Instruction: Generate impression based on findings.

Input: 46-year-old female with pain. Evaluate for medial meniscal tear. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Heterogeneous bone marrow signal abnormality likely represents residual islands of red marrow. There is a full-thickness articular cartilage cleft along the medial facet of the patella with underlying subchondral signal abnormality. There is also a full-thickness articular cartilage cleft along the median eminence of the patella with underlying subchondral signal abnormality.LIGAMENTS: There is increased signal abnormality within the proximal fibers of the lateral collateral ligament proper indicating a sprain or prior injury. The LCL appears intact. The MCL appears intact. The ACL and PCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Full-thickness articular cartilage clefts along the patella with underlying subchondral signal abnormality. The medial meniscus appears intact. 2. Findings suggestive of a sprain or prior injury of the lateral collateral ligament proper, which appears intact.


Instruction: Generate impression based on findings.

Input: Clinical question: Foraminal narrowing, disc disease? Signs and symptoms: Pain down right shoulder. Nonenhanced cervical spine MRI:Examination demonstrates advanced degenerative disc disease with significant loss of intervertebral disc height at multiple levels and mild reversal of cervical lordosis. The alignment of vertebral column however remains anatomic.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes with subtle left neural foraminal compromise and unremarkable otherwise.C3-C4 demonstrate moderate to severe disc disease and loss of disc height, small bilateral uncovertebral hypertrophic changes and mild facet and ligamentum flavum hypertrophy. Constellation of changes results in moderate to severe left and severe right neural foraminal compromise and mild central spinal stenosis.C4-C5 demonstrates moderate to severe disc disease and loss of disc height, large left and smaller right uncovertebral hypertrophic spur and mild facet and ligamentum flavum degenerative changes. Constellation of changes results in flattening and posterior displacement of the cord without central spinal stenosis and severe left neural foraminal compromise.C5-C6 demonstrate advanced disc disease and near complete loss of disc height, small bilateral uncovertebral hypertrophic changes and small central disc/osteophyte complex, mild left facet and bilateral ligamentum flavum hypertrophy. Constellation of changes and including central disc-osteophyte complex results in flattening and posterior displacement of the cord, moderate central spinal stenosis, moderate to severe right and moderate left neural foraminal compromise.C6-C7 demonstrate advanced disc disease and loss of disc height, central disc-osteophyte complex, bilateral uncovertebral hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. Constellation of findings and including central disc-osteophyte complex results in flattening and posterior displacement of the cord and moderate central spinal stenosis. Severe bilateral neural foraminal compromise is also detected.C7-T1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.T1-T2 demonstrate advanced disc disease and loss of disc height without spinal stenosis however moderate to severe bilateral neural foraminal compromise are identified.

Output: 1.Extensive degenerative changes of cervical spine at C3-C4 through C6-C7 levels and including disc osteophyte complex at C5-C6 and C6-C7 levels as detailed.2.Moderate Central spinal stenosis at C5-C6 and C6-C7 levels are noted.3.There is also multilevel bilateral neural foraminal compromise (some severely) as detailed per level above.4.T1-T2 demonstrate degenerative disc disease, loss of disc height and bilateral neural foraminal compromise without central spinal stenosis.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. There is interval progression of moderate loss of disc height at L1-L2 with probable vacuum disc phenomenon. There is STIR signal abnormality at the superior endplate of L2 and inferior endplate of L4, corresponding to areas of Schmorl's nodes. There is diffuse hypointense marrow signal. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.T12-L1: Bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Disc bulge with superimposed central disc protrusion and bilateral facet degeneration, contributing to mild spinal canal stenosis and moderate bilateral foraminal stenosis. L2-L3: Disc bulge with superimposed central disc protrusion and bilateral facet degeneration, contributing to mild spinal canal stenosis and mild bilateral foraminal stenosis. L3-L4: Disc bulge, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild spinal canal stenosis and mild bilateral foraminal stenosis. L4-L5: Disc bulge, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild spinal canal stenosis and moderate right and mild left foraminal stenosis. L5-S1: Disc bulge, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild spinal canal stenosis and moderate left and mild right foraminal stenosis.

Output: 1. Advanced degenerative changes of the lumbar spine with multilevel foraminal and spinal canal stenosis as described above, with interval progression particularly at L1-L2 and L4-L5.2. Interval progression of facet arthropathy throughout the lumbar spine, which may contribute to patient's symptoms.3. Diffuse hypointense marrow signal, which may be related to patient's endstage renal disease or as chronic anemia.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [R40.4], Reason for Study: ^Reason: Please evaluate for seizure focus or myelination disorder History: Ex-full term, global developmental delay, staring spells, R parietal spikes, family history of idiopathic Lennox-Gast No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The cortical thickening on bilateral maxillary sinus.

Output: Normal brain MRI scan.


Instruction: Generate impression based on findings.

Input: Laser ablation. There has been right hippocampal laser ablation, with peripheral enhancement associated with the ablation zone. There are also postoperative findings related to recent removal of bilateral temporal lobe deep brain electrodes. There is no gross evidence of intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is mucosal thickening in the right anterior ethmoid and frontal sinuses.

Output: Expected postoperative findings related to right hippocampal laser ablation.


Instruction: Generate impression based on findings.

Input: There is hemosiderin staining involving the choroid plexus of the lateral ventricles and the fourth ventricle, as well as within debris located in the dependent portions of the occipital horns bilaterally. Additionally, hemosiderin lines the occipital lobes bilaterally (left>right). There is evidence of colpocephaly with associated white matter loss, left greater than right. The corpus callosum is diffusely thinned. These findings are compatible with periventricular leukomalacia. There is slight dysmorphism of the quadrigeminal plate, and the CSF does not demonstrate flow on the sagittal CSF flow images at the level of the aqueduct, yet the aqueduct appears patent on the sagittal fiesta images.The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. No diffusion-weighted abnormalities to suggest acute ischemia are identified. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear.

Output: 1.Findings most compatible with colpocephaly and periventricular leukomalacia with evidence of prior ventricular hemorrhage. 2.There is slight dysmorphism of the quadrigeminal plate, and the CSF does not demonstrate flow on the sagittal CSF flow images at the level of the aqueduct, yet the aqueduct appears patent on the sagittal fiesta images.


Instruction: Generate impression based on findings.

Input: 71-year-old female with a history of metastatic breast cancer presents with right hip pain and lower back pain after fall. Lumbar spine:Again seen are pathologic compression fractures affecting the T12, L4, and L5 vertebral bodies, appearing similar to the prior study. Multiple sclerotic foci are identified within the vertebral bodies of the lumbar spine consistent with the patient's known history of metastatic disease. Vascular calcifications of the aorta.Right femur:Note is made of multiple sclerotic lesions within the imaged portions of the right hemipelvis including the right iliac bone and obturator ring. There are also sclerotic foci within the right femoral neck, intertrochanteric region, metaphysis and proximal diaphysis also consistent with metastatic disease. Mild degenerative changes affect the right hip. No acute fracture is evident. Deformity of the right obturator ring consistent with prior remote trauma as seen on prior MRI examination.

Output: Osseous metastatic disease with multiple pathologic vertebral body compression fractures of the lumbar spine and deformity of the right obturator ring consistent with prior remote trauma/pathologic fracture.


Instruction: Generate impression based on findings.

Input: Reason: recurrent shoulder dislocation History: recurrent shoulder dislocation. ROTATOR CUFF: The rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: No fluid or gadolinium is present in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a full-thickness defect of the articular cartilage involving the anterior inferior glenoid measuring approximately 5 mm in AP dimension and at least 1 cm in CC dimension. The adjacent anterior inferior labrum is attached to the glenoid without gadolinium interposition to indicate a tear. Although we see no gadolinium entering the posterior labrum, the posterior labrum is slightly deformed with prominent undercutting by intermediate signal which could represent a chronic tear. Furthermore, the adjacent inferior labrum (from the 5 to 7:00 positions) appears attenuated. What we presume to be the anterior band of the inferior glenohumeral ligament appears to attach somewhat more superomedial than usual, but this is of uncertain clinical significance.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: Findings compatible with prior dislocation including a Hill-Sachs deformity and full-thickness articular cartilage loss along the anterior inferior glenoid. Although the anterior inferior labrum appears attached to the glenoid, slight deformity of the posterior labrum and attenuation of the inferior labrum may reflect labral tearing. Furthermore, the presumed anterior band of the inferior glenohumeral ligament appears to attach to the glenoid superomedial to usual, but the clinical significance of this is uncertain.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: stroke eval History: as above Brain MRIThere are gyriform restricted diffusion involving right precentral and postcentral gyri indicating acute ischemic infarct without evidence of hemorrhagic transformation.Underlying brain shows multifocal encephalomalacia involving bilateral basal ganglia, caudate nucleus and bilateral thalami indicating prior ischemic infarct.Scattered bihemispheric FLAIR/T2 high signal intensity lesions involving periventricular white matter and centrum semiovale indicate underlying nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifact degraded exam quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate there is a focal signal loss at the junction of right MCA M1 and M2 segment. However, due to patient's significant motion artifact, this signal loss could be an artifact, therefore, if clinically indicated, CT angiography can be considered for further imaging evaluation.Left MCA mid M1 segment 2 the distal M1 segment shows gradual narrowing of the lumen which could indicate atherosclerotic changes. However can't, this finding could also be an artifact.Right ACA A1 segment appears to be hypoplastic.About 20% of luminal stenosis of distal left vertebral artery just before the vertebrobasilar junction. Otherwise posterior circulation appear to be normal.

Output: 1. Right precentral and postcentral gyri acute ischemic infarction without evidence of hemorrhagic transformation.2. Right MCA distal M1 segment signal loss may indicate severe luminal stenosis or intraluminal thrombus. However, possibility of artifactual lesion cannot be excluded. In addition, there is gradual tapering of the left MCA M1 segment lumen which may indicate atherosclerotic changes, however, this lesion could also be related to motion artifacts. Therefore, head and neck CT angiography is recommended for further imaging evaluation of vascular structures. 3. Underlying brain shows multifocal chronic ischemic infarctions with encephalomalacia4. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with for screening affects his and numbness on the right side of the body, exclude thoracic disc or demyelination. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen. No abnormal marrow space enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal cord lesions are seen. No epidural abnormalities are suspected. No pathologic intradural or extradural enhancement is detected.The intervertebral discs are normal in height. At T7-8, there is a small left paracentral disc protrusion. At no level is there any significant spinal canal or foraminal stenosis.

Output: No significant findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: T4N0 nasopharynx adenoid cystic carcinoma, status post chemoradiation. There is a small amount of ill-defined enhancing soft tissue in the left nasopharyngeal region. There is mild scattered paranasal sinus mucosal thickening. There are also persistent left otomastoid effusions. There is no significant cervical lymphadenopathy. The thyroid and salivary glands appear unchanged. There is persistent fluid within the left mastoid air cells and middle ear. The orbits are unremarkable. There is no discernible residual intracranial mass.

Output: Minimal residual treated tumor in the left nasopharyngeal region.


Instruction: Generate impression based on findings.

Input: A 61 year old male with personal history of hypertension, hyperlipidemia and ischemic cardiomyopathy who is now hospitalized with heart failure symptoms and multiple vessel disease on angiography. Referred to cardiac MRI to assess viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 177 ml/m2 (normal range: 74+/-15), the LVEDV is 388 ml (normal range 142+/-34), the LV end systolic volume index is 152 ml/m2 (normal range 25+/-9), the LVESV is 335 ml (normal range 47+/-19), the LV mass index is 119 g/m2 (normal range 85+/-15), and the LV mass is 261 g (normal range 164+/-36). There severe global hypokinesis with regional variation.There is basal aneurysm of the inferior-inferoseptal wall. There is an apical aneurysm. There are several areas with late gadolinium enhancement: the apical cap, the basal-mid inferior-inferoseptum (non-transmural), the proximal part of the base-apical anterior and anteroseptal walls (non-transmural at the proximal aspect of the base and mid segments, transmural at the apex). These findings represent fibrosis secondary to old myocardial infarction (s). The anterior and anteroseptal walls have intermediate to no viability. The apex is not viable. The remainder of the myocardium appears viable. There is moderate hypertrophy of the non-infarcted myocardium (up to 16mm at the basal anteroseptum). No intracavitary thrombus was seen.Left AtriumThe left atrium is severely dilated (216ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 185 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 106 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild 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 sinus of valsalva measures 44 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.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 severely dilated with severely reduced systolic function, the LVEF is 14%. There severe global hypokinesis with regional variation.There is basal aneurysm of the inferior-inferoseptal wall. There is an apical aneurysm.2. There are several areas with late gadolinium enhancement: the apical cap, the basal-mid inferior-inferoseptum (non-transmural), the proximal part of the base-apical anterior and anteroseptal wall (non-transmural at the proximal aspect of the base and mid segments, transmural at the apex). These findings represent fibrosis secondary to old myocardial infarction (s). The anterior and anteroseptal walls have intermediate viability. The apex is not viable. The remainder of the myocardium appears viable. There is moderate hypertrophy of the non-infarcted myocardium (up to 16mm at the basal anteroseptum). 3. No intracavitary thrombus was seen.4. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 43%. 5. The left and right atrium are severely dilated. 6. The sinus of valsalva measures 44 mm.8. The main pulmonary artery is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: Pt with history of CVA and residual right sided deficits, evaluate for possible worsening History: as above Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is slit like tissue defect on the left basal ganglia in particular putamen with susceptibility artifacts indicate chronic hemorrhagic infarction, no change since prior scan.Non specific small vessel ischemic changes on bilateral periventricular white matter, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal various degree intracranial and extracranial arterial luminal stenosis were seen.In particular, the left MCA proximal M1 segment just beyond the the left ICA bifurcation shows more than 70% luminal stenosis. The right ICA cavernous sinus segment and the right MCA proximal M1 segment also show about 50% luminal narrowing.Comparing to prior scan, the left MCA M1 segment luminal narrowing appears to be slightly progressed but the right ICA cavernous sinus segment showed slightly improved since prior scan. Due to inherent technical issue, the degree of luminal stenosis progression of internal carotid artery cannot be reliably compared especially with TOF MRA technique. Therefore, if clinically indicated CTA should be considered. Bilateral extracranial ICA at the junction of cervical segment and carotid canal segment shows more than 50% luminal stenosis. Vertebrobasilar system appears to be slightly ectatic in luminal diameter and irregular lumen without evidence of luminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of chronic hemorrhagic infarction on the left basal ganglia and non specific small vessel disease since prior scan.3. More than 70% stenosis of the left MCA proximal M1 segment stenosis and about 50% stenosis of the right ICA cavernous sinus segment and bilateral extracranial ICA at the junction of cervical segment and carotid canal segment. CTA of head and neck can be considered for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: 60-year-old female with left breast carcinoma with brain metastases. There has been no significant interval change in size of an enhancing lesion in the left superior parietal lobe, which again measures up to 2 mm. There are additional scattered subcentimeter lesions with associated susceptibility in the superior portion of the right precentral gyrus and left inferior parietal lobule. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in size in size of a metastatic lesion in the left superior parietal lobe and other subcentimeter metastatic lesions with susceptibility in the superior portion of the right precentral gyrus and left inferior parietal lobule. No new pathological enhancement.


Instruction: Generate impression based on findings.

Input: Right pain following injury MENISCI: The lateral medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is mild diffuse thinning of the articular cartilage of both the lateral and medial compartments. There is no focal full-thickness articular cartilage defect. A small partial-thickness defect of the medial patellar facet is noted. There is mild diffuse thinning of the articular cartilage of the femoral trochlea but no discrete full-thickness defect appreciated.LIGAMENTS: The ACL is torn. The PCL is intact. The medial and lateral collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Ruptured ACL with associated marrow contusions of the lateral femoral condyle and tibial plateau.2. Moderate joint effusion.3. Mild diffuse thinning of the articular cartilage of the knee without discrete full-thickness defect.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out ischemic stroke. Signs and symptoms: Left upper extremity numbness, condition the accompanied by left face and left lower extremity numbness. Nonenhanced brain MRI:Diffusion weighted images demonstrate a small subtle focus of restricted diffusion in the right posterior/inferior aspect of pons. Finding is not associated with any susceptibility signal change to suggest hemorrhage. Flair and T2 weighted images also also demonstrate this finding. In addition there is a focus of chronic corner infarct adjacent to this finding.Images through supratentorial space demonstrate extensive periventricular and to a lesser degree subcortical foci of flair hyperintensity highly suggestive of moderate chronic nonhemorrhagic small vessel ischemic strokes. Minimal similar findings in the right basal ganglia is also noted.There is no evidence of chronic cortical stroke.The ventricular system and cortical sulci remain within normal size and maintained midline.The signal voids of major intracranial branches are identified.Unremarkable calvarium, orbits and paranasal sinuses

Output: 1.Small subtle focus of restricted diffusion in the right posterior/inferior aspect of pons.2.Findings suggestive of moderate chronic nonhemorrhagic small vessel ischemic strokes and including chronic ischemic strokes of the pons.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Unspecified esotropia [H50.00], Possible Mobius syndrome Esotropia, possible CN 6 palsy, also with sensorineural hearing loss. Medial rectus recession. The examination is limited by motion artifact.With regards to myelination, there is no significant deviation from the expected normal for patient's age. The dorsal pons and middle cerebellar peduncles appear slightly hypoplastic. The gray-white matter differentiation is preserved. No midline shift or mass effect is appreciated. The cortical sulci are in proportion to the cerebral ventricles. No intracranial hemorrhage is identified. There is no diffusion restriction to suggest acute ischemia. No abnormal parenchymal enhancement is seen. There is fluid present in the right mastoid air cells with mild scattered paranasal sinus because of thickening.The bilateral internal auditory canals are suboptimally evaluated secondary to motion artifact and technique, however appear to be grossly unremarkable. No cerebellopontine angle masses are identified. The CSF spaces around the brainstem are visualized.The globes appear symmetric and normal in size. The bilateral optic nerves demonstrate normal caliber and signal intensity. The ocular muscles appear unremarkable. No abnormal postcontrast orbital enhancement is identified.

Output: 1. The dorsal pons and middle cerebellar peduncles appear slightly hypoplastic. The cranial nerves are not well delineated on this examination. If further evaluation is needed, a dedicated cranial nerve protocol may be considered.2. There is fluid present in the right mastoid air cells with mild scattered paranasal sinus mucosal thickening.3. Grossly unremarkable appearance of the bilateral orbits.


Instruction: Generate impression based on findings.

Input: LIGAMENTS: No significant abnormality noted.TENDONS: There is abnormal linear signal ("T sign") indicating at least a partial thickness tear of the anterior band of the ulnar collateral ligament near its insertion onto the sublime tubercle. The remaining tendons of the elbow appear normal.ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Disruption of the anterior bundle of the ulnar collateral ligament


Instruction: Generate impression based on findings.

Input: Recurrent symptoms after microdiscectomy. There is sacralization of the L5 vertebra. There are postoperative findings related to microdiscectomy at L3-4, with patchy enhancement in the soft tissues along the surgical approach. There is a central disc extrusion with superior migration that measures up to 9 mm in width and 17 mm in length superimposed upon a disc bulge at L3-4, which results in severe spinal canal narrowing. In conjunction with bilateral facet hypertrophy at this level, the bilateral neural foramina are at least moderately narrowed. There is a disc bulge and bilateral facet hypertrophy at L4-L5 with mild bilateral lateral recess narrowing and mild left and moderate right neural foraminal narrowing. There is mild degenerative spondylosis at L1-2 and L2-3, without significant spinal canal or neural foraminal stenosis. Aside from mild degenerative signal alterations, the vertebral bone marrow signal is unremarkable. There are multilevel small intravertebral disc herniations, but the vertebral body heights are essentially preserved otherwise. The spinal cord displays normal signal and morphology. There is a large right renal cyst.

Output: 1. Postoperative findings related to microdiscectomy at L3-4, with a central disc extrusion superimposed upon a disc bulge at this level and resultant severe spinal canal narrowing. In conjunction with bilateral facet hypertrophy at this level, the bilateral neural foramina are at least moderately narrowed.2. A disc bulge and bilateral facet hypertrophy at L4-L5 result in mild bilateral lateral recess narrowing and mild left and moderate right neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Clinical question: Restaging of NSCLC -- blurry vision, evaluate for optic nerve. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted images. Revisualization of previously noted focus of increased signal intensity on diffusion weighted images at the level of previously treated tumor lateral to the left thalamus stable since prior exam and without evidence of enhancement.Stable post operative changes of left frontal craniotomy for removal of tumor with revisualization of a tiny linear enhancement along the posterior surgical cavity wall representing posttreatment change.Stable residual flair hyperintensity surrounding the surgical cavity consistent with paralysis.Stable diffuse periventricular and subcortical white matter flair hyperintensity in bilateral cerebral hemispheres consistent with posttreatment /radiation changes.There is no detectable abnormal parenchymal, leptomeningeal or calvarial enhancement to suggest metastatic disease.Unremarkable images through the orbits including axial fat sat post enhanced series. Although this is not a dedicated CT scan for assessment of optic nerves there is no detectable abnormality of the optic nerves in this study. If clinical concern for optic nerve pathology persists recommend dedicated MRI of the orbits. Unremarkable signal void of major intracranial arterial branches.The signal void of intracranial venous sinuses are within normal and with normal pattern of enhancement. Minimal ethmoid sinus disease and unremarkable paranasal sinuses otherwise.Extensive opacification of bilateral mastoid air cells without suggestion of opacification of middle ear cavities similar to prior exam.

Output: 1.No detectable acute or new finding since prior study.2.No detectable abnormality of the orbits and optic nerves on this nondedicated exam.3.Stable post surgical changes of left frontal tumor resection without recurrence.4.Focus of T2 hyperintensity without enhancement lateral to the left thalamus representing treated metastases.5.No detectable abnormal parenchymal, meningeal, calvarial and orbital enhancement to suggest metastases.6.Diffuse opacification of bilateral mastoid air cells without involvement of middle ear cavities similar to prior exam.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (6/15/16), ultrasound images of left breast (9/1/15), breast MRI (2/26/15) performed at outside institution. For comparison, digital mammographic images (12/15/14), ultrasound images of left breast (12/15/14), images from stereotactic biopsy with specimen radiograph and postprocedural left mammographic images (1/6/15), images from ultrasound guided biopsy of left breast (1/6/15) are available. DIGITAL MAMMOGRAPHIC IMAGES (6/15/16):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B). An irregularly mass with extensive pleomorphic calcifications are present in the lower inner quadrant in the left breast. The mass measures approximately 4 cm and the calcifications extends anteroposteriorly approximately 7.5 cm. Calcifications are more extensive than those in the prior study (12/15/14). A marker clip is present within the mass. Pathology result from prior ultrasound guided biopsy of the mass was DCIS.Another marker clip is present at middle upper outer quadrant in the left breast, from prior stereotactic biopsy, resulting in DCIS. There are scattered calcifications around the clip, spanning approximately 4 cm posteriorly and laterally. THere are no significant changes in these calcifications.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (9/1/15):There is an irregularly shaped mass at 7-8:00 position in the left breast measuring 37 x 21 mm (previously 29 x 13 mm on 12/15/14), corresponding to biopsy-proven DCIS. There is ductal extension from the mass.BREAST MRI (2/26/15):There is non-mass enhancement at lower inner quadrant measuring 78 x 24 mm (AP x LR) in the left breast. Non-mass enhancement extends to the nipple. A clip artifact is seen at the middle portion of the non-mass enhancement. There are biopsy changes including signal void and area of high single intensity on STIR images at upper outer quadrant in the left breast, corresponding to the area of prior stereotactic biopsy. No abnormal enhancement is seen around this area.There are scattered enhancing foci in the right breast, likely background parenchymal enhancement.An enlarged lymph node, measuring 13 mm, is present in the left axilla.

Output: 1. Known left breast malignancy; increase in size of the mass with progression of extensive calcifications in the left lower inner quadrant, no change in the calcifications in the upper outer quadrant in the left breast.2. Enlarged lymph node in the left axilla3.No mammographic or MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Low back pain. The vertebral column alignment is within normal limits. There is increased T2 signal and low T1 signal at the endplates of L3-4 likely related to degenerative changes. There is multilevel disc desiccation and moderate loss of height of the L3-4 disc, with what appears to be herniation of disc into the posterior L3 vertebral body. The spinal cord displays normal signal and morphology. There is a partially imaged right renal cyst. There is a large well-circumscribed T1 and T2 hyperintense lesion within the right iliacus muscle, which likely represents a lipoma.Interspace observations:T11-12: There is no significant compromise to spinal canal or neural foramina.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is disc bulge, facet hypertrophy with effusions and possible small synovial cysts, and ligamentum flavum thickening, as well as mild epidural lipomatosis, which cause moderate central canal and moderate right and moderate to severe left neural foraminal narrowing.L4-5: There is disc bulge, facet hypertrophy with effusions, and ligamentum flavum thickening, which cause mild central canal stenosis, as well as moderate to severe right and moderate left neural foraminal narrowing.L5-S1: There is a minimal disc bulge, facet hypertrophy, and ligamentum flavum thickening with mild bilateral neural foraminal narrowing, but no significant spinal canal narrowing.

Output: Degenerative spondylosis with moderate central canal and moderate right and moderate to severe left neural foraminal narrowing at L3-4 and mild central canal stenosis, as well as moderate to severe right and moderate left neural foraminal narrowing at L4-5.


Instruction: Generate impression based on findings.

Input: Clinical question: Normal cavernous sinus pathology/posterior communicating artery aneurysm. Signs and symptoms: Right retro-orbital pain, head CT from outside hospital showed the right frontal hyperdense area. None infuse CT of brain:Examination demonstrates a small area of approximately 8mm times 8mm increased density within the cortex of right frontal lobe. This is not associated with any detectable edema or mass effect. The finding is believed to represent subtle calcification and likely a cavernoma. Further evaluation with a dedicated MRI examination is recommended.Examination the right no additional area of abnormal density, edema, hemorrhage, mass-effect, midline shift or hydrocephalus. Images at the level of the cavernous sinuses demonstrate no pathology. Calvarium, limited real paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. CTA of intracranial circulation:Carotid system.Supraclinoid internal carotids, bilateral anterior and middle cerebral arteries and their branches are visualized and no evidence of abnormality.There is no evidence of aneurysm of the posterior communicating arteries as clinically is questioned. Very small bilateral posterior communicating arteries can be detected only on MIP 2-D images and is not visualized on reformatted 3-D images.Vertebral basilar system:There is no evidence of aneurysm. Both intracranial vertebral arteries are visualized and unremarkable. Basilar artery is widely patent. Bilateral superior cerebellar arteries and posterior cerebral arteries are also unremarkable.Extensive motion artifact obscures some of the detail in both carotid systems and vertebral basilar system. The motion artifact causes significant irregularity and apparent narrowing of intracranial vertebral arteries bilaterally and irregularity of basilar artery.This examination demonstrates no detectable abnormality of cavernous sinuses as clinically is questioned. However note should be made that cavernous sinuses can be significantly better evaluated by an MRI examination read in the CTA. If clinical concern for cavernous sinus abnormality persist an MRI examination of brain is recommended which will also help for further evaluation of small calcific lesion in the right frontal lobe.

Output: 1.Small area of cortical increased density in the right frontal lobe is highly suspected of calcification of a small cavernoma. Follow-up with an MRI exam is recommended. Unremarkable CT of brain without contrast otherwise.2.Essentially unremarkable CTA of intracranial circulation.3.Motion artifact in particular through the images of posterior fossa creates significant irregularity and apparent stenosis of vertebral arteries.4.MRI examination is recommended for further evaluation of a small calcific lesion within the right frontal lobe (likely a cavernoma) as well as cavernous sinuses which cannot be properly Vater that on CTA.


Instruction: Generate impression based on findings.

Input: 29 years Female (DOB:12/4/1986)Reason: paraspinal abscess History: paraplegiaReferring Attending: AGNIESZKA A ARDELT Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. Postcontrast sagittal T1 images, T2 STIR images and postcontrast axial T1 images are degraded due to artifact which in general it suggestive of dielectric effect.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is no compromise to lumbar spinal canal or exiting nerve roots.2.No obvious mass is identified in the lumbar spinal canal.3.Exam is somewhat degraded due to artifact. This may obscure more subtle abnormalities.4.Please refer to MRI of the thoracic spine for further comments


Instruction: Generate impression based on findings.

Input: 45-year-old female with high risk of breast cancer, needs MRI for continued monitoring. There is heterogeneous amount of fibroglandular tissuein both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a homogeneously enhancing benign morphology mass in the 2 o'clock position of the right breast, posterior depth, measuring 17 x 10 x 11 mm (AP X ML X CC), unchanged from prior examination. This mass is a biopsy proven fibroadenoma and a biopsy clip is noted medially. There are 2 stable homogeneously enhancing benign morphology masses in the left central breast, mid depth, measuring 10 x 8 x 7 mm (AP X ML X CC), previously measured 9 x 7 x 7 mm in the 12 o'clock position and 5 x 5 x 5 mm, previously measured 6 x 5 x 5 mm in the 9 o'clock position. A biopsy clip is noted adjacent to the mass in the 10 o'clock position. No abnormal enhancement is noted in either breast. There are no abnormal lymph nodes.

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


Instruction: Generate impression based on findings.

Input: Syrinx, follow-up thoracic disk disease Again seen is a thoracic syrinx extending from the T3-T4 to the T7-T8 levels. It again measures up to 5 x 5 mm in greatest axial dimensions at T4-T5. There is diffuse atrophy of the cord with cystic-appearing diffuse myelomalacia at T7-T8. The positioning of the thoracic cord within the thoracic spinal canal is unchanged, with focal ventral kinking centered at the mid T6 level. Exaggerated thoracic kyphosis is again noted.Multilevel spondylotic changes are again noted, without significant interval change. Vertebral body heights are preserved. There is multilevel disc narrowing and desiccation, more conspicuous along the upper to midthoracic spine. Disc narrowing is also noted at L1-L2, with minimal stable grade 1 retrolisthesis at this level as well as of L2 on L3. Small perineural cysts are again seen in the lower thoracic spine.Counting sequences demonstrate additional spondylotic changes along the cervical spine with trace degenerative subluxations of C4 on C5 and C5 on C6.

Output: 1. Stable extent and caliber of thoracic syringohydromyelia extending from T3-T4 to T7-T8. Mid thoracic cord atrophy with areas of myelomalacia.2. Stable kinked contour of the mid thoracic cord at the mid T6 level where it abuts the ventral dural surface. Findings again may be related to granulation tissue however transdural cord herniation cannot be excluded. 3. Stable scattered degenerative changes with exaggerated kyphosis. Additional lumbar and cervical spondylotic changes partially visualized.


Instruction: Generate impression based on findings.

Input: Compared to the previous study there is a suprasellar mass that measures 22 mm in the CC diameter (601/14) unchanged since the previous study. In the axial view the mass measures 17 x 15 mm (701/12), not significantly changed since the previous study. The cavernous carotids appear normal. The mass abuts the optic chiasm and displaces of the chiasm and left optic nerve superiorly. The left anterior cerebral artery is slightly displaced superomedially.There is subcortical T1 hypointensity and T2 hyperintensity in the right subcentral lobule extending to the right supramarginal gyrus with volume loss representing encephalomalacia. The area is surrounded by FLAIR hyperintensity representing gliosis.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.

Output: 1.Suprasellar mass is grossly unchanged in size since the previous study. 2.Encephalomalacia of the right subcentral lobule extending to the right supramarginal gyrus.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: History of elevated PSA with prior negative biopsy. 6.3 - 10.9 - 7.87 - 12.85 PELVIS:PROSTATE:Prostate Size: 5.3 x 6.3 x 5.6 cmPeripheral Zone: The peripheral zone is relatively homogeneously hyperintense on T2-weighted imaging without a dominant discrete lesion. No discrete lesion with restricted diffusion.Central Gland: Changes from benign prostatic hyperplasia.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Non-specific right external iliac lymph node measuring approximately 7 mm in short-axis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No discrete lesion is evident.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of hydrocephalus. Evaluate hydrocephalus. There is no evidence of intracranial hemorrhage, mass, or extra-axial fluid collection.There is moderate hydrocephalus involving the third ventricle and lateral ventricles bilaterally. There is no evidence of intracranial mass or other obstructive lesion. The cerebral aqueduct of Sylvius is patent. The fourth ventricle within normal limits. There is minimal effacement of the sulci in the parietal occipital lobes bilaterally. There is no midline shift. There are bilateral areas of low attenuation noted in the subcortical white matter of the posterior frontal lobes which are not consistent with transependymal exiting of CSF. These findings are nonspecific and clinical correlation with the patient's history and comparison with the prior CT examination is recommended. If no prior examinations are available, further evaluation with MRI could be considered.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. There is extensive opacification of the left ethmoid air cells associated with minimal bony remodeling.

Output: 1.Moderate hydrocephalus involving the third ventricle and the lateral ventricles bilaterally without a definitive obstructing lesion or mass.2.Bilateral areas of low attenuation in the subcortical white matter of the posterior frontal lobes. These findings are nonspecific and clinical correlation with the patient's history and comparison with the prior CT examination is recommended. If no prior examinations are available, further evaluation with MRI could be considered.3.Opacification of the left ethmoid air cells associated with minimal bony remodeling. Clinical correlation is indicated and further evaluation with a dedicated CT sinus examination is recommended.


Instruction: Generate impression based on findings.

Input: 53-year-old female with tense swelling of the right palm along the thenar muscles for a year. X-rays negative. Note is made of a lobulated mass along the volar aspect of the first metacarpal which demonstrates fat signal intensity on all pulse sequences with thin peripheral enhancement on postcontrast sequences, measuring 3.9 x 3.1 x 3.9 cm (TR by AP by CC) most consistent with a lipoma. There is associated medial displacement of the adductor and abductor pollicis musculature. A skin marker overlies the volar aspect of the aforementioned mass presumably corresponding to the patient's palpable area of concern. There are subcentimeter foci of fluid signal intensity within the base of the second metacarpal with thin peripheral enhancement on postcontrast sequences which may represent subchondral cyst formation or ganglion. No additional bone marrow signal abnormalities are identified. The remainder of the flexor and extensor tendons appear intact. The imaged musculature of the right hand is normal in appearance.

Output: Findings most consistent with a lipoma along the volar aspect of the first metacarpal.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of liver hemangioma.Additional history per EMR: This was diagnosed by outside hospital CT from 5/13/2015, showing an 8 x 7.8 cm hypodense mass in the porta hepatis extending to the inferior left lobe of the liver with irregular peripheral somewhat nodular enhancement within the mass. Probable 2 cm segment 6 hemangioma as well. ABDOMEN:LIVER, BILIARY TRACT: There is a 7.8 x 8.1 cm exophytic lesion in the caudate lobe demonstrating marked T2 hyperintense signal and peripheral discontinuous nodular enhancement iso-intense to blood pool with gradual central fill-in on postcontrast images, compatible with stated history of hemangioma. The lesion demonstrates mass effect onto the intrahepatic IVC.A small 2.1 cm peripheral right hepatic lobe segment 6 lesion demonstrates similar imaging characteristics, compatible with an additional hemangioma. No other focal hepatic lesion is identified.No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant adrenal nodularity or thickening.KIDNEYS, URETERS: Bilateral simple cysts are noted. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two hepatic lesions are consistent with hemangiomas. The large caudate lobe hemangioma demonstrates mass effect upon the intrahepatic IVC which is patent.


Instruction: Generate impression based on findings.

Input: 48-year-old woman with history of sarcoid, cirrhosis, and ascites with liver lesion noted on CT. Please note that this examination is limited to dielectric artifact from volume of ascites.ABDOMEN:LIVER, BILIARY TRACT: There is a poorly defined, approximately 39 x 38 mm region of increased T1 signal in segment 4A (series 801, image 44) which demonstrates loss of signal with opposed phase imaging (series 801, image 43). This area demonstrates very slightly increased T2 signal relative to the remaining liver parenchyma and does not appear to abnormally enhance.The hepatic fissures are widened, there is caudate hypertrophy, and decreased parenchymal signal. Scattered, subcentimeter hepatic cysts are noted.The portal vein is patent. There is no intrahepatic biliary duct dilatation. The gallbladder is distended but normal.SPLEEN: The spleen is enlarged to 20 cm. Numerous perisplenic varices are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a right upper pole renal cyst, the kidneys are otherwise normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The partially visualized small bowel is normal. The colon is gas distended up to 5.3 cm..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a large amount of ascites.

Output: 1.Focal fat in segment 4 of the liver corresponding to lesion seen on prior CT.2.Cirrhotic liver morphology with splenomegaly and perisplenic varices.3.Large volume of ascites with artifact which slightly limits this examination.


Instruction: Generate impression based on findings.

Input: New onset seizure. Examination demonstrates diffuse edema in the right frontal lobe and genu of corpus callosum. The appears slightly effacement of the frontal horn of the right lateral ventricle. These findings have been unchanged since prior MRI. There is no intracranial hemorrhage, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in size and symmetric.The visualized paranasal sinuses and mastoid air cells are normally pneumatized. In view of the orbits is unremarkable. The calvarium is intact.

Output: Right frontal cerebral edema with involvement of the genu of corpus callosum likely represent underlying tumor (primary versus metastasis).


Instruction: Generate impression based on findings.

Input: Resection of ovarian metastases. There are postoperative findings related to recent right frontal craniotomy for resection of a right frontal lobe metastases. There is an intermediate T1 and low T2 signal epidural collection with susceptibility effect in the right frontal convexity anterior to the craniotomy margin that measures up to 20 mm in thickness. There is fluid and hemostatic agent within the right middle frontal gyrus resection cavity, which displays fine linear enhancement along the anterior margin. In addition, there is mild diffuse restricted diffusion surrounding the resection cavity that is out of proportion to the extent of susceptibility effects from blood products. There is also persistent extensive vasogenic edema surrounding the resection cavity. Likewise, there is considerable vasogenic edema associated with the left frontal lobe and right peritrigonal metastases. Overall, there is resultant 8 mm of midline shift to the left, subfalcine and uncal herniation, and partial effacement of the right lateral and third ventricles, which is unchanged. A subcentimeter metastasis in the right cerebellar hemisphere is associated with mild surrounding vasogenic edema. The major cerebral flow voids are intact.

Output: 1. Recent postoperative findings with a right frontal convexity epidural hematoma that measures up to 20 mm in thickness.2. Fine linear enhancement along the anterior margin of the right frontal lobe resection cavity may represent residual neoplasm or post-treatment effects, although the extensive vasogenic edema and remaining intracranial metastases persist and contribute to 8 mm of midline shift to the left, subfalcine and uncal herniation, and partial effacement of the right lateral and third ventricles, which is unchanged. 3. Mild acute ischemic changes surround the right frontal lobe resection cavity, but no evidence of acute territorial cerebral infarction.


Instruction: Generate impression based on findings.

Input: Lower back pain, bilateral foot numbness with exercise. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: minimal ligamentum flavum thickening, no neuroforaminal narrowing or spinal stenosis. L2-L3: minimal ligamentum flavum thickening, no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal ligamentum flavum thickening, no neuroforaminal narrowing or spinal stenosis. L4-L5: dessication of disc. Minimal ligamentum flavum thickening, facet joint osteophytes with minimal bulging of disc causing minimal spina canal stenosis. Especially there is disc bulging toward left side neural foramen causing mild neuroforaminal narrowing. L5-S1: disc dessication with diffuse minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Disc dessication and degeneration, L45 and L5S12. Mild spinal stenosis at the level of L45 with left L45 neuroforaminal mild narrowing as described above.


Instruction: Generate impression based on findings.

Input: Arm weakness The examination is limited by motion artifact and pulsation from surrounding vessels.The musculature of the forearm is normal in caliber and signal without evidence of abnormal atrophy or edema. There is no evidence of a mass lesion or mass effect upon the forearm. The bone marrow signal of the radius and ulna are normal.

Output: Normal unenhanced MRI of the forearm.


Instruction: Generate impression based on findings.

Input: There is reversal of the normal cervical lordosis. There is degenerative anterior spondylolisthesis of C3-4 and C4-5 as well as degenerative posterior spondylolisthesis of C6-7. There is diffuse disc desiccation and loss of intervertebral disc space height at C4-5 through C6-7. The vertebral body heights are maintained. There are mild degenerative endplate changes of C4-5 through C6-7, as well as a Schmorl's node in the superior endplate of C6. The cervical and upper thoracic cord are normal in signal and morphology. The imaged intracranial structures are unremarkable.C2/3: No significant spinal canal stenosis or neural foraminal narrowing.C3/4: Facet joint arthropathy, a small posterior disc osteophyte complex and uncovertebral joint hypertrophy results in moderate bilateral neural foraminal narrowing, but no significant spinal canal stenosis.C4/5: Posterior disc osteophyte complex, uncovertebral joint hypertrophy and facet joint arthropathy results in moderate bilateral neural foraminal narrowing, as well as mild spinal canal stenosis.C5/6: A posterior disc osteophyte complex and facet joint arthropathy results in severe right and moderate left neural foraminal narrowing, but no significant spinal canal stenosis.C6/7: A posterior disc osteophyte complex and facet joint arthropathy results in mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis.C7/T1: Facet joint arthropathy results in mild right neural foraminal narrowing, but no significant spinal canal stenosis.

Output: Moderate multilevel degenerative changes including degenerative spondylolisthesis, facet joint arthropathy, uncovertebral joint hypertrophy and posterior disc osteophyte complexes, most pronounced at C4-5 and C5-6, which results in multilevel spinal canal stenosis and neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Ms. Dieckow is a 58 year old female with a personal history of right breast lumpectomy in 2006 for breast cancer, treated with radiation and chemotherapy. No current breast complaints. Family history of breast carcinoma in a paternal aunt, paternal great aunt, and paternal great-grandmother. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the right breast, compatible with stated history of right breast lumpectomy. Multiple scattered foci of enhancement are seen throughout the left breast, appearing similar when compared to multiple prior examinations. No one focus appears more suspicious than the rest.There is no new abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: 80 years, Male, altered mental status. History of prostate cancer. Evaluate for brain metastasis.. There is no intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement to suggest intraparenchymal or meningeal metastases. Several scattered foci and patchy areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. A right occipital developmental venous anomaly is incidentally noted. There is global parenchymal volume loss, commensurate with patient's age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No extra-axial collections. Major flow-voids are preserved.There is a 7 x 11 x 10 mm heterogeneously enhancing lesion involving the posterior aspect of the sella. Lytic lesion seen involving the dorsum sella on recent CT from 10/25/2015.There is heterogeneity of the bone marrow signal including focal osseous lesions involving the left parietal and right occipital calvarium as well as the clivus, occipital condyles, and visualized upper cervical spine. There is mild mucosal thickening involving the paranasal sinuses, which are otherwise clear.

Output: 1. No intraparenchymal metastatic lesions are appreciated. No evidence of acute infarct, hemorrhage, or intracranial mass effect.2. There is a 7 x 11 x 10 mm enhancing lesion involving the posterior aspect of the sella abutting the pituitary gland suspicious for metastasis. There is an adjacent lytic osseous lesion involving the dorsum sella better seen on recent CT. 3. Multifocal additional osseous metastases involving the calvarium and visualized upper cervical spine. 4. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Female; 41 years old. Reason: left knee pain History: MENISCI: Mild intrasubstance signal of the medial and lateral menisci without a discrete tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage loss with underlying subchondral cysts affecting the lateral facet of the patella. There is focal, near full-thickness cartilage loss of the superior aspect of the femoral trochlea. There is focal, full-thickness loss of articular cartilage of the weight-bearing aspect of the medial femoral condyle measuring 7-8 mm in AP dimension. Small tricompartmental osteophytes. The femoral trochlea appears shallow, suggesting mild dysplasia.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Osteoarthritic changes and articular cartilage loss as described above.


Instruction: Generate impression based on findings.

Input: 49-year-old male with a 30 year history of IV heroin abuse here with severe low back pain. Tender to palpation along L4-L5 with mild weakness in left leg. Evaluate for cord compression; suspect epidural abscess. Multilevel mild degenerative changes in the cervical and lumbar spine without high-grade spinal canal stenosis. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. At L5-S1 there is a disc bulge and disc desiccation present.There are degenerative changes present in the cervical spine with the right-sided uncovertebral osteophytes and disc material at C5-6 and C6-7 and some encroachment of the right-sided exiting nerve roots at C6-7.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. There are some degenerative changes present in the lower cervical spine and lower lumbar spine with suggestion of encroachment of right-sided exiting nerve roots at C6-7.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91] / Unspecified transient cerebral ischemia [435.9], Reason for Study: ^Reason: Follow-up of possible small L cerebellar infarct on June study History: TIA in May No evidence of acute ischemic or hemorrhagic lesion on the scan.Previously reported somewhat patchy enhancing lesions on the inferior aspect of the left cerebellar hemisphere are still demonstrated. The anterior and slightly inferiorly located lesion appears to show tubular shape enhancement on coronal reconstruction, this lesion could represent a developmental venous anomaly. The posterior and laterally located lesion could represent either prominent cortical vein or possible capillary telangiectasia. Patchy bilateral periventricular white matter high signal intensities indicating nonspecific small vessel ischemic disease, no change since prior scan.Scattered high signal intensity lesions on the left cerebellar hemisphere indicating age indeterminate likely chronic ischemic lesions, no change since prior scan.Basilar artery including distal right vertebral artery and the right vertebrobasilar junction shows is significant tortuosity and ectasia indicating atherosclerotic changes such as dolicoectatic changes, comparing to prior scan, there is no significant interval change.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Left cerebellar hemispheric enhancing lesions may represent developmental venous anomaly and either prominent cortical vein or capillary telangiectasia as described above. 3. Dolicoectatic changes of right vertebral artery to the basilar artery indicating atherosclerosis.4. No interval change of nonspecific small vessel ischemic disease and age indeterminate ischemic changes as described above since prior scan.


Instruction: Generate impression based on findings.

Input: Worsening sciatica. Degenerative anterior subluxation of L4 relative to L5 remains minimal. The vertebral bodies are preserved in height. There is mild disc height loss at L5-S1 and moderate at the other levels, which is not significantly changed. The associated degenerative endplate/subjacent marrow changes have slightly increased on the right side at L5-S1 and L1-L2 levels. Spinal canal stenosis remains most most severe at L4-L5, which is very minimally increased since the previous examination. The conus medullaris tip remains at the upper L2 level. The nerve roots are redundant above the severe L4-L5 stenosis as before.Small rounded T2-hyperintense lesions in the right kidney are minimally larger. These may represent cysts though are not completely assessed. The gallbladder is distended. This has not significantly changed since the previous examination.T10-T11 and T11-T12: Limited assessment only in the sagittal plane, shows disc bulges and osteophytes causing mild-moderate spinal canal stenosis. There is suggestion of increased, now moderate-to-severe right foraminal stenoses. T12-L1: Mild disc bulge and facet arthropathy but no significant spinal canal or neural foraminal stenosis.L1-L2: The disc bulge which is eccentric to the right is minimally increased, posteriorly displacing the traversing right L2 nerve root and moderately narrowing the right neural foramen. There is moderate right and mild left facet arthropathy and mild-to-moderate ligamenta flavum thickening. These findings result in mild-to-moderate narrowing the spinal canal and the moderate right worse than left neural foraminal stenosis.L2-L3: The disc bulge is eccentric to the left and is stable. There is mild facet arthropathy and ligamenta flavum thickening. There is mild spinal canal and unchanged mild bilateral neuroforaminal stenoses.L3-L4: Moderate right more than left facet arthropathy and ligamenta flavum thickening along with disc bulge are unchanged and results in mild-to-moderate spinal canal stenosis as well as mild-to-moderate right and mild left neural foraminal stenoses.L4-L5: There is severe left worse than right facet arthropathy and severe ligamentum flavum thickening along with disc uncovering and a bulge that is eccentric to the right. The disc shows slightly increased right foraminal/extraforaminal component resulting in slight increase of the severe spinal canal stenosis and the moderate right foraminal stenosis as well as increased abutment of the extraforaminal part of the right L4 nerve root. Moderate left foraminal stenosis unchanged. L5-S1: Moderate facet arthropathy and mild-to-moderate ligamenta flava thickening as well as disc bulge result in mild-to-moderate spinal canal stenosis and moderate right foraminal stenoses. The right far lateral component of the disc does abut the exiting right L5 nerve root which is increased since the previous examination.

Output: 1.The multifactorial severe spinal canal stenosis at L4-L5 has minimally increased as the right foraminal/extraforaminal component of the disc bulge has increased.2.There is increased abutment of the extraforaminal right L5 nerve root by the L5-S1 disc.3.The L1-L2 disc bulge has slightly increased on the right affecting the right traversing L2 and exiting L1 nerve root.


Instruction: Generate impression based on findings.

Input: Nontraumatic subarachnoid hemorrhage, unspecifiedClinical question: Please evaluate for new infarct or other abnormality to explain SAHSigns and Symptoms: Post-R carotid stent for aneurysm (11/2 then 11/11, with acute/subacute infarcts at the time), new SAH There is susceptibility effect, sulcal FLAIR signal hyperintensity and T1 signal hyperintensity suggestive of subarachnoid blood present along the the right sylvian fissure, the right superior temporal sulcus, the right middle temporal sulcus, the right inferior temporal sulcus, and the lateral aspect of the right posterior central sulcus. A small amount of intraventricular blood is also present.There is redemonstration but decrease in size of diffusion restriction along the right precentral gyrus with. Other foci of diffusion restriction identified on the prior exam at the anterior aspect of the insular cortex and in the parietal lobe are less conspicuous on DWI but evident on FLAIR.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.There is a covered stent with flow void coursing through a now thrombosed right upper neck pseudoaneurysm.

Output: 1.Subarachnoid blood is centered along the right Sylvian fissure, the right superior temporal sulcus, the right middle temporal sulcus, the right inferior temporal sulcus, and the lateral aspect of the right posterior central sulcus. 2.Continued evolution of small foci of infarction along the right precentral gyrus, right parietal lobe and right insular cortex.


Instruction: Generate impression based on findings.

Input: 53 year-old woman with altered mental status. Unsure of baseline. Otherwise stable. There are diffuse regions of hypoattenuation consistent with prior infarct throughout the cerebral cortex. There are diffuse areas of encephalomalacia most pronounced in the left occipital lobe. Extensive periventricular hypoattenuating regions consistent with age indeterminate, small vessel ischemic disease. These findings are unchanged from the prior study dated 5/1/2008. If acute stroke is a clinical concern, recommend MRI. The ventricles are unchanged in size from the prior study. The basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Stable head CT with extensive ischemic changes. If acute stroke is a clinical concern, recommend MRI.


Instruction: Generate impression based on findings.

Input: Ms. Zahiri submitted outside study for review. Submitted for review are:-bilateral breast MRI: 12/14/2016This examination was performed at Dupage Medical Group. Multiple MRI sequences were obtained per outside institutions protocol.There is extreme amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.In the right upper outer breast, far posterior depth, there is an irregular enhancing mass identified measuring approximately 1.5 x 1.1 x 1.3 cm. Susceptibility artifact from biopsy marker clip is seen at the central aspect of this lesion, compatible with biopsy-proven malignancy. Although this mass abuts against the pectoralis muscle, the muscle itself is of normal contour and enhancement pattern. There is no additional abnormal enhancement seen in the remainder of the right breast or in the left breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Unifocal malignancy of the right breast. If breast conservation therapy is desired, the clip can be used as targeting for preoperative surgical guidance.(2) No MRI evidence for malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 29-year-old male with long history of sickle cell disease with crisis and known hip avascular necrosis now with increasing right hip pain and radiculopathy RIGHT HIP:ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Patchy T2 signal within the superior aspect of the femoral head. Focal serpiginous low signal with osteochondral fragmentation along the superior aspect of the femoral head compatible with avascular necrosis. No cortical collapse is evident. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Avascular necrosis with fragmentation involving the right femoral head as described above.2.Edema within the left femoral head likely represent early avascular necrosis.


Instruction: Generate impression based on findings.

Input: Right hip and groin pain ACETABULAR LABRUM: Evaluation of the acetabular labrum is limited by lack of intra-articular contrast. There is abnormal signal within the labrum which extends from the 12-to-3 o'clock position indicating a tear. This tear is suspected to traverse the entire thickness of the labrum and there are small cysts within the adjacent acetabular rim anteriorly. The morphology of the posterior superior labrum also appears abnormal suggesting additional tearing. Additionally, there is a suspected labral tear of the left hip which is seen on the larger field of view images.BONES: There is prominence of the anterior portion of the femoral head neck junction indicating a CAM deformity with an alpha angle of approximately 60 degrees. The bone marrow signal of the pelvis and hip are normal. There is no joint effusion. The sacroiliac joints also appear normal.SOFT TISSUES: There is a minimal amount of peritrochanteric edema bilaterally which is not necessarily of any current clinical significance. A small poorly defined focus of edema type signal is noted within the right rectus femoris muscle which may represent a small contusion or small vascular malformation but is also not necessarily of any current clinical significance.

Output: Acetabular labral tear(s) and mild CAM deformity of the right proximal femur. Other findings are described above.


Instruction: Generate impression based on findings.

Input: 47-year-old BRCA mutation carrier presents for MRI screening study IRB13073B. History of bilateral breast cancer status post right lumpectomy in 2003 for invasive ductal carcinoma and left lumpectomy in May 2012 for invasive ductal carcinoma. Patient received radiation and chemotherapy. History of breast cancer in two sisters, maternal grandmother, maternal aunt and cousin. History of ovarian cancer in mother. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.Right breast:There are stable postsurgical changes from right lumpectomy in the right upper outer quadrant. Diffuse skin thickening is compatible with history of radiation. No abnormal enhancement is noted in the right breast.Left breast:Stable postsurgical and post radiation changes are again noted in the left breast. The nonenhancing low T2 signal mass in the left breast 12:00 position is stable. The previously noted left upper outer quadrant fibroadenolipoma is also stable. No abnormal enhancement is noted in the left breast. No abnormal lymph nodes are identified in either axillary region. Stable postsurgical changes are noted in the bilateral axillae.

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


Instruction: Generate impression based on findings.

Input: 46 year old status post left lumpectomy and sentinel lymph node biopsy (7/17/15) for DCIS with microinvasion. Pathology showed close surgical margins. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST AND LEFT AXILLA:At posterior 11:00 position, there is a post-surgical seroma, measuring 31 x 20 x 13 mm (AP x LR x CC). There are also post-surgical changes in the left axilla. There is a regional non-mass enhancement at posterior 10:00 position, measuring 21 x 17 x 33 mm, located immediately inferior to the seroma cavity. Overall measurement including seroma is 21 x 28 x 37 mm.No abnormal lymph nodes are identified in left axillary regionRIGHT BREAST AND RIGHT AXILLA:No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. Suspicious non-mass enhancement located inferiorly from the post-surgical seroma in the left breast.2. No MR evidence of malignancy in the right breast.3. No abnormal lymph nodes in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Paraganglioma of the thoracic spine: surgical planning. There is a well-defined enhancing left paraspinal mass that spans the T7 through T9 levels and measures approximately 5 cm in the anteroposterior dimension, 3 cm in width, and 8 cm in length. The tumor abuts the posterior aspect of the aorta, which is otherwise not encased. There is no evidence of tumor extension into the neural foramina or spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: A well-defined enhancing left paraspinal mass that spans the T7 through T9 levels and measures approximately 5 cm in the anteroposterior dimension, 3 cm in width, and 8 cm in length. The tumor abuts the posterior aspect of the aorta, which is otherwise not encased. There is no evidence of tumor extension into the neural foramina or spinal canal.


Instruction: Generate impression based on findings.

Input: Clinical question: Colloid cyst, preop planning for resection. Signs and symptoms: Headache. Pre-and post enhanced Stealth brain MRI:Examination demonstrates a nonenhancing colloid cyst of the third ventricle measuring maximum off 10 x 9-mm in transaxial dimensions. No significant change since prior study.Stable mildly prominent supratentorial ventricular system without significant change since prior study and with maintained midline.Unremarkable exam otherwise. This is study is performed as a surgical guidance the study and is not a true diagnostic study.

Output: Nonenhancing colloid cyst of the third ventricle measuring 10 x 9-mm in transaxial dimensions, mild prominence of the supratentorial ventricular system all stable since prior study.


Instruction: Generate impression based on findings.

Input: New headaches with papilledema, spinal cord syrinx. Follow-up for growth and changes. Brain: The signal intensity and morphology of the cerebrum, cerebellum and brainstem are within normal limits. There is no evidence of Chiari malformation, intra-or extra-axial fluid collection/hemorrhage, mass, mass effect or midline shift. There is no abnormal enhancement in the parenchyma leptomeninges. Normal flow voids are identified in major intracranial vessels.The ventricles, cortical sulci and basal cisterns are normal in size and configuration. Small pituitary gland with partially empty sella appearance is again seen and unchanged since prior study from 5/16/2011. Mild distention of the optic nerve sheaths is also not appreciably changed since 2011. Orbits appear otherwise unremarkable. There is minimal paranasal sinus opacification but improved since remote study from 2011.Spine: There is no significant interval change in the small, long segment cervicothoracic syrinx, for example measuring up to 2 x 3 mm at the C6 level with trace prominence of the central canal more superiorly and inferiorly. Prominent central canal/small syrinx in the thoracic cord measuring up to 1 to 2 mm also not significantly changed and extends to the conus. The conus medullaris tip is located at the mid to lower L2 level. No abnormal thickening or fatty infiltration of the filum terminale is appreciated. Compared to remote lumbar spine MRI dated dated 2007, there is clear decrease in size of the syrinx/central canal at the level of the distal cord.The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Small pituitary gland with partially empty sella appearance and mild distention of the optic sheaths are nonspecific findings and not significantly changed since prior from 5/16/2011. Intracranial hypertension however can be considered in the appropriate clinical setting and can be correlated with opening pressures. Brain MRI is otherwise unremarkable.2. No significant change in prominence of the central canal/small syrinx which extends throughout the cord compared to most recent study.3. Conus terminates at the mid to lower L2 level which is at the lower limits of normal. No appreciable thickening or lipomatous infiltration of the filum terminale.


Instruction: Generate impression based on findings.

Input: Female, 53 years old. Pain. ROTATOR CUFF: There is mild edema along the posterior margin of the supraspinatus muscle that is nonspecific but could represent a strain type injury or sequela of recent injection. The remainder of the muscle as well as the supraspinatous tendon appear normal. The infraspinatus, teres minor, and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal for age. We see no frank fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is no joint effusion. Given the limitations of a nonarthrographic study, the glenoid labrum appears normal.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: 1.Edema along the posterior margin of the supraspinatus muscle is nonspecific but could represent a strain or sequela of recent injection.2.No rotator cuff tear. Other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for worsening of cervical spinal stenosis, impingement upon the canal. Signs and symptoms: Neck pain, left hand first 3 digits with decreased strength. Nonenhanced cervical MRI:Examination demonstrates normal anatomical alignment of the vertebral column however with reversal of cervical lordosis likely secondary to extensive degenerative disease.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes with resultant mild central spinal stenosis without neural foraminal compromise.C3-C4 demonstrate moderate disc disease and loss of disc height, there is a broad-based central and left lateral disc protrusion which results in mass effect, flattening and posterior displacement of the cord. There is resultant moderate central spinal stenosis, significant bilateral neural foraminal compromise (left greater than right). There is no detectable cord signal abnormality.C4-C5 demonstrate moderate disc disease and loss of disc height with mild hypertrophic changes of posterior elements. Degenerative changes results in flattening and posterior displacement of the cord and with resultant moderate central spinal stenosis and significant bilateral (right greater than left) neural foraminal compromise.C5-C6 demonstrates moderate disc disease and loss of disc height, mild (left greater than right) facet hypertrophic changes. There is shallow broad-based bulging disc which results in flattening and posterior displacement of the cord and resultant moderate central spinal stenosis. Significant left and moderate right neural foraminal compromise is also present.C6-C7 demonstrate moderate disc disease and loss of disc height and mild hypertrophic changes of posterior elements. Changes at this level results in mild to moderate central spinal stenosis and significant left neural foraminal compromise.C7-T1 through T2-T4 levels are unremarkable.

Output: 1.Extensive degenerative changes of the disc and minimally of the posterior elements in the cervical spine as detailed.2.There is resultant multilevel mass effect and posterior displacement of the cord and moderate central spinal stenosis at C3-C4, C4-C5 and C5-C6 levels without detectable cord signal abnormality. A left lateral broad-based disc protrusion at C3-C4 contributes to mass effect on the cord and central spinal stenosis.3.There is mild reversal of cervical lordosis and multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above.4.No detectable cord signal abnormality.5.Unremarkable upper most visualized thoracic spine to T3-T4 level.


Instruction: Generate impression based on findings.

Input: 57-year-old female evaluate for abdominal abscess ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild biliary prominence and dilatation of the common bile duct. The patient is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measuring 2 cm in diameter. Further evaluation with adrenal MRI may be helpful.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes involving the bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a 8.1 x 5.5 cm air, stool, fluid containing, oval shaped area in the pelvis. Due to poor opacification of the colon it's not clear whether this represents a redundant cecum located in the pelvis versus an extraluminal collection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postsurgical changes involving the bowel. Mild biliary prominence. Redundant cecum located in the pelvis versus less likely an extraluminal collection in the pelvis. Further evaluation with repeat CT with rectal contrast or MRI may be helpful for differentiation.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for SEGA, cortical tubers. Signs and symptoms: Tuberous sclerosis, seizure disorder. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.There is normal anatomical morphology of the brain.There is normal signal intensity of brain parenchyma on all MRI sequences with the exception of a punctate focus of susceptibility in the right posterior temporal-occipital region (axial 3-D swan series 8 image 20) of unknown clinical significance.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal, left meningeal or calvarial enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.The signal void of major intracranial arterial branches are identified.Normal signal intensity of intracranial venous sinuses and right normal pattern of enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Negative diffusion weighted images.2.Single punctate focus of susceptibility in the right posterior temporal-occipital of unknown clinical significance.3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: H/o neuroblastoma. Examination demonstrates an extraaxial, necrotic, enhancing mass occupying at the site of the right sigmoid sinus of the right cerebellopontine angle. There is bony destruction of the right mastoid air cells. The external and internal auditory canals and middle cavity appear intact. No adjacent parenchymal edema is detected.Though technically challenging, a comparison of the current CT with prior MRI leads to an impression of increase in size of the mass. The cerebral and cerebellar hemispheres are normal in attenuation and morphology. There is no intracranial mass, hemorrhage, edema, midline shift or abnormal extraaxial fluid collection. The ventricles are normal in volume. The visualized paranasal sinuses and left mastoid air cells are normal pneumatized.

Output: Given clinical history provided, findings are compatible with a neuroblastoma at the right cerebellopontine angle with involvement of the right sigmoid sinus and mastoid.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma resection surveillance. There are stable postoperative findings related to pituitary tumor resection with an unchanged tumor in the sella that extends through the floor of the sella into the right sphenoid sinus and into the suprasellar cistern. The mass appears to protrude into the right cavernous sinus. Overall, the mass measures up to 24 mm. There is no significant mass effect upon the optic apparatus, which appears to be atrophic particularly on the left side.

Output: No significant interval change in the residual pituitary macroadenoma and optic apparatus atrophy.


Instruction: Generate impression based on findings.

Input: 60 year-old male with lung cancer and brain metastases now with acute onset left hemiparesis evaluate for stroke. Hyperdense focus identified in the right occipital region corresponds to hemorrhagic metastatic lesion on recent MRI. Other lesions from MRI heart difficult to identify on the current examination. No definite new lesions are identified. No evidence of new bleed. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Hyperdense focus corresponding to hemorrhagic metastatic lesion seen on recent MRI seen in right occipital lobe. No other acute findings are seen.


Instruction: Generate impression based on findings.

Input: 60 year old female with a strong family history of breast cancer, who presents for a screening MRI. The patient has two sisters diagnosed with breast cancer at ages 49 and 52. She has a personal history of benign left breast biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally, unchanged from prior studies.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 30-year-old female with syncope and question of seizure and right lower extremity hyperreflexia. Evaluate for MS or other central lesion. Artifact limits evaluation on diffusion-weighted images. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. The cerebellar tonsils are minimally low-lying, but display rounded morphologies. The pituitary gland is mildly flattened, which is nonspecific. There are no areas of abnormal signal or abnormal intracranial enhancement. There is no diffusion abnormality or susceptibility artifact. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses and mastoid air cells are unremarkable. The orbits are unremarkable.

Output: 1. No evidence of potential seizure foci or demyelinating lesions.2. The cerebellar tonsils are minimally low-lying, but display rounded morphologies. 3. The pituitary gland is mildly flattened, which is nonspecific.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The left shoulder was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 17 seconds

Output: Successful injection of intra-articular contrast in the left shoulder. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: 50 -year-old male with metastatic melanoma with multiple brain metastases and intracranial hemorrhage. There is no significant interval change in the size of the left thalamic hematoma to the 2.8 x 2.1 x 3.7 cm (AP x TR x CC image 14; series 4) from 2.7 x 2.2 x 3.4 cm. The hematoma extends into the midbrain. There is no significant interval change in the amount of vasogenic edema in the surrounding area even allowing for technique differences: Edema and hematoma measure together 4.2 cm in diameter (15; series 4), previously 4.2 centimeters. There is mass effect on the superior cerebellar peduncle as well as the fourth ventricle. Additionally, there is distortion and rightward displacement of the third ventricle which is stable. There is no significant interval change in the previously described slight enlargement of the lateral ventricles bilaterally. The temporal horn of the left lateral ventricle measures 9 mm, previously 9 mm. There is narrowing of the basal cisterns which appears unchanged when compared to the previous study. There is no evidence of frank brain herniation. There is no evidence of extra-axial fluid collection. Multiple mass lesions within the cerebral hemispheres are noted, some of them hyperdense consistent with petechial hemorrhage or mineralization. Findings are consistent with known metastatic lesions and appear grossly stable. The area of dominant left frontal lobe and right cerebellar hypoattenuation also appear grossly similar to the recent brain MRI. No new parenchymal lesions or hematomas are noted. The visualized mastoid air cells and paranasal sinuses are clear. The visualized orbits are unremarkable.

Output: 1. No significant interval change in left thalamic hematoma with extension into the midbrain. No significant interval change in the amount of vasogenic edema in the surrounding area. Stable distortion of the third ventricle and stable enlargement of the lateral ventricles bilaterally without evidence of frank brain herniation. 2. Redemonstration of multiple metastatic intraparenchymal brain lesions better visualized on recent MRI examination. No evidence of new parenchymal lesions or sites of hemorrhage.