Instruction: Generate impression based on findings.

Input: There are foci of T2/FLAIR hyperintensities in the subcortical and the periventricular white matter, which are nonspecific, but most likely consistent with chronic small vessel ischemic changes. There is no evidence of acute hemorrhage, mass effect, or edema. The ventricles and sulci are enlarged, which may be age related versus neurodegeneration. There is no midline shift. Corticomedullary differentiation is maintained. The basal cisterns are patent. There is a partial empty sella. There are no diffusion or susceptibility abnormalities. The T2 flow voids are unremarkable.

Output: 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. No evidence of acute cerebral infarction.2. Brain parenchyma volume loss and ventriculomegaly is present. The cause for this is unknown based on this study alone. Differential considerations could include neurodegenerative disorder and normal pressure hydrocephalus3. There is a mild degree of nonspecific T2/FLAIR hyperintensities in the subcortical and periventricular white matter, at this age is most likely vascular related.


Instruction: Generate impression based on findings.

Input: 73-year-old man with left lower extremity radiculopathy. There is mild degenerative disc disease at L3-4 with sclerosis of the superior half of the L4 vertebral body which may be discogenic or may reflect a chronic fracture, but this correlates with similar findings seen on prior MRI and CT studies. Ossification along the upper lumbar and lower thoracic spine anteriorly may reflect diffuse idiopathic skeletal hyperostosis. Alignment is within normal limits. We see no spondylolysis or spondylolisthesis. There is atherosclerotic calcification of the abdominal aorta and common iliac arteries. Surgical clips in the right upper quadrant likely reflect prior cholecystectomy.

Output: Mild degenerative disc disease and other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Presence of intracranial abnormality. Signs and symptoms:somnolent, change in mental status. Unenhanced head CT:Nonspecific periventricular and subcortical foci of low-attenuation is highly suspected of small vessel ischemic disease of indeterminate age. Prior MRI also reveals presence of small muscle ischemic strokes.No evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.CT is insensitive for detection of early acute ischemic strokes.

Output: Small ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 37 year old with BRCA2 mutation and strong family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are scattered enhancing foci in both breasts (right greater than left).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: Lumbar back pain with left lower extremity radiculopathy. Five lumbar type vertebral bodies are presumed to be present. Hypoplastic ribs are noted at T12. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge with foraminal component and bilateral facet arthropathy result in mild narrowing of the neural foramina. No spinal canal stenosis.L4-L5: Mild disc bulge with a tiny central disc extrusion component extending superiorly and endplate osteophyte. There is focus of enhancement within the region of the tiny extrusion which may be in part related to scar tissue. There is moderate bilateral facet arthropathy. There is fairly mild narrowing of the neural foramina. No spinal canal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Moderate bilateral facet arthropathy.There is mild enhancement associated with the facet arthropathy at L3-L4, L4-L5, and L5-S1, which is likely on a degenerative basis. There is focal enhancement at the L4-L5 level as described above. Otherwise no significant enhancement within the thecal sac or epidural space. Calcified uterine fibroids are partially imaged.

Output: 1. Multilevel degenerative changes in the lumbar spine with fairly mild narrowing of the neural foramina at L3-L4 and L4-L5. No high-grade neural foraminal stenosis at any level. No spinal canal stenosis at any level.2. Moderate facet arthropathy at L4-L5 and L5-S1 and to a slightly lesser degree at the L3-L4 levels.3. Minimal focal enhancement in the left ventral epidural space at the L4-L5 level which may represent postoperative scar tissue and/or associated with tiny disc extrusion. No appreciable mass effect on the nerve roots.


Instruction: Generate impression based on findings.

Input: Knee swelling lateral tenderness No discrete plain film radiographic abnormality. Questionable mild swelling cannot be entirely excluded overlying the lower anterior thigh and overlying and anterior to the patella, however an MRI may be indicated if further characterization is required

Output: Questionable soft tissue swelling and changes involving the extensor complex and superficial soft tissues overlying the patella. Consider MRI imaging if further characterization is needed


Instruction: Generate impression based on findings.

Input: 57 year old male with a history of HCV and weight loss found to have biliary dilation on recent ultrasound examination. ABDOMEN:LIVER, BILIARY TRACT: There is mild prominence of the common bile duct which measures up to 7 mm in diameter. There is no intrahepatic biliary ductal dilation. No focal mass lesion identified. No gallstones or common duct stones are identified. Note is made of a normal liver morphology. No evidence of abdominopelvic ascites. There are multiple subcentimeter foci of fluid signal intensity which are too small to characterize but likely represent simple cysts. SPLEEN: No evidence of splenomegaly.PANCREAS: There is mild prominence of the common pancreatic duct. There are is not focal masslesion identified. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Prominence of the common bile duct and main pancreatic duct, as detailed above. While no obstructing mass lesion is identified, further evaluation with ERCP should be considered if clinically indicated in order to exclude a benign stricture or occult masslesion at the level of the ampulla/common trunk.


Instruction: Generate impression based on findings.

Input: 66-year-old male patient with elevated prostate specific antigen. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.7 x 3.7 x 3.8 cm (transverse by AP by craniocaudal).Peripheral Zone: There is a region of signal abnormality within the left base of the peripheral zone demonstrating T2 and ADC hypointensity measuring approximately 1.0 x 0.4 cm (image 18, series 501). This is on a background of rather diffuse, linear T2 hypointensity within the left base and left mid gland of the peripheral zone which may reflect prostatitis or scarring.There is an additional focus of T2 hypointensity, ADC hypointensity, and early enhancement within the medial anterior right apex of the peripheral zone measuring 0.5 x 0.4 cm (image 13, series 501), which is suspicious for tumor.Central Gland: The central gland is hyperplastic containing multiple BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: No definite extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Two sites of signal abnormality within the right apex and left base suspicious for tumor. 2. No definite extraprostatic extension.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, past medical history of HTN, DM (not on insulin), CAD s/p PCI (3 stents 11/2013) on clopidogrel, CHF. Presented to ED with right upper extremity weakness. Brain MRI:The hemorrhage in the posterior left inferior temporal gyrus is now a linear, hemosiderin stained tract without surrounding edema. Other small foci of susceptibility effect present throughout the brain (including the left supramarginal gyrus and in the left thalamus) are not significantly changed. There is no new foci of intracranial hemorrhage. There are multifocal frontal-parietal white matter and deep gray T2 hyperintense lesions as well as more ill defined chronic microvascular ischemia which are not significantly changed compared to the previous examination. There is no mass effect or midline shift. There is minimal ethmoidal mucosal thickening without fluid. The paranasal sinuses are clear as well as the mastoid air cells. The orbits are unremarkable.Head MR Angiography:The intracranial internal carotid arteries show normal, symmetric flow-related contrast enhancement and caliber. Similarly, the paired anterior and middle cerebral arteries are unremarkable. The intracranial vertebral arteries, the basilar artery and posterior cerebral arteries are also unremarkable. There are no or very small posterior communicating arteries. There is no aneurysm.Neck MR Angiography:The left common carotid artery shares the same origin as the right brachiocephalic artery. The aortic arch and great vessels are tortuous and mildly ectatic. There is no significant ostial narrowing at the aortic arch level. There is mild narrowings at the left and the right carotid bifurcations. There is no significant cervical carotid narrowing otherwise. The vertebral arteries conventionally arise from their respective subclavian arteries. There is mild narrowing of the lower segment of the right vertebral artery. Otherwise, there is new significant vertebral artery luminal narrowing.

Output: 1.Cerebral white matter lesions perhaps representing chronic microvascular ischemia and lacunar infarcts are not significantly change since the previous MRI from March 2015. A parenchymal hematoma in the left temporal lobe shows expected evolution no appearing chronic and essentially resolved. There is no new intracranial hemorrhage.2.Head and neck MR angiography shows no significant vessel stenosis or occlusion. There is mild narrowing at the carotid bifurcations and proximal right V1 segment.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: ms [progression History: frequent falls Patchy bihemispheric periventricular white matter and deep white matter FLAIR/T2 high signal intensity lesions appear to be unchanged except slightly smaller lesion at the left subinsular white matter. There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Grossly unchanged FLAIR/T2 high signal intensity lesions consistent with multiple sclerosis since prior scan.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: Lesion. Signs and symptoms: Headaches No evidence of hemorrhage, mass effect, midline shift or hydrocephalus. There is subtle low-density surrounding the trigone of right lateral ventricle and extending into the right temporal lobe is again identified as was noted on MRI of brain from 12 -- 16 -- 2008. There is a slight ex vacuo dilatation of the trigone of right lateral ventricle. These findings all remain stable since prior CT examination dated 7 -- 8 -- 2008. Limited view of paranasal sinuses and mastoid air cells are unremarkable. Calvarium is intact.

Output: Stable examination since prior CT and with no acute findings.


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: Evaluate TFCC History: ulnar sided wrist pain LIGAMENTS: The lunatotriquetral and scapholunate ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Complete disruption of the TFCC along the medial and lateral aspects with gadolinium extending into the distal radioulnar joint.TENDONS: No significant abnormality noted. BONES: 2 small cysts are noted in the capitate likely of no clinical significance.ADDITIONAL

Output: TFCC tear along both the medial and lateral aspects with gadolinium extending into the distal radioulnar joint


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. There are postsurgical changes of corpectomy at T12 with placement of strut graft at this level. Partial corpectomy involving the posterior aspect of the L1 vertebral body is also noted. Left lateral fusion hardware is seen from T11 to L1 with screws and rods. Posterior fusion hardware extends from the T9 to the L3 levels with bilateral pedicle screws and interconnecting paraspinous rods. Hardware is better assessed on same-day CT.No cord signal abnormality is appreciated although evaluation is limited for signal abnormality at the level of the hardware.Bony lesion involving the right lateral aspect of the vertebral body at L1 on same-day CT is obscured on MRI due to susceptibility artifact. There is a fluid collection with peripheral enhancement extending from the upper T12 to the L1-L2 level involving the right lateral epidural and paraspinous soft tissues. No significant mass effect on the thecal sac or evidence of compression of the conus or cauda equina nerve roots at these levels. The fluid collection measures up to 6 cm in the craniocaudal dimension and approximately 18 mm in width. On the left, there is soft tissue filling the left T11-T12 and T12-L1 neural foramen with mild enhancement. Note additional post gadolinium images were obtained without fat saturation to reduce artifact approximately 3 hours later.There are developmental anomalies involving the upper thoracic spine as seen on CT. Counting from superiorly with the first thoracic ribs associated with the T1 vertebral body, there appears to be a right T2 hemivertebra which is fused with the T3 level. The disc space immediately inferior is diminutive developmentally. Note however the numbering of the hardware above is from the inferior L5-S1 level.There is dextrocurvature of the upper thoracic spine, levocurvature of the midthoracic spine, as well as dextrocurvature of the lower thoracic spine. Vertebral body heights and alignment in the lumbar spine are maintained. No significant disc disease, spinal canal or neural foraminal stenosis in the lumbar spine.Approximately 1 cm T2 hyperintense lesion seen in the right inferior hepatic lobe which is not well assessed and if clinically indicated ultrasound may be considered.

Output: 1. Although there is susceptibility artifact from hardware, there is no evidence of significant spinal canal stenosis in the thoracic spine or lumbar spine. No evidence of cord compression. No appreciable cord signal abnormality, although assessment of cord signal abnormality at the level of the hardware is limited.2. Bony lesion which may represent residual or recurrent tumor involving the right aspect of the L1 vertebral body is better seen on CT and obscured on MRI due to artifact. Enhancing soft tissue fills the left T11-T12 and T12-L1 neural foramina and may represent scar tissue versus tumor. Would suggest obtaining prior imaging and preoperative extent of tumor to help differentiate. 3. Postoperative changes of tumor resection including T12 corpectomy as well as partial posterior L1 corpectomy with fusion hardware extending from T9 to L3 as detailed above. Hardware is better assessed on same-day CT. 4. Peripherally enhancing fluid collection measuring up to 6 cm in the craniocaudal dimension extending from the upper T12 to the L1-L2 level and involving the right lateral epidural and paraspinous soft tissues. No significant mass effect on the thecal sac. This collection is favored to represent a pseudomeningocele; superimposed infection can be considered in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: evaluate for changes from prior MRI History: continued sleepiness and concern for hx of seizure. There is no new acute ischemic or hemorrhagic lesion on this scan.Some restricted diffusion lesions are more conspicuous on today's scan which is not that unusual finding. Previously seen multifocal ischemic lesions with surrounding edema including bilateral occipital lobe lesions are again seen and more conspicuous than prior scans on FLAIR/T2 images.On T1 weighted images, those lesions show high signal intensity with somewhat gyriform in configuration and low signal intensity on T2 images indicating interval development of hemorrhagic conversion or possible early laminar necrosis. Although those lesions do not show significant susceptibility artifacts, possibility of hemorrhagic conversion cannot be excluded.Follow up MR imaging and/or brain CT scan may help to exclude possibility of parenchymal hemorrhage.Subtle punctate susceptibility lesions on bilateral occipital lobe lesions are again seen, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no significant mass effect, midline shift. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. High signal intensity on T1 and low signal intensity on T2 within previously shown ischemic lesions suggest possibility of development of hemorrhagic conversion on previously recognized ischemic infarctions or early development of laminar necrosis.2. No evidence of new ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: New onset of back pain in patient with metastatic melanoma. Please evaluate. Signs and symptoms: Back pain. Pre and post enhanced thoracic MRI:There is normal anatomical alignment of vertebral column however with mild exaggeration of thoracic kyphosis likely secondary to degenerative disease.Mild to moderate degenerative disease with loss of intervertebral disc height throughout the mid to lower thoracic spine is noted.There is a tiny focus of T2 STIR hyperintensity with very faint enhancement in the superior T12 vertebral body and without convincing signal abnormality on T1-weighted images. Remote possibility of a metastatic lesion cannot be entirely excluded.Otherwise there is no definitive focus of signal abnormality or enhancement to suggest metastatic disease of the vertebral column. There is normal signal intensity and caliber of thoracic cord and without detectable abnormal enhancement of the cord or the leptomeninges.There is no evidence of a spinal stenosis and no significant neural foraminal compromise at any level is identified.No evidence of perispinal soft tissue abnormality. Pre and post enhanced lumbar MRI:The anatomical alignment of vertebral column is normal.There is an approximately 11 mm focus of T1 hyperintense, T2 and T2 STIR hyperintense in the vertebral body of L1 with faint enhancement. This examination also redemonstrate a tiny focus of enhancement in the vertebral body of T12 measuring 9 mm size as mentioned above.The signal intensity in the alignment of vertebral column is otherwise unremarkable.The signal intensity of the lower most visualized thoracic cord, conus and cauda equina is also within normal and without detectable abnormal enhancement.There is mild degenerative changes of the discs and mild to moderate hypertrophic changes of posterior elements without spinal stenosis.Left facet effusion at L2-L3, L3-L4 and bilaterally at L4-L5 levels are noted.No detectable. Spinal soft tissue abnormalities.

Output: 1.Pre and post enhanced MRI of thoracic spine demonstrate a tiny focus of enhancement in the superior T12 vertebral body which is a nonspecific finding however possibility of a tiny metastatic lesion cannot be entirely excluded. Unremarkable pre and post enhanced exam otherwise for metastatic disease, spinal canal or neural foraminal compromise. Normal signal intensity and caliber of the cord without abnormal enhancement. 2.Pre- and post enhanced lumbar MRI demonstrate an 11 mm faint focus of enhancement in the inferior body of L1 which is a nonspecific finding however possibility of a metastatic lesion cannot be entirely excluded. Unremarkable pre and post enhanced MRI of lumbar spine otherwise without detectable abnormal enhancement of the vertebral column, lower most visualized thoracic cord, conus or the cauda equina. No spinal stenosis or neural foraminal compromise. Degenerative changes and mild facet effusion as detailed above.3.Neither one of the small lesions in vertebral bodies of T12 and L1 are detected on CT of abdomen performed on 7-1-15.


Instruction: Generate impression based on findings.

Input: 21 years, Male, history of myxopapillary ependymoma status post radiation therapy. History of cavernous malformations. There are again punctate foci of T2 hypointensity in the cervical cord including the right lateral C2 level right dorsolateral C3 level. Previously noted questionable subtle linear low T2 signal along the surface of the cord at the C5 level and C6-C7 level is not well visualized on this examination. Diffuse postradiation marrow changes are again noted. The enhancing 12 mm STIR hyperintense lesion in the posterior-superior aspect of C7 vertebral body is unchanged since at least 11/23/2014. A stable region of irregular marrow enhancement and STIR hyperintensity in the left posterior T6 vertebral body minimally extending into the left pedicle also appears similar to at least 11/23/2014. The left ventral C1 level focus of enhancement along the surface of the cord is stable. Foci of enhancement along the dorsal and lateral surface of the distal thoracic cord are again noted, appearing more similar to the examination of 12/08/15 rather than the immediate prior examination of 06/20/16, perhaps due to differences in technique. The linear focus of enhancement in the thecal sac on the left at the L1 level is not appreciably changed. A small rounded enhancing lesion along the left cauda equina at the L2 level measuring 8 x 5 mm mm is not significantly change. Small enhancing nodule at the S1 level is also not significantly changed. More diffuse enhancement in the lumbar thecal sac is favored to reflect differences in contrast timing and is similar to study from 12/8/2015. Postoperative changes relating to lumbar laminectomies are redemonstrated. Small central disc protrusion at the T4-T5 level is not significantly changed. Lumbar degenerative changes including disc bulges and facet arthropathy which contribute to multilevel mild to moderate neural foraminal stenosis again seen. Mild narrowing of the thecal sac at the L3-L4 also again seen. No high-grade spinal canal stenosis at any level.

Output: 1. Punctate foci of low T2 signal in the cervical cord, compatible with posttreatment change/cavernous malformations, not significantly changed since 6/20/2016.2. No significant change in nodular foci of enhancement within the thecal sac which given stability are favored to represent treated leptomeningeal disease. No definite evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: History of bladder cancer status post cystectomy in 2013 with neobladder. ABDOMEN:LIVER, BILIARY TRACT: Normally distended gallbladder with gallstones. Minimally prominent common bile duct tapers smoothly at the level ampulla without evidence of an obstructing stone or mass. The liver is normal in morphology, signal intensity and enhancement without a focal lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys demonstrate symmetric enhancement and excretion into normal collecting systems and unremarkable ureters. Punctate right renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Status post cystectomy with neobladder formation. No specific evidence of tumor recurrence in the cystectomy bed. No locoregional lymphadenopathy.Minimal fluid posterior to urethra.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes from radical cystectomy and neobladder formation without evidence of local recurrence or metastatic disease.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: There are multiple small nodular areas isointense to gray matter on all sequences along the posterior aspect of the lateral ventricles especially along the occipital horns and atria, consistent with heterotopia. There is decreased lateral ventricular caliber posteriorly due to the intraluminal projection of the nodular heterotopia.There are no diffusion abnormalities. There is no midline shift. There is focal prominence of the extra-axial space along the posterior fossa with mild mass effect on the cerebellum. Midline structures are unremarkable.There is a prominent mildly T1 and prominently T2 hyperintense oval structure in the lateral left frontal sinus.

Output: 1. Extensive subependymal nodular heterotopia along the posterior aspect of the lateral ventricles.2. Prominence of the extra-axial space along the posterior fossa, representing incidental mega cisterna magna versus small retrocerebellar arachnoid cyst.3. Probable mucosal retention cyst in the left frontal sinus.


Instruction: Generate impression based on findings.

Input: 64-year-old man with history of bladder and Gleason 9 prostate cancer status post RALP and BPLND 5/2016, now with rising PSA. PELVIS:PROSTATE: The patient is status post prostatectomy and lymph node dissection. BLADDER: The anterior left bladder wall (401/104) is irregularly thickened with 2 cm masslike region on the left.LYMPH NODES: There is an enlarged left perirectal lymph node (401/124) which is not seen on the post-contrast or diffusion weighted images. Additional prominent left obturator lymph node noted (401/156). BONES, SOFT TISSUES: No marrow signal abnormality in the pelvis.OTHER: No significant abnormality noted.

Output: 1.Lymphadenopathy suspicious for nodal recurrence.2.Known bladder wall tumor.


Instruction: Generate impression based on findings.

Input: Reason: labral tear/dislocation History: pain ROTATOR CUFF: The rotator cuff is intact.SUPRASPINATUS OUTLET: The supraspinatus outlet is within normal limits. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint and glenoid labrum are intact. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal-appearing shoulder without evidence of labral pathology.


Instruction: Generate impression based on findings.

Input: Clinical question: 40F with left pulsatile tinnitus and SNHL and nasal congestion with decreased smellSigns and Symptoms: above MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is extracranial origin of the left posterior inferior cerebellar artery present.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.

Output: 1.There is no evidence for an internal auditory canal mass or other lesion to account for the patient's suspected sensorineural hearing loss.2.There is no evidence for intracranial aneurysm to account for the patient's sensorineural hearing loss.3.There is no convincing evidence for arteriovenous fistula on the basis of this exam to account for pulsatile tinnitus. However, conventional angiography is more sensitive in detecting arteriovenous fistula than MR angiography.


Instruction: Generate impression based on findings.

Input: Clinical question: cryptogenic SAH, s/p neg angiography, eval for dural AVF or CVTSigns and Symptoms: cryptogenic SAH, s/p neg angiography, eval for dural AVF or CVT MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate signal hyperintensity is present on the DWI images within the left frontal subcortical white matter without ADC signal change.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is FLAIR and T2 signal hyperintensity in the periaqueductal gray matter without contrast enhancement.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary and sphenoid sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.MR venogram of the brain is within normal limits.4.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 5.There is a punctate focus of in the left frontal subcortical white matter which is nonspecific but could represent a microinfarct.6.Periaqueductal gray signal abnormality without enhancement is non-specific. This could be reactive, related to thiamine deficiency or a toxic or metabolic cause.


Instruction: Generate impression based on findings.

Input: Autism and intractable partial complex seizures since teenage. Left temporal discharges. Increasing trouble with language. Evaluate for abnormality to explain seizures. The bilateral hippocampi are unremarkable. There is no evidence of gross cortical dysplasia or gray matter heterotopia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of seizure focus.2. No evidence of intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There appears to be mild heterogeneous enhancement of the pituitary gland. Otherwise, there is no focal mass or enlargement of the pituitary. Conversely, the pituitary gland is not atrophic. The pituitary stalk lies in the midline. The suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.

Output: Nonspecific mildly heterogeneous pituitary gland without evidence of hyperplasia, atrophy, or focal tumor.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 31 years old, with burning sensation in the skin and pain. Thoracic:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Scattered patchy areas of T1 and T2 hyperintensity within several of the thoracic vertebral bodies likely represent areas of focal fat or benign hemangiomas. No pathologic marrow signal abnormality or enhancement is seen.Spinal cord demonstrates normal signal intensity and morphology. No areas of pathologic cord or left meningeal enhancement are seen. No epidural abnormalities are suspected.The intervertebral discs are preserved. No significant disc bulge or herniation is seen. The spinal canal and neural foramina are patent.Lumbar:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits.Scattered patchy areas of T1 and T2 hyperintensity within the vertebral bodies likely represent areas of focal fat or benign hemangiomas. No pathologic marrow signal abnormality or enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic intraspinal or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.The intervertebral disc spaces are preserved. No significant disc bulge or herniation is noted. The spinal canal and neural foramina are patent. Mild facet arthropathy is demonstrated at L4-5 and L5-S1.

Output: No findings are seen in the thoracic or lumbar spine to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Note that the limited obtained sequences, including sagittal T1, diffusion weighted imaging, and FLAIR sequences are significantly degraded by patient motion. Diffusion-weighted images demonstrate a focus of diffusion restriction in the right frontal lobe corresponding with focus of hypoattenuation adjacent to the recently placed ventriculostomy catheter, compatible with a small infarct. Bilateral subdural collections again seen. Left parietal encephalomalacia. Ventricular system is decompressed. The examination otherwise nondiagnostic.

Output: Significantly limited examination. There is a focus of restricted diffusion in the right frontal lobe adjacent to the ventriculostomy catheter which is compatible with acute/early subacute infarct. This infarct corresponds to a focus of hypoattenuation that can be seen on head CT exams dating back to 5/17/2015. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 41 years old Reason: Left knee pain, injured knee, patient was struck on the lateral aspect of knee, also had prior injury while doing exercise, pain with stairs, + McMurray's, pain lateral, evaluate for lateral meniscus tear History: Left knee pain. MENISCI: The lateral meniscus appears intact. There is slight blunting and attenuation of the posterior horn and body of the medial meniscus, which may reflect chronic attritional fraying or, possibly partial prior meniscectomy if there is such a history; but we see no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the medial femoral condyle just anterior to the posterior horn of the medial meniscus measuring approximately 1 cm in diameter. There is signal abnormality within as well as slight prominence of the underlying subchondral bone that is likely degenerative in etiology, although could conceivably reflect sequelae of prior microfracture. There is also full-thickness degeneration of the articular cartilage of the medial femoral condyle posterior to the meniscus, with delamination of the adjacent articular cartilage. Signal abnormality within the underlying subchondral bone is presumably degenerative in etiology. There is moderate degeneration of the articular cartilage of the inferior aspect of the patella with full thickness cartilage loss of the most inferior aspect of the medial patellar facet. There are patellofemoral osteophytes, including a prominent osteophyte along the medial aspect of the femoral trochlea, devoid of overlying cartilage. Articular cartilage of the lateral compartment appears relatively intact. A tiny focus of signal abnormality in the distal femoral metaphysis may represent a small enchondroma.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Possible mild chronic attritional fraying of the medial meniscus, but we see no discrete meniscal tear.2.Cartilage degeneration as described above, most severely affecting the medial and patellofemoral compartments.3.Joint effusion and nonspecific soft tissue edema as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Examination of participant in clinical trial. Multiple sclerosisClinical question: please do Dr Javed MS protocol on 3 T with DTI compare to priorSigns and Symptoms: progression MS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a mild degree of periventricular white matter lesions and subcortical white matter lesions some of which are perpendicularly oriented to the lateral ventricles. Some lesions extend to the colossal cingulate junction. Compared to the prior exam via appear to be unchanged in number and location. There is also little change in the general appearance to. There is no associated intraparenchymal enhancing lesion.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is redemonstration and no change in periventricular and subcortical white matter lesions as well as corpus callosum lesions. These are compatible with demyelinating disorder.


Instruction: Generate impression based on findings.

Input: 60 years, Male, with recent left hemiplegia, hemineglect, and hemisensory loss secondary to right PCA territory infarct. There is diffusion restriction and increased T2 signal within the right occipital lobe and posterior temporal lobes, which also involves the cuneus, lingual gyrus, and fusiform gyrus. The right thalamus is also involved to a mild degree. Similar areas were identified on CT as having relative hypoattenuation and loss of gray-white matter differentiation. No intracranial hemorrhage, mass or mass-effect is evident. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Sella and orbits are grossly within normal limits. There is a large mucous retention cyst and some dependent secretions in the left maxillary sinus. Deformity of the right maxillary sinus may be posttraumatic. The paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Acute/subacute right posterior cerebral artery territory infarct. No MR evidence of hemorrhagic conversion.2. No evidence of acute intracranial hemorrhage or mass.


Instruction: Generate impression based on findings.

Input: Right nasopharyngeal carcinoma, treated with and radiation and chemotherapy. Additional clinical history: pain along the (1) surface of the right mandible (the interface between gums and teeth), a pain which numbs as it loops toward the front of the face.  This area is also very sensitive to hot and cold, (2) seriously compromised hearing in the right ear due to radiation resulted in a very "rigid" ear drum. There are post-treatment findings in the right nasopharynx without definite measurable tumor, although assessment is limited by the lack of contrast. There is interval decrease in size of the defect in the right nasopharyngeal treatment bed and adjacent prevertebral and parapharyngeal spaces, which is occupied, by what may represent more confluent scar or granulation tissue. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is persistent diffuse high T2 signal in the central skull base, eccentric to the right, and within the anterior arch of C1. There is also persistent high T1 and low T1 signal in the right mandibular ramus. There are denervation changes in the right masticator muscles. There is persistent fluid within the right middle ear and mastoid air cells. There is also fluid in the left mastoid air cells. The thyroid and major salivary glands are unchanged. There is multilevel degenerative cervical spondylosis. There are also degenerative changes in the right temporomandibular joint. There is moderate mucosal thickening in the bilateral maxillary sinuses. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. Post-treatment findings in the right nasopharynx and cental skull base with evolution of the necrotic soft tissues in the region of the treatment bed, but no definite gross measurable residual tumor, although the assessment is limited by the lack of intravenous contrast and subtle tumor cannot be excluded. 2. Degenerative spondylosis of the cervical spine with spinal canal stenosis at C5 and C6.3. Findings suggestive of right Eustachian tube dysfunction, perhaps with superimposed otomastoiditis.4. Persistent high T1 and low T1 signal in the right mandibular ramus may be treatment-related edema or osteonecrosis, although superimposed osteomyelitis is a consideration in the appropriate clinical setting. Once again, assessment is limited without contrast.


Instruction: Generate impression based on findings.

Input: 7-year-old with breast cancer and confusion with hallucinations rule out brain metastases Noncontrast CT scan brain demonstrates no evidence of hemorrhage, mass or edema.There is evidence of periventricular hypodensities which given the patient's age most likely represent small vessel ischemic disease.Please note the lack of intravenous contrast limits the sensitivity in evaluating for metastatic disease. If this is of clinical concern repeat study with contrast or preferably MRI with contrast is recommended as a more sensitive means of islet for metastatic disease.

Output: No evidence of acute intracranial process sensitivity for metastatic disease is limited by the lack of intravenous contrast material


Instruction: Generate impression based on findings.

Input: Cervical MRI:Redemonstrated are postoperative changes of suboccipital craniotomy for Chiari decompression. CSF flow analysis demonstrates a minimal flash of biphasic CSF flow posteriorly at the level of the foramen magnum and cerebellar peduncular tips.The osseous alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized paraspinal contents are unremarkable. There is no spinal canal or neural foraminal compromise.Thoracic MRI:There is a smooth, physiologic thoracic kyphotic curve. There is mild anterior wedge deformity of T7 and T8 which is chronic in appearance. The remaining vertebral body heights are maintained. Marrow signal intensity is benign throughout. The thoracic cord is normal in signal and morphology. The conus appears to terminate at L2.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates a small left paramedian disc protrusion which causes anterior left hemicord flattening without intrinsic cord signal abnormality or central stenosis. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.

Output: 1.Redemonstrated are postoperative changes of suboccipital craniotomy for Chiari decompression. CSF flow analysis demonstrates a minimal flash of biphasic CSF flow posteriorly at the level of the foramen magnum and cerebellar peduncular tips.2.No MRI evidence of syrinx.3.T2/3 demonstrates a small left paramedian disc protrusion which causes anterior left hemicord flattening without intrinsic cord signal abnormality or central stenosis.


Instruction: Generate impression based on findings.

Input: Calf pain while running. Patient heard "pop" Very minimal questionable soft tissue edema in the subcutaneous fat, please correlate with physical exam. No underlying acute or subacute osseous abnormality, however mild cortical thickening along the anterior aspects is likely related to patient's history and running. If there is concern for possible stress fractures, consider follow-up dedicated imaging such as bone scan or MRI, to increase sensitivity.Soft tissues are grossly and additionally intact, other than the distal Achilles, again consider dedicated imaging if there is a concern this distally.

Output: No acute abnormality, see comments above


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [728.87], Reason for Study: ^Reason: please look for occlusion in right sided weakness There are multiple restricted diffusion lesions on the left thalami and left basal ganglia including left external and internal capsule without evidence of hemorrhagic conversion indicating acute ischemic infarction.Underlying brain shows multifocal patchy high signal intensities on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal luminal narrowings including bilateral MCAs and proximal to mid basilar artery showing about more than 50% of luminal stenosis indicating intracranial atherosclerosis.No intracranial aneurysm was seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate minimal to moderate (about 30%) luminal narrowings on the right proximal extracranial ICA just above the carotid bifurcations. Right vertebral artery is hypoplastic. The left vertebral artery shows multifocal narrowings on the cervico-cranial junction to the level of vertebrobasilar junction area.

Output: 1. Acute ischemic infarction on the left thalami and basal ganglia without evidence of hemorrhagic conversion. 2. Underlying non specific small vessel ischemic disease.3. MR evidence of intracranial atherosclerosis.4. About 30% luminal stenosis of the right extracranial ICA as described above. The right vertebral artery is hypoplastic.


Instruction: Generate impression based on findings.

Input: 74-year-old female with right ear pain, right neck pain, right shoulder pain, right suboccipital adenopathy, fever and chills. History of contrast allergy premedication (unreadable wording.) Enhanced CT of soft tissues of neck:Limited view of the intracranial content is essentially unremarkable for patient's stated age of 74.Images through the skull base, cavernous sinuses, paranasal sinuses and bilateral petrous bones are also normal.Very small soft tissue densities within the left external auditory canal is likely secondary to debris.The soft tissues of the suboccipital region demonstrate no evidence of lymphadenopathy as clinically indicated. No abnormality of occipital bone is detected either.Images through the neck demonstrate no evidence of a mass or pathologic adenopathy. The facia planes are well preserved. There is no evidence of any inflammatory changes of soft tissues of neck. There is no abnormal enhancement of soft tissues of neck. There is no evidence of any osseous or cartilaginous erosion. Limited images of mediastinum and upper lung fields are negative for masses or adenopathy.The aortic arch appears a slightly dilated and measures 43.5-mm in its widest visualized portion.Moderate degenerative disk disease at C5 -- C6 and C6 to C7 levels are noted. There is loss of disk height and subtle sclerotic changes of the adjacent endplates. There is a slight reversal of cervical lordosis which may be positional or secondary to degenerative spondylosis. There is partial visualization of the neural foramina in the cervical region. This demonstrate compromise the right neural foramina at C6 -- C7, C5 -- C6 bilaterally and C4 -- C5 on the right. Although this test is not appropriate for evaluation of central spinal stenosis there is no bony central canal stenosis. Considering a provided clinical date of an MRI of cervical spine might be helpful for further evaluation of patient's pain.

Output: 1.No evidence of mass or pathologic adenopathy in the neck.2.No evidence of any inflammatory/infectious process in the neck.3.No detectable suboccipital adenopathy as clinical data indicates.4.Well pneumatized paranasal sinuses, mastoid air cells and middle ear cavities.5.Degenerative disk disease throughout the cervical spine with multilevel neural foramina compromise as detailed above.6.Limited view of intracranial content is essentially unremarkable for patient's stated age.


Instruction: Generate impression based on findings.

Input: Impingement syndrome of left shoulder [M75.42] / Pain in thoracic spine [M54.6] / Low back pain [M54.5], Reason for Study: ^Reason: eval for disc herniation History: lbp 2011 with disc herniation; better now but recent strain of the back For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. 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 conus medullaris terminates at the L1 level. 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: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: disc dessication appears to be progressed since prior scan, there is broad based focal disc protrusion central to right which abuts thecal sac. Minimal narrowing of the right side neuroforamen is seen. No spinal stenosis. L5-S1: minimal bulging of disc, unchanged since prior scan, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Progressed disc dessication at the level of L45. Slightly changed disc protrusion from central to central to right side with minimal right side neuroforaminal stenosis at the level of L45.2. Unchanged minimal bulging of disc at L5S1 level.


Instruction: Generate impression based on findings.

Input: 48 year-old female with history of posterolateral knee pain. MENISCI: The posterior horn of the medial meniscus is replaced with increased signal intensity near its root compatible with a complete or near-complete radial tear. There is ill-defined globular increased signal intensity within the remaining posterior horn and body of the medial meniscus indicating degeneration. There is mild medial extrusion of the body of the medial meniscus. The anterior horn of the medial meniscus appears normal.There is slight blunting of the free edge of the body of the lateral meniscus which may reflect mild fraying, but we see no discrete lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There are near-full thickness to full thickness defects in the articular cartilage of the medial femoral condyle above and anterior to the posterior horn of the medial meniscus. There is also diffuse thinning of the articular cartilage along the weight bearing portions of the medial tibial plateau. There is relatively mild degeneration of the articular cartilage of the lateral compartment. The patellofemoral cartilage appears normal.LIGAMENTS: The superficial band of the MCL is intact. The deep meniscotibial ligament is visible. The deep meniscofemoral ligament is not well visualized and could be torn. There is mild edema between the iliotibial band and lateral femoral condyle posterior to the lateral synovial recess which is nonspecific but may indicate a friction syndrome. The ACL and PCL are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Tear of the posterior horn of the medial meniscus near its root.2.Cartilage degeneration most pronounced in the medial tibiofemoral compartment.3.Joint effusion, Baker cyst and other findings as above.


Instruction: Generate impression based on findings.

Input: A right-sided thoracic scoliosis and left-sided lumbar scoliosis are better demonstrated on previous x-ray.Artifact induced by braces regionally as well as motion overall degrades images. Given this caveat:Cervical spine:There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. CSF flow analysis is greatly compromised secondary to braces artifact, however biphasic CSF flow appears grossly maintained at the level of the cerebellar tonsils. There are no segmentation abnormalities or stenoses.Thoracic spine:There were no fractures or subluxations. Marrow signal intensity is benign throughout. The spinal cord and conus are normal in signal. There are no segmentation abnormalities or stenoses.Lumbar spine:There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at L1/2. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no segmentation abnormalities or stenoses.

Output: 1.No MRI evidence of Chiari malformation, syrinx, fatty filum, or tethered cord.2.A right-sided thoracic scoliosis and left-sided lumbar scoliosis are better demonstrated on previous x-ray.


Instruction: Generate impression based on findings.

Input: Benign intracranial hypertension [G93.2], Reason for Study: ^Reason: meningeal enhancement History: encephalopathy Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.Bilateral I globes appear to be slightly flattened on the posterior aspect, however, there is no definitive MR evidence of buckling of optic nerves on the scan.Suprasellar cistern appear to be slightly expanded however, pituitary gland are seen and appears to maintain normal size.Minimal expansion of extra-axial CSF spaces especially bilateral hemisphere.On gadolinium enhancement, there are diffuse patchy meningeal enhancement which may indicate post lumbar puncture status, clinical correlation is recommended.Multifocal scattered T2/FLAIR high signal intensity lesions are seen on bilateral periventricular white mater which most likely represent non specificThe ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate an aneurysmal dilatation of the left cavernous sinus segment directing superior and left laterally (6mm x 10mm) and fusiform ectasia of the left cavernous sinus segment itself (largest diameter is about 8mm) and total length of 14mm. There is about 2.3mm sized right cavernous sinus segment of ICA.Bilateral MCAs and ACAs appears to be normal.Vertebrobasilar system appears to be normal.

Output: 1. Slightly flattened bilateral eye globes, expanded suprasellar cistern and bihemispheric extra axial fluid collections suggest possible diagnosis of intracranial hypertension. The pachymeningeal enhancement might be related to prior lumbar puncture procedure, clinical correlation is recommended.2. Fusiform aneurysmal dilatation of the left ICA cavernous sinus segment with associated 6mm x 10mm sized cavernous sinus segment aneurysm.3. 2.3mm sized right cavernous sinus segment aneurysm of ICA.


Instruction: Generate impression based on findings.

Input: 59 years, Female, Reason: liver masses seen on usg, has hep c ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple gallstones.Segment 6 lesion measures 1.1 x 0.8 cm (4/24) with T2 hyperintensity and progressive enhancement, likely a hemangioma.Two left hepatic lobe lesions, including a lesion immediately caudal to the heart measuring 1.1 x 1.0 cm (4/29) and a smaller more peripheral lesion measuring 0.5 x 0.8 cm, with high T2 signal and progressive enhancement, likely hemangiomas.Subcentimeter peripheral right hepatic segment 6 lesion with T2 hyperintensity and progressive enhancement (4/24) also likely represents a hemangioma.There is punctate peripheral focus of T2 hyperintensity (4/22) which is too small to characterize but a cyst is favored.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.

Output: Multiple hepatic lesions likely represent hemangiomas. No suspicious lesion identified.


Instruction: Generate impression based on findings.

Input: 49-year-old female with history of multiple PEs/DVTs. Noted to have right lower lobe nodule on MRI/M.R.C.P. Remainder of the requisition is illegible. CHEST:LUNGS AND PLEURA: In the left lung base there are multiple focal areas of groundglass opacity. The largest area measures 8 mm in greatest dimension. Additionally there is scarring at the left lung base. While these may represent post inflammatory changes, 6 month follow up is recommended for further evaluation. This may necessitate long-term follow-up if there is no resolution of the 6 months. No abnormality is seen at the right lung base. This may have represented atelectasis on the recent MRI.MEDIASTINUM AND HILA: There is a small hiatal hernia. No other abnormalities noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted. Cholecystostomy clips are present in the right upper quadrant.

Output: 1. Ground glass nodules in the left lung base for which further follow-up is recommended.2. No right lower lung nodule as seen on the recent MR. The abnormality seen in the right lung base may have represented atelectasis.


Instruction: Generate impression based on findings.

Input: Male, 56 years old. Reason: eval for osteo History: bacteremia, low back/hip pain BONE MARROW: Normal bone marrow signal throughout the pelvis and imaged proximal femurs.SOFT TISSUES: No significant abnormality noted. The visualized musculature is unremarkable.JOINTS: See same day lumbar spine MRI for discussion of degenerative and other findings partially imaged on this exam. The hip joints are unremarkable.ADDITIONAL

Output: Normal MR examination of the pelvis. Specifically, no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with extradural subdural abscess. Evaluate for progression. History of RA, SLE and A. fib. Extensive edema and ill-defined enhancement is seen involving the left paraspinal soft tissues at C4 and C5. The left C4-5 facet complex is involved with evidence of marrow edema and abnormal marrow enhancement. The C5 component of the facet joint is particularly eroded, compatible with findings noted on prior CT. Thickened enhancing tissue is also seen intraspinally at the C4-5 level involving the left posterior epidural space. At most, there may be trace epidural fluid in this location, but no discrete or drainable collections are seen. This epidural process does contribute to moderate narrowing of the thecal sac. On comparison with the prior exam, the epidural thickening has decreased from 5 mm to 3 mm, and previously seen small locules of possible epidural fluid have resolved.The vertebral bodies and facets otherwise demonstrate normal signal intensity and morphology. There is a grade 2 anterolisthesis of C5 relative to C6. A scoliotic curvature is also seen. Vertebral body heights are grossly preserved.The visualized spinal cord demonstrates normal signal intensity. No pathologic cord or leptomeningeal enhancement is seen. As noted above, there is spinal canal narrowing at the C4-5 level which does contribute to slight deformation of cord morphology, but no cord edema is seen.Incidentally noted is an enlarged left thyroid lobe with one or more nodular lesions.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Marked left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: Marked left facet edema, enhancement and destruction. Mild posterior disc-osteophyte complex formation. Moderate spinal canal narrowing primarily due to epidural thickening. Moderate left foraminal narrowing. C5-6: Advanced left facet arthropathy. Spondylolisthesis with disc bulging and disc uncovering. Mild to moderate spinal canal narrowing without significant cord deformation. Moderate left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal compromise. C7-T1: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal compromise.

Output: Edema, abnormal enhancement and osseous destruction is seen centered on the left C4-5 facet complex. The surrounding paraspinal soft tissues are also edematous and enhancing.The left posterior epidural tissues at C4-5 are thickened and solidly enhancing. Small possible locules of epidural fluid seen on the prior outside examination appear to have resolved, and the degree of epidural thickening has improved as well.The above findings are compatible with infection, perhaps centered on the left C4-5 facet complex. Although the epidural tissues at this level are likely involved, no definite residual epidural collection is seen. The spinal canal is moderately narrowed at this level.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: Stroke activation 10/18/16 History: Left sided weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Mucosal thickening on bilateral maxillary sinuses with retention cyst on the right maxillary sinus and sphenoid sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

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


Instruction: Generate impression based on findings.

Input: 91 years Male (DOB:3/17/1925)Reason: stroke History: left facial and arm hypoesthesiaPROVIDER/ATTENDING NAME: CHRISTINE A BABCOCK KOUROSH ANNA REZANIA MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a subcentimeter T2 and FLAIR hyperintense lesion present in the right thalamus.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.Incidental note is made of C2-3 congenital fusion.Exam is somewhat degraded by motion artifact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the left posterior cerebral artery with a medium sized left P1 segment. The right posterior communicating artery is small. The anterior communicating artery is small. The vertebral arteries are similar in size.The right vertebral artery is smaller than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is mild narrowing at the origin of the right vertebral artery

Output: 1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.An old lacunar infarct is present in the right thalamus4.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.5.Examination is somewhat degraded by motion artifact which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 51-year-old female with right foot pain status post trauma. Assess for anterior process of calcaneus fracture.IMAGE ACQUISITIONS: CT examination of the right foot was performed without IV contrast. Transverse, coronal, and sagittal reformations were performed. Soft tissue and bone windows were reviewed. There is no evidence of fracture. Specifically, the anterior process of the calcaneus appears normal. Mild osteoarthritis affects the first metatarsophalangeal joint. A bipartite medial sesamoid is identified which is a normal variant. Tiny accessory navicular bones are identified which are of doubtful clinical significance.The visualized tendons and ligamentous structures of the ankle appear normal given the limitations of CT relative to MRI. Note is made of a low-lying soleus muscle.Nonspecific subcutaneous edema along the lateral aspect of the foot and ankle.

Output: Mild lateral soft tissue swelling without evidence of fracture.


Instruction: Generate impression based on findings.

Input: History of tuberous sclerosis and seizures with increased frequency of auras for follow-up. There is interval development of a 7 mm enhancing lesion just inferior to the right superior frontal sulcus with mild associated edema.There is a stable CSF signal intensity fluid collection in the prior right parietooccipital resection, measuring 66 x 20 x 47 mm (AP x TR x CC), previously 66 x 22 x 47 mm. There is unchanged associated T2/FLAIR signal abnormality around the postoperative resection margin, likely gliosis and encephalomalacia. There is unchanged prominence of the ventricles and sulci diffusely indicative of global volume loss as well as unchanged prominence in the right atrium of the lateral ventricle, likely due to focal ex vacuo dilatation. There is no midline shift. There are multiple scattered foci of susceptibility in the parenchyma and around the previous resection, likely due to old hemosiderin deposition from prior surgery. Stable patchy high signal in the frontal lobe deep white matter, slightly greater on the right. No intracranial hemorrhage is identified. Normal vascular flow voids are present in the major intracranial vascular structures.

Output: 1. A new 7 mm enhancing lesion is identified just inferior to the right superior frontal sulcus with mild associated parenchymal edema. This lesion would be atypical for any of the usual CNS stigmata of tuberous sclerosis. Consideration should be given to the possibility of either a primary brain neoplasm or a metastatic lesion. Patients with tuberous sclerosis are at increased risk for the development of certain abdominal malignancies, and as such, screening of the chest abdomen and pelvis should be considered.2. Stable appearance of the right parietal postoperative resection cavity with surrounding gliosis and encephalomalacia. No mass effect or midline shift. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 78 year old male with history of coronary artery disease and myocardial infarction presenting with chest pain and negative biomarkers. MEDICATIONS: aspirin, plavix, metoprolol, rosuvastatin, ranolazine First Pass PerfusionDuring hyperemia, no perfusion defects were present. Dark rim artifact is noted. Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction. There is an atypical pattern of late gadolinium enhancement involving the basal inferior and inferolateral wall. The late gadolinium enhancement spares the endocardium and is not consistent with infarction but suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 104 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 44 ml (normal range 47+/-19), the LV mass index is 33 g/m2, and the LV mass is 60 g. There is a sigmoid septum present. There is tardokinesis of the basal inferior and inferolateral walls. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVEDV is 111 ml (normal range 142+/-31), the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. There is an atypical pattern of late gadolinium enhancement involving the basal inferior and inferolateral wall. The late gadolinium enhancement spares the endocardium and is not consistent with prior myocardial infarction but suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. 3. Normal LV size and systolic function (LVEF 58%) with tardokinesis of basal inferior and inferolateral walls.4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 41 year old with known BRCA mutation. 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 are a few scattered enhancing foci in each breast, but none is uniquely suspicious. Kinetic patterns appear typically benign with increased contrast uptake on later post contrast series. 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: 54 years, Female, brain metastases, surveillance Again seen is a punctate enhancing lesion in the left cerebellar hemisphere, post gadolinium 3-D series 903 axial image 49, measuring 2 mm and unchanged. No associated edema or hemorrhage. No new parenchymal or meningeal enhancement is seen. Again seen is a small resection cavity involving the left inferior parietal lobule without mass or enhancement to suggest recurrent tumor. There is susceptibility related to chronic blood products in this region. Surrounding FLAIR hyperintensity compatible with gliosis is also not significantly changed in the interval, although appears minimally more prominent which may reflect differences in technique. Minimal additional scattered T2/FLAIR hyperintense foci are nonspecific and not appreciably changed in the interval.A cavernoma with an associated developmental venous anomaly is again seen in the right parietal lobe showing no significant interval change. No evidence of hydrocephalus, intracranial mass effect, midline shift, or herniation.Again seen is an enhancing lesion involving the squamous portion of the right temporal bone, which demonstrates continued enlargement currently measuring 11 x 13 mm in the AP and transverse dimension, previously 6 x 9 mm on 7/26/2016. The lesion abuts the anterior aspect of the right superior temporal gyrus without significant mass effect.There is an enhancing lesion involving the C4 vertebral body which is incompletely evaluated but may represent osseous metastases.

Output: 1. Compared to 7/26/2016, there is no significant change in size of 2 mm left cerebellar enhancing lesion likely representing metastasis. No new parenchymal or meningeal enhancement.2. Continued enlargement of a right temporal calvarial lesion, now measuring 11 x 13 mm. Lesion abuts the anterior aspect of the right superior temporal gyrus without mass effect.3. Evidence of left parietal tumor resection without evidence of local recurrence.4. Stable right parietal cavernous malformation.5. Enhancing lesion involving the C4 vertebral body, post gadolinium sagittal 3-D T1 image 76, but is not imaged on prior studies and may represent an osseous metastasis. Bone scan may be considered to assess the burden of osseous metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: OA History: Pain Left knee: There is narrowing of the medial joint space, sharpening of the tibial spines, and small osteophytes indicating mild-to-moderate osteoarthritis.Right knee: Sharpening of the tibial spines and small osteophytes indicate mild-to moderate-osteoarthritis.

Output: Mild-to-moderate osteoarthritis of the knees.


Instruction: Generate impression based on findings.

Input: LLE radicular pain and EHL weakness. There is an eccentric left disc extrusion at the L4-5 level with impingement upon the nerve roots in the left lateral recess. There is also an eccentric left disc extrusion at the L5-S1 level with impingement upon the nerve roots in the left lateral recess, as well as mild left neural foraminal narrowing. There is a 7 mm posteriorly-directed synovial cyst associated with the left facet joint at the L5-S1 level. There is no significant spinal canal or neural foraminal narrowing at T12 through L4. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Eccentric left disc extrusions at the L4-5 and L5-S1 levels impinge upon the nerve roots in the respective left lateral recesses.


Instruction: Generate impression based on findings.

Input: 45 years Male (DOB:6/5/1970)Reason: radiculopathy History: radiculopathyPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a mild broad-based disc protrusion present at the left lateral recess at this level which is associated with uncovertebral osteophytes and narrowing of the left neural foramen.At C4-5 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present this level associated with disc material and narrowing of the neural foramina bilaterally.At C5-6 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present at this level associated with disc material and encroachment of the neural foramina bilaterally. This neural foramen encroachment is worse on the left than the right side at this level.At C6-7 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level associated with disc material and encroachment of the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Some osteophytes are present at the T1-2 level without significant compromise to spinal canal or exiting nerve roots.

Output: 1.There are multilevel degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes and encroachment of exiting nerve roots at multiple levels as detailed above. Neural foraminal encroachment appears to be worse on the left-sided C5-6 but also present on the left-sided C3-4, bilaterally at C4-5 on the right-sided C5-6 and bilaterally at C6-7.


Instruction: Generate impression based on findings.

Input: Altered mental status in a 55-year-old female. No evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus is detected. This examination is essentially normal limits for patient of stated age of 55. If clinical symptoms persist an MRI would be helpful. Calvarium, paranasal sinuses and mastoid air cells also unremarkable.

Output: Normal CT brain.


Instruction: Generate impression based on findings.

Input: 69-year-old African-American male with history of hypertension and multiple myeloma. Presents with left-sided weakness for 24 hours. There is a moderate for stroke or hemorrhage. Patchy periventricular and subcortical areas of low-attenuation are consistent with small vessel disease of indeterminate age. A very small area of cortical lucency in high convexity right parietal may represent a nonhemorrhagic small acute cortical stroke (axial image 20 and 21. An MRI examination is recommended for further evaluation.

Output: Unless a small doses of indeterminate age. Suspect a small nonhemorrhagic cortical stroke in right parietal lobe.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out compression fracture. Signs and symptoms: Pain and tenderness in lower back. Nonenhanced lumbar MRI:There are patchy foci of T1 and T2 hyperintense and T2 STIR isointense throughout the lumbar spine consistent with inhomogeneous marrow signal changes. This finding is nonspecific and often is detected in patients of upper age group.T12-L1 demonstrate mild degenerative changes and unremarkable otherwise.L1-L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease and mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate left and mild right facet and ligamentum flavum hypertrophy and including mild bilateral facet effusion. No spinal stenosis however moderate left and mild to moderate right neural foraminal compromise is detected.There is less than 50% compression deformity of the superior endplate of L4 without retropulsion into the spinal canal. There is very subtle linear T2 STIR hyperintensity of the depressed endplate and normal signal intensity of the marrow space otherwise. This fracture is likely chronic in etiology.L4-L5 demonstrate mild disc disease and loss of disc height, significant left and mild right facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. No central spinal stenosis however mild bilateral (left greater than right) neural foraminal compromise is detected.L5-S1 demonstrate advanced disc disease and loss of disc height, asymmetric moderate left facet hypertrophic changes and mild right facet and bilateral ligamentum flavum hypertrophy. There is significant left neural foraminal compromise however without central spinal stenosis and patent right neural foramina.

Output: 1.Less than 50% compression fracture of superior endplate of L4 vertebrae without malalignment and likely representing chronic fracture.2.Degenerative changes of lumbar spine however without evidence of central spinal stenosis at any level.3.Significant left neural foraminal compromise at L5-S1 and mild neural foraminal compromise levels.


Instruction: Generate impression based on findings.

Input: Male 67 years old Reason: new heart failure, elevated liver enzymes History: le swelling LIVER: Liver measures 16 cm. No focal liver lesions. Hepatic veins and IVC are dilated likely secondary to congestive heart failure.BILIARY TRACT: Gallbladder is contracted, therefore cannot be optimally evaluated. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 7 cm.RIGHT KIDNEY: Both kidneys are echogenic. No evidence of hydronephrosis. 1.1 cm simple cyst in the right kidney.There is a 2.2 x 3 cm cyst with thick septations in the upper pole of the left kidney. Further evaluation of this lesion with renal mass protocol CT or MRI is recommended. OTHER: Bilateral small pleural effusions and trace ascites.

Output: Bilateral echogenic kidneys compatible with medical renal disease.Complex left renal cyst. Further evaluation with renal mass protocol CT or MRI is recommended.Bilateral small pleural effusions and trace ascites.


Instruction: Generate impression based on findings.

Input: Evaluate for Chiari. Non-enhanced CT:This examination was tailored to include the upper cervical spine to facilitate detection of Chiari malformation as clinically is questioned.There is no evidence of intracranial hemorrhage, edema, midline shift or hydrocephalus.Images through posterior fossa as well as reformatted sagittal and coronal 2-D images demonstrate 18-mm upward herniation of the dens through the foramen magnum into the posterior fossa. There is evidence of platybasia.The anatomical orientation of the articulation of occipital condyles with lateral mass of C1 are abnormal and they appear more vertical in orientation. There is suggestion of at least partial fusion of the right lateral mass of C1 with the occipital condyles. There is no fusion of the lateral mass of C1 with the occipital condyles on the left. There is fusion of the anterior arch of C1 to the anterior lip of foramen magnum. There is apparent fusion of the posterior elements of C1 with C2. There is no fusion of the articulating facets of C1 and C2. Sagittal reformatted images demonstrate mass effect and posterior displacement of medulla by the upwardly herniated dens and there is no detectable subarachnoid space at this level. There is suggestion of possible herniation of cerebellar tonsils anterior to the posterior nipple foramina magnum. Recommend further follow-up with an MRI examination for better assessment.

Output: 1.No evidence of intracranial pathology or brain parenchyma.2.Platybasia and upward herniation of dens of approximately 18 mm through the foramina magnum.3.Congenital anatomical variation of fusion of anterior arch of C1 to the anterior lip of the foramen magnum, partial fusion of the right occipital condyles and lateral mass of C1 and partial fusion of posterior elements of C1 and C2.4.Above findings were discussed with the referring clinical physician Dr. Ben Roitberg at the time of interpretation.


Instruction: Generate impression based on findings.

Input: Left ear tinnitus and sensorineural hearing loss. . There is apparent deficiency of bone overlying the left superior semicircular canal. The rest of the inner ear structures otherwise appear unremarkable. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The bilateral mastoid air cells and middle ears also appear unremarkable. A subcentimeter focus of high T1 signal along the midline of the anterior cranial fossa may represent prominent fatty marrow within the crista galli rather than a meningioma, although this is incompletely characterized.

Output: 1. Apparent left superior semicircular canal dehiscence, which can be confirmed via a temporal bone CT, if clinically warrented. Otherwise, no evidence of vestibular schwannoma.2. A subcentimeter focus of high T1 signal along the midline of the anterior cranial fossa may represent prominent fatty marrow within the crista galli rather than a meningioma, although this is incompletely characterized.


Instruction: Generate impression based on findings.

Input: Left-sided blurred vision and eye pain There is subtle STIR hyperintensity with postcontrast enhancement involving the canalicular portion of the left optic nerve (series 4, image 19 and postcontrast series 12, image 8). The right optic nerve appears unremarkable. The globes, extraocular muscles, and intraorbital fat appear unremarkable bilaterally.Scattered foci of T2/FLAIR hyperintensity involving the white matter are again seen. Patchy areas of T1 hyperintensity involving the basal ganglia is nonspecific and may be metabolic. There is no evidence for acute ischemia or intracranial hemorrhage. Mild ethmoid sinus mucosal thickening is present.

Output: 1. Findings compatible with optic neuritis involving the canalicular portion of the left optic nerve.2. Scattered foci of T2/FLAIR hyperintensity involving the cerebral white matter are partially visualized, consistent with known demyelinating disease.


Instruction: Generate impression based on findings.

Input: 65-year-old female with right knee pain and antalgic gait with history of osteoarthritis, evaluate for meniscus tear MENISCI: Globular increased signal intensity within the medial meniscus at the junction of the body and posterior horn represents intrasubstance degeneration. Additionally, the inner third of the posterior horn of the medial meniscus is replaced with intermediate signal intensity likely representing degenerative tearing. Horizontally oriented signal abnormality within the posterior horn of the medial meniscus may represent additional tearing. The anterior horn of the medial meniscus appears intact. Increased signal intensity within the undersurface fibers of the inner half of the posterior horn of the lateral meniscus likely represents a degenerative articular surface tear. Intermediate signal within the body and anterior horn of the lateral meniscus suggests degeneration.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the patellofemoral joint with subchondral cysts along the lateral facet of the patella and the femoral trochlea. There is moderate thinning of the articular cartilage along the weightbearing portion of the medial femoral condyle. There is also subchondral cyst formation posteriorly within the medial femoral condyle. Edema-type signal within the lateral tibial plateau with heterogeneity of overlying articular cartilage is likely degenerative in etiology. Tricompartmental osteophytes are noted.LIGAMENTS: There is mild edema along the medial collateral ligament, but the ligament itself appears intact. The lateral collateral ligament proper appears attenuated which may reflect prior injury, but this is equivocal. The iliotibial band and biceps femoris tendon are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Tricompartmental osteoarthritis with degenerative tearing of both menisci and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for meniscal tear, evaluate ligaments History: patient with knee popping and knee giving out, grinding heard as well, no OA seen on XR.. MENISCI: There is complex multidirectional tearing of the posterior body and posterior horn of the medial meniscus including horizontal and vertical components that extend to the tibial and femoral articular surfaces.There is globular intrasubstance intermediate signal throughout the lateral meniscus compatible with degeneration without discrete tear. ARTICULAR CARTILAGE AND BONE: There is partial-thickness defect of the articular cartilage of the weightbearing portion of the lateral tibial plateau measuring 9 mm in AP dimension. The articular cartilage of the lateral tibiofemoral compartment is otherwise intact.The articular cartilage of the medial tibial femoral compartment is intact.There is severe thinning of the articular cartilage of the patella with foci of full-thickness defects with underlying bone marrow edema and subchondral cyst formation. Small focus of full-thickness defect involving the medial trochlea with underlying bone marrow edema. Tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex degenerative tearing of the medial meniscus as described above. Degeneration of the lateral meniscus without discrete tear.2.Partial and full-thickness defects of the articular cartilage as described above.3.Moderate joint effusion.4.Small Baker's cyst.5.Nonspecific edema within the infrapatellar subcutaneous fat.


Instruction: Generate impression based on findings.

Input: 28-year-old male with conjugated jaundice/cholelithiasis ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is present. There is mild gallbladder wall thickening and perfusion abnormality of the liver parenchyma adjacent to the gallbladder fossa. The common bile duct measures 10 mm. At the level of the ampulla is a low signal rounded focus compatible with choledocholithiasis. Beneath the discrete stone is ovoid tissue signal that may represent represent a hypertrophic ampulla versus sludge. Mild intrahepatic biliary ductal dilation is present.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Choledocholithiasis with CBD dilation measuring up to 10 mm. Beneath the discrete stone is ovoid tissue signal that may represent represent a hypertrophic ampulla versus sludge. 2. Cholelithiasis with locoregional hyperemia although the gallbladder itself does not appear acutely inflamed.


Instruction: Generate impression based on findings.

Input: 16 year old male with pain. Evaluate for osteochondral lesion. MENISCI: The medial lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Note is made of a 2.1 x 2.3 cm osteochondral defect along the weightbearing surface of the lateral aspect of the medial femoral condyle. There is increased signal abnormality along the superior margins of the defect consistent with an unstable lesion. No definite bony bridging is identified. LIGAMENTS: The cruciate collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings consistent with an unstable osteochondral defect along the lateral aspect of the medial femoral condyle as described above. Large joint effusion.


Instruction: Generate impression based on findings.

Input: Tenderness to palpation at the base of the neck to both shoulders. No provided history of trauma. There is multilevel cervical spine degenerative spondylosis. At C3-4, there is a slight disc-osteophyte complex that results in mild left neural foraminal narrowing, but significant spinal canal narrowing. At C4-5, there is an eccentric left disc extrusion that indents the spinal cord and results in mild left neural foraminal narrowing. At C5-6 and C6-7, there are posterior disc-osteophytes that mildly narrow the spinal canal and perhaps slightly narrow the bilateral neural foramina. There is no significant spinal canal or neural foraminal narrowing at C2-3 and C7-T1. There is mild loss of C6 vertebral body height centrally associated with endplate irregularities. There is moderate disc space height loss at C5-C6 and C6-7. There is no evidence of acute vertebral subluxation or fracture. There is no evidence of intraspinal tumors. The paravertebral soft tissues are unremarkable.

Output: Multilevel cervical spine degenerative spondylosis, including most notably a left C4-5 paracentral disc extrusion that indents the spinal cord.


Instruction: Generate impression based on findings.

Input: Reason: rule out MCL, ACL tears History: R knee pain and ligamentous laxity MENISCI: There is linear increased signal abnormality within the posterior horn and body of the medial meniscus which extends to the femoral and tibial articular surfaces indicating complex tearing with a large horizontal component (image 25; series 6). The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness articular cartilage degeneration along the anterior aspect of the medial femoral condyle with underlying degenerative subchondral signal abnormality (image 17; series 5). The lateral tibiofemoral articular cartilage appears intact. There is a full-thickness articular cartilage fissure along the medial facet of the patella with underlying subchondral signal abnormality (image 10; series 4). There is increased bone marrow signal abnormality within the posterior aspect of the medial tibial plateau which may be degenerative in etiology or perhaps a direct bone contusion.LIGAMENTS: There is disruption of the proximal fibers of the superficial band of the MCL. The ACL and PCL appear intact. The LCL appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Disruption of the proximal fibers of the superficial band of the MCL.2. Complex tearing of the medial meniscus.3. Focal articular cartilage degeneration and fissuring as described above.4. Small joint effusion.