Instruction: Generate impression based on findings.

Input: T2N0 right oral tongue squamous cell carcinoma treated with CRT completed in 6/2009 with right partial glossectomy for salvage in 10/2009 with recurrent right oral tongue tumor treated with chemoradiation. There are post-treatment findings in the oral cavity, including radiation effects and partial right glossectomy and neck dissection with radial forearm flap reconstruction. There is residual measurable lesion in the oral cavity. There is also no evidence of significant lymphadenopathy in the neck. The remaining salivary glands are unremarkable. The thyroid gland also appears unremarkable. There are upper thoracic spinal rods that produce susceptibility effect in the region. There is a right maxillary sinus retention cyst.

Output: Post-treatment findings without residual measurable lesion in the oral cavity or evidence of significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: 11-year-old male with left knee pain and swelling MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: At the anterior aspect of the lateral femoral condyle, there is a focal loss of at least 2.2 cm articular cartilage. A small amount of fluid tracks beneath the remaining superior aspect of the articular cartilage. Bone marrow edema is noted deep to this region in the anterior aspect of the lateral femoral condyle.Articular cartilage of the patella appears intact.LIGAMENTS: The anterior cruciate ligament is intact. The posterior cruciate ligament is intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Large focal defect of the articular cartilage along the anterior aspect of the lateral femoral condyle as described above. Loose body within the joint effusion likely represent articular cartilage from lateral femoral condyle. 2.Fluid interposed between the articular cartilage superior to the defect and the bone suggestive of laminar tearing. 3.Large joint effusion with likely layering of blood products.


Instruction: Generate impression based on findings.

Input: Please evaluate for SEGA, hydrocephalus, or other tumors: TS with intractable epilepsy. There are numerous T2 hyperintense cortical and subcortical lesions in the bilateral cerebral hemispheres, some of which extend towards the lateral ventricles in a linear configuration. There is no evidence of acute intracranial hemorrhage or acute infarct. There are multiple nodules involving the bilateral lateral ventricles, the largest of which measure up to 7 mm in the bilateral foramina of Monro regions. The ventricles are otherwise not particularly enlarged. 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: Stigmata of tuberous sclerosis complex, including numerous "tubers" and subependymal nodules, but no evidence of SEGA and hydrocephalus.


Instruction: Generate impression based on findings.

Input: Female 77 years old with L4-L5 pain that wraps around to abdomen. Evaluate for compression fracture. The bones are demineralized suggesting osteopenia/osteoporosis. We see no lumbar compression fracture. There is slight loss of height of the T12 vertebral body suggesting a compression fracture of indeterminate age but new compared to the MRI from 1/26/2015. Lumbar intervertebral disc spaces are preserved. Moderate facet joint osteoarthritis affects the lower lumbar spine. There is moderate SI joint osteoarthritis.

Output: 1. Facet joint osteoarthritis of the lower lumbar spine.2. Although we see no lumbar compression fracture, there is slight loss of height of T12 indicating a compression fracture of indeterminate age.


Instruction: Generate impression based on findings.

Input: Female 56 years old with postmenopausal bleeding. Assess for change in right ovarian cyst. PELVIS:UTERUS, ADNEXA: The uterus is anteverted and measures 9.4 x 4.1 cm in the sagittal plane. Endometrial thickness is normal. The inner myometrium/junctional zone measures up to 10 mm (series 7/43). The junctional zone/inner myometrium and outer myometrial junction is heterogeneous and poorly defined as on the previous exam. A few punctate foci of T1 and T2 hyperintensity within the junctional zone are more clearly seen on today's study. A 9 mm subserosal anterior uterine body fibroid is not significantly changed (series 9/17). A 1.6 x 0.9 cm intramural fibroid in the uterine fundus is better seen on today's exam (series 8/31).The cervix and vagina are normal in appearance and are without abnormal enhancement.The left ovary measures 1.9 x 0.9 cm (series 5/30) and is without focal lesion.The right adnexa measures 7.9 x 7.1 cm (series 4/21) and is predominantly comprised of a 7.0 x 6.2 cm (series 4/23) T2 hyperintense lesion with smooth, thin wall enhancement. There is no internal nodularity, septation or enhancement. The lesion size has increased (previously 5.9 x 5.2 cm) but the imaging characteristics are unchanged.BLADDER: The urinary bladder is decompressed and without focal abnormality.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The right adnexal cystic lesion has increased in size with a current maximal dimension of 7.9 cm. There is no internal complexity2.Mild myometrial heterogeneity with a few punctate T1 and T2 hyperintense foci. While the junctional zone is not thickened, this finding is suggestive of adenomyosis.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: Recurrent left shoulder Pain History: s/p rotator cuff repair with pain ROTATOR CUFF: There is a full-thickness tear of the posterior fibers supraspinatus at the musculotendinous junction measuring 2 mm in AP dimension. Some of the fibers anteriorly are intact. No significant retraction is identified. Overall this tear appears similar to prior examination. There is a screw in the humeral head at the insertion of the supraspinatus. Increased signal in the subscapularis and supraspinatus tendon indicating tendinosis.SUPRASPINATUS OUTLET: Fluid in the subacromial bursa. Osteophytes and T2 hyperintense signal at the acromial clavicular joint indicating osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Full-thickness tear of the supraspinatus in the posterior fibers at the musculotendinous junction. No significant retraction.2.Subscapularis and supraspinatus tendinopathy.3.Osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Pancreatic cystic lesion. Decreased appetite. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in contour and morphology. No focal hepatic lesion is identified. The gallbladder is unremarkable. No intrahepatic ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is dilated, measuring up to 5 mm. There is a large cystic lesion within the pancreatic head, contiguous within the main pancreatic duct measuring 2.9 x 2.3 cm, (series 1001, image 155), which contains thick septal enhancement and abuts the superior mesenteric vein, without evidence of invasion. This cystic lesion limits evaluation of the main pancreatic duct opening, possible pancreatic divisum.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: Large cystic lesion within the pancreatic head with thick septal enhancement contiguous with a dilated main pancreatic duct, suspicious for combined type IPMN


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: eval for stroke History: R sided weakness Brain MRIMultifocal bihemispheric subcortical gyriform diffusion restrictions on bilateral basal ganglia, bilateral MCAs', bilateral PCAs' territory and bilateral cerebellar hemispheres indicating acute/subacute ischemic infarctions. Gyriform subcortical T1 high signal intensity lesions demonstrate laminar necrosis. There are multifocal nodular susceptibility lesions within restricted diffusion lesions suggesting hemorrhagic transformations.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.Bilateral mastoid air cells show fluid collections.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. The right PCA is fetal origin and the right ACA A1 segment is hypoplastic. Vertebrobasilar system appears to be normal.

Output: Bihemispheric, supra and infra tentorial mainly subcortical most likely subacute ischemic infarctions with hemorrhagic transformation without evidence of focal indicate possible global hypoxia instead of embolic origin.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness and glioblastoma. There is interval development of confluent T2 hyperintensity in the anterior right temporal lobe with associated restricted diffusion. There is also interval development of diffuse gyriform intrinsic T1 hyperintensity, with superimposed faint patchy enhancement of the underlying white matter in the right temporal lobe. The peripherally enhancing lesion in the right peritrigonal white matter has nearly resolved. There is no definite elevated perfusion, without the limits of artifact on the perfusion sequence. There are scattered punctate foci of susceptibility effect within the right temporal lobe and left posterior midbrain. There is persistent confluent white matter T2 hyperintensity in the bilateral centrum semiovale, right more than left. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Interval development of confluent T2 hyperintensity in the anterior right temporal lobe with associated restricted diffusion, may represent acute infarction and/or treatment effects rather than tumor progression. 2. Interval development of diffuse gyriform intrinsic T1 hyperintensity, with superimposed faint patchy enhancement of the underlying white matter in the right temporal lobe may represent subacute infarction and/or treatment effects rather than tumor progression. 3. The peripherally enhancing lesion in the right peritrigonal white matter has nearly resolved.


Instruction: Generate impression based on findings.

Input: Female; 19 years old. Reason: HCC screening and eval for biliary strictures History: cirrhosis, and chronic rejection ABDOMEN:LIVER, BILIARY TRACT: Again seen is a cirrhotic-appearing transplanted liver. Multiple scattered siderotic nodules are seen, but there are no suspicious, enhancing hepatic lesions.Gallbladder is absent. Mild dilation of the left hepatic bile ducts with transition point in the mid liver and a long segment, narrowed intrahepatic bile duct extending from the transition point to the choledochojejunostomy (MRCP series 7/22). More severe stricturing is seen over a short segment measuring approximately 1 cm just past the transition point (MRCP series 6/20).SPLEEN: Splenomegaly with large amount of peri-splenic varices. Small scattered siderotic nodules are also noted within the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Cirrhotic transplanted liver with no suspicious, enhancing hepatic lesions.2. Mild dilation of the left intrahepatic bile ducts with transition point in the mid liver and a narrowed/strictured intrahepatic bile duct seen extending from the transition point to the choledochojejunostomy. 3. Sequela of portal hypertension including splenomegaly and perisplenic varices.


Instruction: Generate impression based on findings.

Input: Memory loss and difficulty with word finding. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a nonspecific punctate focus of T2 hyperintensity in the right corona radiata and mild T2 hyperintensity surrounding the right frontal horn. The brain parenchyma and pituitary gland otherwise 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, and scalp soft tissues are grossly unremarkable. There are postoperative findings related to endoscopic sinus sugary with diffuse mucosal thickening in the left maxillary and ethmoid sinuses.

Output: Nonspecific punctate focus of T2 hyperintensity in the right corona radiata and mild T2 hyperintensity surrounding the right frontal horn, which may represent small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Female 66 years old Reason: common duct stones History: right upper quadrant pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. No intrahepatic biliary ductal dilatation. No gallstones are evident. The gallbladder is folded upon itself. Common bile duct is normal in caliber. No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology and signal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above average stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Normal caliber biliary tree without evidence of cholelithiasis or choledocholithiasis2.Gallbladder is folded upon itself representing variant anatomy.


Instruction: Generate impression based on findings.

Input: There is no new intracranial mass or abnormal enhancement to suggest progression of metastatic disease. Again seen are postoperative findings related to right temporoparietal craniotomy for resection of metastatic lesion. There is hyperintense T2 signal abnormality in the treatment bed, which appears similar to prior and consistent with posttreatment change. Again seen are areas of encephalomalacia in the left parietal lobe, left basal ganglia and corona radiata, as well as a small focus in the right cerebellar hemisphere. There is ex vacuo dilatation of the left lateral ventricle. No hydrocephalus.There are scattered foci of hyperintense T2 signal abnormality within the periventricular and subcortical white matter, which likely represent combination of chronic small vessel ischemic disease and posttreatment-related change. Again seen is a punctate focus of susceptibility in the left cerebellar hemisphere which is compatible with a chronic microhemorrhage. There is no acute infarct. There is mild opacification of the right mastoid air cells. There are bilateral lens implants. Paranasal sinuses are grossly clear. No suspicious lesions involving the calvarium.

Output: 1. No new or recurrent metastatic lesions. 2. Multiple chronic supra- and infratentorial infarcts as above.


Instruction: Generate impression based on findings.

Input: 47 years, Male, brain tumor, preoperative planning with individuals. Examination is limited to sequences for operative planning and intraoperative navigation. Fiducial markers are in place. Again seen is an expansile mass centered at the sella measuring approximately 5.4 x 5.5 cm in the AP and transverse dimensions and approximately 7.8 cm in the craniocaudal dimension. Mass is almost entirely solid with a cystic component more superiorly.Mass fills the suprasellar cistern and extends posteriorly into the right perimesencephalic cistern with mild mass effect on the right cerebral peduncles. Noted is lateral extension into the bilateral cavernous sinuses. There is encasement and superior displacement of the optic chiasm and prechiasmatic optic nerves. Noted is intracranial extension involving the left inferior frontal lobe and anterior basal ganglia. Also noted is surrounding vasogenic edema in the left frontal lobe. There is mass effect with rightward subfalcine herniation as before. Anteriorly mass involves the clivus and sphenoid sinus.Tumor abuts the right posterior cerebral artery. The distal ICA, bilaterally A1 segments, and left M1 segments are also intimately associated with the tumor. The distal ACAs are rightward displaced. There is mild entrapment of the right lateral ventricle. Remainder of the brain appears unremarkable without additional lesions.

Output: Examination for surgical planning. Large mass most favored to represent a pituitary macroadenoma with invasive features, peritumoral cyst, and intracranial mass effect as detailed above. Craniopharyngioma is less likely but remains a possibility.


Instruction: Generate impression based on findings.

Input: Evaluate liver lesions ABDOMEN:LIVER, BILIARY TRACT: Multiple cystic lesions in the liver without enhancement measuring up to 6.3 x 5.9 cm in the left hepatic lobe (series 10, image 12).Soft tissue enhancing nodule in the gallbladder fundus measuring 2.2 x 1.1 cm (series 13, image 42).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, left greater than right.RETROPERITONEUM, LYMPH NODES: Multiple prominent mesenteric lymph nodes.BOWEL, MESENTERY: Circumferential wall thickening and enhancement of the cecum (series 13, image 202). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enhancing soft tissue nodule in the gallbladder fundus as described above. Differential considerations include adenomyomatosis and gallbladder neoplasm.2.Circumferential wall thickening and enhancement of the cecum. Follow-up with colonoscopy is recommended.3.Multiple prominent mesenteric lymph nodes, abnormal by number.4.Multiple bilobar cystic lesions in the liver most compatible with benign cysts.


Instruction: Generate impression based on findings.

Input: The floor of the sella is asymmetric, again downsloping towards the right. The rounded area of T2 hyperintensity along the lowered right side of the sella floor measures minimally larger. On the coronal T2-weighted images, the abnormality measures 9 mm in width, compared to 7 mm previously. The significance of this minimal change in size is doubtful given the different angulation between the two examinations resulting in slice selection mismatch. The focal abnormality is still associated with thin, partial rim enhancement and no central enhancement. There is also a contiguous line of ossification separating the lesion from the adjacent sphenoidal body marrow. It is difficult to determine whether this lesion arises from or is external to the pituitary gland. The pituitary gland otherwise continues to show normal, homogeneous enhancement. The pituitary stalk is not deviated. There is no suprasellar mass. There is no mass effect on the optic chiasm.The 5-mm cystic lesion with rim enhancement in the pineal gland is unchanged, most probably representing an incidental pineal cyst.Included brain is unremarkable. An unchanged small contrast enhancing focus involving the frontal bone along the left superior orbital rim is unchanged and probably reflects a small venous lake.

Output: 1.The tiny focal signal abnormality along the right side of the floor of the sella is stable to very minimally larger, allowing for differences in technique. While it is still difficult to determine whether this lesion arises from the pituitary gland or is external to it, the lack of significant size change over the one-year interval favors a benign etiology, with unchanged differential. Underlying chronic developmental asymmetry of the sellar floor remains possible.2.Unchanged small incidental pineal cyst.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [225.2], Reason for Study: ^Reason: meningioma size History: seizures There is evidence of left frontoparietal craniotomy.Previously recognized left frontal extra dural mass (meningioma) extending toward the superior sagittal sinus is again seen. Measured size of the mass does not show any significant interval change since prior scan. However, surrounding parenchymal edema appear to be increased since prior scan which is likely due to postoperative changes.There is no evidence of acute ischemic lesion.Multiple bihemispheric signal voids on gradient echo images indicating petechial hemorrhage are seen, no change in number and size since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No change of left frontal lobe extra axial mass likely meningioma in terms of size and signal characteristics since prior scan.2. Status left frontoparietal craniotomy with interval increase of peritumoral brain edema.3. No evidence of acute ischemic or hemorrhagic lesion on the scan.


Instruction: Generate impression based on findings.

Input: C5 -- C6, C6 -- C7 radiculopathy. History of C7 -- T1 herniated disk there Nonenhanced CT of the cervical spine:Routine nonenhanced CT of cervical spine the sagittal and coronal 2-D reformatted images were obtained.This is not an appropriate exam for detection of herniated disk. The CT examination of cervical spine cannot precisely evaluate the soft tissues of the cervical spine (disk material or hypertrophic changes of the ligamentum flavum).To evaluate for a herniated disk an MRI examination of cervical spine is the study of choice.Very advanced degenerative disease throughout the cervical spine is noted. There is exaggerated lordosis of cervical spine. The alignment the vertebral column is otherwise unremarkable.Foramen magnum.Examination at this level is unremarkable.C2 -- C3.Degenerative disk disease and hypertrophic changes of posterior elements. No bony central spinal stenosis or neural foramina compromise.C3 -- C4.Advanced degenerative disk disease with loss of intervertebral disk height. Moderate hypertrophic changes of posterior elements. Compromise of bilateral neural foramina secondary to bony hypertrophic changes (left greater than right). No central spinal stenosis.C4 -- C5.Moderate degenerative disk disease and extensive hypertrophic changes of posterior elements (left greater than right). Compromise of bilateral neural foramina secondary to a both changes. No central spinal stenosis.C5 -- C6.Moderate degenerative disk disease and exaggerated hypertrophic changes of posterior elements with resultant bilateral neural frontal compromise. No central spinal stenosis.C6 -- C7.Advanced degenerative disk disease and also disk height. Moderate hypertrophic changes of posterior elements. Mild to moderate compromise of the left neural foramina. Questionable minimal compromise the right neural foramina. No central spinal stenosis.C7 -- T1.Advanced degenerative disk disease and minimal hypertrophic changes of posterior elements. No central spinal stenosis. No definitive neural foramina compromise.Limited view of upper thoracic spine demonstrate no central spinal stenosis and no significant degenerative changes.

Output: 1.Extensive degenerative disk disease and hypertrophic changes of posterior element throughout the cervical spine as detailed.2.No central spinal stenosis at any level however multi-level bilateral neural foramina compromise secondary to degenerative changes is present as detailed per level above.3.This examination cannot assess for herniated disk as mentioned above. If concern for acute herniated disk exist a dedicated MRI of the cervical spine is recommended.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma of the right pterygopalatine fossa with right V2 numbness treated with chemoradiation. There is decrease in size of the enhancing tumor within the right cavernous sinus extending from the right foramen rotundum and pterygopalatine fossa, now measuring up to 5 mm in width, previously 8 mm. The skull base and adjacent internal carotid artery flow voids are otherwise intact. There is moderate mucosal thickening in the right maxillary sinus, mild mucosal thickening in the left maxillary sinus, and secretions in the left nasal cavity. There is fluid signal within the bilateral mastoid air cells.

Output: Interval decrease in size of perineural tumor involving the second division of the right trigeminal nerve and extending in the cavernous sinus.


Instruction: Generate impression based on findings.

Input: Dysphagia, unspecified [R13.10] / Dysphagia, unspecified [R13.10], Reason for Study: ^Reason: r/o ischemic stroke History: dysphagia, voice change, s/p Afib earlier this month No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Examination is slightly motion degraded.Thoracic spine: There is mild straightening of the thoracic spine with otherwise preserved alignment. The vertebral body and disk heights are well-maintained. There is diffuse low T1 marrow signal without focal suspicious lesions. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Small perineural cysts are incidentally noted at multiple levels. No epidural collections. No paraspinous collections.Lumbar spine: There is mild straightening of the lumbar spine with otherwise preserved alignment. Vertebral body heights are maintained. There is diffuse low T1 marrow signal without focal suspicious lesions. There is small nonspecific focus of T2 hyperintensity involving the L3 vertebral body anteriorly with possible corresponding T1 hyperintensity.No epidural collections. No paraspinous collections. Small amount of fluid is noted within the subcutaneous fat at the L4 level slightly with from the midline bilaterally and is nonspecific.Mild degenerative changes are seen with mild multilevel disc bulges throughout the lumbar spine. There is mild left and minimal right neural foraminal stenosis at L4-L5. There is also mild left relatively greater than right L5-S1 neural foraminal narrowing.Atrophic kidneys noted.

Output: 1. Lack of contrast and motion degradation slightly limit evaluation however no edema within the intervertebral discs or endplates is appreciated to suggest discitis-osteomyelitis. No fluid collections to suggest abscess within the epidural space or paraspinous soft tissues.2. Diffuse low T1 marrow signal which can be seen in conditions such as chronic anemias. Small focus of T2 hyperintensity involving the L3 vertebral body which may represent a benign entity such as hemangioma but is nonspecific.3. Mild degenerative changes in the lumbar spine with mild neural foraminal narrowing at L4-L5 and L5-S1 as described above.


Instruction: Generate impression based on findings.

Input: Shoulder dislocation ROTATOR CUFF: There is mild increased signal within the distal fibers of the supraspinatus tendon. There is no evidence of rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild subchondral cysts are noted within the humeral head. Otherwise no significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Os acromiale with edema across the synchondrosis as well as at the acromioclavicular articulation.2. Minimal supraspinatus tendinopathy. Otherwise there is no evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 38-year-old man with history of right shoulder dislocation. ROTATOR CUFF: There is high signal intensity along the undersurface of the supraspinatus tendon indicating partial tear of the articular surface fibers. Additionally, there is a 7 x 5 mm subchondral cyst at the insertion of the supraspinatus tendon which fills with gadolinium. The supraspinous muscle belly appears normal. The infraspinatus, subscapularis, and teres minor appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is no significant subacromial/subdeltoid fluid collection.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint is an anatomic alignment.There is a large Hill-Sachs deformity of the humeral head.There is irregularity of the posterior labrum, however the anterior labrum appears intact.BICEPS TENDON: The long head of the biceps tendon is intact with a normal amount of fluid in the tendon sheath.ADDITIONAL

Output: 1.Large Hill-Sachs deformity of the humeral head.2.Irregularity and fraying of the posterior labrum.3.Partial tear of the supraspinatus tendon articular surface fibres.


Instruction: Generate impression based on findings.

Input: 51-year-old female with a history of neurosarcoidosis and lesions in multiple pelvic bones, Osteonecrosis of the bilateral femoral heads. Again seen are multiple round lesions within the sacrum, innominate bones, and proximal femora, overall appearing more extensive compared to the prior exam. In particular, the right subtrochanteric lesion represents greater than 50% of the cross sectional area. These lesions are largely isointense (or perhaps slightly hyperintense) to skeletal muscle on T1, hyperintense on T2, and enhance following contrast administration. Osteonecrosis of the femoral heads appears similar to the prior exam. Moderate to severe degenerative disk disease is noted at L4-5. There is a small amount of fluid in the SI joints, but no enhancement to suggest inflammatory arthritis. There is no hip joint effusion or frank synovitis. Prominent retroperitoneal, iliac, and inguinal lymph nodes are again noted. The inguinal nodes appear slightly larger compared to the prior exam. Uterine fibroids and nabothian cysts are noted.

Output: 1.Multiple bone lesions appearing more extensive overall compared to the prior exam. The differential diagnosis remains metastatic disease, multiple myeloma, and granulomas of sarcoid. 2.Stable femoral head osteonecrosis and other findings as described above.3.Slight interval enlargement of the inguinal lymph nodes.


Instruction: Generate impression based on findings.

Input: Alteration of mental status. Evaluate for acute stroke. . Study is degraded by motion.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. There are very subtle nonspecific T2 hyperintensities, many in the posterior periventricular white matter, most likely related to chronic small vessel ischemic findings. There is prominence of the extra-axial space around the right cerebellum as compared to the contralateral side, with possible trace chronic subdural hygroma,The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is partial opacification of the right posterior ethmoid sinus.There is partially visualized degenerative changes in the cervical spine with probable spinal stenosis; however, not well evaluated.

Output: 1. Motion limited exam. No evidence of acute infarct.2. Mild chronic small vessel ischemic changes.3. Minimal asymmetric prominence of the extra-axial space around the right cerebellum, possibly representing a trace chronic subdural hygroma.4. Partially visualized degenerative changes in the cervical spine with possible spinal stenosis; however this is not well evaluated. Dedicated MRI of the cervical spine may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: Evaluate for renal mass invasion of liver. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal superior pole mass measuring 6.1 x 5.2 x 8.9 cm (series 10/60), demonstrating relative hypoenhancement compared to the remaining renal parenchyma with central hypoenhancement suggestive of a central scar. There is no definite normal renal tissue encasing the superior aspect of the mass suggestive of perinephric fat involvement by the tumor. There is no definite evidence of invasion of the adjacent liver. The right adrenal gland is displaced anteromedially and not well visualized. Dorsomedially the tumor abuts the psoas fascia (series 10/65). No evidence of renal vein invasion. The mass distorts the superior collecting system without frank invasion. No locoregional lymphadenopathy or evidence of metastatic disease to the abdomen or pelvis.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: 6.1 cm right renal superior pole mass with suggestion of perinephric fat invasion and abutment of the psoas fascia without specific evidence of invasion into the adjacent liver as clinically questioned.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Cutler is a 42 year old female with a Cowden-like syndrome as well as kidney and thyroid cancer. Breast parenchyma is almost entirely fat in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: History of lumbar laminectomy 2006 with recurrent left lumbar radiculopathy. There is loss of fluid signal and height of the L4-5 disc with associated annular fissuring and an eccentric left disc extrusion that impinges upon the descending nerve roots in the left lateral recess. There is slight narrowing of the left neural foramen. There is bilateral facet hypertrophy at L3-4 and L5-S1 without significant spinal canal or neural foraminal narrowing. There are no significant degenerative changes involving T12 through L3. The imaged portions of the spinal cord are unremarkable. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis at L4-5 with impingement upon the descending nerve roots in the left lateral recess.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: History of meningioma. Syncopal episode today, balance problem for one week. Clinical question: Change of meningioma. Non-infused CT of brain:Small partially calcific meningioma along the right petroclinoid ligament is identified. Non-infused study is significantly less sensitive for detection of true measurements of meningioma. On this non-infused study meningioma measures approximately 13.7 mm in AP access and 10.6-mm in transverse axis (axial image 8). Considering the significant difference between the two studies of CT of brain today an MRI from 8 -- 28 -- 2009 no significant interval change can be appreciated. This mass is in contact with the right aspect of the pons with minimal flattening. This was noted on prior study as well. There is no evidence of edema of brain parenchyma adjacent to the meningioma. This non-infused CT examination of brain also demonstrates findings consistent with small vessel disease of indeterminate age. No intracranial hemorrhage is detected.

Output: 1.Small vessel disease of indeterminate age.2.Stable right petroclinoid meningioma and B. no appreciable change since prior MRI study. Please see above comments.3.No acute intracranial findings.


Instruction: Generate impression based on findings.

Input: Ms. Valenti is a 60 year old female with a personal history of left breast lumpectomy in 2001 for IDC treated with radiation, chemotherapy, and Arimidex. Family history of breast cancer in maternal aunt and paternal grandmother. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the left breast and left axilla. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Stable postsurgical changes in the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Right arm weakness and aphasia. Nonenhanced brain MRI:Diffusion weighted images demonstrate multiple small foci of restricted diffusion involving the cortex, subcortical and periventricular white matter of the left frontal lobe consistent with acute ischemic stroke without evidence of hemorrhage or mass effect or mass effect. This finding is also poorly appreciated on FLAIR and T2-weighted images. Note should be made that there is extensive motion artifact on FLAIR and T2 series.Additionally study demonstrate moderate to advanced chronic nonhemorrhagic small vessel ischemic strokes of bilateral subcortical and periventricular white matter and pons.There is a large focus of FLAIR/T2 hyperintensity in the left middle cerebellar peduncle with suggestion of mild increased volume. The finding measures approximately at 20 x 21 mm in transaxial dimensions (FLAIR series 601 image 8). The morphology and location of this finding is not highly suggestive of an ischemic change. This finding however demonstrate no significant change when compared to 2 prior head CTs including the exam from 11-26-12. Although relatively stable since 2012 follow-up with an enhanced imaging is recommended to exclude a mass.There is slight prominence of cortical sulci and supratentorial ventricular system with maintained midline.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Extensive chronic sinus disease similar to prior CT examination.Findings and concerns on this exam were discussed by radiology resident on-call Dr. Alexander Anup with neurology resident on call Issa Naoum # 9203 at the time of review of the exam.

Output: 1.Incomplete and suboptimal exam due to motion artifact.2.Small patchy foci of restricted diffusion in the left frontal cortex and subcortical-periventricular white matter consistent with acute nonhemorrhagic ischemic strokes.3.Moderate chronic nonhemorrhagic small vessel ischemic strokes is noted.4.A focus of FLAIR/T2 hyperintensity (20 x 21 mm) in the left middle cerebellar peduncle which has remained stable since 2012 head CT exam however follow-up with enhanced imaging is recommended to entirely exclude possibility of a mass.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with macrocephaly and increasing head size, developmental delay, sacral dimple. Evaluate for hydrocephalus, tethered cord, or other spinal cord abnormal. Brain:Parenchymal morphology is within normal limits. No tissue defects are seen. No evidence of any dysplasia or migrational anomaly is detected. No pathologic signal abnormality is seen including no evidence of diffusion restriction. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is normal in size and morphology. The pattern of intracranial enhancement is within normal limits. The paranasal sinuses and right mastoid air cells are opacified.Spine:A full complement of normally formed vertebral bodies is seen. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is detected. Within the limitations of motion degradation, the spinal cord, conus and cauda equina are within normal limits. The conus tip terminates at the L1-2 level which is within normal limits. On prone imaging, the conus and cauda equina demonstrate normal anterior translation. No evidence of fatty filum terminale or any other fatty intraspinal lesion is detected. No epidural abnormalities are seen. The intervertebral discs are preserved with no areas of spinal canal or foraminal compromise.

Output: 1.Unremarkable evaluation of the brain and spine. Specifically, no evidence of hydrocephalus or tethered cord is seen.2.Opacification of the paranasal sinuses and the right mastoid air cells is seen.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with history of prostate cancer and worsening lower extremity weakness. Widespread osseous metastatic disease is seen through the entire spine, progressed from prior MRIs. No acute cord compression is seen and there is no evidence to suggest any significant spinal canal narrowing in the cervical or thoracic regions. Several of the upper thoracic vertebral bodies show loss of height on the order of 30% when compared to a prior CT examination from 3/26/2015. Postoperative findings are again seen at T10-L1 compatible with corpectomy and lateral fusion. Kyphoplasty of L2 is also seen. The L2 vertebral body is compressed with up to 60% loss of vertebral body height, similar to prior. As on the prior examination, there is an undulating prominently dorsal epidural fluid collection in the lumbar region which causes a significant spinal canal narrowing, particularly at lower lumbar levels, and likely some crowding and/or compression of the cauda equina nerve roots. It is difficult to determine on this limited examination whether the degree of spinal canal narrowing has progressed from prior.

Output: 1.Progression of widespread osseous metastatic disease.2.No definite evidence of cord compression or significant spinal canal narrowing in the cervical and thoracic regions.3.Postoperative findings are redemonstrated at the thoracolumbar junction.4.Redemonstration of an undulating epidural collection involving much of the lower thoracic spine which results in significant spinal canal narrowing and likely crowding and/or compression of the cauda equina. It is difficult to determine on this limited examination if the degree of spinal canal narrowing has progressed from prior. Dedicated lumbar imaging would be helpful in this regard.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with hard palate tumor. Evaluate tumor extent. A solid, nearly homogeneously enhancing tumor is evident centered on the mucosa of the hard palate measuring 34 x 32 x 24 mm. The tumor is bilateral but somewhat asymmetrically prominent on the left. Internal low signal may reflect either mineralization or fibrous tissue. The lesion causes scalloping of the overlying hard palate and maxilla but without obvious osseous destruction.The remainder of the aerodigestive mucosa is within normal limits. No pathologic adenopathy is detected by size criteria. The major salivary glands and the thyroid are free of focal lesions. Bone marrow signal characteristics are within normal limits.

Output: An enhancing hard palate mass is evident with scalloping of the overlying bones suggesting a chronic, indolent course. No evidence of pathologic adenopathy is seen.


Instruction: Generate impression based on findings.

Input: There is an extra-axial T2 hyperintense area in the right pineal cistern that measures 5 mm in width, but otherwise 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, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst and mucosal thickening in the right sphenoid sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. An extra-axial lesion in the right pineal region that measures up to 5 mm in width may represent a cystic structure, but is incompletely characterized. Follow up via MRI with contrast and DRIVE/FIESTA sequences may be useful.3. Right sided inflammatory paranasal sinus disease.


Instruction: Generate impression based on findings.

Input: 3 month follow up from ETV for aqueductal stenosis. There are postoperative findings related to right transfrontal endoscopic thrid ventriculostomy, with what appears to be a faint jet of cerebrospinal fluid across the ventriculostomy, although no defect is discernible otherwise. There is decreased dilatation of the third and lateral ventricles. However, there is no evidence of aqueductal stenosis. There is deficiency of surrounding cerebral white matter, particularly in the right peritrigonal region. There is interval evolution of the intraventricular hemorrhage, with residual diffuse susceptibility effect along the margins of the ventricular system and choroid plexus. There is also susceptibility effect along the surfaces of some of the posterior fossa structures. There is paucity of cerebral white matter, particularly in the right peritrigonal region. Furthermore, the degree of myelination appears to be delayed. There is mild prominence of the subarachnoid spaces in the frontal convexities. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to right transfrontal endoscopic thrid ventriculostomy, with what appears to be a faint jet of cerebrospinal fluid across the ventriculostomy, indicating patency, although no defect is discernible otherwise. Interval decrease in the degree of hydrocephalus and interval evolution of the prior intraventricular hemorrhage with superimposed superficial siderosis in the posterior fossa. In addition, there appears to be periventricular leukomalacia and delayed myelination.


Instruction: Generate impression based on findings.

Input: 46 year old man. Evaluate for bleed. Headache. There is no evidence of intracranial hemorrhage, mass or edema. Cerebellar volume loss is once again noted and is unchanged from the prior CT. The asymmetry of the cerebellar peduncles noted on the prior MRI is not clearly visible on this study.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Scattered mucosal thickening and opacification is present throughout the ethmoid air cells -- this finding was also seen on the patient's prior CT.

Output: No CT evidence of acute intracranial process.


Instruction: Generate impression based on findings.

Input: 35-year-old female with melanoma with brain and lung metastases. Evaluate progression. CT of brain without and with infusion:Enhancing lesion measuring approximately 7 mm times 6 mm in transaxial dimension within the pons is noted. No evidence of surrounding edema. This finding was noted on prior MRI and considering the difference in technique no definitive interval change is detected. Images two posterior fossa otherwise demonstrate no detectable metastatic lesion.Images through supratentorial space demonstrate an area of encephalomalacia along the interhemispheric aspect of right frontal lobe with no abnormal enhancement. This was noted on prior MRI examination at the site of prior craniotomy.A small calcific/hemorrhagic and with possible enhancement in the right posterior temporal adjacent to the trigone of right lateral ventricle measuring 4 mm x 4 mm is consistent with an additional metastatic lesion. This was noted on prior MRI exam and is stable. No definitive detectable additional lesions.Calvarium demonstrates post operative changes of right frontal craniotomy and is otherwise negative. Mastoid air cells and paranasal sinuses are unremarkable.120 cc of Omnipaque 350 was utilized for the above study.

Output: The visualized lesions on this exam are similar to what were noted on the prior MRI examination. CT is significantly less sensitive to detect smaller lesions.


Instruction: Generate impression based on findings.

Input: 54-year-old female with concern for pheochromocytoma, normal plasma metanephrines ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Patent hepatic vasculature. The gallbladder is within normal limits.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No lesions are evident.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of pheochromocytoma.


Instruction: Generate impression based on findings.

Input: 58-year-old man with history of osteomyelitis, now with low back pain and fever. Decreased T1 and increased T2 signal involving the inferior endplate of L4 and superior endplate of L5 with abnormal intermediate signal in the L4/L5 disc is again noted. Overall, the extent of the signal abnormality appears similar to the study from 3/31/2016. There is subcentimeter area of what may represent a heterogeneous fluid collection surrounded by edema in the right posterior paraspinal muscles. The vertebral body heights are within normal limits. The alignment is within normal limits. The conus medullaris is normal in position terminating at the T12 level. There is a disc bulge at L3/L4 with effacement of the anterior subarachnoid space and moderate bilateral neural foraminal narrowing.

Output: 1.Sequela of chronic osteomyelitis and discitis involving L4/5, although assessment is limited due to the lack of intravenous contrast.2.Probable residual fluid collection and surrounding edema in the right paraspinal musculature which may represent a small persistent abscess, although assessment is limited due to the lack of intravenous contrast.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68-year-old male with history of GBM resection, presenting with stroke symptoms There is no restricted diffusion to suggest the presence of acute ischemia. Redemonstrated are postoperative changes from left parietal tumor resection including dural thickening. This study is limited by lack of contrast, however there is increased associated T2 signal which is especially notable extending anteriorly along both frontal and temporal lobes, without associated mass effect. Previously demonstrated hemorrhage within the immediate postoperative cavity have resolved. There remains susceptibility etching the operative cavity. Scattered foci of chronic small vessel ischemic disease is stable. The ventricles are unchanged in size or shape. There are no extra-axial fluid collections. Minimal mucosal thickening is present within the left maxillary sinus. The remaining paranasal sinuses and the mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Output: 1.There is no restricted diffusion to suggest the presence of acute ischemia.2.This study is limited by lack of contrast, however there is increased associated T2 signal surrounding the left parietal postoperative cavity which is especially notable extending anteriorly along both frontal and temporal lobes, without associated mass effect. This may be related to treatment effect, however neoplastic extension cannot be excluded.


Instruction: Generate impression based on findings.

Input: 59-year-old female with history of left mastectomy for IDC in 2012. No current breast complaints Motion artifacts are presents on the subtraction images.There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.Status post left mastectomy and implant placement.Bilateral retropectoral implants appear intact.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 60 old male with bloody diarrhea ABDOMEN:LUNG BASES: 2 x 1.3 cm paracardiac hypodense lesion adjacent to the right atrium, Bessemer number 11, series number 3. This may represent a solid lesion versus pericardial cyst. Further evaluation with MRI may be helpful.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal stones. No hydronephrosis. Bilateral simple 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: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Wall thickening involving the sigmoid colon and rectum which may indicate colitis. Further ovation with endoscopy is recommended.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Wall thickening of the rectosigmoid compatible with colitis.Right nephrolithiasis.Right paracardiac lesion which likely represents a complex pericardial cyst. Further evaluation with cardiac MRI may be helpful to differentiate from paracardiac adenopathy due to its high density..


Instruction: Generate impression based on findings.

Input: Ms. Caddell is a 61-year-old female with recently diagnosed DCIS of the left breast. She presents today for MRI evaluation for staging purposes There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Left breast - In the left upper outer breast, there is a segmental distribution of clumped nonmass enhancement identified measuring approximately 4.6 x 2.6 cm in the AP x ML dimension, and 4.8 cm in the AP oblique dimension. This corresponds in location to the mammographically detected calcifications in the left upper outer breast, which are biopsy proven to be malignant. Susceptibility artifact from biopsy marker clip is seen centrally within this clumped nonmass enhancement.Seen approximately 2 cm inferior to this is an additional segmental distribution of clumped nonmass enhancement measuring approximately 2.0 cm in the AP dimension. Susceptibility artifact from biopsy marker clip with associated benign enhancing focus is seen in the left medial breast, at site of prior benign biopsy.Right breast - There is no abnormal enhancement seen in the right breast. Axillae - No abnormal lymph nodes are identified in either axillary or internal mammary region.Extra-mammary findings - Incidental note is made of a peripherally enhancing lesion in the manubrium, measuring approximately 3.5 x 2.4 cm. This lesion is associated with high internal T2 signal intensity and is partially visualized on prior MRI cardiac exam from 2012. Imaging findings favor a benign hemangioma.

Output: (1) 4.8 cm clumped nonmass enhancement in a segmental distribution in the left upper outer breast, corresponding in distribution to the mammographically detected calcifications which are biopsy proven to be malignant.(2) 2.0 cm segmentally distributed clumped nonmass enhancement in the left inferior breast. An MR guided biopsy with clip placement is recommended for further evaluation.(3) No MRI evidence for malignancy in the right breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 21 months, Female, Reason: assess for intracranial abnormality and/or seizure foci History: stereotype staring episodes that seem consistent with localization related epilepsy with h/x of normal EEGs No evidence of cortical dysplasia, gray matter heterotopia, or other findings to suggest seizure focus. No intracranial mass or mass effect. No significant parenchymal signal abnormality. Sulcation and myelination appear age-appropriate. Midline and posterior fossa structures appear within normal limits. No evidence of infarct or hemorrhage. No extra-axial collections. Ventricles are normal in size. Orbits and sella are grossly unremarkable. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Brain MRI appears within normal limits. No findings to suggest seizure focus are appreciated.


Instruction: Generate impression based on findings.

Input: Diagnosis: Pain in limbClinical question: assess for lumbar stenosisSigns and Symptoms: intermittent weakness in the legs Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level. There is disc desiccation present at this level as well as some mild chronic endplate reactive changes.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some mild loss of disc space height and disc desiccation associated with a diffuse disc bulge and mild ligamentum flavum hypertrophy. There is some signal hyperintensity within the posterior aspect of the annulus of the disc at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There are some mild disc desiccation and a disc bulge present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.At T11-T12 there is a mild disc bulge present

Output: 1.There are degenerative changes present in the lumbar spine without significant compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 43 year old with dense breasts and strong family history of breast cancer. Prior benign right breast MRI guided biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Artifact in the right central breast from the biopsy clip is seen. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Female, 24 years old. History of AML s/p matched sibling stem cell transplant with knee pain. History of steroid treatment. Evaluate for AVN. MENISCI: Medial and lateral menisci appear intactARTICULAR CARTILAGE AND BONE: The cartilaginous surface is intact. No evidence of avascular necrosis or focal marrow occupying lesion. No bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. No evidence of avascular necrosis or focal marrow occupying lesion.2. No meniscal, cartilaginous, or ligamental injury.


Instruction: Generate impression based on findings.

Input: 42-year-old man with right shoulder pain, weakness in abduction and external rotation. ROTATOR CUFF: There is a full thickness tear of the supraspinatus. There is no retraction of the muscle belly. The infraspinatus, teres minor and subscapularis appear normal. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Full-thickness tear of the supraspinatus.


Instruction: Generate impression based on findings.

Input: Unspecified psychosis [298.9], Reason for Study: ^Reason: assess for reversible causes of new onset psychosis History: new onset psychosis No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: 42-year-old with known left breast cancer on neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A rim-enhancing known cancer is located ar posterior 11:00 position in the left breast, measuring 14 x 11 x 12 mm (previously: 20 x 18 x 21 mm). No other abnormal enhancing lesion is present in the left breast. No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: Interval decrease in size of of left breast cancerBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Evaluate hepatic mass. History of acute kidney injury, elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour, with no evidence of cirrhosis. Within segment 5/6 there is a T1 hypointense, T2 hyperintense lesion measuring 9.8 x 6.1 cm (series 7, image 25), and contains an area of heterogeneity that is T1 hyperintense and T2 hypointense, corresponding to foci of hemorrhage. This lesion does not contain fat or restrict diffusion. There is no capsular retraction. There is no intrahepatic or extra hepatic biliary ductal dilatation. Additional smaller lesions with similar features are identified in segment 4A measuring 2.1 x 1.6 cm (series 7, image 29) and segment 2 measuring 2.3 x 1.5 cm (series 7, image 33). The gallbladder is normal in appearance. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few subcentimeter T2 hyperintense renal lesions are identified within the left lower pole, probably cysts, but too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.

Output: Few hepatic lesions as described above, favor hemangiomas in conjunction with CT and US findings. Follow-up may be obtained when renal function normalizes or short term (3-6months) as indicated.


Instruction: Generate impression based on findings.

Input: 36 week old infant with apnea; evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. 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.Subtle areas of questionable low attenuation within the subcortical white matter and bilateral frontal lobes that could represent prior hypoxic injury; recommend follow up MRI if clinically indicated.

Output: Subtle areas of questionable low attenuation within the subcortical white matter in bilateral frontal lobes that could represent prior hypoxic injury; recommend follow up MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: Please evaluate whether there is any extension more deeply of the skin lesion on right side of neck: girl with NF1, had excision of a small solid lesion in the left neck which turns out to be a plexiform with some malignant features. There is patchy low T1 signal in the subcutaneous fat of the left lower anterior neck without appreciable corresponding enhancement. There is no evidence of a mass in the right side of the neck. There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: 1. Patchy low T1 signal in the subcutaneous fat of the left lower anterior neck without appreciable corresponding enhancement may represent postoperative effects rather than residual tumor. Follow up with dedicated ultrasound of this region may be useful.2. No evidence of a mass in the right side of the neck.


Instruction: Generate impression based on findings.

Input: History of right mastectomy with immediate recon for ILC. Currently on Zoladex and Tamoxifen. There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in either the left breast or right chest wall overlying the implants. Bilateral retropectoral implants are again noted, saline on the left and silicone on the right. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Partial resection of a schwannoma at T8-T9 level in 2004, in addition to a possible lesion in the upper thoracic spine and in midbrain adjacent to the aqueductal area. Brain: There is a non-enhancing 7 mm diameter lesion with thin peripheral high T2 signal and central intermediate T2 signal in the right posterior midbrain periaqueductal region. There is no evidence of intracranial hemorrhage or acute infarct. There is a partially empty sella. 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.Cervical Spine: There is no evidence of tumor 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 stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Thoracic Spine: There are postoperative findings in the lower thoracic spine. There is a lobulated, enhancing right posterolateral extramedullary intradural mass that spans the T9 to T12 levels, which measures up to 9 mm in thickness, with associated marked spinal cord compression and a small posterior midline defect in the spinal cord inferiorly. There is no evidence of tumor within the rest of the thoracic spine. There is focal kyphosis and convex left scoliosis centered at T11-12 with mild anterior wedging of the T11 and T12 vertebral bodies, but no spondylolisthesis. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. A subcentimeter tumor in the right periaqueductal region may represent a low grade glioma, for example.2. Tumor in the spinal canal that spans the T9 to T12 levels with marked compression of the spinal cord corresponds to the reported residual schwannoma. 3. No discernible finding that corresponds to the reported possibility of tumor at the T2 level.4. Nonspecific partially empty sella.


Instruction: Generate impression based on findings.

Input: 63 year old female with family history of breast cancer in mother diagnosed at the age of 58 and sister diagnosed at the age of 48. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapseClinical question: s/p SAH and contusionSigns and Symptoms: fu s/p SAH and contusion The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchyma.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense lesions present in the basal ganglia, thalami and brainstem.There are punctate foci of signal loss on susceptibility imaging present along the subcortical white matter of the parietal lobes bilaterally as well as the thalami, brainstem and deep gray nuclei of the cerebellum.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities. There is nasal septum deviation towards the left. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a moderate degree as well as punctate lesions along the brainstem thalami and basal ganglia are nonspecific. At this age they are most likely vascular related. 2.Multiple microhemorrhages are present in the parietal lobes, brainstem, thalami and cerebellum. This does not establish a clear pattern. This could represent a combination of hypertensive microhemorrhages. The possibility of amyloid angiopathy is also raised.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of knee pain. MENISCI: There is poorly defined signal abnormality within the body and posterior horn of the medial meniscus which may reflect intrasubstance degeneration, however no discrete tear is appreciated.ARTICULAR CARTILAGE AND BONE: Mild osteoarthritis affects the knee with tiny tricompartmental osteophytes and focal articular cartilage defects centrally and along the medial facet of the femoral trochlea.LIGAMENTS: There is mucoid degeneration of the ACL with small intrasubstance ganglia proximally and intraosseous ganglion within the intercondylar eminence of the tibia.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Mild osteoarthritis of the knee with focal articular cartilage degeneration along the femoral trochlea.2. Mucoid degeneration of the ACL.3. Mild degeneration of the medial meniscus without discrete tear.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with bilateral leg pain concerning for chronic regional pain syndrome or radiculopathy. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or evidence of marrow edema is seen.The visualized distal spinal cord, conus and cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Minimal bulging disc. Superimposed left foraminal/far lateral disc protrusion, unchanged. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes. L3-4: Mild facet arthropathy. Mild bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Mild bulging disc with a small right foraminal protrusion, unchanged. No significant spinal canal stenosis. Mild left foraminal narrowing. No significant interval changes.

Output: No significant interval change in mild degenerative findings as discussed above. No new findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Wrist pain The exam is limited by motion artifact as well as inability of the patient to complete all sequences.LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: There are degenerative cystic changes within the proximal carpal row specifically within the lunate. There is no evidence of fracture or malalignment. Positive ulnar variance is again noted.ADDITIONAL

Output: Positive ulnar variance with degenerative changes in the proximal carpal row (particularly the lunate), suggesting ulnar abutment syndrome.


Instruction: Generate impression based on findings.

Input: Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. A few scattered punctate foci of T2 hyperintensities are noted in the subcortical frontal lobe white matter bilaterally. There is no abnormal intracranial enhancement. The cavernous sinuses appear to be intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. Orbits: There is a disconjugate gaze and apparent mild volume loss of the left lateral rectus. The globes otherwise appear to be intact. The optic nerves, chiasm, and tracts appear normal. There is no optic nerve sheath dilatation. The extraocular muscles are normal and symmetric with physiologic, homogeneous, and intense contrast enhancement. The lacrimal glands are symmetric and within normal limits for size. There is no evidence of orbital mass lesion or abnormal enhancement.

Output: 1.Minimal punctate foci of T2 hyperintensities in the subcortical frontal lobe white matter bilaterally, but otherwise no specific findings to suggest a demyelinating process or acute infarct. 2.Apparent disconjugate gaze and mild volume loss of the left lateral rectus related to left abducens nerve palsy, but no discernible mass along the course of the abducens nerve or evidence of brainstem lesions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: eval left thumb mass, likely glomus tumor History: above Adjacent to the volar aspect of the distal phalanx of the thumb is a well-circumscribed, ovoid lesion which demonstrates high signal on T2-weighted images and intermediate signal T1 weighted images in addition to avid, uniform enhancement. The lesion abuts the cortex of the distal phalanx but there is no evidence of cortical destruction. The soft tissues of the thumb and underlying osseous structures are otherwise normal in appearance.

Output: Lesion abutting the volar cortex of the distal phalanx of the thumb demonstrates imaging characteristics most consistent with a glomus tumor.


Instruction: Generate impression based on findings.

Input: Clinical question: Progression of stroke. Signs and symptoms: Bilateral weakness. Nonenhanced brain MRI:Examination is performed in limited fashion based on recommendation from clinical services due to patient's condition. Only diffusion-weighted and axial flair images were acquired.Diffusion weighted images redemonstrate a nonhemorrhagic subacute left aica and PICA ischemic stroke involving the left cerebellum and vermis with associated mass effect on the fourth ventricle. There is mild interval increase in the extent of stroke with further extension into the left cerebellum inferiorly and the tiny small new additional noncontiguous foci of restricted diffusion in the left cerebellum, vermis and a tiny focus in the right cerebellar. Additionally there are new small foci of restricted diffusion involving the left occipital lobe involving the cortex and subcortical white matter. The larger focus of restricted diffusion in the left occipital lobe measures at 25 x 8 mm in transaxial dimensions.Findings are not associated with any hemorrhagic changes.Above findings aren't well identified on axial FLAIR sequence as well. Additionally examination redemonstrates previously known mild chronic nonhemorrhagic small vessel ischemic strokes only in the periventricular and subcortical white matter of cerebral hemispheres.Nonenhanced brain MRA:Bilateral internal carotid arteries remain widely patent across the skull base and in their supraclinoid segments. Bilateral anterior and middle cerebral arteries demonstrate any significant vascular compromise or distal vascular occlusion. No change since prior exam.The vertebrobasilar system redemonstrated without interval change a short segmental high-grade stenosis immediately superior to the origin of the right AICA are unchanged. There is poor visualization of right Aica and nonvisualization of the left similar to prior exam. Basilar artery superior to this stenosis remains patent and bilateral superior cerebellar arteries and posterior cerebral arteries are patent.A hypoplastic uniformly small right vertebral artery and right I, branch are identified. A very small caliber right vertebral artery terminates into the basilar artery which can be appreciated only on source images.

Output: 1.Interval increased extent of left cerebellar subacute nonhemorrhagic ischemic stroke and with multiple new small additional noncontiguous foci of acute ischemic stroke in left cerebellum and left occipital lobe and a tiny focus in the right cerebellum. No evidence of hemorrhage and only mild mass effect upon the fourth ventricle.2.MRA of intracranial circulation demonstrate no definitive evidence of any new finding since prior study from 6-30-15. High-grade stenosis of the proximal basilar artery and absence of the left AICA and left PICA as detailed above. Hypoplastic right vertebral artery remains patent and the visualization of the right PICA branch. Patent bilateral internal carotid, anterior and middle cerebral arteries.


Instruction: Generate impression based on findings.

Input: 15 year old male patient with history of juvenile nasopharyngeal angiofibroma status post resection. Post-contrast imaging is degraded by motion artifact. There has been interval partial resection of the left sphenoid sinus component and the left nasal cavity component of an enhancing mass consistent with the patient's known history of juvenile nasopharyngeal angiofibroma. There is residual infiltrative, enhancing tumor involving the left cavernous sinus, the left sphenoid bone, sella, clivus, and left pterygopalatine fossa extending into the left masticator space.There is no abnormal enhancement or diffusion-weighted abnormalities within the brain parenchyma. 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 intact. There are post-surgical changes of a left antrostomy and middle turbinectomy with mucosal thickening of the left maxillary sinus.

Output: Interval partial resection of the patient's known left-sided nasopharyngeal angiofibroma with residual infiltrative tumor as described above.


Instruction: Generate impression based on findings.

Input: Evaluate for cause of acute on chronic weakness and pain in the left arm and shoulder. 47-year-old female with lymphoma status post chemotherapy. Worsening pain and weakness in left arm and shoulder. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign with T1 hyperintense focus at T2 compatible with hemangioma.The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancement.Minimal degenerative changes are seen throughout the cervical spine with minimal disc bulges at all levels from C2-C3 to C6-C7 with partial effacement of the ventral thecal sac, relatively worse at C5-C6 and C6-C7. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. No abnormal enhancement.

Output: 1. Minimal degenerative changes in the cervical spine without significant spinal canal or neural foraminal stenosis at any level. 2. No abnormal cord signal. No abnormal enhancement or mass involving the spinal canal.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1 consistent with prior examination. There is minimal grade 1 retrolisthesis of L5 on S1 without significant change. Vertebral body heights are preserved. There is disk desiccation seen at multiple levels with loss of disk height at L5-S1, L3-4, and L1-2, similar prior exam. The conus terminates at L1-2 and shows normal caliber and signal. The osseous marrow signal is benign. There are scattered high T1 signal foci in the vertebral bodies likely representing focal fatty deposition versus hemangiomas.T11-12: No disk herniation or spinal stenosis. No significant change.T12-L1: No disk herniation or spinal stenosis. No significant change.L1-2: Disk bulge with superimposed worsening disk extrusion which extends superiorly by 16 mm above the superior endplate of L2, and measures up to 6 mm in maximal thickness, with central annular fissure. No significant spinal canal or neural foraminal stenosis.L2-3: Mild disk bulge, and facet arthrosis with ligamentum flavum thickening causing mild central spinal canal stenosis and no significant neural foraminal stenosis. This is unchanged.L3-4: Diffuse disk bulge with right foraminal and far lateral protrusion, ligamentum flavum thickening and facet arthrosis resulting in moderate to severe central spinal canal stenosis and moderate right and mild left neural foraminal narrowing. This is unchanged.L4-5: Diffuse disk bulge, posterior epidural fat prominence, and moderate bilateral facet arthrosis with ligamentum flavum thickening causing mild bilateral right worse than left neural foraminal stenosis and moderate central spinal canal stenosis. This is unchanged.L5-S1: Right central/paracentral disk protrusion, ligamenta flava thickening and facet hypertrophy resulting in encroachment upon the right subarticular zone. No significant central spinal canal stenosis. Mild to moderate neural foraminal stenosis similar to prior.

Output: Multilevel lumbar spondylosis with interval worsening of disk extrusion at L1-2 and central annular fissure without significant spinal stenosis at this level. Additional levels are not significantly changed since 11/14/2013 including moderate to severe central spinal canal stenosis at L3-L4 and moderate central canal stenosis at L4-5.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 39-year-old female with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. There is focal low attenuation in the left basal ganglia, which may represent a prior lacunar infarction or perivascular space. Further evaluation with MRI may be considered if clinically indicated. There is diffuse parenchymal volume loss.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: Focal low attenuation in the left basal ganglia may represent prior lacunar infarction or perivascular space. If stroke is clinically suspected, MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 15-year-old male patient status post colectomy for colitis, now being evaluated for possible anastomosis. Evaluate for evidence of small bowel Crohn's disease.EXAMINATION: MR enterography without and with IV contrast 10/04/2016. ABDOMEN:LIVER, BILIARY TRACT: Layering sludge noted within the gallbladder.SPLEEN: Splenule 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: There are postsurgical changes from end ileostomy in the right lower quadrant and rectal pouch. There is long segment moderate to marked thickening of the duodenum and proximal jejunum without significant enhancement. Decreased peristalsis is noted in this segment of bowel. There is mild thickening of the remaining rectum, which also demonstrates mucosal enhancement and decreased peristalsis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of fluid in the pelvis.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Long segment thickening of the duodenum and proximal jejunum without significant enhancement. This suggests an element of chronic inflammation.2.Mild mucosal thickening and enhancement of the remaining rectum suggestive of active on chronic inflammation.


Instruction: Generate impression based on findings.

Input: Sickle cell anemia and iron overload due to chronic transfusions.EXAMINATION: MR abdomen without contrast 8/17/2016 Limited noninfused MR of the liver in the coronal and axial planes was performed for iron load measurements. The T2 star determination in the liver was made using 18 echoes of a T2 star sequence in the axial and coronal planes. The range in the axial plane was 4.7-8.2 ms with an average of 5.6 ms. The range in the coronal plane was 5.2-6.0 ms with an average of 4.8 ms.Autosplenectomy is again noted.

Output: Normal T2 star values with no evidence of iron overload.


Instruction: Generate impression based on findings.

Input: For purposes of numbering, T12 was again assigned to a level containing a small right hypoplastic rib. With this numbering nomenclature, there is transitional anatomy with sacralization of L5, including pseudoarthrosis on the left. If procedural intervention is contemplated, verification of levels with CT or x-ray before hand is recommended.There has been interval mild (less than 25%) height loss anteriorly in the L1 vertebral body with increased STIR signal in the bone marrow suggesting edema. There is no retropulsion of bony fragments. The conus is normal in signal and morphology and terminates at an appropriate level. Disc desiccation with disc height loss is present from L1-2 through L4-5. Degenerative endplate marrow signal changes are redemonstrated at L4-5, progressed from prior.T12-L1: Mild right facet hypertrophy without stenosis, unchanged.L1-2: Asymmetric bulge to the left which abuts the exiting left L1 nerve root, which is slightly increased in size in the interval. There is also mild bilateral facet hypertrophy. There is no central or significant neural foraminal stenosis. Mild interval worsening of the degenerative disc disease.L2-3: Disc bulge with a new right paracentral disc protrusion narrowing the right subarticular recess, ligamentum flavum thickening, mild to moderate left facet hypertrophy, and moderate right facet hypertrophy. There is moderate right and mild left neural foraminal stenosis. Degenerative changes and stenoses have progressed at this level.L3-4: Minimal anterolisthesis L3 on L4, diffuse mild disc bulge with disc uncovering, ligamentum flavum thickening, and severe bilateral facet hypertrophy. There is mild bilateral subarticular recess and mild bilateral neural foraminal stenosis. These findings are unchanged.L4-5: Asymmetric disc bulge the left, slight ligamentum flavum thickening, moderate left facet hypertrophy, and mild right facet hypertrophy. There is moderate left neural foraminal and mild right neural foraminal stenosis. These findings are unchanged.L5-S1: No disc herniation. No significant spinal canal or neural foraminal stenosis.

Output: 1.New, mild compression deformity of the L1 vertebral body with edema suggesting relatively recent occurrence. No retropulsed bony fragments or spinal canal compromise at this level.2.Multilevel moderate lumbar degenerative changes, as detailed above, with mild interval worsening at several levels.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with neck pain and arthritis. Spinal alignment is grossly anatomic. Vertebral body heights are preserved. Patchy inhomogeneous marrow signal is seen, but there are no aggressive or worrisome lesions. No evidence of marrow edema is observed. The visualized spinal cord shows normal signal intensity throughout. No epidural abnormalities are suspected. The spinal canal is congenitally slender, with superimposed degenerative findings as follows:C2-3: Posterior disc-osteophyte complex formation with central focality which just contacts the ventral cord. No significant spinal canal or foraminal compromise. C3-4: Posterior disc-osteophyte complex formation with a small central extrusion which contacts and slightly flattens the ventral cord. Mild generalized spinal canal narrowing. No significant foraminal compromise. C4-5: Posterior disc-osteophyte complex formation with a right paracentral protrusion or extrusion which contacts and mildly deforms the ventral cord. Moderate generalized spinal canal narrowing. No significant foraminal compromise. C5-6: Posterior disc-osteophyte complex formation with central focality which just contacts the ventral cord. No significant spinal canal or foraminal compromise. C6-7: Posterior disc-osteophyte complex formation with central focality. No significant canal or foraminal compromise. C7-T1: Unremarkable.

Output: Multilevel disc degeneration is seen most severely affecting C3-4 and C4-5 where there is mild to moderate spinal canal stenosis and slight impingement of the spinal cord.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with right arm ataxia, history of cerebral aneurysm and stroke. Numerous foci of T2 hyperintensity are seen, predominantly within the periventricular white matter but with a few also evident in the subcortical regions. No evidence of restricted diffusion is seen. No significant mass effect is detected. Some of the lesions, particularly in the left basal ganglia, show evidence of mild hemosiderin staining. Otherwise, no significant intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology. Artifact is seen within the anterior interhemispheric fissure and in the right paraclinoid region compatible with aneurysm coiling.

Output: 1.No acute intracranial abnormality.2.Sequelae of numerous prior lacunar and microvascular ischemic lesions particularly involving the left basal ganglia.


Instruction: Generate impression based on findings.

Input: Left face and arm numbness. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple nonspecific foci of high T2 signal in the periventricular white matter. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is a hypoplastic T1 segment of the right posterior cerebral artery with a relatively prominent right posterior communicating artery. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Nonspecific foci of T2 hyperintense signal in the supratentorial white matter may represent mild chronic small vessel ischemic disease.2. No evidence of flow-limiting stenosis, occlusion, or aneurysm in the major intracerebral arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: left volar ulnar wrist mass r/o ganglion cyst History: mass and pain Multiple sequences are slightly limited by patient motion. We see no well-defined soft tissue mass such as a ganglion. There is mild reticulation of the subcutaneous fat volar to the pisiform and ulnar neurovascular bundle. This is nonspecific and could reflect small focus of inflammation or perhaps a small collection of blood vessels (e.g., small vascular malformation), but this is equivocal. Please note that it can be difficult to identify subcutaneous lipoma amidst normal subcutaneous fat. Otherwise we see no soft tissue mass.The ulnar nerve appears slightly prominent before entering Guyon's canal, but this is not necessarily of clinical significance. Median nerve is unremarkable.Flexor and extended tendons are within normal limits. Bone marrow signal and osseous alignment are within normal limits.There is small amount of fluid and enhancement in the distal radioulnar joint, conceivably reflecting mild synovitis, but of questionable significance.There is thinning and perhaps focal perforation of the articular disc of the triangular fibrocartilage complex just medial to the radial attachment, but this is not necessarily of current clinical significance.Small ossicle adjacent to the ulnar styloid may reflect prior trauma, of doubtful current clinical significance.Please note that this study is not optimized to evaluate for ligaments, but we see no gross abnormality.

Output: No discrete mass is identified on this study. Mild reticulation of the subcutaneous fat volar to the pisiform and ulnar neurovascular bundle is nonspecific and may reflect focal inflammation or perhaps a small vascular malformation, but this is equivocal. Please note that it can be difficult to identify subcutaneous lipoma amidst of normal subcutaneous fat.


Instruction: Generate impression based on findings.

Input: Epilepsy. The hippocampi show normal, symmetric volume and signal characteristics. There is no evidence of grey matter heterotopia, intracranial hemorrhage, mass, or acute infarct. The degree of myelination is appropriate for age, otherwise. The ventricles and sulci are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening in the paranasal sinuses. Thre is also mild scattered T2 hyperintensity in the mastoid air cells, left more than right. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: No potential seizure foci are identified.


Instruction: Generate impression based on findings.

Input: 30 year-old female with hypertension, coronary artery disease and history of falls. Question bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse periventricular hypodensity consistent with small vessel disease common age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Ventricles are prominent but may be within normal limits for age.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.