Instruction: Generate impression based on findings.

Input: Female, 58 years old, history of ependymoma, evaluate for progression. Evidence of extensive prior surgery is redemonstrated with laminectomy defects along the mid to lower cervical and upper thoracic spine. From C2 through C6, syringohydromyelia of the cervical cord is again seen similar to the prior examination. From C7 through T1, the cord becomes very thin. At the T2 level, a loculated cystic collection is seen within the cord which was present on the prior examination from the 2013. Subjectively, this cyst appears slightly larger, but when measurements are made and compared, these are fairly similar to the prior exam yielding 10 x 11 mm transaxial and 21 mm craniocaudal. This cyst has, however, increased in size when compared to examinations from 2011 and 2010.Linear enhancement is evident within the center of the syringohydromyelia beginning at C2 and extending down to C7, a finding which is not changed from prior exam. The margins of the loculated cyst at T2, and particularly the inferior margin, also enhance. The degree of enhancement along the inferior margin seems to be more intense than on the prior examination, but this could be due at least in part to technical differences.Below the cyst, syringohydromyelia tapers down to the T5 level. Below T5, the spinal cord is thin but shows no definite abnormal T2 signal intensity. No definite pathologic enhancement is seen elsewhere.The thoracic kyphosis is exaggerated but otherwise spinal alignment is anatomic. Fatty marrow replacement compatible with radiation therapy is seen beginning from the top of the odontoid process down to the T7 level. No worrisome marrow signal abnormality or enhancement is detected.A large disk osteophyte complex is present at C5-6 in the right paracentral and foraminal zones which probably contributes to foraminal narrowing. A smaller disk osteophyte complex is present diffusely at C6-7. A small left paracentral disk protrusion is present at T6-7. A large superiorly directed disk extrusion is seen at T8-9 in the right paracentral zone which mildly indents the spinal cord. Bulky facet hypertrophy is seen at L4-5 and to a lesser degree at L5-S1.The right kidney is atrophic.

Output: 1. Syringohydromyelia of the cervical spinal cord extending from C2 through C6 is approximately unchanged relative to the prior examination. Also unchanged is linear enhancement which extends through the middle of this syringohydromyelia. The enhancing tissue may represent residual tumor, granulation or a combination of both.2. The cord becomes very thin between C7 and T1. At T2, there is a loculated cystic component within the cord which, although not convincingly changed relative to the prior examination from 2013, has increased in size from older studies. The margins of this cyst, and particularly the inferior margin, do enhance.3. Fatty marrow replacement compatible with radiation therapy is seen from C2 through T7. Marrow signal is otherwise unremarkable.4. Scattered disk herniations and degenerative findings as above.5. Atrophy of the right kidney.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:2/4/1960)Reason: L sided wekaness, slurred speech History: s/p TPA, pls see abovePROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG FERNANDO D. GOLDENBERG The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is some asymmetric subtle difference in the in signal intensity of the right middle cerebellar peduncle compared to the left. This is not confirmed on coronal imaging. There is no clear-cut mass effect associated with this is possible is related to artifact.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 opacities in the sphenoid sinus and left posterior ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for acute ischemic cerebral infarction. No intracranial lesion is appreciated which would explain the patient's left-sided weakness and slurred speech.


Instruction: Generate impression based on findings.

Input: 66-year-old female with history of lung cancer. Evaluate for metastatic disease at T7. There is an ill-defined subcentimeter focus of signal abnormality along the superior aspect of the vertebral body of T7 demonstrating decreased T1 and increased T2/STIR signal. There is a similar appearing abnormality within the vertebral body of T6. These foci correlate with findings on recent chest CT. On postcontrast imaging, these lesions demonstrate enhancement. Overall these findings suggest two foci of osseous metastatic disease. There is no evidence of epidural extension. No abnormal signal within the thoracic cord.Minimal degenerative disease affects the thoracic spine. Vertebral heights and intervertebral disk spaces are maintained. Alignment is normal. No compression fractures. Multiple cysts are present within the left kidney. Diffuse apparent enhancement involving the partially imaged L1 and L2 vertebral bodies is likely artifactual. No abnormal signal on T1 or STIR sequence.. No associated destructive changes.

Output: Subcentimeter enhancing lesions involving the T6 and T7 vertebral bodies are consistent with osseous metastatic disease. No pathologic fracture or epidural tumor extension.Apparent enhancement involving the partially imaged L1 and L2 vertebral bodies is of likely artifactual due to incomplete fat saturation. No abnormal signal on the precontrast sequences is seen.


Instruction: Generate impression based on findings.

Input: Ms Greco is a 37 year old female with history of right triple negative breast cancer and metastatic right axillary lymphadenopathy, status post neoadjuvant chemotherapy. Patient is on I-SPY 2 research protocol, with most recent breast MRI (10/10/2016) demonstrating reduction in size of the index mass, satellite lesions and metastatic right axillary lymph node. Patient also has history of benign right 9:00 biopsy (fibrocystic change, ductal ectasia) and benign left retroareolar biopsy. Family history is positive for premenopausal breast cancer in a maternal aunt. This is I-Spy MRI #4. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. There is a 3 mm enhancing focus located several centimeters medial to the site of the previously enhancing right breast index malignancy. This focus has central high T2 signal and thin peripheral enhancement. The high T2 signal at this site is even more apparent on the most recent prior study. The appearance is compatible with either a small inflamed cyst or an oil cyst/fat necrosis (consensus opinion of 3 breast radiologists). The two Hydromark clips in the right breast and one on the left are well seen. The index malignancy clip is not well seen on MRI today. The anterior left breast proven benign mass does not significantly enhance today. The biopsied right axillary lymph node contains Hydromark clip artifact and measures up to 8 mm, previously 1.3 cm on the October MRI. The additional axillary clip is seen outside of this node, in fat anterolateral to the node. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: 1. No significant residual enhancement at the sites of proven right breast malignancy. 2. Interval decrease in size of biopsied right axillary lymph node.3. Enhancing focus in the right medial breast is benign in appearance, compatible with an inflamed cyst or oil cyst/fat necrosis. Once treatment is completed, an annual MRI follow up should be considered based on her breast density and young age at cancer diagnosis.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Chiari decompression and cervical syrinx with shunt tubing in thoracic cord: right arm pain, upper back and Low back pain, LE pain more left side. There are postoperative findings related to Chiari decompression. There is cerebrospinal fluid flow across the anterior neo-foramen magnum, but deficiency of fluid posteriorly. There is a long-segment cervicothoracic syrinx that measures up to 6 mm in width in the upper cervical spine. There is a syrinx shunt tube in position in the lower cervical spine. There is reversal of the usual cervical lordosis and multilevel degenerative spondylosis, with mild spinal canal stenosis at C4 and C5. There is mild thoracic levoscoliosis, but no significant thoracic spinal canal stenosis. There is slight anterolisthesis of L4 on L5 and degenerative spondylosis in the lower lumbar spine, with moderate spinal canal stenosis and left neural foraminal stenosis at L4-5. The vertebral body heights are preserved. The vertebral bone marrow signal appears to be unremarkable. There are hepatic and right renal cysts.

Output: 1. Postoperative findings related to Chiari decompression with cerebrospinal fluid flow across the anterior neo-foramen magnum, but deficiency of fluid posteriorly.2. Long-segment cervicothoracic syrinx, with a syrinx shunt tube in position in the lower cervical spine.3. Degenerative spondylosis with mild spinal canal stenosis at C4 and C5 and moderate spinal canal stenosis and left neural foraminal stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: Male, 31 years old. H/o dislocation R shoulder in 2012 with ongoing pain, acutely worse ROTATOR CUFF: There is a partial thickness articular surface tear of the supraspinatus tendon near its insertion, extending for approximately 15 mm in AP diameter and involving approximately 75% of the tendon thickness. No full-thickness tear is identified. There is no significant atrophy of the supraspinatus muscle. The infraspinatus, subscapularis, and teres minor tendons and muscles are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is unremarkable. No significant fluid is noted within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears intact. The articular cartilage is intact.BICEPS TENDON: The tendon of the long head of biceps is normal in course and morphology. ADDITIONAL

Output: 1.Partial thickness tear of the supraspinatus tendon as above.2.The glenoid labrum appears intact.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness since one week, upper extremity deltoid weakness, history of cancer The vertebral bodies are appropriate in the overall alignment and height. There is no evidence of cord compression or high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine.Degenerative changes are noted worst at the C4-C5 level with at least mild spinal canal stenosis at this level. Examination is inadequate to assess for cord signal abnormality at this level.There is subtle focal scalloping of the dorsal cord at the T3 level and focal anterior cord displacement. Mild degenerative changes are seen at multiple levels in the thoracolumbar spine. There is disk and endplate T2 hyperintensity at the T10-T11 level which is likely on a degenerative basis/Schmorl's node.

Output: 1. This is a limited exam specific for the exclusion of cord compression with additional axial T2 images of the upper thoracic cord. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. However, no cord compression or high grade spinal canal stenosis is identified.2. Dorsal scalloping of the thoracic cord at the T3 level and mild focal anterior displacement. Possibilities include arachnoid cyst versus transdural cord herniation. If patient has history of leptomeningeal disease, it is conceivable that this could be related to an adhesion. No cord signal abnormality is seen at this level. If clinically indicated, further evaluation of this area with myelogram can be considered. 3. Degenerative changes relatively worse at the C4-C5 level with at least mild spinal canal stenosis at this level related to disk osteophyte complex. Examination protocol is inadequate to assess for cord signal abnormality at this level.


Instruction: Generate impression based on findings.

Input: Male 63 years old Reason: 63M w/metastatic bladder CA and abdominal pain, ?SBO; MRE to delineate planes between pelvic masses and bowel History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal is in morphology. No definite solid hepatic lesion. Subcentimeter hypodense focus near the middle hepatic vein is unchanged from prior CT.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. There is a right renal cyst.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal lymphadenopathy. There is a duplicated IVC with bilateral stents.Left femoral vein deep venous thrombosis is better evaluated on the CT scan.BOWEL, MESENTERY: Upper abdominal small bowel is dilated which may be due to enterography technique. There is a focal obstruction adjacent to the left lower rectus muscle due to a soft tissue mass measuring 3.1 x 2.4 cm involving the proximal ileum. There is a second area of narrowing involving the rectosigmoid junction in the pelvis with direct extension of tumor that extends to the left pelvic sidewall. The mass in this region measures 4.2 x 3.6 cm.BONES, SOFT TISSUES: Right body wall metastatic deposits. Soft tissue mass adjacent to the right ileal conduit most suspicious for disease near the ostomy site.OTHER: Trace upper abdominal ascites.

Output: 1.Small bowel obstruction in the proximal ileum in the lower quadrant due to an obstructing mass. Obstruction is near complete.2.Second site of bowel obstruction which is incomplete involving the proximal rectum due to extension of left pelvic sidewall mass.3.Right body wall metastases and metastases adjacent to the right lower abdominal ileal conduit.4.Confluent retroperitoneal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There are no T2/FLAIR abnormalities. There is normal ventricular size with no midline shift. No evidence of mass effect or edema. There are no diffusion or susceptibility abnormalities. Vascular flow voids are normal. There is mild mucosal thickening in the left maxillary sinus.The pituitary gland is small, less than the expected for post partum patient.MRV BRAIN:The left transverse sinus is diminutive as the right transverse and sigmoid sinus are dominant. No evidence of sinus vein thrombosis.

Output: 1. Diminutive left transverse sinus. Otherwise, the superior and the inferior venous system are within the normal limits without evidence of sinus thrombosis.2. No acute findings in the brain parenchyma.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer treated with WBRT: headaches. The supratentorial and infratentorial enhancing lesions are no longer conspicuous. There is unchanged patchy cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The clivus and left frontal bone lesions appear to be unchanged. There may also be a partly-imaged lesion in the C3 vertebra.

Output: 1. Post-treatment effects in the brain with interval involution of the intracranial metastases.2. Unchanged appearance of the osseous metastases.


Instruction: Generate impression based on findings.

Input: 69 years, Male, memory loss, evaluate for structural lesions. History of prostate cancer. Examination is slightly limited due to motion degradation. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Relatively more prominent T2/FLAIR hyperintensity is evident involving the left frontal corona radiata. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Incidentally seen is a 3 x 7 mm pineal cyst. No suspicious masses or evidence of intracranial mass effect. Partially empty sella is incidentally noted, which can be normal variant. There is mild to moderate global parenchymal volume loss. There is questionable mild disproportionate enlargement of the ventricular system for the degree of volume loss. No definite evidence of hydrocephalus however. No disproportional volume loss involving the hippocampi is appreciated. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease.There is evidence of prior endoscopic sinus surgery including bilateral uncinectomies and ethmoidectomies. There is moderate opacification of the bilateral frontal sinuses and left greater than right ethmoid sinuses. There is also mild mucosal thickening involving the maxillary sinuses, left greater than right. No destructive lesions involving the calvarium.

Output: 1. Mild chronic small vessel ischemic disease.2. Mild to moderate global parenchymal volume loss.3. No suspicious intracranial masses or evidence of intracranial mass effect. No evidence of intracranial metastatic disease.4. Ventriculomegaly is at least predominantly related to the volume loss. There is questionable mild disproportionate enlargement of the ventricular system for the degree of volume loss, which can be correlated for clinical signs of communicating hydrocephalus/NPH.5. Paranasal sinus disease as described above.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is decreased conspicuity of terminal zones of myelination in the parietal periventricular white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening.

Output: No evidence of intracranial hemorrhage, mass, or acute infarction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 24 year old male with dilated cardiomyopathy, referred for cardiac MRI to evaluate for etiology of LV dysfunction and possible LV thrombus. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is global hypokinesis. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 170 ml/m2 (normal range: 74+/-15), the LVEDV is 432 ml (normal range 142+/-34), the LV end systolic volume index is 132 ml/m2 (normal range 25+/-9), the LVESV is 340 ml (normal range 47+/-19), the LV mass index is 74 g/m2 (normal range 85+/-15), and the LV mass is 190 g (normal range 164+/-36). There is a mid-wall stripe of late gadolinium enhancement in the basal to mid septum , which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern of delayed enhancement is atypical for prior myocardial infarction, and can be seen with dilated cardiomyopathy or prior myocarditis. There is no evidence of LV thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 114 ml/m2 (normal range 82+/-16), the RVEDV is 294 ml (normal range 142+/-31), the RV end systolic volume index is 81 ml/m2 (normal range 31+/-9), and the RVESV is 207 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. Left ventricle is severely dilated with severely reduced systolic function (LVEF 22%). There is no evidence of LV thrombus.2. There is a mid-wall stripe of late gadolinium enhancement in the basal to mid septum , which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern of delayed enhancement is atypical for prior myocardial infarction, and can be seen with dilated cardiomyopathy or prior myocarditis. There is no evidence of LV thrombus.3. Right ventricle is mildly dilated with moderately reduced systolic function (RVEF 30%)4. At least moderate mitral regurgitation.5. Mild tricuspid regurgitation.6. Severe bi-atrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Seizure like activity. There is no evidence of heterotopia or mesial temporal sclerosis. 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 a mega cisterna magna. 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 extensive diffuse paranasal sinus mucosal thickening. There is patchy fluid signal within the bilateral mastoid air cells.

Output: 1. No discernible seizure foci.2. Findings suggestive of sinusitis and mastoiditis.


Instruction: Generate impression based on findings.

Input: Low back pain and nerve tension signs. There is an incompletely imaged small disc bulge at T12-L1, which appears to mildly indent the conus medullaris, but no intraparenchymal signal abnormality. There is mild degenerative endplate signal alteration at T12-L1, but no bone marrow edema, and mild focal kyphosis associated with mild anterior wedging of L1. The rest of the vertebral column alignment and vertebral bone marrow signal is within normal limits. There is no significant spinal canal or neural foraminal stenosis from L1 to S1. The L2 to L5 vertebral body heights are preserved. The paravertebral soft tissues are unremarkable.

Output: Incompletely imaged small disc bulge at T12-L1, which appears to mildly indent the conus medullaris. Dedicated thoracic spine imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 14 day old infant born at 29 weeks of gestation with E. Coli sepsis, seizure, and coagulopathy; now with decreased respiratory drive and fixed pupils. There is extensive predominantly T1 hyperintense hemorrhage diffusely within the cerebellum and within portions of the brainstem, as well as within the effaced fourth ventricle, particularly along the choroid plexus. There is substantial superior transtentorial herniation of the cerebellum with diffuse restricted diffusion and compression of the brainstem. There is also extensive predominately T1 hyperintense hemorrhage within the third and fourth ventricles, particularly along the choroid plexus. There is marked dilatation of the third and bilateral lateral ventricles. Furthermore, there are areas of T1 hyperintensity and susceptibility effect involving portions of the bilateral basal ganglia, particularly in the caudothalamic grooves bilaterally, and along the bilateral lateral ventricular margins. There is diffuse lack of cerebral myelination and paucity of cortical folding. The major cerebral flow voids are intact. There is caput succedaneum that measures up to 10 mm in thickness. There are bilateral middle ear effusions. There appears to be mild staphylomatous deformity of the bilateral globes.

Output: 1. Extensive subacute hemorrhage in the posterior fossa and throughout the ventricular system, as well as along the lateral ventricular margin, including in the region the the germinal matrices bilaterally, with associated superior transtentorial cerebellar heliation, ischemia, and obstructive hydrocephalus.2. Diffuse lack of cerebral myelination and paucity of cortical folding is likely related to prematurity. Discussed with Dr. Singh at 10:10 AM on 7/13/16.


Instruction: Generate impression based on findings.

Input: 70-year-old female with osteoarthritis, can't raise arm. ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus and infraspinatus indicating mild to moderate tendinosis. There is fluid signal intensity traversing the majority of the thickness of the rotator cuff at its insertion on the greater tuberosity involving the posterior fibers of the supraspinatus and anterior fibers of the infraspinatus. The tear does appear to disrupt the bursal surface fibers of the tendon, but we suspect the articular surface fibers are spared. This tear measures approximately 1 cm in the AP dimension. There is fatty infiltration along the myotendinous junction of the supraspinatus and infraspinatus, which otherwise appear normal for age. The teres minor and subscapularis muscles and tendons appear normal for age.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial/subdeltoid bursa. Mild to moderate osteoarthritis affects the acromioclavicular joint. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. There is intermediate signal intensity within the superior labrum likely representing degeneration/degenerative tearing. Otherwise the labrum appears normal within the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact.

Output: 1. Rotator cuff tendinosis and high-grade bursal surface tear of the supraspinatus/infraspinatus.2. Acromioclavicular joint osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:3/19/1971)Reason: MS ? History: cord Sx Optic neuritis x 3 NL brain MRI in 2006PROVIDER/ATTENDING NAME: ANTHONY T REDER ANTHONY T REDER MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild disc bulge at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal. There is a small central and left paramedian disc protrusion present at this level. There is some associated narrowing of the left-sided neural foramen with mild encroachment of left-sided exiting nerve roots..At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No lesions are identified within the brain parenchyma or the cervical spinal cord to suggest demyelinating disorder.2.There are some mild degenerative changes present in the cervical spine worse at C6-7 where there is some mild encroachment of left-sided exiting nerve roots due to a disc protrusion.


Instruction: Generate impression based on findings.

Input: 50-year-old female with a strong family history of breast cancer in three sisters (diagnosed at the ages of 35, 42, and 55) and a paternal great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate 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: Low back and right lower extremity pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild exaggeration of lumbar lordosis. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is congenitally narrow lumbar spinal canal with superimposed degenerative changes as described below: T11-T12: Mild disc bulge with mild to moderate spinal canal stenosis based on sagittal sequences. Moderate right and mild left neural foraminal narrowing.T12-L1: There is mild disc bulge and bilateral facet arthropathy, and ligamentum flavum thickening resulting in mild to moderate spinal canal narrowing. There is mild narrowing of the neural foramina.L1-L2: There is mild to moderate spinal canal stenosis related to bilateral facet arthropathy and ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis.L2-L3: There is moderate spinal canal stenosis related to prominent bilateral facet arthropathy and ligamentum flavum thickening. Minimal disc bulge. There is mild to moderate left and mild right neural foraminal stenosis.L3-L4: There is severe spinal canal stenosis related to advanced bilateral facet arthropathy, ligamentum flavum thickening, and mild disc bulge. There is mild bilateral neural foraminal narrowing.L4-L5: There is moderate spinal canal stenosis related to advanced facet arthropathy and ligamentum flavum thickening. There is effacement of the lateral recesses. Minimal disc bulge. There is no significant neural foraminal stenosis. L5-S1: There is mild to moderate spinal canal narrowing related to bilateral facet arthropathy and minimal disc bulge. There is effacement of the bilateral lateral recesses. There is moderate to severe neural foraminal stenosis bilaterally, right relatively worse in left.There appears to be surgical scar involving the midline lower paraspinous tissues which can be correlated with prior history. Due to the advanced facet arthropathy, small laminectomy defects are difficult to delineate with MRI. Paraspinous soft tissues are otherwise grossly within normal limits.

Output: 1. Advanced multilevel degenerative changes in the lumbar spine. There is severe spinal canal stenosis at L3-L4, moderate spinal canal stenosis at L2-L3 and L4-L5, and mild to moderate at additional levels in the lumbar and lower thoracic spine as described above.2. Moderate to severe neural foraminal stenoses bilaterally at L5-S1, right relatively worse than left.3. Advanced facet arthropathy throughout the lumbar spine.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of right hip pain. ACETABULAR LABRUM: There is a cleft within the anterior, superior acetabular labrum best seen on radial views and likely represents a labral tear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Anterior, superior labral tear.


Instruction: Generate impression based on findings.

Input: 36 years, Male, melanoma with newly diagnosed brain lesions. Examination for SRS treatment planning. There are multiple enhancing lesions in the brain. There are two lesions within the left frontal lobe, best seen on axial post gadolinium series 501 image 110 and 108 and measuring 4 mm and 6 mm, respectively. There is also a 5 mm lesion in the right parietal lobe, image 128. No associated hemorrhage is appreciated. No significant edema, intracranial mass effect, midline shift, or herniation. Ventricles and sulci are normal in size. Major vascular structures appear patent. Calvarium and extracranial soft tissues are grossly unremarkable. These lesions are not evident on outside study from 6/10/2015.

Output: Examination for treatment planning demonstrates three subcentimeter enhancing lesions in the left frontal lobe and right parietal lobe as detailed above and consistent with metastatic disease.


Instruction: Generate impression based on findings.

Input: The CSF spaces are generally but mildly prominent. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal in the visualized portion of the brain. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: This examination without contrast was tailored towards the skull base where no abnormalities are seen to account for the patient's symptoms. On limited evaluation of the entire brain, no specific abnormalities are identified. However, if complete brain imaging is desired clinically, the patient may return for additional sequences at no charge.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Postpartum, ready to resume DMT, numbness Brain: Again seen are several scattered foci of T2/FLAIR hyperintensity in the supra- and infratentorial white matter with morphology and distribution consistent with known demyelinating disease. Again seen are relatively more prominent lesions involving the right precentral gyrus, right parietal periventricular white matter, as well as the left posterior middle cerebellar peduncle. Current study was obtained with higher resolution, and some small lesions appear new or more prominent when compared to prior, such as one in the right frontoparietal corona radiata; findings are therefore favored to be due to differences in technique. There are no new relatively larger lesions to definitively suggest progression. Few foci of T1 hypointensity are also again seen. No lesions with enhancement to suggest active demyelination. Brain parenchymal volume is preserved. No intracranial mass effect, midline shift, or herniation. Ventricle size is normal. Calvarium and extracranial soft tissue structures are grossly unremarkable.Cervical spine: There is no definite cord signal abnormality to suggest demyelinating disease involvement of the cervical cord. No abnormal enhancement. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is straightening of the cervical spinal curvature. Alignment is otherwise maintained. Bone marrow signal is benign. Unchanged T3 vertebral body lesion likely representing an atypical hemangioma. There is no significant disc disease or spinal canal or neural foraminal stenosis at any level.

Output: 1. No findings to suggest progression of demyelinating disease in the brain allowing for slight differences in technique.2. No evidence of demyelinating disease in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Reason: right ankle swelling and pain. s/p lung transplant, diabetic, r/o Charcot joint History: as noted above TENDONS: The peroneal tendons appear intact. The flexor and extensor tendons appear intact. The Achilles tendon is normal in appearanceLIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is nonspecific edema type signal abnormality within the distal tibial metaphysis which is nonspecific but may reflect islands of red marrow. There is subcutaneous edema about the distal tibia and fibula most pronounced along the lateral aspect of the ankle.ADDITIONAL

Output: Nonspecific diffuse subcutaneous and soft tissue edema/inflammatory change about the ankle as described above. No evidence of Charcot joint as clinically questioned.


Instruction: Generate impression based on findings.

Input: 63-year-old woman with history of multiple myeloma and endometrial cancer, pancreatic ductal dilatation and cystic lesion seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. There are gallstones, otherwise the gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation. Portal venous patient.SPLEEN: No significant abnormality noted.PANCREAS: 16 x 10 mm T2 hyperintense lesion in the tail of the pancreas (7/25) is noted with septations, not clearly communicating with the duct. Additionally, there is a 9 mm area of T2 hyperintensity (7/30) in the pancreatic head. The pancreatic duct is mildly prominent at the head but appears normal distally.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The hypoattenuating lesion seen in the head of the pancreas on the prior CT appears to be within the medial duodenal wall (7/41) and measures 8 x 6 mm. This cystic area invaginates the duodenal wall and appears to be mostly within the bowel lumen. The small bowel and colon are otherwise normal.BONES, SOFT TISSUES: Soft tissue nodule in the left breast (14/237) noted measuring approximately 19 mm.OTHER: No significant abnormality noted.

Output: 1.Cystic area within the medial duodenal wall near the ampulla with prominence of the proximal pancreatic duct. No mass identified, however this finding is nonspecific, possibly representing a periampullary cyst, a duodenal diverticulum, or choledochocele.2.Cystic lesion in the pancreatic tail, possibly a serous or mucinous cystadenoma or a nonfunctioning islet cell tumor. Imaging follow-up warranted.3.Third cystic lesion in the pancreatic head favored to represent an IPMN.4.Left breast mass, please correlate with mammographic history.5.Contrast extravasation as described above.


Instruction: Generate impression based on findings.

Input: 46 years Male (DOB:7/20/1969)Reason: lumbar radiculopathy vsl infiltration History: severe length-dependent axonal neuropathyReferring Attending: ANTHONY T REDER 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. No abnormal enhancing lesions are appreciated in the lumbar spine. There is a T2 hyperintense 9 mm round focus within the L2 vertebral body which is slightly hyperintense on T1 and demonstrates some contrast uptake on the postcontrast imaging. There is a 11 mm T1 hyperintense lesion within the L3 vertebral bodyAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There are some endplate reactive changes present this level. There is a broad-based right lateral disc protrusion present which extends into the right neural foramen and mildly encroaches on the right-sided exiting nerve roots. There are some chronic type endplate reactive changes associated with this.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal . There is a right far lateral disc protrusion at L5-S1 which mildly encroaches on the right-sided exiting nerve roots within the right L5-S1 neural foramen.2.There is an enhancing lesion within the L2 vertebral body. It is suspected most likely represents an atypical hemangioma. Follow-up exam or CT of the lumbar spine may help confirm this.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Brain: There are numerous, greater than 10, T2 hyperintense lesions in the supratentorial and infratentorial white matter. Many of the lesions also display T1 hypointensity. There is no discernible associated enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There are multiple areas of T2 hyperintensity in the cervical spinal cord without appreciable associated enhancement. The thoracic spinal cord appears unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foramen stenosis. However, there are multiple subcentimeter perineural cysts within the cervical neural foramina. The paravertebral soft tissues are unremarkable.

Output: Numerous white intracranial and spinal cord matter lesions are compatible with demyelinating disease.


Instruction: Generate impression based on findings.

Input: Clinical question: 23 year-old female with sickle cell disease and new onset of headaches. Signs and symptoms: New onset headaches. Nonenhanced head CT:No detectable acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Very subtle foci of low attenuation in the periventricular and subcortical white matter of bilateral cerebral hemispheres are likely result of prior strokes of indeterminate age considering provided clinical history of sickle cell disease. There are no prior exams for comparison. CT is insensitive for early detection of acute ischemic strokes. Consider MRI for further evaluation.The cortical sulci and ventricular system is not CSF cisterns are unremarkable.Calvarium is intact.Limited view of paranasal sinuses demonstrate chronic left maxillary, left ethmoid and minimally of the sphenoid chronic sinus disease.

Output: 1.No acute intracranial process. CT is insensitive for early detection of acute ischemic strokes.2.Few small periventricular and subcortical foci of low-attenuation although nonspecific considering history of sickle cell disease there are suspected of age indeterminate strokes pain knee small vessel vascular territory.3.Partially visualized paranasal sinuses demonstrate chronic sinusitis of the left maxillary and left ethmoid air cells.4.Unremarkable calvarium.


Instruction: Generate impression based on findings.

Input: History of brain metastasis, from tonsillar squamous cell carcinoma. Status post resection and stereotactic radiosurgery. The postcontrast sequences are limited by patient motion.There are findings related to previous surgery and stereotactic radiosurgery in the inferior left parietal lobe, which remain unchanged with no perceptible contrast enhancement, accounting for expected overlying postcraniotomy dural contrast enhancement and thickening. The associated surrounding white-matter T2-hyperintense signal has very gradually minimally increased along the inferior aspect of the lesion, best seen on axial image #21 of series #501 and coronal image #36 of series #901.There is no new focal brain lesion. There is no acute infarct or acute intracranial hemorrhage. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass-effect, midline shift or brain herniation. Major intracranial vascular flow voids are preserved. The mastoid air cells are clear. Left maxillary retention cysts and bilateral maxillary and ethmoid sinus mucosal thickening remain unchanged. There is increased mucosal thickening in the left frontal sinus which is nonspecific.

Output: Post contrast sequences are limited by patient motion. There are posttreatment findings in the left parietal lobe but no contrast enhancement. These are unchanged since the previous examination except for minimal increase in the surrounding T2 hyperintensity, which is nonspecific and may represent evolving posttreatment changes. Continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with low back pain. Artifact from aortic stent grafting obscures visualization of some of the upper lumbar vertebral bodies.A scoliotic curvature of the lumbar spine is demonstrated. Spinal alignment is otherwise anatomic. Within the limitations noted above, vertebral body morphology and signal characteristics are unremarkable.As on the prior exam, osseous fusion along the posterior elements is noted from the lower thoracic spine down to approximately L3 or L4.The visualized spinal cord, conus and cauda equina are unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc asymmetric to the left. No significant spinal canal or neuroforaminal stenosis. No interval changes. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mild disc bulging asymmetric to the left with left foraminal and far lateral annular fissuring. Mild lateral recess narrowing without change. Moderate left and mild right foraminal narrowing without change. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Moderate bulging disc. Moderate generalized spinal canal stenosis particularly effacement of the lateral recesses without significant change. Moderate bilateral foraminal narrowing without significant change.

Output: Disc degeneration and posterior element hypertrophy are again seen, most severely affecting the L5-S1 level. There is a moderate generalized spinal canal stenosis and moderate bilateral neuroforaminal narrowing at this level. All findings are stable from the prior exam.


Instruction: Generate impression based on findings.

Input: Liver lesion seen on ultrasound exam, please evaluate further and exclude hepatocellular carcinoma, history of hepatitis C ABDOMEN:LIVER, BILIARY TRACT: No focus of signal abnormality seen to definitely correlate with echogenic focus seen on prior sonography, where focus measured approximately 9 x 7 x 5 mm. No suspicious liver lesion visualized. Mildly T2 hyperintense nonenhancing subcentimeter focus seen in hepatic segment 8/4A, measuring 5 x 4 mm, image 27 series 4, small size makes evaluation difficult but may be a tiny cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter gastrohepatic/peripancreatic nodes, may be reactive in setting of chronic liver disease.BOWEL, MESENTERY: Collapsed distal gastric body and antrum, making assessment suboptimal.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. No suspicious liver lesion seen.


Instruction: Generate impression based on findings.

Input: 37-year-old man with history of ileal Crohn's disease on therapy, now with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter cyst in the right lobe of the liver, otherwise the liver and gallbladder are normal.SPLEEN: The spleen is normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Kidneys are normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post small bowel resection with reanastomosis and preservation of the ileocecal valve. There is concentric wall thickening, enhancement, and mild diffusion restriction of the distal ileum. Additionally, approximately 7 cm of the terminal ileum is narrowed and there is submucosal fat deposition. Fibrofatty proliferation is noted in the right lower quadrant. Proximal bowel loops are dilated to approximately 3.8 cm (series 4, image 2) and the walls are mildly thickened with slight enhancement.Additionally, there is noncontiguous submucosal fat deposition in the proximal descending and mid descending colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of chronic inflammation and narrowing involving approximately 7 cm of terminal ileum, with evidence of new upstream distal ileal dilatation.2.Mild active inflammation of dilated ileal loops immediately proximal to the area of narrowing.3.Additional, noncontiguous areas of chronic inflammation involving the descending colon.


Instruction: Generate impression based on findings.

Input: 84-year-old male with possible rotator cuff tear. ROTATOR CUFF: High T2 signal is present within the anterior supraspinatus tendon supraspinatus tendon near its insertion, most likely representing a full-thickness tear, as there is a small amount of fluid within the subacromial/subdeltoid bursa. There is no evidence of tendinous retraction. Foci of low T1 and T2 signal adjacent to the supraspinatus insertion are consistent with calcium hydroxyapatite deposition, corresponding to enthesopathic changes seen on the recent left shoulder radiograph. The remaining rotator cuff musculature and tendons are within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact, as is the articular surface of the humeral head.BICEPS TENDON: A small amount of fluid is present within the biceps tendon sheath, just distal to the bicipital groove. ADDITIONAL

Output: Findings consistent with calcific tendinopathy of the supraspinatus tendon, with a tear at its insertion which is most likely full-thickness, but without evidence of retraction.


Instruction: Generate impression based on findings.

Input: Male 47 years old with metastatic colon cancer. Reevaluate liver metastases. Additional history from the electronic medical record indicates resection of the segment 7 liver lesion in September 2016. ABDOMEN:LIVER, BILIARY TRACT: At the site of the previously seen hepatic segment 7 lesion there is a larger fluid signal cavity consistent with interval resection. There is a subcentimeter nodular focus of enhancement along the medial aspect of the cavity (image 44 of series 10011) favored to represent vessels as seen on image 46 of series 10011 but attention to this region on follow-up imaging is recommended. Surrounding small T1 hyperintensity and susceptibility artifact consistent with postoperative change. The 1 mm T2 hyperintense cyst in hepatic segment 6 is unchanged and likely benign. No new focal hepatic lesions are identified.The hepatic vasculature appears patent. Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate right hydroureteronephrosis appears unchanged as do subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes are seen in the anterior abdominal wall. Nodularity along the deep margin of the inferior left rectus muscle on the outside hospital CT 8/12/2016 is not included in the field-of-view on today's MRI.OTHER: No significant abnormality noted.

Output: 1.Status post hepatic segment 7 metastasis resection. A subcentimeter nodular focus of enhancement along the resection cavity is favored to represent vessels however attention to this region on follow-up imaging is recommended.2.No new hepatic lesions.3.Stable moderate right hydroureteronephrosis.


Instruction: Generate impression based on findings.

Input: There is redemonstration of postoperative and treatment findings of the left mid and posterior temporal lobe without interval change since prior exam. The resection cavity with surrounding T2 signal abnormality are unchanged. Minimal enhancement within the cavity is unchanged and likely post-operative in nature. There is dilatation of the trigone of the left lateral ventricle similar to prior exam. There is no significant enhancement elsewhere. The signal intensity in the brain parenchyma otherwise is within normal limits on all MRI sequences. There are no diffusion weighted abnormalities.

Output: Stable post-treatment changes with no evidence of recurrence or new lesions.


Instruction: Generate impression based on findings.

Input: Other malaise and fatigue [780.79], Reason for Study: ^Reason: please r/o new MS lesions or any other pathology History: new weakness Motion artifacts degraded exam quality.Limited exam due to patient's movement.Brain MRI:Only post contrast T1 weighted scans were obtained.There is no evidence of abnormal enhancement. The ventricles, sulci and cisterns appear to be symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. If necessary, this exam should be repeated for thorough brain evaluation.C-Spine MRIOnly Post contrast T1 sagittal and axial scans were available.Normal cervical lordosis. Normal spinal cord signal intensity. No abnormal enhancement.Degenerative changes include mild neuroforaminal stenosis on bilateral C34 level, prominent posterior longitudinal ligament which abuts thecal sac at the level of C45 and C56.T-Spine MRI: Normal thoracic kyphotic angulation. Normal spinal cord signal intensity. No evidence of abnormal enhancement. Multifocal degenerative changes especially on the lower thoracic vertebral bodies without evidence of neuroforaminal stenosis or spinal canal stenosis.L-Spine MRI:There is grade 1 anterolisthesis of L5 on S1.Normal lumbar lordosis. Vertebral body heights were preserved.Spinal cord signal intensity is normal.The conus medullaris terminates at the L1 level.Degenerative changes are; T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: diffuse bulging of disc with minimal to mild spinal canal stenosis. L3-L4: diffuse bulging of disc with moderate spinal canal stenosis. L4-L5: diffuse bulging of disc with minimal to moderate spinal canal stenosis. L5-S1: grade 1 anterolisthesis of L5 on S1. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Provided very limited exam due to patient's motion and poor cooperation, no evidence of abnormal enhancement, nor evidence of spinal cord compression.2. Multi-level degenerative changes were seen on both cervical spine and lumbar spine level as described above without evidence of abnormal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: Female; 44 years old. Reason: bright red blood per rectum. History: abdominal pain, LLL quadrant ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Few subcentimeter omental, mesenteric, and cardiophrenic lymph nodes are likely benign, however could also represent early metastatic disease in the setting of ovarian carcinoma.BOWEL, MESENTERY: Narrow-mouthed low midline ventral hernia containing mesenteric fat, a small bowel loop, and small amount of free fluid (series 3 image 111). No wall thickening in the herniated loop or evidence of obstruction. There is a mild amount of surrounding stranding in the pannus, suggestive of mild inflammation. The hernia sac measures approximately 13 x 8.5 cm with a 3-cm orifice.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus is absent. Enlarged left adnexa/ovary (series 3 image 120) measures 4.8 x 4.3 cm; ovarian mass cannot be excluded and correlation with gynecologic ultrasound and/or MRI is advised. Cystic lesion in the right ovary (series 3.1) measures 4.1 x 3.5 cm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Ventral hernia containing small bowel loop and small free fluid with mild inflammatory changes of the surrounding  pannus. No evidence of bowel obstruction or bowel inflammation. 2. Enlarged, solid appearing left ovary and a 4 cm cyst in the right ovary. Correlation with pelvic ultrasound or MR is recommended to exclude a mass.Critical findings discussed and acknowledged by Dr. Patel via telephone at the time of dictation.


Instruction: Generate impression based on findings.

Input: Left side numbness. There is no evidence of intracranial hemorrhage or acute infarct. There are mild scattered foci of white matter T2 hyperintensity. There is a subcentimeter arachnoid cyst over the left superior parietal convexity. 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.

Output: Mild chronic small vessel ischemic disease, but no evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Normal lumbar lordosis is decreased and lumbar spine alignment appear to be straightened.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: There is broad-based diffuse bulging of disc towards left side neural foramen however, no definitive evidence of nerve compression is demonstrated.. L3-L4: Diffuse bulging of disc weight broad-based disc bulging toward bilateral neural foramen show minimal neural foraminal narrowing. Again there is no evidence of direct no overt compression at this level. Disc desiccation is also demonstrated.L4-L5: Diffuse bulging of disc weight possible central focal protrusion of the left thecal sac and anterior epidural fat. Disc desiccation is also demonstrated. L5-S1: There is broad-based focal disc protrusion central to slightly left abuts anterior epidural fat and thecal sac. Mild neural foraminal narrowing on the left side. Disc desiccation is demonstrated.

Output: Multifocal various degree disc bulging as well as neural foraminal narrowing with disc desiccation as described above.


Instruction: Generate impression based on findings.

Input: Seizure. Weakness. History of metastatic thyroid cancer with recent diagnosis of cord compression. This study is moderately limited by patient motion.BRAIN:Of note, susceptibility-weighted imaging was not performed. There is no acute infarct, mass-effect, midline shift or brain herniation. A few nonspecific T2-hyperintense lesions are present in the cerebral white-matter. The ventricles and the other CSF-containing spaces are normal in size. Following contrast infusion, there is no abnormal parenchymal or leptomeningeal contrast enhancement. There is no expansile, destructive skull lesion. There is moderate right ethmoid mucosal thickening. The orbits are grossly unremarkable.CERVICAL SPINE:There is fatty marrow signal in the cervical/upper thoracic spine, probably reflective of previous radiation treatment. There is a T1-hypointense, T2-hyperintense, contrast-enhancing lesion in the C7 vertebral body without osseous expansion, epidural extension or pathologic fracture. There is no suspicious cervical mass or lesion otherwise.Sagittal alignment is anatomic. The cervical spinal canal is developmentally narrowed. There is mild multilevel vertebral body height loss throughout the cervical spine, probably reflective of osteopenia and associated minimal compression. There is multilevel degenerative disease most pronounced at C3-C4 where disc-osteophyte complex and ligamenta flava thickening result in moderate-to-severe spinal canal stenosis associated with cord volume loss and mild, patchy increased T2 signal but no abnormal enhancement. A small bulge at C6-C7 causes mild spinal canal stenosis. Multilevel facet and uncovertebral arthropathy is associated with moderate left C3-C4 neural foraminal stenosis while C7-T1 ligamenta flava thickening results in no significant spinal canal stenosis. The left internal jugular vein is small in the left lower neck which might be developmental. Otherwise, the major neck vessels show preserved flow voids. A lobulated fatty density area with thick T1/T2-hypointense rim may reflect atypical lipoma associated with scarring.THORACIC SPINE:There is patchy T1-hypointense, STIR-hyperintense, contrast-enhancing signal abnormality in the left superior aspect of T6 vertebral body associated with mild height loss. This may represent a relatively recent compression fracture. Otherwise, the marrow is heterogeneous throughout the thoracic spine though without a discrete focal lesion. There are intravertebral herniations at T7-T8, T9-T10 and along the inferior endplate of T10. The spinal canal is notable for dorsolateral indentations by facet arthropathy and ligamenta flava thickening, most pronounced at T2-T3, where there is moderate spinal canal and mild neural foraminal stenosis, and to a lesser extent T6-T7, T7-T8, T10-T11 and T11-T12. There is suggestion of multiple pulmonary nodules but these are better assessed by CT scan of the chest, if clinically warranted.LUMBAR SPINE:Axial T1 and T2-weighted images were not obtained. Of note, there are 4 lumbar-type vertebrae and the last well-formed disc is between L4 and the sacralized L5. There has not been change since the recent examination of April 25, 2016. The heterogeneous lesion involving all the L4 and the lower part of L3 vertebral bodies is unchanged as well as its posterior extension and expansion along the left pedicle, articulating pillars and to a lesser extent lamina and right pedicle. The associated 25% posterior height loss at L4 vertebral body is also unchanged with mild posterior retropulsion narrowing the left subarticular recess. There is also abnormal contrast enhancement in soft tissues surrounding the left L3-L4 facet and the left L4 pedicle and lamina but no sizable epidural mass.The multilevel degenerative disease has not changed but results in no significant spinal canal stenosis. Neural foraminal stenoses are most pronounced in the lower lumbar spine; moderate-to-severe left and mild-to-moderate right L3-L4 as well as moderate bilateral L4-L5. Please refer to the report of the previous examination for more details.The tip of the conus medullaris lies at L1-L2 level. There is no abnormal contrast enhancement in the conus or the cauda equina roots.Noncontrast enhancing foci within the kidneys and the liver are incompletely assessed but may represent cysts.

Output: 1.Transitional spinal anatomy, as noted above. If surgery is to be contemplated, please correlate with imaging of the entire spine.2.BRAIN: There is no acute infarct or brain mass.3.CERVICAL SPINE: Multilevel degenerative cervical spondylosis is most pronounced at C3-C4 where there is moderate-to-severe spinal canal stenosis with minimally increased cord T2 signal and volume loss at the same level, probably compressive myelopathy. Contrast-enhancing lesion in C7 vertebral body is probably metastatic but is not associated with epidural extension/osseous expansion or pathologic fracture.4.THORACIC SPINE: Heterogeneous thoracic marrow signal but no discrete mass. Focal marrow signal abnormality in T6 vertebral body may represent a recent mild insufficiency compression fracture. Multilevel degenerative change is most pronounced at T2-T3, where facet arthropathy and ligamenta flava thickening result in moderate spinal canal stenosis. Suggestion of multiple pulmonary metastasis.5.LUMBAR SPINE: Stable metastatic lesions in the lumbar spine, without significant epidural disease. There is no compression of the conus or cauda equina.


Instruction: Generate impression based on findings.

Input: Reason: 58M with prostate CA interested in localizer ablation, please assess for prostate lesions History: prostate CA. He was found to have an elevated PSA, which increased from 3.11 in 10/2014 to 6.52 (13% free: total) in 04/2016. He therefore underwent TRUS and prostate biopsy on June 3, 2016, revealing Gl 3+3 in 1 of 12 cores in R apex with tumor present in >50% of core. His approximate tumor length was 6.0 mm. PELVIS:PROSTATE:Prostate Size: 4.9 x 3.6 x 4.0 cm.Peripheral Zone: There is diffusely decreased T2 signal within the peripheral zone which somewhat limits evaluation for lesions. There is an area of decreased T2 and ADC signal within the right apex/mid gland which measures 1.0 x 1.2 cm and is suspicious for neoplasm.Central Gland: There is a sharply marginated focus of decreased T2 signal within the left transitional zone which is most compatible with a hyperplastic nodule.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: The bone marrow signal is diffusely heterogeneous.OTHER: No significant abnormality noted.

Output: 1.Area of signal abnormality in the right peripheral zone apex/mid gland suspicious for neoplasm without evidence of extracapsular extension.2.Nonspecific heterogeneous bone marrow signal, correlation with nuclear medicine bone scan can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: 56 year old female with left shoulder pain, concern for SLAP tear. ROTATOR CUFF: There is a very small curvilinear focus of intermediate signal intensity along the articular surface of the distal supraspinatus tendon (series 4, image 10) compatible with a very small articular sided partial tear. No contrast extends to the subacromial subdeltoid bursa. The supraspinatus muscle appears normal. The remaining rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: Mild acromioclavicular joint osteoarthritis is present.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint is in anatomic alignment. The glenoid labrum appears normal.BICEPS TENDON: Long head of the biceps tendon appears normal with small amount of fluid communicating with the glenohumeral joint. ADDITIONAL

Output: Very small small articular sided partial tear of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: Male, 13 days old, ex 34 week infant, with feeding intolerance, right eye ptosis, and head ultrasound with questionable findings in the thalamus. A 5 mm focus of T1 and T2 hyperintensity is seen within the region of the ventrolateral nucleus of the left thalamus. In addition, a 4 mm focus of T1 hypointensity and T2 hyperintensity suggesting cystic degeneration is seen along the superior margin of the right frontal horn. Several very small cystic spaces are suspected along the left frontal horn, best seen on coronal T2-weighted images.No restricted diffusion is seen. No parenchymal edema or mass effect is detected. There is no evidence of any significant acute intracranial hemorrhage or abnormal extra-axial fluid. The ventricles are normal in size and morphology.The pituitary region is within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The corpus callosum is fully formed and intact. The pattern of white matter myelination is appropriate for the corrected gestational age.

Output: A focus of parenchymal injury is evident centered on the ventrolateral nucleus of the left thalamus. Small cystic areas within the white matter along the frontal horns are also favored to represent foci of parenchymal injury, less likely congenital or developmental cysts. Such findings are most commonly seen in the context of perinatal ischemia. Lack of diffusion restriction would suggest that the insult occurred at least 7-10 days previously.


Instruction: Generate impression based on findings.

Input: Six-year-old male with history of hydronephrosis BLADDER  Wall Thickness: Irregular bladder wall without significant thickening.  Contents: Debris is again seen with in the bladder appearing similar to the prior exam. Distal Ureter -- SFU Grade**  Right: 3  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Poor corticomedullary differentiation, appearing similar to the prior exam   Medullary Echogenicity: Poor corticomedullary differentiation, appearing similar to the prior exam  Pelvicaliceal System -- SFU Grade*  Right: 3 Left: 0  Length*** Right: 10.0 cm Left: 4.6 cm   Mean for age: 7.8 cm  Range for age: 6.5 - 9.3 cmADDITIONAL OBSERVATIONS: Small atrophic left kidney is visualized with a hypoechoic structure measuring 1.1 x 0.8 x 0.6, which appears multicystic. This may represent an involuted multicystic dysplastic kidney. Atrophic kidney with cystic structures is seen on MRI dated 7/28/11.

Output: 1.Persisting right grade 3 pelvicaliceal dilatation with increasing hydroureter. 2.Small atrophic left kidney with a small multicystic structure. This may represent an involuted multicystic dysplastic kidney.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on findings.

Input: History of renal cell cancer and liver lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. The previously seen complex lesion in the right hepatic dome has nearly completely resolved with a 1.4 cm T1 weighted hypointense residual abnormality. There is no associated T2-weighted signal abnormality or restricted diffusion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes from a left partial nephrectomy. There are bilateral renal lesions which are incompletely characterized without intravenous contrast. These are unchanged in size and likely represent simple and minimally complex cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Diverticulosis.BONES, SOFT TISSUES: Scoliosis. Note is made of prominent left lower lobe vessels, incompletely characterized and unchanged from the 2014 CT.OTHER: No significant abnormality noted.

Output: 1.Interval near complete resolution of the right hepatic dome lesion with residual 1.4 cm T1-weighted hypointense abnormality. This likely represented infection/abscess. 1 year follow-up to document resolution is suggested.2.Incompletely characterized bilateral renal lesions are stable in size and likely represent multiple simple and minimally complex cysts.


Instruction: Generate impression based on findings.

Input: 75-year-old male patient with Gleason 7 prostate cancer and concern for extraprostatic extension. PELVIS:PROSTATE:Prostate Size: 5.1 x 4.7 x 5.6 cmPeripheral Zone: There is a large area of signal abnormality extending from the left base to the left apex which demonstrates T2 hypointensity with moderate to marked corresponding low ADC signal. For example, a region of signal abnormality in the left apex compatible with tumor measures 2.0 x 0.6 cm (image 9, series 801). Furthermore, the overlying capsule appears indistinct within the left apex likely representing extraprostatic extension with questioned invasion of the neurovascular bundle on the left. There is an additional focus of signal abnormality within the left apex suspicious for tumor with questioned invasion into the left seminal vesicle (image 69, series 301)Curvilinear foci of increased T1 signal within the right peripheral zone may be secondary to prior biopsy.Central Gland: There is hyperplasia with BPH nodules. There is curvilinear foci of increased T1 signal within the right central gland which may be secondary to prior biopsy.Seminal Vesicles: As described above.Extracapsular Extension: As described above.BLADDER: No significant abnormality noted.LYMPH NODES: A small left internal iliac lymph node is non-specific. BONES, SOFT TISSUES: Mild asymmetric enhancement of the right hip joint is nonspecific, possibly representing a synovitis.OTHER: No significant abnormality noted.

Output: Tumor within the left peripheral zone with extraprostatic extension and questioned invasion of the left neurovascular bundle and left seminal vesicle.


Instruction: Generate impression based on findings.

Input: 59 year old female with family history of breast cancer in mother diagnosed at the age of 49 and maternal cousin diagnosed at the age of 43 and personal history of benign left breast Bilateral silicone implants which appear intact, retropectoral in right and retroglandular in left. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A metallic artifact from prior benign biopsy is again seen in the left lower outer quadrant.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: Right arm and leg pain/paresthesias. EMG shows cervical radiculopathy. Evaluate for disk disease. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is mild straightening of the cervical spine curvature; alignment is otherwise maintained. There is T1 hyperintense lesions with fat suppression involving C7, T1, and T2 vertebral bodies which may represent small hemangiomas or focal fat. There is mild diffuse low T1 signal throughout the bone marrow, which is nonspecific, but without discrete destructive osseous lesions.The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes changes are seen in the cervical spine including disk desiccation at C2-C3, C3-C4, and C4-C5. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal central disk protrusion. No significant compromise to the spinal canal or neural foramina.C4-5: Minimal central disk protrusion. 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.

Output: Minimal degenerative changes without significant spinal canal or neural foraminal stenosis at any level in the cervical spine. If clinically indicated, may consider MRI of brachial plexus to evaluate the nerve roots more peripherally.


Instruction: Generate impression based on findings.

Input: Lymphoma, receiving intrathecal chemotherapy. Brain: Again seen is enhancement and mild enlargement involving multiple cranial nerves, particularly the bilateral trigeminal and ocular motor nerves which is stable or slightly decreased since prior. No new parenchymal or meningeal enhancement is seen to suggest tumor progression. There is no intraparenchymal mass or evidence of intracranial mass effect. There is a right transfrontal Ommaya catheter with interval increase in pneumocephalus which may be related to recent catheter manipulation. There is extensive confluent cerebral white matter T2 hyperintensity similar to prior. 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. There is diffuse right maxillary sinus mucosal thickening which is new since prior. Additional partial opacification of the paranasal sinuses similar to prior.Cervical Spine: There is been improvement in previously seen diffuse enhancement and enlargement of multiple bilateral cervical and upper thoracic extraforaminal enhancing nerve roots. Residual enhancement and mild enlargement is most apparent involving the right C5 nerve root as well as the partially imaged thoracic nerve roots. Otherwise, there is no evidence of tumor or abnormal enhancement within the cervical spinal canal. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is unchanged mild multilevel degenerative spondylosis, but no significant spinal canal or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Stable to minimal decrease in enhancement involving multiple cranial nerves compatible with known lymphoma. No intraparenchymal mass or new enhancement to suggest disease progression in the brain. There is relatively more pronounced decrease in enhancement involving the multiple bilateral cervical and upper thoracic nerve roots. These findings suggest disease improvement.2. The no significant change in extensive white matter signal abnormality involving the bilateral cerebral hemispheres likely representing posttreatment change.


Instruction: Generate impression based on findings.

Input: Please evaluate vagal schwannoma in the left neck. There is a well-defined, ovoid, heterogeneous mass in the left neck anterior triangle centered at the level of the larynx, which measures up to 6 cm. There is also a left maxillary periapical cystic lesion with thick peripheral enhancement that measures up to 17 mm. There is no evidence of other tumors or significant lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The upper aerodigestive tract structures appear to be intact. There are small retention cysts in the bilateral maxillary sinuses. The imaged intracranial structures and orbits are unremarkable.

Output: 1. A well-defined mass in the left neck that measures up to 6 cm is compatible with a peripheral nerve sheet tumor.2. A left maxillary periapical cystic lesion with thick peripheral enhancement that measures up to 17 mm may represent a periodontal abscess or inflamed globulomaxillary cyst.


Instruction: Generate impression based on findings.

Input: Female 56 years old Reason: unresectable pancreatic adenocarcinoma, SBRT evaluation History: unresectable disease ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is mild to moderate intrahepatic biliary ductal dilatation. Common bile duct stent is present. Status post cholecystectomy.No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: There is a pancreatic head/body mass that extends to the pancreatic head. The mass is hypoenhancing. It measures 3.2 x 1.8 cm. It occludes the pancreatic duct with resultant pancreatic ductal dilatation in the tail. The mass narrows the portal vein. Posteriorly, the mass extends to the level of the IVC and superiorly extends to the level of the caudate. There is infiltrative soft tissue surrounding the caudate.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: Post surgical changes in the anterior abdomen.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 7/26/2016 10:45:00)PANCREATIC MASS: 3.2 x 1.8 cm (Image 229, Series 10); 2.3 x 4.0 cm on prior (12/22/2015) (Image 92, Series 17).

Output: Pancreatic head/body mass with extensive regional extent of disease


Instruction: Generate impression based on findings.

Input: History of CVA and CNS vasculitis, presenting with worsening right sided weakness. The images are generally degraded by patient motion. There is no evidence of acute infarction. There are numerous patchy areas of high T2 signal in the bilateral cerebellar hemispheres, right occipital lobe, left frontal lobe, bilateral basal ganglia, and subcortical and periventricular white matter. There is also encephalomalacia in the bilateral cerebellar hemispheres, right pons, and bilateral basal ganglia. There is unchanged susceptibility effect within the bilateral basal ganglia and right frontal lobe. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is bilateral tympanomastoid fluid.

Output: 1. Extensive chronic ischemic infarcts and small vessel ischemic disease, but no evidence of acute infarction.2. Bilateral tympanomastoid effusions may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is a 3-mm retrolisthesis of L5 on S1 with disk desiccation and mild loss of disk height at L5-S1. Disk heights and signal at other levels are preserved. Vertebral body heights are preserved. The conus terminates at inferior L2 level, at the lower limits of normal, although still within normal limits.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: Mild posterior epidural fat, ligamenta flava thickening and mild bilateral facet arthropathy with no significant spinal stenosis.L3-4: Mild diffuse disk bulge, bilateral facet arthropathy and prominence of posterior epidural fat causing no significant spinal stenosis.L4-5: Diffuse disk bulge, ligamenta flava thickening, moderate bilateral facet arthropathy causing mild spinal canal and bilateral neural foraminal stenosis. Disk material encroaches upon the bilateral subarticular zones without significant nerve root impingement.L5-S1: Diffuse disk bulge with central disk protrusion causing no significant spinal canal stenosis. Moderate bilateral facet arthropathy causing mild to moderate bilateral neural foraminal stenosis, right greater the left.

Output: Multilevel lumbar spondylosis as described above, worst at L4-5 where there is mild spinal canal and bilateral neural foraminal stenosis. Please see details above.


Instruction: Generate impression based on findings.

Input: Female 47 years old Reason: pain History: pain. Four views of the left knee show a poorly defined curvilinear lucency overlying the lateral tibial plateau indicating a nondisplaced fracture best seen on recent MRI. The previously seen joint effusion has decreased in size. Mild osteoarthritis affects the knee.Mild to moderate osteoarthritis affects the right knee as seen on frontal views.

Output: Nondisplaced lateral tibial plateau fracture and osteoarthritis.


Instruction: Generate impression based on findings.

Input: 63-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 5.7 x 7 x 8.3 cm.Peripheral Zone: No definite focus suspicious for prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing bilateral inguinal hernias.OTHER: No significant abnormality noted.

Output: No definite focus suspicious for prostate cancer.


Instruction: Generate impression based on findings.

Input: Reason: osteomyelitis of the right History: cellulitis, pain Patient motion artifact limits evaluation on multiple sequences. The first toe has been amputated through the first metatarsal. The underlying osteotomy margins are sharp without evidence of osteomyelitis. There is plantar and medial displacement of the middle phalanx of the second toe relative to the proximal phalanx. There is tapering of the head of the proximal phalanx with abnormal signal intensity within the proximal phalanx most concentrated at the head indicating osteomyelitis. There is abnormal signal intensity within the soft tissues dorsal to the head of the proximal phalanx likely representing ulceration. There is also abnormal signal intensity within the subluxed/dislocated middle phalanx most concentrated at its base compatible with osteomyelitis. There also appears to be ulceration dorsal to the distal phalanx. As seen on the prior radiographs, the tuft of the distal phalanx is absent which may be chronic in etiology. The fatty signal intensity of the base of the distal phalanx appears preserved. The remaining phalanges and metatarsals appear intact as do the tarsal bones. There is subcutaneous edema extending along the dorsal soft tissues of the forefoot and midfoot. There is atrophy of the plantar musculature of the foot.

Output: Osteomyelitis of the proximal and middle phalanges of the second toe. Absence of the tuft of the distal phalanx of the second toe may reflect prior surgery or long-standing infection.


Instruction: Generate impression based on findings.

Input: Female 55 years old Reason: head and neck cancer, metastatic, with bone pain in left hip/spine There is a mass within the left ilium resulting in expansile remodeling of bone representing patient's known metastasis. The signal intensity of the lesion is heterogeneous on T1 and T2-weighted images with enhancement following gadolinium administration. There is mild enhancement of adjacent iliacus muscle. The remainder of the left ilium and lateral one third of the sacrum is predominantly yellow marrow which likely reflects radiation treatment effect. There are multiple foci of abnormal signal intensity and mild enhancement in the right iliac wing, and sacral body likely representing metastatic disease. There are also tiny foci of abnormal signal intensity and mild enhancement in the proximal right femur which may represent metastases.There is compression deformity of L3 with abnormal signal in the underlying bone presumed to represent pathologic fracture; please refer to lumbar spine MR report. Fibroid uterus is again noted.

Output: Metastatic disease involving the bones of the pelvis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Again seen are multiple neurofibromas involving the neural foramina throughout the cervical spinal canal bilaterally. There is severe cervical spinal canal stenosis related to the bilateral nerve sheath tumors at the C1-C2 level with severe compressive deformity of the cord due to epidural tumor bilaterally similar to prior. Lesions measure approximately 19 mm in the AP dimension, similar to prior. Focus of cystic change within the tumor on the left is minimally larger than prior. No evidence of significant spinal canal stenosis or significant epidural extension at any level aside from the C1-C2 level mentioned above.Again seen is reversal of cervical lordosis with kyphotic attenuation with apex at the C4-C5 level, similar to prior. There is angulation of the cervical cord related to the kyphosis. No cord signal abnormality is definitively appreciated. There is enlargement of a lesion involving the left posterior paraspinous soft tissues at the C2 level which measures 18 x 26 x 30 mm previously 14 x 20 x 20 mm. Numerous additional lesions involving the cutaneous, subcutaneous, and paraspinous soft tissues are also similar to prior. Mastoid air cell opacification again noted on the right.THORACIC SPINE

Output: 1. There is interval enlargement of left posterior paraspinous soft tissues lesion at the C2 level which measures 18 x 26 x 30 mm previously 14 x 20 x 20 mm.2. No significant change in the multiple neurofibromas involving the neural foramina relatively largest of which is seen at the C1-C2 level and extends into the epidural space, resulting in severe compressive deformity of the upper cervical cord at this level. This appearance however is not significantly changed compared to MRI from 8/8/2013. 3. No significant change in multiple thoracic neurofibromas relatively largest of which is seen in the left upper thoracic paraspinous region extending into the left thoracic apex. Left T10-T11 lesion which extends into the epidural space and causes mild mass effect on the thoracic cord is also not significantly changed. 4. In the lumbar spine, multiple neurofibromas are mostly not significantly changed, the relatively largest of which is along the left L4 nerve root and not significantly changed. There is enlargement of a 10 mm lesion in the spinal canal at the L5 level, previously 8 mm on prior lumbar spine MRI study from 2007.5. Splenomegaly and elevation of the left hemidiaphragm noted.


Instruction: Generate impression based on findings.

Input: Clinical question: 51-year-old female with metastatic renal cell cancer status post S RSto Right cerebellum, evaluate for progression. Signs and symptoms: None Pre and post enhanced brain MRI:Examination demonstrate slight interval increased size of a hemorrhagic metastatic lesion in the right cerebellum. It measures 16.5 x 20 mm in transaxial dimensions which is slightly larger than prior study. Measurement of 14.7 x 18.3 mm. There is also interval increased surrounding vasogenic edema with resultant regional mass effect.A tiny focus of hemorrhagic enhancement in the right cerebellar cortex also demonstrates subtle interval increase in the edema and enhancement since prior study. Finding is consistent with additional small metastatic lesion measuring approximately at 5.5 x 6 mm (axial fat-sat post enhanced series 12 image 16) in transaxial dimensions compared to prior study remeasurement of approximately 3 x 4 mm.Diffusion-weighted images are negative and there are stable few nonspecific, nonhemorrhagic and nonenhancing foci of FLAIR/T2 hyperintensity in the subcortical white matter of bilateral cerebral hemispheres. Findings in proper clinical setting could represent minimal chronic small vessel ischemic strokes.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits.Unremarkable visualized paranasal sinuses.

Output: 1.Mild interval increased size and surrounding vasogenic edema of a right cerebellar hemorrhagic metastatic lesion as detailed/measured above.2.Mild interval increased edema and size of a hemorrhagic metastatic lesion in the right subinsular white matter as detailed/measure above.3.Negative diffusion weighted series.4.Stable few nonspecific foci of subcortical FLAIR hyperintensity.5.Unremarkable calvarium and all visualized paranasal sinuses.


Instruction: Generate impression based on findings.

Input: There are foci of T2 hyperintensity within the white matter, periventricular and subcortical. There are also small foci of T2 hyperintensity involving gray matter cortices of the left parietal lobe. These findings are unchanged.Redemonstrated is an enhancing lesion involving the left cavernous sinus, anterior clinoid and planum sphenoidale, extending along the petroclival ligament and floor of the anterior cranial fossa. The mass extends into the basilar cisterns. It abuts and displaces the optic chiasm and pituitary infundibulum and extends to the optic canal and orbital apex where the optic canal is dilated. These findings are unchanged.A left frontal enhancing lesion with a broad dural base is again noted, resulting in adjacent vasogenic edema of the cortex, unchanged in size or shape. A small enhancing dural based mass is noted along the posterior leftward falx adjacent to the medial left post central gyrus, unchanged. There is no restricted diffusion to suggest acute ischemia. The ventricles are unchanged in size or shape without interval dilatation. The visual paranasal sinuses and mastoid air cells are clear. Expected vascular flow voids are demonstrated. MR imaging through the internal auditory canals demonstrates intracanalicular enhancement which extends along the facial nerve bilaterally to involve the geniculate ganglion as well as the adjacent horizontal portion of the facial nerve, diagnostic for facial nerve schwannoma. These are not significant changed in size or shape.Additionally, enhancing lesions are noted involving the hypoglossal canals bilaterally, larger on the left were abuts the left cerebellum with a 7 mm cystic component invaginating into cerebellar parenchyma. These are also stable in appearance.

Output: 1.No change in multiple meningiomas.2.No change of probable bilateral IAC facial nerve schwannomas, although a separate additional component of vestibular schwannoma cannot be excluded.3.No change in bilateral hypoglossal canal schwannomas.


Instruction: Generate impression based on findings.

Input: 15 year-old female, evaluate for patella fracture MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Increased T2 signal within the medial aspect of the patella and lateral femoral condyle consistent with contusions from transient lateral patellar dislocation. Patella alignment is now anatomic. No evidence of trochlea dysplasia.LIGAMENTS: The ACL and PCL are intact. The MCL and LCL appear normal. There is focal signal abnormality within the medial patellar retinaculum at its attachment on the patella suggesting injury. The medial and lateral patellar retinacula are otherwise intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Kissing contusions consistent with the history of transient lateral patellar dislocation. Intact menisci, cruciate and collateral ligaments.


Instruction: Generate impression based on findings.

Input: Migraine without aura, not intractable, without status migrainosus [G43.009] / Sleep disorder, unspecified [G47.9], Reason for Study: ^Reason: structural abnormalities History: headaches on occasion has awakened from sleep with HA and emesis No evidence of acute ischemic or hemorrhagic lesion on scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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: 55-year-old female with ESRD, diabetes, severe peripheral vascular disease, and hypertension with gangrenous toes of the right foot and sacrum decubitus ulcerIMAGE ACQUISITIONS: Pelvis CT after intravenous administration of 120 mL Omnipaque 350 There is soft tissue ulceration adjacent to the sacrum. Anteroverted coccyx bone is noted which could be posttraumatic. This bone is demineralized, and we cannot rule out infection. MRI is recommended if further imaging is indicated.L5-S1 degenerative changes with vacuum disk phenomenon.Calcified uterine fibroids are noted.

Output: 1. Sacral soft tissue ulceration2. Anteroverted coccyx which is demineralized. Infection cannot be excluded.


Instruction: Generate impression based on findings.

Input: 13-year-old female patient with knee pain for two years on and off. Question of old fracture of the tibia two years ago. Evaluate for proximal tibia fracture. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signal is within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

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


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of multiple myeloma with concern for cord compression. Multilevel spondylotic changes are again seen involving the spine, most pronounced at C4-5 where there is moderate central spinal canal stenosis and mild indentation of the spinal cord. There is no evidence of acute compression. There is no cord signal abnormality. Tumor involving the sacrum and T7 are partially imaged without gross interval change since the recent prior study.

Output: Mild indentation of the spinal cord at C4-5 without acute cord compression. Please refer to dedicated MRI for further details regarding the degenerative changes affecting the cervical spine.