Instruction: Generate impression based on findings.

Input: Headache, ataxia, slurred speech. Brain: There is no evidence of intracranial mass or abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The vertebral column alignment is within normal limits. There are multiple small thoracic Schmorl nodes. The vertebral body and disc space heights are otherwise preserved. The vertebral bone marrow appears unremarkable. There is prominent anterior epidural fat in the sacral spinal canal. There is otherwise no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of intracranial or spine tumors or abnormal enhancement on this abbreviated post-contrast study. Please refer to the recent non-contrast brain and spine MRI for additional details.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: history of brain metastases. follow up MRI History: none There is about 6.9mm (RL) x 8.6mm (AP) x 7.5mm (CC) peripheral enhancing intra axial lesion on the right superior frontal gyrus. Comparing to prior scan, the size of the lesion has been decreased, however the extent of surrounding edema appears to be stable.There is no other abnormal enhancing lesion seen on this scan.Evidence of prior bifrontal craniotomy is again seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval decrease in size of the right superior frontal gyrus metastatic lesion since prior scan.2. No evidence of new metastatic lesion.


Instruction: Generate impression based on findings.

Input: Reason: Infected ulcers, rule out osteomyelitis RIGHT TIBIA/FIBULA:There is ulceration of the lateral soft tissues of the lower leg and ankle with enhancement of the adjacent skin, indicating inflammation. The subcutaneous fat of the medial and lateral right ankle demonstrates heterogeneous signal, likely representing a combination of chronic scarring and edema. There is mild fatty atrophy of the calf musculature. We see no fluid collections within the soft tissues to indicate abscess. Chronic appearing periosteal bone formation is better seen on ankle radiographs. We see no edema within the bone to indicate osteomyelitis. Intermediate signal replaces the marrow on T1W images, likely reflecting red marrow replacement from sickle cell disease. Nonenhancing T2 hyperintense focus in the distal tibia may represent a degenerative cyst. There is a small amount of fluid in the right knee joint.LEFT TIBIA/FIBULA: There is ulceration of the soft tissues along the medial and lateral aspects of the ankle/lower leg with enhancement of the skin along the medial aspect of the ankle. Heterogeneous signal within the subcutaneous fat likely represents a combination of chronic scarring and edema. There is mild fatty atrophy of the calf musculature. We see no fluid collections within the soft tissues to indicate abscess. There is periosteal bone formation along the distal tibia/fibula but we see no abnormal bone marrow signal to indicate osteomyelitis. Intermediate signal replaces the marrow on T1 images, likely reflecting red marrow replacement from sickle cell disease.

Output: Cellulitis and soft tissue ulceration without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Ms. Rubin is a 31-year-old female with known right breast cancer and metastatic lymph node in the right axilla. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the right upper outer breast, there is an irregular enhancing mass identified measuring 3.1 x 2.3 x 2.6 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this lesion, compatible with biopsy-proven malignancy. There is no additional abnormal enhancement identified in the right breast.There are at least four abnormally enlarged right axillary lymph nodes identified, the largest of which measures approximately 1.7 cm in maximal dimension. This particular lymph node along with associated adjacent postbiopsy changes is compatible with history of biopsy-proven metastatic lymph node.No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: (1) Unifocal malignancy within the right upper outer breast with enlarged biopsy-proven metastatic axillary lymph nodes.(2) No MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS; f/u progressionSigns and Symptoms: ataxia MRI brain:There is a moderate degree of periventricular and subcortical white matter lesions some which are perpendicularly oriented to the lateral ventricles and some of which extend to the corpus callosum. There are T2 and FLAIR punctate signal hyperintensity is also present in the internal capsules, external capsules as well as within the brainstem. These were also present on the prior exam from 1/6/2015 and have not changed tremendously.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are patchy small signal hyperintensities present throughout the cervical spinal cord which were also present on the prior exam as well. More prominent lesions are present at C2, C3-4, C4-5-7 which can also be identified on the prior exam. There is reversal of the normal cervical curvature present.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 small central disc protrusion at this level.At C4-5 there is no significant compromise to the spinal canal. There is a small left paramedian disc protrusion at this level. There are bilateral uncovertebral osteophytes present this level which are associated with encroachment of exiting nerve roots. There is no significant change since prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small left paramedian broad-based disc protrusion at this level. There is no significant change since prior exam.At C6-7 there is no significant compromise to the spinal canal. There is a left lateral disc protrusion present this level which encroaches on the left-sided exiting nerve roots within the neural foramen. There is no significant change since prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions scattered throughout the periventricular and subcortical white matter as well as the brainstem and internal capsules which are compatible with patient's clinical diagnosis of multiple sclerosis and have not changed when compared to the previous exam.2.The multiple lesions within the cervical spinal cord which are compatible with patient's diagnosis of multiple sclerosis. These are stable since the prior exam.3.There are multilevel degenerative changes present cervical spine with reversal of the normal cervical curvature and neural foramen encroachment of exiting nerve roots at C4-5 and on the left side at C6-7


Instruction: Generate impression based on findings.

Input: 23-year-old female with left adnexal mass, MRI to further evaluate PELVIS:UTERUS, ADNEXA: Heterogeneous T2 hypointense, mildly enhancing, left ovarian mass measures 6.8 x 7.2 x 10.8 cm (series 6, image 28). The follicles of the left ovary are located medially.The right ovary and uterus are normal. Moderate pelvic ascites extending to the lower abdomen.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Left ovarian mass and ascites. Findings of an ovarian neoplasm, such as a fibrothecoma or a Brenner tumor.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is minimal fraying of the undersurface of the posterior horn and body of the medial meniscus but we see no discrete medial or lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: Again seen is moderate degeneration of the articular cartilage of the patella with foci of near full-thickness to full-thickness degeneration affecting both the lateral and medial facets with associated subchondral marrow signal abnormality appearing similar to the prior exam. There is also near full-thickness to full-thickness cartilage loss of the posterior aspect of the medial femoral condyle, also appearing similar to the prior exam. Subjectively, the articular cartilage of the weightbearing portion of the medial compartment appears thinned. Subchondral cysts are noted in the lateral tibial plateau with degeneration of the overlying cartilage. Edema type signal within the intercondylar eminence appears less prominent than on the prior exam.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Possible mild undersurface fraying of the medial meniscus with no discrete medial or lateral meniscal tear.2. Tricompartmental cartilage degeneration as detailed above which overall appears similar to the prior exam.


Instruction: Generate impression based on findings.

Input: Supervision of high risk pregnancy, unspecified, unspecified trimester [O09.90], Reason for Study: ^Reason: brain mass, please perform seizure 2 protocol History: seizure 29 years Female (DOB:10/25/1987)Reason: brain mass, please perform seizure 2 protocol History: seizurePROVIDER/ATTENDING NAME: MAHMOUD A. ISMAIL Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.FLAIR/T2 high signal intensity tubular structure across the deep white matter of left frontal lobe [series 401, image 22] is representing developmental venous anomaly.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, 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.Brain MRV3D MRV brain nonenhanced phase contrast with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. The left transverse sinus is hypoplastic which is normal variation.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Developmental venous anomaly on the left frontal lobe3. Normal brain MRV


Instruction: Generate impression based on findings.

Input: Clinical question: Possible sacroiliitis. Signs and symptoms: New right low back pain. Nonenhanced lumbar MRI:T12 -- L1 demonstrate mild disk desiccation and mild hypertrophic changes of posterior elements without spinal stenosis or neural foraminal compromise. A tiny right lateral disk protrusion noted on prior exam is significantly less conspicuous on current study and likely representing improvement.L1 -- L2 is unremarkable with the exception of mild degenerative changes. Stable since prior study.L2 -- L3 demonstrate mild disk desiccation and loss of disk height, mild to moderate ligamentum flavum hypertrophy and mild facet disease. There is decrease in transverse diameter of thecal sac secondary to hypertrophic ligamentum flavum similar to prior exam. No central spinal stenosis and AP axis and no neural foraminal compromise.L3 -- L4 demonstrate moderate disk desiccation and loss of disk height, moderate to severe right facet and ligamentum flavum hypertrophy and including right facet effusion, mild left facet and ligamentum flavum hypertrophy. Degenerative changes demonstrate no significant interval change however a previously noted centrally located disk protrusion at this level demonstrate interval increased size and with resultant significant left lateral recess and left neural foraminal compromise, mild mass effect on the ventral aspect of the thecal sac and mild central spinal stenosis.L4 -- L5 demonstrate mild disk desiccation and loss of disk height, moderate bilateral (right greater than left) facet and ligamentum flavum hypertrophy. There is a tiny centrally located disk protrusion without interval change since prior exam and with very subtle indentation on thecal sac. No central spinal stenosis. There is no moderate right and mild left neural foraminal compromise without significant change since prior study.L5 -- S1 demonstrate mild degenerative disk disease and no significant degenerative changes of posterior elements. No central spinal stenosis or neural foraminal compromise.Additional MRI sequences were acquired for assessment of the SI joints which demonstrate no detectable signal abnormality of the joints or the adjacent bony structures.

Output: 1.New since prior exam is interval increased size of central and leftward broad-based disk protrusion at L3 -- L4 with resultant significant left lateral recess and left neural foraminal compromise and mild central spinal stenosis. Extensive degenerative changes at this level and including mild grade 1 anterolisthesis otherwise remain stable.2.Degenerative changes at other levels as detailed however without central spinal stenosis.3.Neuroforaminal compromise as detailed per level above.4.Dictated images for SI joint evaluation were also acquired and demonstrate no abnormality.


Instruction: Generate impression based on findings.

Input: 77-year-old with altered mental status. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. This examination is essentially within normal limits for patient's stated age of 77. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium, paranasal sinuses and mastoid air cells are also unremarkable. If clinical concern persists an MRI is recommended.

Output: Normal CT of brain for age.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is loss of disc height with endplate degenerative changes throughout the cervical spine. There is mild heterogeneity of the marrow signal. The spinal cord displays normal signal and morphology. There is no abnormal osseous or intrathecal enhancement.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Disc osteophyte complex, facet arthropathy and uncinate spurs, contributing to mild spinal canal stenosis and mild left foraminal stenosis. No significant right foraminal stenosis.C4-C5: No significant disc bulge, spinal canal or foraminal stenosis.C5-C6: Disc osteophyte complex, facet arthropathy and uncinate spurs, contributing to mild spinal canal stenosis and mild right foraminal stenosis.C6-C7: Disc osteophyte complex with superimposed central to left paracentral disc extrusion, facet arthropathy and uncinate spurs, contributing to impingement of the ventral cord, moderate spinal canal stenosis and mild left foraminal stenosis. No significant right foraminal stenosis. No definite abnormal cord signal.THORACIC SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is mild heterogeneity of the marrow signal. There is mild disc bulging with endplate degenerative changes at T11-T12, but no significant spinal canal or foraminal stenosis at this or other thoracic levels. The spinal cord displays normal signal and morphology. There is fatty atrophy of the left paravertebral muscles.LUMBAR SPINE: There is straightening of the normal lumbar lordosis. The vertebral body heights are preserved. There is loss of disc height and disc dessication at L5-S1. There is mild heterogeneity of the marrow signal. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is fatty atrophy of the paravertebral muscles. Partially imaged is a 2.5 cm T2 hyperintense lesion in the liver. There is also intra- and extrahepatic biliary ductal dilatation, with common bile duct measuring up to 11 mm, which may be seen in the post cholecystectomy state. Incidentally noted are scattered colonic diverticula.L1-L2: Bilateral facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis. L2-L3: Mild disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to mild bilateral foraminal narrowing. No significant spinal canal stenosis. L3-L4: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to mild bilateral foraminal narrowing. No significant spinal canal stenosis. L4-L5: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to mild bilateral foraminal narrowing. No significant spinal canal stenosis. L5-S1: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to mild right greater than left foraminal narrowing. No significant spinal canal stenosis.

Output: 1. Degenerative spondylosis of the cervical and lumbar spine, most prominent at C6-C7, with disc osteophyte complex and superimposed central to left paracentral disc extrusion, contributing to impingement of the ventral cord at C6-C7, moderate spinal canal stenosis and mild left foraminal stenosis. No definite abnormal cord signal.2. No definite evidence of an myelomatous lesion.


Instruction: Generate impression based on findings.

Input: 14-year-old female with cerebral cyst. Follow up exam at 3 Tesla. Redemonstrated is a focal intraparenchymal cystic appearing structure involving the left periatrial white matter right just cranial to the atrium of the left lateral ventricle. This currently measures up to 10 mm (previously 13 mm and 18 mm) demonstrating continued retraction. 3D FLAIR as well as FIESTA thin cuts through this reveal a small T2 hyperintense focus laterally, as well as adjacent perivascular spaces, both of which were present previously. There is no associated abnormal enhancement.The remaining images redemonstrates prominence of the perivascular spaces. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Redemonstrated is a focal intraparenchymal cystic appearing structure involving the left periatrial white matter right just cranial to the atrium of the left lateral ventricle. This currently measures up to 10 mm (previously 13 mm in 2009 and 18 mm in 2006) demonstrating continued retraction. 3D FLAIR as well as FIESTA thin cuts reveal a small T2 hyperintense focus laterally, as well as adjacent perivascular spaces, both of which were present previously. There is no associated abnormal enhancement. Given the continued retraction and lack of enhancement now over a 9 year time interval, this is felt to represent a benign lesion, most likely a dilated perivascular space. A postinflammatory cyst remains in the differential diagnosis. Given the lateral T2 hyperintense focus, neuroglial cyst is felt to be unlikely. Given the retraction over an extended period of time, without associated enhancement, cystic neoplasm is also felt to be unlikely.


Instruction: Generate impression based on findings.

Input: 18-year-old male football player with two separate injuries to the right shoulder in the past two weeks with normal outside ER radiographs. Still in pain with mild weakness to abduction. ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis tendons are intact. No focal tear is evident. The muscle bellies are within normal limits.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. An os acromiale is is present. A type II acromion is noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Humeral head is well-seated in the glenoid cavity. The labrum is intact without evidence of focal fluid-filled tear. No abnormal marrow signal.BICEPS TENDON: The biceps tendon is intact and within the bicipital groove.ADDITIONAL

Output: Os acromiale may be the cause of the patient's pain. No evidence of trauma is noted.


Instruction: Generate impression based on findings.

Input: Gait impairment. Assess for cervical myelopathy. There is a diffusely congenitally narrow cervical spinal canal and multilevel degenerative spondylosis. In particular, there are posterior disc-osteophyte complexes at C2-3 through C7-T1 that indent the spinal cord. There are also moderate bilateral neural foramen stenosis at C3-4, severe bilateral neural foramen stenosis at C4-5, moderate to severe bilateral neural foramen stenosis at C5-6, and mild to moderate bilateral neural foramen stenosis at C6-7. There is high T2 signal and volume loss in the spinal cord at the C3-4 and C5-6 levels. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. However, there is a T2 hyperintensity right thyroid nodule that measures up to 20 mm. There is patchy T2 hyperintensity in the pons.

Output: 1. Multilevel congenitally narrow cervical spinal canal and degenerative spondylosis with spinal cord compression and associated myelomalacia at the C3-4 and C5-6 levels.2. An incompletely characterized right thyroid nodule measures up to 20 mm. A dedicated thyroid ultrasound may be useful for further evaluation.3. Patchy T2 hyperintensity in the pons is incompletely characterized. Please refer to the prior brain MRI report for additional details.


Instruction: Generate impression based on findings.

Input: history of Chiari decompression in 1995Signs and Symptoms: neck and arm pain paresthesia The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.The patient status post suboccipital craniectomy for Chiari 1 decompression.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. There is loss of disc space height as well as a mild disc bulge and mild uncovertebral osteophytes bilaterally. There is mild narrowing of neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal. There is loss of disc space height, disc bulge and endplate and uncovertebral osteophytes is also mild posterior ligamentous hypertrophy at this level. There is a encroachment of the left-sided exiting nerve roots more than the right exiting nerve roots related to combination of disc material and osteophytes.At C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation and a disc bulge at this level. There is narrowing of the neural foramina bilaterally at this level with mild encroachment of exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation and a disc bulge at this level. There is narrowing of the neural foramina bilaterally at this level with mild encroachment of exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Incidental note is made of partial empty sella.

Output: There are multilevel degenerative changes present in the cervical spine with associated narrowing of the neural foramina at multiple levels and some mild encroachment of exiting nerve roots at multiple levels as described above.


Instruction: Generate impression based on findings.

Input: 27-year-old female with headaches. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal T2 signal is evident in the brain. No enhancing intracranial mass is evident. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is mild flattening of the superior aspect of the pituitary gland/partially empty sella. The orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Essentially unremarkable MRI of the brain. There is mild flattening of the superior aspect of the pituitary gland/partially empty sella, which can be a normal variant or may represent intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: 34 years, Female, multiple sclerosis, evaluate for progression. Brain: Again seen are several scattered supratentorial foci of subcortical and periventricular T2/FLAIR hyperintensity compatible with known demyelinating disease. These are not significantly changed since 11/26/2014. No infratentorial lesions are appreciated. No new lesions. No lesions with enhancement. No intracranial mass or mass effect. Brain parenchymal volume is preserved. There is mild mucosal thickening involving the bilateral maxillary and right frontal sinuses and was present previously. The calvarium and extracranial soft tissues are unremarkable.Cervical spine: Cervical spine sequences are motion degraded slightly limiting evaluation. Again seen is a T2 hyperintense lesion in the dorsal aspect of the cervical cord at the C4 level, and is less conspicuous in the interval. There is intrinsic T1 hyperintensity without definite enhancement. There is a questionable T2 hyperintense lesion in the left aspect of the cord at the C7 level without corresponding abnormality on sagittal STIR or T2 sequences and may be artifactual. No new lesions or lesions with enhancement in the cervical cord are definitively appreciated. Vertebral body heights and alignment in the cervical spine are maintained. Bone marrow signal is benign. There is no significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are unremarkable.

Output: Several T2 hyperintense lesions involving the supratentorial white matter as well as in the cervical cord at the C4 level are consistent with known chronic demyelinating disease. No evidence of new lesions in the brain or cervical spine compared to 11/26/2014. No abnormal enhancement to suggest active demyelination.


Instruction: Generate impression based on findings.

Input: Breast cancer, back pain with a wraparound pain throughout abdomen. Lumbar: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is moderate disc height loss with fatty endplate marrow signal changes. There is mild disc bulge. No significant spinal canal stenosis. There is minimal narrowing of the bilateral neural foramina. Paraspinous soft tissues are within normal limits.

Output: 1. No evidence of metastatic disease in the lumbar spine.2. Degenerative changes at the L5-S1 level including disc height loss and mild bulge. No spinal canal stenosis. Minimal bilateral neural foraminal narrowing.3. MR Technologist note: Thoracic MRI could not be obtained due breast tissue expander. Per manufacturer, thoracic MRI may damage implant but would not pose safety risk to patient.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule-out acute intracranial hemorrhage. Signs and symptoms: Headaches Unenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal limits.Area of calcification within the left sylvian fissure measuring 10-mm in AP access and 7.5-mm in transverse axis on axial image 9 and approximately 15 mm in AP access and 6-mm in prandial -- cephalad access on the sagittal reformatted image 11. This finding has the appearance of a heavy vascular calcification. Recommend follow-up with an MRI.

Output: 1.No evidence of acute intracranial findings.2.Heavy calcification within the left sylvian fissure as described above likely a vascular calcification.3.Unremarkable exam otherwise for brain parenchyma and the calvarium.


Instruction: Generate impression based on findings.

Input: Postoperative changes are seen from previous anterior cervical fusion of C5 through C7. The exam was requested to be done at 3T, there is susceptibility artifact resulting from the indwelling instrumentation which limits evaluation of surrounding structures. In addition, there appears to be a prominent T2/STIR hyperintense collection along the right paramedian lateral aspect of the location extending from the mid C5 level down to the lower C7 level. This measures 2.6 cm transverse by 1.7 cm AP, by 3.7 cm CC. There is mild mass effect upon the right lobe of the thyroid gland.The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. Previously seen susceptibility along the upper cervical cord surface circumferentially on the prior dedicated brain MRI images is again noted and appears similar. Precontrast T1-weighted images also suggest intrinsic T1 hyperintensity along the cord margins likely representing residual blood products, as suggested on the prior brain MRI images as well.There are mild scattered spondylotic changes without significant spinal canal or foraminal stenosis at any level. THORACIC SPINE

Output: 1. No abnormal flow voids or enhancement to suggest vascular malformation. No cord signal abnormality.2. Redemonstration of superficial siderosis along surface of upper cervical cord and likely within the dependent thecal sac.3. Mild lower lumbar spondylotic changes, with previous anterior cervical fusion C5-7. Prominent nonenhancing fluid collection along the right aspect of the previous cervical fusion, likely representing a seroma.


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB:6/19/1978)Reason: previous c5-c6 hnp History: lue radiculopathyPROVIDER/ATTENDING NAME: MICHAEL J LEE SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is some loss of disc space height and disc desiccation as well as a left lateral recess disc protrusion which impresses on the ventral aspect of the thecal sac and encroaches on the left hemicord and nerve roots at the left lateral recess and the left neural foramen. There are associated uncovertebral osteophytes. This was present on the prior exam and does not appear to have changed substantially.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a left lateral recess disc protrusion associated with uncovertebral osteophytes at C5-C6 which encroaches on the left hemicord and the nerve roots at the left lateral recess.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with radicular pain and positive straight leg raise, left worse than right. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.The L5-S1 disc demonstrates reduced T2 signal and a mild reduction in height. Mild diffuse disc bulging is seen at this level with mild bilateral foraminal narrowing but no significant spinal canal stenosis. Mild facet arthropathy is also seen at this level.At L4-5, there may be a very small right foraminal protrusion which slightly narrows the neural foramen.The remaining intervertebral discs are preserved. The spinal canal and neural foramina are otherwise patent.

Output: 1.Disc degeneration is evident at L5-S1 with disc desiccation, mild loss of disc height and mild disc bulging. At most, this results in mild bilateral foraminal narrowing.2.No significant findings are seen at the remaining levels.


Instruction: Generate impression based on findings.

Input: Left parotid gland lesion. Dementia. There are multiple lesions present involving gray and white matter scattered in both hemispheres of the supratentorial brain but in asymmetric locations. Some are located along the medial aspects of the frontal lobes, the insular cortex bilaterally as well as a lesser degree the lateral aspects of the frontal and parietal lobes and temporal lobes. These are best appreciated on the FLAIR MRI images. There is no associated contrast enhancement. There is no associated susceptibility effect with these lesions. There is associated vasogenic edema on some of these lesions. There may be a small amount of diffusion restriction associated with these. There is no involvement of the thalami.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Postcontrast imaging is degraded by patient motion which may obscure more subtle abnormalities.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 mild mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a small cystic lesion present in the right parotid gland measuring 7 mm in diameter. It is not entirely included on this exam.

Output: 1.There are multiple lesions scattered throughout the cortex of the supratentorial brain. Differential considerations include Creutzfeldt-Jakob disease, encephalitis due to another cause, paraneoplastic encephalitis and hypoglycemic encephalopathy.2.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.3.Postcontrast imaging is degraded by patient motion which may obscure more subtle abnormalities.4.There is a small peripherally based lesion in the right parotid gland which is not entirely included on this exam. It is nonspecific


Instruction: Generate impression based on findings.

Input: A 40 years old male with past history of syncope years ago, palpitations with PVCs on holter and transesophageal echocardiography in 2013 with normal left and right ventricular size and function, significantly enlarged left and right atrial volumes with no evidence of shunt. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 204 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 78 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 120 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No VSD noted. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 200 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).AtriaThe left atrium is severely dilated (168ml). The right atrium is severely dilated (151ml). No evidence of inter-atrial shunt based on anatomic visualization, first pass contrast imaging, and normal Qp/Qs (1.03).Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. Normal LV size and systolic function (LVEF 62%) without underlying myocardial fibrosis, infiltration, inflammation.2. Normal RV size and systolic function (RVEF 61%).3. Severe biatrial dilation.4. No evidence of intra-cardiac shunt. Normal pulmonary venous drainage.


Instruction: Generate impression based on findings.

Input: 52-year-old male with history of right upper quadrant pain, liver mass, and elevated bilirubin. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions with associated atelectasis.LIVER, BILIARY TRACT: There is a segment 5/8 lesion measuring 3.2 x 2.0 cm which demonstrates high T2 signal abnormality with progressive fill-in after contrast administration. Distal to this lesion there is mild wedge-shaped restricted diffusion extending to the periphery with mild intrahepatic biliary ductal dilatation. There appears to be attenuation of the anterior branch of the right portal vein. The main portal vein is open. The hepatic hilum is not involved.There are scattered areas about the left and right hepatic lobes of ductal dilatation with multiple sharp cutoffs.The common bile duct is unremarkable. The gallbladder is unremarkable.SPLEEN: No significant abnormality notedPANCREAS: Mildly increased restricted diffusion within the pancreatic head which may indicate a mild pancreatitis.Normal pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There is an enlarged right retroperitoneal lymph node adjacent to the right renal hilum measuring 2.4 x 1.7 cm (image 12 of series 701).The proximal IVC is open however the distal appears relatively attenuated with multiple retroperitoneal and anterior abdominal wall venous collaterals.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Right hepatic lobe segment 5/8 mass with imaging characteristics suggestive of cholangiocarcinoma. The hepatic hilum and main portal vein appear to be spared, however the anterior branch of the right portal vein is not well seen and may be involved.2. Scattered areas of biliary ductal dilatation in both hepatic lobes with multiple sharp cut offs can be seen in PSC, multifocal strictures, or less likely, biliary spread of tumor.3. Enlarged right retroperitoneal lymph node adjacent to the right renal hilum is highly suspicious for metastatic disease.4. Abnormal IVC with multiple venous collaterals in the anterior abdominal wall and retroperitoneum is suggestive of a distal obstruction. This can be further evaluated with a contrast-enhanced CT.5. Mildly increased streaky diffusion about the pancreatic head may indicate pancreatitis.


Instruction: Generate impression based on findings.

Input: Left shoulder pain. Concern for rotator cuff tear. ROTATOR CUFF: There is mild increase signal intensity within the distal fibers of the supraspinatus tendon compatible mild tendinopathy. The supraspinatus, infraspinatus, teres minor muscles/tendons are intact. There is increased signal intensity within the subscapularis tendon compatible moderate tendinopathy. The tendon is otherwise intact without evidence of muscle atrophy. SUPRASPINATUS OUTLET: There is no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Increased T2 signal within the region of the greater tuberosity is non-specific and may be related to degenerative changes or edema; correlate for history of trauma. No fracture is evident.There is increased signal within the body and possible partial detachment of the superior labrum extending anteriorly. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Moderate subscapularis and mild supraspinatus tendinopathy. No rotator cuff tear.2. Abnormal signal within the region of the greater tuberosity may represent degenerative change or edema possibly from trauma; correlate for history of injury.3. Signal abnormality and possible detachment of the superior labrum extending anteriorly.


Instruction: Generate impression based on findings.

Input: History: Left parietal intracranial hemorrhage follow-up Bilobed shape left frontal parietal hematoma is again seen. It appears slightly different on the current CT due to technique and angle of acquisition when compared to the recent brain MRI. Left high convexity frontal lobe hematoma, slightly ill defined and relatively hypodense, measuring about 2.2 x 1.9-cm. More inferiorly, the left frontal parietal lobe hematoma measures 2.3 x 2.4-cm. They are associated with large amount of adjacent edema. Trace amount of adjacent subarachnoid blood are also seen, unchanged. There are mild to moderate diffuse cerebral edema overall with paucity of extra axial space and sulci, effacement of basal cisterns, especially in the left. There is probable left-sided uncal herniation. No evidence of midline shift. The lateral ventricles are compressed. No hydrocephalus. Marked mucosal thickening with bubbly material seen in the sphenoid sinuses. Large right maxillary sinus retention cyst or polyp is present. Left inferior mastoid air cells opacification, left more than right. Minimal mucosal thickening seen in the ethmoid sinuses. Small right frontal sinus osteoma.

Output: 1. Left frontoparietal hematoma as described above with large amount of adjacent edema. Diffuse overall brain edema with paucity of extra-axial space and sulci, decrease in visualization of the left suprasellar cistern raising the possibility of left-sided uncal herniation. 2. Within limit of the comparison between current CT and prior MRI, there is no conclusive evidence of new separate intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 72-year-old female with HCV, HCC status post TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Trace perihepatic ascites. Again noted is a left hepatic lobe ablation cavity measuring 2.5 x 2.0 cm (series 11, image 27) with intrinsic T1 hyperintensity consistent with postprocedural blood product. No abnormal enhancement is present in or around the lesion cavity. No new liver lesion is present. The vasculature is patent. The gallbladder is within normal limits. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter nonspecific left intramammary lymph node is unchanged.BOWEL, MESENTERY: Unchanged superior endplate compression deformity of L5 is partially visualized. Unchanged wedge deformity of L1 with focal kyphosis at L1.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology without evidence of residual tumor in or around the left liver lobe ablation cavity. No new suspicious lesion is evident.


Instruction: Generate impression based on findings.

Input: 76-year-old male with elevated PSA (4.72 ng/mL) after prostatectomy. Evaluate for extent of disease. Fullness of the prostatic fossa on the left. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Not apical.Central Gland: Not applicable.Seminal Vesicles: Not applicable.Extracapsular Extension: Not applicable.BLADDER: There is a 2.4 x 1.6 cm nodular focus with early enhancement and washout also demonstrating hypointense ADC signal intensity. This lesion is located adjacent to the left posterior aspect of the urinary bladder base (axial series 708 image 324).LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nodule focus adjacent to the left posterior base of the urinary bladder measuring 2.4 x 1.6 cm with hypointense ADC signal and early enhancement and washout concerning for recurrent or residual tumor.2.Please refer to same day nuclear medicine bone scan for additional details regarding osseous findings.


Instruction: Generate impression based on findings.

Input: 9-year-old male with ALL on steroids, rule out AVN Right ankle: Confluent increased T2 and decreased T1 signal within the proximal aspect of the cuboid without discrete fracture line may represent a healing nondisplaced fracture or stress reaction. Multiple additional scattered foci of increased STIR signal within the marrow of the distal tibia, talus, calcaneus, and tarsal bones as well as the visualized portions of the metatarsals are normal for the patient's age. The tibiotalar joint is normal. The medial and lateral collateral ligaments are intact. The extensor and flexor tendons appear normal.Left ankle: Scattered foci of mildly increased STIR signal within the marrow are normal for the patient's age. There is no evidence of fracture or malalignment. The tibiotalar joint is normal. The medial and lateral collateral ligaments are intact. The extensor and flexor tendons appear normal.

Output: Signal abnormality involving the right cuboid, which may represent a healing nondisplaced fracture or stress reaction. Right foot radiographs may be considered to evaluate for healing if clinical warranted.


Instruction: Generate impression based on findings.

Input: Male 81 years old Reason: Pt is an 81 y/o male with met RCC, evaluate for progression History: met RCC ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are approximately 6 hepatic lesions distributed through both lobes. Reference measurements are provided below. There is a residual thin rim of enhancement. The majority of the lesion has undergone necrosis in its center.The other lesions are also undergone similar areas of necrosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Convex cystic lesion with dense calcification (correlate with prior CT imaging) in the left upper pole is unchanged. There are several other simple cysts in the left kidney.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affects the lumbar spine.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 6/7/2016 14:30:00)LIVER LESION: 4.3 x 3.2 cm (Image 208, Series 9); 5.6 x 4.2 cm on prior (2/18/2016) (Image 13, Series 10).SEGMENT 2 LESION: 2.7 x 2.9 cm (Image 209, Series 9); 4.5 x 3.7 cm on prior (2/18/2016) (Image 22, Series 10).SEGMENT 6 LESION: 3.4 x 2.5 cm (Image 225, Series 9); 3.5 x 3.9 cm on prior (2/18/2016) (Image 40, Series 10).

Output: 1.Decrease in the size of the reference lesions with increasing central necrosis.


Instruction: Generate impression based on findings.

Input: Palpable lump on IP joint of the thumb, on extensor side. Evaluate extensor tendon on left thumb for giant cell tumor of tendon sheath. There is a lobulated mass within the soft tissues of the thumb that completely surrounds the interphalangeal joint. Dorsally, the mass lies deep to the extensor tendon, extending from the mid-diaphysis of the proximal phalanx to the level of the interphalangeal joint. The mass extends in both the radial and ulnar directions to surround the head and neck of the proximal phalanx with what appears to be extension deep to the flexor digitorum profundus tendon. There is also a relatively large (14 mm) nodular component of the mass situated superficial and medial to the flexor digitorum profundus tendon at the level of the interphalangeal joint. The mass is of similar signal intensity to muscle on T1-weighted images and shows persistent low signal intensity on T2-weighted images. Although the mass shows relatively mild enhancement following gadolinium administration, the low signal intensity on T2-weighted images favors the suspected diagnosis of tenosynovial giant cell tumor. I see no definite tumor within the joint, nor do I see any definite bone erosions. Both the extensor and flexor tendons can be traced to their insertions on the distal phalanx.

Output: Soft tissue mass in the thumb as described above with MR imaging features compatible with the suspected clinical diagnosis of tenosynovial giant cell tumor.


Instruction: Generate impression based on findings.

Input: Female, 18 years old, with simple partial seizures. A single punctate non-specific focus of T2 hyperintensity is seen in the white matter just anterior to the left insula. The cerebral and cerebellar hemispheres and brainstem otherwise show normal signal intensity and morphology. No restricted diffusion is seen. The medial temporal lobe structures are symmetric and free of focal lesions.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

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


Instruction: Generate impression based on findings.

Input: Parotid cancer status post surgery and radiation. Neck CT:There has been interval decrease in volume of the hyperintense right parotid tissues. No discrete mass is identified. There are scattered small lymph nodes in bilateral neck, unchanged in size, and are within normal limits based on size criteria.In the right shoulder, at the right supraspinatus muscle, there is new hypodense lesion, seen on coronal image number 27 of series 80380, and axial image 63 series 4. The clinical significance is uncertain, but given the history of adenocystic carcinoma, unusual distant metastasis needs to be considered. Further evaluation with right shoulder MRI without and with contrast is recommended.There is minimal mucosal thickening in right mastoid air cells and left maxillary sinus.The osseous structures and limited view of the upper lungs appear unremarkable for metastatic disease.

Output: 1. Interval decrease of right parotid tissues with asymmetric hypodensity, probably related to post treatment changes. No evidence of tumor recurrence or adenopathy in the neck.2. New hypodense lesion in the right shoulder at the supraspinatus muscle. Although this can represent benign musculoskeletal disease, distant metastasis cannot be excluded. Further evaluation with right shoulder MRI without and with contrast is recommended.


Instruction: Generate impression based on findings.

Input: Female 72 years old Reason: HCC/ s/p TheraSphere Administration History: HCC/ S/P TheraSphere Administration The absence of intravenous contrast limits evaluation of the solid organs and of the bowels. Additionally, extensive abdominal ascites noted. Given these limitations, despite repetition of multiple sequences the study is essentially nondiagnostic.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology is again seen. Previously described T2 hyperintense lesions are poorly seen.Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive ascites. Esophagogastric varices.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Essentially nondiagnostic study for the reasons detailed above. It is not possible to assess response to therasphere administration.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:12/30/1951)Reason: Treatment planning for SRS to L temporal lesion History: Treatment planning for SRS to L temporal lesionPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA There is a 18 x 15 mm axial dimension ring-enhancing lesion adjacent to the trigone of the right lateral ventricle which previously measured 10 x 11 mm axial dimensions. Currently the central component is hypointense on T2 and has a slightly hyperintense appearance on T1 scout images. There are some patchy susceptibility weighted imaging signal loss associated with the lesion. There is vasogenic edema associated with the lesion appears to be greater on the current exam versus the prior exam from July 5. There is a small enhancing tract anterior inferior to this periventricular lesion presumably related to the stereotactic needle tract.Since the prior exam a right middle frontal gyrus surgical site has remained stable.The patient is status post burr hole placement along the right parietal bone and right frontal craniotomy.There is a small ring-enhancing focus in the left temporal lobe measuring 6 mm in diameter associated with some surrounding T2 signal hyperintensity. This is also stableThere is redemonstration of an enhancing punctate focus adjacent to the frontal horn of the left lateral ventricle.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. The eyeball lenses are thin.

Output: 1.Multiple intracranial lesions present. One in the right periventricular white matter is enlarged however the rest are stable compared to prior exam. 2.The patient is status post recent stereotactic surgery for the right periventricular white matter lesion which now has a larger appearance. The change in size may potentially be accounted for on the basis of blood products within the lesion.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma status post TSH in 11/2013: surveillance. There has been interval evolution postoperative findings related to transphenoidal surgery. There is a hypoenhancing lobulated structure in the sella that measures up to 15 mm in width. The infundibulum remains deviated slightly to the left. The optic apparatus is intact. There is an unchanged probable Thornwaldt cyst in the nasopharynx. There is a subcentimeter left maxillary sinus retention cyst.

Output: Interval evolution postoperative findings related to transphenoidal surgery with a hypoenhancing lobulated structure in the sella that measures up to 15 mm in width, which may represent recurrent tumor.


Instruction: Generate impression based on findings.

Input: Brain metastasis treated with SRS: surveillance exam. There is a small area of unchanged high T2 signal in the left parietal lobe treatment bed. There is no evidence of associated enhancement or mass effect. There is no evidence of additional intracranial lesions. There is no evidence of acute intracranial hemorrhage acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There are scattered paranasal sinus retention cysts and mucosal thickening.

Output: Post-treatment findings in the left parietal lobe without evidence of measurable tumor.


Instruction: Generate impression based on findings.

Input: 61-year-old man with history of Gleason 6 prostate cancer under active surveillance. Pathology results within the left base and left apex with adenocarcinoma. PELVIS:PROSTATE:Prostate Size: Prostate measures 49 x 37 mm.Peripheral Zone: Multiple areas of abnormal signal are identified:In the lateral left base (301/44) there is a 9 x 5 mm area of T2 hypointense signal with corresponding ADC abnormality.Additionally, in the right lateral base (301/41) there is a 14 x 9 mm area of T2 hypointense signal with corresponding ADC abnormality.In the medial left mid gland (301/42) there is a 5 x 4 mm area of hypointense T2 signal and questionable ADC abnormality.Other tiny T2 hypointense foci also seen.Central Gland: Nodular without additional significant abnormality.Seminal Vesicles: The seminal vesicles appear normal without tumor involvement.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Foci of signal abnormality in the left lateral prostate base and right lateral prostate base suspicious for adenocarcinoma.2.Questionable focus in the medial left mid gland which may represent an additional site of disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Kappa light chain multiple myeloma with increasing back pain. Signs and symptoms: As above. Unenhanced cervical MRI:There is normal anatomical alignment of vertebral column. There is however significant exaggeration of cervical lordosis centered at C5 level.There is large focus of marrow signal T2/T2 hyperintensity of the vertebral body of C5 consistent with clinical diagnosis of multiple myeloma. A punctate focus of similar signal change within the anterior body of C3 is also noted. Mild similar T2/T2 stir hyperintense signal along the superior half of C6 is also present and as well suspected of multiple myeloma. No evidence of fracture. Degenerative changes in particular ligamentum flavum hypertrophy at C4 -- C5 and C5 -- C6 levels results in mild central spinal stenosis. The signal intensity and caliber of the cervical cord is within normal.Nonenhanced thoracic MRI:The alignment of the vertebral column remains anatomical, there is however significant kyphotic deformity of thoracic spine centered at the approximate T7 level and likely secondary to multiple compression deformities of thoracic vertebral bodies.There is subtle concave deformity of the superior and inferior endplates of T2, superior endplates of T3 suggestive of mild compression deformities without associated marrow signal changes.There is more than 50% wedge compression deformity of T5 measuring 16.2-mm posteriorly and 7.7-mm anteriorly. No detectable marrow signal changes.There is uniform increased T2/T2 stir signal intensity of T6 vertebral body with more than 50% compression fracture deformity. The posterior aspect of body of measures at 13-mm in height and anteriorly at 6 mm. Although this exam is nonenhanced there is suggestion of exostosis epidural spread of tumor in the right paramedian anteriorly and extending to the right neural foramina at T6 -- T7 level. This finding is best appreciated on axial T2 series 1701 on image number 8 and sagittal T2/T2 stir series 1301 on image 9. There is mild central spinal stenosis as result of this finding. The sacral intensity of the cord remains within normal.There is less than 50% compression deformity of the superior endplate of T7 without malalignment. There is a large focus of T2/T2 stir hyperintensity in the dorsal aspect of body of T7 on the right.T8 demonstrate diffuse marrow signal abnormality of vertebral body and mild compression deformity consistent metastatic multiple myeloma. There is extra osseous spread of tumor into the spinal canal on the right at T8 level which results in flattening deformity of the ventral aspect of the cord on the right and result in mild central spinal stenosis. This finding is best appreciated on axial T2 series 1401 image 21. Tiny central ventral epidural defect at T8 -- T9 disk level could represent a tiny additional focus of tumor extension and less likely representing a disk herniation/protrusion.At T9 there is a distal marrow signal change consistent with multiple myeloma. There is wedge compression deformity of approximately 50% without malalignment. The dorsal aspect of vertebral body of T9 measures at 20-mm and anteriorly at 10.5-mm.mild compression fracture of superior and inferior endplates of T10 with associated marrow signal changes is also noted.There is also patchy foci of matter signal changes of T1 hypointensity in the vertebral bodies of T11, T12 without T2/T2 stir hyperintensity. There is mild compression fracture of superior endplate of L1 without malalignment and the David is a focus of T2 hyperintensity along the dorsal left aspect of body of T1 suggestive of tumor.Nonenhanced lumbar MRI:Examination demonstrate diffuse patchy foci of marrow signal changes consistent with multiple myeloma throughout the lumbosacral spine involving vertebral bodies and the posterior elements. There is marrow signal changes and less than 50% compression deformity of L4 vertebrae however with maintained normal alignment. Mild compression deformity of L3 is also noted. There is no evidence of central spinal stenosis at any level. Mild to moderate bilateral neural foraminal compromise at lower lumber spine is however present.

Output: 1.Nonenhanced MRI cervical spine demonstrate matter signal changes consistent with multiple myeloma extensively involving the vertebral body of C5, superior aspect of vertebral body of C6 and punctate focus in the vertebral body of C3. No evidence of fracture. Mild central spinal stenosis at C4 -- C5 and C5 -- C6 levels secondary to degenerative changes.2.Nonenhanced MRI of the thoracic spine demonstrate multi-level compression fractures of varying degrees involving primarily T5, T6, T7, T9 and T10 levels. There is resultant significant kyphotic deformity of thoracic spine centered at T6 and T7 levels. There is evidence of right lateral ventral epidural and right neural foraminal extraosseous spread of tumor at T6 with result in mild central spinal stenosis. Small right lateral epidural spread of tumor T8 results in mild flattening deformity the cord however without central spinal stenosis. The signal intensity of the cord remains within normal throughout its length. 3.Nonenhanced MRI of the lumbosacral spine demonstrate diffuse osseous marrow signal changes consistent with multiple myeloma. Mild compression fractures of the L3 and to a lesser degree L2 levels are noted. No evidence of malalignment or central spinal stenosis. Neural foraminal compromise in the lower lumber spine secondary to degenerative disease.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, history of meningioma, one year follow-up. Evidence of prior left-sided craniotomy is again seen. A homogeneously enhancing mass is redemonstrated along the left greater sphenoid wing showing no significant interval change in size with a measurement of 13 x 11 mm.No new intracranial lesions are detected. No evidence of edema or mass effect is seen. Scattered small foci of FLAIR hyperintensity in the cerebral white matter are nonspecific and unchanged. No evidence of new hemorrhage or any abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: Stable left sphenoid wing meningioma.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with radiculopathy and neck pain, presurgical assessment. Evidence of laminectomy is seen from C4 through C6 and partially at C3 and C7, similar to prior. The typical lumbar lordosis is straightened but sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are otherwise within normal limits. No pathologic marrow replacement or edema is seen. No abnormal marrow space enhancement is detected.The spinal cord is thinned and demonstrates patchy abnormal T2 signal beginning at approximately C4 and continuing down to C7. This appearance is unchanged when compared to the prior examination. No pathologic spinal cord enhancement is seen. Mild prominence of the ventral epidural venous plexus is demonstrated at C6 and C7, of doubtful significance.C2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. C3-4: Facet arthropathy, right worse than left. Mild posterior disc-osteophyte complex formation. Posterior spinal canal decompression. Moderate left and mild right foraminal narrowing. No significant interval changes. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the right foraminal zone. Posterior spinal canal decompression. Severe right foraminal narrowing, not significantly changed. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation. Posterior spinal canal decompression. Moderate left and mild right foraminal narrowing. No interval changes.C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the right. Posterior spinal canal decompression. Severe right and moderate left foraminal narrowing, not significantly changed. C7-T1: Facet arthropathy. No significant disc degeneration or spinal canal stenosis. At most, minimal left foraminal narrowing. No interval changes.

Output: 1.Evidence of prior posterior spinal canal decompression from C3 through C7. Thinning and patchy T2 signal abnormality of the spinal cord through this region likely represents myelomalacia from prior impingement.2.Multilevel disc and posterior element degeneration is seen. Although there are no areas of high-grade spinal canal stenosis, severe foraminal narrowing is suspected on the right at C4-5 and on the right at C6-7.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left parietal craniotomy for resection of a subjacent tumor. There is an unchanged 5 mm thick subjacent subdural fluid collection that does contain foci of susceptibility effect compatible with blood products. The enhancing portion of the tumor along the anterior resection margin measures 15 x 27 mm on coronal plane (series 1202 image 80), previously 13 x 15 mm, and 27 x 18 mm axially (series 1201 image 39), previously 23 x 15 mm. There is a new 5 x 10 mm focus of enhancement medial to the resection cavity. There are some areas of elevated relative cerebral blood volume in the enhancing tissue on perfusion scan. Enhancement along the posterior aspect of the resection cavity has essentially resolved and enhancement along the medial resection cavity margin corresponds to an area diffusion restriction on the immediate postoperative exam and likely represents infarcted tissue. Left temporal lobe superior gyrus resection cavity show increased signal intensity on FLAIR images comparing to prior scan. However, considering there is no visible mass effect nor enhancement on post Gad scans, this is likely represent trapped resection cavity from surrounding CSF space instead of tumor recurrence.The T2 hyperintensity surrounding the resection cavity is essentially unchanged, allowing for differences in technique. The bilateral confluent T2 hyperintensity throughout the supratentorial white matter is also unchanged and is compatible with treatment related changes.There is unchanged apparent hypoplasia of the right cerebellar hemisphere. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Findings are concerning for disease progression along the anterior resection cavity margin and medial to the cavity as detailed above.


Instruction: Generate impression based on findings.

Input: Mesenchymal chondrosarcoma of the left maxillary sinus; completed radiation therapy in March 2013 and chemotherapy in May 2013. There are post-treatment findings in the left maxillary sinus and nasal cavity region. There is no evidence of measurable mass lesions to suggest tumor recurrence. There are small retention cysts within the bilateral maxillary sinuses. The facial soft tissues are unremarkable. There is no significant cervical lymphadenopathy. The partially imaged intracranial structures and orbits are grossly unremarkable.

Output: Post-treatment findings in the left sinonasal region without evidence of measurable locoregional tumor recurrence.


Instruction: Generate impression based on findings.

Input: 32 years, Female, cystic fibrosis and epilepsy and bilateral cortical changes on prior MRI. There is T2/FLAIR hyperintensity involving the cortex and subcortical white matter of the right frontal and right parietal lobes which is decreased compared to 7/17/2016. There areas of subtle thinning involving the gyri consistent with volume loss. There are also areas of T1 hyperintensity compatible with laminar necrosis related to prior injury.There is no evidence of acute infarct, hemorrhage, intracranial mass, or mass effect. No new area of parenchymal signal abnormality is evident. No midline shift or herniation. Ventricles are normal in size. There is diffuse opacification of the right maxillary sinus as well as the right anterior ethmoid air cells and to a milder degree on the left but similar to prior. There is suggestion of prior endoscopic sinonasal surgery.

Output: Compared to multiple prior studies from June and July 2016, there has been decrease in extent of cortical and subcortical FLAIR signal abnormality, which predominantly involved the right cerebral hemisphere. Residual FLAIR abnormality with areas of laminar necrosis and volume loss in the right frontal and right parietal lobes is compatible with encephalomalacia/gliosis as sequela of prior injury.


Instruction: Generate impression based on findings.

Input: Plantar soft tissue mass and Achilles tendon pain Note that the examination was tailored for the evaluation of the plantar soft tissues.TENDONS: Within the limits of the exam, there are no significant abnormalities. Specifically, the visualized portion the Achilles tendon appears normal.LIGAMENTS: Within the limits of the exam, there are no significant abnormalities.ARTICULAR SURFACES AND BONE: There is metallic susceptibility artifact within the head of the first metatarsal relating to an orthopedic screw. There is severe osteoarthritis of the first MTP joint. ADDITIONAL

Output: 1. No evidence of plantar soft tissue mass or abnormal enhancement contrast demonstration.2. Surgical changes of the first MTP joint with osteoarthritis.


Instruction: Generate impression based on findings.

Input: 51 year old woman with coronary artery disease s/p CABG referred to evaluate for ischemia. First Pass PerfusionDuring hyperemia, a perfusion defect is noted in the basal anteroseptum and mid anterolateral and anteroseptum. Viability/ Myocardial ScarThere is a nontransmural myocardial infarction noted in the apical septum and the mid anterior and anteroseptal. These segments have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size and systolic function. The left ventricle is mildly hypertrophied.. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), the LVEDV is 164 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 64 ml (normal range 31+/-10), the LV mass index is 85 g/m2, and the LV mass is 192 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 76%, the RV end diastolic volume index is 57 ml/m2 (normal range 69+/-14), the RVEDV is 131 ml (normal range 110+/-24), the RV end systolic volume index is 14 ml/m2 (normal range 22+/-8), and the RVESV is 99 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, a perfusion defect is noted in the basal anteroseptum and mid anterolateral and anteroseptum. 2. There is a nontransmural myocardial infarction noted in the apical septum and the mid anterior and anteroseptal walls. These segments have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable. 3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 76%).


Instruction: Generate impression based on findings.

Input: 64-year-old female with a soft tissue mass present for 30 years. A marker was placed on the posterior aspect of the shoulder. Deep to this marker is a predominantly fatty mass within the subcutaneous fat measuring 5.3 x 4.3 x 3.5 cm (TR x AP x CC), although accurate measurement is difficult due to lack of contrast with the adjacent subcutaneous fat. There are thin septations within this mass that show minimal, if any, enhancement. This is most compatible with a lipoma. Please note that this study was not protocoled for detailed evaluation of the rotator cuff, however, there is a full-thickness tear of the anterior fibers of the supraspinatus measuring approximately 1 cm in the AP dimension. There is perhaps mild fatty atrophy of the supraspinatus muscle. Severe osteoarthritis affects the acromioclavicular joint with a mild synovitis. There also appears to be a mild synovitis of the glenohumeral joint.

Output: 1. Subcutaneous lipoma.2. Full-thickness tear of the supraspinatus tendon.3. Osteoarthritis of the acromioclavicular joint. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 67-year-old male patient with T2a prostate cancer, Gleason 4+3, PSA 15. Evaluate for extent of disease in prostate and pelvis.Right side prostate biopsiesSpecimen: Date: 11/10/14Prostate adenocarcinoma, Gleason score 3+4=7 involving Four biopsy cores and 10% of entire tissueLeft side prostate biopsy- Focal prostatic adenocarcinoma, Gleason score 3+3=6 involving <5 % of tissue PELVIS:PROSTATE:Prostate Size: 5.4 x 3.4 x 3.9 cm (ML x AP X CC).Peripheral Zone: There is a 1.5 x 0.7 cm (series 604 image 264) focus of decreased T2 and ADC signal in the mid right peripheral zone extending towards the apex.There is a 1.5 x 0.6 cm (series 604 image 324) focus of decreased T2 and ADC signal in the mid left peripheral zone.Central Gland: No suspicious lesions.Seminal Vesicles: No evidence of seminal vesicle involvement.Extracapsular Extension: Lesion in the right peripheral zone abuts the capsule without evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered small subcentimeter lymph nodes bilaterally in the pelvis.BONES, SOFT TISSUES: Patchy enhancement is noted in the bones the pelvis.OTHER: No significant abnormality noted.

Output: 1.Likely neoplastic foci in the mid right peripheral zone extending towards the apex as well as in the left peripheral zone without evidence of extracapsular extension or significant pelvic lymphadenopath as described above.2.Mottled, patchy enhancement of the bones in the pelvis. When correlated with outside hospital CT and recent bone scan, favor Paget's disease over metastatic disease.


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: downtrending UOP s/p kidney transplant History: see above RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No evidence of hydronephrosis. There is a 6 x 10 mm hyperechoic focus within the transplant kidney. The etiology is uncertain. This may represent a focal area of hemorrhage or less likely a small angiomyolipoma. If further characterization of this lesion is clinically indicated contrast enhanced CT or MRI is recommended.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Peak systolic velocity of the transplant artery is 100 cm/s. RI values are borderline elevated measuring around 0.8. Transplant vein is patent.OTHER: No significant abnormality noted

Output: Borderline elevated RI values.Indeterminate small hyperechoic lesion in the transplant kidney of uncertain etiology and significance.


Instruction: Generate impression based on findings.

Input: Evaluate for spondylolysis: low back pain for years worse with arching; x-ray with possible spondylolysis. There perhaps mild sclerosis in the region of the left L5 pars interarticularis. The vertebral column alignment is within normal limits and there is no evidence of bone marrow edema. The vertebral body heights are preserved. There is mild loss of disc space height at L5-S1, but no significant disc bulge, spinal canal stenosis, or neural foraminal stenosis. The spinal cord and cauda equina nerve roots display normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Perhaps mild sclerosis in the region of the left L5 pars interarticularis, which may represent chronic spondylolysis, but no evidence of spondylolisthesis or vertebral bone marrow edema. However, MRI generally has limited sensitivity for chronic spondylolysis otherwise and a focused lower lumbar CT may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for disk herniation/cord compression. Signs and symptoms: Tearing sensation with left-sided radiculopathy. Unable to move 2/2 pain Pre-and post-enhanced lumbar MRI:T12 -- L1 demonstrate no spinal stenosis or neural foramina compromise.Examination demonstrates mild compression fracture of L1 vertebral body with extensive increased marrow signal intensity suggestive edema. Finding is suggestive of a recent fracture. The longest cranial cephalad axis of L1 vertebrae measures at 24.7-mm compared to 18-mm at the level of maximum compression. Very subtle expansion of fractured vertebrae into the spinal canal without central spinal stenosis. There is however mild to moderate left neural foramina secondary to degenerative changes is present. There is no detectable perispinal soft tissue abnormality. Post-enhanced images demonstrate a patchy band of enhancement surrounding the compressed vertebrae. Follow-up exam is recommended to entirely exclude the remote possibility of a mass.The alignment the vertebral column is anatomical.L2 -- L3 demonstrate minimal degenerative changes and unremarkable otherwise.L3 -- L4 demonstrate mild degenerative disk disease and mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise. Minimal left facet effusion is present.L4 -- L5 demonstrate mild disk desiccation and mild bilateral facet and ligamentum flavum hypertrophy. There is a broad-based central and rightward disk protrusion which results in moderate central spinal stenosis and right neural foraminal compromise. Mild left neural foraminal compromise secondary to degenerative disease is also present.L5 -- S1 demonstrate mild to moderate disk desiccation and loss of disk height, small central and leftward disk protrusion is present. No evidence of central spinal stenosis. A right-sided disk osteophyte complex results in severe right neural foraminal compromise.Post-enhanced images at this level demonstrates subtle enhancement of the adjacent endplates representing Modic changes inno detectable abnormal enhancement of the cord or leptomeninges.

Output: 1.Mild likely subacute compression fracture of L1 vertebrae with subtle expansion into the spinal canal without spinal stenosis. Mild to moderate left neural foraminal compromise at L1 -- L2 secondary to degenerative disease is present.2.Degenerative changes at L4 -- L5 and a large broad-based disk protrusion results in central spinal stenosis and neural foraminal compromise as detailed.3.Extensive degenerative changes at L5 -- S1 without central spinal stenosis. Disk osteophyte complex on the right results in significant right neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Evaluate Syrinx, history of Chiari malformation. Motion artifacts degraded image quality.About 20.7mm of caudal cerebellar tonsilar herniation was seen which is compatible with Chiari malformation.Syrinx is seen from the level of C23 to T78.There is normal thoracic kyphosis and lumbar lordosis. The spine alignment appear to be anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: 1. Chiari malformation with about 20.7mm tonsilar herniation.2. Syrinx from the level of C23 disc space to T78 vertebral level.


Instruction: Generate impression based on findings.

Input: Clinical question: 19-year-old with persistent left origin headaches compatible with migraine. A small percentage of these aneurysm. Check for aneurysm. She is a surgical candidate. Signs and symptoms: Persistent headache. Nonenhanced brain MRI:Normal appearing bilateral intracranial vertebral arteries, bilateral pica branches, basilar artery and its distal branches.Normal appearing right internal carotid artery, right anterior and middle cerebral arteries and their distal branches. Normal appearing small right posterior communicating artery is identified.Normal left internal carotid artery, normal left anterior cerebral artery and its branches. There is anatomical variation of both divisions of the left middle cerebral artery arising from the supraclinoid left internal carotid however without evidence of an aneurysm and with normal distal branches.

Output: Unremarkable intracranial MRA.


Instruction: Generate impression based on findings.

Input: 75-year-old female with radicular right lower extremity pain as well as hamstring weakness Marrow signal remains benign. The conus is normal in signal and morphology and terminates at an appropriate level. Redemonstrated is a gallstone, unchanged in appearance. A simple renal cyst is noted on the left, unchanged.L1/2: Asymmetric bulge to the left and bilateral mild facet hypertrophy with mild central canal stenosis with moderate left and mild right neural foraminal stenosis, unchanged.L2/3: Large Schmorl's node in the upper endplate of L3 and more extensive endplate degenerative bone marrow signal alterations. Diffuse annular disc bulge, ligamentum flavum thickening, prominent posterior epidural fat, and mild to moderate bilateral facet hypertrophy. There is moderate central, moderate bilateral lateral recess, and mild to moderate bilateral neural foraminal stenosis. Findings are unchanged.L3/4: There is a new/recurrent left paracentral disc extrusion which extends below the disc level causing new severe left lateral recess stenosis and now moderate to severe central stenosis. Residual underlying disc bulge, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy with mild right and moderate left neural foraminal stenosis is unchanged. As before there is also evidence of Baastrup's disease.L4/5: There is unchanged grade 1 anterolisthesis of L4 on L5, a disc bulge, ligamentum flavum thickening, moderate to severe left facet hypertrophy, and moderate right facet hypertrophy. There is mild spinal canal and mild bilateral neural foraminal stenosis. There is also evidence of Baastrup's disease. These findings are stable.L5/S1: There is a mild disc bulge and mild left facet hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing. These findings are unchanged.

Output: 1.Redemonstrated is a gallstone.2.L1/2: Mild central canal stenosis with moderate left and mild right neural foraminal stenosis, unchanged.3.L2/3: Moderate central, moderate bilateral lateral recess, and mild to moderate bilateral neural foraminal stenosis, unchanged.4.L3/4: There is a new/recurrent left paracentral disc extrusion which extends below the disc level causing new severe left lateral recess stenosis and now moderate to severe central stenosis. Mild right and moderate left neural foraminal stenosis is unchanged. 5.Mild spinal canal and mild bilateral neural foraminal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: 44-year-old male with cerebral cavernous malformations, yearly surveillance Redemonstrated is cavernous reformation within the right postcentral gyrus which is unchanged in size, signal intensity and overall morphology. Surrounding parenchymal hemosiderin staining remains also similar to prior exam and without perilesional edema. The lesion measures approximately 10 mm in transverse axis which is nearly identical to prior exam. There is no associated cavernous reformation. Also redemonstrated is a small focus of susceptibility in the right thalamus without enhancement or interval change. This may present a focus of microhemorrhage or a second hemorrhaged cavernous reformation. There are no other foci of susceptibility abnormality. Cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise are unremarkable and stable. No abnormal parenchymal, leptomeningeal or calvarial enhancement. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.Stable right postcentral gyrus cavernous malformation.2.Stable punctate focus of susceptibility in the right thalamus which may represent a focus of microhemorrhage or a tiny second cavernous malformation.


Instruction: Generate impression based on findings.

Input: The last well formed disc space is referred to as L5-S1. The spinal cord and cauda equina appear unremarkable. There is disc desiccation at L4-5 and L5-S1 discs with mild loss of disc height at L4-5 and moderate loss of disc height at L5-S1 with endplate degenerative changes at the L5-S1 endplates and mild enhancemnt along the posterior aspect of the L5-S1 disc. There is mild bilateral neural foramen stenosis at L5-S1, but no significant spinal canal stenosis. There is sacral perineural cysts. There is normal alignment of the lumbar spine with preserved vertebral body heights. There is a dominant right renal exophytic cyst and a few subcentimeter left renal cysts.

Output: 1.Mild degenerative spondylosis in the lower lumbar spine with mild bilateral neural foramen stenosis at L5-S1, but no significant spinal canal stenosis.2.No evidence of mass lesions within the spine.3.Large right renal exophytic cyst and few subcentimeter left renal cysts. A dedicated ultrasound exam may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 32 year old male with a family history of cardiomyopathy and newly diagnosed reduced ventricular function referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 130 ml/m2 (normal range: 74+/-15), the LVEDV is 280 ml (normal range 142+/-34), the LV end systolic volume index is 67 ml/m2 (normal range 25+/-9), the LVESV is 143 ml (normal range 47+/-19), the LV mass index is 39 g/m2 (normal range 85+/-15), and the LV mass is 84 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial iron overload. The pre-contrast native myocardial T1 relaxation time is normal (1044 ms). Left AtriumThe left atrium is normal in size . Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 126 ml/m2 (normal range 82+/-16), the RVEDV is 271 ml (normal range 142+/-31), the RV end systolic volume index is 61 ml/m2 (normal range 31+/-9), and the RVESV is 130 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no 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. The left ventricle is moderately dilated with mildly reduced systolic function (LVEF 49%).2. The right ventricle is mildly dilated in size with normal systolic function (RVEF 52%). 3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: eval right distal forearm mass History: above 2 skin markers are present along the dorsal aspect of the forearm and wrist presumably corresponding to the patient's palpable area of concern. There is prominence of the subcutaneous fat in the immediately adjacent area without evidence of an enhancing mass lesion on postcontrast sequences. These findings appear most consistent with a lipoma which is difficult to accurately measure due to the lack of inherent contrast with the adjacent subcutaneous fat. There is no bone marrow signal abnormality in the surrounding area. The imaged musculature of the right forearm is unremarkable. No focal fluid collections are identified to suggest abscess formation. Note is made of prominent synovial enhancement about the radiocarpal and midcarpal joints which may reflect a very mild synovitis. No other abnormal enhancement is seen on postcontrast sequences.

Output: Prominence of the subcutaneous fat corresponding to the patient's palpable area of concern likely representing a lipoma.


Instruction: Generate impression based on findings.

Input: 28-year-old male with low-grade glioma status post resection 2008. Redemonstrated is stable cystic encephalomalacia of the right temporal lobe anteriorly associated with associated gliosis. There is no abnormal enhancement.Redemonstrated is a stable 17 x 36 mm axial dimension extra-axial cyst adjacent to the left inferior and middle frontal gyri as well as the left temporal pole with associated calvarial scalloping present.Redemonstrated is a stable small T2 and FLAIR hyperintense lesion the left thalamus (as compared by T2 coronal technique).No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Normal vascular flow voids are demonstrated.The visualized portions of the paranasal sinuses demonstrate mucous retention cyst in the right maxillary sinus as well as mucosal thickening in the ethmoid air cells, frontal sinuses sphenoid sinuses and left maxillary sinus, unchanged. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for tumor recurrence in the right temporal lobe compared to studies obtained in 2015 and 2012.2.Stable left-sided arachnoid cyst.3.Stable lesion in the left thalamus.4.Persistent pan-sinus changes.