Instruction: Generate impression based on findings.

Input: 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. Mucosal thickening is present within bilateral mastoid, sphenoid, and ethmoid sinuses. There are no superimposed air fluid levels. Mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Mucosal thickening is present within bilateral mastoid, sphenoid, and ethmoid sinuses. There are no superimposed air fluid levels. Otherwise negative MRI of the brain including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: Male 55 years old Reason: US shows pancreatic head mass and liver masses History: weight loss, abd pain ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense rim enhancing lesions throughout the liver. A reference lesion in the right hepatic lobe measures 1.8 x 1.9 cm (series 1302, image 124). These are suspicious for liver metastases. Multiple small gallstones within the gallbladder. There is intrahepatic duct dilatation. The common duct is also dilated to Klatskin point where it appears encased by the below described mass. There is a small filling defect within the mid common duct suggestive of choledocholithiasis. SPLEEN: No significant abnormality noted.PANCREAS: Large hypoattenuating mass in the posterior aspect of the lesser sac which appears to arise from the pancreatic neck and measures approximately 4.8 x 3.3 cm (series 1302, image 115). No significant pancreatic duct dilatation. The mass encases the celiac trunk, superior mesenteric artery and proximal hepatic and splenic arteries. There is occlusion of the superior mesenteric vein and splenic vein. The extrahepatic portal vein is occluded.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Necrotic mass in the posterior aspect of the lesser sac with liver metastases and vascular involvement as detailed above. There is moderate intra-and extrahepatic area duct dilatation secondary to compression from this mass. The findings are most consistent with adenocarcinoma, possibly a pancreatic primary neoplasm.2. Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 47 year old male with PVC and RV dilation, MRI for further evaluation Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 64%. The LVEDV is 138 ml (normal range 142+/-34), the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVESV is 50 ml (normal range 47+/-19) and the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9). The LV mass is 129 g (normal range 164+/-36) and the LV mass index is 66 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 50%. The RVEDV is 160 ml (normal range 142+/-31), RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVESV is 80 ml (normal range 54+/-17), and the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPectus excavatum. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is normal in size and function. The overall LV ejection fraction is 64%.2. Right ventricle is normal in size and function. The overall RV ejection fraction is 50%.3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in the ventricular myocardium.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 20-year-old female with perianal Crohn's in clinical remission. Planning for seton removal. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Left mildly prominent inguinal lymph nodes are noted.BOWEL, MESENTERY: Redemonstrated is a left perianal fistulous track to the skin with a seton in place. There is minimal abnormal T2 signal and enhancement immediately surrounding the seton track. Overall appearance improved from prior study, accounting for differences in technique and presence of seton. No fluid collection to suggest abscess. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left perianal fistulous track to the skin with a seton in place without fluid collection to suggest abscess.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of intraventricular hemorrhage. Now with fever and abdominal pain. Exam is somewhat limited by motion artifact.CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions and basilar atelectasis. Right apical scarring also present.MEDIASTINUM AND HILA: Calcified hilar lymph nodes without any pathologically enlarged lymph nodes. Small pericardial effusion. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Calcified granuloma indicative of prior granulomatous infection. There is a likely gallstone in the gallbladder neck but this is unclear due to the motion artifact. No pericolicystic fluid or biliary ductal dilatation.SPLEEN: Calcified granuloma without any other abnormality.PANCREAS: No significant abnormality notedADRENAL GLANDS: 3 x 1.8 centimeter left adrenal nodule. 1.3 x 1.7 cm right adrenal nodule. These are nonspecific on this examination but likely represent adenomas given the patient has no primary malignancy. Dedicated adrenal CT or MRI may be performed for further characterization as clinically indicated.KIDNEYS, URETERS: Atrophic. Hypodense lesions in both kidneys are too small to characterize but likely represent cysts.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: The prostate is slightly enlarged.BLADDER: The bladder is distended without any focal abnormalities.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No specific source of fever as clinically queried.2. Bilateral pleural effusions and pericardial effusion.3. Distended bladder with enlarged prostate. Consider Foley catheter for drainage.4. Bilateral adrenal nodules which are nonspecific on this examination but likely represent bilateral adenomas. Dedicated imaging of the adrenals with either CT or MR could be obtained for more specific diagnosis if clinically indicated.These findings were communicated to the clinical service at 9:15 a.m.


Instruction: Generate impression based on findings.

Input: Right lower quadrant pain and concern for rectovaginal fistula in the setting of vaginal delivery. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small and large bowel is normal in caliber wall thickness and without adjacent inflammatory changes. The terminal ileum is unremarkable. No free fluid or loculated fluid collection. The appendix is not definitively seen although I suspect it is partially seen in the retrocecal position (series 8/13). No adjacent inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus and adnexa are unremarkable. Several bilateral physiologic cysts are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace amount of nonloculated fluid in the rectouterine pouch. No evidence of a rectovaginal fistula.BONES, SOFT TISSUES: There is an equivocal focus of linear signal abnormality extending posteriorly from the distal vaginal canal towards the rectum (series 270 0/56, series 19/20, series 5/43) which may represent a very small fistulous communication in light of the given history. OTHER: No significant abnormality noted.

Output: There is an equivocal focus of linear signal abnormality extending posteriorly from the distal vaginal canal towards the rectum which may represent a very small fistulous communication in light of the given history. If clinically warranted a fluoroscopic study with direct instillation of contrast may be of value.No specific findings to account for the patient's right lower quadrant pain. Trace free fluid in the pelvis is within physiologic limits.


Instruction: Generate impression based on findings.

Input: Clinical question: MS, high burden of disease, concerning for new lesion, ataxia. Signs and symptoms: Ataxia. Pre and post enhanced brain MRI:There is difference of technique between the 2 exams which precludes precise comparison. There are 2 and 1 slice images on prior exam compared to 4 mm slice thickness on current study.Within this limitation examination redemonstrate fairly extensive findings of demyelinating disease in the periventricular and subcortical white matter of cerebral hemispheres, left thalamus and extensively in the midbrain and pons and including cerebellar peduncles and left cerebellum. Comparison with prior exam demonstrates no convincing evidence of progression of disease. Postcontrast images also demonstrate no detectable enhancing demyelinating plaques.Lateral ventricles are mildly prominent without change since prior exam and with maintained midline.Cortical sulci and CSF spaces are unremarkable and similar to prior exam.The signal void in major intracranial arterial branches are identified.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium and soft tissues of the scalp.Unremarkable signal intensity of all visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: 1.Extensive findings of demyelinating disease both in supra and infratentorial brain without convincing evidence of interval change. Please see above comments.2.No detectable abnormal enhancing plaques.3.Stable ventricular system, cortical sulci and CSF spaces since prior study.


Instruction: Generate impression based on findings.

Input: 54 year old woman with frequent PVCs and LV dysfunction referred to rule out ischemia and myocardial scar 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 with mildly reduced systolic function. The overall LV ejection fraction is 49.8%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 128 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 64 ml (normal range 31+/-10), the LV mass index is 57 g/m2, and the LV mass is 90 g. There is global hypokinesis. Assessment of left ventricular ejection fraction is limited by the presence of frequent premature ventricular contractions.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 68%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 94 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with mildly reduced systolic function (LVEF 49.8%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 68%).


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Evaluate for possible MR ultrasound fusion biopsy. 5/13/2016 prostatic adenocarcinoma Gleason score 7 (3+4) (ISUP grade group 2), tumor volume is 40% of the submitted tissue. PSA 5.43 on 12/20/2016. PELVIS:PROSTATE:Prostate Size: 4.0 x 5.6 x 5.4 cmPeripheral Zone: Demonstrated again in the paramedial right mid gland is a 1.5 x 0.6 cm T2 weighted hypointense lesion with associated restricted diffusion (series 403 image 304), suspicious for prostatic adenocarcinoma. The lesion extends towards the base. It is not significantly changed from the prior. This lesion is associated with faint arterial enhancement. Additional punctate 3 mm focus in the lateral right peripheral zone of the mid gland is noted, unchanged.Punctate 3 mm focus in the lateral left peripheral zone of the base is noted, unchanged. Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right peripheral zone paramedial lesion abuts the capsule without specific evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stable right mid-gland to base peripheral zone lesion with imaging characteristics suspicious for prostatic carcinoma. No specific evidence of extraprostatic extension or pelvic lymphadenopathy. 2. Additional punctate foci of abnormal signal in the right and left lateral peripheral zone are unchanged.


Instruction: Generate impression based on findings.

Input: cT2N0M0 left oral tongue squamous cell carcinoma, p16 negative, status post glossectomy with free flap reconstruction. There are postoperative findings related to glossectomy and free flap reconstruction, without evidence of measurable tumor. There is no evidence of significant upper cervical lymphadenopathy. The remaining salivary glands and thyroid appear unremarkable. There are cystic defects in the anterior mandible, which may be related to prior dental disease. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. Postoperative findings related to glossectomy and free flap reconstruction, without evidence of measurable tumor. 2. No evidence of significant upper cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with known right ICA plaque and area of right-sided ischemia on CT, evaluate for ischemia. Patchy restricted diffusion is seen in the right centrum semiovale, along the right lateral ventricular atrium, within the right occipital lobe, and minimally in the right temporal lobe. These lesions demonstrate correlating T2 hyperintensity. A few additional scattered T2 hyperintense lesions are demonstrated in the cerebral hemispheres which do not show diffusion restriction. Evidence of a small chronic lacunar infarct is seen in the left basal ganglia, along with a small chronic right cerebellar cortical stroke.No evidence of significant generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.

Output: 1.Scattered areas of acute ischemia are seen within the right cerebral hemisphere, predominantly within the MCA distribution.2.No evidence of significant generalized mass effect is seen. No intracranial hemorrhage is detected.


Instruction: Generate impression based on findings.

Input: Ms. Stange is a 56 year old female with a personal history of bilateral mastectomies in 2016 for right breast DCIS. She had expanders placed which were complicated by infection and subsequently removed. She now presents with left breast wound dehiscence and fluid collection. The patient is status post bilateral mastectomies. On the right side, there is a simple fluid collection identified that is partially retro-pectoral and partially pre-pectoral. The collection measures 2.5 x 4.8 x 5.3 cm (AP x ML x SI). The antero-lateral portion of this fluid collection appears to extend towards the skin surface and may represent local wound dehiscence. On the left side, there is an encapsulated complex fluid collection identified that is partially retro-pectoral and partially pre-pectoral. The collection measures 2.7 x 8.6 x 6.1 cm (AP x ML x SI) and has multiple fluid-fluid layers. The capsule surrounding this collection demonstrates mild peripheral rim enhancement, which may be an indication of superimposed infection. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Patient is status post bilateral mastectomies with bilateral complex fluid collections. Please see above for full details. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, history of GBM, assess for growth. Has been on Avastin and AMG386 since 1/2015. Findings are redemonstrated compatible with prior left temporal surgery. A heterogeneous, hemosiderin stained lesion occupying a large part of the left lateral temporal lobe has increased in size, including the thick enhancing component, particularly when compared to examinations from early 2015 and before.Numerous additional areas of tumor have also progressed, including an enhancing lesion within the right frontal lobe, as well as scattered nodular diffusion-restricting deposits along the corpus callosum and bilateral centrum semiovale bilaterally, some of which are new and some of which are larger. Diffuse nonenhancing T2 hyperintense thickening through the right temporal lobe is not substantially increased. Likewise, T2 hyperintense signal within the bilateral thalami is grossly stable. Vague bilateral periventricular T2 hyperintensity, distinct from the nodular disease mentioned above, has not significantly changed and is likely treatment related.No new or significant generalized mass effect is seen. No new abnormal collections are detected. Ventricular system is stable in size.

Output: Progressive multifocal tumor with a combination of growing and new lesions.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. 2014 biopsy demonstrated 3+4 disease in the right lateral apex. PELVIS:PROSTATE:Prostate Size: 3.3 x 5.0 x 5.3 cm.Peripheral Zone: Postbiopsy changes in the peripheral zone which is relatively thinned. No dominant lesion in the peripheral zone is evident.Central Gland: Extensive changes of benign prostatic hyperplasia. Within the left mid gland extending to the apex there is a 1.4 cm ill-defined T2 weighted hypointense region with dystrophic diffusion which may represent a site of prostatic carcinoma versus a BPH nodule.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.4 cm focus within the left mid gland extending to the apex may reflect a site of prostatic carcinoma versus a BPH nodule. This is amenable to MRI/ultrasound fusion biopsy.


Instruction: Generate impression based on findings.

Input: Ventricular size is normal. No midline shift. There is a normal gray-white matter differentiation. No evidence of bleed, mass effect, or edema.There are nonspecific T2 and FLAIR high signal in the white matter, most likely representing chronic ischemic small vessel disease.Diffusion images demonstrate no restricted abnormalities. Susceptibility images are within normal limits.Flow void of the visualized internal carotid arteries and the cerebral arteries are within normal limits.There is a midline cyst in the nasopharynx, representing a Thornwaldt cyst.There is fluid retention cyst in the right maxillary sinus.A bony overgrowth is seen in the right occipital bone, unchanged from the previous study.

Output: No evidence for acute intracranial hemorrhage, mass effect, or edema.


Instruction: Generate impression based on findings.

Input: Ms. Oest is a 62 year old female with recent diagnostic workup revealing possible silicone leak of the right breast. She presents for MRI for further evaluation. This is an incomplete examination. Unfortunately, no implant specific sequences were obtained at time of MRI. The patient will be notified to return for additional implant sequences.

Output: Incomplete examination. The patient will return for additional implant specific sequences. A final impression/recommendation will be made once all sequences have been appropriately obtained.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views.


Instruction: Generate impression based on findings.

Input: 62 old male with history of peritoneal mesothelioma. Evaluate for disease status. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Scattered subcentimeter simple cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Of note, there is misregistration artifact on the postcontrast images.Bilateral T2 hyperintense, T1 hypointense, nonenhancing foci compatible with simple cyst. The largest cyst demonstrates thin septations at the right upper pole measuring 5.7 x 4.8 cm.Additionally, there are T1 hyperintense, T2 isointense nonenhancing foci compatible with hemorrhagic cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal deposits are decreased in size. Reference nodule adjacent to the left hepatic lobe measures 2.4 x 2.1 cm (series 7, image 14), previously measuring 3.3 x 2.2 cm.Nodule adjacent to the lesser curvature measures 2.4 x 1.6 cm (series 7, image 8), previously measuring 2.9 x 1.4 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Improving peritoneal nodules.2.Bilateral renal simple and hemorrhagic cysts with the right upper pole cyst demonstrating thin septations.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: lumbar radiculopathySigns and Symptoms: leg painComments: Pt will have PO valium to take before MRI | Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height, mild disc desiccation and a minor disc bulge at this level associated with a mild to moderate degree of facet hypertrophy.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some facet hypertrophy. There is a 3 mm posterior subluxation of L4 on L5. There is effacement of the fat at the lateral recess bilaterally at this level. The exiting nerve roots within the neural foramina are surrounded by fat on the left side, however it is partially effaced on the right side. Overall there is a mild to moderate degree of spinal stenosis present at this level. Lung the adjacent endplates there is some mild T2 signal hyperintensity along the right half of the disc space.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation at this level as well as a mild disc bulge and a moderate degree of facet and ligamentum flavum hypertrophy. There is crowding of the nerve roots within the thecal sac at this level. Overall there is a moderate degree of spinal stenosis at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation at this level associated with a mild disc bulge and mild to moderate ligamentum flavum and to lesser degree facet hypertrophy. There is a mild crowding of nerve roots within the thecal sac at this level. Overall there is mild spinal stenosis at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are multilevel degenerative changes present in the lumbar spine with moderate spinal stenosis at L3-4 and mild to moderate spinal stenosis at L4-5 where there is some mild subluxation and a small amount of subacute endplate reactive change. There is also some mild to moderate encroachment of right-sided exiting nerve roots at L4-5.


Instruction: Generate impression based on findings.

Input: Dysphonia [R49.0], Reason for Study: ^Reason: neuro History: same Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Retention cyst is seen on the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 5 mm sized right paraophthalmic aneurysm.Otherwise, bilateral MCAs and ACAs appears to be normal., Vertebrobasilar system appears to be normal. No evidence of significant luminal 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. About 5 mm sized right paraophthalmic aneurysm. No other intracranial aneurysm is seen. 3. No evidence of arterial luminal stenosis on both intracranial and extracranial arterial system.


Instruction: Generate impression based on findings.

Input: 42-year-old female with headaches and vision change. History of CVA. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. No evidence of any acute or chronic stroke is detected on this exam. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. Widening of the level from in magnum with bony remodeling is highly suspected ectopic cerebellar tonsils. Further evaluation with an MRI is recommended.

Output: 1.No evidence of acute findings.2.Suspected ectopic cerebellar tonsils with bony remodeling at the level of foramen magnum.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma. On immunotherapy. There is a superficially located, lobulated, heterogeneous mass measuring up to 2.9 cm involving the medial aspect of the posterior right parietal lobe. It shows intense, heterogeneous contrast enhancement, which also extends into the adjacent sulci. The mass and the adjacent sulci show susceptibility effect reflecting the presence of blood products. This is associated with moderate surrounding white-matter T2-hyperintensity as well as mass-effect, on the overlying sulci and the adjacent posterior right lateral ventricle, and trace midline shift. This is new since prior examinations from October 20, 2015. There is no other space-occupying or contrast-enhancing brain lesion. A tiny subcortical focus of susceptibility effect in the left parietal lobe is not associated with contrast enhancement or edema. There is no generalized meningeal abnormal contrast enhancement. There is no acute infarct. There is encephalomalacia involving the inferior medial frontal lobes (gyri recti), which probably represents previous traumatic injury. There is no hydrocephalus or brain herniation. There is trace mucosal thickening in the maxillary and ethmoid sinuses. There has been a right eye lens replacement. There is a partially empty sella, There is no destructive skull lesion. A 7 mm midline cystic lesion involving the nasopharyngeal mucosa is probably an incidental Thornwaldt cyst.

Output: 1.New, since October 2015, right parietal mass with vasogenic edema and mild mass-effect, compatible with hemorrhagic brain metastasis. Contrast enhancement and susceptibility effect in the adjacent sulci are likely related to the hemorrhage and venous engorgement. 2.No other brain mass or diffuse leptomeningeal contrast enhancement. A tiny subcortical focus of susceptibility effect in the left parietal lobe with no associated contrast enhancement or edema likely reflects an incidental prior microhemorrhage.3.Inferior frontal encephalomalacia most likely from prior traumatic injury.


Instruction: Generate impression based on findings.

Input: Male 63 years old Reason: staging exam History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.2 x 5.4 x 4.1 cmPeripheral Zone: Dominant focus of signal abnormality within the prostate gland posteromedially at the left base. This measures approximately 1.3 x 0.8 cm (series 901, image 20). This abuts the prostatic capsule. Additional smaller subcentimeter foci identified throughout the gland. For example in the right base posteriorly measuring 0.9 x 0.7 cm (series 804, image 324) and within the left mid gland and left apex. Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No significant abnormality.Extracapsular Extension: The above described lesion in the left base abuts the prostatic capsule. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.3-cm dominant focus of signal abnormality within the left prostate gland at the base which abuts the capsule with additional subcentimeter foci as detailed above. These are suspicious for foci of prostatic adenocarcinoma. No evidence of seminal vesicle invasion or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: The medial meniscus is intact. There is abnormal is diminished morphology and increased signal of the lateral meniscus suggesting the presence of a inner surface fraying with additional tearing of the body with extension into both the anterior and posterior horns. This is superimposed upon complex signal within the meniscus.ARTICULAR CARTILAGE AND BONE: There is severe full-thickness loss of the articular cartilage of the medial compartment particularly along the tibial plateau. Scattered areas of full-thickness loss are also noted within the medial compartment with moderate diffuse loss of the patellofemoral articular cartilage. There are tricompartmental osteophytes as well as along the anterior tibial tubercle.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Maceration of the lateral meniscus.2. Moderate to severe tricompartmental articular cartilage loss which is worst medially.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is abnormal signal intensity within the articular cartilage of the patella centrally indicating near full-thickness to full-thickness degeneration with at least a partial-thickness fluid-filled defect measuring approximately 1 cm in diameter. The articular cartilage of the femoral trochlea is preserved. The articular cartilage of the lateral and medial compartments is also preserved. Small cysts are noted within the tibial plateau near the attachment of the PCL which are not necessarily of any clinical significance.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: There is a mild amount of edema within the superolateral corner of Hoffa's fat pad which can be seen in patients with patellofemoral instability. The Insall Salvati ratio and TT to TG distance are both within normal limits. Subjectively, the femoral trochlea appears slightly shallow which may reflect mild dysplasia but this is equivocal.ADDITIONAL

Output: Patellar cartilage degeneration and defect with other findings described above.


Instruction: Generate impression based on findings.

Input: Female 74 years old Reason: Assess for etiology of AMS. Has AML,CLL, sz hx, s/p induction chemo, now with neutropenic sepsis high fevers. History: No longer following commands, clonus, warm extremities, nystagmus. There are bilateral subdural collections, most prominent along the frontal lobes measuring up to 5 mm in thickness. These collections do not suppress completely on FLAIR and do not diffusion restrict. There is mild associated dural thickening. There is no abnormal intracranial enhancement to suggest infection. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. Unchanged partially empty sella. Pituitary gland is otherwise within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No definite evidence of an intracranial infectious process.2.Small bilateral subdural collections, new since the prior exam, which could represent proteinaceous hygromas or possibly late subacute to chronic hematomas.


Instruction: Generate impression based on findings.

Input: History of metastatic breast cancer. Increasing size of liver masses. ABDOMEN:LIVER, BILIARY TRACT: Numerous right greater than left lobe well defined T2 hyperintense lesions without associated enhancement are compatible with multiple cysts. No suspicious ring or solid enhancement.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes from a right mastectomy. Osseous metastases.OTHER: No significant abnormality noted.

Output: Numerous variable size hepatic lesions without suspicious rim or mural enhancement likely represents numerous hepatic cysts.


Instruction: Generate impression based on findings.

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

Output: 1. Recent right temporal craniotomy for resection of a left temporal mass, with residual tumor along the posterior and medial surgical margins, measuring up to 8 mm in thickness, and extensive surrounding vasogenic edema. 2. A smaller lesion in the anterior right temporal lobe also likely represents a metastasis.3. Intraparenchymal hemorrhage within the right temporal lobe posterior to the surgical cavity that measures up to approximately 25 mm appears unchanged, accounting for differences in technique.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are postsurgical findings related to right neck dissection and resection of the posterior right hemimandible with hardware fixation and flap reconstruction of the right-sided pharyngeal soft tissues. There are also radiation effects in the nasopharyngeal region with mild swelling and mucositis, but no measurable residual tumor within the right nasopharynx. There is also no significant cervical lymphadenopathy. There are denervation changes in the right tongue. The thyroid and remaining salivary glands appear unchanged. The imaged intracranial structures are unremarkable. The bone marrow signal abnormalities in C1 and C2 have nearly resolved.

Output: Post-treatment effects in the right nasopharyngeal region and right neck without measurable residual or recurrent locoregional tumor.


Instruction: Generate impression based on findings.

Input: 61 years Female (DOB:11/30/1954)Reason: Left hemi sensory disturbance and face pain History: abovePROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 22 x 15 mm axial dimension CSF collection adjacent to the right cerebellar hemisphere which could represent a small arachnoid cyst.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 right vertebral artery is very small. There appears to be fetal origin of the right posterior cerebral artery.The cerebellar tonsils extend 1 mm below the level of the foramen magnum.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No intracranial lesions appreciated which can explain the patient's hemisensory disturbance. There is a small arachnoid cyst present in the posterior fossa.2.There is a small right-sided vertebral artery which could simply be congenital. If there is clinical concern for right vertebral artery disease, specific imaging of vertebral arteries may be of benefit.


Instruction: Generate impression based on findings.

Input: 59-year-old woman with history of PSC, evaluate for new strictures. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology.The patient is status post cholecystectomy.There are multifocal intra and extrahepatic biliary ductal strictures with dominant strictures at the Klatskin's point and a short segment of the mid common bile duct. These structures are unchanged in morphology and there is upstream dilatation, also stable. Additionally, there is circumferential thickening of the wall and mild hyperenhancement of the ducts in these regions, but no mural nodule or mass.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable appearance of PSC affecting the intra and extrahepatic biliary ducts. Enhancement suggestive of cholangitis without evidence of tumor.


Instruction: Generate impression based on findings.

Input: 31 year old female with history of Chiari 1 malformation, pseudotumor, and hypertension, presenting with acute dysarthria and confusion. Evaluate for intracranial hemorrhage versus enlarging ventricular size. There is no evidence of intracranial hemorrhage or edema. A round homogeneously hypoattenuating mass is seen in the region of the pineal gland, which may represent a cyst. 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: 1. No acute intracranial abnormalities.2. Hypoattenuating mass in the region of pineal gland, which may represent a cyst. Consider MRI to further evaluate if clinically indicated.


Instruction: Generate impression based on findings.

Input: Right lateral neck to upper posterior shoulder area discomfort relieved temporarily with Tylenol and Advil. Denies injury/trauma. No systemic infectious symptoms. There is no evidence of mass or abscess within the cervical spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of cervical spine epidural abscess, spinal cord compression, or intraspinal tumor.


Instruction: Generate impression based on findings.

Input: 16-year-old female history of right patellar dislocation. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is edema within the anterolateral aspect of the lateral femoral condyle as well as the medial aspect of the patella indicating contusions from a recent transient lateral patellar dislocation. There is a small rounded focus of low signal intensity along the medial aspect of the patella, which may represent a small avulsion fracture, but this is equivocal. The femoral trochlea is shallow indicating dysplasia. The articular cartilage of the lateral facet of the patella appears normal. There appears to be blistering of the articular cartilage of the far lateral aspect of the femoral trochlea. The tibiofemoral articular cartilage appears intact.LIGAMENTS: Cruciate ligaments are intact. Edema along the superior band of the MCL could represent a sprain but the ligament itself otherwise appears normal. The LCL is intact. There is thickening and increased signal intensity of the medial retinaculum and neither attachment of the medial patellofemoral ligament is clearly visualized indicating a tear. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. The TTTG distance is 17-18 mm which is borderline abnormal.ADDITIONAL

Output: Imaging findings of recent patellar dislocation as described above with femoral trochlea dysplasia, borderline elevated TTTG, and tearing of the medial patellofemoral ligament. Although we see no loose bodies within the joint, there is a lipohemarthrosis and a possible small avulsion fracture from the medial aspect of the patella.


Instruction: Generate impression based on findings.

Input: headache, persistent, possibly cluster headache. No evidence of acute ischemic or hemorrhagic lesion on this scan.There is fluid containing thin wall cystic structure (about 16mm) in the right lateral ventricle without evidence of enhancement nor diffusion restriction. This lesion is most likely representing benign intraventricular cyst.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst on the right maxillary sinus.

Output: Intraventricular cyst (16mm) in the right lateral ventricle.No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancing lesion.


Instruction: Generate impression based on findings.

Input: 65 year-old man with ischemic cardiomyopathy referred for EF assessment. Left VentricleThe left ventricle is moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVEDV is 341 ml (normal range 142+/-34), the LV end systolic volume index is 112 ml/m2 (normal range 25+/-9), the LVESV is 271 ml (normal range 47+/-19), the LV mass index is 117 g/m2 (normal range 85+/-15), and the LV mass is 282 g (normal range 164+/-36). There is global hypokinesis with regional variation. The interventricular septum is dyssynchronous. Left AtriumThe left atrium is moderate-severely dilated. Right VentricleThe right ventricle is visually mildly dilated with a moderately reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 231 ml (normal range 142+/-31), the RV end systolic volume index is 69 ml/m2 (normal range 31+/-9), and the RVESV is 167 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is at least mild-moderate mitral regurgitation which could be underestimated. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild-moderate tricuspid regurgitation which could be underestimated.AortaThe ascending aorta is dilated. The maximum diameter is 41mm. 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 dilated and has a diameter of 33mm.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderate-severe LV dilatation with a severely reduced systolic function (LVEF 20%).2. Visually mild RV dilatation with a moderately reduced systolic function (RVEF 28%).3. Biatrial dilatation.5. At least mild-moderate mitral amd tricuspid regurgitation.6. Ascending aorta is 41mm in maximum diameter.


Instruction: Generate impression based on findings.

Input: Female, 26 years old, with intermittent right-sided visual changes, and tingling in the right arm and right leg. Evaluate for multiple sclerosis lesions. Brain:Brain parenchymal morphology is within normal limits. No evidence of restricted diffusion or any other focal signal abnormality is seen. No pathologic parenchymal or extra-axial enhancement is observed. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collections. The ventricles are normal in size and morphology.Orbits:The globes are symmetric and round. The extraocular muscles show normal caliber and pattern of enhancement. The optic nerves are not enlarged and are free of pathologic signal alteration and enhancement. No intraconal abnormalities are seen.Cervical spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement, edema or pathologic enhancement is seen. The visualized spinal cord shows normal signal intensity and morphology. No focal cord lesions or any pathologic cord or leptomeningeal enhancement is observed. The intervertebral discs are preserved. No spinal canal or foraminal stenosis is detected.

Output: Unremarkable evaluation of the brain, orbits and cervical spine with no specific findings which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of bone [C79.51], Reason for Study: ^Reason: metastatic prostate cancer with skull metastasis History: metastatic prostate cancer Redemonstration of 24 mm x 30.5 mm x 7.7 mm sized left frontal bone sclerotic lesion without evidence of enhancement indicating metastatic sclerotic skull lesion, no change in terms of MR characteristics and size since prior scan. Specifically, there is no evidence of surrounding soft tissue lesion, no evidence of periosteal reaction.There is no evidence of abnormal enhancement.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, 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: Stable left frontal skull sclerotic metastatic lesion since prior scan.Otherwise unremarkable brain MRI scan.


Instruction: Generate impression based on findings.

Input: Ataxia. New onset seizure. Rule out intracranial hemorrhage, ischemia or tumor. History of cerebral palsy, ADHD and autism. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Increased T2 FLAIR signal in the deep biparietal white-matter may represent terminal zones of myelination, a normal variation. Asymmetrically increased T2/FLAIR signal involving the right temporal lobe, including the hippocampal formation, and part of the right frontal and parietal lobes is probably artifactual. The temporal horn of the right lateral ventricle is asymmetrically enlarged but without definite architecture distortion or volume loss of the hippocampus. These findings are unchanged since the previous examination of 2013. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and scalp soft tissues are grossly unremarkable. The adenoids and nasal turbinate mucosa are enlarged. There are also prominent lateral retropharyngeal lymph nodes. There is also mild ethmoid mucosal thickening. The mastoid air cells are clear. There is no destructive skull lesion.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Asymmetric enlargement of the temporal horn of the right lateral ventricle without definite signal or morphologic abnormality of the right hippocampus might be developmental. Increased deep parietal white-matter T2 signal may reflect terminal zones of myelination, which is a normal variation.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical lordosis, which may be positional. There are no fractures or subluxations. The marrow signal is benign. There is T2 hyperintensity within the spinal cord at the left lateral aspect of the C6 level. The cervical and upper thoracic cord are otherwise normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant neural foraminal or spinal canal stenosis.C2/3: No significant neural foraminal or spinal canal stenosis.C3/4: No significant neural foraminal or spinal canal stenosis.C4/5: No significant neural foraminal or spinal canal stenosis.C5/6: No significant neural foraminal or spinal canal stenosis.C6/7: There is endplate edema, disc degeneration and diffuse disc bulge causing mild ventral thecal sac effacement. No significant neural foramina or spinal canal stenosis.C7/T1: No significant neural foraminal or spinal canal stenosis.

Output: 1. Mild degenerative changes at the C6-C7 level without significant spinal canal or neural foraminal stenosis.2. Questionable T2 hyperintensity within the left lateral spinal cord at the C6 level is of uncertain significance. In a patient of this age group, a demyelinating condition can be considered and re-imaging of the brain may be helpful for identification of other supportive findings.


Instruction: Generate impression based on findings.

Input: Headache and thoracic and lumbar pain and left arm shaking and numbness after MVA. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The spinal cord displays normal signal and morphology and the conus medullaris is unremarkable. There is no evidence of tumors within the spinal canal. The vertebral column alignment is within normal limits. There are a few small Schmorl nodes in the lumbar spine. The vertebral body and disc space heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of gross intracranial structural abnormalities. 2. No evidence of spinal cord lesions.


Instruction: Generate impression based on findings.

Input: 85 year old patient with left pontine infarct in bilateral cerebellar lesions please evaluate patient has right hemiparesis and gaze deviation to the rightTechnique: Contiguous axial images of the brain. Subsequently high resolution contiguous axial images were obtained through the lower half of the head and neck and aortic arch during bolus injection of intravenous contrast. On the noncontrast head CT a hypodense focus corresponding to the MRI abnormality along the left cerebellar hemisphere measuring 25 x 15 mm axial dimensions is present and not clearly evident on the prior exam. Hypodense foci in the lower mid brain and upper pons predominant involving the left upper pons and lower midbrain were also not readily identified on the prior exam. There are punctate lesions present along the right posterior inferior cerebellar artery territory and to a lesser degree left posterior inferior cerebellar artery territory.There is opacification of both distal vertebral arteries along their cervical segments. The right vertebral artery is somewhat smaller than the left intracranially and along the cervical segment. The right posterior inferior cerebellar artery does display contrast enhancement as does the left, however, the right vertebral artery does not opacify distal to the posterior inferior cerebellar artery suggesting that it is likely either highly stenotic or occluded. The basilar artery, therefore fills from the left vertebral artery. There are some mural calcifications associated with luminal narrowing as the left vertebral artery enters the subarachnoid space. The left anterior inferior cerebellar artery is larger than its right counterpart. The basilar artery is highly attenuated distal to the AICA origins and suspected to be occluded below the level of the superior cerebellar arteries. The posterior communicating arteries are of similar in size to the P2 segments. The P1 segments are asymmetric right larger than left. The right P1 segment is about the same size as the posterior communicating artery on the right side the left one is smaller than the left P2 segment. It is and therefore considered that the superior cerebellar arteries fill from the anterior circulation as do the posterior cerebral arteries in this patient.There are atherosclerotic calcifications along the distal internal carotid arteries bilaterally. No significant stenosis is appreciated along the anterior or posterior cerebral arteries. The anterior communicating artery is identified and is relatively small compared to the A1 segments which are approximately equal in size. There are atherosclerotic calcifications present along the carotid bifurcations however on the basis of NASCETcriteria no significant stenosis is present along the carotid bifurcations. There is some mild narrowing of the left internal card artery just distal to its origin but approximately a 40%.The left vertebral artery is significantly narrowed at its origin with approximately an 80% stenosis along its cervical segment there are foci of narrowing along the mid cervical vertebral artery with approximately 60% stenosis at the C4-5 disk space level. View right vertebral artery is small and intracranially essentially only supplies the right posterior inferior cerebellar artery which is otherwise disconnected. There is some mild prominent muscular branch is present along the the tube in segment collateralization to the left occipital artery is unknown basis of this exam.The patient is intubated both endotracheally and nasogastric.Some atherosclerotic calcifications are present along the aorta and some of the branches. There is atherosclerotic in narrowing of the innominate artery by approximately 75%. There are degenerative changes present along the cervical spine at C6-7 with left sided neural foraminal narrowing, and c3-4 with right sided neural foraminal narrowing.

Output: 1.Subacute foci of infarction in the left cerebellar hemisphere more than the right as well is within the upper pons and lower midbrain left worse than right. No evidence for hemorrhagic conversion2.Occlusion or near occlusion of the right vertebral artery distal to the origin of the posterior inferior cerebellar artery.3.High-grade stenosis at the origin of the left vertebral artery with a tandem lesion along the mid cervical segment of the left vertebral artery and atherosclerotic in narrowing of the left internal artery as it enters the subarachnoid space. 4.There is occlusion or near occlusion of the basilar artery between the anterior inferior cerebellar artery and the superior cerebellar artery origins.5.The posterior communicating arteries are fairly large as described above. The anterior circulation appears to be the dominant supply for the posterior cerebral arteries as well is the superior cerebellar arteries. 6.High-grade stenosis (approximately 75%) of the innominate artery due to atherosclerotic narrowing7.Mild narrowing at the left internal carotid artery origin as described above. no significant stenosis at the carotid bifurcations on the basiss of NASCET criteria.8.If clinically appropriate, a more detailed assessment of the supply to the posterior circulation may be provided via conventional angiography to confirm or exclude complete occlusion of right vertebral artery and basilar artery and to provide a more accurate description of the percent of stenoses described above, assess circulation time and to identify any collateralization from the external circulation to the intracranial circulation - which cannot be identified on this exam.9.Degenerative changes are present in the cervical spine as indicacated above. Please correlate with clinical symptoms.


Instruction: Generate impression based on findings.

Input: 75 years, Male, status post motor vehicle accident and subarachnoid hemorrhage one month ago. Slow recovery with lingering cognitive deficits and impaired short-term, verbal memory. There are multiple foci of susceptibility effect involving scattered sulci in the bilateral cerebral hemispheres consistent with prior subarachnoid hemorrhage. Blood products are relatively more prominent in the posterior frontal and bilateral parietal regions. Linear foci of susceptibility along the anterior body of the corpus callosum on the right are also noted which may be related to prior shear/diffuse axonal injury, a thrombosed vessel seems less likely. Parenchymal foci of petechial hemorrhage are also noted in the right parietal lobe white matter with corresponding T2/FLAIR hyperintensity.No intracranial mass or mass-effect. There is global parenchymal volume loss commensurate with patient's age. No hydrocephalus. No extra-axial collections. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is minimal scattered paranasal sinus mucosal thickening. Calvarium and extracranial soft tissues appear grossly unremarkable.

Output: Multiple foci of susceptibility effect related to chronic blood products, primarily involving the sulci along the frontoparietal convexities, are consistent with history of prior traumatic subarachnoid hemorrhage. There is also evidence of minimal chronic parenchymal hemorrhage. Linear foci of parenchymal hemorrhage are seen along the right corpus callosum, which can be a sign of diffuse axonal injury.


Instruction: Generate impression based on findings.

Input: Hodgkin lymphoma with mastoiditis. There is fluid within the right middle ear and mastoid air cells with extensive mucosal thickening. There is also diffuse enhancement of the bone marrow in the right lateral and central skull base, with mild overlying dural enhancement diffusely. Furthermore, there is diffuse enhancement of the soft tissues in the right prevertebral and paravertebral spaces. There is apparent signal abnormality in the upper right internal jugular vein. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Findings compatible with right otomastoiditis, which what may represent right skull base osteomyelitis and right prevertebral and paravertebral space inflammation and/or involvement by lymphoma. No evidence of intracranial abscess or acute infarct.


Instruction: Generate impression based on findings.

Input: 59-year-old male with a history of prostate cancer with Hx of osteomyelitis of the sacrum and pelvic abscess anterior to S1joint 15mm seen in previous MRI done 01/21/16. MRI of the pelvis reveals increased STIR signal abnormality and enhancement involving the lateral left sacrum, left sacroiliac joint and medial left ilium which has increased in extent and signal abnormality compared to the exam dated 12/20/2016. There is corresponding T1 hypointensity involving the left lateral sacrum and medial ileum which has also increased compared to the prior exam, indicating a high likelihood of osteomyelitis. There is also an increase in the abnormal signal abnormality and enhancement involving the left gluteus muscles and the iliopsoas muscle within the pelvis just anterior to the medial ileum is a small heterogeneous fluid collection which measures 1.6 x 2.0 cm (series 801, image 32) appears more pronounced. This location also demonstrates restricted diffusion on DWI imaging indicating further evidence of abscess formation.

Output: 1.Enhancement of the left sacroiliac joint with T1 hypointense and T2 hyperintense lateral sacrum and medial ileum highly suspicious for osteomyelitis.2.1.6 x 2.0 cm heterogeneous peripherally enhancing fluid collection just anterior to the left sacroiliac joint compatible with an abscess, which has increased compared to the prior exam.3.Enhancement and edema involving the gluteal and iliopsoas musculature indicating extension of the inflammation/infection into the adjacent soft tissues.


Instruction: Generate impression based on findings.

Input: 71 year old female with low back pain and altered gait, assess for stenosis LUMBAR SPINE:Alignment is anatomic. Level disk desiccation. Vertebral body heights are intact. No abnormal signal within the distal cord with the conus, ending at L2-L3. T12-L1: No central or neuroforaminal stenosis.L1-L2: No central or neuroforaminal stenosis.L2-L3: Mild facet arthropathy and ligamentum flavum thickening. No central or neuroforaminal stenosis.L3-L4: Mild facet arthropathy and ligamentum flavum thickening. No central or neuroforaminal stenosis.L4-L5: Diffuse disk bulge is unchanged. Moderate facet arthropathy and effusions are increased. Mild ligamentum flavum thickening with a new 6-mm synovial cyst in the left lateral recess (12/20). Moderate central canal stenosis is slightly increased. Severe right neural foraminal stenosis is increased. Mild left foraminal stenosis is unchanged.L5-S1: Diffuse disk bulge, mild facet arthropathy and ligamentum flavum thickening is unchanged. Mild central canal stenosis is unchanged. Severe left and moderate to severe right neuroforaminal stenosis is unchanged.CERVICAL SPINE:There is straightening of the cervical spine with minimal grade 1 retrolisthesis of C4 on C5. There are multi-level end plate degenerative marrow signal changes and disk desiccation. Vertebral body heights are intact. There is increased T2 signal within the cord at C4 and C5 where there is thinning of the cord, likely reflecting myelomalacia. There are postsurgical changes of laminectomies involving C3 through C6C2-C3: No spinal or neuroforaminal stenosisC3-C4: Mild posterior disk osteophyte complex. Mild bilateral neuroforaminal stenosis, unchanged. No significant spinal stenosis.C4-C5: Posterior disk osteophyte complex. No significant central canal stenosis. Moderate bilateral neuroforaminal stenosis, unchanged.C5-C6: Central posterior disk osteophyte complex without significant central canal stenosis. Moderate left and mild right more neuroforaminal stenosis, unchanged.C6-C7: Posterior disk osteophyte complex. No central canal stenosis. Moderate left neuroforaminal stenosis, unchanged.C7-T1: Posterior disk osteophyte complex is increased. Mild left neuroforaminal stenosis.

Output: 1.Spondylosis of the lower lumbar spine, most severe at L4-L5 and L5-S1, with increased facet arthropathy, right neuroforaminal stenosis, central canal stenosis and a new left lateral recess synovial cyst at the L4-L5 level.2.Postsurgical changes and multilevel neuroforaminal stenosis are mostly unchanged with slight increase in posterior disk osteophyte complex at C7-T1 without associated significant canal narrowing.


Instruction: Generate impression based on findings.

Input: Male, 12 years old, with seizure and altered mental status in a child with sickle cell hemoglobinopathy, hypertension and vasculitis. Multiple scattered areas of subcortical T2 hyperintensity are redemonstrated without significant interval change. As before, these lesions are found in the bilateral frontal lobes, parietal lobes, occipital lobes, the temporal-occipital junctions, and the splenium of corpus callosum.Several of the above-mentioned lesions, including the most prominent lesion in the left parietal lobe, are associated with susceptibility effect. In addition, there are innumerable foci of susceptibility within the supratentorial brain with relative sparing of the posterior fossa. Most of these lesions, suspected to represent chronic microhemorrhage, show no correlating T2/FLAIR signal abnormality.No definite evidence of any new lesion is seen. No evidence of generalized mass effect is detected. The ventricular system is stable and normal in size.Diffuse marrow replacement and osseous expansion of the clivus are again seen likely related to sickle cell disease. The mastoid air cells are partially opacified.

Output: 1.No significant interval change in the size or number of numerous subcortical T2 hyperintense lesions.2.No significant interval change in the appearance of innumerable supratentorial chronic microhemorrhages.3.No new or progressing lesions are appreciated.


Instruction: Generate impression based on findings.

Input: 44 year old man with heart block and exercise intolerance referred to evaluate for infiltrative cardiomyopathy. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 165 ml (normal range 142+/-34), the LV end systolic volume index is 89 ml/m2 (normal range 25+/-9), the LVESV is 198 ml (normal range 47+/-19), the LV mass index is 74 g/m2 (normal range 85+/-15), and the LV mass is 165 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 91 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsHilar and mediastinal lymphadenopathy is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 56%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 51%).3. Mild biatrial dilation.4. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Reason: Right knee pain, hx of gout. Medial and lateral joint line pain. Evaluate for meniscal or ligamentous injury History: knee pain MENISCI: Note is made of linear branching increased signal abnormality within the posterior horn of the medial meniscus which extends to the tibial and femoral articular surface consistent with complex degenerative tearing which extends to the body of the meniscus. The anterior horn appears intact. There is intrasubstance degeneration of the posterior horn of the lateral meniscus. Some of the signal in the posterior horn of the lateral meniscus extends to the tibial articular surface indicating superficial fraying/degenerative tearing. There is blunting and deformity of the anterior horn of the lateral meniscus indicating degeneration/degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle with large portions completely devoid of articular cartilage. There is subjective thinning of the articular cartilage of the medial tibial femoral compartment. There is full-thickness articular cartilage degeneration affecting the patellofemoral compartment most pronounced along the lateral facet of the patella and femoral trochlea. There are tricompartmental osteophytes.LIGAMENTS: There is thickening and increased signal abnormality within the proximal fibers of the lateral collateral ligament proper which likely represents a gouty tophus formation although this could reflect a sprain or partial thickness tear of the LCL proper. The MCL appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex degenerative tearing of the medial and lateral meniscus as described above.2. Findings consistent with a prepatellar bursitis as described above which can be seen in patients with gout.3. Findings which appear most consistent with a gouty tophus along the lateral aspect of the lateral femoral condyle, although this could conceivably represent a sprain/partial thickness tearing of the lateral collateral ligament proper in the correct clinical setting, particularly if there is a recent history of trauma/injury.4. Severe osteoarthritis of the knee including full-thickness articular cartilage degeneration. Other findings as described above


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with urinary incontinence. Evaluate for cord compression. History of renal cell cancer with metastases. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement or edema are seen. No epidural lesions are suspected. There is no significant compromise of the spinal canal and there are no findings to suggest cord compression. Disc osteophyte disease is seen in the cervical spine.

Output: No evidence of cord compression.


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: stroke w/u History: L sided weakness and neglect, R gaze deviation. Brain MRIScattered multiple restricted diffusion lesions on the right frontal, temporal lobes and insular without evidence of hemorrhagic transformation indicating acute ischemic infarct.Underlying brain shows multifocal FLAIR high signal intensity lesions on white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. 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 about 50% luminal stenosis at the proximal basilar artery just after the right AICA origin. Otherwise there is no evidence of intracranial arterial luminal stenosis or intracranial aneurysm. There are luminal irregularities at the distal right vertebral artery without significant luminal stenosis. Bilateral PCAs are fetal origin. Acom artery is patent.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate suspicious arterial luminal stenosis of more than 70% with post stenotic dilatation. However, due to motion artifacts, image quality has bee significantly degraded.The left CCA and extracranial ICA appears to be unremarkable.Right vertebral artery is hypoplastic and the left vertebral artery is dominant. Vertebral ostium on the left side appears to be normal but the right side cannot be evaluated due to artifacts. Brachiocephalic artery, right CCA and proximal left subclavian artery cannot be evaluated due to artifacts related poor image quality.

Output: 1. Acute ischemic infarctions without hemorrhagic transformation at the right frontal, temporal lobes and insular.2. Possible significant luminal stenosis at the proximal right extracranial ICA just above the bifurcation as described above. 3. About 50% of luminal stenosis at the proximal basilar artery with irregularities of the distal right VA. Otherwise unremarkable brain MRA.Rec: CT angiography of head and neck can be considered for further imaging evaluation.


Instruction: Generate impression based on findings.

Input: Postcontrast images are limited by patient motion. Patient's dental hardware has been removed and previous susceptibility artifact along the anterior aspect of intracranial structures is no longer present. Focal susceptibility along the lateral aspect of the mid left ventricular body appears similar to prior exam, demonstrating corresponding minimal nodular enhancement, with a more punctate focus along the right lateral atrial margin. An additional focus of susceptibility is seen along the left foramen of Monro, with minimal corresponding peripheral enhancement measuring 4 mm, unchanged. An additional punctate nodular focus of enhancement is seen along the right lateral aspect of the foramen of Monro on 5/86, appearing unchanged.Thre are scattered foci of T2/FLAIR hyperintensity within the white matter, which along the right centrum semi-ovale and lateral left frontal lobe appear to represent radial fiber gliosis. In addition, there are scattered patchy areas of intrinsic T1 hyperintensity within the subcortical white matter consistent with subcortical tubers.There is moderate mucosal thickening in the left maxillary sinus, with trace thickening in the right. There is focal prominence of the extra-axial space along the anterior left frontal lobe on 7/18, although appearing similar to prior exam. Incidental small pineal cystic lesion with peripheral enhancement appears stable.

Output: Stable stigmata of tuberous sclerosis, with enhancing nodules demonstrating corresponding susceptibility along the lateral ventricular margins, including at the left foramen of Monro. These likely represent subependymal nodules, without definite SEGA at this time, although close follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsClinical question: First seizureSigns and Symptoms: above The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A couple punctate T2 and FLAIR hyperintense subcortical white matter foci in the frontal lobes are likely of little clinical significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for intracranial mass lesion or other explanation for the patient's seizure.


Instruction: Generate impression based on findings.

Input: Unresponsive Non-enhanced CT of brain:Examination demonstrate a left parietal craniectomy. There is a large area of encephalomalacia involving the left posterior frontal -- parietal region under the craniectomy site.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. There is ex vacuo dilatation of left lateral ventricle adjacent to the above described foci of encephalomalacia. The gray -- white matter differentiation is preserved. Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable. The provided clinical data low follow-up with an MRI is recommended.

Output: 1.No evidence of the acute intracranial process.2.Left parietal craniectomy and underlying parenchymal encephalomalacia of unknown etiology.3.Unremarkable calvarium otherwise and normal visualized paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Male, 20 years old, with right leg paralysis. Assess for cord compression. No acute cord compression is seen. In fact, no evidence of any significant spinal canal or neuroforaminal stenosis is detected. With the exception of perhaps a mild scoliotic curvature of the lower lumbar spine, spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. The spinal cord, conus, and cauda equina are unremarkable.

Output: No acute cord compression.


Instruction: Generate impression based on findings.

Input: Chiari malformation: headaches. The cerebellar tonsils are mildly pointed and extend up to 5 mm inferior to the foramen magnum. In addition, there is crowding of the tissues at the foramen magnum with diminished flow of cerebrospinal fluid posteriorly, but the flow of cerebrospinal fluid is preserved anteriorly. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L1-2 level. There is no evidence of fibrofatty filum. The paravertebral soft tissues are unremarkable.

Output: 1. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum with other features suggestive of Chiari 1 malformation.2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Tibial pain for one year with history of stress fracture. MR images of the right tibia and fibula demonstrate normal bone marrow signal intensity without evidence of fracture or stress reaction. The visualized musculature and soft tissues are within normal limits. The large field-of-view images also demonstrate a normal appearance of the left leg.

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


Instruction: Generate impression based on findings.

Input: Generalized tonic clonic seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. In particular, the hippocampi appear to be grossly intact and there is no evidence of heterotopia, hamartoma, or gross cortical dysplasia. There is no abnormal intracranial enhancement. There is a cavum septum pellucidum and vergae with mildly convex boundaries measuring up to 11 mm in width. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No definite evidence of hippocampal lesions. 2. Mildly cystic appearing cavum septum pellucidum and vergae measuring up to 11 mm in width.


Instruction: Generate impression based on findings.

Input: cT4N1M0 squamous cell carcinoma of the left maxillary sinus. There is a bulky heterogeneous and infiltrative mass centered in the left sinonasal region, completely obliterating the left maxillary sinus and much of the left nasal cavity and ethmoid sinuses, with extension into the inferior and medial extraconal orbit, abutting the left inferior rectus muscle and globe, and into the overlying left facial subcutaneous tissues with surrounding fat stranding and into the retromaxillary space. There is also compression of the left nasolacrimal duct, with dilatation of the lacrimal sac. Overall, the mass measures up to approximately 7 cm. There are secretions and mucosal thickening in the left frontal sinus and portions of the bilateral ethmoid sinuses. The left optic nerve is intact. The right orbit is unremarkable. There is no significant upper cervical lymphadenopathy. The salivary glands appear to be intact. There is no evidence of gross intracranial tumor. There is no evidence of acute cerebral infarction, hemorrhage, or ventriculomegaly. There is minimal nonspecific periventricular T2 hyperintensity.

Output: A large, aggressive mass centered in the left sinonasal region with extension into the left extraconal orbit, the overlying left facial subcutaneous tissues, and the retromaxillary space is compatible with a squamous cell carcinoma.


Instruction: Generate impression based on findings.

Input: Diagnosis: CervicalgiaClinical question: History of motor vehicle accidentSigns and Symptoms: Neck pain 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 are minor disc bulge is present at C3-4, C4-5 and 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.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are mild degenerative changes present in the cervical spine but no significant compromise to spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Clinical question: GBM, cerebellar lesion growth? Signs and symptoms: MS. Pre and post enhanced brain MRI:A focus of FLAIR/T2 hyperintensity along the right lateral aspect of the fourth ventricle without enhancement is again noted and without convincing evidence of interval change.There is mild interval decreased size and mass effect of the focus of FLAIR hyperintensity involving the right anterior cingulate gyrus and surrounding the right frontal horn of lateral ventricle without enhancement.There is a visualization of a focus of enhancement within the right frontal horn of lateral ventricle and the ependymal lining with interval decreased size. The finding on current exam on FLAIR T2 weighted series measures at 18 x 11 compared to prior study the measurements of approximately 15 x 18 mm.Examination also demonstrate interval decreased size of a mildly enhancing mass along the dorsal aspect of right frontal surgical cavity since prior study. Prior exam the finding measured approximately 27 mm in AP axis compared to current study measurements of 18. This finding on coronal T2-weighted images measured approximately 32 mm in transverse axis compared to current study measurements of approximately 24 mm.Stable focus of FLAIR and T2 hyperintensity involving the cortex and subcortical white matter of left frontal lobe along its anterior superior aspect without enhancement and likely representing posttreatment changes.Ex vacuo dilatation of right lateral ventricle and mildly prominent left lateral ventricle with maintained midline remains similar to prior exam.

Output: 1.Interval decreased size of an enhancing mass within the right frontal horn and with involvement of the right frontal ependymal lining as detailed/measured above.2.Interval decreased size of an enhancing mass along the posterior edge of right frontal resection cavity as detailed/measured above.3.Interval mild decreased extent and mass effect surrounding the right frontal horn and right frontal cingulate generous without convincing evidence of enhancement.4.Stable focus of FLAIR hyperintensity along the interhemispheric aspect of the left frontal lobe without enhancement and likely representing posttreatment change.5.Stable focus of FLAIR hyperintensity along the right lateral aspect of fourth ventricle without enhancement.


Instruction: Generate impression based on findings.

Input: 12-year-old male with knee pain for months with swelling and tenderness along the tibial tubercle. Evaluate for patellar tendon tear versus tibial tubercle. MENISCI: The medial and lateral menisci are normal without evidence for tear.ARTICULAR CARTILAGE AND BONE: There is mild increased T2 signal in the tibial tubercle and epiphysis anteriorly. Additionally, there is a small osseous contusion involving the medial femoral condyle.LIGAMENTS: The anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments are normal. EXTENSOR MECHANISM: The patellar and quadriceps tendon are intact.ADDITIONAL

Output: 1.Findings compatible with tibial tubercle apophysitis. 2.Medial femoral condyle contusion.


Instruction: Generate impression based on findings.

Input: 73 old female with history of breast cancer and left shoulder pain, concerning lesion seen on recent shoulder radiograph. The apparent lucent lesion seen on the prior radiographs does not have a correlate on MRI and may simply reflect osteopenia/osteoporosis. We see no findings to suggest metastatic disease to the shoulder. Moderate osteoarthritis affects the glenohumeral joint with subchondral cysts and edema within the glenoid and additional cysts in the humerus. There is a small joint effusion and synovitis of the glenohumeral joint. There is mild rotator cuff tendinosis with perhaps mild undersurface fraying of the supraspinatus tendon, but we see no frank fluid filled rotator cuff tear. Small cysts are noted in the greater tuberosity, which are most likely degenerative in etiology. There is an os acromiale and mild osteoarthritis of the acromioclavicular joint. No frank fluid is noted within the subacromial/subdeltoid bursa. There is thickening and increased signal intensity of the proximal tendon of the long head of the biceps indicating severe tendinosis.

Output: Glenohumeral joint osteoarthritis and other findings as above. We see no specific findings to suggest metastatic disease to bone.


Instruction: Generate impression based on findings.

Input: 63-year-old male with neck pain and brisk right upper and lower extremity reflexes. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Minimal degenerative grade 1 anterolisthesis of C7 on T1 is noted. Alignment is otherwise maintained. Degenerative bone marrow signal is demonstrated in the vertebral body endplates of the mid to lower cervical spine. No focal worrisome bone marrow signal abnormality is identified.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: Mild posterior disc osteophyte complex, bilateral facet arthropathy and ligamentum flavum thickening contribute to mild spinal canal stenosis. Moderate, left greater than right, bilateral neural foraminal narrowing. C4-5: Moderate posterior disc osteophyte complex with a left paracentral and right foraminal component. There is moderate spinal canal stenosis. Bilateral facet arthropathy and uncovertebral hypertrophy. Severe right and moderate to severe left neural foraminal narrowing. C5-6: Posterior disc osteophyte complex. Moderate to severe spinal canal stenosis with indentation of the ventral spinal cord. Minimal T2 hyperintense signal is demonstrated in the right aspect of the cord at the C5-C6 level and minimal T2 hyperintensity is seen dorsally just caudal to it. Bilateral facet arthropathy and uncovertebral hypertrophy. Severe right and moderate to severe left neural foraminal stenosis.C6-7: Posterior disc osteophyte complex with moderate spinal canal stenosis. Bilateral mild facet arthropathy and uncovertebral hypertrophy. Moderate bilateral neural foraminal narrowing.C7-T1: Small posterior disc osteophyte complex slightly eccentric to the right. Bilateral facet arthropathy. Mild spinal canal stenosis. Moderate to severe bilateral neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine with multilevel spinal canal stenosis, worst at the C4-C5 and C5-C6 levels. There is associated mild cord deformity. There is minimal cord signal abnormality at the C5-6 level. 2. Moderate to severe multilevel neural foraminal stenoses as detailed above.


Instruction: Generate impression based on findings.

Input: Cerebral cysts [348.0], Reason for Study: ^Reason: history of arachnoid cyst. Please eval for recurrence. No evidence of acute ischemic or hemorrhagic lesion on the scan.Redemonstration of suboccipital craniectomy and C1 laminectomy status.The retro cerebellar arachnoid cyst is again shown. The maximum diameter of the arachnoid cyst is 30.4mm (AP) x 78.1mm (Craniocaudal) x 42.5mm (Right to left) which does not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no abnormal/unusual 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. Post decompressive suboccipital craniectomy and C1 laminectomy status.2. No change of retro cerebellar subarachnoid cyst in terms of size and MR signal intensity since prior scan.3. No acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Reason: right achilles tendon strain vs. tear History: right ankle pain TENDONS: There is thickening of the Achilles tendon at its insertion, which is consistent with tendinopathy. Additionally, there is increased signal in the retrocalcaneal bursa on the T2 weighted images, which is consistent with bursitis.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Findings consistent with achilles tendinopathy and retrocalcaneal bursitis.