mild foraminal narrowing.C5-C6: The disc-osteophyte complex has a left paracentral component that indents the spinal cord causing moderate spinal canal narrowing similar to prior. This is associated with relatively severe bilateral uncovertebral productive change and results in moderate bilateral foraminal narrowing.C6-C7: Disc osteophyte complex is associated with bilateral uncovertebral proliferative change. This results in moderate central and bilateral foraminal stenoses.C7-T1: There is no central or foraminal stenosis.Included cervical soft tissues show no gross abnormality. Fluid in the right mastoid air cells can be inflammatory or congestive. Included brain shows no contrast-enhancing mass. Tiny CSF intensity focus involving the undersurface of the left cerebellum may represent a tiny, chronic infarct.Thoracic Spine:Alignment is anatomic. Irregularity along the endplates with small intravertebral herniations of the discs are present at multiple levels but without associated kyphotic deformity. The marrow signal is normal without suspicious focal lesion. The thecal sac is not compressed (tiny anterior indentations by discs are present). The spinal cord shows normal morphology and signal. There is no spinal canal or foraminal stenosis. Dependent atelectasis in the lungs and other findings are better described on the chest CT scan from August 5, 2015.Lumbosacral Spine:Alignment is anatomic. The marrow signal is normal without suspicious focal lesion. The thecal sac is not focally compressed but the lumbar spinal canal is mildly narrowed by short pedicles (congenital narrowing). The conus medullaris has normal morphology and signal characteristics. The tip is at the lower L1 vertebral level. There is no abnormal contrast enhancement along the conus medullaris or nerve roots. Fluid-like signal is present in the subcutaneous tissues of the lower back which is probably dependent edema.T12-L1, L1-L2 and L2-L3: There is no significant spinal canal or foraminal stenosis.L3-L4: Mild ligamenta flava thickening and left more than right facet productive change along with disc bulge result in mild central canal narrowing. There is also mild left subarticular and foraminal stenoses. L4-L5: Disc bulge, ligamenta flava thickening and facet productive change result in mild spinal canal stenoses. There is also bilateral mild foraminal stenoses.L5-S1: There is no significant central or foraminal stenoses.

Output: 1.No evidence of metastatic disease in the cervical, thoracic, or lumbar spine. No abnormal enhancement to suggest epidural, leptomeningeal, or, intramedullary tumor2.There is moderate degree of spinal canal stenosis at the C4-C5, C5-C6, and C6-C7 levels which is stable to slightly worse since 2014. There is flattening of the cord without cord signal abnormality.3.Lumbar spondylosis is mild as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 19 years old, history of von Hippel-Lindau, history of brain hemangioblastoma status post resection. Assess for hemangioblastomas and endolymphatic sac tumor. Image quality is degraded by motion artifact. Given this limitation, the following observations are made.Brain/IAC:Evidence of prior midline approach suboccipital surgery is demonstrated. A 5-mm nodule of enhancement is evident along the dorsal surface of the medulla at the level of the foramen magnum. This lesion is associated with mild edema.Elsewhere in the cerebellum, at least 5 small enhancing lesions are demonstrated (see key images) ranging in size from punctate up to about 3 mm in diameter. Mild edema is associated with some of these lesions.Dedicated imaging of the temporal bones and inner ear structures shows no evidence of any enhancing or destructive mass to suggest the presence of an endolymphatic sac tumor.No definite supratentorial lesions are seen. No evidence of significant mass effect is demonstrated. No abnormal fluid collections or acute intracranial hemorrhage is detected. Ventricles are normal in size and morphology.Spine:An enhancing lesion is seen within the dorsal spinal cord at the C4 level measuring up to 6 mm in diameter. This lesion is associated with moderate cord edema.An enhancing lesion is demonstrated within the right posterior cord at the T4 level measuring up to 6 mm in diameter. Another lesion within the right posterior cord at the T6 level measures up to 5 mm in diameter. Both are associated with modest cord edema.No evidence of any additional spinal cord or cauda equina enhancing lesions is seen. No significant spinal canal stenosis is demonstrated.Small Schmorl's nodes are seen at T10 through L1 where there is a mild exaggeration of the thoracic kyphosis. The vertebral bodies are mildly wedged at this level as well. No pathologic marrow signal or evidence of marrow edema is seen. Mild subcutaneous enhancement of the posterior neck is nonspecific and of uncertain significance.

Output: 1. Multiple enhancing nodules are demonstrated within the cerebellum and along the dorsal surface of the medulla compatible with hemangioblastomas. These lesions are associated with mild edema. Evidence of prior surgery is seen within the posterior fossa. No supratentorial lesions are identified, including no evidence of endolymphatic sac tumor.2. Enhancing lesions are seen within the spinal cord at the C4, T4 and T6 levels compatible with hemangioblastomas. These are associated with mild cord edema. No disease is demonstrated in the lumbar region.3. Schmorl's nodes are seen at T10 through L1 were mild vertebral body wedging results in exaggeration of the thoracic kyphosis. Findings may represent incidental Scheuermann's disease.


Instruction: Generate impression based on findings.

Input: Brachial neuritis or radiculitis NOS The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present. There is reversal of the normal cervical curvature centered at approximately C5-6.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion present.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based left lateral disc protrusion at this level which mildly narrows the left neural foramen and mildly encroaches on the left-sided exiting nerve root. There is a smaller right lateral recess disc protrusion at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are mild multilevel degenerative changes present in the cervical spine mainly in the form of disk disease with some mild encroachment of the exiting nerve roots at C5-6 (left more than right) due to disc material.