Instruction: Generate impression based on findings.

Input: Reason: Lateral meniscus tear History: left knee pain MENISCI: There is mild undersurface fraying of the posterior horn of the medial meniscus. The lateral meniscus appears normal. No meniscal tear. ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the knee, particularly notable along the lateral aspect of the patellofemoral compartment where there is underlying subchondral cyst formation compatible with underlying osteoarthritis. No full-thickness tear in the articular cartilage of the knee is evident. Bone marrow signal is within normal limits throughout.LIGAMENTS: The cruciate and collateral ligaments of the left knee appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Mild undersurface fraying of the posterior horn of the medial meniscus, but no meniscal tear is evident.2. Moderate osteoarthritis of the knee, particularly affecting the patellofemoral compartment.


Instruction: Generate impression based on findings.

Input: Intracerebral hemorrhage [431] / Occlusion and stenosis of carotid artery without mention of cerebral infarction [433.10] / Cerebral aneurysm, nonruptured [437.3], Reason for Study: ^Reason: 3T Scanner, hx ICH, carotid stenosis, aneurysm History: yearly Redemonstration of evidence of left frontal craniotomy.Evidence of encephalomalacia seen on the left superior temporal gyrus as well as part of supramarginal gyrus, again demonstrated, no change since prior scan.Encephalomalacia with ex vacuo changes of the left lateral ventricle especially occipital horn do not show any interval changes since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate a small left distal ICA likely superior hypophyseal artery aneurysm, no change since prior exam.There is no evidence of another intracranial arterial aneurysm. The left MCA especially distal M1 segment shows luminal narrowing likely about 50% which again shows no interval change since prior exam.The right distal ICA, MCA, bilateral ACA and vertebrobasilar system appear to be normal.

Output: 1. Post surgical and embolization status of left distal MCA aneurysm, no interval change of left superior temporal gyrus and left anterior supramarginal gyrus encephalomalacia since prior exam.2. No change of left MCA distal M1 segment narrowing since prior exam.3. No change of a small left superior hypophyseal artery aneurysm since prior exam.4. No other intracranial aneurysm. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Reason: Hx of bladder cancer- s/p cystectomy with ileal conduit urinary diversion (10/2014) , new dx of colon cancer History: Colon cancer, abd pain. 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: Postsurgical changes of an ileal conduit with a right lower quadrant ostomy. Left kidney is atrophic. Right renal cysts. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Enlarged peripancreatic and left paraaortic lymph nodes. For reference, peripancreatic lymph node measures 2.2 x 1.3 cm (series 1100 image 22). BOWEL, MESENTERY: Circumferential bowel wall thickening involving approximately 8 cm of the proximal transverse colon (series 6 image 39) compatible with patient's history of newly diagnosis of colon cancer. Interval decrease in upstream colonic and small bowel wall thickening. Right lower quadrant ileal conduit.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Transverse colonic wall thickening compatible with history of colon cancer with peripancreatic and left para-aortic lymphadenopathy. Interval decrease in upstream colonic and small bowel dilatation.


Instruction: Generate impression based on findings.

Input: 9-year-old male with a history of an abnormal MRI. Evaluate for interval change. MRI Brain:Again seen is a decreased craniofacial ratio which may suggest microcephaly. Otherwise, the brain shows no acute infarct or hemorrhage and the myelination is appropriate for age. The ventricles and other CSF-containing spaces are normal in size. There is no mass-effect or midline shift. The major intracranial vascular flow voids are preserved.MRI Pituitary:The pituitary bright spot is preserved. The pituitary gland has a maximum height of 4 mm and again there is an unchanged concave superior border, which is slightly, focally more concave to the left of the pituitary infundibulum insertion. The pituitary tissue is homogenous without focal lesion. The pituitary infundibulum is of normal thickness and midline.

Output: Redemonstration of stable subtle nonspecific asymmetric concavity of the left upper margin of the pituitary gland.


Instruction: Generate impression based on findings.

Input: 63 year old male with cavernous malformation. Redemonstrated is a left hemispheric frontal tumor cavernous malformation, unchanged in size or shape. As before, there is no perilesional edema and there is no associated mass effect.Redemonstrated is a slight prominence of bilateral hemispheric cortical sulci which could be still within limits of normal for patient's stated age. There are a few punctate foci of increased T2 signal intensity in the subcortical and periventricular white matter as well as within the left thalamus which are unchanged and consistent with chronic small vessel ischemic disease. As before, there are foci of encephalomalacia with gliosis involving the distribution of bilateral PCA consistent with remote ischemic strokes. There is a well-demarcated focus of increased T2 and decreased FLAIR signal in the right paramedian posterior pons which in combination with additional small foci of similar signal changes in bilateral cerebellum (left greater than right) are consistent with chronic ischemic changes in the distribution of the vertebro-basilar system, unchanged in appearance.There is no restricted diffusion to suggest the presence of acute ischemia. Previously demonstrated lack of flow within the distal left vertebral artery is again noted. Otherwise expected vascular flow voids are demonstrated. Post enhanced images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges and no convincing enhancement of the cervical cavernous malformation.Redemonstrated is sinus disease within the maxillary sinuses (left greater than right). The remaining visualized paranasal sinuses as well as the mastoid air cells are clear.

Output: 1.Stable left frontal cavernous malformation without perilesional edema or mass effect.2.Stable mild chronic small vessel ischemic disease, large left PCA and a smaller right PCA chronic remote ischemic strokes, small bilateral cerebellar chronic strokes, and a right paramedian pontine chronic lacunar infarct.


Instruction: Generate impression based on findings.

Input: Headache. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum and the posterior fossa appears to be relatively small. Nevertheless, the cerebellar tonsils display rounded morphologies. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum and the posterior fossa appears to be relatively small, which may represent a mild form of Chiari type 1 malformation. 2. No evidence of intracranial hemorrhage, mass, or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Cervical stenosis, arm weakness Again seen are postsurgical changes of anterior cervical fusion from C4-C5. There is solid osseous fusion. There is also evidence of laminectomy from C3 to C6. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. No suspicious osseous lesions. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disk osteophyte complex. No significant spinal canal stenosis. There is moderate to severe right and mild left neural foramina stenosis.C4-5: Minimal left neural foraminal narrowing. No significant compromise to the spinal canal or right neural foramina.C5-6: There is diminished disk height and disk osteophyte complex with minimal effacement of the ventral thecal sac. Ligamentum flavum thickening also seen with partial dorsal thecal sac effacement. Minimal spinal canal stenosis. There is moderate to severe left neural foramina stenosis. Artifact makes evaluation difficult. There is some low ill-defined T2 signal in the right neural foramen which may be related to scar tissue if there has been a foraminotomy or possibly extruded disk material. There is also bilateral uncovertebral hypertrophy. CT may be helpful to assess the surrounding bony anatomy given hardware artifact.C6-7: There is diminished disk height and small disk osteophyte complex eccentric to the right. There is extruded disk material effacing the left ventral aspect of the thecal sac and narrowing the left neural foramen which appears to be present on prior study but better visualized on the current study. There is mild right neural foramina stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postsurgical changes of anterior cervical fusion at C4-C5 as well as posterior decompression with laminectomies from C3 to C6. 2. Multilevel degenerative changes including narrowing of the right C5-C6 neural foramen which may represent disk material or possibly scar tissue if there has been a foraminotomy (axial T2 23-24/39). Artifact related to the hardware makes evaluation difficult and CT may be helpful to better define the bony anatomy. There is also moderate to severe right C3-C4 and mild right C6-C7 neural foraminal stenosis. 3. Additional levels of neural foraminal narrowing as detailed above. No significant spinal canal stenosis or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 74Yrs-old male with a history of CAD s/p failed PCI of PDA In 2004, admitted with dyspnea and new LV dysfunction, referred for ischemic evaluation.MEDICATIONS: ASA, losartan, nifedipine, coreg, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is present. Viability/ Myocardial ScarThere is a mid myocardial stripe of late gadolinium enhancement in the basal to mid septum. This pattern is not typical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The "mid wall stripe" pattern can be seen in non-ischemic dilated cardiomyopathies.Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 211 ml (normal range 142+/-34), the LV end systolic volume index is 86 ml/m2 (normal range 25+/-9), the LVESV is 157 ml (normal range 47+/-19), the LV mass index is 76 g/m2, and the LV mass is 137 g. LV dysfunction is global.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 111 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 53 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is apically displaced due to bi-leaflet tethering. There is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSee recent CT for lung findings. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction.3. Mildly dilated LV with severely reduced systolic function (LVEF 26%). There is a pronounced mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid septum. The pattern is atypical for prior myocardial infarction and most likely represents myocardial fibrosis. It has been commonly described in dilated cardiomyopathy.4. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI of the brainNo diffusion weighted abnormalities are appreciated.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.No perfusion defects are appreciatedMRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.No evidence for cerebrovascular occlusive disease. There is no evidence for supraclinoid internal carotid artery narrowing on this exam which was performed at 3T.2.No evidence for intracranial aneurysm.3.MR venogram of the brain is within normal limits.4.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Refractory epilepsy, h/o subdural s/p resection surgery, gait-coordination abnormalities. Many of the sequences are degraded by patient motion. There are postoperative findings related to right inferior frontal gyrus topectomywith persistent areas of high T2 signal medial to the surgical defect, with a somewhat linear configuration. There is also a small amount of susceptibility effect along the surgical margin, which may represent chronic blood products. There are linear areas of susceptibility effect along the sulci of the bilateral parietal lobes, which may also represent chronic blood products. However, there is no residual subdural hemorrhage, and there is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is diffuse cerebellar volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are left mastoid effusions.

Output: 1. Diffuse cerebellar volume loss may be related to chronic anti-epileptic therapy.2. Postoperative findings related to right inferior frontal gyrus topectomy with persistent areas of nonspecific signal abnormality medial to the surgical defect, which may represent gliosis.3. No evidence of residual subdural hemorrhage.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: MS; f/u progression History: leg weakness There are multifocal bihemispheric periventricular and deep white matter high signal intensity lesions on FLAIR imaging.The extent and number of high signal intensity lesions appear to be increased in number and size since prior scan. In addition, there are multiple new lesions involving left cerebellar hemisphere, lateral aspect of left side Pons, mid to lower pons, left middle cerebellar peduncle and pontomedullary junction.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval progression of supratentorial white matter lesions since prior scan.2. New development of posterior fossa white matter lesions as described above since prior scan.


Instruction: Generate impression based on findings.

Input: Right arm numbness and tingling. Back pain with worsening bowel incontinence, exquisitely tender lower back. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild retrolisthesis of C4 on C5 and minimal of C5 on C6. Alignment of the cervical spine is otherwise maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is mild retrolisthesis with disc osteophyte complex resulting in effacement of the ventral thecal sac and mild impression on the ventral cord. There is mild to moderate spinal canal stenosis at this level and mild bilateral neural foraminal stenosis.C5-6: Small disc osteophyte complex, ligamentum flavum thickening, and bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis. There is moderate right worse than left neural foraminal stenosis..C6-7: Small disc osteophyte complex. There is mild left neural foraminal stenosis. No significant spinal canal or right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina. Prominent right-sided facet arthropathyThe vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5 not significant changed since 6/26/2008. There is also minimal L3 on L4 anterolisthesis also similar to prior. Bone marrow signal is heterogeneous without discrete suspicious lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy without neural foraminal stenosis. There is mild spinal canal narrowing which is worse in the interval.L3-L4: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy without significant spinal canal stenosis. There is minimal bilateral neural foraminal stenosis.L4-L5: Disc uncovering and mild bulge with advanced bilateral facet arthropathy and prominent bilateral ligamentum flavum thickening. There is resulting mild spinal canal stenosis which appears slightly worse since 6/26/2008. The ligamentum flavum thickening partially effaces the posterior lateral aspects of the thecal sac. There is mild to moderate bilateral neural foraminal narrowing which is slightly worse in the interval.L5-S1: Severe loss of disc height, mild disc bulge and facet arthropathy are seen without significant spinal canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis similar to prior. Paraspinous soft tissues are within normal limits. Renal cysts again seen

Output: 1. Multilevel degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at the C4-C5 level. There is mild neural foraminal narrowing on the right at the C4-C5 level and moderate neural foraminal narrowing on the right at the C5-C6 levels which may be impinging on the right C5 and C6 nerve roots. Individual levels as above.2. Multilevel degenerative changes in the lumbar spine which have slightly progressed since 6/26/2008. There is degenerative grade 1 anterolisthesis of L4 on L5. There is neural foraminal stenosis at L4-L5 and L5-S1 as detailed above. There is mild spinal canal stenosis at the L4-L5 level and to a lesser degree at the L2-L3 level. No high-grade spinal canal stenosis in the lumbar spine is appreciated.3. Advanced facet arthropathy at the L4-L5 level which may be contributing the patient's low back pain.


Instruction: Generate impression based on findings.

Input: 69 years, Female, brain metastases. Examination for SRS planning. Examination is limited to sequences per radiation therapy planning protocol. Again seen is a heterogeneously enhancing mass in the right occipital lobe consistent with known metastasis and has enlarged. Lesion measures approximately 2.3 x 2.8 x 3.2 cm in the AP, transverse, and craniocaudal dimensions, previously 1.7 x 2.0 x 2.0 cm. Lesion now extends to the ependymal surface of the right occipital horn. There is evidence of hemorrhage within the lesion, which was seen previously. Surrounding vasogenic edema involving the right temporal, parietal, and occipital lobes has slightly increased since prior but not well assessed due to limited sequences. Mild effacement of the posterior aspect of the right lateral ventricle is similar to prior. No midline shift or uncal herniation. T1 hypointensity in the bilateral periventricular and subcortical white matter is compatible with chronic small vessel ischemic disease and/or posttreatment-related changes. Lytic lesion in the right temporal occipital calvarium with enhancement is again seen and appears to be present since CT 4/4/2014 and nonspecific.

Output: Examination limited to sequences for radiation treatment planning. Compared to 3/9/2016, there has been mild enlargement of the hemorrhagic right occipital metastasis. There is also mild increase in surrounding vasogenic edema. No new lesions are appreciated.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There are numerous, greater than 10 T2 hyperintense lesions in the supratentorial and infratentorial white matter, which are not significantly changed. 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, and scalp soft tissues are grossly unremarkable. There is a small retention cyst in the right maxillary sinus.

Output: No significant interval change in the intracranial multiple sclerosis lesions.


Instruction: Generate impression based on findings.

Input: 3-year-old with history of tethered cord repair and syrinx. Follow-up exam. There ar postoperative findings related to prior tethered cord release. The conus medullaris terminates at the L1-2 level. There is unchanged curvilinear structure in the region of the filum terminale with T1 hyperintense components, which may be related to surgery. There is slight ventral translation of the conus medullaris and cauda equina nerve roots on the prone versus supine images. There is unchanged caliber of the syringomyelia that extends from the cervical spine cranial to the highest image level and extends to the conus medullaris. The vertebral body and intravertebral disc heights are maintained. The vertebral column alignment is anatomic. There is no significant neural foraminal or spinal canal stenosis. The vertebral bone signal is unremarkable.

Output: 1. Postoperative findings related to tethered cord release with slight ventral translation of the conus and cauda equina nerve roots.2. Stable long-segment syringomyelia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 36-year-old female with sciatica. Rule out cord compression. Five lumbar type vertebral bodies are presumed to be present. Again seen is trace grade 1 retrolisthesis of L5 on S1, without significant interval change. The remainder of the lumbar spine is normal in alignment, with straightening of the normal lumbar lordosis. Bone marrow signal is benign. Degenerative endplate bone marrow changes are noted at the L5-S1 level. Vertebral body heights are within normal limits. There is disc desiccation at the L4-L5 and L5-S1 levels with mild loss of intervertebral disc height at the L5-S1 level. The spinal cord is normal in signal. The conus medullaris is normal in position. Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Mild facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Mild disc bulge and facet arthropathy without significant spinal canal or neural foraminal stenosis.L5-S1: There are interval postoperative changes from left hemilaminectomy and microdiscectomy. Again seen is a disc bulge with large leftward central disc extrusion, the original component of which appears smaller than the prior exam. However, there is new, ill-defined soft tissue material contiguous with the L5-S1 disc effacing the left aspect of the spinal canal and causing at least moderate spinal canal stenosis. There is possible impingement of the left L5 and sacral nerve roots with mild left neural foraminal stenosis. Mild facet arthropathy is also noted.There is a small amount of fluid in the laminectomy bed, as well as a small amount of dorsal epidural fluid just superior to the laminectomy, which may be within normal limits in the recent postoperative period. The epidural fluid contributes the spinal canal stenosis.

Output: 1. Findings compatible with interval L5-S1 left hemilaminectomy and microdiscectomy. While the original leftward central disc extrusion at this level appears somewhat smaller, there is new, ill-defined soft tissue contiguous with the disc which effaces the left thecal sac and potentially impinges the adjacent nerve roots. Differential diagnosis includes scar tissue versus recurrent disc.2. Fluid in the laminectomy bed and a small amount of dorsal epidural fluid just above the laminectomy level. Findings may be within normal limits in the recent postoperative period.


Instruction: Generate impression based on findings.

Input: 78-year-old male with history of cholelithiasis, status post cholecystectomy in 2012, complicated by bile leak, treated with biliary stent sphincterotomy and stent placement, status post ERCP for stent removal in 11/2014 complicated by post-ERCP pancreatitis and large pancreatic pseudocyst status post drainage. ABDOMEN:LUNG BASES: Stable persistent right basilar atelectasis/consolidation. Trace right pleural effusion.LIVER, BILIARY TRACT: Status post cholecystectomy. Stable subcentimeter segment 8 hepatic cyst. Stable mild dilatation of the common bile duct measuring 8 mm in diameter, and smooth distal tapering is again noted. Stable mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic parenchymal atrophy is again noted of the body and tail with loss of the normal T1 hyperintense signal intensity, which is suggestive of chronic pancreatitis. The previously described short segment dilatation of the pancreatic duct at the junction of the upstream body and tail is similar and could be related to stricture. No pancreatic or peripancreatic drainable fluid collection.Blunted physiologic response to secretin. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: IVC filter.BOWEL, MESENTERY: Stable small fat-containing ventral hernia (series 9 image 19).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stable findings suggestive of chronic pancreatitis with possible stricturing of the pancreatic duct at the body/tail junction. Blunted physiologic response to secretin.2. No new peripancreatic fluid collection.3. Stable persistent right basilar nonspecific atelectasis/consolidation.


Instruction: Generate impression based on findings.

Input: Female, 15 days old, ex-36 weeker with signs and symptoms concerning for perinatal asphyxia at birth, now stable LFNC. No evidence of restricted diffusion or any other abnormal parenchymal signal is seen to suggest acute or subacute ischemic injury. Brain parenchymal morphology is within normal limits. The degree of gyral development and immature pattern of white matter myelination are appropriate for the stated gestational age. No evidence of edema or mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid collection is detected. The ventricular system is normal in size and morphology.

Output: No evidence of hypoxic-ischemic injury or any other acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 23 year old with history of recurrent syncope Left VentricleThe left ventricle is upper normal in size with lower normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 163 ml (normal range 109+/-23), the LV end systolic volume index is 75 ml/m2 (normal range 18+/-5), the LVESV is 39 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. LGE imaging was limited by motion artifact. There are prominent trabeculations in the LV apex.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 82 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 73 ml (normal range 35+/-13). There are no focal regional wall motion abnormalities to suggest arrhythmogenic right ventricular cardiomyopathy. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace 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 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. Upper normal left ventricular size with lower normal systolic function (LVEF 54%). There are prominent trabeculations in the LV apex, however the quantitative compaction ratio criteria are not met for the MRI diagnosis of non-compaction.2. Normal right ventricular size and systolic function (RVEF 54%)3. No MRI evidence of arrhythmogenic right ventricular dysplasia. 4. Late gadolinium imaging limited by motion artifact, however, no obvious scar, inflammation or infarction seen on LGE imaging.


Instruction: Generate impression based on findings.

Input: Female 76 years old Reason: solid pelvic mass suggestive of a pedunculated fibroid but left ovary not seen raising possibility of solid ovarian tumor History: intermittent abdominal pelvic pain PELVIS:UTERUS, ADNEXA: Uterus measures 4.2 x 2.6 x 5.9 cm. There is a T1 hyperintense lesion in the fundus of the uterus measuring 11 mm and may represent a endometrioma.Right adnexa measures 2.4 x 1.3 cm and is located adjacent to the right pelvic sidewall vessels. There is a T2 hyperintense mass is inseparable from the left ovary measuring 4.8 x 3.6 cm. Lesion has foci of T1 hyperintensity within it indicating areas of hemorrhage.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of a 4.8 cm left adnexal mass. The lesion has some foci of hemorrhage within it and may have subtle enhancement.2.No ovarian fibroids as clinically suggested.3.Probable small endometrioma at the fundus of the uterus.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified ptosis of eyelidClinical question: intermittent left ptosis, especially rule out pathology of CN3 tractSigns and Symptoms: intermittent ptosis of the left upper eyelid MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A small extra-axial fluid collection is present just inferior to the left cerebellar hemisphere measuring 7 x 10 mm in coronal dimensions and most likely represents a small arachnoid cyst. Follows spinal fluid on all pulse sequences. It is not associated with diffusion restriction.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are identified and are small. The posterior communicating arteries are associated with small infundibula. The left vertebral artery is larger than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction.4.Findings are compatible with a small arachnoid cyst adjacent to the left cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, somewhat of a limitation.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:12/11/1946)Reason: lesion to left temporal area History: 6 month follow up severe pain behind eyePROVIDER/ATTENDING NAME: JAVAD HEKMATPANAH JAVAD HEKMATPANAH The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a 7 x 20 mm sagittal dimension extra-axial mass adjacent to the right parietal lobe which measured 5 x 16 mm sagittal dimensions the previous exam the prior exam which was without contrast.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: There is mild interval enlargement of the patient's right parietal meningioma.


Instruction: Generate impression based on findings.

Input: Nontraumatic intracerebral hemorrhage, intraventricular Abnormal electroencephalogram (EEG) The myelination pattern is appropriate for patient's age. The corpus callosum is thin. There is mild prominence of the extra-axial subarachnoid spaces. The gray-white matter differential aeration is preserved. The left lateral ventricle remains asymmetrically enlarged, similar to prior examination No areas of diffusion abnormality are identified. There is no evidence for acute intracranial hemorrhage. Susceptibility artifact from hemosiderin deposition is demonstrated within the lateral ventricles. There is no midline shift or mass effect.

Output: Stable asymmetric enlargement of the left lateral ventricle, prominence of the subarachnoid spaces, and thinning of the corpus callosum without evidence for acute abnormality.


Instruction: Generate impression based on findings.

Input: Recent tumor resection (right lateral ventricle central neurocytoma). There has been recent right posterior parietal craniotomy with re--resection of the right alteral ventricle mass and external ventricular drain insertion, with what appears to be a small amount of residual tumor anterior to the catheter tip. There is also confluent T2 hyperintensity, restricted diffusion, linear enhancement, and susceptibility effect along the surgical tract, a small amount of extradural fluid deep to the craniotomy flap, and extensive subgaleal fluid. The catheter extends to the midline of the right lateral ventricle. There is also a right transfrontal ventricular catheter that terminates in the third ventricle. The ventricular sytem is unchanged in size and there is a small amount of residual intraventricular hemorrhage and pneumocephalus. There has been interval evolution of postoperative findings related to right frontal craniotomy with right frontal lobe edema and areas of gyriform restricted diffusion and susceptibility effect. There is persistent mild scattered leptomeningeal enhancement in the right frontal region. There are scattered foci of restricted diffusion in the right centrum semiovale.

Output: 1. Postoperative findings related to recent re-resection of a right lateral ventricle central neurocytoma with what appears to be a small amount of residual tumor, as well hemorrhage, ischemia, and edema along the right transfrontal surgical tract. 2. Unchanged size of the shunted ventricular system with a small amount of intraventricular hemorrhage.3. Punctate foci of acute infarction in the right centrum semiovale.4. Gyriform recent infarcts and hemorrhage superimposed upon vasogenic edema in the right frontal lobe surgical bed region.


Instruction: Generate impression based on findings.

Input: 8 year old male with pulmonic valve stenosis s/p balloon valvuloplasty. He also has a dysplastic tricuspid valve. Patient is participating in a clinical trial. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 79 ml/m2 (normal range: 74+/-15), the LVEDV is 75 ml, the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 26 ml, the LV mass index is 49 g/m2 (normal range 85+/-15), and the LV mass is 46 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 148 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml, the RV end systolic volume index is 63 ml/m2 (normal range 31+/-9), and the RVESV is 59 mlRight AtriumThe right atrium is significantly 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 severe pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely; however, the leaflets are thickened and possibly calcified. There is severe 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 dilated and significantly pulsatile. During diastole it is 24mm in diameter and during systole it is 31mm in diameter. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThymus tissue is noted. 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. Normal LV size and systolic function (LVEF 66%).2. Severe RV dilation (RVEDVi 148ml/m2) with normal systolic function (RVEF 57%).3. Severe tricuspid valve regurgitation.4. Severe pulmonic valve regurgitation. 5. Dilated main pulmonary artery.


Instruction: Generate impression based on findings.

Input: 43-year-old female with a personal history of bilateral mastectomy in 2012 with implant based reconstruction. History of right benign biopsy in Jan 2016. Status post bilateral mastectomy with retropectoral silicone implants.Implants appear intact, with no evidence of rupture or herniation.A small biopsy change is present in the right breast at 9:00 position, but no abnormal enhancement is associated.No abnormal enhancement is seen in either recontracted breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with history of skull base meningioma status post resection, yearly surveillance. Again seen is evidence of prior right frontal/pterional craniotomy. Encephalomalacia and associated gliosis of the bilateral inferior frontal lobes, right side more than left, are unchanged. Within the limitations of a noncontrast examination, no definite evidence of recurrent tumor is seen along the planum sphenoidale. No new lesions are detected. No edema or mass effect is observed. There are no findings to suggest acute intracranial hemorrhage. The ventricles remain normal in size and morphology.

Output: Redemonstration of postoperative findings with no evidence of recurrent skull base tumor.


Instruction: Generate impression based on findings.

Input: Cognitive decline, memory loss. No intracranial mass or mass-effect is seen, although absence of intravenous gadolinium slightly limits evaluation for small lesions. There is mild global parenchymal volume loss. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as pons, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. Nonspecific focus of hyperostosis noted adjacent to the left squamosal temporal bone as seen on prior CT without significant mass effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No hydrocephalus. Major flow-voids are preserved.There is pansinus opacification which appears improved compared to prior CT from 7/29/2013, with evidence of interval endonasal sinus surgery. There is dental hardware artifact. Sella and orbits are grossly within normal limits. Mastoid air cells are clear. Bone marrow signal is within normal limits.

Output: 1. MRI brain without gadolinium demonstrates no intracranial mass or mass-effect. Mild chronic small vessel ischemic changes.2. Mild global parenchymal volume loss.3. Pansinus disease is improved compared to prior CT with evidence of interval endonasal sinus surgery.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with history of renal cell carcinoma and brain metastases, RT planning. A hemorrhagic, partially enhancing tumor in the right basal ganglia/subinsular region shows no significant interval change from the immediate prior examination. Slightly posteriorly and inferiorly, the adjacent 5 mm focus of enhancement also shows no significant interval change.No new lesions are suspected. The previously treated right cerebellar lesion demonstrates hemosiderin staining and minimal if any residual enhancement. No significant generalized mass effect is seen. The ventricles remain normal in size and morphology.

Output: 1.No interval change in the size of the right basal ganglia lesions.2.Stable posttreatment appearance of a lesion in the right cerebellum.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapseClinical question: stenosisSigns and Symptoms: syncope MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A punctate T2 and FLAIR hyperintense lesion is present in the right cerebellar hemisphere measuring approximately 7 mm in diameter. This could represent an old lacunar infarct.There are multiple punctate subcortical foci of susceptibility effect identified on susceptibility imaging. As a punctate focus of susceptibility present within the midbrain. Several foci of susceptibility effect are present in the cerebellar hemispheres.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the right posterior cerebral artery. The left posterior communicating artery is small. The right A1 segment is smaller than the left A1 segment. The pericallosal arteries are asymmetric in diameter. The left pericallosal artery is larger than the right pericallosal artery. The vertebral arteries are similar in size.There is extracranial origin of the right posterior inferior cerebellar artery. The right vertebral artery is smaller than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is a mild degree of microhemorrhages distributed in predominantly subcortical white matter and also brainstem and cerebellum which do not have a specific pattern of distribution.4.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.5.Findings are compatible with old lacunar infarct in the right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Patient with history of parotitis and sialolithiasis status post endoscopic removal of stones. Now with right parotid cutaneous fistula and infection, recurrent abscess in the past 3 months. There has been interval removal of the right parotid duct calculi. However, there is now a tract that extends from the overlying skin to the and decreased inflammation involving the junction between the parotid gland and parotid duct. There is minimal residual diffuse enhancement of the otherwise fat-replaced right parotid gland and overlying subcutaneous tissues. There appears to be a 2 mm diameter low signal structure in the anterior right parotid gland. There is no evidence of drainable fluid collections. There are mildly prominent right parotid lymph nodes, which are likely reactive. The left parotid gland and submandibular glands appear to be unremarkable. There is interval resolution of the fluid and mucosal thickening within the right maxillary sinus. There is a ovoid cystic lesion in the left auricle, which may represent an inclusion cyst. There is a partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.

Output: 1. Interval removal of the right parotid duct calculi with development of a parotid-cutaneous fistula. Minimal residual diffuse enhancement of the otherwise fat-replaced right parotid gland and overlying subcutaneous tissues related to parotitis.2. Probable calculus within the anterior right parotid duct measuring 2 mm in diameter.3. Partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.


Instruction: Generate impression based on findings.

Input: 39-year-old male with left shoulder pain and weakness. Difficulty reaching. Suboptimal evaluation on multiple sequences due to patient motion artifact.ROTATOR CUFF: There is intermediate signal abnormality within the supraspinatus tendon indicating mild tendinosis. The supraspinatus muscle and tendon appear intact. There is a small partial thickness undersurface tear of the infraspinatus muscle at the level of its insertion on the greater tuberosity measuring approximately 6 mm in the AP dimension without significant retraction, involving less than 50% of the tendon width. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. The infraspinatus muscle appears intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the acetabular labrum, there is heterogeneity and increased signal abnormality within the anterior superior glenoid labrum with associated deformity suggesting degenerative tearing.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the joint versus a mild tenosynovitis. The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Findings consistent with avascular necrosis of the humeral head as described above.2. Small partial-thickness rotator cuff tear without evidence of a full-thickness rotator cuff tear or retraction.


Instruction: Generate impression based on findings.

Input: 84-year-old male with a 3 day history of altered mental status, and history of falls on Coumadin. Evaluate for bleed There is no evidence of intracranial hemorrhage, mass or edema. Multiple patchy areas of hypodensity in a periventricular and subcortical distribution consistent with age indeterminate microangiopathic changes. If there is clinical concern for acute ischemia, an MRI may be considered.Prominent sulci and proportionally prominent ventricles, within normal limits for age.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Age indeterminate small vessel disease. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: There is unchanged patchy nonenhancing increased T2 signal in the medulla extending into the posterior pons. There is unchanged mild increased T2 signal in the right cuneus without mass effect. There are scattered subcortical and periventricular white matter T2 hyperintensities again seen. The ventricles are unchanged with no hydrocephalus. There is no acute infarct, mass effect or midline shift. There are unchanged postoperative findings the occipital scalp. There is a stable small CSF intensity collection likely postsurgical adjacent to the lateral right cerebellar hemisphere without significant change. There are retention cysts in the bilateral maxillary sinuses.

Output: Stable exam with no significant change in patchy T2 hyperintense signal in the brainstem. Of note, overall appearance is much improved since remote MRI from 8/2/2011.


Instruction: Generate impression based on findings.

Input: There is a solitary small focus of T2 hyperintensity in the right periventricular white matter without mass effect, which is T1 hypointense, nonenhancing, and without susceptibility abnormality. 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: There is a solitary small focus of T2 hyperintensity in the right periventricular white matter without mass effect, which is T1 hypointense, nonenhancing, and without susceptibility abnormality. This is nonspecific in appearance, and given its solitary nature is of uncertain etiology or significance.


Instruction: Generate impression based on findings.

Input: 62-year-old female with right lumbar radicular pain. There is 8 mm of anterolisthesis of L4 upon L5. There are mild multilevel Schmorl's nodes; otherwise, the vertebral body heights are intact. There is multilevel disc desiccation without significant disc space loss. The vertebral bone marrow signal is unremarkable. There is no abnormal signal within the distal cord and conus medullaris, which ends at L1-L2. At L3-L4, there is mild ligamentum flavum hypertrophy without significant spinal or neural foramen stenosis. At L4-L5, there is a disc bulge that is eccentric to the left, moderate ligamentum flavum hypertrophy, moderate spinal canal stenosis, and mild bilateral neural foramen stenosis. At L5-S1, there is a mild disc bulge with small annular fissure, mild ligamentum flavum hypertrophy, and mild bilateral neural foraminal stenosis without significant spinal stenosis. There are multiple T2 hyperintense foci in the myometrium of the uterus.

Output: 1. Grade 1 anterolisthesis of L4 upon L5 and mild degenerative spondylosis in the lower lumbar spine.2. Findings suggestive of adenomyosis. Dedicated pelvic ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 19-year-old male with Crohn's disease. Evaluate active disease involving the terminal ileum. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There has been significant interval improvement in the marked inflammatory changes including thickening and irregularity of the terminal ileum. There is residual thickening of the terminal ileum measuring approximately 1.5 cm with evidence of diffusion restriction and mild contrast enhancement at this location.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There has been significant interval improvement in the marked inflammatory changes including thickening and irregularity of the terminal ileum. There is residual thickening of the terminal ileum measuring approximately 1.5 cm with evidence of diffusion restriction and mild contrast enhancement at this location.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Significant interval improvement in the marked inflammatory changes involving the terminal ileum with evidence of residual terminal ileum active inflammatory disease.


Instruction: Generate impression based on findings.

Input: Squamous cell carcinoma of the right nasal bridge and left cheek with perineural invasion. Status post Mohs 9/9/2014 and radiation therapy completed 12/4/2014. Evaluate for recurrence. There are post-treatment changes of the left cheek. There is no evidence of mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are grossly intact. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. There is interval persistent mucosal thickening and secretions within the paranasal sinuses. There is fluid within the left mastoid air cells and middle ear.

Output: 1. No definite evidence of local tumor recurrence, although the assessment is limited by the lack of intravenous contrast.2. Persistent mucosal thickening and secretions within the paranasal sinuses, which may represent sinusitis. 3. Fluid within the left mastoid air cells and middle ear may represent otomastoiditis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 73Yrs male with multiple medical problems and recently diagnosed bulky stage 4 non-GCB DLBCL History: Change in mentation, increased confusion. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Susceptibility sensitive sequence is motion degraded limiting assessment for small foci of hemorrhage, although no obvious hemorrhage is evident within this limitation.There are patchy foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate degree of chronic small vessel ischemic disease. There is also more notable T2/FLAIR hyperintensity involving the pons which is nonspecific but in association with the supratentorial findings is favored to to be related to chronic small vessel ischemic disease. No associated restricted diffusion or enhancement.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. There is mild mucosal thickening involving the left maxillary sinus as well as minimal scattered ethmoid opacification.

Output: 1. No evidence of intracranial neoplasm. No evidence of acute infarct or intracranial mass effect.2. Patchy FLAIR signal abnormality in the periventricular and subcortical white matter is nonspecific but likely related to moderate chronic small vessel ischemic disease. T2/FLAIR hyperintensity in the pons is favored to be related to chronic small vessel ischemic disease given the supratentorial findings; however, osmotic demyelination involving the pons can be considered in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Reason: left ankle sprain History: STF rupture/PTT tear -> tendinosis -? injury x > 5 years. TENDONS: No significant abnormality noted.LIGAMENTS: The anterior talofibular ligament is not well visualized and likely chronically torn. The remainder of the ligaments appear intact. ARTICULAR SURFACES AND BONE: Small amount of edema within the talus and anterior calcaneus, likely stress reaction. Large talar osteophyte. Small amount of abnormal signal within the posterior tibiotalar joint likely representing synovitis. ADDITIONAL

Output: 1.Probable chronic ATFL tear.2.Edema within the talus and anterior calcaneus, likely stress reaction. 3.Posterior tibiotalar joint synovitis.4.Intact PTT as clinically questioned.


Instruction: Generate impression based on findings.

Input: 56-year-old male with right-sided abdominal pain. A CT scan elsewhere 6/2016 noted hepatic hemangioma and other nonspecific hypoattenuating areas. MRI liver requested for further characterization. ABDOMEN:LIVER, BILIARY TRACT: The 1.1 x 1.1 cm T2 hyperintense focus of hepatic segment 7 (series 301 image 29), a 3 x 2 cm lobulated lesion of hepatic segment 8 (series 201 image 21), and a 0.8 x 0.7 cm T2 hyperintense focus of hepatic segment 6 (series 301 images 19) all demonstrate peripheral nodular enhancement that fill in on venous and delayed phases compatible with benign hemangiomas. Otherwise normal hepatic parenchyma. No intra or extrahepatic biliary ductal dilatation. Patent vasculature. Normal gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Normal T1 hyperintense precontrast signal intensity of the pancreatic parenchyma. No pancreatic ductal dilatation.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: Mild degenerative changes at L2/L3. Well-circumscribed focus of the L1 vertebral body is hyperintense on T2 and fat sensitive sequences most compatible with a benign osseous hemangioma (coronal series 301 image 23).OTHER: No significant abnormality noted.

Output: Imaging characteristics consistent with 3 benign hepatic hemangiomas. The largest measures 3 x 2 cm with a lobulated contour.


Instruction: Generate impression based on findings.

Input: History of breast cancer: headaches x 1 month. Many of the sequences are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity, which is nonspecific. There is also a punctate focus of high T2 signal in the basal ganglia, which likely represents a chronic lacunar infarcts or prominent perivascular space. 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, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Pineal cyst. There is a cystic pineal gland that measures up to 11 mm. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. 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.

Output: The cystic pineal gland that measures up to 11 mm.


Instruction: Generate impression based on findings.

Input: Knee injury pain MENISCI: Medial and lateral menisci are normal morphology and signal characteristics.ARTICULAR CARTILAGE AND BONE: Heterogeneity of the epiphysis of the tibia, likely physiologic. LIGAMENTS: Medial and lateral collateral ligaments are intact. Anterior and posterior cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small joint effusion with findings suggestive of Hoffa's fat pad impingement syndrome.2. Inflammatory changes surrounding the popliteal vasculatures and tibial nerve of unclear etiology, but this may be related to contusion.3. No evidence of medial or lateral meniscal tear.


Instruction: Generate impression based on findings.

Input: 18-year-old male with history of cerebrovascular malformation. Preoperative planning. This study is limited to T1 and T2 sequences secondary to Stealth acquisition protocol.Redemonstrated is an evolving and contracting hematoma adjacent to the right caudate head now measuring 5 x 4 mm on the T2 weighted sequence. There is a surrounding T2 hypointense hemosiderin rim. There is no significant surrounding vasogenic edema. No mass-effect or midline shift. Adjacent to this hematoma, there is a right frontal lobe developmental venous anomaly coursing cranially into a curvilinear vascular malformation within the right superior frontal gyrus measuring proximally 9 x 6 mm, which again demonstrates significant enhancement which would be unusual for a cavernoma. Blooming artifact is again noted on susceptibility. Ventricles and sulci within normal limits. The cisterns are patent. There is no midline shift or mass-effect. There is complete opacification of the right frontal sinus extending into the right anterior ethmoid air cells. Additionally, the right maxillary sinus demonstrates complete opacification and moderate mucosal thickening.

Output: 1.Limited Stealth protocol. Redemonstration of presumed cavernoma and superimposed resolving hematoma near the right caudate head as well as associated developmental venous anomaly coursing cranially.2.Additional stable small avidly enhancing vascular malformation located within the right superior frontal gyrus with chronic hemosiderin deposition.3.Persistent right paranasal sinus disease as above.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of meninges, unspecified [D32.9], Reason for Study: ^Reason: resection of meningioma History: Meningioma Post left frontotemporal craniotomy status with extradural fluid collection underneath of the craniotomy site. There are diffuse dural enhancements, however, there is no evidence of residual meningioma on this scan.There is no evidence of acute ischemic lesion.Several susceptibility artifacts especially on the left side frontal and temporal lobe may indicate postoperative blood products.There are also blood products within the ventricular system especially bilateral lateral ventricle occipital horn.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Postoperative status of the left sphenoid wing meningioma.2. No evidence of residual mass on this scan.3. Some parenchymal and ventricular blood products with craniotomy site extradural fluid collections are procedure related, there is no post-operative unusual finding.


Instruction: Generate impression based on findings.

Input: History of transphenoidal resection of pituitary tumor with residual tumor: new headache and feeling of pressure behind eyes. Pituitary: There are stable postoperative findings related to transsphenoidal surgery. There is an unchanged subcentimeter enhancing focus within the right posterolateral aspect of the sella, which otherwise displays a partially empty configuration. The infundibulum is deviated slightly to the right. There is no mass effect upon the optic apparatus. Brain: There are subcentimeter defects in the right cerebellar hemisphere. There is also mild scattered nonspecific cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation.

Output: 1. Stable postoperative findings with an unchanged 6 mm focus of enhancement within the right posterolateral aspect of the sella.2. Chronic right cerebellar lacunar infarcts.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, status post fall, with findings on prior MRI suggestive of cervical epidural hematoma and ligamentous injury. As visualized on the survey images only, there is a T1 hyperintense subdural collection along the left cerebral hemisphere measuring up to 17 mm in thickness.Since the prior examination, the ventral epidural collection which was previously seen spanning the C1-C4 levels has resolved. No residual intraspinal fluid collections are seen and there are no areas of significant spinal canal compromise.Minimal residual STIR hyperintensity is seen within the soft tissues along the posterior atlanto-occipital ligament. Signal abnormality seen previously along the posterior atlanto-axial ligament has resolved. No other findings are seen to suggest soft tissue or ligamentous injury.The spinal cord demonstrates normal signal intensity throughout. No areas of myelomalacia or susceptibility effect are seen to suggest cord injury or cord contusion.Spinal alignment is anatomic. Vertebral body heights are preserved. Endplate edematous signal abnormality is seen at C6-7 but improved from the prior examination.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing.C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing.C5-6: Posterior disc-osteophyte complex formation with a small central protrusion. No significant spinal canal stenosis. Mild left foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.A subacute subdural hematoma is evident along the left cerebral hemisphere measuring up to 17 mm in thickness. This is only visualized on the survey images. Discussed with Dr. Warnke at 4:20 PM on 5/23/16.2.Resolution of cervical epidural hematoma.3.Improvement in mild soft tissue/ligamentous edema as above.4.Scattered degenerative findings without significant interval change.


Instruction: Generate impression based on findings.

Input: Clinical question: Worsening back pain after an epidural. Signs and symptoms: Back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column. There is unremarkable signal intensity of vertebral column are changes secondary to degenerative disease.As was noted on prior exam there is significant generalized narrowing of the spinal canal to represent a congenital anatomical variation.This finding in combination with degenerative disease resulting in multilevel central spinal stenosis without significant change since prior study.Previously noted a small epidural collection along the dorsal aspect of T12 as completely resolve and non-detectable on current exam.T12 -- L1 however demonstrate mild degenerative disease and bulging disk and resultant moderate central spinal stenosis without interval change and neural foraminal compromise.L1 -- L2 demonstrate mild disk disease, loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Similar to prior study there is evidence of mild to moderate central spinal stenosis and without neural foraminal compromise.L2 -- L3 demonstrate minimal disk desiccation without loss of disk height and a mild to moderate bilateral facet and ligamentum flavum hypertrophy. Mild central spinal stenosis and no neural foraminal compromise without change since prior exam.L3 -- 4 demonstrate mild disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. Constellation of degenerative changes in combination with congenitally small canal results in moderate to severe central spinal stenosis at this level and without evidence of neural foraminal compromise. There is no significant change since prior exam.L4 -- L5 demonstrate mild disk desiccation and moderate bilateral ligamentum flavum hypertrophy and to a lesser degree of facet hypertrophy. Changes of this level results in central spinal stenosis without change since prior exam. No convincing evidence of neural foraminal compromise. New since prior exam at this level is a small annular fissure in the left paramedian location (sagittal T2/T2 stir image 6).L5 -- S1 demonstrate mild disk desiccation and facet/ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.

Output: 1.Interval complete resolution of previously noted small epidural lesion likely sequestered disk along the dorsal aspect of T12 vertebral body.2.Interval tiny annular fissure at the L4 -- L5 since prior exam.3.Stable mild degenerative disk disease and moderate facet and ligamentum flavum hypertrophic changes are lumbar spine which in combination with congenitally small canal results in multilevel mild to moderate central spinal stenosis as detailed level.4.There is no appreciable neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: There is a new pathologic compression fracture of the T11 vertebral body with mild retropulsion. However, there is no significant spinal canal stenosis at this level. Again noted are post-operative changes related to posterior laminectomies as well removal of the spinous processes for tumor resection at the T8 and T9 levels with posterior spinal fusion and placement of bipedicular screws at the T7 and T10 levels. Susceptibility artifact limits evaluation of these levels; however, there is suspected narrowing of the spinal canal with mass effect of the cord at the T8/T9 levels related to epidural tumor spread. There are metastatic lesions in the T10 spinous process, T8, T9, T11, T12, L3, L5 vertebral bodies and S1, S2 segments. There may be narrowing of the bilateral S1 foramen. There are additional metastases to the pelvic bones. The visualized spinal cord otherwise displays normal signal characteristics. There is no detectable enhancement of the cord or the meninges.Incidentally noted are enlarged subcarinal, pretracheal, aortopulmonary window and left hilar lymph nodes, which are increased in size compared to prior study. A left adrenal mass measuring up to 3.4 cm is also increased in size. A partially imaged T2 hyperintense lesion at the right lung base is incompletely evaluated. There is a trace left pleural effusion.

Output: 1. New pathologic compression fracture of the T11 vertebra with mild retropulsion, but no significant spinal canal stenosis.2. Post-operative changes related to T8/9 posterior laminectomies with posterior spinal fusion at the T7 and T10 levels. Evaluation of the spinal canal is limited by susceptibility artifact from spinal hardware at these levels; however, there is suspected narrowing of the spinal canal and mass effect on the cord at the T8/T9 levels related to epidural tumor spread. 3. Metastatic lesions of the T10 spinous process, T8, T9, T11, T12, L3, L5 vertebral bodies and S1, S2 segments, at least one of which is new at T12. Pelvic osseous metastases with suspected S1 foraminal narrowing.4. Interval increase in size of mediastinal and left hilar lymphadenopathy. 5. Interval increase in size of a left adrenal mass measuring up to 3.4 cm, which likely represents metastasis.6. A partially imaged T2 hyperintense lesion at the right lung base, may represent a new loculated effusion. However, this is incompletely evaluated and CT may be considered for further evaluation. Findings conveyed to Dr. Melotek by EPIC email on 3/7/2015 at the time of dictation.


Instruction: Generate impression based on findings.

Input: Ms. Zishka is a 46 year old female with a strong family history of breast cancer in paternal aunt. She is BRCA-2 positive. She presents for MRI high-risk screening evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: left shoulder possible SLAP tear History: left shoulder possible SLAP tear ROTATOR CUFF: There is intermediate signal within the supraspinatus tendon, indicating mild tendinosis. The rotator cuff is otherwise unremarkable. No rotator cuff tear is evident.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a complete thickness tear of the posterior superior labrum with extension anteriorly into the bicipitolabral complex, consistent with a SLAP tear. The glenohumeral joint is otherwise normal in appearance.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Findings compatible with SLAP tear as above.2. Mild supraspinatus tendinosis without rotator cuff tear evident.


Instruction: Generate impression based on findings.

Input: Von-Hippel Lindau and pre-existing spinal hemangioblastomas. Also has inner ear canal lesion. Evaluate for growth and new hemangioblastomas in brain and spine. BRAIN: There is redemonstration of postoperative findings in the posterior fossa with unchanged minimal marginal T2 hyperintensity and susceptibility effect related to chronic hemosiderin deposition. There are multiple scattered subcentimeter enhancing nodules in the cerebellum bilaterally and dorsal to with minimal associated T2 signal intensity, likely representing vasogenic edema, unchanged. The largest of these lesions is within the left cerebellum and measures up to 8 mm, unchanged in size. There are also unchanged enhancing lesions within the medulla and left internal auditory canal, which have not significantly changed in size. There are postoperative changes are previous right frontotemporal craniotomy with a small peripheral area of encephalomalacia within the right lateral frontal lobe. In addition, there is a punctate enhancing lesion in the surgical cavity that appears to be unchanged. The ventricular sizes are unchanged. The basal cisterns remain patent. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.SPINE: There are postoperative findings from previous C4-C6 laminoplasty, as well as multiple upper thoracic and upper lumbar laminectomies, with near-interval resolution of the paraspinal soft tissue enhancement in the upper thoracic spine region. There are numerous intramedullary leptomeningeal enhancing nodules throughout the spinal canal, many which are associated with prominent vascularity and edema, particularly of the lower thoracolumbar spine. The lesions do not appear to have significantly changed in size. The largest of these is along the conus measuring approximately 9 x 8 x 28 mm, but has not significantly changed in size. The vertebral body heights are preserved and disc spaces are unchanged. There is loss of usual cervical lordosis centered at C4/C5, which is unchanged. The rest of the spine alignment is intact. There is developmental narrowing of the cervical spinal canal with superimposed degenerative spondylitic disease resulting in unchanged moderate central canal stenosis at C4/5 and moderate to severe stenosis at C5/C6 with impingement upon the spinal cord. There is diffuse T2 hyperintensity in the posterior spinal cord at these levels. There is no significant spinal canal or neural foraminal stenosis in the thoracic or lumbar spine.

Output: 1. Postoperative findings in the posterior fossa and spine with multiple enhancing lesions throughout the infratentorial compartment and spine, as well as a punctate lesion in the right frontal lobe resection cavity, compatible with hemangioblastomas and appear stable. 2. A subcentimeter enhancing lesion within the left internal auditory canal also likely represents a hemangioblastoma or perhaps a vestibular schwannoma, but is unchanged. 3. Cervical spondylosis, congenital spinal canal narrowing, and laminoplasty with indentation upon the spinal cord. Signal abnormality at C4-5 to C6 suggestive of edema may be related to an hemangioblastoma and the spinal cord compression. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Low grade astrocytoma. There are postoperative findings related to biopsy of a heterogenously enhancing stellate-shaped mass in centered in the left peritrigonal white matter extending to left pre and postcentral gyri and left thalamus that measures up to approximately 4 cm. The mass also contains areas of susceptibility effect that correspond to calcifications and is surrounded by confluent areas of high T2 signal. Some portions of the mass appear to have gradually increased in size. Furthermore, there is now a small patchy area of enhancement in the right paracentral lobule with surrounding high T2 signal, as well as a punctate focus of enhancement in the left splenium of the corpus callosum in an area of increased high T2 signal and swelling. There are otherwise unchanged T2 hyperintense lesion in the periventricular and subcortical white matter and in the brainstem, which are nonspecific. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings suggestive of gradual progression of the mass centered in the left peritrigonal white matter extending to left pre and postcentral gyri and left thalamus , as well as development of what appears to be additional enhancing tumor in the left paracentral lobule and splenium of the corpus callosum.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with left lower extremity radiculopathy. Alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are heterogeneous but no concerning areas of marrow replacement or marrow edema are detected. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.Facet arthropathy develops at lower lumbar levels, most notably at L4-5 and L5-S1. At L4-5, severe disc degeneration is seen with loss of disc height and chronic fatty endplate signal change. An inferiorly directed disc protrusion is also evident on the left at this level where it effaces the lateral recess likely impinging upon the transiting left L5 nerve root. The spinal canal is generally mildly narrowed. The neural foramina are moderately narrowed.At L5-S1, there is minimal disc bulging but no significant spinal canal or foraminal stenosis.

Output: Severe disc degeneration is seen at L4-5 with loss of disc height and a disc herniation projecting into the left lateral recess likely impinging the transiting left L5 nerve root.


Instruction: Generate impression based on findings.

Input: Male 67 years old Reason: cholangiocarcinoma History: cholangiocarcinoma ABDOMEN:LIVER, BILIARY TRACT: Progressive atrophy of the left lateral segment of the liver and segment 4. This is due to an infiltrative mass which two large portions. The segment 2/3 portion of the mass measures at least 6.6 x 5.5 cm (image 75 /series 17). The lesion appears to extend past the capsule with extension across the gastrohepatic ligament to the stomach.The segment 4 portion of the mass at the hepatic dome measures at least 4.3 x 3.3 cm (image 84/series 17). It invades the diaphragm with tumor bulging the diaphragm.Additional probable lesion near segment 4/5 of the liver.Left portal vein is thrombosed. The left hepatic vein is thrombosed. The middle hepatic vein is narrowed.There is diffuse T2 signal abnormality involving the right hepatic lobe without a correlate on the postcontrast imaging.Subcentimeter scattered lesions in the right hepatic lobe are too small to characterize.There is no biliary ductal dilatation. The common bile duct is normal in caliber. Left hepatic ducts are obliterated by the tumor.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. Probable cyst at the lower pole of the right kidney.RETROPERITONEUM, LYMPH NODES: Are small retroperitoneal lymph nodes. An aortocaval lymph node measures 1.7 x 1.2 cm (image 255/series 15). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of upper bowel ascites adjacent to the left lobe of the liver.

Output: 1.Findings of a large predominantly left hepatic lobe mass with likely extension across the gastrohepatic ligament to the stomach.2.Thrombosis of the left portal vein, left hepatic vein and severe narrowing of the middle hepatic vein.3.Upper abdominal ascites near the gastrohepatic ligament suspicious for peritoneal disease.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: 67 yo M with new onset vertigo and nystagmus vs occular flutter, ?cerebellar lesion History: nystagmus vs. occular flutter, vertigo Bilateral lateral ventricles, third ventricle are enlarged with a subtle FLAIR/T2 high signal intensity seen on bilateral periventricular white matter especially occipital horn area and artifact which are non specific but could be related to ventricular enlargement. There is no evidence of occlusive lesion in CSF pathway.There is no evidence of acute ischemic or hemorrhagic lesion on scan.About 7 mm downward displacement of bilateral cerebellar tonsils through the foramen magnum.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Right maxillary sinus retention cyst.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Ventriculomegaly involving bilateral lateral ventricles and 3rd ventricle without evidence of occlusive lesion within CSF pathway.2. No evidence of acute ischemic or hemorrhagic lesion.3. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of lung. The patient has abnormal gait associated with lower extremity hyperreflexia.Clinical question: With a history of newly diagnosed lung cancer and unsteady gait, there is concern that the cause of the abnormal gait is related to spinal metastasis. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.There is a 6 x 5 mm sagittal dimension lesion present along the right posterior lateral aspect of the C5 vertebral body which is bright on T1-weighted imaging. This lesion is also bright on the T2 STIR image acquisitions. It is associated with some contrast enhancement.No abnormal enhancing lesions are identified in the cervical spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level. There are uncovertebral osteophytes present on the right side at this level which mildly narrow the right neural foramen. There is mild facet hypertrophy present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level. There are uncovertebral osteophytes present on the right side at this level which narrow the right neural foramen. There is mild facet hypertrophy present at this level.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present which narrow the neural foramina bilaterally in the face the fat surrounding the exiting nerve roots. At C6-7 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present which narrow the neural foramina bilaterally in the face the fat surrounding the exiting nerve roots. There are some endplate reactive changes at this levelAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI 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.There is a mass present in the right lung measuring approximately 5.7 cm in diameter

Output: 1.There is no convincing evidence for metastatic disease to the cervical or thoracic spinal cord or the cervical or thoracic spine. A lesion within the C5 vertebral body most likely represents a vertebral body hemangioma.2.There is a mass in the right lung. Please refer to chest CT from 6/19/2015 for further comments.3.There are degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is encroachment of the exiting nerve roots within the neural foramina due to uncovertebral osteophytes.


Instruction: Generate impression based on findings.

Input: ESRD, IV drug use: here with abnormal writhing movements of arms and legs. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a subcentimeter focus of cerebrospinal fluid signal in the periventricular white matter adjacent to the left frontal horn of the lateral ventricle. There is also mild confluent T2 hyperintensity in the anterior periventricular white matter. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Probable focus of chronic lacunar infarction in the left frontal lobe periventricular region. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Evaluate for lesions in hypothalamus: Progressively worsening cataplexy and sleep paralysis x 6 months. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is susceptibility effect in the bilateral globi pallidi. There is encephalomalacia in the anterior right frontal lobe. Thre is minimal periventricular 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 are grossly unremarkable. There are secretions within the right frontal sinus.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. In particular, the hypothalami appear unremarkable. 2. Encephalomalacia in the anterior right frontal lobe may be related to prior trauma.3. Nonspecific mineralization in the bilateral globi pallidi.4. Secretions within the right frontal sinus may represent acute sinusitis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Anesthesia of skinSigns and Symptoms: pt with DDD in neck patient with cintined numbness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge at this level.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. There is a broad-based left lateral recess disc protrusion at this level which encroaches on the left-sided exiting nerve root within the neural foramen. It is associated with small uncovertebral osteophytes.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are some degenerative changes present in the cervical spine which are worse at C5-6 where there is some encroachment of the left-sided exiting nerve roots within the neural foramen due to disc material and osteophytes


Instruction: Generate impression based on findings.

Input: Female, 47 years old. Evaluate right arm for osteomyelitis, History: 47 female with history of nasal septal perforation s/p buccal and right radial forearm free flap reconstruction now with RUE cellulitis and XR showing possible osteomyelitis. Redemonstrated is an osseous defect in the distal radial diaphysis at the bone donor site with poorly defined and irregular margins consistent with prior CT study. There is decreased signal of the bone marrow on T1 precontrast imaging. There is enhancement of the periosteum at this level. There is mild enhancement of the bone marrow. While more intense enhancement of the bone marrow was expected, this may represent the effects of incompletely or intermittent treatment. While some of these these findings may represent postsurgical changes, overall this is compatible with osteomyelitis. There is diffuse enhancement of the adjacent soft tissues consistent with inflammation. There is soft tissue irregularity at the incision site. There is no drainable fluid collection. There are multiple foci of metallic blooming artifact on the radial aspect of the forearm consistent with surgical clips seen on the prior CT study.

Output: Findings compatible with osteomyelitis of the distal radial diaphysis. No evidence of drainable fluid collection.


Instruction: Generate impression based on findings.

Input: 50 year-old with history of right mastectomy for breast cancer in 01/13. No current breast complaints. Status post right mastectomy with retropectoral silicone implant placement.The implant appears intact.There is heterogeneous amount of fibroglandular tissue in the left breast.Moderate parenchymal enhancement is noted in the left breast.Retropectoral implant in the left breast appears intact.An enhancing focus in the left retroareolar region is unchanged.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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