Instruction: Generate impression based on findings.

Input: Ms. Lee is a 47-year-old female who is BRCA1 positive. Family history of breast cancer in maternal grandmother, maternal great grandmother, maternal aunt and several maternal cousins. Personal history of benign left breast MRI guided biopsy in 2012. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Previously identified high probability benign focus of enhancement in the right upper inner breast is no longer appreciated on today's examination. There is no new abnormal enhancement identified 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: 56 year old male with atrial fibrillation PULMONARY VEINS: The right inferior and middle pulmonary vein have a common ostium. The right superior pulmonary vein is normal in appearance.The left superior and inferior pulmonary veins are normal in appearance. No evidence of left atrial thrombus.Right superior pulmonary vein: 24 x 23mmRight middle pulmonary vein: 6 x 8mmRight inferior pulmonary vein: 17 x 25mmLeft superior pulmonary vein: 21 x 18mmLeft inferior pulmonary vein: 19 x 12mmLUNGS AND PLEURA: 4-mm micronodule the right upper lobe, image 58/153. No pleural effusions.MEDIASTINUM AND HILA: Common origin of the brachiocephalic artery and left common carotid artery, and a normal anatomic variant. Heart size is normal without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Three pulmonary veins on the right, a normal anatomic variant. Two pulmonary veins on the left.2. 4-mm micronodule in the right upper lobe. If the patient has no risk factors for lung cancer, such as smoking, no further follow up is recommended. If patient has history of smoking, 6 to 12 month follow up with CT is recommended.


Instruction: Generate impression based on findings.

Input: Male; 70 years old. Reason: pancreas cancer with a subcentimeter liver lesion please assess and further characterize if this is a hemangioma versus metastasis History: As above ABDOMEN:LIVER, BILIARY TRACT: No focal, suspicious hepatic lesion is seen to correlate with the subcentimeter hypoattenuating focus in the left hepatic lobe seen on preceding CT, and the abnormality on CT may be related to intrahepatic biliary ductal dilation.Faint, focal T2 hyperintensity is seen in the location of the hepatic hilum hypoattenuating focus described on prior CT, which is nonspecific and may be related to focal periportal edema or biliary dilation.Distal bilateral intrahepatic biliary ductal dilation with poor visualization of the central intrahepatic biliary ducts proximal to the common duct (series 3/26), suspicious for tumor infiltration from the large pancreatic mass invading into the porta hepatis (see below).SPLEEN: No significant abnormality noted.PANCREAS: Stable ill-defined pancreatic body and tail mass with invasion into the porta hepatis, were multiple collateral vessels are seen likely due to occlusion of the superior mesenteric vein/portal confluence and partial cavernous transformation, as described on preceding CT.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right superior pole renal cyst.RETROPERITONEUM, LYMPH NODES: Retroperitoneal infiltration of the pancreatic mass along the celiac trunk with attenuation seen of the proximal common hepatic and splenic arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered nonspecific T2 hyperintense vertebral body lesions, correlating with the sclerotic foci seen on prior CT. Nonspecific focus of enhancement in the right paraspinal muscles measuring 10 x 17 mm (series 1001/52).

Output: 1. Distal intrahepatic biliary ductal dilation with poor visualization of the central intrahepatic biliary ducts proximal to the common duct (series 3/26), which may be due to pancreatic tumor infiltration.2. Otherwise, no definite focal, suspicious hepatic mass.3. Pancreatic mass and additional findings as stable since prior CT.


Instruction: Generate impression based on findings.

Input: 72 year-old female, twisted knee with pain MENISCI: There is extensive degeneration and loss of substance/degenerative tearing of the anterior horn, body, and posterior horn of the lateral meniscus. There is intrasubstance signal within the medial meniscus likely representing mucoid degeneration without extension to an articular surface.ARTICULAR CARTILAGE AND BONE: There is diffuse near full-thickness cartilage loss involving the patellofemoral joint and bilateral tibiofemoral joint compartments. There is minimal subchondral signal abnormality along the lateral femoral condyle and the median eminence of the patella. A small bone island is noted in the distal femur. The bone marrow signal is otherwise within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. There is pre-patellar edema.ADDITIONAL

Output: 1. Extensive degeneration and degenerative tearing of the lateral meniscus, as described above.2. Tricompartmental articular cartilage loss, as detailed above. 3. Moderate joint effusion.4. Baker's cyst.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: Eval GBM. Pt is on a trial of HSPPC96 vaccine.Signs and Symptoms: GBM. There is redemonstration of a left temporal lobe mass is T2 signal abnormality measures 68 x 43 mm in axial dimensions and appears to have extended a little more posteriorly on the current exam relative to the prior exam. A cystic component along its inferior anterior aspect appears smaller on the current exam. The cystic component currently measures 17 x 18 mm axial dimensions and previously measured 25 x 28 mm axial dimensions. On sagittal imaging the enhancing component currently measures 59 x 40 mm and previous and measured 36 x 52 mm. Cerebral blood volume map demonstrates elevated cerebral blood volume in the central portion of the mass. Serpiginous flow-voids are identified within the central portion of the tumor on susceptibility weighted imaging.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since prior exam the patient's left temporal lobe mass has enlarged and appears to have infiltrated further back posteriorly. It is associated with increased cerebral blood volume suggesting increased microvascular within the tumor.


Instruction: Generate impression based on findings.

Input: Right upper quadrant abdominal pain with elevated lipase ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without wall thickening. Non-cirrhotic liver. No focal hepatic lesion. No intrahepatic or extrahepatic ductal dilatation. Hepatic vessels patent.SPLEEN: Absent or atrophicPANCREAS: No significant abnormality noted. Specifically, no evidence for pancreatic ductal dilatation. No significant peripancreatic inflammatory changes. No significant pancreatic necrosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace ascitesBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence for significant complication from patient's known pancreatitis. Specifically, no evidence for pancreatic ductal dilatation, significant necrosis, or significant peripancreatic loculated fluid collection.2.Cholelithiasis without acute inflammation or ductal dilatation.3.Trace ascites.


Instruction: Generate impression based on findings.

Input: Medial left knee pain MENISCI: There is a complex tear of the posterior horn of the medial meniscus consisting of a partial-thickness radial component as well as a horizontal component which extends into the body and to the tibial articular surface. There is low signal intensity adjacent to the root of the posterior horn of the medial meniscus which may represent a displaced flap/fragment. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There are tricompartmental osteophytes. Subjectively, the articular cartilage of the medial compartment appears slightly thinned but we see no gross fluid-filled defect. There may be slight loss of the articular cartilage along the lateral tibial spine but the remaining articular cartilage of the lateral compartment is relatively intact. There is full-thickness cartilage loss along the lateral patellar facet and lateral femoral trochlea with underlying subchondral cysts and marrow edema. There is a small lobulated collection of signal abnormality in the tibial epiphysis posteriorly which may represent an intraosseous ganglion.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tear of the medial meniscus and tricompartmental osteoarthritis of the knee (most severely affecting the patellofemoral compartment) with other findings described above.


Instruction: Generate impression based on findings.

Input: History of left scalp squamous cell carcinoma metastatic to LN s/p CRT (2015), now with left neck recurrence s/p resection and 2 cycles of induction chemotherapy with carboplatin/taxol followed by 5/5 cycles of TFHX completed on 8/5/16. The images are degraded by patient motion and the lack of contrast limits the assessment for tumor. There are postoperative findings related to left neck dissection, with resection of the left submandibular gland and parotidectomy. There appear to be denervation changes in the left vocal cord, sternocleidomastoid, and trapezius. There is also edema in the left pharyngeal and parapharyngeal soft tissues, but no discernible residual significant lymphadenopathy in the neck. The remaining salivary glands appear to be unremarkable. The thyroid gland appears to be unchanged. There is multilevel degenerative cervical spondylosis. There is unchanged encephalomalacia in the right frontal lobe. There are small retention cysts in the right maxillary sinus.

Output: Post-treatment findings in the left neck without discernible residual significant lymphadenopathy in the neck, although assessment is limited by the lack of contrast.


Instruction: Generate impression based on findings.

Input: 54 years, Female, pain in lower extremities, rule out multiple sclerosis. Brain parenchyma appears within normal limits for age. There is no significant parenchymal signal abnormality to suggest the demyelinating disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Brain parenchyma appears within normal limits for age. There is no evidence of demyelinating disease.


Instruction: Generate impression based on findings.

Input: History of urothelial cancer status post neoadjuvant chemotherapy with cystoprostatectomy and bilateral pelvic lymph node dissection, who was initially seen in May of 2016 for a 1.1 cm pancreatic body cyst indecently discovered on surveillance CT for his urothelial cancer, most likely representing a branch duct IPMN. After being seen by Dr. Roggin in clinic at the end of May, he had an EUS on 6/14/16 which showed 3 cysts in the pancreatic body measuring 5mm, 10mm, and 12 mm in size, all anechoic, thin walled and communicate to the main PD via small dilated side branch ducts. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity without focal lesions. There is no biliary ductal dilation. The gallbladder appears within normal limits. SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement. The pancreatic duct is not dilated. There are two cystic structures in the pancreatic body which appear to communicate with the pancreatic duct and which are compatible with side-branch IPMNs. No associated worrisome features are identified. The more anterior cystic structure measures 8 x 11 mm (4/34), the more posterior 6 x 8 mm (4/30), not significantly changed from prior CTs. ADRENAL GLANDS: Mild nodularity of the left adrenal gland with drop out of signal on out-of-phase images compatible with small adrenal adenoma. KIDNEYS, URETERS: Simple right renal cyst, not significantly changed from prior CTs. RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic disease of the abdominal aorta and its branches. BOWEL, MESENTERY: Post-surgical changes to the bowel. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Post-surgical changes related to cystoprostatectomy and ileal conduit.

Output: Two cystic structures in the pancreatic body which are compatible with side branch IPMNs the largest of which measures up to 11mm, not significantly changed.


Instruction: Generate impression based on findings.

Input: First metatarsal foot pain Tendons and ligaments: The visualized extensor tendons are intact. The visualized flexor tendons are intact. The Lisfranc ligament is intact. There is no subluxation or dislocation in the tarsometatarsal articulations.Bones: There is a trace amount of fluid within the first MTP joint which is not necessarily of any clinical significance. There are no osteochondral lesions identified. The bone marrow signal is normal. There is no fracture or contusion. There is no marrow replacing lesions. There is normal alignment of the metatarsals. There is no hallux valgus deformity.Soft tissues: The plantar musculature is unremarkable. There is no surrounding soft tissue edema.

Output: Unremarkable MRI of the right forefoot.


Instruction: Generate impression based on findings.

Input: Male; 70 years old. Reason: Assess hepatic vessel patency, panc head mass followup, biliary strictures History: cirrhosis, s/p OLT 8/95 ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant. No focal hepatic mass. Cavernous transformation of the main portal vein, similar to prior exam. Hepatic veins are patent. Hepatic artery and its branches are patent.Mild right intrahepatic biliary ductal dilation with a stricture seen of the right main hepatic duct near Klatskin's point (series 4/1 and 83). No significant left intrahepatic biliary ductal dilation. Patent choledochojejunostomy.SPLEEN: Stable subcentimeter splenic cysts. Extensive parasplenic collateral vessels are again seen.PANCREAS: Three cystic lesions in the head of the pancreas are seen and have probable connections to the pancreatic duct, most compatible with sidebranch IPMNs. A superomedial lesion measures 11 x 6 mm, unchanged (series 9/21). A posterior lesion measures 7 x 7 mm, unchanged (series 9/23). An anterior lesion measures 16 x 14 mm, again mildly increased in size since prior study when it measured 9 x 9 mm (series 9/26). The lesions do not have mural nodularity or significant enhancement. No main pancreatic duct dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post liver transplant with no focal hepatic lesions.2.Stable cavernous transformation of the main portal vein.3.Mild right intrahepatic biliary ductal dilation with a stricture seen of the right main hepatic duct. Patent choledochojejunostomy.4.Multiple sidebranch IPMNs of the pancreatic head with one of the lesions again mildly increased in size. No mural nodularity or significant enhancement.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, status post lumbar surgery with right greater trochanter pain. Assess for stenosis. A grade 2 anterolisthesis of L4 relative to L5 has mildly progressed from prior. Otherwise spinal alignment is anatomic. No worrisome marrow replacement, edema or enhancement is seen.The visualized spinal cord, conus and nerve roots of cauda equina are unremarkable except as discussed below. No pathologic intracanalicular enhancement is seen.L1-2: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L2-3: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes.L4-5: Marked facet hypertrophy with inflammation of the surrounding soft tissues. Marked ligamentum flavum thickening. Spondylolisthesis, mildly progressed, with disc uncovering and disc bulging. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina nerve roots, not significantly changed. Moderate left and severe right foraminal narrowing, not significantly changed. L5-S1: Moderate facet hypertrophy. Minimal bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes.

Output: 1.Slight progression of spondylolisthesis at L4-5. Moderate to severe generalized spinal canal stenosis at this level, along with severe right and moderate left foraminal narrowing, not significantly changed.2.Mild degenerative findings at the remaining levels are not significantly changed.


Instruction: Generate impression based on findings.

Input: Reason: r/o osteomyelitis History: fever, back pain MRI thoracic spine:At T10-T11 there is loss of vertebral body height, irregularity of the endplates and heterogeneous signal within the disk space as well as marrow replacement within the vertebral bodies and posterior elements. There is epidural extension of disk material associated with the compression of the thecal sac and mild compression of the spinal cord. There is a CT of the abdomen study from 7/16/14 which indicates that the endplates were intact at that time. There is a peri-vertebral infiltration present.The thoracic vertebral bodies are appropriate in the overall alignment. 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 appreciated in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Findings are compatible with diskitis and osteomyelitis at T10-T11 associated with epidural extension and some mild compression of the spinal cord. There is both the anterior and posterior element involvement associated with compression deformities of T10 and T11. Post-contrast imaging of the thoracic spine may help further assess the extent of involvement.2.Exam is somewhat limited due to inability on for the patient to tolerate the exam.3.Findings were discussed with Dr Pulimi at the time of this interpretation at approximately 9:40 a.m.


Instruction: Generate impression based on findings.

Input: Amenorrhea. The pituitary gland is not enlarged, but enhances heterogeneously. The pituitary stalk and posterior pituitary bright spot are intact. There is no mass effect upon the optic apparatus or cavernous sinuses.

Output: The pituitary gland is not enlarged, but enhances heterogeneously, which may be due to the presence of microadenoma, infarction, or physiologic variant.


Instruction: Generate impression based on findings.

Input: Mrs. Steffen has a personal history of left lumpectomy for left breast ALH and LCIS in 2010. She also has a significant family history of breast cancer. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. A few scattered enhancing foci are noted in both breasts, grossly unchanged from the prior. Mild motion artifact is present, though the exam remains diagnostic. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Extramammary findings: Two T2 high signal lesions are noted in the inferior aspect of the liver, which measures 2.9 cm in the segment 5 and 0.5 cm in the segment 3, respectively (image 20 series 301). These likely represent benign hepatic cysts.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 82 years Female (DOB:11/22/1934)Reason: stroke, evaluate for presence of any acute ischemic infarct History: slurred speech and word finding difficultiesPROVIDER/ATTENDING NAME: NAVNEET CHEEMA MARK K. FERGUSON The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate focus of signal hyperintensity and diffusion-weighted imaging associated with diffusion restriction on the ADC maps located in the inferior semilunar lobule of the left cerebellar hemisphere. On the T2 images and measures 6 x 2 mm axial dimensionsNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Some punctate foci of signal hyperintensity on T2 and FLAIR MRI are present in the basal ganglia and internal capsules bilaterally as well as the brainstem.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is an acute microinfarct involving the left cerebellar hemisphere along the left inferior semilunar lobule. 2.Periventricular and subcortical white matter lesions of a mild to moderate degree and punctate lesions in the brainstem, internal capsules and basal ganglia are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, with brain cysts, status post cyst aspiration. Redemonstrated is evidence of extensive prior right-sided surgery including hemispherectomy and multiple prior craniotomies with fragmentation and a large deficiency in the residual right calvarium.Findings are also seen compatible with recent revision of the patient's cyst catheter which has been replaced with a Rickham catheter. Artifact from the reservoir obscures visualization along the right calvarial defect.The extracranial/extradural fluid collection along the right craniectomy shows no significant interval change. The cyst catheter has been redirected posteriorly to penetrate a growing cyst as demonstrated on the prior MRI. The targeted cyst has indeed diminished in size. An adjacent slightly more anteriorly positioned cyst has not significantly changed. A cyst occupying the medial left temporal lobe measures 2 to 3 mm larger than on the immediate prior examination but is similar in size to the examination of 05/12/16. Extensive chronic cerebral dysmorphism is unchanged. The left sided periventricular white matter shows T2 hyperintensity which is stable to slightly increased in extent.

Output: 1.Findings are seen compatible with recent catheter revision and placement of a Rickham catheter directed slightly more posteriorly to drain a growing cyst. This targeted cyst has decreased in size relative to the prior examinations.2.A cyst just anterior to the catheter is unchanged in size. A cyst within the medial left temporal lobe shows some fluctuation in size over the two prior examinations but is not larger than that seen on the examination of 05/12/16.


Instruction: Generate impression based on findings.

Input: 60 year-old male with history of end-stage renal disease with altered mental status. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Multiple, mild areas of patchy hypodensity in a periventricular and subcortical white matter distribution consistent with microangiopathic changes. If there is clinical concern for acute ischemia, an MRI may be considered. Dystrophic calcifications along the cerebellar tentorium.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Age indeterminate microangiopathic changes. No evidence of intracranial bleed. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Reason: Lesion suspicious for HCC on CT scan History: HCV ETOH cirrrhosis, 2.8 cm R lobe mass ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic morphology. Two subcentimeter adjacent nodules in the right lobe that are nonenhancing, but low on T2 and high on T1 (12:269, 8:15, 11:81) suspicious for dysplastic nodules.2.7 x 2.8 cm T1 hyperintense lesion in the posterior right hepatic lobe (11:85) is isointense on T2. This lesion has arterial enhancement with subsequent washout, and is compatible with hepatocellular carcinoma.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1.2.8 cm hepatocellular carcinoma in the posterior right hepatic lobe.2.Two subcentimeter probable dysplastic nodules on a background of nodular cirrhosis and likely portal hypertension, as above.


Instruction: Generate impression based on findings.

Input: Cervical spine:Alignment is normal. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Unremarkable and unchangedC3/4: Unremarkable and unchangedC4/5: Mild disc bulge without stenosis, unchangedC5/6: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is moderate central, moderate left neural foraminal, and mild to moderate right neural foraminal stenosis. These findings are unchanged.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild to moderate left neural foraminal and moderate right neural foraminal stenosis. These findings are unchanged.C7/T1: Mild right neural foraminal stenosis, unchanged.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There is no abnormal enhancement.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates a small right paracentral disc protrusion without cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates mild disc bulge without cord encroachment. T7/8 demonstrates mild disc bulge without cord encroachment. T8/9 demonstrates mild disc bulge without cord encroachment. T9/10 demonstrates mild disc bulge without cord encroachment.T10/11 demonstrates mild disc bulge without encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. There is no abnormal enhancement.L1/2: Mild bilateral facet hypertrophy without stenosisL2/3: Mild bilateral facet hypertrophy without stenosisL3/4: Mild bilateral facet hypertrophy without stenosisL4/5: Mild disc bulge and mild to moderate bilateral facet hypertrophy without stenosisL5/S1: Unremarkable

Output: 1.C5/6: Moderate central, moderate left neural foraminal, and mild to moderate right neural foraminal stenosis, unchanged.2.C6/7: Mild to moderate left neural foraminal and moderate right neural foraminal stenosis, unchanged.3.C7/T1: Mild right neural foraminal stenosis, unchanged.4.Multilevel disc bulges throughout the thoracic spine, as well as a small right paracentral disc protrusion at T4/5, none of which encroach the cord.5.Multilevel facet hypertrophy throughout the lumbar spine without significant stenosis.6.There are no abnormal enhancing foci.


Instruction: Generate impression based on findings.

Input: Prostate cancer. PELVIS:PROSTATE:Prostate Size: 2.6 x 3.7 x 4.1 cmPeripheral Zone: In the left mid gland lateral peripheral zone there is a 9.0 x 8.1 mm lesion demonstrating T2 weighted hypointensity (series 301/78) with associated restricted diffusion (series 403/304). Otherwise the peripheral zone is atrophic and diffusely heterogeneous in T2-weighted signal intensity without a dominant lesion on ADC or T2-weighted imaging.Central Gland: In the anterior transition zone there is a 1.3 x 1.2 cm lesion demonstrating restricted diffusion (series 403/284) heterogeneous low T2 weighted signal intensity (series 801/15) and significant early arterial enhancement and washout (series 1 401/1 207).Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The mid-gland anterior lesion has small spicules of enhancement extending beyond the margin of the prostate.The left mid gland lesion has a broad base of abutment with the prostatic margin with mild bulging but no frank extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific external iliac lymph nodes are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Highly suspicious midline mid-gland anterior transition zone lesion measuring up to 1.4 cm with enhancement outside of the margin of the prostate.2.Additional moderately suspicious lesion in the left mid gland peripheral zone.3.Nonspecific small external iliac lymph nodes.


Instruction: Generate impression based on findings.

Input: 60-year-old male with a history of glial neural tumor status post resection, radiation therapy, biopsy. There are postoperative findings related to left frontal craniotomy for tumor resection. Although the postcontrast sequences are limited secondary to motion, the ovoid area of enhancement along the anterior margin of the right frontal horn is similar in appearance allowing for differences in technique, with persistent hemosiderin staining. There is also no significant interval change in the surrounding confluent areas of T2 hyperintensity in the bilateral frontal lobes, adjacent to the surgical cavity. There is a previous procedural tract in the right frontal lobe with resultant hemosiderin. There is also an associated small amount of hyperintense FLAIR signal in this same region indicating gliosis. There is also some curvilinear sulcal susceptibility abnormality located along the right lateral frontal sulci and along the paramedian frontoparietal sulci bilaterally indicating hemosiderin staining along the sulci, which is slightly decreased compared to previous exam. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is scattered paranasal sinus mucosal thickening. The left TMJ has a small amount of fluid in the joint, likely degenerative.

Output: Unchanged post-treatment findings in the left greater than right frontal lobes without evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: History of kidney transplant now with central sleep apnea. Evaluate for PRES versus encephalitis. No evidence of acute ischemia. Again seen is a bandlike region of increased T2 signal in the bilateral middle cerebellar peduncles and crossing the pons. The pontine abnormal signal may be slightly increased in conspicuity, although this may be related to differences in technique. No associated mass effect. No additional parenchymal signal abnormalitiesThere is no evidence of mass or edema The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The visualized mastoid air cells are partially opacified bilaterally, increased from prior.

Output: Stable bandlike increased T2 signal in the bilateral cerebellar peduncles and crossing the pons. Findings remain nonspecific and the differential considerations remain an atypical form of posterior reversible encephalopathy syndrome, drug toxicity, or other toxic metabolic syndrome.


Instruction: Generate impression based on findings.

Input: 58-year-old female with shoulder pain, evaluate for rotator cuff pathology, frozen shoulder ROTATOR CUFF: There is diffusely increased T2 signal within the supraspinatus tendon suggesting a tendinopathy. There is focal partial thickness tearing along the bursal surface measuring approximately 1 cm with areas of full-thickness perforation and fluid in the subacromion subdeltoid bursa. The superior fibers of the subscapularis are also likely involved with the remainder of the subscapularis intact. The infraspinatus and teres minor are intact. The rotator muscles appear normal. Reactive marrow edema is present within the humeral head at the greater tuberosity.SUPRASPINATUS OUTLET: Small amount of fluid is noted in the subacromion subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degeneration of the anterior and superior labrum.BICEPS TENDON: Biceps tendon is intact with underlying tendinosisADDITIONAL

Output: 1.Tendinopathy and partial-thickness tearing of the supraspinatus with small areas of full-thickness perforation.2.Degeneration of the anterior glenoid labrum.


Instruction: Generate impression based on findings.

Input: Cognitive impairment. Rule out reversible causes for dementia. There is fairly symmetric moderate brain volume loss involving the parietal lobes and to lesser extent the frontal lobes with relative sparing of the occipital and temporal lobes. This results in expansion of the ventricles and sulci as well as basal cisterns. This has slightly progressed since previous MRI from 2010. There is moderate involvement of the cerebral white matter and brainstem by hyperintense lesions which likely reflect microvascular ischemia and is unchanged to very minimally increased compared to the previous 2010 MRI. The anterior communicating artery aneurysm remains grossly unchanged, compared to the previous CT angiogram from November 7, 2012. There is no acute infarct or intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. Major vascular flow voids are preserved.The orbits are notable for findings of previous cataract surgery.

Output: 1.Moderate symmetric brain volume loss is most pronounced in the parietal lobes and to a lesser extent the frontal lobes, with relative sparing of the occipital and temporal lobes. This has slightly increased since the 2010 brain MRI.2.Moderate chronic microvascular ischemia, unchanged to very minimally increased since April 2010.3.Grossly unchanged anterior communicating artery aneurysm.


Instruction: Generate impression based on findings.

Input: Chronic left ankle/heel pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: A small focus of increased signal is noted posterior to the talocalcaneal articulation which may represent a small ganglion or small amount of posterior joint fluid. Otherwise no significant abnormality noted. ADDITIONAL

Output: No acute internal derangement.


Instruction: Generate impression based on findings.

Input: Diagnosis: Compression of brainClinical question: eval postop changesSigns and Symptoms: s/p Chiari decompressionComments: Please also do CINE flow sequence. | The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient is status post posterior fossa decompression since the prior exam. There are postsurgical changes present with blood products, air bubbles and fluid accumulating at the surgical site. There is some signal change present within the cerebellar tonsils associated with some blood products.CSF flow study indicates impeded flow through the foramen magnum.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.The patient status post recent posterior fossa decompression for Chiari I malformation. There is some postoperative change present with fluid and edema accumulation at the surgical site. CSF flow study suggests impeded flow at the level of the foramen magnum.


Instruction: Generate impression based on findings.

Input: Sacral chordoma, evaluate response to therapy There are surgical changes of a partial sacrectomy extending from the level of S2 down with displacement of the rectum posteriorly, appearing similar to the prior study. There is increased fluid signal surrounding the rectum, likely representing a small amount of physiologic free fluid which is not significant in a patient of this age.Edema-type signal within the bodies of the pubic bones adjacent to the symphysis is likely degenerative in etiology.Innumerable nodular masses are again noted within the gluteus maximus musculature bilaterally as well as within the adjacent subcutaneous fat of the buttocks bilaterally. Additional nodular masses are situated along the posterior column of the acetabula adjacent to the obturator internus muscles, more so on the left than on the right. These masses are hypointense to skeletal muscle on T1 sequences and heterogeneously hyperintense to skeletal muscle on T2 sequences. Following contrast administration, they demonstrate heterogeneously, predominantly peripheral enhancement. One of the larger masses within the left gluteus maximus muscle again measures approximately 6 cm obliquely on series 9, images 13 through 15. A second mass within the subcutaneous fat between the intergluteal cleft and the medial margin of the left gluteus maximus (series 6 image 34) measures approximately 2.6 x 2.1 cm, similar to the prior exam. A smaller mass within the medial fibers of the right gluteus medius muscle (series 8 image 24) measures approximately 1.5 x 1.0 cm also similar to the prior exam. Multiple additional lesions are seen which appear similar in size and extent to the prior exam.

Output: Innumerable masses within the posterior soft tissues as described above, presumably representing multifocal chordoma. When compared to the prior exam, overall these lesions appear similar in size and extent.


Instruction: Generate impression based on findings.

Input: 30 years Female (DOB:9/26/1985)Reason: MS please do dr Javed MS protocol History: paresthesiasPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular white matter lesions which are perpendicularly oriented to the lateral ventricles. They are approximately 10 or 11 in number. Some extend to the colossal cingulate junction. None of these periventricular white matter lesions enhance following contrast administration. They are asymmetric in number with more in the left hemisphere.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.The visualized upper cervical spinal cord suggests a FLAIR hyperintense lesion at the C2 vertebral body level.

Output: 1.Multiple periventricular white matter lesions are compatible patient's clinical diagnosis of demyelinating disorder.2.There is a suspected lesion present along the posterior aspect of the spinal cord at the C2 vertebral body level. If clinically appropriate MRI of the cervical spine may be of further benefit to confirm this and evaluate for others.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: assess for stroke History: dizziness Brain MRIThere are restricted diffusion lesions on bilateral PICA territories indicating acute ischemic infarctions.There is no evidence of hemorrhagic conversion.Prior ischemic infarction related bilateral cerebellar PICA territorial encephalomalacia are seen.Patch bi-hemispheric FLAIR/T2 high signal intensities on periventricular white matter indicating nonspecific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.There is a retention cyst on the right maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate small right distal vertebral artery. However, bilateral ICAs, MCAs, ACAs, basilar artery and the distal left vertebral artery appear to be unremarkable.No significant intracranial arterial luminal stenosis.No intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate irregularities of the right vertebral artery which terminate at the origin of the right PICA. The PICA itself is visualized.Otherwise, bilateral CCAs and extra cranial ICAs appear to be normal without luminal stenosis.The left vertebral artery shows some irregularity of lumen without evidence of critical (more than 50%) stenosis.

Output: 1. Acute ischemic infarctions on bilateral PICA territories without hemorrhagic transformation.2. Chronic ischemic infarction related encephalomalacia.3. Non specific small vessel ischemic disease, unchanged.4. No evidence of significant (more than 50%) extracranial luminal stenosis. The right vertebro basilar junction is not seen but the right PICA is visualized on neck MRA.


Instruction: Generate impression based on findings.

Input: For consistency, numbering is performed based on prior MRI with the lowest lumbar type vertebral body transitional and represent S1 (or L6).CervicalAgain seen are multiple segmentation anomalies within the cervical spine. Convex left curvature of the cervical spine is seen from the occipital atlantal articulation through C4 with convex right curvature from C5 through C7. Anterior tubercle of C1 appears to be fused with the dens. Left C1 facet and left C2 facet are fused. C3 vertebral body is a butterfly vertebral body with fusion with C2 in its right aspect. C4 is a left sided hemivertebral body. C5 through C7 demonstrates shortening of the left aspect of the vertebral body heights in comparison with the right on the coronal images. No signal abnormality in the cervical cord including syrinx or evidence of stenosis. CSF spaces at the craniocervical junction are also patent.Thoracic spine demonstrate a left T2 hemi-vertebral body. Dedicated thoracic spine study was not obtained, however on the coronal T2 sequence, there is evidence of prominent central canal/tiny syrinx which was present on prior study from 5/7/2013.LumbarConus tip terminates at L2/L3 (based on prior numbering) which is at the lower limits of normal with tip directed dorsally. Fatty filum terminale again noted. Interval tethered cord release has been performed. Prone sequence demonstrates some anterior motion of the conus. Vertebral body heights and alignment are maintained. No significant spinal canal or neural foramina stenosis. Conjoined right S1 and S2 nerve roots incidentally noted.

Output: 1. No signal abnormality in the cervical cord or extrinsic compression.2. Dedicated thoracic spine study was not performed. On the coronal T2 sequence including the thoracic spine, there is evidence of prominent central canal/tiny syrinx which was present on prior study from 5/7/2013. Finding is of uncertain clinical significance. May consider complete thoracic spine study if clinical symptoms are thought to be attributable to it for better comparison with prior.3. Multiple segmentation anomalies involving the cervical and upper thoracic spine as detailed above.4. Fatty filum terminale and conus at L2-3 again seen. There is some anterior motion of the conus on the prone sequence compatible with history of untethering.Central cord T2 prominence/syrinx starting at the level of C7 through the conus tip measuring up to 3 x 2 mm at the level of T7/T8. Borderline low-lying position of the conus tip with positioning of the tip dorsally possibly representing tethering particularly in light of the fat within the filum terminale. Prone imaging can be done for further evaluation. Right sided distal nerve root clumping. Multiple segmentation anomalies predominantly involving the cervical spine.


Instruction: Generate impression based on findings.

Input: Pain and numbness in bilateral lower extremities. Alignment is anatomic. The vertebral body heights are preserved. Degenerative endplate marrow signal abnormality as well as contour irregularity is present on multiple endplates most notably at L2-3. Severe disc degeneration at L2-3 without increased T2 signal to suggest an acute inflammatory or infectious process. No extra axial masses or fluid collections are identified. No abnormality in the visualized soft tissues. Level by level findings are as follows:L1-L2: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: Severe disc degeneration with moderate diffuse disc bulge and superimposed focal right paracentral herniation. Moderate facet and ligamentum flavum hypertrophy. Mild left and moderate to severe right neuroforaminal stenosis and mild spinal canal stenosis.L3-L4: Mild diffuse disc bulge, facet hypertrophy, and ligamentum flavum hypertrophy create mild right and minimal left neural foraminal stenosis. Moderate spinal canal stenosis.L4-L5: Moderate to severe facet arthropathy and hypertrophy of the ligamentum flavum. There is mild right neuroforaminal narrowing. No spinal canal stenosis.L5-S1: Moderate to severe facet arthropathy and hypertrophy of the ligamentum flavum creating mild bilateral neural foraminal narrowing. No significant spinal canal stenosis.

Output: 1. Severe degeneration at L2-3 with associated chronic endplate changes and advanced degeneration of the facet joints. This results in moderate to severe right neural foraminal stenosis. Given the advanced disc degeneration at this level compared to the others in the lumbar spine, this raises the possibility of a remote traumatic or inflammatory process at this level.2. Scattered multilevel degenerative changes in the rest of the lumbar spine which create multiple mild neural foraminal narrowings.


Instruction: Generate impression based on findings.

Input: Abdominal pain and diarrhea, evaluate for mesenteric ischemia ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. No focal hepatic lesions. The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: The abdominal aorta, iliac arteries, celiac artery, SMA, IMA, and renal arteries are patent without evidence of thrombus, and normal in caliber. There are two right renal arteries and one left renal artery.BOWEL, MESENTERY: Limited evaluation of the bowel. The appendix is normal.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of mesenteric ischemia.


Instruction: Generate impression based on findings.

Input: Female 51 years old Reason: Pain in left shoulder, evaluate for rotator cuff tear ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon anteriorly near the insertion with no retraction.SUPRASPINATUS OUTLET: There is a small amount of contrast in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is grossly intact.BICEPS TENDON: The long head of the biceps tendon is intact. Small amount of contrast is noted in the biceps tendon sheath. ADDITIONAL

Output: Full-thickness tear of the supraspinatus tendon near the insertion anteriorly.


Instruction: Generate impression based on findings.

Input: Evaluate/monitor for neurovascular assessment. The current invasive squamous cell cancer concern for sinus/skull/left ORBIT/current artery. CTA of intracranial circulation:45 cc of Omnipaque 350 is administered for this exam.Vertebral -- basilar system.Taken bilateral vertebral arteries, basilar artery, posterior cerebral arteries and superior cerebellar arteries. It is some mild intracranial atherosclerotic disease with moderate to severe compromise of the origin and proximal portion of the right superior cerebellar artery and high-grade stenosis of the perimesencephalic component of right superior cerebellar artery. Atherosclerotic irregularity of basilar artery and posterior cerebral arteries with no vascular lumen compromise. There is no evidence of tumor involvement/encasement of these vasculature from patient's known skull base destructive tumor.Right internal carotid is patent across the skull base and mid neuritis of compromise of the lumen or encasement by tumor in the skull base. The right anterior and middle cerebral arteries and their branches are well visualized and unremarkable. There is hypoplastic right A1 segment of anterior cerebral artery. There is a single trunk of the anterior subdural tree beyond the anterior communicating level consistent with azygos anterior cerebral artery.Left internal carotid artery demonstrate slight decreased in its caliber is pre-cavernous and its posterior genu within the cavernous sinus. This appears to be result of extension of tumor into the left cavernous sinus which applies to mass effect on the left internal carotid artery anteriorly. In the left internal carotid artery proximal and distal to these segments demonstrate normal caliber. There is no evidence of high-grade stenosis of the muscle and no areas of an aneurysm is identified. Cavernous carotids demonstrate heavy calcifications bilaterally. The branches of left anterior and middle cerebral arteries are unremarkable. There are no posterior communicating arteries visible.  Nonenhanced head CT:Examination demonstrates a large destructive mass in the skull base primarily on the left however with extension across the midline to the right side. The tumor destruction involves the left carotid canal and left cavernous sinus. There is also extensive postoperative changes of left maxillary sinus left nasal cavity, sphenoid sinus. These findings were described more in detail on prior CT of soft tissues of neck.Images through the intracranial space demonstrate no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.There is evidence of minimal periventricular low attenuation of the left posterior frontal -- parietal which was noted on prior MRI exam. Bilateral posterior frontal cortical and subcortical low attenuation likely local small old strokes are again identified and unchanged since prior MRI exam.

Output: 1.Non-infused head CT demonstrate no evidence of acute intracranial process. Small areas of encephalomalacia of bilateral posterior frontal -- parietal lobes remains stable since prior MRI exam. Extensive destructive bony lesion of the skull base with involvement of left cavernous sinus and left carotid canal is partially visualized on this exam.2.CTA of intracranial circulation demonstrate minimal compromise of the lumen of the pre-cavernous left internal carotid artery as well as posterior genu of left internal carotid artery. There is no evidence of any vascular aneurysm or any significant compromise of any intracranial vasculature secondary to tumor encasement. There is evidence of intracranial atherosclerotic disease with moderate stenosis at the origin of the right superior cerebellar artery and perimesencephalic component of left superior cerebellar artery. Minimal atherosclerotic vascular irregularity of other intracranial vasculature with no hemodynamically significant stenosis. There is azygos anterior cerebral artery as described above.


Instruction: Generate impression based on findings.

Input: Decreased rectal tone, Left lower extremity pain and weakness. Reason for study: evaluate for spinal cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no acute cord compression. Multilevel spondylotic changes are seen in the cervical and lumbar spine which does narrow the spinal canal in some places. There is a synovial cyst in the right subarticular L4-L5 level which does narrow the spinal canal and was present on previous exam. There is bilateral degenerative advanced facet arthropathy with facet effusion at L4-L5, unchanged. No concerning marrow signal changes.

Output: No acute cord compression is identified. Multilevel degenerative changes noted.


Instruction: Generate impression based on findings.

Input: T4aN2b BOT SCC, p16+ on OPTIMA IC with carbo/Abraxane. There has been marked interval decrease in size of a right tongue base tumor, without measurable residual tumor. There is no evidence of residual significant lymphadenopathy in the neck. For example, a necrotic right level 2B lymph node measures 6 mm in short axis and an ill-defined right level 2A lymph node measures 5 mm in short axis. The thyroid salivary glands are unremarkable. The larynx appears to be intact. There is multilevel degenerative cervical spondylosis with mild spinal canal narrowing at C3-4 and C4-5. The orbits and imaged intracranial structures are unremarkable.

Output: No evidence of residual measurable tumor in the right tongue base and no evidence of residual significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: 11 years Female (DOB:9/2/2005)Reason: AVM, history intracranial hemorrhage, resection and radiation, yearly follow up History: yearly surveillance.PROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI of the brainNo diffusion weighted abnormalities are appreciated.There are numerous flow voids present in the left parietal lobe. An area of encephalomalacia and gliosis is present in the left parietal lobe adjacent to the AVM. Patient status post left-sided craniotomy. The left middle, anterior and posterior cerebral artery vasculature appears larger than the right middle, anterior and posterior cerebral artery vasculature.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. The left middle cerebral artery vasculature appears larger than the right middle cerebral artery vasculature. The left posterior cerebral artery vasculature appears larger than the right posterior cerebral artery vasculature. The left anterior cerebral artery vasculature appears larger than the right anterior cerebral artery vasculature. Venous drainage appears to be superficially draining.The prior exam was limited, however, based on the cerebral artery caliber and appearance, the AVM has not changed significantly.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Status post left parietal lobe surgery for arteriovenous malformation. There is persistence of arteriovenous malformation in the left parietal lobe. The prior exam was limited, however, based on the cerebral artery caliber and appearance, the AVM has not changed significantly. Follow-up surveillance exams inclusive of the entire head and possible with time resolved MRA would help further assess. 2.Status post left parietal surgery for AVM removal.3.Encephalomalacia adjacent to the AVM.


Instruction: Generate impression based on findings.

Input: History of early morning vomiting for several years and prior syncope. 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 or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: No evidence of Chiari malformation, mass, or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: 64-year-old male with history of nasopharyngeal cancer presents with increasing fatigue, right ear effusion and ulcer noted in the nasopharynx Beam hardening artifact from dental hardware limits evaluation of oral cavity.There is intense enhancement and swelling of the mucosa of posterior nasopharynx. A nonenhancing ulceration is seen in the posterior-superior nasopharynx with debris and air bubbles seen within the ulcer crater. There is subtle cortical erosion along the anterior clivus immediately posterior to the ulceration which appears more prominent and conspicuous on this exam as compared to the previous exam. These findings may represent infection, tumor, or be related to post radiation changes. MRI with contrast is recommended for further characterization.There is no evidence of exophytic mass. The right submandibular gland appears slightly enlarged in comparison to the left; however no discrete mass is identified. The parotid and thyroid glands are unremarkable.Atherosclerotic calcifications are again seen at the common carotid artery bifurcation bilaterally and at the origins of the great vessels arising from the aortic arch. Stable postsurgical changes are seen in the right neck. No pathologically enlarged cervical lymph nodes are identified.There is mild mucosal thickening involving the left ethmoid and sphenoid sinuses. Additionally, there is partial opacification of the right mastoid air cells without bone erosions or destruction. The right middle ear cavity also appears opacified without evidence of bony destruction.Vertebral body heights are maintained without evidence of acute fracture. Mild degenerative changes affect the cervical spine. See accompanying CT scan of the chest for additional information.

Output: 1. Ulceration is seen in the posterior-superior nasopharynx with associated subtle cortical erosion of the anterior clivus which appears mildly progressed as compared to the prior exams. These findings may represent infection, tumor or be related to post-radiation change. MRI with contrast is recommended for further characterization.2. New partial opacification of the right mastoid air cells and right middle ear cavity without bony destruction, raising the question of post obstructive otitis.


Instruction: Generate impression based on findings.

Input: Cervical spine:There is slight reversal of the cervical curvature. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Minimal disc bulge without significant mass effect.C4/5: There is a right paracentral disc protrusion which causes anterior right paramedian cord flattening without intrinsic cord signal abnormality as well as focal mild central stenosis.C5/6: There is a right paracentral disc protrusion which causes anterior right paramedian cord flattening without intrinsic cord signal abnormality as well as focal moderate central stenosis.C6/7: There is a central disc protrusion which causes anterior cord flattening without intrinsic cord signal abnormality and minimal central stenosis.C7/T1: UnremarkableThoracic spine:Marrow signal abnormality consisting of T1 hypointensity, T2 hyperintensity, and enhancement, are noted throughout the marrow spaces at several levels including T3, T10, T11, T12, and L1. These appear confined to the osseous structures without extension beyond cortical confines into the intraspinal epidural space. Elsewhere, similar abnormality with enhancement is noted involving the right transverse process at T6 extending into the adjacent soft tissues and rib.The vertebral body heights are maintained. Redemonstrated is an atrophic left kidney and absence of the right kidney.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates a tiny right paracentral disc protrusion without significant resulting mass effect or stenosis.T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates a tiny left paracentral disc protrusion without significant resulting mass effect or stenosis.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates a right paracentral disc protrusion causing anterior right hemicord flattening without intrinsic cord signal abnormality.T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.

Output: 1.C4/5: There is a right paracentral disc protrusion which causes anterior right paramedian cord flattening without intrinsic cord signal abnormality as well as focal mild central stenosis.2.C5/6: There is a right paracentral disc protrusion which causes anterior right paramedian cord flattening without intrinsic cord signal abnormality as well as focal moderate central stenosis.3.C6/7: There is a central disc protrusion which causes anterior cord flattening without intrinsic cord signal abnormality and minimal central stenosis.4.Marrow signal abnormality consisting of T1 hypointensity, T2 hyperintensity, and enhancement, are noted throughout the marrow spaces at several levels including T3, T10, T11, T12, and L1. These appear confined to the osseous structures without extension beyond cortical confines into the intraspinal epidural space. Elsewhere, similar abnormality with enhancement is noted involving the right transverse process at T6 extending into the adjacent soft tissues and rib. These findings are consistent with lymphomatous involvement.5.T3/4 demonstrates a tiny right paracentral disc protrusion without significant resulting mass effect or stenosis.6.T5/6 demonstrates a tiny left paracentral disc protrusion without significant resulting mass effect or stenosis.7.T7/8 demonstrates a right paracentral disc protrusion causing anterior right hemicord flattening without intrinsic cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Total spine findings: The cervical and thoracic spinal cord is enlarged with intrinsic abnormal T2 hyperintensity predominantly noted involving bilateral dorsal columns, although also involving the bilateral lateral-most aspects of the cord in skip-like fashion, extending from C1 through T12. There is no associated abnormal enhancement (the appearance of enhancement at T1 is felt to be secondary to artifact).Cervical spine:Alignment is normal. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: UnremarkableC2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: UnremarkableC6/7: UnremarkableC7/T1: UnremarkableThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. There are no masses. There is no abnormal enhancement.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates a tiny anterior disc protrusion without significant resulting mass effect or stenosis.T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized intra-abdominal and paraspinal contents are unremarkable. There is no abnormal enhancement.T12/L1: UnremarkableL1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: UnremarkableL5/S1: Unremarkable

Output: The cervical and thoracic spinal cord is enlarged with intrinsic abnormal T2 hyperintensity predominantly noted involving bilateral dorsal columns, although also involving the bilateral lateral-most aspects of the cord in skip-like fashion, extending from C1 through T12. There is no associated abnormal enhancement. This constellation of findings, in context of the clinical history, is most consistent with subacute combined degeneration. The differential diagnosis would less likely include demyelination or transverse myelitis. Given lesional appearance, neoplasm is felt to be unlikely.


Instruction: Generate impression based on findings.

Input: Bilateral skin/nipple sparing mastectomy in 2009 for right breast ADH/ALH. Status post immediate reconstruction with implants. Left breast thickness/density at 12:00 position, please assess on MRI Status post bilateral mastectomy with bilateral subpectoral silicone/gel implants which appear intact. No evidence of intra or extracapsular rupture.Bandlike area of enhancement is identified between the implant and the skin in the right chest wall at 5 to 6:00 position (close to the inframammary fold), that is dark on T2-weighted sequence measuring 2.5 x 1.1 x 0.5 cm (APX ML x CC ).Similar morphology band like area of enhancement is also identified between the implant and skin surface measuring 1.3 x 0.7 x 0.6 cm (APX ML x CC ) at the 12:00 to 1:00 position of the right chest wall. These areas of enhancement appear to be related to Alloderm configuration used at the time of reconstruction surgery. No abnormal enhancement is seen in either chest wall. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy especially in patient's area of concern (area of thickness/density in left breast at 12:00 position). Band like areas of enhancement along the inframammary fold and 12 to 1:00 position of the right chest wall are most likely related to alloderm usage at the time of reconstructive surgery or fat necrosis. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R 41.82]64 years Male (DOB:2/9/1952)Reason: cva History: cvaPROVIDER/ATTENDING NAME: DANIEL W ROBINSON Brain MRIRestricted diffusion areas are seen on the right internal capsule posterior limb, right side midbrain as well as right cerebellar hemisphere indicating acute ischemic stroke without evidence of hemorrhagic conversion.There are encephalomalacia involving left inferior parietal lobule and superior and posterior temporal gyrus suggesting prior ischemic infarct. Focal increased signal intensity on diffusion-weighted imaging on the left inferior parietal lobule (series 3, image 25) does not show any definitive evidence of restricted diffusion and is associated with adjacent chronic ischemic infarct related gliotic changes. Therefore, this lesion is more likely representing T2 shine through artifacts.Another small lacunar infarct is seen on the right inferior parietal lobule.Scattered patchy T2/FLAIR high signal intensity lesions on centrum semiovale indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear. Redemonstration of right medial orbital wall fracture deformity, unchanged since prior scan.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.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Acute ischemic infarct without evidence of hemorrhagic conversion involving right internal capsule posterior limb, right side midbrain, and right cerebellar hemisphere.2. Chronic ischemic infarction involving left inferior parietal lobule and posterior superior temporal gyrus.3. Nonspecific small vessel ischemic disease, unchanged.4. No evidence of flow-limiting arterial luminal stenosis on both intracranial and extracranial arterial system. No aneurysm is seen.


Instruction: Generate impression based on findings.

Input: 46-year-old female with history of pancreatic mass who presents for MRI evaluation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is a T2 hyperintense, diffusion restricting focus in the pancreatic body measuring 4.0 x 2.3 cm (series 3, image 25) with avid enhancement. Adjacent to this dominant lesion, there is additional enhancing soft tissue signal which may be contiguous with this lesion. The pancreatic tail is atrophic. The head and uncinate process are preserved. There is decreased intrinsic T1 hyperintensity in the residual pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral breast nodules are noted.

Output: 1.Large pancreatic body solid enhancing neoplasm as detailed. Findings are concerning for neuroendocrine tumor given history of MEN1.2.Bilateral breast nodules are present. Correlation with mammography is recommended.


Instruction: Generate impression based on findings.

Input: One-day-old female with abdominal and pelvic mass. There are likely 3 perineal orifices. A cystic mass extends from the pelvis into the abdomen and measures approximately 6.7 x 7.4 x 7.9 cm. The contents of the mass are bright on T1 and T2 weighted images, consistent with subacute blood products. There is a fluid-fluid level and layering debris in the dependent portion of the mass with lower signal intensity on the T1 and T2 weighted images, which likely reflects chronic blood products. The vagina has an upside down pear shape and is indented in the midline inferiorly with the right side slightly larger than the left. An obliquely oriented fine tubular structure arises from the inferior apex of the left side of the vagina and extends from the left superiorly to the right inferiorly approaching the perineum. The mass appears to compress the urinary bladder anteriorly in addition to the inferior vena cava posteriorly. The hemiazygos and azygos veins are dilated. The mass also obstructs the ureters with bilateral grade 3 hydronephrosis. Anterior to the superior portion of the left kidney is a fluid-filled structure measuring 2 cm in diameter, which most likely represents a duplicated ureter with an obstructed upper pole system.The uterus is located anterior to the mass in the midline and measures approximately 2.5 x 2.0 cm.Atelectasis is seen in both lung bases. There is extensive soft tissue edema. The liver, gallbladder and spleen are normal. The bowel is normal in caliber.

Output: 1. Obstructed vagina and uterus. There appears to be a longitudinal septum in the vagina with the right side larger than the left.2. Extrinsic obstruction of the ureters due to the mass with grade 3 hydronephrosis bilaterally. 3. Findings of a probable left duplicated ureter with an obstructed upper pole system.4. Extensive soft tissue edema.Please note that ultrasonography would be helpful in further evaluation of the anatomy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49-year-old male with altered mental status and seizure. There is no evidence of intracranial hemorrhage, or mass. Multiple patchy hypodensities in a periventricular distribution are consistent with small vessel disease, age indeterminate.Additional small focal hypodensity at the right frontal lobe, image 14 represents a cortical stroke which is new when compared to the prior study but of uncertain chronicity. An additional finding of a small atrophic gyrus in the high left parietal convexity represents an old small cortical calcific stroke which was present on the previous CT scan of 4/07. MRI is recommended to further characterize these findings.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Subcortical stroke as described above of uncertain chronicity, new when compared to the previous study. MRI is recommended for further evaluation if clinically warranted.


Instruction: Generate impression based on findings.

Input: Characterize liver lesion seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The subcapsular segment 7 lesion demonstrates avid arterial enhancement which appears peripheral nodular and discontinuous. It is very T2-weighted hyperintense. It measures 1.5 x 1.0 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcapsular segment 7 lesion with imaging characteristics most suggestive of a benign hemangioma measuring 1.5 cm.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, type 1 with moyamoya and brainstem mass.. There is an unchanged heterogenously enhancing mass centered within the right midbrain, which measures 22 AP x 20 RL x 18 SI mm. There is no evidence of intracranial hemorrhage or acute infarct.. There is unchanged encephalomalacia with subcentimeter cystic defects in the left frontal deep and periventricular white matter and within the right temporal occipital region. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are postoperative findings related to bilateral pial synangiosis. There is steno-occlusive disease involving the internal carotid arteries with associated collateral vessels. There is a probable right basal ganglia developmental venous anomaly. There is a partially-imaged left cleft palate and associated postoperative findings.

Output: 1. Unchanged right brainstem mass, accounting for differences in technique.2. Unchanged areas of encephalomalacia in the left frontal deep and periventricular white matter and within the right temporal occipital region are compatible with chronic infarcts. No evidence of acute cerebral infarction.3. Postoperative findings related to bilateral pial synangiosis and steno-occlusive disease involving the internal carotid arteries are better depicted on the prior MRA. .


Instruction: Generate impression based on findings.

Input: History of tethered cord release with syringomyelia Again seen is dilatation of the central spinal canal that extends from approximately T4-T5 level to the conus medullaris, which terminates at the level of L1-L2. There are 2 components with maximal dilatation noted at the T7 level measuring proximally 10 x 11 mm similar to prior and a more inferior component with maximal dilatation at the T12 level measuring 5 x 4 mm. Allowing for differences in measurement technique, there is no significant change. There is also no significant change in the craniocaudal extent. Enlargement of the cord caliber at these levels is also unchanged.There is appropriate ventral motion of the cord with prone positioning. There is no evidence of filar lipoma or other masses along the filum terminale and cauda equina nerve roots.The vertebral column alignment is within normal limits. The vertebral body and disk space heights are preserved. There is no worrisome bone marrow signal. There is no significant spinal canal stenosis, disc herniation, or neural foraminal narrowing. There is evidence of prior surgery in the lumbar spine for release of presumed tethered cord.

Output: 1. No significant change in size and extent of the thoracolumbar syrinx. 2. No MR evidence of cord tethering.


Instruction: Generate impression based on findings.

Input: 82-year-old male with history of urothelial cancer. ABDOMEN: Limited examination due to absence of IV contrast due to to patient's low GFR.LIVER, BILIARY TRACT: Gallbladder sludge within a mildly hydropic gallbladder. There is an outpouching along the gallbladder wall which may represent focal adenomyomatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a T1 mildly hyperintense T2 hypointense 1.3 cm the lesion within the interpolar left kidney which is nonspecific although may represent a hemorrhagic/complex cyst. T2 hyperintense cysts, some of which are too small to further characterize and the left kidney. No hydronephrosis or perinephric inflammation. Status post right nephrectomy. There is no filling defect within the left ureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Clonic diverticulosis is noted. Trace ascites is present. There is a nonobstructing ventral abdominal hernia.BONES, SOFT TISSUES: T2 hyperintense focus in the L1 vertebral body and left iliac wing may represent hemangiomas.

Output: 1.Limited examination secondary to absence of IV contrast due to to patient's low GFR.2.Status post right nephrectomy without evidence of residual or recurrent disease.3.T1 mildly hyperintense, T2 hypointense lesion within the interpolar left kidney is nonspecific but may represent a hemorrhagic cyst, can be re-assessed on future imaging.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: brain mets, please evaluate for progressionSigns and Symptoms: brain mets The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an irregularly-shaped enhancing focus present in the left cerebellar hemisphere lung the inferior semilunar lobule which measures 23 x 27 mm axial dimensions and measured the same on the September 1 exam. There is associated susceptibility effect. The patient is status post left posterior fossa surgery.There is redemonstration of a right temporal lobe mass which measures 20 x 17 mm axial dimensions and on the September 1 exam measured 15 x 15 mm axial dimensions.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A right temporal lobe mass has increased in size when compared to the previous exam. This compatible with metastatic disease2.A left cerebellar mass remains stable when compared to the prior exam. The patient status post surgery in this location.3.Please note that this exam is a limited exam for the purposes of treatment planning


Instruction: Generate impression based on findings.

Input: Dystonia, unspecified [G24.9], Reason for Study: ^Reason: Follow up progression abnormal right external capsule lesion History: left hand dystonia Redemonstration of the right insular cortex and external capsular FLAIR/T2 high signal intensity lesions with mild volume loss with corresponding CSF space dilatation, unchanged since prior scan. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Right insular cortex and external capsule FLAIR/T2 high signal intensity lesions with volume loss, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Severe low back pain since one month, status post fall Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild retrolisthesis of L5 on S1. Alignment of the lumbar spine is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position. Multilevel degenerative changes are seen particularly at the L5-S1 level where there is severe disc height loss and vacuum phenomena.Additional details as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge. No significant spinal canal stenosis. Minimal narrowing of the neural foramina.L3-L4: Mild disc bulge and mild facet arthropathy. No significant spinal canal stenosis. There is mild right and no significant left neural foraminal stenosis.L4-L5: Mild disc bulge, facet arthropathy, ligamentum flavum thickening. No significant spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis.L5-S1: Severe disc height loss, vacuum phenomena, and mild retrolisthesis. There is bilateral facet arthropathy. No significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.Postgadolinium images demonstrate no abnormal enhancement. Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine as detailed above, relatively worse at the L5-S1 level. No evidence of compression fracture.


Instruction: Generate impression based on findings.

Input: 46-year-old male with left buttock wound and fistula status post multiple surgeries. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: A prominent left pelvic sidewall lymph node measures up to 9 mm in short axis, possibly reactive (series 10/32). No pathologically enlarged lymph nodes by size criteria.BOWEL, MESENTERY: There is perianal fistula is present and arises from the posterior 5 o'clock position and extending laterally and inferiorly within the left medial gluteal fold, possibly transsphincteric though evaluation for such is difficult. This fistula has a seton in place. A blind-ending tract from the same fistula is seen extending superiorly into the left ischioanal fossa. No evidence of abscess.BONES, SOFT TISSUES: Somewhat linear low T2 signal with increased enhancement within the the subcutaneous soft tissues of the medial left buttock, most likely related to prior surgical change though mild phlegmon cannot be excluded.OTHER: Small right scrotal hydrocele.

Output: Transsphincteric left perianal fistula as above. Possible mild phlegmon versus surgical change within the subcutaneous soft tissues of the medial left buttock, but no evidence of abscess.


Instruction: Generate impression based on findings.

Input: Reason: low back and buttock pain and Lt leg pain for 3-4 weeks History: as above Evaluation is limited by patient motion artifact. Evaluation of the hamstring tendon origins is limited due to patient motion artifact, however, the proximal end of the conjoined tendon on the left is indistinct and may be avulsed from the ischium. The semimembranosus tendon appears intact at its origin. The sacrotuberous ligament likewise appears intact. There is a small quantity of fluid situated between the ischium and hamstring tendons which could reflect the sequela of a hamstring tear or a bursitis. There is a small amount of fluid and enhancement also noted tracking posteriorly and laterally supporting a bursitis. The relatively mild nature of the edema adjacent to the hamstring tendons suggests that this process may be chronic in etiology. There is mild edema and enhancement between the ischium and lesser trochanter on the left which may represent inflammation due to the aforementioned process or potentially a ischiofemoral impingement, although the ischiofemoral interval does not appear particularly narrowed. There is also a small amount of fluid adjacent to the right hamstring tendons at their origin that may represent a combination of partial-thickness tearing and a bursitis. Mild peritrochanteric edema and enhancement on the left is not necessarily of any current clinical significance. The bone marrow signal intensity of the pelvis and proximal femora is normal. Please refer to the lumbar spine MRI report regarding the degenerative changes of the lumbar spine. There is a small amount of fluid within the right hip, but no frank joint effusion.

Output: 1. Limited examination due to patient motion artifact. There is fluid adjacent to the hamstring tendons at their origin, left greater than right, which likely represents a combination of bursitis and partial-thickness tearing with possible avulsion of the left conjoined tendon from the left ischium. We are uncertain, however, if these findings, which may be chronic, are responsible for the patient's pain.2. Degenerative disc disease of the lumbar spine. Please refer to the dedicated MRI lumbar spine report for additional details.


Instruction: Generate impression based on findings.

Input: 34 years, Female, history of mechanical mitral valve presenting with TIA/?CVA. Thrombus on the mitral valve on TEE. Monocular blindness. No restricted diffusion to suggest acute ischemia. No intraparenchymal mass or mass-effect. The ventricles are within normal limits in size and configuration. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific. There also few scattered foci of susceptibility such as in the left frontal lobe and left temporal lobe deep white matter compatible with chronic microhemorrhages. 5 mm pineal cyst is incidentally noted. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct.2. Few nonspecific scattered foci of T2/FLAIR hyperintensity in the white matter which may represent mild chronic small vessel ischemic changes, related to prior inflammation, or less likely demyelination. There are also a few nonspecific foci of chronic microhemorrhage.


Instruction: Generate impression based on findings.

Input: MRI CARDIAC W/FLOW QUANT WWO, 2/24/2015 1:00 PM Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 166 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 79 ml (normal range 31+/-10), the LV mass index is 60 g/m2, and the LV mass is 124 g. The motion of the left ventricle is distorted by extrinsic compression from the adjacent stomach; however, there is additionally, tardokinesis of the basal inferior wall.There is epi-myocardial late gadolinium enhancement of the basal inferior and inferolateral walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction.There is no intracardiac thrombus.No evidence of iron overload.No findings of cardiac amyloid.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 68%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 122 ml (normal range 110+/-24), the RV end systolic volume index is 18 ml/m2 (normal range 22+/-8), and the RVESV is 39 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation visualized. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation visualized. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation visualized. Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsA right side breast implant was noted. The stomach is significantly distended and causing extrinsic compression of the cardiac inferior and infero-lateral wall. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function, LVEF is 52%. There is tardokinesis of the basal inferior wall. The function and size have improved compared to previous cardiac MRI (2011).2. There is epi-myocardial late gadolinium enhancement of the basal inferior and inferolateral walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. There is no significant difference compared to previous cardiac MRI (2011).3. The right ventricle is normal in size and systolic function, RVEF is 68%. 4. There is a small pericardial effusion.5. The stomach is significantly distended and causing extrinsic compression of the inferior and inferolateral wall of the heart.


Instruction: Generate impression based on findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: evaluate for lesion History: weakness and loss of sensation Slight kyphotic angulation of cervical spine at C56 with disc dessication at the level of C23, C34, c45 and C56. There is no evidence of neuroforaminal stenosis. There is no evidence of spinal canal stenosis. Spinal cord signal intensity is normal.There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1. L12 disc shows dessication maintaining its height.Otherwise, the thoracic and lumbar intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues and musculature are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. Loss of normal lordosis with disc dessication at cervical spine and disc dessication at the level of L12.2. Otherwise normal spinal cord signal intensity. Normal vertebral body height. No evidence of spinal canal stenosis nor neuroforaminal stenosis.3. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Congenital anomaly of cerebrovascular system [747.81] / Hereditary hemorrhagic telangiectasia [448.0], Reason for Study: ^Reason: AVM, prior hemorrhage in 2014, please evaluate, HHT History: HHT, motor, cognitive, speech deficits from previous stroke Brain MRI:There is extensive left parieto-occipital encephalomalacia.There is evidence of left fronto-temporo-parietal craniotomy.Within the encephalomalacia, there are multiple somewhat punctate and tubular restricted diffusion lesions indicating acute ischemic infarctions at remained brain parenchyme.There are enlarged left PCA and its branches converging into the left posterior aspect of the temporal lobe middle temporal gyrus area nidus. The size of the nidus was measured about 23mm(R to L) x 18mm (AP) x 17mm (Craniocaudal). There is large draining vein on the posterior temporo-occipital cortex and reaching into the left transverse sinus.The left lateral ventricle shows ex vacuo changes.There is no evidence of acute hemorrhagic lesion.Multiple susceptibility lesions on the left frontal, parietal and temporal lobes may be related to prior hemorrhagic stroke.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate enlarged left ICA with fetal left PCA which is also enlarged.There is no identifiable arterial aneurysm.Right ICA, bilateral ACA, bilateral MCA and vertebrobasilar system appear to be normal.

Output: 1. Acute ischemic infarctions without hemorrhagic transformation on the left hemisphere especially on the remained brain parenchyme within encephalomalacia as described above. 2. Left temporooccipital brain AVM mainly supplied by the left PCA.3. Left hemispheric extensive encephalomalacia.