Instruction: Generate impression based on findings.

Input: A significant portion of the exam is motion degraded, and multiple repeated sequences were attempted. Given this caveat:The extent of the patient's scoliosis is better demonstrated on previous x-ray.Cervical spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The visualized paraspinal contents are unremarkable. There are no degenerative changes or stenoses.The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Biphasic CSF flow is noted posteriorly at the level of the cerebellar tonsils.Thoracic spine:The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no stenoses.Lumbar spine:There are no fractures. The marrow signal is benign. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no stenoses.The conus is normal in signal and morphology and terminates at L1/2. Upon prone positioning, the conus and cauda minimally translate anteriorly. However, this is often the observation in patients with significant scoliosis.

Output: 1.No Chiari malformation.2.No syrinx.3.No MRI evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: 59 year-old female history of abdominal pain and mass seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: There is no intra or extrahepatic biliary ductal dilatation. Common bile duct measures 5 mm. There is smooth narrowing noted at the pancreatic head, however the distal duct appears normal..The main portal vein, SMV, and splenic vein are thrombosed, likely chronic, with cavernous transformation of the portal vein. There is also extensive increased T2 signal abnormality within the porta hepatis and near the head of the pancreas with delayed enhancement and restricted diffusion. No discrete masses identified.Moderate gallbladder wall thickening, edema, and small amount of pericholecystic fluid.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct measures 3 mm. Abrupt cutoff is noted in the pancreatic head, however the distal duct reconstitutes near the ampulla . No discrete mass or filling defect.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing left renal cyst.RETROPERITONEUM, LYMPH NODES: Prominent para-aortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Chronic thrombosis of the portal, superior mesenteric, and splenic veins with cavernous transformation of the main portal vein. Soft tissue thickening and extensive surrounding signal abnormality including delayed enhancement most likely secondary to combination of scarring/fibrosis and cavernous transformation and less likely due to extrahepatic cholangiocarcinoma given the lack of corresponding significant biliary ductal dilation.2.Gallbladder wall thickening and edema with pericholecystic fluid can be seen in acute cholecystitis, however this appears similar to the prior study, and probably chronic due to the aforementioned fibrosis.


Instruction: Generate impression based on findings.

Input: Rising PSA status post prostatectomy. PSA 0.16, per medical record. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. No detectable prostatic tissue.Seminal Vesicles: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: 5 mm left pelvic lymph node noted. No lymphadenopathy by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Status post prostatectomy without recurrent or residual tumor identified.


Instruction: Generate impression based on findings.

Input: Female; 67 years old. Reason: Known hepatic cysts, increase RUQ abdominal pain, eval for interval change History: RUQ pain, hepatic cysts ABDOMEN:LIVER, BILIARY TRACT: Several simple cysts in both lobes of the liver are not significantly changed in size since prior study on 4/7/14. No suspicious hepatic lesions. No biliary ductal dilation. Main portal vein and its branches are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple simple cysts in both kidneys are unchanged.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: No significant interval change in multiple hepatic and renal cysts. No findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Reason: eval for structural lesions History: paraparetic, urine retention Thoracic spine: Redemonstration edema of the C6/7 disc space with asymmetric anterior widening and suggestion of anterior longitudinal ligament disruption. Cervical prevertebral edema again noted. Exaggerated thoracic kyphosis noted. Bone marrow signal is benign. Vertebral body heights are maintained. Diffuse thoracic disc desiccation and mild mid thoracic disc height loss. There is rightward thoracic curvature. Thoracic spinal cord has a smooth contour and is without focal atrophy, edema, myelomalacia. No spinal canal hematoma, mass, or mass effect. There is dorsal and right epidural lipomatosis which pushes the thecal sac towards the left and ventrally within the bony canal but without deformity or effacement of the thecal sac. There is focal fat or hemangioma of the T4, T6, and T9 vertebral bodies.C7/T1: Mild uncovering of the disc from minimal grade 1 retrolisthesis of C7 over T1. No significant spinal canal stenosis or neural foraminal narrowing.T1/2: No significant spinal canal stenosis. Facet arthropathy with moderate bilateral foraminal narrowing.T2/3: No significant spinal canal stenosis or foraminal narrowing.T3/4: No significant spinal canal stenosis or foraminal narrowing.T4/5: No significant spinal canal stenosis. Ligamentum flavum thickening, left greater than right with moderate right foraminal narrowing.T5/6: No significant spinal canal stenosis or foraminal narrowing.T6/7: No significant spinal canal stenosis or foraminal narrowing.T7/8: No significant spinal canal stenosis or foraminal narrowing.T8/9: Tiny central disc protrusion without significant spinal canal stenosis. Ligamentum flavum thickening with mild right neuroforaminal narrowing.T9/10: No significant spinal canal stenosis. Facet joint arthropathy with moderate left and mild right neural foraminal narrowing.T10/11: No significant spinal canal stenosis. Facet joint arthropathy, left greater than right. Moderate left greater than right foraminal narrowing.T11/12: Ligamentum flavum hypertrophy particularly on the left, with mild spinal canal narrowing. Moderate bilateral foraminal narrowing.T12/L1: Left facet arthropathy with mild spinal canal narrowing. No significant foraminal narrowing.Lumbar spine: Alignment is anatomic. There are no subluxations. There is Schmorl's node with degenerative marrow changes at L2-3 and L3-4 levels. Degenerative marrow changes also at L5-S1 level. The conus is normal in signal and morphology and terminates at an appropriate level. No intraspinal hematoma, mass, or mass effect. Redundant and thickened cauda equina roots. There is leftward lumbar curvature.There is 1.6 cm rounded filling defect in the gallbladder, likely gallstone.Multiple bilateral large T2 hyperintense cystic structures in the kidneys, incompletely characterized. Gross comparison to 2006 CT exam shows interval growth. Variant anatomy of the psoas musculature with accessory muscle on the left, posteriorly. There is ill-defined T2 hyperintensity in this accessory muscle, as well as in portions of visualized bilateral iliacus muscles. There are a few rounded and irregular heterogeneous lesions with rim of T2 hypointensity in this accessory muscle and right iliacus, which may be mineralization associated with old blood products or prior abscesses. CT may be performed to confirm this but in the absence of patient symptoms, these findings are of questionable clinical significance. L1/2: Mild posterior disc bulge. Bilateral facet joint arthropathy with ligamentum flavum thickening resulting in moderate spinal canal stenosis. There is mild to moderate right and moderate left foraminal narrowing. L2/3: Mild to moderate disc bulge posteriorly. Facet joints arthropathy with ligamentum flavum thickening, left greater than right, with moderate bilateral foraminal narrowing and severe spinal canal stenosis.L3/4: T1 and T2 hypointense disc, suggestive of mineralization and vacuum phenomenon. Mild disc bulge posteriorly. Facet joint arthropathy with ligamentum flavum thickening resulting in moderate spinal canal stenosis. There is bilateral mild neural foraminal narrowing. L4/5: Right ligament flavum is not well-visualized, correlate with possible prior surgery versus developmental finding. There is right far lateral bridging osteophyte resulting in a mild right foraminal narrowing. No significant spinal canal stenosis.L5/S1: Mild to moderate posterior disc bulge slightly right sided without significant spinal canal stenosis. Bilateral facet joint arthropathy with bilateral moderate foraminal narrowing.

Output: 1.Multilevel degenerative disc disease as above, with up to severe central spinal canal stenosis at L2-3. 2.Midthoracic eccentric epidural lipomatosis.3.Variant anatomy of the left psoas musculature, with findings suggestive of possible myositis ossificans, also affecting the right and possibly left iliacus muscles, of questionable clinical significance. CT could be obtained as clinically indicated.4.Interval 1.6 cm gallbladder filling defect consistent with cholelithiasis. Ultrasound may be obtained for further evaluation if clinical symptoms.5.Multiple bilateral large T2 hyperintense cystic structures, which appear increased in size from 2006 CT exam. These lesions are incompletely evaluated. Ultrasound may performed for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: 44 y/o man with developmental delay referred for evaluation for possible hypertrophic cardiomyopathy. Left VentricleThe left ventricle is moderately enlarged with overall normal systolic function, there is asymmetric hypertrophy (IVSd 17mm and PWd 9mm). The overall LV ejection fraction is 55%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 299 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 135 ml (normal range 47+/-19), the LV mass index is 69 g/m2 (normal range 85+/-15), and the LV mass is 163 g (normal range 164+/-36). There is a subtle wall motion abnormality in the mid inferoseptum. There is mild late gadolinium enhancement in the mid wall pattern involving the basal septum. There is extensive circumferential late gadolinium enhancement along the endocardial surface involving much of the mid to apical left ventricle. The LGE in the basal septum is atypical for prior myocardial infarction and likely represents underlying fibrosis. The remainder of late gadolinium enhancement could be due to either a large myocardial infarction or due to extensive fibrosis. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 257 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 114 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is mild systolic anterior motion of the mitral valve chords associated with mild flow acceleration in the left ventricular outflow tract. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Hypertrophic cardiomyopathy with normal systolic function (LVEF 55%). The maximum wall thickness is 17mm; however, there is an extensive amount of late gadolinium enhancement as described above. The late gadolinium enhancement could be due to: (1) fibrosis related to hypertrophic cardiomyopathy; (2) myocardial infarction due to extrinsic compression of the coronary artery within the hypertrophied segment; (3) myocardial infarction due to coronary artery disease; or (4) a variety of other less likely possibilities.2. Normal RV size and systolic function (RVEF 56%).3. Moderate biatrial dilation.4. Mild systolic anterior motion of the mitral valve chords associated with mild flow acceleration in the LVOT.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 30 year-old male with tenderness over pubic symphysis radiating to right inguinal area. Evaluate chronic pubic symphyseal pain/groin pain. BONE MARROW: No evidence of stress fracture.SOFT TISSUES: No evidence of tear in the rectus femoris adductor aponeurosis. No other significant abnormality is evident. JOINTS: Pubis symphysis appears normal. The hips and sacroiliac joints are unremarkable.ADDITIONAL

Output: No findings to account for patient's symptoms. Specifically, no stress fracture or myotendinous injury at the symphysis pubis is identified.


Instruction: Generate impression based on findings.

Input: Renal angiomyolipoma status post renal artery embolization on 1/20/2015 ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable bilateral fat-containing renal lesions consistent with angiomyolipomas of tuberous sclerosis. The large exophytic angiomyolipoma arising from the right inferior renal pole measures 13.0 x 8.2 x 13.3 cm, previously 14.4 x 11.3 x 15.5 cm. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic vertebral lesions, similar to prior studies and compatible with tuberous sclerosis.

Output: Decreased size of the large exophytic right inferior renal pole angiomyolipoma, compatible with embolization therapy.


Instruction: Generate impression based on findings.

Input: Minimal motion artifact is seen in the postcontrast images. There is normal ventricular size with no evidence of bleed, mass effect, or edema. There is normal gray-white matter differentiation. No T2/FLAIR abnormalities. No abnormal enhancement seen.There is no gross elevation of the optic nerve heads although dedicated orbit images are not available. The sella appears normal.There are no diffusion or susceptibility abnormalities. Major intracranial flow voids appear unremarkable.

Output: Normal MRI of the brain. No MR evidence of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: 32-year-old male with right-sided neck pain and right lower back pain. Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant disc bulge/herniation, spinal canal stenosis, or neuroforaminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a small right maxillary sinus retention cyst. There is a subcentimeter Thornwaldt cyst.Lumbar Spine: There is prominent lumbosacral epidural lipomatosis with substantial narrowing of the spinal canal at L4, L5, and throughout the sacrum. There are also disc bulges are noted at L4-5 and L5-S1, which contribute to the spinal canal narrowing. There is also mild bilateral neural foraminal narrowing at L4-5 and L5-S1. There is no significant spinal canal or neural foraminal narrowing at T12 through L4. There is no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged distal spinal cord and cauda equina are unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1.No spinal canal or neural foraminal stenosis in the cervical spine.2.Prominent lumbosacral epidural lipomatosis with substantial narrowing of the spinal canal at L4, L5, and throughout the sacrum. In addition, disc bulges are noted at L4-5 and L5-S1 contribute to the spinal canal narrowing and result in mild bilateral neural foraminal narrowing at L4-5 and L5-S1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Meningioma 6 month: no prior surgical intervention. There is an enhancing extra-axial mass overlying the left paracentral lobe that measures up to 25 mm in thickness and 35 mm in length, which is not significantly changed. There is mild mass effect upon the underling brain parenchyma and an unchanged nonspecific punctate focus of high T2 signal in the nearby posterior superior frontal gyrus. The tumor abuts, but does not appear to invade the superior sagittal sinus. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions in the left maxillary and ethmoid sinuses.

Output: 1. No significant interval change in size of an enhancing extra-axial mass overlying the left paracentral lobe, which likely represents a meningioma. 2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left frontoparietal craniotomy for resection of left frontal lobe mass. There is a susceptibility effect within and along the margins of the left frontal lobe cavity with near total resection of the mass and a nonspecific subcentimeter focus of enhancement along the medial aspect of the surgical cavity in the left frontal lobe. There is a left extra-axial postsurgical fluid collection measuring 4 mm in thickness with mild thickening and enhancement of the dura subjacent to the craniotomy, along with a left scalp fluid collection with blood products and mild to moderate swelling of the superficial left facial, periorbital and scalp soft tissues. Apparent restricted diffusion along the margins of the surgical cavity may be related to hemorrhage or ischemic tissue. There is no evidence of territorial infarction, however. There are unchanged heterogeneously enhancing masses with extensive vasogenic edema in the right frontal lobe. There is no significant midline shift or herniation. There are bilateral maxillary sinus mucus retention cysts.

Output: 1. Postoperative findings related to left frontal lobe metastasis resection with nonspecific subcentimeter foci of enhancement along the medial aspect of the resection cavity, which may represent residual tumor or granulation tissue, and extensive residual left frontal lobe vasogenic edema.2. Unchanged metastases un the right frontal lobe with extensive surrounding vasogenic edema, but no significant midline shift.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained.  DynaCad was used to localize the left medial apex of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the left medial apex prostate gland lesions.


Instruction: Generate impression based on findings.

Input: There are no structural or migrational abnormalities. There are no T2/FLAIR signal abnormalities. The hippocampi are symmetric and unremarkable. Ventricular size is normal. There is no midline shift. There is no restricted diffusion or abnormal susceptibility signal.

Output: Unremarkable MRI of the brain with no structural or migrational abnormalities.


Instruction: Generate impression based on findings.

Input: Reason: Assess for possible meniscal tear History: Posterior knee pain despite conservative treatment (knee injection). MENISCI: The menisci appear normal.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Baker cyst without other abnormality identified. Specifically, the menisci appear normal.


Instruction: Generate impression based on findings.

Input: Right foot pain Abnormal signal intensity is identified within the lateral cuneiform although a discrete fracture line is not visualized. Additional abnormal linear signal intensity is noted within the first metatarsal diaphysis extending to the head which may represent a a nondisplaced subacute fracture. The marrow signal of the remaining metatarsals is normal. Mild osteoarthritis affects the midfoot. Mild soft tissue edema overlies the dorsum of the foot. The visualized portions of the tendons are intact. Of the plantar musculature of the foot is normal in caliber and signal.

Output: 1. Abnormal signal within the lateral cuneiform likely represent stress reaction.2. Abnormal signal within the first metatarsal may reflect a subacute but nondisplaced fracture.


Instruction: Generate impression based on findings.

Input: Abdominal pain status post liver transplant. History of abscess; cystic pancreatic mass - FNA showed inflammatory debris. ABDOMEN: Susceptibility artifact at the porta hepatis due to cholecystectomy clips and the TIPS catheter limits examination.LIVER, BILIARY TRACT: No intrahepatic biliary ductal dilatation. The common hepatic and common bile duct are obscured by susceptibility artifact from the patient's TIPS catheter. The hepatic veins appear patent. The SMV and splenic vein appear patent as is the portal vein distal and proximal to the TIPS supporting patency. The hepatic artery is not visualized. Stable 4.5 x 3.3 cm T2 hyperintense well-circumscribed complex mass/collection in the subcapsular region adjacent to the caudate lobe which communicates with a more inferior multilobulated mildly T2 hyperintense lesion measuring 6.4 x 4.9 cm in the gastrohepatic region and pancreatic head with heterogeneous T2 weighted hypointense and intrinsically hyperintense T1 -weighted irregular contents and thin septations. The appearance is unchanged compared to the recent prior MRI. No definite post-contrast enhancement.Additional T2 hyperintense nonenhancing subcentimeter right hepatic lobe lesions, are not significantly changed from the MR dated 5/4/15, but decreased from the CT dated 5/23/15. Associated perfusional changes are again noted. These are compatible with decreasing/treated abscesses including superinfected cysts. Mild diffuse hepatic parenchymal wedge-shaped heterogeneity, likely perfusional.The liver is normal in morphology, contour and size.SPLEEN: Trace perisplenic fluid and perisplenic varices. Splenomegaly, measuring 13.4 cm.PANCREAS: The previously mentioned heterogeneous complex mass/collection extending from the pancreatic head superiorly into the lesser curvature and adjacent to the caudate lobe is not significantly changed in appearance. The pancreatic parenchyma is atrophied and the pancreatic duct distal to this pancreatic head lesion is irregularly dilated up to 6 mm, slightly increased, likely due to mass affect. The pancreatic parenchyma otherwise enhances homogeneously. There is mild mass effect on the gastroduodenal artery.Additional complex cystic mass/collection inferior to the pancreatic body measures 5.0 x 3.3 cm (series 401/12), not significant changed when remeasured on the prior study (series 301/8).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are numerous enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No intrahepatic biliary ductal dilatation. Evaluation of the common hepatic and common bile duct is obscured by susceptibility artifact from the TIPS catheter. Similarly the hepatic artery is obscured by susceptibility artifact. 2.Relatively stable complex masses/collections inferior to the pancreatic body, within the pancreatic head dissecting cranially to the level of the caudate lobe.3.Subcentimeter intrahepatic cystic lesions with associated perfusion abnormality are now similar in size to the prior MR but decreased from the interval CT; suggesting treatment response of abscesses as opposed to hepatic cysts or biliary hamartomas.4.Mild increase in pancreatic ductal dilatation likely due to mass effect of the complex mass/collection in the pancreatic body.5.No new fluid collections.


Instruction: Generate impression based on findings.

Input: Clinical question: Fecal and urinary incontinence, left leg weakness; history of multiple myeloma and cerebral hemorrhage status post evacuation. Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol which is a limited study.There is normal signal intensity and caliber of cervical and thoracic cord without detectable mass effect on the cord or any significant central spinal stenosis.The alignment of vertebral column is anatomical and without evidence of fracture. There is no detectable perispinal soft tissue abnormalities.

Output: 1.Normal signal intensity and caliber of cord.2.No evidence of fracture, malalignment or spinal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: post mastectomy ln dissection neck and shoulder pain History: above ROTATOR CUFF: There is increased fluid signal abnormality within the distal supraspinatus tendon at the level of its insertion on the greater tuberosity indicating an interstitial insertional tear. No full-thickness tear is evident. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a small to moderate size glenohumeral joint effusion with associated enhancement on postcontrast sequences indicating a synovitis. Although this examination is not optimized for evaluation of the glenoid labrum, the anterior labrum is indistinct indicating degeneration/tearing.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps indicating a tenosynovitis. The tendon appears intact.ADDITIONAL

Output: 1. Nonspecific synovitis of the glenohumeral joint and tenosynovitis of the long head of the biceps tendon.2. Interstitial tearing of the rotator cuff without evidence of a full-thickness tear or retraction.


Instruction: Generate impression based on findings.

Input: Evaluate for left medial meniscal tear in a patient with left knee pain. MENISCI: The posterior horn of the medial meniscus appears blunted and there is a complex meniscal undersurface tear with both a vertical and horizontal component.ARTICULAR CARTILAGE AND BONE: Marked abnormality of the medial facet of the patella with fissuring, irregularity, and severe loss of cartilage of the whole medial facet. There is minimal bone marrow edema of the medial proximal tibia. There is marked loss of cartilage of the medial femoral condyle.LIGAMENTS: The ACL and PCL appear intact. The MCL and the ostial complex also appear intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the undersurface of the posterior horn of the medial meniscus.2. Marked osteoarthritis of the patellofemoral joint and marked loss of cartilage of the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: 36-year-old male with left wrist pain. Evaluate for scapholunate ligament tear. LIGAMENTS: Dilute gadolinium was injected into the midcarpal joint where it remained without extension into the radiocarpal joint to indicate a scapholunate or lunotriquetral ligament tear. There is a lobulated collection of fluid signal intensity volar to the long radiolunate ligament at its radial styloid attachment, compatible with a ganglion, measuring approximately 16 mm in its greatest dimension. We see no definite tear of the volar extrinsic ligaments, however. TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact.TENDONS: The tendons appear normal. BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: 1. No evidence of scapholunate ligament tear.2. Fluid within the radiocarpal joint appearing similar to the prior study which is of questionable significance.3. Ganglion along the volar aspect of the long radiolunate ligament at its styloid attachment.


Instruction: Generate impression based on findings.

Input: 42-year-old female with a right shoulder mass. Evaluate for interval change. Again seen is the reference area within the subcutaneous fat overlying the lateral aspect of the deltoid muscle belly with ill-defined increased signal abnormality on fluid sensitive sequences, which demonstrates enhancement on postcontrast sequences, underlying the vitamin E capsule which presumably corresponds to the patient's palpable area of concern. There is no intramuscular extension or signal abnormality within the underlying deltoid musculature.

Output: 1.Persistent nonspecific, ill-defined area of enhancement and signal abnormality within the subcutaneous soft tissues overlying the deltoid musculature. While this could conceivably represent an inflammatory process, neoplasm cannot be excluded.2.Full-thickness tear of the supraspinatus tendon with retraction. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Bilateral knee pain and locking. MENISCI: There is blunting of the free edge of the posterior horn and body of the lateral meniscus (series 601, image 22) compatible with a radial tear. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: A small subchondral cyst is present deep to the tibial spine with adjacent reactive bone marrow edema. Bone marrow signal is otherwise within normal limits including scattered small foci of red marrow. Tricompartmental osteophytes are present. There is thinning of the medial and lateral patellar cartilage without focal defects. Tibiofemoral cartilage is grossly intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Right knee with radial tear of the body and posterior horn of the lateral meniscus, moderate joint effusion, popliteal cyst, and degenerative arthritic changes.2.Left knee with ACL tear and associated posterior tibial bone contusion, large joint effusion, popliteal cyst, and degenerative arthritic changes.


Instruction: Generate impression based on findings.

Input: Reason: eval bilateral forearms History: extrinsic tightness - hx of multiple malignancies Right forearm: No abnormal marrow edema. No evidence of fracture or osseous metastases. No abnormal signal in the soft tissues. No soft tissue masses or fluid collections.Left forearm: No abnormal marrow edema. No evidence of fracture or osseous metastases. No abnormal signal in the soft tissues. No soft tissue masses or fluid collections.

Output: No findings to explain patient's symptoms.


Instruction: Generate impression based on findings.

Input: The patient submitted outside mammogram dated 6/2/2014, outside ultrasound dated 6/2/2014, and MRI dated 9/9/2014, from UICMC. Submitted outside study was compared to the current mammogram dated 7/23/2015.Interval increase in a circumscribed mass in the right breast at the 5:00 to 6:00 position from 10 to 18 mm; this area mostly corresponds to a clustered cyst seen on ultrasound dated 6/2/2014 with atypical blood flow. No abnormal enhancement is seen on MRI. A few cysts are noted in the right breast with the largest measuring 8 mm.

Output: Clustered cyst in the right breast with atypical blood flow on outside ultrasound, which is increased in size; this area needs further evaluation with ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 46 year old female with left wrist pain and weakness. Concern for tendon rupture. EMG normal. The musculature of the forearm appears normal. We see no findings to suggest tendon rupture, although please note that the large field of view technique used in this examination is suboptimal for evaluation of the tendons of the wrist. Given this limitation, we see no gross abnormalities of the tendons of the wrist. There is a focus of abnormal signal intensity within the lunate which likely represents a degenerative cyst. The bone marrow signal intensity is otherwise within normal limits.

Output: Focus of signal abnormality within the lunate likely representing a degenerative cyst, but the forearm appears normal without evidence of tendon rupture. If further evaluation of the tendons of the wrist is clinically warranted then a dedicated MRI examination could be considered.


Instruction: Generate impression based on findings.

Input: History of ependymoma, status post resection and radiation therapy. Off therapy for about 31 months.. The findings related to left frontal craniotomy with a resection cavity in the posterior aspect of the left inferior frontal gyrus is unchanged. The associated, surrounding T2 FLAIR hyperintensities unchanged. There is no suspicious contrast enhancement at the resection bed. Susceptibility artifact within the surgical cavity is still present.There is no intracranial hemorrhage, new mass, or acute infarct. There is no abnormal brain parenchymal or leptomeningeal contrast enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: There has not been significant change in the treatment bed in the posterior inferior left frontal lobe since the previous examination of May 2015, as well as multiple priors. There is no sign of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with lightheadedness, amnesia. Diffusion-weighted images are unremarkable. No evidence of parenchymal edema or mass effect is seen. In fact, no significant parenchymal signal abnormality is noted. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricular system is normal in size and morphology.

Output: No acute intracranial abnormality, and no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Evaluate for ischemia, etiology of seizures: right sided weakness. The images are markedly degraded by patient motion. There appears to be a punctate focus of restricted diffusion in the left pons. There is moderate cerebral white matter T2 hyperintensity, particularly in a periventricular distribution. There is mild diffuse cerebral white matter T2 hyperintensity. There is high T2 signal in the left maxillary sinus, infundibulum, and anterior ethmoid sinuses, which may represent secretions.

Output: 1. Apparent recent infarct in the left pons versus artifact superimposed upon probable chronic small vessel white matter disease, although the images are degraded by patient motion and the full exam was not completed.2. Left osteomeatal unit complex sinus disease, which is otherwise incompletely characterized.


Instruction: Generate impression based on findings.

Input: Follow up of meningioma found on imaging. Brain: There is no appreciable change in the enhancing dural-based mass in the right cavernous sinus region that measures up to approximately 25 mm. There has been interval evolution multiple punctate infarcts in the bilateral cerebral hemispheres superimposed upon scattered T2 hyperintense cerebral white matter foci without restricted diffusion. There is a small area of encephalomalacia in the left paramedian pons. There is also patchy T2 hyperintensity in the bilateral cerebellar peduncles. However, there is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.Orbits: There is no evidence of intraorbital mass lesions or abnormal enhancement. The bilateral globes, lacrimal glands, optic nerves, and extraocular muscles are unremarkable.

Output: 1. No appreciable change in the right cavernous sinus region mass without orbital extension.2. Interval evolution of multiple cerebral infarcts without evidence of new acute infarction.3. Chronic pontine lacunar infarction appears to be associated with Wallerian degeneration of the bilateral pontocerebellar tracts.


Instruction: Generate impression based on findings.

Input: 23-year-old male with change in mental status. Evaluate for interval changes. There is no evidence of intracranial hemorrhage, mass or edema. The left-sided region of encephalomalacia or porencephalic cyst is unchanged in appearance. Ventricular size is unchanged from the previous study. Basal cisterns are preserved.A healed left parietal craniotomy is present. Orthopedic hardware of cervico-occipital fusion is present. The middle ear cavities are opacified. Foreign bodies or debris are present in the external auditory canals bilaterally.Ossified structures appear to narrow the cervical spinal canal. This region is incompletely visualized. If clinically appropriate consider further evaluation with dedicated cervical spine CT or MRI.

Output: No significant interval change.


Instruction: Generate impression based on findings.

Input: 56-year-old male status post pancreatic islet cell transplant. Research examination. ABDOMEN:LIVER, BILIARY TRACT: Note is made of multiple bilobar subcentimeter foci of increased T2 signal abnormality throughout the liver. None of these foci demonstrated contrast enhancement after administration of the hepatobiliary contrast agent. There are no foci of abnormal enhancement. There are no focal mass lesions. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple bilobar subcentimeter foci of increased T2 signal abnormality are identified throughout the liver which do not enhance after administration of the intravenous hepatobiliary contrast agent. These findings are nonspecific but may represent simple cysts. No enhancing mass lesions are identified.


Instruction: Generate impression based on findings.

Input: MRI Brain: There are no areas of abnormal signal or pathological enhancement to suggest demyelinating disease. There is unchanged cavum septum pellucidum and vergae. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI Orbits: There may be minimal residual T2 hyperintensity and enhancement involving the prechiasmatic left optic nerve. There is no significant T2 hyperintensity or enhancement involving the right optic nerve, which is otherwise unchanged. The optic chiasm appears to be uninvolved. The globes and extraocular muscles are otherwise unremarkable. MRI Cervical spine: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disc heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. Questioned minimal if any residual T2 hyperintensity and enhancement involving the prechiasmatic left optic nerve. No significant interval change in the appearance of the right optic nerve.2. No abnormal signal or pathological enhancement of the brain or cervical cord to suggest demyelinating disease.


Instruction: Generate impression based on findings.

Input: Images are somewhat motion degraded, especially postcontrast images, and repeats were attempted. Given this caveat:Brain:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of an 11 mm, oval, T1 hypointense focus within the left parietal scalp, most likely representing an epidermal inclusion cyst.Cervical spine:Alignment is normal. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Mild facet hypertrophy without stenosis.C3/4: Left uncinate hypertrophy and bilateral facet hypertrophy. There is moderate left neural foraminal stenosis.C4/5: Trace anterolisthesis C4 and C5, diffuse annular disc bulge, left uncinate hypertrophy, ligamentum flavum thickening, severe left facet hypertrophy, and mild right facet hypertrophy. There is moderate to severe left neural foraminal stenosis.C5/6: Trace retrolisthesis C5 on C6, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is moderate central stenosis with flattening of the cord, however without intrinsic cord signal abnormality. There is moderate to severe left neural foraminal and severe right neural foraminal stenosis.C6/7: Trace retrolisthesis C6 on C7, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild to moderate central stenosis with flattening of the cord, however without intrinsic cord signal abnormality. There is moderate to severe bilateral neural foraminal stenosis.C7/T1: UnremarkableThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. There is no abnormal enhancement.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates a right paracentral disc protrusion causing flattening of the anterior right hemicord without intrinsic cord signal abnormality.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The conus is normal in signal and morphology and terminates at an appropriate level. There is no abnormal intrathecal enhancement.The sacrum and portions of the adjacent iliac bones demonstrate patchy enhancement with some associated STIR abnormality.T12/L1: Minimal disc bulge without stenosis.L1/2: Minimal disc bulge without stenosis.L2/3: Mild disc bulge without stenosis.L3/4: Mild disc bulge without stenosis.L4/5: Mild disc bulge and mild left facet hypertrophy without stenosis.L5/S1: Asymmetric bulge to the right and mild right facet hypertrophy. There is moderate right neural foraminal stenosis.

Output: 1.Images are somewhat motion degraded, especially postcontrast images, and repeats were attempted. Given this caveat, there is no convincing intrathecal enhancement to suggest the presence of metastatic disease.2.The sacrum and portions of the adjacent iliac bones demonstrate patchy enhancement with some associated STIR abnormality. The lumbar spine acquisition technique, this is only partially imaged, and is nonspecific in appearance. This may be secondary to metastatic disease, however may be a response to therapy, or even insufficiency fracture. The remaining osseous elements are intact without abnormal enhancement to suggest the presence of metastatic disease.3.C3/4: Moderate left neural foraminal stenosis.4.C4/5: Moderate to severe left neural foraminal stenosis.5.C5/6: Moderate central stenosis with flattening of the cord, however without intrinsic cord signal abnormality. There is moderate to severe left neural foraminal and severe right neural foraminal stenosis.6.C6/7: Mild to moderate central stenosis with flattening of the cord, however without intrinsic cord signal abnormality. There is moderate to severe bilateral neural foraminal stenosis.7.T9/10 demonstrates a right paracentral disc protrusion causing flattening of the anterior right hemicord without intrinsic cord signal abnormality.8.L5/S1: Moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Patient with chronic maxillary sinus pressure. Please evaluate for sinusitis. CT of paranasal sinuses:Extensive opacification of bilateral maxillary sinuses with mixed high and low density material. This is believed to be secondary to long-standing chronic sinus disease. No definite evidence of any associated bony changes. Less likely possibility of fungal sinusitis cannot be entirely ruled out due to high density of the sinuses.Complete occlusion of bilateral ostiomeatal units.Extensive sinus disease of bilateral ethmoid air cells. Mucoperiosteal thickening in bilateral chambers of the sphenoid sinus.Mucoperiosteal thickening of bilateral frontal sinuses.Images through the nasal cavity demonstrate increased soft tissue density within the nasal cavity which is believed to be secondary to mucoperiosteal thickening. No bony abnormalities detected. Possibility of polyp in particular within the left nasal cavity cannot be entirely ruled out.The osseous structures of the area of the study are unremarkable. Images through the orbits are grossly within normal limits.Visualized mastoid air cells and medullary cavities are within normal limits.MRI examination of brain from 2006 is also reviewed which also demonstrated extensive chronic pansinusitis with more severe involvement of bilateral maxillary sinuses.

Output: 1.Extensive pansinusitis and with more significant involvement of bilateral maxillary sinus.2.Extensive soft tissue density within the nasal cavity as detailed.3.No definitive osseous abnormality.4.High density content of maxillary sinuses could be secondary to chronic long-standing sinus disease however possibility of fungal sinusitis cannot be entirely ruled out.


Instruction: Generate impression based on findings.

Input: 48 years Female (DOB: 8/20/1968)Reason: Multiple Sclerosis History: Follow up progressionPROVIDER NAME: ADIL JAVED ADIL JAVED MRI brain:There are multiple periventricular and subcortical T2 and FLAIR hyperintense patchy and partially confluent lesions scattered in both hemispheres of the cerebrum. Some of these extend towards the corpus callosum.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are T2 hyperintense lesions present within the cervical spinal cord. One small one is located along the left posterior lateral aspect of the cervical spinal cord at the T2 vertebral level. Another one is present at the C4 vertebral body level along the right anterior aspect of the cervical spinal cord. Another one is present at the left hemicord at the C4-5 disc space level another one at the left posterior lateral aspect of the spinal cord at the C5-6 level. Still another one is present in the right hemicord at the C6-7 level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is small right lateral recess disc protrusion present this level which narrows the right neural foramen.At C5-6 there is no significant compromise to the spinal canal. There is a left lateral recess broad-based disc protrusion at this level which encroaches on the left-sided exiting nerve root within the neural foramen.At C6-7 there is no significant compromise to the spinal canal. There is a broad-based left lateral recess disc protrusion at this level which displaces the left hemicord and encroaches on the left-sided exiting nerve root.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is a T2 hyperintense lesion present within the thoracic spinal cord at the T2 level, there is the right hemicord at the T4 vertebral level and another one in the right hemicord at the T5 level, another in the right hemicord at the T7 and T8 levels, one in the right anterolateral aspect of spinal cord at the T9 level and still another one at the conus at the T12 level.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a central disc protrusion present at T3-4 which effaces spinal fluid ventral but not posterior the spinal cord.

Output: 1.There are multiple patchy lesions in the periventricular white matter which are nonspecific but compatible with patient's diagnosis of demyelinating disorder.2.There are multiple lesions present within the cervical spinal cord and thoracic spinal cord compatible with demyelination.3.There are degenerative changes present cervical spine worse at C5-6 and C6-7 there is encroachment of the left-sided exiting nerve roots at C5-6 and C6-7 as well as the left hemicord at C6-7.4.There are degenerative changes present in the thoracic spine with a central disc protrusion at T3-4.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with increased falls and decreased sensation in the legs, bowel and bladder incontinence, symptoms over a one to two month period per patient and family. History of prostate cancer, unclear staging. Unclear history prior back surgery. Spinal alignment is anatomic. Vertebral body height and morphology are normal. Marrow signal characteristics and pattern of enhancement are unremarkable. No evidence of metastatic disease is seen.The spinal cord shows normal signal intensity and morphology. No pathologic intramedullary or leptomeningeal enhancement is seen. No intraspinal masses are detected.A very small disk protrusion is seen at T1-2. Mild facet hypertrophy and ligamenta flava thickening is demonstrated at T7-8 and T11-12. No significant spinal canal or neuroforaminal stenosis is detected.Small renal lesions are seen on the left. Note is made of numerous prominent mediastinal and perihilar lymph nodes of uncertain significance.

Output: 1. No findings in the thoracic spine to account for the patient's symptoms.2. Note is made of mediastinal and perihilar adenopathy. This adenopathy may have been present as far back as 2010 based on chest x-ray and is therefore of uncertain significance.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with cognitive and language decline. Scattered small foci of T2 hyperintensity are seen within the periventricular white matter and to a lesser degree the subcortical white matter and brainstem. No evidence of restricted diffusion is seen. No edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collection. The cerebral sulci are generally slightly prominent suggesting a mild degree of underlying parenchymal volume loss. The size and morphology of the ventricular system are within normal limits.

Output: 1.Scattered lesions are seen which statistically most likely represent chronic microvascular ischemic disease.2.Although there is a mild degree of generalized parenchymal volume loss, no diagnostically specific atrophy pattern is appreciated.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, status post arrest with slowly improving mental status. Image quality is degraded by motion artifact. Within this limitation, no clear or convincing restricted diffusion is seen. A few scattered small foci of T2 hyperintensity are present within the cerebral white matter. No mass effect or significant edema is detected. No large intracranial hemorrhage is seen. The ventricles are normal in size morphology. Very mild prominence of the CSF space along the bilateral frontal lobes is again observed similar to prior CT.

Output: No evidence of acute ischemia or any other definite acute intracranial abnormality is seen.


Instruction: Generate impression based on findings.

Input: 39 years Female (DOB:2/17/1977)Reason: back pain- rule out herniated disc History: pain increases when supine- could be a posterior herniated discPROVIDER/ATTENDING NAME: MINDY ALYCE SCHWARTZ MINDY ALYCE SCHWARTZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present this level associated with disc desiccation and narrowing of the neural foramina bilaterally with mild encroachment of the right-sided exiting nerve roots. This appears stable and compared to the previous exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with chronic appearing endplate reactive changes which are stable compared to the previous exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a T1 hyperintense lesion within the L2 vertebral body and another one within the L1 vertebral body which most likely represent vertebral body hemangiomas. These suppress on the T2 inversion recovery images.

Output: There are degenerative changes present in the lower lumbar spine mainly in the form of disc degeneration which are relatively stable and compared to the previous exam from 2013 without significant compromise to spinal canal or exiting nerve roots. There is mild encroachment of the nerve roots in the right neural foramen at L5-S1.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, five lumbar type vertebral bodies are presumed. There are no findings to suggest acute fracture, and lumbar vertebral alignment is normal. The imaged cord and cauda equina are normal in signal and morphology. There is no evidence of epidural collection. There is disc desiccation of L1-2, L2-3 and L3-4. The vertebral body heights and intervertebral disc spaces are preserved. There is no significant spinal canal stenosis or neural foraminal narrowing. The uterus is partially imaged but appears enlarged, consistent with post gravid state. There is mild right hydronephrosis and mild bilateral hydroureter.

Output: 1.No evidence of epidural collection or cauda equina compression.2.Mild right hydronephrosis and mild bilateral hydroureter.


Instruction: Generate impression based on findings.

Input: No diffusion-weighted abnormality is identified. No evidence of intracranial mass, mass-effect, or hydrocephalus. No extra-axial fluid collections. Flow voids are present within the major vessels indicating patency. The imaged paranasal sinuses are unremarkable. No abnormal enhancement within the brain. Partial left mastoid air cell opacification. Bilateral lens implants. No suspicious osseous lesions. Bilateral parietal and right occipital punctate T1 hyperintense lesions, likely small hemangiomas.

Output: MRI of the brain is within normal limits. No intracranial mass or mass effect. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Right-sided weakness with history of previous stroke. Evaluate for stroke. Motion artifact somewhat limits evaluation. There is no evidence of acute infarct. There is encephalomalacia and ex vacuo dilatation of the right lateral ventricle, related to chronic infarct in the right MCA territory involving the right frontal and temporal lobes as well as the insula and basal ganglia. There is hemosiderin staining in the region of the prior right MCA territory infarct. There is no evidence of acute intracranial hemorrhage or mass effect. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is chronic volume loss in the right cerebral peduncle, likely due to Wallerian degeneration. The ventricles and basal cisterns are unchanged in size and configuration. There is mild mucosal thickening in the small left maxillary sinus. The skull and extracranial soft tissues are unremarkable. There is attenuation of the right middle cerebral artery flow void.

Output: 1.No evidence of acute infarct or intracranial mass effect.2.Chronic right MCA territory infarct which has evolved since prior MRI from 3/17/2011. There is associated Wallerian degeneration along the right corticospinal tract.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left shoulder pain. ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. There is increased signal intensity within the subscapularis indicating a combination of moderate tendinosis and partial-thickness undersurface tearing at its insertion on the lesser tuberosity.SUPRASPINATUS OUTLET: Minimal osteoarthrosis affects the acromioclavicular joint. There is a trace amount of fluid within the subacromial-subdeltoid bursa of questionable clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Given the limitations of a non arthrogram study, the glenoid labrum appears intact.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps as it courses through the rotator interval indicating mild tendinosis. There is a small amount of fluid within the biceps tendon sheath, which is not necessarily of any clinical significance. ADDITIONAL

Output: Moderate tendinosis and undersurface tearing of the subscapularis tendon with other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 51 years old, with history of GBM status post RT, now on temozolomide. Postoperative findings are seen compatible with partial resection of an ill-defined infiltrative and originally minimally enhancing lesion from the left temporal lobe. The lesion originally involved both the lateral and medial aspects of the temporal lobe extending anteriorly along both sides of the temporal horn.Over the subsequent examinations, enhancement has developed around the resection cavity and this has continued to progress on the present study. Enhancement is now seen extending anteriorly along the temporal horn. A significant portion of this enhancing tissue is seen to correlate with elevate rCBV. T2 hyperintensity within and surrounding the lesion has also progressed, now filling the entire left temporal lobe with extension into the occipital lobe and superiorly into the parietal lobe. Regional mass effect is seen in the form of sulcal effacement and effacement of the left ventricular atrium. The left temporal horn is relatively more dilated than on earlier exams, but it is difficult to tell if this is from volume loss or from entrapment and dilatation.Scattered small foci of T2 hyperintensity elsewhere in the cerebral hemispheres are nonspecific and not significantly changed. No definite evidence of tumor involvement is seen in the contralateral hemisphere.Findings related to functional endoscopic sinus surgery are noted on the left. The paranasal sinus mucosa is diffusely thickened.

Output: Progressive irregular enhancement is noted around the left temporal lobe resection cavity extending further anteriorly along the left temporal horn. A significant portion of this enhancing tissue correlates with elevated blood volume which would favor the presence of viable tumor. Given the timing relative to treatment, the possibility of a mixed process with some true progression and some pseudoprogression should also be considered.


Instruction: Generate impression based on findings.

Input: 68-year-old male with weakness secondary to myopathy. Assess for myopathy and which muscle is appropriate for biopsy. There is mild increased signal abnormality on fluid sensitive sequences within the quadriceps musculature, particularly involving the vastus lateralis, and to a lesser degree the vastus intermedius, which is most pronounced along the lateral aspect of the mid thigh/mid femoral diaphysis. Image support for guided sampling could be considered. There is also minimal increased signal abnormality within the adductor musculature of the left hip. There is mild diffuse fatty atrophy of the musculature of the left thigh, particularly affecting the semimembranosus and semitendinosus muscles. There is a small amount of nonspecific edema within the soft tissue anterior to the patella. There is also increased signal abnormality within the vastus lateralis of the right thigh as seen on the large field-of-view images. No bone marrow signal abnormalities identified. There is a small Baker's cyst.

Output: Nonspecific increased edema type signal abnormality within the quadriceps musculature, bilaterally, suggesting a myositis, as described above.


Instruction: Generate impression based on findings.

Input: 58 year old male with history of systolic heart failure, atrial fibrillation on warfarin, DVT, and BPH who was admitted with acute decompensated ADHF. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 153 ml/m2 (normal range: 74+/-15), the LVEDV is 291 ml (normal range 142+/-34), the LV end systolic volume index is 128 ml/m2 (normal range 25+/-9), the LVESV is 242 ml (normal range 47+/-19), the LV mass index is 77 g/m2 (normal range 85+/-15), and the LV mass is 146 g (normal range 164+/-36). The left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 times are borderline-mildly elevated at 1100 ms (nl < 1050 ms)Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 18%, the RV end diastolic volume index is 132 ml/m2 (normal range 82+/-16), the RVEDV is 250 ml (normal range 142+/-31), the RV end systolic volume index is 108 ml/m2 (normal range 31+/-9), and the RVESV is 204 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsBilateral pleural effusions, right greater than left. This 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 overall LV ejection fraction is 17%. The left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 2. The right ventricle is moderately dilated with severely reduced systolic.3. Biatrial enlargement.


Instruction: Generate impression based on findings.

Input: History of sarcoma of the right thigh. Right thigh mass. There is a large mass centered within the distal vastus lateralis muscle with extension into the surrounding soft tissues and breakthrough of the skin. The mass has intermediate T1 signal, heterogeneous T2 signal, and heterogeneous enhancement on post-contrast imaging compatible with areas of necrosis. The entire mass, including the intramuscular and exophytic portions, measures approximately 9.8 x 10 x 8.1 cm (transverse x craniocaudal x AP). It appears to infiltrate the distal lateral border of the rectus femoris, the quadriceps tendon, and the vastus medialis muscle. The inferior border of the lesion ends approximately 7 cm proximal to the knee joint. The underlying femoral cortex is intact with separation of the lesion from bone by a compressed vastus medialis muscle. There are small inguinal lymph nodes.

Output: Large soft tissue lesion centered within the vastus lateralis muscle without underlying bony involvement is compatible with provided history of sarcoma.


Instruction: Generate impression based on findings.

Input: Female 81 years old Reason: 81 F with HCC, please eval for evidence of disease recurrence. No contrast due to low GFR. History: none ABDOMEN:LIVER, BILIARY TRACT: Segment 4 ablation cavity measures 3.6 x 3.0 cm and is mostly T2 hypointense. There is new surrounding nodular T2 hyperintensity and areas of restricted diffusion involving segments 4 extending to segment 8 which is suspicious for tumor. There is signal abnormality measures approximately 13 x 6 cm. Vessel patency of the left portal vein cannot be verified without contrast. There is some signal abnormality on the T2-weighted imaging which may be a sequelae of tumor vs. flow artifact due to portal hypertensionGallbladder contains multiple gallstones. Percutaneous cholecystostomy tube is present. Common bile duct is normal in caliber.SPLEEN: Spleen is mildly enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount upper abdominal ascites.

Output: 1.Findings suspicious for tumor recurrence surrounding the ablation cavity with details provided above. Confirmation can be obtained with a contrast enhanced MRI or possibly biopsy.2.Abnormal findings in the left portal vein represents either tumor thrombus vs. flow artifact due to portal hypertension.


Instruction: Generate impression based on findings.

Input: 72 year old man non ischemic cardiomyopathy referred for cardiac MRI for further evaluation of underlying etiology. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVEDV is 303 ml (normal range 142+/-34), the LV end systolic volume index is 93 ml/m2 (normal range 25+/-9), the LVESV is 199 ml (normal range 47+/-19), the LV mass index is 66 g/m2 (normal range 85+/-15), and the LV mass is 142 g (normal range 164+/-36). LV dysfunction is global with regional variation. There is mid-myocardial pattern of late gadolinium enhancement in the basal inferior and inferolateral walls that is not in a typical infarct pattern and suggests the presence of underlying myocardial fibrosing, infiltrative, or inflammatory process. The pattern is not suggestive of prior myocardial infarction or amyloidosis. There is also no evidence of myocardial iron overload. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 176 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 75 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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 moderately reduced systolic function. The overall LV ejection fraction is 33%. LV dysfunction is global with regional variation.2. There is mid-myocardial pattern of late gadolinium enhancement in the basal inferior and inferolateral walls that is not typical for myocardial infarction and suggests the presence of underlying myocardial fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.4. Significant bi-atrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of fusion, evaluate hardware, patient is quadriplegic Image is limited by patient positioning and overlying upper extremity. Again seen is cervicothoracic spine fusion with posterior stabilization rods and screws entering C2-T3 except C7. No specific evidence of hardware complication. Alignment is anatomic. There is severe degenerative disc disease with anterior osteophytes of the cervical spine. There is exaggerated kyphosis and anterior osteophytes of the thoracic spine.

Output: Surgical fusion of the cervicothoracic spine as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Extracranial stenoses. Signs and symptoms: Syncope. Nonenhanced brain MRI:No evidence of an acute intracranial process detected.There is a slight prominence of cortical sulci and supratentorial ventricular system for patient's stated age. There is however no detectable signal abnormality of brain parenchymal on any of the MRI sequences.Cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination are unremarkable otherwise.The signal void of major intracranial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable calvarium and soft tissues of the scalp. Unremarkable orbits, paranasal sinuses and mastoid air cells.Nonenhanced brain MRA:Patent bilateral internal carotid arteries across the skull base and there supraclinoid segments. Patent bilateral anterior and middle cerebral arteries and their branches. Patent bilateral vertebral arteries, bilateral pica branches, basilar artery, superior cerebellar and bilateral posterior cerebral. There is a prominent left posterior communicating artery present and read resultant hypoplastic P1 segment of the left posterior cerebral.Enhanced neck MRA: The visualized aortic arch and the origins of the major vessels are unremarkable.Brachial cephalic and bilateral subclavian arteries are unremarkable. Patent bilateral common carotid arteries.Patent bilateral internal carotid arteries. Very minimal shallow atherosclerotic plaque at the origins of bilateral internal carotid arteries without compromise of lumen is noted.Patent bilateral external carotid arteries.Unremarkable left vertebral artery.The origin and the proximal segment of the right vertebral artery is not well visualized likely secondary to severe tortuosity. However possibility of atherosclerotic disease and result in stenosis cannot be entirely excluded. Beyond the very proximal segment the right vertebral artery remains widely patent throughout the neck and across to skull base.

Output: 1.Unremarkable nonenhanced brain MRI. Please see above comments.2.Unremarkable nonenhanced brain MRA.3.Unremarkable enhanced MRA of neck. Note should be made that the very origin and proximal right vertebral artery is not well visualized likely secondary to tortuosity.


Instruction: Generate impression based on findings.

Input: Glioblastoma multiforme. Status post resection in November 2014 and redo resection in December 2014 followed by concomitant chemoradiation therapy. Now on maintenance chemotherapy with Temozolomide. The surgical cavity in the left parietal lobe has not changed in size. Contrast enhancement along the medial surgical margin has not significantly changed except in the superficial part of the surgical tract where a new contrast enhancing focus measuring 12 mm x 5 mm in the axial plane (image #18 of series #1101) has developed and is associated with slightly increased surrounding FLAIR signal. The small focus of enhancement is also associated with mild diffusion restriction and relatively low T2 signal. The contrast enhancement along the medial surgical margin otherwise extends toward the trigone as it did before. The FLAIR signal associated with the treatment is largely unchanged except for slight increase superficially and relation to the progressive nodular enhancement.Additionally, the contrast enhancing nodule overlying the left temporal lobe has remarkably progressed and now measures 11 mm in the axial plane compared to 4 mm previously. It is based on the dura though does not involve the skull.The contrast enhancing dura overlying the right frontal and parietal lobes underneath and anterior to the craniotomy has not changed.The perfusion scan showed slightly increased CBV and MTT on the left parietal lobe surgical resection cavity enhancing lesion suggest possibility of recurrence of malignant mass. The left temporal area extra axial enhancing lesion shows subtle increased CBF and CBV, this MR perfusion characteristics cannot differentiate the diagnosis of meningioma from possible metastatic nodule.

Output: 1.Since the previous examination, a new focus of contrast enhancement has the lobe along the medial surgical margin superficially and has signal characteristics that are in favor of disease progression.2.The small dural based contrast enhancing extra axial lesion overlying the left temporal lobe has also progressed significantly since the previous examination. The rate of progression makes a meningioma less likely and would favor metastatic disease from the known glioblastoma.3.MR perfusion study indicate possibility of recurrent malignant mass on the surgical resection cavity. The MR perfusion finding of the left temporal extra axial lesion is non-specific.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evidence of herniation, please evaluate for brainstem and foramina magnum. Signs and symptoms: Status post PEA arrest, nonresponsive. Nonenhanced CT of brain:Portable CT at bedside is performed. Images through posterior fossa are severely obscured due to extensive artifact from patient's multiple bilateral dental fillings. The brainstem cannot be properly evaluated due to extensive artifact. Recommend follow-up with a standard nonportable CT. The fourth ventricle is identified in the midline. The prior portable CT did not include the fourth ventricle and comparison cannot be made.Images through supratentorial space demonstrate no gross evidence of hemorrhage, mass-effect, hydrocephalus or midline shift. Possibility of edema cannot be evaluated due to very poor quality of the study. There is however no visualization of cortical sulci this may indicate underlying diffuse cerebral edema. Follow-up exam with a dedicated nonportable CT or an MRI is recommended.

Output: Suboptimal study due to extensive artifact however no gross abnormality since prior exam. Possibility of cerebral edema cannot be evaluated.


Instruction: Generate impression based on findings.

Input: Reason: Chiari 1 malformation History: headaches MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Metal artifact from the patient's oral cavity - presumably from dental hardware - partially degrades imaging and obscures visualization of the orbits. The DWI and SWI images are significantly degraded.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the visualized portions of the sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is no evidence for Chiari one malformation. The cerebellar tonsils are low lying extending approximately 2 to 3 mm below the level of foramen magnumMRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine: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 identified in the lumbar spine.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.The cerebellar tonsils are low lying. There is no convincing evidence for Chiari I malformation.2.There is no evidence for ventriculomegaly of syrinx.3.There is no compromise to the cervical, thoracic or lumbar spinal canal or neural foramina.4.Exam is somewhat degrade by metal artifact related to the patient's dentition.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural abnormality, particularly Arnold Chiari malformationSigns and Symptoms: Headache and transient episodes of confusionComments: Sedation as standby. Patient believes he can undergo the study. | The CSF spaces are appropriate for the patient's stated age with no midline shift. The tips of the cerebellar tonsils extend approximately 1 mm below the level of the foramen magnum.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.On the T2 axial images there is artifact centered within the pons. This is not present on any other other pulse sequences.

Output: MRI of the brain is within normal limits. Some artifact partially obscures the pons on one of the pulse sequences.


Instruction: Generate impression based on findings.

Input: 75-year-old male with right upper quadrant abdominal pain, obstructive jaundice, metastatic small cell prostate cancer. Evaluate for biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: Extensive metastatic lesions of the liver with luminal narrowing of the intrahepatic IVC are again noted. There are prominent periportal lymph nodes. A 2.2 x 3 cm peripancreatic lymph node causes compression of the adjacent common bile duct and results and intra and extrahepatic biliary ductal dilatation (axial series 8 image 42, series 7 image 90).Hydropic gallbladder without wall thickening or inflammatory changes to suggest acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. Trace ascites including trace peripancreatic fluid, nonspecific. Peripancreatic adenopathy demonstrating restricted diffusion. However no definite restricted diffusion related to pancreatic parenchyma itself to support acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left-sided hydroureteronephrosis, which is again felt to be related to the enlarged pelvic lymph node compressing the distal ureter (coronal series 3 image 18). The enlarged pelvic lymph node is only partially visualized at the anterior aspect of the coronal T2 sequence. A punctate intraluminal hypointense focus seen only on the coronal T2 sequence (series 3 image 18) could represent a nonobstructive stone versus artifact and is not the cause of the left hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace ascites.BONES, SOFT TISSUES: Stable appearance of the known sclerotic osseous metastatic lesions (coronal series 3 images 6, 12).OTHER: Known pulmonary metastatic nodules of the lung bases are appreciated on the diffusion weighted series.

Output: 1.Extensive metastatic lesions of the liver. Periportal and peripancreatic adenopathy likely metastatic also present; as seen on prior CT study, an enlarged peripancreatic lymph node compresses the adjacent distal common bile duct and results in mild intra and extrahepatic biliary ductal dilatation.2.Mild left hydroureteronephrosis related to the known enlarged pelvic nodal lesion compressing the distal ureter (partially imaged on current exam but well depicted on earlier CT study).3.Metastatic pulmonary nodules and osseous metastatic lesions are better evaluated on the recent CT exam.


Instruction: Generate impression based on findings.

Input: Reason: r/o acute ischemic infarct vs. structural lesion History: vertigo, gait instability The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are 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.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Shoulder pain Single scout image of the left shoulder was obtained in preparation for MRI arthrogram. The patient declined intra-articular contrast injection.

Output: Single scout image of the left shoulder obtained in preparation for MRI arthrogram


Instruction: Generate impression based on findings.

Input: Continued pain and swelling after microfracture of the medial femoral condyle and patella. Evaluate healing. Evaluate for SONK. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Moderate degenerative changes are present at the articular cartilage of the medial and patellofemoral compartments, with focal areas of near full-thickness defects. Underlying bone marrow edema-type signal likely represent a combination of degenerative reactive changes and post-surgical effects. No evidence of osteonecrosis. No fracture is present.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Cartilage degeneration with bone marrow reactive changes, as above. No specific evidence of osteonecrosis.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: The menisci are normal in appearance.ARTICULAR CARTILAGE AND BONE: Bipartite patella noted, a normal variant. The lateral ossicle measures 1.4 x 1.0 cm. There is mild edema within the lateral ossicle and along the synchondrosis. Otherwise, no bone or cartilage abnormality noted in the remainder of the knee.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. No evidence of medial meniscal or MCL injury.2. Bipartite patella with mild edema within the lateral ossicle. Correlation for extensor compartment pain is recommended.


Instruction: Generate impression based on findings.

Input: Interval postsurgical changes of spinal decompression are seen with laminectomy at the T8 level and partially at the T7 level. Susceptibility artifact from posterior fusion hardware, which extends from the T6 to the T10 levels, slightly limits evaluation however the spinal cord appears well decompressed.There is diffuse marrow infiltration involving the T8 vertebral body extending into the residual bilateral posterior elements. There is also subtle signal abnormality involving the anterior superior aspect of the T9 vertebral body which may be related to an additional lesion or possibly sequela of a mild compression fracture. Mild pathologic fracture of T8 also again evident. Remainder of the vertebral body heights are maintained. Alignment is maintained. Tumor extends to the left T8 costovertebral junction as seen on prior CT. No lesions are seen within the remainder of the thoracic spine. Extent of epidural tumor which appeared to extend from the T7 to the T9 level was better assessed on preoperative MRI without susceptibility artifact from the hardware. Tumor infiltration involving the left T7-T8 and bilateral T8-T9 neural foramina was also better seen previously and at least partially resected. No cord signal abnormality.

Output: 1. Expected postsurgical changes of spinal canal decompression and posterior T6-T10 fusion with the spinal canal now well decompressed.2. Susceptibility artifact from the hardware limits evaluation, and the epidural tumor was better seen previously extending from the T7 to the upper T9 levels and involved the T7-T8 and T8-T9 neural foramina. There is at least partial interval resection of the epidural tumor.3. Signal abnormality involving the anterior superior aspect of T9 may be related to a mild compression fracture which was also present previously although metastatic lesion in this location is not excluded. No additional lesions elsewhere in the spine are definitively appreciated.


Instruction: Generate impression based on findings.

Input: There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. The cerebellar tonsils are in normal position. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Negative noncontrast brain MRI.


Instruction: Generate impression based on findings.

Input: Concern for brain and spine abscess. Exam is limited by motion artifact.MRI brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI of the cervical spine: There is extensive abnormal signal and enhancement involving the C3 and C4 vertebral bodies and disc space with extension into the anterior epidural space, with narrowing of the spinal canal. There is extensive inflammatory changes and enhancement of prevertebral soft tissue and paraspinal musculature. There is loss of the usual cervical lordosis, but no subluxation. The vertebral body heights are maintained. There are secretions within the trachea. MRI of the thoracic spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is right pleural fluid.

Output: No evidence of intracranial abscess.Findings compatible with discitis-osteomyelitis involving C3 and C4 with extension of inflammatory changes in to the anterior epidural space and prevertebral space, but no abscess. 3. Secretions within the trachea may be a risk factor for aspiration pneumonia. Findings discussed with Dr. Sarah Tarplin at 11 AM on 2/20/2016.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's headaches.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with sudden onset of left upper extremity weakness following windmill like swinging of the arms. Concern for nerve root avulsion or brachial plexus injury. Cervical spine:Trace retrolisthesis of C6 relative to C7 is noted. The cervical lordosis is mildly straightened which is likely positional.Vertebral body height and morphology are within normal limits. Mild edema is seen along the right posterior aspect of the C7-T1 endplate. Elsewhere marrow signal characteristics are unremarkable.The visualized spinal cord is free of significant signal abnormality. Beginning at the C7-T1 level, the spinal cord does deviate towards the right aspect of the spinal canal. However, no obvious intraspinal or paraspinal fluid collection is observed.C2-3: Left facet arthropathy. No spinal canal stenosis or neuroforaminal narrowing. C3-4: Bilateral facet arthropathy. No significant spinal canal or foraminal stenosis.C4-5: Right uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right foraminal narrowing. C5-6: Bilateral facet arthropathy. Posterior disc-osteophyte complex formation. Mild effacement of ventral thecal sac. Moderate to severe bilateral foraminal narrowing. C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac. Moderate to severe bilateral foraminal narrowing. C7-T1: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. Brachial plexus:The left C8 nerve root is mildly thickened and T2 hyperintense from the level of the foramen distally to at least the level of the brachial plexus trunk. No obvious mass or fluid collection is seen. More distally, the left brachial plexus is unremarkable.

Output: 1.Edema of the left C8 nerve root is seen continuing into the brachial plexus to at least the level of the trunks. No obvious hematoma or pseudomeningocele is demonstrated. Findings may therefore represent a stretching injury of the nerve.2.The spinal cord at the C7-T1 level deviates slightly towards the right within the spinal canal. Although this can be seen in cases of nerve root avulsion, it may also be secondary to a mild coronal curvature of the thoracic spine.3.Multilevel disc degeneration is demonstrated. Although there were no areas of high-grade spinal canal stenosis, the neural foramina at C5-6 and C6-7 are significantly narrowed bilaterally.4.Edema along the right posterior C7-T1 endplate is seen which could reflect endplate degeneration or mild traumatic injury.