Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for myelopathy, foraminal stenosisSigns and Symptoms: B/L LE weakness, numbness Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is reversal of the normal cervical curvature present. The patient is status post laminectomies at C3, C4, C5, C6. Patient is status post posterior fusion at C3 through C6. There is multilevel disc desiccation present. There is loss of disc space height at C3-4, C4-5, C5-6, C6-7 and C7-T1.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level. There is some mild narrowing of the left neural foramen at this levelAt C3-4 there is no significant compromise to the spinal canal. There is a left paramedian disc protrusion present at this level. There is encroachment of the left-sided exiting nerve roots at this level due to disc material and some uncovertebral osteophytes.At C4-5 there is no significant compromise to the spinal canal. There are some mild encroachment of the left-sided exiting nerve roots at this level due to disc material and osteophytesAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is mild narrowing of the neural foramina at this level due to degenerative changes.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is mild narrowing of the neural foramina at this level due to degenerative changes.At C7-T1 there is a broad-based central disc protrusion present which impresses on the ventral aspect of the thecal sac and is associated with effacement of spinal fluid ventral and posterior to the spinal cord. There is posterior ligamentous hypertrophy present at this level contributing to the spinal stenosis. Overall there is a mild to moderate degree of spinal stenosis present at this level. Additionally there is encroachment of the exiting nerve roots bilaterally at this level due to disc material.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are some mild multilevel degenerative changes present thoracic spine without significant compromise to spinal canal or exiting nerve roots.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. There is multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some ligamentum flavum hypertrophy present at this level. There are subchondral cysts present on the right side facet joint.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level. There is subchondral cyst on the left facet joint.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.The patient status post cervical spine surgery with laminectomy and fusions from C3 through C6. 2.There is a mild to moderate degree of spinal stenosis at C7-T1 associated with encroachment of the exiting nerve roots bilaterally.3.There are mild degenerative changes present in the thoracic and lumbar spine without significant compromise to the spinal canal or exiting nerve roots.4.No intrinsic spinal cord lesion is appreciated.


Instruction: Generate impression based on findings.

Input: Reason: eval interval changes History: weakness Nonenhanced CT of brain:Examination again demonstrate large area of left frontal -- temporal craniectomy with resultant slight bulge of brain parenchyma through the bony defect. The entire left anterior temporal lobe, left inferior frontal lobe has uniformly high density compared to the rest of brain parenchyma which remains stable and is concerning for petechial hemorrhage. A follow-up with an MRI is recommended. This finding remains stable since prior exam. Subtle encephalomalacia/edema in the left basal ganglia is again noted with no change. Extra-axial fluid density at the site of craniectomy and extension posterior to the posterior edge of craniectomy is again noted. There is slight increase in the fluid collection at this site since prior exam.

Output: 1.No definitive evidence of new intracranial findings since prior study. Please see above comments.2.Slight interval increase in the extra-axial fluid collection at the craniectomy site with extension posterior to the dorsal edge of craniectomy.


Instruction: Generate impression based on findings.

Input: There are primarily sclerotic (T1 and T2 hypointense) foci within the L1 and T9 vertebral bodies, containing mild STIR hyperintensity. These correlate with previous sclerotic lesions identified on x-ray comparison.There are no fractures. The conus is normal in signal and morphology and terminates at an appropriate position. T12/L1: UnremarkableL1/2: Trace retrolisthesis L1 on L2, a small left paracentral disc protrusion with associated osteophyte, and mild bilateral facet hypertrophy. There is marked left lateral recess stenosis.L2/3: Asymmetric bulge to the left and mild bilateral facet hypertrophy without stenosis.L3/4: Trace retrolisthesis L3 on L4, a shallow central to right paracentral disc protrusion, asymmetric bulge to the left, and minimal left facet hypertrophy. There is mild left neural foraminal stenosis.L4/5: There are small bilateral foraminal disc protrusions as well as moderate left facet hypertrophy and mild to moderate right facet hypertrophy. There is mild left neural foraminal and mild-to-moderate right neuroforaminal stenosis.L5/S1:Minimal disc bulge, minimal left facet hypertrophy, and moderate to severe right facet hypertrophy containing a small right facet effusion. There are no significant stenoses.

Output: 1.There are primarily sclerotic (T1 and T2 hypointense) foci within the L1 and T9 vertebral bodies, containing mild STIR hyperintensity. These correlate with previous sclerotic lesions identified on x-ray comparison.2.L1/2: There is a small left paracentral disc protrusion with associated osteophyte resulting in marked left lateral recess stenosis.3.L3/4: Mild left neural foraminal stenosis.4.L4/5: There are small bilateral foraminal disc protrusions resulting in mild left neural foraminal and mild-to-moderate right neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: Tethered cord and Chiari status post spinal cord untethering. Brain: The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum with apparently diminished flow of cerebrospinal fluid across the posterior aspect of the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. There is fluid within the right mastoid air cells. The orbits, skull, paranasal sinuses, and scalp soft tissues are partly obscured by dental brace artifact.Cervical Spine: There are interval postoperative findings in the lumbar spine related to tethered cord surgery via L4 osteoplastic laminoplasty. The conus medullaris remains positioned at the L1-2 level. There is upper thoracic levoscoliosis, thoracolumbar dextroscoliosis and lower lumbar levocurvature, but no spondylolisthesis. The spinal cord displays normal signal and morphology. There is no evidence of fibrofatty filum. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Persistent upper thoracic levoscoliosis, thoracolumbar dextro scoliosis and lower lumbar levocurvature. 2. Mildly low-lying cerebellar tonsils without evidence of syringomyelia. 3. Interval tethered cord surgery. The conus medullaris remains positioned at the L1-2 level. 4. No evidence of ventriculomegaly.5. Fluid within the right mastoid air cells may be due to effusions.


Instruction: Generate impression based on findings.

Input: Patient with breast cancer and dizziness. Evaluate for edema/bleed. There is no evidence of intracranial hemorrhage, edema, or midline shift. No definite evidence of metastatic involvement. However MRI is more sensitive for evaluation of metastases.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: No acute findings.


Instruction: Generate impression based on findings.

Input: Medial elbow pain LIGAMENTS: No significant abnormality noted.TENDONS: Mildly increased signal is noted at the common flexor tendons however the tendons are intact. The remaining tendons of the elbow are also intact.ARTICULAR SURFACES AND BONE: There is a minimal amount of increased signal of the radial head best appreciated on series 9 image 9/25. Otherwise there is no significant abnormality noted. SURROUNDING STRUCTURES: There is increased signal and thickening of the ulnar nerve at the level of the ulnar trochlea. A mild amount of increased signal is also noted in the surrounding soft tissues.ADDITIONAL

Output: Increased signal and thickening of the ulnar nerve particularly at the level of the ulnar trochlea with increased signal in the surrounding soft tissues and common flexor tendons. Findings likely represent a component of ulnar neuritis. The common flexor tendons may demonstrate some tendinopathy but are otherwise intact.


Instruction: Generate impression based on findings.

Input: 48-year-old male patient with history of HCV and cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Mild iron deposition noted. No arterial enhancing foci with washout to suggest hepatocellular carcinoma.SPLEEN: Splenomegaly, measuring up to 16 cm in craniocaudal dimension. Stable 2 cm T1 and T2 hyperintense lesion in the anterior spleen may represent a sclerosed hemangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts appear unchanged compared to prior examination. 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: Cirrhosis and splenomegaly without suspicious appearing hepatic lesions.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Evaluate for metastatic disease. Prior biopsy shows widespread right-sided disease. PELVIS:PROSTATE:Prostate Size: 4.5 x 4.5 x 3.1 cmPeripheral Zone: Within the right posterior peripheral zone mid gland there is a 11 x 8 mm nodular focus of low T2 signal, restricted diffusion, early arterial enhancement compatible with patient's biopsy-proven cancer. There is more mild signal abnormality extending from this lesion from the base to the apex which may represent additional lower grade tumor.In the left peripheral zone abutting the transitional zone is an additional 6 mm low T2 signal nodule is without definite early enhancement or restricted diffusion that is indeterminate.Central Gland: Mild nodular changes of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: There is extension of the low T2 signal through the posterior right capsule with asymmetry of the rectal prostatic angle indicating extracapsular extension. The signal abnormality does not extend to the neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with adenocarcinoma in the posterior right mid gland peripheral zone as described. There is evidence of extracapsular extension, but no metastatic disease.


Instruction: Generate impression based on findings.

Input: Right neck mass; growing for 5 months. In the right anterior neck, there is a well-circumscribed, multilobulated mass, which measures transaxially 3.4 cm x 2.8 cm while craniocaudally measures 4.1 cm. The mass is T2 hyperintense and mildly T1-hyperintense. Following contrast injection, there is laterally nodular but otherwise thin uniform rim contrast enhancement. The mass extends from just inferior to the right submandibular gland, which is mildly deformed but not invaded by the mass, reaching inferiorly to the right thyroid lobe with no clear separation between the two. The mass is located just deep to and inseparable from the right-sided strap muscles. It causes mass-effect on the adjacent trachea and larynx causing mild-to-moderate airway narrowing. The mass also posteriorly displaces the right carotid sheath contents, without vessel narrowing, as well as the anterior margin of the sternocleidomastoid muscle. There is no active inflammation in the adjacent tissues. There are multiple mildly prominent lymph nodes in both sides of the neck, including lateral retropharyngeal lymph nodes, which is a common finding in this age group. There is no mass within the major salivary glands. There is no other mass in the thyroid gland.Cervical spine and included brain are unremarkable.

Output: Cystic anterior right neck mass, closely related to the right thyroid lobe and the strap muscles with differentials including thyroglossal duct cyst and lymphatic malformation. Location is not typical for brachial cleft cyst. Intrinsic T1 hyperintensity within the cyst and mildly nodular rim of contrast enhancement may be related to prior hemorrhage or infection.


Instruction: Generate impression based on findings.

Input: 54-year-old man with history of prostate cancer, evaluate prior to possible focal ablation therapy. Additional history as per chart indicates a needle biopsy in the left mid prostate gland which identified prostate adenocarcinoma (Gleason grade 3+3) involving approximately 5% of a 1 mm tissue sample. PELVIS:PROSTATE:Prostate Size: 42 x 29 mmPeripheral Zone: There is a questionable focus of T2 hypointensity and diffusion restriction in the left apex measuring approximately 2 x 3 mm (series 1101, image 8). A prostatic utricle cyst is noted.Central Gland: The central gland is unremarkable.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter focus of signal abnormality in the left prostatic apex which may represent a very small focus of adenocarcinoma, however this finding is equivocal.


Instruction: Generate impression based on findings.

Input: 56-year-old man with fever of unknown origin. The patient is status post great toe amputation. Evaluate for osteomyelitis or other infection. Examination is limited due to motion artifact on some sequences. As seen on prior radiographs from 11/1/2016, the patient has undergone an amputation of the first ray through the mid-diaphysis of the first metatarsal. There is a fluid collection in the soft tissues distal to the remaining first metatarsal, measuring approximately 2 x 2 cm in transverse dimension, and approximately 4 cm in longitudinal dimension. The collection extends toward but does not definitively contact a linear defect in the skin dorsally, that presumably represents a surgical incision. The fluid collection contacts the surgical margin of the first metatarsal. There is mild edema-type signal within the bone adjacent to the surgical margin on the fat-suppressed T2-weighted sequences, but marrow signal intensity appears relatively normal on the T1-weighted images. Signal intensity of the remaining bones of the forefoot is normal. There is relatively mild edema in the surrounding soft tissues. Small foci of low signal intensity within the collection are nonspecific, and may represent gas.

Output: Postoperative changes of first ray amputation through the mid-diaphysis of the first metatarsal. There is a fluid collection abutting the surgical margins of the bone that is nonspecific and could represent a seroma or an abscess. Relatively mild signal abnormality in the adjacent bone favors reactive osteitis, although we cannot entirely exclude the possibility of early osteomyelitis.


Instruction: Generate impression based on findings.

Input: Rule-out osteomyelitis. Lower extremity wounds Interval decreased bilateral subcutaneous emphysema and swelling observed in 2013 with overall mild interval decrease in soft tissue mass. Mild to moderate diffuse soft tissue subcutaneous swelling with questionable shallow ulceration observed in the lower aspects along the anterior aspect (overlying gauze); however no discrete focal abnormalities or deep ulceration extending to the deep compartments or osseous structures. Specifically no bone marrow signal abnormality or cortical distraction to suggest osteomyelitis bilaterally.Persistent diffuse muscle atrophy without evidence of loculated fluid. Limited visualization of the distal ankles or proximal knees.

Output: Mild to moderate diffuse subcutaneous soft tissue changes with interval decreased diffuse edema and suspected shallow ulcerations observed. These changes however do not extend into the deep compartments are involved the osseous structures. No evidence of osteomyelitis or abscess.


Instruction: Generate impression based on findings.

Input: Male, 54 years old. Left knee pain MENISCI: There is a radial tear of the posterior horn of the medial meniscus. The anterior horn and the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is abnormal signal within the medial aspect of the medial femoral condyle, compatible with a bone contusion. Otherwise, the bones and articular cartilage are unremarkable.LIGAMENTS: The cruciate and collateral ligaments are unremarkable. EXTENSOR MECHANISM: The extensor mechanism is unremarkable.ADDITIONAL

Output: Radial tear of the posterior horn of the medial meniscus and other findings as above.


Instruction: Generate impression based on findings.

Input: The left cerebellar tonsil extends 4 mm below the level of the foramen magnum, and the right 5 mm. Both maintain a normal rounded morphology.The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.The left cerebellar tonsil extends 4 mm below the level of the foramen magnum, and the right 5 mm. Both maintain a normal rounded morphology. This constellation of findings is indeterminate, but the differential diagnosis is cerebellar ectopia versus Chiari malformation, with distinction requiring correlation with symptoms.2.Otherwise negative MRI of the brain including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: Reason: rule out osteomyelitis History: infected LLE venous stasis ulcer RIGHT ANKLE: Again seen is ulceration along the lateral aspect of the right ankle with heterogeneity of the underlying fat, which likely represents a combination of chronic scarring and edema. There is signal abnormality of the marrow of the distal tibia/fibula, which likely represents residual/reconverted red marrow. We see no specific findings to suggest osteomyelitis. We see no fluid collections to indicate abscess. A small focus of signal abnormality in the distal tibia may represent a cyst. Additional patchy signal abnormality indicates red marrow within the bones of the foot. Low signal along the posterior medial ankle likely represents chronic scarring. There is a small volume of fluid in the tibiotalar joint but no large effusion. Linear increased signal in the Achilles tendon suggests mild tendinosis.LEFT ANKLE: Ulceration along the medial and lateral aspects of the ankle with heterogeneity of underlying fat likely represents a combination of edema and chronic scarring. Signal abnormality of the marrow of the distal tibia/fibula likely represents residual/reconstituted red marrow but we see no specific findings of osteomyelitis. We see no fluid collections or abscess. Additional patchy signal abnormality in the bones of the foot represents additional red marrow. The visualized tendons appear normal. There is atrophy of the muscles of the ankle with what appears to be an anomalous muscle extending to the calcaneus.

Output: Soft tissue ulceration and bony sequelae of sickle cell disease without specific radiographic findings of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Male 71 years old Reason: history of prostate cancer, interested in active surveillance, prostate biopsy to follow History: see above PELVIS:PROSTATE:Prostate Size: The prostate gland measures 5.1 x 3.5 x 3.6 cm.Peripheral Zone: Multiple foci of T2 hypointense signal identified within the peripheral zone. The largest which demonstrates early arterial enhancement is in the right peripheral zone of the mid gland/base and measures approximately and 1.0 x 0.8 cm (series 904, image 264). An adjacent additional focus of signal abnormality is identified in the midgland posteriorly in the midline. This measures 1.0 x 1.0 cm (series 904, image 264). These are dark on ADC map. Additional smaller subcentimeter foci are also identified for example, series 904 image 304.Central Gland: Enlarged and heterogeneousSeminal Vesicles: No significant abnormality notedExtracapsular Extension: The dominant lesion in the right peripheral zone abuts the overlying prostatic capsule. It is difficult to visualize on axial T2 weighted images however no definite extracapsular extension is identified.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific mildly prominent inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focal areas of signal abnormality in the peripheral zone. The dominant focus is in the right mid gland/base and measures approximately 1.0 cm in maximum dimension. These are suspicious for foci of prostatic adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Reason: Please follow-up on the fluid collection seen on prior MRI of tib/fib. Please schedule for before or on 10/19/16 if possible History: S/p Symes amputation of the R foot, admitted for cellulitis, and fluid collection suspicious for abscess Again seen are postsurgical changes following resection of the distal tibia and fibula consistent with history of Symes amputation. There is loss of the cortex of the distal tibia just above the resection margin with increased T2 signal intensity, highly suspicious for osteomyelitis. There is a persistent fluid collection abutting the bone with areas of low T1 and T2 signal intensity consistent with scarring. Compared to the prior MRI dated 9/27/2016, there has been no significant interval change in size of the fluid collection.There is diffuse increased T2 signal intensity throughout the soft tissues, consistent with intramuscular and subcutaneous edema. The remainder of the tibia and fibula appear unremarkable.

Output: 1. Persistent fluid collection abutting the bone with areas of scarring, remaining concerning for abscess.2. Findings highly suspicious for osteomyelitis of the distal tibia.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: CVA. Nonenhanced head CT:Patchy periventricular and subcortical foci of low-attenuation likely result of small vessel disease of indeterminate age are noted.There is no evidence of residual subdural hematoma as was noted on prior exam.There is no evidence of intracranial hemorrhage, mass effect, midline shift or hydrocephalus. No evidence of acute cortical stroke. Recommend follow-up with an MRI if concern for acute stroke persists. Bilateral frontal burr holes are again noted in calvarium is otherwise unremarkablelimited view of paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage or cortical stroke.2.Small vessel disease of indeterminate age.3.No evidence of residual subdural as was noted on prior exam.


Instruction: Generate impression based on findings.

Input: Reason: Left side liver / L kidney lesion/ cystic on US. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal signal intensity and enhancement without focal hepatic lesions. There is no intra or extrahepatic biliary ductal dilatation, common duct is upper normal, measuring 7 mm. The gallbladder is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic mass is identified. The main pancreatic duct is not dilated.ADRENAL GLANDS: There is a lobulated, predominantly cystic mass extending from the lateral limb of the left adrenal gland, which demonstrates internal septations and peripheral T2 hypointensity, which is suggestive of calcification. Additionally, there is nodular peripheral enhancement of the lesion. The mass directly abuts the pancreas, but it is favored to be separate.The right adrenal gland is normal. 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: Predominantly cystic mass with enhancing rim and peripheral calcification favored to extend from the left adrenal gland. Differential consideration includes cystic pheochromocytoma and other cystic adrenal neoplasms.


Instruction: Generate impression based on findings.

Input: History of relapsed astrocytoma treated with craniotomy and chemotherapy: surveillance exam. There are post-treatment findings in the posterior fossa, including suboccipital craniotomy with scattered foci of susceptibility effect in the surgical bed. There is no significant interval change in size of the partially enhancing infiltrative mass involving the tectum, midbrain, right cerebellar peduncle, cerebellar vermis, and superior cerebellar hemispheres. The mass measures up to approximately 30 mm, previously also 30 mm. There are multiple unchanged foci of susceptibility effect in the treatment bed, bilateral occipital lobes, and medial temporal lobe. There is a right transfrontal ventricular shunt catheter that terminates in the left lateral ventricle. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged. There is a right mesiodens.

Output: No significant interval change in size of the treated infiltrative hindbrain mass or the shunted ventricular system.


Instruction: Generate impression based on findings.

Input: Female 59 years old. Reason: History of multiple myeloma, lower back and bilateral hip pain, r/o lesions. History: bilateral hip and lower back pain Bone marrow signal is within normal limits. We see no discrete myelomatous lesions. No acute fracture is seen.Degenerative disk disease affects the visualized lower lumbar spine. Please refer to dedicated MRI of the lumbar spine for further characterization. The sacroiliac joints appear normal. The hip joints are within normal limits.Musculature of the hips appears normal. There is mild enhancement along the greater trochanter and hamstring origin bilaterally suggesting mild inflammation at tendinous attachments, but these findings are not necessarily of any clinical significance.

Output: No discrete lesions of multiple myeloma. Other findings as above.


Instruction: Generate impression based on findings.

Input: The left face arm and leg weakness and paresthesia with rapid improvement. No evidence of acute ischemic or hemorrhagic lesion.Multifocal patchy high signal intensities on bilateral periventricular white matter indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate less than 50% of luminal narrowing on the right MCA proximal M1 segment and more than 50% of luminal narrowing on the left distal ICA. Bilateral PCAs are fetal origins. It appears to be that there is one large ACA indicating Azygos ACA. Left ACA A1 segment is hypoplastic. Acom artery is patent. No evidence of intracranial aneurysm. Vertebrobasilar system appears to be normal.3D 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. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Multifocal intracranial arterial luminal stenosis, right MCA proximal M1 (less than 50% stenosis) and left distal ICA (more than 50% stenosis). 3. Normal extracranial craniocervical arterial system. Comment: although the patient appears to be asymptomatic on the left distal ICA stenosis, bilateral various degreed intracranial arterial luminal stenosis indicate intracranial atherosclerosis. Therefore, precise evaluations and management are suggested. If indicated, clinical follow up through Dr.Brorson of Neurology is suggested.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There is high T2/FLAIR signal in the left temporal/occipital lobe without restricted diffusion representing vasogenic edema with laterally adjacent tortuous vascular flow voids. The flow void is enhancing with a tangle of vessels lumenal dark susceptibility signal, representing the patient's known AVM, which is unchanged in size since the previous study by MRI appearance. There are no other T2/FLAIR signal abnormalities. No other enhancing lesions. There is no diffusion abnormality suggest the presence of acute ischemia.MRA BRAIN:There is a tangled vascular nidus of the left MCA, with a prominent draining vein, representing the patient's known AVM, unchanged in size since previous study.

Output: Unchanged left temporal/occipital AVM by MRI appearance. Since the prior study, there is no associated vasogenic edema, representing a treatment response.


Instruction: Generate impression based on findings.

Input: Female 53 years old right shoulder pain, instability and history of a slip and fall. ROTATOR CUFF: Severe atrophy is noted of the infraspinatus muscle. The remaining rotator cuff muscles are intact. No full thickness tear of the rotator cuff tendons.SUPRASPINATUS OUTLET: Degenerative changes are noted about the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Cystic degenerative changes are noted about the anterosuperior aspect of the humeral head. A tear is noted of the posterior labrum.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.Severe atrophy of the infraspinatus muscle without a tear of the rotator cuff.2.Posterior labral tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post Omaaya placement. Signs and symptoms: Same Nonenhanced head CT:Interval placement of a right frontal Omaaya placement.The tip of the shunt catheter is in the dilated right frontal horn. Minimal expected post operative air in the ventricle and the subarachnoid space is present.There is no definitive decrease in the size of the ventricles since prior MRI exam.Extensive post operative changes of a left anterior temporal lobectomy and residual encephalomalacia is noted.

Output: 1. Expected pot op changes of right frontal ventricular catheter with the tip in the right frontal horn.2. No change in the size of dilated supra tentorial ventricles.3. Stable exam otherwise.


Instruction: Generate impression based on findings.

Input: 14-year-old female with left hand string pain x 6 months without improvement after therapy. The left hamstring tendon is intact. Signal abnormality in the left ischial tuberosity with adjacent soft tissue edema is consistent with a subacute ischial tuberosity avulsion fracture. Associated callus formation suggests attempts at healing. The adjacent sciatic nerve is intact. There is no significant regional muscle atrophy or muscle edema. The tendinous origin of the right hamstring is intact. The right ischial tuberosity is within normal limits.Physiologic fluid is present in the pelvis. The remainder of the pelvis is unremarkable.

Output: 1.Intact left hamstring tendon. 2.Avulsion fracture of the left ischial tuberosity with attempts at healing. 3.Moderate associated edema.


Instruction: Generate impression based on findings.

Input: History of meningioma resection. Surgical changes of the calvarium related to meningioma resection including frontal craniectomy with presence surgical changes in the nasal cavity and anterior cranial fossa skull base. Redemonstrated pockets of pneumocephalus deep to the craniectomy site along with extra-axial density tracking along the skull base which likely represents reconstruction material. Packing material is noted within the nasal cavity along with bilateral nasal tubing. Slight interval increased/fluid within the sphenoid sinuses and maxillary sinuses. Redemonstrated into the clivus which is remodeled and absence of the osseous floor of the sella. Redemonstrated volume loss and encephalomalacia of the frontal lobes as seen on prior MRI. No evidence of acute territorial ischemia within the brain. There is no evidence of intra-axial hemorrhage or cerebral edema. The ventricles are stable in size and midline. The basal cisterns are patent. Mastoid air cells are clear. Mucosal thickening and fluid is also noted in the maxillary sinuses. The orbits are unremarkable. Diffuse scalp swelling.

Output: Stable postsurgical changes related to meningioma resection. Slight increased amount of fluid in the maxillary and sphenoid sinuses. Stable pneumocephalus without evidence of acute intraparenchymal process.


Instruction: Generate impression based on findings.

Input: Recurrent meningioma status post resection. Brain: There are postoperative findings related to recent biparietal craniotomy with scattered pneumocephalus and dural thickening and enhancement. There is interval decrease in size of the tumor along the falx cerebri, measuring up to 20 mm in craniocaudal thickness, previously 25 mm. There are mild foci of susceptibility effect in the brain parenchyma surrounding the surgical cavity, which may represent blood products. There are persistent confluent areas of T2 hyperintensity within the posterior cerebral hemisphere white matter bilaterally, which is compatible with vasogenic edema, as well as unchanged left parieto-occipital encephalomalacia. There is no convincing evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a partially empty sella. There is persistent right tympanomastoid fluid. MRV: There is lack of signal in the posterior superior sagittal sinus. The other dural venous sinuses are grossly intact.

Output: 1. Postoperative findings related to partial resection of the posterior falcine meningioma with interval decrease in size of the residual tumor along the falx cerebri.2. Persistent right tympanomastoid fluid may represent otomastoiditis.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: 55 years, Female, imbalance, left-sided tinnitus and aural pressure. Asymmetric sensorineural hearing loss. There is moderate degree of global supratentorial and infratentorial parenchymal volume loss which is advanced for patient's age, but not appreciably changed since 7/3/2012. Ventriculomegaly is also not significantly changed and appears somewhat disproportional to the degree of volume loss. Cerebral aqueduct appears grossly patent. There are multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, and also not significantly changed. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No evidence of mass effect, midline shift or herniation. Mild opacification of the right-sided mastoid air cells. Partially empty sella is again seen which is nonspecific and may be normal variant or associated with intracranial hypertension in the appropriate clinical setting.High-resolution noncontrast images of the internal auditory canals demonstrate an approximately 7 x 8 x 6 mm nodule involving the left internal auditory canal. This lesion does not appear to extend into the cochlea. Bilateral cerebellopontine angles and remainder of the visualized inner ears structures are grossly unremarkable within the limitations of noncontrast study.

Output: 1. 8 x 7 x 6 mm lesion involving the left internal auditory canal is not well evaluated without contrast but suspected to represent a vestibular schwannoma.2. Remainder of the brain parenchyma demonstrates global parenchymal volume loss supra and infratentorially which is prominent for patient's age, but not significantly changed since 7/3/2012. There are also multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter which are nonspecific but may represent mild chronic small vessel ischemic disease. Sequela of prior inflammation or less likely demyelination are other possibilities.3. Ventriculomegaly also remains unchanged since 2012. Suggest correlation for clinical signs of communicating hydrocephalus/NPH, which incidentally has been associated with a vestibular schwannomas.


Instruction: Generate impression based on findings.

Input: Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is reversal of the normal cervical curvature centered at C4-5, unchanged. There is subtle signal hyperintensity within the spinal cord at C4-5 the disk space level which is unchanged.At C2-3 there is no significant compromise to the spinal canal or neural foramina, unchanged. At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small right paracentral disk protrusion present at this level which is unchanged in appearance. There is partial effacement of spinal fluid ventral and posterior the spinal cord and overall mild spinal stenosis.At C4-5 there is loss of disk space height, diffuse disk bulge and small endplate and uncovertebral osteophytes with more uncovertebral osteophytes on the right side relative to the left. There is encroachment of the right-sided exiting nerve roots within the neural foramina at this level. There is effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall moderate there is a degree of spinal stenosis which has not significantly changed.At C5-6 there is no significant compromise to the spinal canal or neural foramina, unchanged.At C6-7 there is no significant compromise to the spinal canal or neural foramina, unchanged.At C7-T1 there is no significant compromise to the spinal canal or neural foramina, unchanged.The vertebral artery flow voids appear are intact.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is normal. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized paraspinal contents are unremarkable.Disc desiccation and mild disc height loss are present at L3/4, L4/5, and L5/S1, unchanged. L1/2: Unremarkable and unchanged.L2/3: Unremarkable and unchanged.L3/4: There is a left foraminal/lateral disc protrusion which impinges the adjacent left L3 nerve root and causes moderate left neural foraminal stenosis. There is also diffuse annular disc bulge, bilateral ligamentum flavum thickening, and bilateral facet hypertrophy without significant central or right foraminal stenosis. These findings are unchanged.L4/5: A previously demonstrated central disc extrusion, extending below the disc level, has slightly decreased in size. There is mild central stenosis (previously mild to moderate) as well as moderate bilateral lateral recess stenosis which is unchanged. Mild bilateral facet hypertrophy and mild left neural foraminal stenosis is stable.L5/S1: There is a right paracentral disc protrusion which abuts, posteriorly displaces, and effaces the right S1 nerve root sheath origin, unchanged.

Output: 1.C3-4: A small right paracentral disk protrusion present is unchanged in appearance. 2.C4-5: Moderate central spinal stenosis which has not significantly changed. Subtle signal hyperintensity within the spinal cord is also unchanged.3.L3/4: A left foraminal/lateral disc protrusion which impinges the adjacent left L3 nerve root and causes moderate left neural foraminal stenosis is unchanged.4.L4/5: A central disc extrusion has slightly decreased in size. There is mild central stenosis (previously mild to moderate) as well as moderate bilateral lateral recess stenosis which is unchanged. Mild left neural foraminal stenosis is stable.5.L5/S1: A right paracentral disc protrusion abuts, posteriorly displaces, and effaces the right S1 nerve root sheath origin, unchanged.


Instruction: Generate impression based on findings.

Input: Male, 51 years old, with abnormal brain MRI. Evaluate brain lesion status post nondiagnostic brain biopsy. Evidence of prior biopsy is again seen in the right cerebral hemisphere. A small hemosiderin stained cavity involving the right basal ganglia is unchanged.Ill-defined T2 hyperintense signal and thickening are again seen involving the right temporal lobe, insula, basal ganglia, thalamus, cerebral peduncle and centrum semiovale. No significant interval change is seen in the geographic extent of this abnormality or in the degree of parenchymal thickening, even when compared to multiple prior studies. There is no associated diffusion restriction, and no pathologic enhancement.Generalized right cerebral mass effect with slight midline shift to the left and partial effacement of the right lateral ventricle is unchanged. No evidence of acute intracranial hemorrhage is seen. Ventricular size and morphology are unchanged.

Output: No change is seen in the extent of signal abnormality and parenchymal thickening involving a substantial portion of the right cerebral hemisphere. No new intracranial lesions are detected. Findings related to prior right cerebral biopsy are redemonstrated.


Instruction: Generate impression based on findings.

Input: Right-sided weakness. Evaluate for stroke. The study is severely limited by motion.Parenchymal loss as well as abnormal signal in the left occipital and temporal lobes associated with facilitated diffusion from chronic infarcts. Also moderate confluent periventricular white matter T2/FLAIR signal abnormality (most pronounced in the parietal lobes) is not associated with diffusion restriction and likely reflects chronic microvascular ischemia. There are multiple foci of restricted diffusion involving the bilateral pons and left cerebellum. There is some variation in the degrees of restricted diffusion within the infarcts reflecting differences in timing but appear acute to subacute. Minimal diffusion restriction is also noted involving the left thalamus which demonstrated evolution between CT studies from 7/28 and 8/1/2015.No evidence of significant intracranial mass effect, midline shift, or herniation.

Output: Severely motion degraded study. There is encephalomalacia involving the left temporal and occipital lobes compatible with remote large left PCA infarct. There are multiple foci of varying degrees of diffusion restriction involving the bilateral pons, left cerebellar hemisphere, and left thalamus which are compatible with acute to subacute infarcts. These are grossly similar to prior CT although the differences in technique limit comparison.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Status post liver transplant with elevated bilirubin. Transplant in 1999 for biliary atresia. ABDOMEN:LIVER, BILIARY TRACT: Moderate diffuse fatty infiltration of the liver. Cirrhotic liver morphology with marked progressive fibrosis. No focal lesion. Hepaticojejunostomy is noted with mild upstream biliary ductal dilatation appearing similar to mildly progressed from prior. The hepatic artery anastomosis is well seen and the vessel is well opacified.The portal vein is patent. The hepatic veins are opacified. The anastomosis is obscured by surgical clip susceptibility artifact.SPLEEN: Marked splenomegaly measuring 21 cm in length with peripheral small infarcts. No focal lesion.PANCREAS: Peripancreatic collateral vessel formation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small volume abdominopelvic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild intrahepatic biliary ductal dilatation to the level of the biliary enteric anastomosis appears mildly progressed from the prior. Cirrhotic liver morphology with progressive fibrosis. No suspicious lesion.


Instruction: Generate impression based on findings.

Input: 35 y/o female with DLBCL admitted for chemotherapy now found to have a depressed EF on echocardiography where previously normal LVEF on cMR. Left VentricleThe left ventricle is mildly dilated (when indexed) and systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 98 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 47 ml/m2 (normal range 18+/-5), the LVESV is 71 ml (normal range 31+/-10), the LV mass index is 32 g/m2 (normal range 67+/-11), and the LV mass is 48 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 105 ml/m2 (normal range 69+/-14), the RVEDV is 159 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a common right brachiocephalic and left common carotid trunk takeoff (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is artifact within the SVC, likely related to catheter. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is mildly dilated when indexed for body surface area with normal systolic function (LVEF 53%)2. Right ventricle is mildly dilated when indexed for body surface area with normal systolic function (RVEF 55%) Compared to CMR of 4/2/2015, the pericardial effusion is smaller and the LV and RV volume are slightly larger on current study. LVEF is also slightly lower.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 48 year old with family history of breast cancer in paternal aunt, grandmother and 2 cousins. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Metastatic maxillary sinus cancer. Evaluate response to chemotherapy. Also, please evaluate for perineural spread. The examination is mildly limited by artifact that is most pronounced on the diffusion weighted and fat suppressed sequences.FACE:There has been regression in the destructive right maxillary sinus soft tissue mass and its extension beyond the right maxillary sinus since the prior examination. The bulging into the right nasal cavity has resolved. There is now circumferential soft tissue thickening in the right maxillary sinus that is markedly T2 bright and shows uniform peripheral contrast enhancement, which probably represents mucosal thickening. Similar involvement is present in the right ethmoid sinuses as well. Associated osseous destruction is better assessed on CT scan. While the floor of the right orbit was previously involved, there is no gross extension into the right orbit. Previously described asymmetric contrast-enhancing soft tissue involving the right pterygopalatine fossa is slightly improved, which reflects perineural spread through the right infraorbital nerve. It extends into the right vidian canal and reaches very close to the right foramen rotundum though does not definitely extend into it. The asymmetric increased contrast enhancement/fullness in the anterior aspect of the right cavernous sinus is also now less pronounced. Asymmetric prominence of the right posterior glenoid is unchanged.There is no brain parenchymal or leptomeningeal abnormal contrast enhancement. There is no mass-effect or brain herniation.NECK:The associated right level 2A lymphadenopathy has regressed. The largest lymph node that previously measured 1.4 cm x 2.1 cm now measures 0.8 cm x 1.4 cm. The other lymph nodes are even smaller. The upper right lateral retropharyngeal lymph node that measured 10 mm x 12 mm now is barely visible measuring 0.6 cm x 0.4 cm. There is no new cervical lymph node enlargement. Major salivary glands are unremarkable. Major neck vessels show preserved flow voids. The airway is preserved The cervical spinal cord shows no gross abnormality in the spinal canal is fairly preserved. Less fatty than expected marrow signal in the cervical spine may reflect red marrow reconversion.

Output: 1.Significant improvement of the destructive, locally invasive right maxillary sinus cancer. The circumferential soft tissue and now present in the right maxillary sinus probably reflect mucosal thickening. There is no measurable definite tumor mass in the right maxillary sinus region.2.The associated right cervical lymphadenopathy is also improved. Indeed, the residual lymph nodes are subpathologic in size.3.Associated findings of perineural spread are slightly improved.


Instruction: Generate impression based on findings.

Input: Extensive cervical truncal/upper extremity lymphatic venous malformations. There is redemonstration of relatively large multiseptated cystic and solid lesions bilaterally at the base of the neck, right more so than left, which are partially visualized. Descending multiple spaces in the neck and extending into the bilateral chest cavities, upper mediastinum, axillae, and right posterior chest wall. The dominant right-sided lesion have significantly decreased in size, compatible with history of debulking, with the largest cystic component measuring up to 2.1 x 1.4 cm superior to the right scapula (series 601 image 16). The lesions remain in close contact the major cervical vessels. An additional lesion also visualized posterior soft tissues of the back in the midline at the T3-T4 level, which do not appear significantly changed. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. However, there is prominent epidural fat in the posterior cervicothoracic spine, without spinal cord compression. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.

Output: 1. Interval debulking of the partly imaged extensive right-sided mediastinal, chest wall, and right lower neck lymphangioma related to CLOVES syndrome. Please refer to the separate chest MRI report for additional details.2. Multiple other neck lymphangiomas appear to have evolved, although comparison is limited due to differences in technique.3. Prominent epidural fat in the posterior cervicothoracic spine, without spinal cord compression, which may be related to the overgrowth syndrome.


Instruction: Generate impression based on findings.

Input: Seizure, rule out structural cause. Examination is mildly motion degraded. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. The bilateral hippocampi are symmetric in size and signal characteristics.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the pons, which are nonspecific, but compatible with chronic small vessel ischemic changes. There is a focus of CSF intensity involving the left lateral thalamus with a rim of gliosis likely representing a lacunar infarct. There is global parenchymal volume loss, commensurate with age. 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. There is a small mucous retention cyst in the left sphenoid sinus. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No intracranial mass or abnormal parenchymal or meningeal enhancement. No findings to definitively suggest a seizure focus.2. Mild chronic small vessel ischemic disease. Chronic lacunar infarct in the left lateral thalamus.3. Global parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with known glioblastoma, on Avestin, now with speech difficulties, right-sided weakness. Rule out bleed. Signs and symptoms: Same Unenhanced head CT:Examination demonstrates no evidence of acute intracranial hemorrhage.Extensive low-attenuation of white matter of the left cerebral hemisphere and to a lesser degree of the right hemisphere is consistent with posttreatment changes as well as residual edema/encephalomalacia of patient's known tumor. There is no appreciable change when compared to prior MR. There is an irregularly shaped calcification of the proximal left frontal lobe at the site of previously noted susceptibility signals are prior MR. Dilated supratentorial ventricular system are essentially similar to prior study. There is no evidence of midline shift. Recommend further follow-up with an MRI exam.

Output: 1.No evidence of acute intracranial hemorrhage as clinically questioned.2.When compared with prior MRI constellation of intracranial findings of brain tumor, post therapy changes, ventriculomegaly remains essentially similar.3.Recommend follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: 51-year-old woman with history of cystic pancreatic lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. Parenchymal loss of signal on the opposed phase images indicates steatosis. No focal lesion identified.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal.PANCREAS: A 7 x 5 mm T2 hyperintense, nonenhancing focus in the pancreatic body (series 601, image 20) is again seen communicating with the main pancreatic duct and is unchanged.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a subcentimeter hemorrhagic cyst in the inferior pole of the right kidney, otherwise the kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unchanged pancreatic body sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: Clinical question: Stenosis? Signs and symptoms: RLE pain. Nonenhanced lumbar MRI:T12 -- L1 is unremarkable.L1 -- L2 demonstrate mild disk disease and loss of disk height and mild bilateral facet and ligamentum flavum hypertrophy. No central spinal stenosis however a moderate bilateral neural foraminal compromise is noted.L2 -- L3 demonstrate moderate disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy and resultant moderate central spinal stenosis and significant left and moderate right neural foraminal compromise. There is a large left lateral disk extrusion with inferior migration behind the vertebral body of L3 contributing to spinal stenosis posterior to L3 vertebrae.L3 -- L4 demonstrate moderate disk disease, loss of disk height, significant facet and moderate ligamentum flavum hypertrophy bilaterally. Degenerative changes results in grade 1 anterolisthesis and pseudo-bulge of the disk. There is resultant significant central spinal stenosis and bilateral neural foramina compromise.L4 -- L5 demonstrate advanced disk disease with loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy and grade 1 anterolisthesis. There is resultant significant central spinal stenosis and moderate to significant bilateral neural foraminal compromise (right greater than left).L5 -- S1 demonstrate mild degenerative disk disease and moderate facet hypertrophy without significant ligamentum flavum hypertrophy. There is no central spinal stenosis or neural foraminal compromise. The paraspinal soft tissues are unremarkable.

Output: 1.Degenerative changes at L2 -- L3 and including a left lateral disk extrusion with inferior migration is noted. Findings results in moderate central spinal stenosis and neural foraminal compromise.2.Extensive degenerative disk disease at L3 -- L4 results in mild grade 1 retrolisthesis, significant central spinal stenosis and neural foraminal compromise.3.Advanced degenerative changes at L4 -- L5 with resultant grade 1 anterolisthesis and significant central spinal stenosis and bilateral neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: 38 year old female with a history of right lumpectomy 3/2010 for invasive ductal carcinoma. The patient received neoadjuvant chemotherapy, adjuvant radiation and hormonal therapy. History of benign right medial retro areolar breast biopsy with pathology of fat necrosis and left breast reduction. History of breast carcinoma in maternal grandmother and 2 paternal great aunts. There are motion artifacts.There is heterogeneous amount of fibroglandular tissue in both breasts.A few cysts in the left breast.Moderate parenchymal enhancement is noted bilaterally.There are post lumpectomy changes in the right breast and post reduction changes in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: please do Dr Javed MS protocol, c/w priorSigns and Symptoms: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There is a small T2 hyperintense lesion present along the right posterior lateral aspect of the spinal cord at the C3-4 disc space level. There is a small T2 hyperintense lesion along the left posterior lateral aspect of the spinal cord at the C6-7 level. There is a T2 hyperintense lesion measuring 11 mm in superior-inferior length along the posterior aspect of the spinal cord at the T1 vertebral level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C5-6 there is a disc bulge present associated with hypertrophy of the ligamentum flavum and partial effacement of spinal fluid ventral and posterior to the spinal cord. There is some narrowing of the left neural foramen at this level as a result of disc material with encroachment of left-sided exiting nerve roots. Overall there is a mild to moderate degree of spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is a T2 hyperintense lesion measuring 11 mm in superior-inferior length along the posterior aspect of the spinal cord at the T1 vertebral level. This is associated with mild mass effect but no contrast enhancement.There is a T2 hyperintense lesion along the right posterior lateral aspect of the spinal cord at the T6-7 disc space level.A small disc protrusions present along the right paramedian region at the T7-8 level.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: 1.There are multiple lesions identified in the cervical and thoracic spinal cord which are suspicious for demyelinating lesions. The largest one is at the T1 vertebral level. Lack of contrast enhancement suggests that these are not acute.2.On the available pulse sequences, there are no lesions identified in the brain parenchyma to suggest demyelination.3.There are some degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C5-6 and some encroachment of the left-sided exiting nerve roots at C5-6.


Instruction: Generate impression based on findings.

Input: Male, 12 years old, with history of left frontal grade 2 ependymoma status post resection on 10/31/2012 followed by radiation, and therapy on 2/1/2013. Follow-up examination. A resection cavity within the posterior aspect of the left inferior frontal gyrus is stable in size and morphology. No concerning enhancement is seen within or around the cavity margins. Minimal parenchymal T2 hyperintensity surrounding cavity, and susceptibility effect within the cavity, are unchanged as well.No areas of new parenchymal signal abnormality or pathologic enhancement are detected. Brain morphology is otherwise unremarkable. No evidence to suggest any new pathologic fluid collection is seen. Ventricles are stable and normal in size.

Output: Stable examination with no evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Male 55 years old Reason: Metastases and primary cancer/ staging History: Rectal Polyp Overall image quality: GoodPELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Present. Reference measurement of 0.7 x 0.5 cm (series 7 image 13).Lymph nodes outside the mesorectal fascia: None.BOWEL, MESENTERY: Rectal Tumor:Size: 2.6 x 3.6 x 4.4 cm (image 28/series 5) (series 7 image 27)Tumor appearance on T2-weighted images: Hyperintense to muscle.Tumor location: (For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 4.5 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Extends into the external sphincter complexCircumference of the rectum involved: 360Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): No prostate invasion.MRI T-stage: T3a - Tumor invades < 0.5 cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: < 0.5 cm (image 22/series 7).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Circumferential mass arising from the distal rectum with small adjacent perirectal lymph nodes as detailed above.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. There is a biopsy proven malignancy in the left breast at the periareolar region. Submitted for review are breast MRI (8/10/16), ultrasound images of both breast (8/16/16) performed at outside institution. For comparison, digital mammographic images (7/25/2016), ultrasound images of left breast (7/25/2016), images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (7/26/2016) are available. BREAST MRI (8/10/16):Breast MRI was performed with a protocol outlined in the outside radiology report.MR images could not be processed on the DynaCAD workstation; therefore, an interpretation was made with axial images on PACS. No reformatted sagittal or coronal images were available.There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is an enhancing mass at superior aspect of the left retroareolar region, measuring 9 x 8 mm (AP x LR) on axial view, which corresponds to the proven carcinoma. The mass attaches to the skin and is located superior to the nipple. A marker clip is present within the mass.Although there are multiple enhancing foci in both breasts, they are background parenchymal enhancement. None of them are suspicious enough to require MR directed ultrasound or MR guided biopsy.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.ULTRASOUND IMAGES OF BOTH BREAST (8/16/16):Although a hypoechoic structure is captured in each breast, the outside radiology report stated that these findings were non-specific, such as a fat lobule or normal background in real time study.

Output: 1. Unifocal carcinoma at superior aspect in the left retroareolar region.2. No abnormal enhancement in right breast. 3. No abnormal lymph nodes are identified in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: There is no abnormal lesions or masses in the region of the olfactory bulbs or elsewhere in the brain, within the limits of noncontrast study. Numerous scattered periventricular and subcortical white matter T2 hyperintensities are redemonstrated. There appears to be minimally more punctate areas of T2 signal abnormality, particularly in the posterior right frontal corona radiata, likely more conspicuous secondary to differences in technique. However, there are no new large lesions to suggest progression of demyelinating disease. The ventricles and sulci are unchanged, with stable prominence of the anterior parafalcine extra-axial spaces. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is minimal mucosal thickening in the bilateral ethmoid air cells and frontal sinuses.

Output: 1.No masses involving the olfactory bulbs or anterior cranial fossa are appreciated.2.Multiple T2/FLAIR hyperintense lesions in the white matter are redemonstrated, which may represent small vessel ischemic disease and/or demyelinating lesions. Please note this MRI was not tailored for following up of demyelinating disease.


Instruction: Generate impression based on findings.

Input: 70-year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.5 cm in transverse, 2.7 cm in AP, and 3.8 cm in craniocaudal diameter.Peripheral Zone: Small volume of peripheral zone. Extensive hazy T2 hypointense signal throughout the peripheral zone could represent prostatitis, and this limits evaluation for a discrete lesion.Central Gland: Nodular changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious focus is identified. Hazy T2 hypointense signal throughout the peripheral zone could represent prostatitis, and this limits evaluation for a discrete lesion.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: 52-year-old female with pain and swelling. An alternative knee coil was utilized for this examination, rather than the HD coil, presumably due to the patient's body habitus, resulting in suboptimal image quality.MENISCI: The body and posterior horn of the medial meniscus are attenuated which may represent postoperative changes of prior partial meniscectomy, chronic attritional tearing or a combination of both. There is also abnormal intermediate signal intensity within the body of the medial meniscus which extends to the tibial articular surface. We cannot determine if this represents a meniscal tear or residual degenerative signal subsequent to prior partial meniscectomy. No fluid signal intensity is identified within the meniscus to confirm a tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial tibiofemoral compartment with additional small foci of near-full-thickness articular cartilage degeneration along the medial femoral condyle which have perhaps progressed slightly when compared to the prior examination.There is superficial degeneration of the articular cartilage of the lateral tibial plateau with degenerative signal abnormality in the underlying subchondral bone. There is also superficial degeneration of the articular cartilage of the patella, particularly along the medial facet. There is a small focus of signal abnormality in the distal femoral metaphysis which likely represents an enchondroma.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial meniscus abnormalities which are presumably postoperative in etiology. There is intermediate signal intensity within the body of the medial meniscus which extends to the tibial articular surface which may represent residual mucoid degeneration of the body of the medial meniscus; however, we cannot exclude an undersurface tear of the meniscus. We see no fluid signal intensity entering the meniscus to confirm a tear.2. Articular cartilage degeneration, as described above, which has perhaps progressed slightly when compared to the prior study, particularly along the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine with aura, intractable, with status migrainosus Episodic cluster headache, intractableClinical question: worsening , new headacheSigns and Symptoms: worsening new headache, periods of confusion associated with unusual new headache MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for intracranial mass lesion or other explanation for the patient's migraines.


Instruction: Generate impression based on findings.

Input: 44 years, Male, facial droop and slurred speech.. Examination is motion degraded. No restricted diffusion is seen to suggest acute ischemia is definitively appreciated. Subtle punctate focus of diffusion hyperintensity in the right anterior aspect of the pons is favored to be artifactual. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved with tortuosity of the cavernous internal carotid arteries noted.There is mild global parenchymal volume loss which is advanced for age. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic changes. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. Motion degraded study without definite evidence of acute infarct, hemorrhage or intracranial mass effect. Subtle focus of diffusion hyperintensity in the right anterior aspect of the pons is favored to be artifactual. 2. Patchy foci of T2/FLAIR signal abnormality in the white matter are nonspecific but compatible with mild to moderate chronic small vessel ischemic disease, which is advanced for age. There is also mild global parenchymal volume loss which is advanced for age.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (4/21/16) performed at DuPage Medical Group. For comparison, digital mammographic images (4/18/2016), ultrasound images of right breast (4/18/2016), images from ultrasound guided biopsy of the right breast and postprocedural right mammographic images (4/18/2016) are available. Breast MRI was performed with a protocol outlined in the outside radiology report.There is an irregularly shaped enhancing mass measuring 24 x 22 x 32 mm (AP x LR x CC) at 12:00 position in the right breast, which is a biopsy-proven carcinoma. An artifact from a marker clip is present at posterior aspect within the mass. The lesion is close to the skin on the sagittal view; the distance from the skin is about 4 mm.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal cancer in the right breast at 12:00 position.2. No MRI evidence for malignancy in left breast. 3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 17 years old. Reason: h/o GSW to right foot with resultant cellulitis, concern for osteomyelitis History: pain, erythema, swelling, known fracture There is diffuse signal abnormality involving the first metatarsal, centered on the diaphysis, but extending to the proximal articular surface. There is decreased signal on T1 weighted imaging and increased signal on T2-weighted imaging, and there is significant associated circumferential cortical destruction through the length of the metatarsal. There is soft tissue edema/inflammation primarily involving the plantar soft tissues of the foot, and there is a sinus tract extending from the proximal first metatarsal diaphysis to the plantar soft tissues. These findings are compatible with osteomyelitis.The other imaged bones have normal marrow signal and intact cortical margins.

Output: Findings compatible with osteomyelitis of the first metatarsal, with a sinus tract extending from the adjacent inflamed plantar soft tissues to the involved bone.


Instruction: Generate impression based on findings.

Input: Female, 21 years old, with headache for one month, nausea and vomiting, and history of HIV with low CD4 count (88). Assess for tumor or mass. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of parenchymal enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Mucosal thickening is seen in the sphenoid sinuses. Bone marrow signal characteristics are within normal limits.

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


Instruction: Generate impression based on findings.

Input: Female, 21 years old, with epilepsy. Presurgical planning fMRI is requested. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri.Of the tested language paradigms, the most reliable language-related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Language is overall left dominant. On one trial of the word generation paradigm, a substantial right sided Wernicke's contribution was seen, but the remaining paradigms show left dominant activation, and Broca's area activity is only seen on the left. Broca's area is identified in the inferior frontal gyrus (predominantly pars triangularis). Wernicke's area is identified along the posterior aspect of the superior temporal sulcus.The visual stimulation paradigm elicits bilateral activity along the inferior calcarine sulcus of the occipital lobes.A set of conventional FLAIR images of the brain was also obtained and these show no obvious or discrete parenchymal lesions.

Output: Successful functional MRI for surgical planning purposes. Sensorimotor cortical activation maps as expected along the pre- and postcentral gyri.Language is left dominant with Broca's and Wernicke's areas located in their customary locations.Visual cortical stimulation maps along the calcarine sulcus bilaterally.


Instruction: Generate impression based on findings.

Input: Known Chiari: Dizziness, near syncope. There are unchanged mildly low-lying cerebellar tonsils, with otherwise rounded morphologies and essentially intact biphasic cerebrospinal fluid flow across the foramen magnum. The spinal cord appears unremarkable, without evidence of syringohydromyelia. There is lack of the usual cervical lordosis, but no evidence of spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is dependent edema in the posterior lower back subcutaneous tissues.

Output: 1. Unchanged mildly low-lying cerebellar tonsils, with otherwise rounded morphologies and essentially intact cerebrospinal fluid flow across the foramen magnum. 2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for pituitary adenoma. Signs and symptoms: Galacturia, irregular menses. Pre and post enhanced pituitary MRI:Examination demonstrates homogeneous signal intensity or pituitary gland on all nonenhanced images and measuring approximately 7.3 mm in height is within normal for patient of stated age of 26 years. Pituitary stalk is also normal in size and morphology. There is normal homogeneous enhancement of pituitary gland and pituitary stalk without detectable pituitary mass/adenoma. There is normal anatomical asymmetrical pneumatization of the sphenoid sinus with the right chamber being larger (with resultant mild elevation of the floor of the sella on the right) compared to left. There is normal signal intensity and morphology hypothalamus and without abnormal enhancement. There are normal bilateral cavernous sinuses and without abnormal enhancement. Bilateral Meckel's caves are also within normalThere is no abnormality at the level of the skull base and without abnormal enhancement.

Output: 1.No detectable pituitary lesion.2.Normal anatomic variation of asymmetric pneumatization of the sphenoid sinus sinus (R>L) results in mild inferior slanting of the floor of the sella to the left as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate plexiform neurofibroma History: Patient with NF-1 and large plexiform tumor causing pain Due to technologist error, the superior extent of the plexiform neurofibroma was not included in its entirety on the field of view. We will attempt to have the patient return for repeat sequences that cover the entire cranial extent of the tumor in addition to the sagittal sequences that were not obtained as part of the routine University of Chicago protocol. Note is made of an extensive plexiform neurofibroma involving the soft tissues of the distal thigh, knee, and leg. The largest mass is again noted within the lateral aspect of the popliteal fossa, measuring approximately 8.6 x 4.9 cm, appearing similar to the previous study, following remeasurement. Medial to this large mass, is a second mass measuring approximately 5 x 3.6 cm in the transverse dimension, previously 3.9 x 3.3 cm. A third mass, resulting in scalloping of the posterolateral aspect of the proximal tibia, measures approximately 2.6 x 2.0 cm, appearing similar to the prior study when accounting for positional differences. A fourth lesion along the lateral aspect of the mid fibular diaphysis measures approximately 3.8 x 2.1 cm, appearing similar in size when accounting for positional differences. Additional smaller neurofibromas are noted surrounding the distal femoral diaphysis and along the lateral and posterior margins of the distal femoral metaphysis, as well as within the biceps femoris muscle and along the sciatic nerve. Multiple additional neurofibromas are noted within all of the compartments of the leg, appearing similar to the prior study. There is fatty infiltration of the deep posterior compartment musculature of the leg, appearing similar to the prior study.

Output: Incomplete study showing plexiform neurofibromas as described above. We will attempt to have the patient return for further images so that the proximal extent of the tumor can be scanned along with the remainder of the lesion.


Instruction: Generate impression based on findings.

Input: 20 years Female (DOB:2/2/1996)Reason: eval for optic nerve swelling or mass History: severe headache with right eye visual changes for 5 daysPROVIDER/ATTENDING NAME: DIANE B CHANEY KEEGAN CHECKETT MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .The pituitary gland measures 6 mm in height.

Output: MRI of the brain and orbits is within normal limits.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge without significant spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge with mild to moderate bilateral neural foraminal narrowing. No spinal canal stenosis.L4-L5: There is disc bulge and moderate bilateral facet arthropathy. No spinal canal stenosis. There is moderate bilateral neural foraminal stenosis. L5-S1: Minimal disc bulge. No spinal canal stenosis. No significant neural foraminal stenosis. Moderate bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild multilevel degenerative changes in the lumbar spine with mild disc bulges. There is up to moderate narrowing of the neural foramina at the L4-L5 level which may be impinging on the L4 nerve roots. Minimal degenerative changes at additional levels as described above. There is no spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Dandy-Walker variant. Colloid cyst, treated. Low-lying conus medullaris. Prone imaging was not performed. The anesthesia team recommended against performing prone imaging given the small size of this tracheostomy.Brain:Hypoplastic inferior cerebellar vermis, rotation of the superior cerebellar vermis and mild elevation of the torcular herophili are compatible Dandy-Walker spectrum/continuum. Mild lateral and third ventricular dilatation is unchanged. There is no sign of recurrence of the colloid cyst in the third ventricle. T2-hyperintensity in the parietal deep white-matter may represent terminal zones of myelination.Few foci of susceptibility effect along the brain surface and the ventricular lining are more prominent than on the previous examination. This may relate to improved sensitivity of the examination or to increased cerebral hemosiderosis. There is also hemosiderin staining along the surgical tract in the right frontal lobe. A prominent vessel in the left occipital lobe may represent a developmental venous anomaly and was present previously. There is no midline shift or brain herniation. Major intracranial vascular flow voids are preserved.There is fluid in the right mastoid air cells. There is minimal ethmoid mucosal thickening which is nonspecific. The adenoids are enlarged but this is a common finding in this age group.Whole Spine:The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris tip lies at the lower L3 level which is unchanged. There is no evidence of filum terminale fibrolipoma and the cauda equina nerve roots are unremarkable. There is no malignancy seen. There is no fistulous tract in the subcutaneous tissues over the sacrum and lower lumbar spine. Other findings including agenesis of the left kidney, tracheostomy and a gastrostomy tube only partially included. The rectum is distended with stool.

Output: 1.Dandy-Walker spectrum/continuum findings as described above.2.Unchanged mild dilatation of the third and lateral ventricles.3.Cerebral hemosiderosis may have slightly increased since the previous examination.4.Unremarkable spine apart from low-lying conus medullaris which is unchanged. As discussed above, sagittal imaging was not performed in the prone position because of the small size of the tracheostomy, per the recommendation of the anesthesia team.


Instruction: Generate impression based on findings.

Input: History of hepatic metastases with abdominal pain and elevated liver enzymes, evaluate for biliary obstruction. ABDOMEN:LUNG BASES: Small left pleural effusion. Right breast prosthesis partially visualized.LIVER, BILIARY TRACT: The liver is enlarged. The liver parenchyma is replaced with innumerable heterogeneous enhancing masses encompassing greater than 90% of the liver volume consistent with diffuse metastatic disease. The main portal vein is patent. There is attenuation of the right portal vein without obvious thrombus. The hepatic veins are poorly visualized.There is mild segmental intrahepatic biliary duct dilation particularly in the left lobe (series 8, image 152) likely from the parenchymal metastases. The extrahepatic bile ducts are normal in caliber.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: Prominent aortocaval lymph nodes are present.BOWEL, MESENTERY: There is mild nodular thickening of the peritoneum adjacent to the inferior aspect of the spleen and elsewhere with associated restricted diffusion suspicious for peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate volume ascites.

Output: 1.Diffuse metastatic disease throughout the liver.2.Mild segmental intrahepatic biliary ductal dilatation likely related to parenchymal metastases. No extrahepatic biliary ductal dilatation.3.Findings suspicious for peritoneal carcinomatosis. Moderate volume ascites.


Instruction: Generate impression based on findings.

Input: Radicular pain in the left upper extremity and neck pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign including a T2 hyperintense lesion involving the C4 vertebral body which is favored to represent an atypical hemangioma and similar to prior.Degenerative changes are seen are again seen the cervical spine, as described below, and have progressed since 8/15/2009:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a central disc extrusion which is larger than prior and associated with moderate spinal canal stenosis and mild deformity of the cervical cord in the midline and to the right of the midline. No significant neural foraminal stenosis. Subtle T2 hyperintensity suspected in the cervical cord which is new/increased since prior.C4-5: There is severe spinal canal stenosis at this level related to disc extrusion and ligamentum flavum thickening which have progressed since prior with increased flattening of the cord with subtle T2 signal abnormality. There is mild to moderate right neural foraminal stenosis and mild left neural foraminal stenosis related to uncovertebral hypertrophy.C5-6: There is right paracentral disc protrusion which appears slightly worse than prior. There is mild to moderate spinal canal stenosis. There is minimal right and no left neural foraminal stenosis.C6-7: Minimal degenerative changes. No significant compromise to the spinal canal or neural foramina.C7-T1: Minimal degenerative changes. No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Interval progression of multilevel degenerative changes compared to prior study from 2009. There is severe spinal canal stenosis at C4-C5 and and to a lesser degree at C3-C4 and C5-C6 levels primarily related to disc extrusions. There is abnormal T2 hyperintensity in the cervical cord at the C3-C4 and the C5 levels which is worse since prior. There is mild left C4-C5 neural foraminal narrowing; otherwise no high-grade left-sided neural foraminal stenosis is appreciated. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Spinal stenosis, cervical regionClinical question: right arm pain and weaknessSigns and Symptoms: right arm pain and weakness 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 anterior fusion and disc spacer placement at the C5-6-7.Axial imaging is degraded by phase encoding artifact and motion artifact. There is mild reversal of normal cervical curvature which was also present on the prior exam but not substantially changed. Please note that the reversal of normal cervical curvature may be positional effect rather than true reversal. This is centered at approximately C5-6. Compared to the previous exam there is no observable significant interval change.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. There is mild narrowing of the neural foramina bilaterally at this level which is unchanged since the prior exam.At C6-7 there is no significant compromise to the spinal canal. There is left sided uncovertebral osteophyte formation present associated with narrowing of the neural foramen. Some degree this was also present on the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.The patient is status post anterior cervical fusion from C5 through C7. There is redemonstration and no change in encroachment of the left-sided exiting nerve roots at C6-7 as a result of degenerative change. Apparent mild reversal of the normal cervical curvature would be better assessed on upright plane film exams.2.Exam is degraded by artifact including phase encoding artifact and some mild motion by the patient.