Instruction: Generate impression based on findings.

Input: Female, 61 years old, with low back and leg pain. Alignment is anatomic. Vertebral body height and morphology are preserved. No concerning marrow replacement or evidence of marrow edema is seen. Fatty degenerative endplate signal is demonstrated at L4-5, similar to the prior examination.The visualized spinal cord, conus and cauda equina are unremarkable.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disk asymmetric to the left. Moderate spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes.L5-S1: Marked facet hypertrophy with ligamentum flavum thickening. Bulging disk with perhaps a small superimposed left paracentral protrusion. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.

Output: Multilevel degenerative disk findings and posterior element hypertrophy, most severely affecting the L4-5 level where there is a moderate spinal canal stenosis and mild bilateral foraminal narrowing. No significant interval change is seen and there are no new abnormalities.


Instruction: Generate impression based on findings.

Input: Right upper extremity pain and weakness Several sequences are slightly limited by patient motion artifact.ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although evaluation of the glenoid labrum is limited on this nonarthrogram study, high signal intensity traverses the superior labrum suggestive of a tear. The inferior glenohumeral joint capsule appears thickened, but the clinical significance of this is uncertain. Glenohumeral joint alignment is normal. I see no effusion.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Tear of the superior labrum. The inferior glenohumeral joint capsule appears thickened, but the clinical significance of this is uncertain. If further imaging evaluation of the capsular/labral structures is clinically warranted, MR arthrography may be considered.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified main bronchus [C34.00], Reason for Study: ^Reason: metastatic lesions History: back pain Cervical spineThere bone marrow replacing enhancing lesions involving C7 left side facet joints and lamina as well as T1 vertebral body indicating metastatic lesions.There is diffuse bulging of disc at the level of C45 and C56 without showing significant spinal canal stenosis.Spinal cord signal intensity is normal.Thoracic MRIThere are multifocal bone marrow replacing lesions involving T7, T8, T12 and L1 vertebral bodies. In particular, the T7 and T8 vertebral bodies demonstrate various degree of compression fractures; about 50% for T7 and 30% for T8.The T8 vertebral compression fracture is associated with minimal retropulsion, however, there is no evidence of spinal canal stenosis, nor abnormal spinal cord signal intensity. There are multiple non vertebral abnormal enhancing lesions indicating metastatic lesion involving right mid to lower pleural spaces and lung parenchyme as well as right side paravertebral muscle at the level of L1.The cord signal is normal. The conus medullaris terminates at the level of T12-L1.

Output: 1. Multifocal metastatic lesions involving C7, T1, T7, T8, T12 and L1 vertebral levels.2. Vertebral compression fractures on T7 and T8.3. No spinal cord signal abnormality.4. Multifocal metastatic lesions involving left pleural space, left lung parenchyme and right paraspinal muscle (L1 level).


Instruction: Generate impression based on findings.

Input: Seizures Examination is mildly motion degraded. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No evidence of hemorrhage. The ventricles are within normal limits without evidence of hydrocephalus. Bilateral hippocampi are symmetric in size and signal characteristics with preserved internal architecture. There is mild global parenchymal volume loss supratentorially as well as in the cerebellum. There are minimal foci of T2/FLAIR hyperintensity in the bilateral frontal subcortical white matter, which are nonspecific, but within normal limits for age. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: There is mild parenchymal volume loss. Otherwise, examination is unremarkable for age without findings to suggest a seizure focus.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of the vagina. Right-sided pain and vaginal bleeding. History of grade 2 squamous carcinoma of the vagina. Patient with history of hysterectomy in 2005. PELVIS:UTERUS, ADNEXA: Patient is status post hysterectomy. There is an enhancing eccentric right vaginal, with central necrosis, measuring 4.5 x 3.4 cm. There is right parametrial invasion. BLADDER: The vaginal mass invades the posterior bladder serosa and causes buckling of the bladder mucosa (series 1201, image 39). LYMPH NODES: There is nonspecific mildly prominent pelvic lymph nodes. The largest left inguinal lymph node measures 1.4 x 1.3 cm (series 401, image 18). A representative left external iliac lymph node measures 1.2 x 0.8 cm (series 401, image 42).BOWEL, MESENTERY: The vaginal mass is tethered to the sigmoid colon, best identified on series 1201, image 34. There is no evidence of bowel obstruction. There is no ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Ventral abdominal surgical scar.

Output: Enhancing centrally necrotic vaginal mass (directed eccentrically to right) invading the bladder and right parametrium, with tethering and involvement of adjacent colon, consistent with known malignancy and accounting for patient's pelvic pain.


Instruction: Generate impression based on findings.

Input: Spinal stenosis, 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.Mild degenerative changes are seen including mild disc desiccation at the L4-L5 and L5-S1 levels. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: Mild disc bulge and dorsal annular fissure. No spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy.L5-S1: There is mild disc bulge with small right-sided protrusion component. There is minimal effacement of the right lateral recess. No central spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Minimal degenerative changes in the lumbar spine. There is minimal effacement of the right lateral recess at the L5-S1 level with mild disc bulge contacting the right S1 nerve root, but without clear evidence of impingement. There is otherwise no significant spinal canal or neural foraminal stenosis at any level.2. Facet arthropathy involving the lower lumbar spine which may be contributing to low back pain.


Instruction: Generate impression based on findings.

Input: Male, 83 years old, with cognitive impairment. Fairly extensive patchy periventricular and subcortical FLAIR hyperintensity is seen. Lesions are also evident within the pons. No restricted diffusion, edema or mass effect is observed. There are no findings to suggest acute intracranial hemorrhage. A focus of susceptibility within the right superior cerebellum likely reflects chronic hemosiderin deposition. No abnormal extra-axial fluid collections are seen. There appears to be a developmental venous anomaly traversing the right cerebellum. Ventricular size morphology are within normal limits. Brain parenchymal volume is generally well preserved.

Output: 1.No acute intracranial abnormality.2.Findings compatible with moderately extensive chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 44 years, Male, progression of lesion. Compared to multiple prior studies, there is evidence of gradual decrease in foci of intraparenchymal hemorrhage which involve the right mid callosal body and extend superiorly to the posterior aspect of the right superior frontal gyrus. There is also interval decrease in previous seen associated T2/FLAIR hyperintensity involving the adjacent periventricular and subcortical white matter related to edema. There is no abnormal enhancement or abnormal flow-voids to suggest an underlying lesion.Remainder of the brain demonstrates no intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. No evidence of recent ischemia or new hemorrhage. There is a tiny nonspecific focus of T2/FLAIR hyperintensity involving the left inferior frontal white matter. No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. Tiny left maxillary sinus mucus retention cyst. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Compared to multiple prior studies, there is evidence of gradual decrease in blood products involving the right mid callosal body and extending superiorly to the posterior aspect of the right superior frontal gyrus. Current study demonstrates essentially resolution of the prior findings with residual signal abnormality compatible with hemosiderin staining and gliosis. No underlying enhancing mass or abnormal flow-voids are appreciated to suggest an underlying lesion. Remainder of the brain is unremarkable.


Instruction: Generate impression based on findings.

Input: There are two small foci of restricted diffusion with associated T2 signal abnormality within the right occipital lobe and the lateral right precentral gyrus compatible with acute ischemic infarcts. There is no associated susceptibility artifact to suggest hemorrhage. There is no abnormal intracranial enhancement. There are no masses, mass effect, or midline shift. The ventricles and sulci are normal in size. The cerebral tonsils are normal in position. There are no extra-axial fluid collections. The paranasal sinuses and mastoid air cells are clear.

Output: Two small foci of restricted diffusion within the right precentral gyrus and right occipital lobe compatible with acute ischemic infarcts.


Instruction: Generate impression based on findings.

Input: Ms. Burbridge is a 40 year old female with recent diagnosis of DCIS of the right outer breast. She presents for MRI for further evaluation. There is scattered fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination. In addition, there is mild motion artifact present bilaterally.Within the limitations provided above (motion artifact + moderate background parenchymal enhancement), there is very small amount of enhancement seen around the biopsy marker clip in the right outer breast, far posterior depth, measuring approximately 1.3 x 1.5 x 0.9 cm (AP x ML x SI). This approximates the mammographically detected calcifications span approximately 1 cm. There is no additional abnormal enhancement seen in the right breast. There is no abnormal enhancement seen in the left breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Slightly limited exam due to moderate background parenchymal enhancement and motion artifact. Given this: (1) Unifocal malignancy of the right breast. If breast conservation therapy is desired, that clip can be used for targeting. There are no residual calcifications. (2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: eval for spondylolysis History: lbp for a year with both flexion and extension For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level.The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: Normal lumbar spine MRI


Instruction: Generate impression based on findings.

Input: Clinical question: 73-year-old male with metastatic prostate cancer. Recent chemotherapy and thrombocytopenia with altered mental status. Signs and symptoms: Altered mental status. Non-enhanced head CT:Technique.Axial contiguous CT images of head were obtained. Sagittal and coronal 2-D reformatted images were also acquired.There is no any subacute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact.Visualized paranasal sinuses, mastoid air cells and middle ear cavities are pneumatized and unremarkable.Images through the orbits demonstrate bilateral retro-orbital high density lesions that may represent very prominent bilateral superior ophthalmic veins or bilateral retro-orbital masses (hemangiomas). Correlate with patient's history and physical exam. This finding can be further evaluated with a dedicated MRI examination of orbits.

Output: 1.Unremarkable CT examination of brain.2.There prominent bilateral superior ophthalmic veins and or retro-orbital hemangiomas. Please correlate with history and direct physical exam and if clinically warranted recommend further follow-up with dedicated MRI examination of orbits.


Instruction: Generate impression based on findings.

Input: Female 67 years old Reason: history of T4b rectal cancer with rectovaginal fistula. Now s/p chemoradiation. History: rectal cancer PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Near imperceptible residual linear focus of T2 hyperintense signal and diffusion signal abnormality extending from the 12:00 position of the anus and extending anteriorly towards the posterior wall of the vagina (series 4, image 60). This is significantly decreased compared to prior study. Again seen is asymmetry of the external sphincter along its left posterior inferior margin and asymmetric thickening of the left anal wall anteriorly measuring up to 9 mm (series 4, image 60). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Significant interval decrease in size of previously described anovaginal fistula extending from the 12:00 position of the anal canal.2.Unchanged thickening and asymmetry of the left-sided anal wall and external sphincter.


Instruction: Generate impression based on findings.

Input: 65 years, Male, Reason: HCC screening History: cirrhosis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic liver morphology. Multiple gallstones without evidence cholecystitis. Common bile duct appears normal. No focal suspicious lesions evident.Paradoxical signal change on in phase images suggests iron deposition.SPLEEN: Splenomegaly. Paradoxical signal change on in phase images suggests iron deposition.PANCREAS: Paradoxical signal change on in phase images suggests iron deposition.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic morphology without focal lesion to suggest HCC.2.Paradoxical low signal in the liver, spleen and pancreas. In a patient with a known hematologic malignancy and multiple transfusions, this likely reflects iron deposition.3.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:12/31/1949)Reason: persistent back pain History: back painPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height, disc desiccation and a disc bulge. There is mild facet and ligamentum flavum hypertrophy at this level. There is partial effacement of the fat at the right lateral recess at this level with mild to moderate encroachment of the nerve roots at the right recess. There is minimal effacement of fat at the right lateral recess at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a disc bulge at this level associated with mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is 1 mm anterior subluxation of L4 on L5 present. There is partial effacement of the fat at the lateral recess on the left side into a lesser degree right side. There is mild to moderate encroachment of the nerve roots at the left lateral recess at this level. There is some mild encroachment of the nerve roots of the right lateral recess at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height, diffuse disc bulge and disc desiccation associated with moderate ligamentum flavum hypertrophy and mild to moderate facet hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level but more on the left compared to the right side. There is encroachment of the nerve roots at the left lateral recess at this level. There is some mild encroachment of the nerve roots of the right lateral recess at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge at this level associated with disc desiccation and loss of disc space height. There are Schmorl's nodes present at this level. There is mild to moderate ligamentum flavum hypertrophy at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. The right anterior lateral endplate osteophytes present this levelThere are multiple cysts present along the kidneys.

Output: 1.There are multilevel degenerative changes present in the lumbar spine associated with some encroachment of the nerve roots of the right lateral recess at L5-S1, the left lateral recess at L4-5 and the left lateral recesses at L3-4 as detailed above.2.There are multiple renal cysts present.


Instruction: Generate impression based on findings.

Input: Other cerebrovascular disease [I67.89], Brain MRIThere is focal restricted diffusion without evidence of hemorrhagic transformation at the left basal ganglia. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal irregularities of intracranial arterial system. In particular, distal right ICA, distal right MCA M1 segment and right MCA genu, proximal basilar artery, and superior aspect of the right MCA M1 segment indicate intracranial relatively larger vessel involving pathology such as intracranial atherosclerosis, vasculitis, RCVS or underlying atherosclerosis with left MCA M1 segment dissection. There is no intracranial arterial aneurysm.

Output: 1. Acute ischemic infarction on the left basal ganglia without hemorrhagic conversion.2. Multifocal intracranial arterial luminal irregularities and stenosis. Differential diagnosis include intracranial atherosclerosis, vasculitis, RCVS and focal left MCA M1 segment dissection with underlying atherosclerosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Seizure protocol, patient with spells of inattention and right-sided weakness likely nonepileptic. Signs and symptoms: History of spells, with inattention and right-sided weakness and likely nonepileptic. Pre and post enhanced brain MRI:No diffusion-weighted findings.Examination demonstrate multiple small foci of periventricular and minimally of subcortical FLAIR/T2 hyperintensity which are nonspecific, nonenhancing and nonhemorrhagic. This appearance in proper clinical setting could represent chronic small vessel ischemic strokes of mild degree. There is minimal interval progression of the findings since prior exam from brain MRI from 2010.The anatomical morphology and signal intensity of the brain is otherwise within normal on all MRI sequences and without detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement on this nondedicated study.Unremarkable calvarium and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization with the exception of the small right maxillary retention cyst.

Output: 1.Negative diffusion-weighted images.2.Findings suggestive of mild chronic small vessel ischemic strokes as detailed.3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 64 years, Male, recurrent lung cancer, evaluate for CNS involvement. There is no intracranial mass or abnormal enhancement to suggest intracranial metastatic disease. Again seen are areas of encephalomalacia with adjacent FLAIR hyperintensity including the left frontal lobe and the right parietal lobe which may be related to prior infarcts or other injury. There is susceptibility effect and thickening of the right frontoparietal scalp which may be related to prior surgery or trauma. Remainder of the brain demonstrates scattered foci of T2/FLAIR hyperintensity which are nonspecific and compatible with mild chronic small vessel ischemic changes. No hydrocephalus. No extra-axial collections. Bone marrow signal is slightly heterogeneous but similar to prior without discrete enhancing or destructive lesions demonstrated.Left internal carotid artery flow-void is severely diminutive which was present previously and may be related to chronic occlusion or high-grade proximal stenosis. Small mucous retention cysts in the maxillary sinuses and minimal sphenoid sinus mucosal thickening incidentally noted.

Output: 1. No evidence of intracranial metastatic disease.2. Unchanged areas of encephalomalacia in the right parietal lobe and left frontal lobe which may be related to prior infarcts or other injury.3. Severely diminished flow-void of the intracranial left internal carotid artery similar to prior, which may be related to chronic occlusion or high-grade stenosis proximally.4. Heterogeneous bone marrow is similar to prior without discrete enhancing or destructive lesions appreciated.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up lumbar stenosis. Signs and symptoms: Low back and lower extremity pain. Nonenhanced lumbar MRI:At T11-12 through L2-L3 levels mild to moderate degenerative changes without central spinal or neural foraminal compromise is noted. There is no significant change since prior exam.L3-L4 demonstrate progression of degenerative changes with resultant moderate to severe central spinal stenosis. There is worsening diffuse broad based bulging disc (L>R) contributing to spinal stenosis. No significant neural foraminal stenosis. Mild left facet effusion is noted.L4-L5 demonstrate progression of degenerative changes with resultant severe central sinal stenosis and bilateral moderate foraminal since prior exam.L5-S1 demonstrate mild interval progression of degenerative changes without spinal stenosis, however severe bilateral (L>R) neural foraminal stenosis.

Output: 1.Progression of degenerative changes at L3-L4 and L4-L5 levels with resultant sever central stenosis at both levels as detailed. 2.No spinal stenosis at other levels.3.Neural foraminal compromise at detailed per level above.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with right face, arm and leg weakness, and slurred speech. No restricted diffusion is seen. On the basis of these limited images, no significant parenchymal edema or mass effect is suspected. No large fluid collections are noted. The ventricles are normal in size and morphology.

Output: Within the limitations of this limited examination, no evidence of acute ischemia or any other definite acute intracranial abnormality is seen.


Instruction: Generate impression based on findings.

Input: Cervicalgia, paresthesias. Chronic low back pain, leg weakness, history of trauma. Cervical spine: The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis with minimal retrolisthesis of C4 on C5 and C5 on C6. Alignment is otherwise maintained. There is irregularity involving the left lateral mass of C1 with suggestion of loss of height on the left and may be on a degenerative basis; CT can better assess this finding if clinically warranted although there is no significant edema in this region to suggest acute inflammation in this region. There is moderate degree of bone marrow edema associated with facet arthropathy at the left C2-C3 facet joint. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal. There is moderate left and mild right neural foraminal stenosis with prominent facet arthropathy on the left as above.C3-4: There is no spinal canal stenosis. There is moderate to severe right neural foraminal stenosis related to severe right-sided facet arthropathy. There is mild facet arthropathy on the left and mild to moderate left neural foraminal stenosisC4-5: No significant compromise to the spinal canal. Bilateral uncovertebral hypertrophy and bilateral facet arthropathy, which is worse on the left. There is associated moderate to severe left and moderate right neural foraminal stenosis.C5-6: Severe loss of disc height with mild associated edema in the adjacent vertebral bodies. There is a disc osteophyte complex, bilateral uncovertebral hypertrophy, and bilateral facet arthropathy with moderate spinal canal stenosis. There is severe bilateral neural foraminal stenosis.C6-7: Small disc defect complex and bilateral uncovertebral hypertrophy. Mild spinal canal narrowing and moderate to severe bilateral neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal. There is mild to moderate left and mild right neural foraminal stenosis. There is bilateral facet arthropathy with mild distention of the facet joint on the left.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from straightening of the normal lordotic curvature. There is severe loss of disc height at the L5-S1 level with suggestion of vacuum phenomena. There is also disc desiccation at L4-L5 with minimal overall height loss. There is suggestion of a pars defect or cleft involving the left L5 posterior neural arch (not well evaluated with MRI) but without associated edema.Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: Mild disc bulge with dorsal annular fissure and moderate facet arthropathy, worse on the left. There is no significant spinal canal stenosis. There is mild left and minimal right neural foraminal narrowing.L5-S1: There is a disc bulge without significant spinal canal stenosis. There is moderate right neural foraminal stenosis and mild left neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. Degenerative changes throughout the cervical spine, worst at the C5-C6 level where there is moderate spinal canal stenosis and severe bilateral neural foraminal stenosis. There is also multilevel cervical facet arthropathy including edema associated with the left C2-C3 facet arthropathy. Additional levels in the cervical spine as detailed above. 2. Degenerative changes in the lumbar spine, particularly at the L5-S1 level. There is no significant spinal canal stenosis at any level in the lumbar spine. There is moderate right and mild left L5-S1 neural foraminal stenosis. There is also facet arthropathy in the lumbar spine, worst at the left L4-L5 level.


Instruction: Generate impression based on findings.

Input: 75 years Male (DOB:3/3/1940)Reason: cognitive decline, h/o diabetes - assess for cerebrovascular disease History: memory declinePROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The right basal vein of Rosenthal is markedly dilated along its junction with the deep middle cerebral vein. There is no associated aneurysm present involving the right basal vein of Rosenthal immediately adjacent to the right middle cerebral artery M1 segment origin. This aneurysm measures approximately 11 mm in size. There is some suggestion of some dilated left ventricular striate arteries at the right M1 segment.The CSF spaces are appropriate for the patient's stated age with no midline shift. The Excel note is made of cavum septum pellucidum and cavum vergae.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal 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.

Output: 1.A dilated the right basal vein of Rosenthal, an aneurysm and dilated contiguous right arteries suggest arteriovenous malformation with aneurysm formation. An MRA of the brain will be helpful to further evaluate this. This finding was communicated to Dr. Mastrianni at the time the exam. The patient was recalled before the left the MRI area so that the MR angiogram could be performed.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Claudication and radicular symptoms. There is multilevel degenerative spondylosis of the lumbar spine with diffuse loss of disc space height and fluid signal. At T12-L1, there is mild right facet joint hypertrophy with mild right neural foramen stenosis, but no significant spinal canal stenosis. At L1-L2, there is a slight disc bulge, but no significant spinal canal or neural foraminal stenosis. At L2-L3, there is bilateral facet hypertrophy with mild left and minimal right neural foraminal narrowing, but no significant spinal canal stenosis. At L3-L4, disc bulging, ligamentum flavum thickening, and bilateral facet hypertrophy result in mild right and moderate left bilateral neural foramen stenosis. At L4-5, there is trace disc bulging, mild ligamentum flavum thickening, and bilateral facet hypertrophy with mild right and mild-to-moderate left neural foraminal stenosis, but no significant spinal canal stenosis. At L5-S1, there is no significant spinal canal or neural foraminal stenosis. There is partial sacralization of L5. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is diffuse paraspinal muscle atrophy.

Output: Multilevel degenerative spondylosis of the lumbar spine, as described in the findings section.


Instruction: Generate impression based on findings.

Input: Female; 28 years old. Reason: evaluate for small bowel inflammation History: severe diarrhea, colonoscopy bx show ileitis and colitis ABDOMEN:LIVER, BILIARY TRACT: 2.7 x 1.6 cm segment 5/8 T2 hyperintense lesion (series 701/32) with peripheral nodular enhancement, compatible with benign hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Trace endometrial fluid, likely physiologic. Multiple small T2 hyperintense lesions in both ovaries, most compatible with physiologic cysts/follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid is likely physiologic.

Output: No bowel pathology is evident.


Instruction: Generate impression based on findings.

Input: Trigeminal nerve entrapment versus CNS demyelinating lesion: right facial pain. Internal Auditory Canals: A small venous structures courses along the superior and medial aspects of the root entry zone of the right trigeminal nerve. The bilateral trigeminals nerves are otherwise intact. There is no evidence of mass lesions. The bilateral cavernous sinuses and Meckel caves appear unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is hypertrophy of the posterior left inferior turbinate. There is cosmetic filler material in the bilateral cheeks, but not near the infraorbital foramen. There are postoperative findings related to maxillary reconstruction, with metal susceptibility artifact that obscures surrounding structures.

Output: 1. A small venous structures courses along the superior and medial aspects of the root entry zone of the right trigeminal nerve, which is nonspecific and may be indicative of a vascular loop syndrome or represent an incidental anatomical variant. Otherwise, no evidence of tumor or demyelinating lesions.2. Postoperative findings related to maxillary reconstruction and cosmetic fillers in the bilateral cheeks.MRI BRAIN WWO, MRI INT AUD CANAL WWO, 1/12/2016 8:02 PMCLINICAL INFORMATION:Trigeminal nerve entrapment versus CNS demyelinating lesion: right facial pain.TECHNIQUE: MRI BRAIN WWO, MRI INT AUD CANAL WWO CONTRAST. A total of 13 cc of Multihance was administered intravenously, with 2 cc wasted.COMPARISON: Sinus CT from 6/3/15.FINDINGS:Internal Auditory Canals: A small venous structure courses along the superior and medial aspects of the root entry zone of the right trigeminal nerve. The bilateral trigeminals nerves are otherwise intact. There is no evidence of mass lesions. The bilateral cavernous sinuses and Meckel caves appear unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is hypertrophy of the posterior left inferior turbinate. There is cosmetic filler material in the bilateral cheeks, but not near the infraorbital foramen. There are postoperative findings related to maxillary reconstruction, with metal susceptibility artifact that obscures surrounding structures.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB:6/23/1964)Reason: cause of LE weakness? PML? History: B-LE weakness, AIDSPROVIDER/ATTENDING NAME: VINEET A ARORA VINEET A ARORA 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 demonstrate partial opacification of the sphenoid sinuses and some mucosal thickening in the left maxillary sinus and left posterior ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for intracranial mass lesion or other explanation for the patient's lower extremity weakness.2.Partial opacification of the sphenoid sinuses is most likely inflammatory in nature.


Instruction: Generate impression based on findings.

Input: Clinical question: Abnormal brain MRI and advanced; evaluate for progression. Signs and symptoms: Anesthesias. Nonenhanced brain MRI:Negative diffusion weighted series.Considering the difference between the 3T scanner utilized on current exam and 1.5T scan or on prior study there is no evidence of any definitive interval change in the extent of nonspecific foci of FLAIR and T2 hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and along the dorsal aspect of the lower pons since prior exam. Several of the lesions however are more conspicuous and appear larger on current exam which is believed to be due to better quality of this study. No convincing evidence of new lesions since prior exam. Mild prominence of supratentorial ventricular system with maintained midline measures identical to prior exam. The cerebral cortex and cortical sulci as well as the CSF spaces are otherwise unremarkable and stable since prior exam.Nonenhanced cervical MRI: Examination is compromised due to motion artifact which precludes assessment for subtle findings. Within this limitation examination demonstrates no signal abnormality of cervical or the upper most visualized thoracic cord. The caliber of the cord also remains within normal.The signal intensity in the alignment of the vertebral column is anatomical.There is no evidence of spinal canal compromise or central spinal stenosis at any level.Foramen magnum is unremarkable.C2-C3 demonstrate mild left neural foraminal compromise secondary to degenerative changes.C3-C4 is unremarkable.C4-C5 demonstrates mild bilateral neural foraminal compromise.C4-C5 demonstrate mild disc disease and loss of disc height, shallow bulging disc and moderate bilateral neural foraminal compromise.C6-C7 demonstrate mild disc disease and loss of disc height, mild bilateral ligamentum flavum hypertrophy. There is a right paramedian and lateral shallow broad-based disc protrusion (sagittal T2 and T2 STIR image 10 and axial T2 series 1501 image 8) with resultant partial effacement of ventral subarachnoid space and subtle flattening deformity of right aspect of the cord. No spinal stenosis or neural foraminal compromise.C7-T1 demonstrate mild degenerative changes with resultant mild left neural foraminal compromise and unremarkable otherwise.

Output: 1.Nonenhanced brain MRI demonstrate few foci of FLAIR/T2 hyperintensity in the periventricular and subcortical white matter and dorsal aspect of pons which are more conspicuous on current exam likely due to utilization of 3T scanner without convincing evidence of progression since prior study. Please review above comments. Unremarkable exam otherwise.2.Nonenhanced MRI of cervical spine is compromised due to motion artifact however within this limitation no convincing evidence of cord caliber or signal abnormality. Mild degenerative changes and including a shallow right paramedian and right lateral disc protrusion at C6/C7 as detailed. No spinal stenosis at any level. There are however neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Increase in falling, evaluate for worsening stenosis Again seen is evidence of basilar invagination/cranial settling with the anterior arch of C1 articulating with the mid dens and the tip of the odontoid process abutting the ventral aspect of the medulla. Odontoid erosions, osseous proliferation anterior to C2 and mild anterior subluxation of C1 on C2 better seen on prior CT. Alignment of the remainder of the cervical spine remains unchanged with mild retrolisthesis of C3 on C4 and minimal retrolisthesis of C4 on C5. There is also trace C7-T1 anterolisthesis. No abnormal cord signal is definitively appreciated. Degenerative changes are seen in the cervical spine as described below:At C2-C3, there is no significant spinal canal or neural foraminal stenosis.At C3-C4, there is is a prominent central disc osteophyte complex as well as ligamentum flavum thickening resulting in moderate spinal canal stenosis and mild cord flattening slightly worse on the left than the right. The stenosis is slightly worse compared to MRI 10/2/2013. No cord signal abnormality. There is bilateral uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis.At C4-C5, disc osteophyte complex with mild to moderate spinal canal stenosis. Uncovertebral hypertrophy is associated with moderate right and mild to moderate left neural foraminal narrowing.At C5-C6, there is a small disc osteophyte complex with mild spinal canal stenosis. There is mild to moderate left and mild right foraminal narrowing.At C6-C7, there is a small disc osteophyte complex and uncovertebral hypertrophy with mild to moderate narrowing of the neural foramina. Mild spinal canal narrowing.At C7-T1, there is a small disc osteophyte complex with mild neural foraminal narrowing. There is effacement of the ventral thecal sac resulting in mild spinal canal narrowing.

Output: 1. Compared to CT from 8/26/2014, there is no significant change in degree of basilar invagination and cranial settling with mild mass effect of the dens on the ventral medulla. Erosions involving the C1 and C2 levels as well as osseous proliferation related to known rheumatoid arthritis are better seen on prior CT.2. There is moderate degree of spinal canal stenosis at the C3-C4 level with mild flattening of the cervical cord, which is slightly worse since prior MRI from 10/2/2013. No cord signal abnormality is appreciated.3. Additional findings related to multilevel degenerative changes including neural foraminal stenosis as detailed above.


Instruction: Generate impression based on findings.

Input: 77-year-old female with pelvic mass/fluid seen on pelvic ultrasound. PELVIS:UTERUS, ADNEXA: Mild atrophy of the uterus. 13 mm T2 hypointense fibroid is seen within the myometrium at the fundus series (901/33).There has been significant interval decrease in previously seen pelvic free fluid, presumably hemorrhage, since on prior CT on 5/6/2015. Abutting the left posterolateral aspect of the lower uterine segment, there is an ovoid lesion measuring up to 2.4 x 1.6 cm (series 801/48) which demonstrates T1 hyperintensity, T2 shading with low signal rim, and questionable minimal enhancement. This lesion is separate from the left ovary, which is felt to be visualized more superiorly. Overall, this lesion is felt to represent a small residual hematoma.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right perineal T2 hyperintense cystic lesion measuring 8 mm (series 801/21), most likely a Bartholin's gland cyst. A left sacral neural foraminal Tarlov cyst is noted (series 801/60).OTHER: No significant abnormality noted.

Output: Interval decreased pelvic free fluid, presumably hemorrhage, with left pelvic lesion likely representing a small residual hematoma, as detailed above.


Instruction: Generate impression based on findings.

Input: 16-year-old boy with history of wrist pain for multiple months. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear grossly intact within the limitations of a nonarthrogram study.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact within the limitations of a nonarthrogram study.TENDONS: The extensor and flexor tendons appear intact.BONES: There is decreased T1-weighted signal at the proximal pole of the scaphoid in comparison to the distal pole. Additionally, there is increased T2-weighted signal of the proximal pole of the scaphoid. These findings are consistent with a fracture through the midpole of the scaphoid with avascular necrosis of the proximal pole. There is low T1-weighted and high T2-weighted signal surrounding the circumference of the scaphoid bone consistent with edema.ADDITIONAL

Output: Scaphoid fracture of the midpole with presence of avascular necrosis of the proximal pole.


Instruction: Generate impression based on findings.

Input: 53-year-old female with pain and swelling at the right second and third MCP joints. Personal history of sarcoidosis. Evaluate for RA, tendinitis, or other inflammation. TENDONS: There is circumferential fluid within the tendon sheath of the flexor digitorum profundus and superficialis of the middle finger of the right hand, extending from the level of the mid diaphysis of the third metacarpal to the level of the interphalangeal joint. There is associated enhancement on postcontrast sequences. There is also a small amount of fluid within the tendon sheath of the flexor pollicis longus tendon at the level of the proximal phalanx of the thumb. BONES: No bone marrow signal abnormality is identified. No evidence of erosions.ADDITIONAL

Output: Findings most consistent with tenosynovitis involving the flexor digitorum profundus and superficialis of the middle finger of the right hand. No erosions are evident.


Instruction: Generate impression based on findings.

Input: Reason: 72 yo s/p distal pancreatectomy and splenectomy for IPMN; please evaluate for recurrence and or abnormalities History: pancreas mass ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Interval distal pancreatectomy and splenectomy. No peripancreatic fluid collections. No abnormal enhancement. The main pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval distal pancreatectomy and splenectomy without evidence of recurrence or complication.


Instruction: Generate impression based on findings.

Input: Reason: L knee pain, swelling, giving out x 8-9 months History: L knee pain, swelling, giving out x 8-9 months Please note that the high-resolution coil was unable to be used secondary to patient body habitus. An alternative coil was used, however, image quality is suboptimal.MENISCI: There is globular high signal intensity in the body of the medial meniscus extending into the posterior horn without a clear linear component. The lateral meniscus appears intact. ARTICULAR CARTILAGE AND BONE: There is marked thinning with full-thickness signal abnormalities of the articular cartilage of the patella, particularly along its medial facet. There is also pronounced thinning of the condylar surface of the medial compartment. Patchy red marrow signal is seen within the distal femur and proximal tibia. The bones are otherwise unremarkable.LIGAMENTS: Edema-type signal intensity surrounding the medial collateral ligament and iliotibial band suggest a low grade sprain. There are no full thickness defects identified. The cruciate ligaments are intact.EXTENSOR MECHANISM: There is edema throughout the subcutaneous tissues of the knee, particularly within the fat anterior to the patella and proximal tibia. The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Degeneration of the medial meniscus without a definite tear.2. Sprain of the medial collateral ligament and iliotibial band.3. Degeneration of the articular cartilage of the patella and medial tibiofemoral compartment.


Instruction: Generate impression based on findings.

Input: Male, 43 years old. Lateral ankle pain. TENDONS: There is a small amount of fluid around the peroneal tendons which is likely within normal limits. The peroneal tendons are otherwise intact. The Achilles tendon is intact. The posterior tibial, flexor digitorum longus and flexor hallucis longus tendons are intact.LIGAMENTS: There is abnormal signal within the deltoid ligament which may represent a partial sprain. The anterior and posterior talofibular ligaments are intact.ARTICULAR SURFACES AND BONE: Marked edema within the anterior talus, distal tibia, posterior subtalar articulation of the calcaneus and the cuneiforms which likely represent bone contusion. No definite evidence of fracture. ADDITIONAL

Output: 1. Marked edema within multiple bones of the hindfoot and midfoot which are likely related to bone contusion. No definite evidence of fracture. Recommend radiographs of the left ankle for further characterization.2. Abnormal signal within the deltoid ligament which may represent a partial sprain.


Instruction: Generate impression based on findings.

Input: Reason: eval for cholecystitis, choledocholithiasis, etc History: ruq pain after eating fatty meal, transaminitis, elevated alk phos Please note several sequences are affected by motion artifact, however, overall study quality remains diagnostic.ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrate normal signal intensity without evidence of hepatic steatosis or focal hepatic lesion. There are multiple layering gallstones within gallbladder lumen, but there is no evidence of acute cholecystitis. There is no choledocholithiasis or biliary ductal dilatation.SPLEEN: Normal signal intensity within the spleen without focal lesion.PANCREAS: The pancreatic duct is not dilated. No focal pigmented lesion is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is no hydronephrosis or nephrolithiasis identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cholelithiasis without evidence of acute cholecystitis. There is no biliary ductal dilatation or choledocholithiasis identified.


Instruction: Generate impression based on findings.

Input: Patient with AML, now presents with worsening low back pain for one month. Status post bone marrow transplant, left iliac crest. Extensive marrow replacement is observed bilaterally in a largely symmetric pattern involving both the pelvis and proximal femurs. Pattern and signal abnormality consistent with patient's underlying known AML and marrow replacement. No discrete focal marrow or osseous abnormalities observed other than a small faint biopsy track observed in the posterior left iliac crest correlating with the known previously described marrow sampling.Mild degenerative changes of both hips and SI joints without evidence of superimposed acute or subacute abnormalitySurrounding musculature and compartments are otherwise intact without evidence of complication or superimposed focal abnormality. Vasculature unremarkable. The demonstrated is the anterolisthesis involving the lower lumbar upper sacrum described more detail on the concomitant lumbar spine imaging; please correlate.Intrapelvic contents are also unremarkable. No distinct lymphadenopathy

Output: No superimposed acute or subacute additional abnormality observed outside of the lower lumbar spine findings described on the concomitant exam. Extensive marrow replacement compatible with known AML and treatment.


Instruction: Generate impression based on findings.

Input: Female 73 years old evaluate for re-tear of rotator cuff. ROTATOR CUFF: There is a new complete, full-thickness tear of the supraspinatus tendon with retraction of muscle fibers to the mid humeral head. There is associated atrophy of the supraspinatus muscle. A small amount of fluid is present in the subacromial/subdeltoid bursa. The infraspinatus, teres minor, and subscapularis tendons are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the glenohumeral joint. The posterior glenoid labrum is irregular and degenerated.BICEPS TENDON: Status post biceps tenodesis. The most superior portion of the biceps tendon is visualized and appears unremarkable. ADDITIONAL

Output: 1.New complete, full-thickness tear of the supraspinatus tendon.2.Degeneration of the posterior labrum.


Instruction: Generate impression based on findings.

Input: There are at least 5 punctate to small foci of susceptibility hypointensity within the supratentorial brain, as well as a punctate focus in the right pons. The largest of these is present within the anterior left temporal lobe measuring 9 mm AP x 11 mm transverse x 11 mm craniocaudal dimension (as measured on T2 sequences). None demonstrate perilesional edema. There are no associated developmental venous anomalies.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no 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. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There are at least 5 punctate to small foci of susceptibility hypointensity within the supratentorial brain, as well as a punctate focus in the right pons, consistent with the provided history of familial cerebral cavernous malformations. The largest of these is present within the anterior left temporal lobe measuring 9 mm AP x 11 mm transverse x 11 mm craniocaudal dimension (as measured on T2 sequences). None demonstrate perilesional edema. There are no associated developmental venous anomalies.


Instruction: Generate impression based on findings.

Input: 40 years, Male, right arm weakness, postop tumor resection. There are postsurgical changes of left-sided craniotomy for resection of previously seen hemorrhagic lesion in the left frontal lobe. There is no definite evidence of any residual tumor in this location although due to the extensive hemorrhagic nature of this lesion and relative lack of appreciable enhancement, assessment is slightly limited. There are blood products in the resection bed which are likely postoperative. Additional expected postsurgical changes include small amount of pneumocephalus as well as edema and emphysema involving scalp. There is edema surrounding the resection cavity similar to prior. There is minimal restricted diffusion surrounding the resection cavity compatible with blood products and minimal if any cytotoxic edema. Again seen is hemorrhagic lesion involving the body of the right lateral ventricle and abutting the septum pellucidum which is suspected to represent an additional metastatic focus. There are small amount of layering blood products in the right occipital horn, which were present preoperatively. There is no significant midline shift or herniation. No hydrocephalus. Unchanged opacification of the left maxillary sinus.

Output: 1. Expected postsurgical changes of resection of hemorrhagic left frontal lesion. Due to the extensive hemorrhagic nature of the lesion and relative lack of appreciable enhancement preoperatively, assessment for residual tumor is slightly limited. There is however no clear evidence of residual tumor in the left frontal lobe.2. Hemorrhagic intraventricular lesion along the septum pellucidum is again seen and suspected to represent an additional metastatic focus.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic lung cancer, status post 2 cycles of chemotherapy. Please compare with previous study to evaluate meningioma. Signs and symptoms: Meningioma. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination redemonstrates a small dural based homogeneously enhancing mass along the inner table of the skull in the right posterior temporal without interval change since prior exam. There is no associated adjacent parenchymal signal abnormality/edema. There is no interval change in size or pattern of enhancement since prior exam. It measures approximately at 9 x 8 mm in size. Finding likely representing a small meningioma however less likely possibility of a metastatic lesion cannot be entirely excluded considering patient's history. Lack of any appreciable interval change is more suggestive of a meningioma also.There is no detectable abnormal parenchymal or meningeal enhancement to suggest metastatic disease.Scattered foci of FLAIR and T2 hyperintensity in bilateral subcortical and periventricular white matter grossly similar to prior exam from April 2015 and suggestive of moderate chronic small vessel ischemic strokes.Unremarkable calvarium and images through the orbits including post enhanced series. All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: .1.Negative diffusion weighted images.2.Findings moderate chronic nonhemorrhagic small vessel ischemic strokes grossly similar to prior study.3.Stable small dural base right posterior temporal enhancing focus without associated adjacent parenchymal signal abnormality highly suggestive of a meningioma.


Instruction: Generate impression based on findings.

Input: Perianal Crohn's; evaluate for perianal fistula or abscess PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel wall thickening and enhancement of the rectosigmoid colon with high T2 signal in the surrounding fat tissues consistent with inflammatory changes and edema appearing similar to prior.BONES, SOFT TISSUES: Minimal residual scarring is present in the ischiorectal fossa. No enhancement or diffusion restriction is present in the ischiorectal fossa. No new abscess or fistula noted.OTHER: Minimal free fluid is present.

Output: Bowel wall thickening, edema, and adjacent inflammatory changes of the rectosigmoid colon not significantly changed. No abscess or fistula is identified.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural lesions. Signs and symptoms: Headache and syncope. Signs and symptoms : Headache and syncope. Nonenhanced brain MRI:No diffusion weighted abnormalities.There is normal anatomical development, morphology and signal intensity no brain parenchymal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal voids of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Reason: eval for stroke L sided hemiparesis and dizziness History: stroke w/u: assess for LV thrombus, wall motion abnormalities, PFO, valvular disease MRI brain:Punctate focus of increased DWI signal in the right anterior medulla is suspicious for an acute infarct. There is minimal associated increased FLAIR signal. A few scattered subcortical T2 hyperintensities within the supratentorial white matter are nonspecific but may reflect chronic small vessel ischemic disease. Multiple T2 hyperintensities without diffusion restriction or FLAIR abnormality in the bilateral cerebellum, with a left cerebellar lesion corresponding to prominent finding seen on prior CT likely represent old lacunar infarcts..There is no evidence of intracranial hemorrhage or mass. Ventricles and sulci are slightly prominent, suggesting a mild degree of volume loss. There is no midline shift or herniation. There is an absent flow void in the right vertebral artery. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.MRA brain and neck:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are patent with mild narrowing at the bifurcations, left greater than right. The intracranial internal carotid arteries are normal in course and caliber. The right A1 segment is hypoplastic with fetal type posterior cerebral arteries bilaterally. The middle and anterior cerebral arteries are otherwise unremarkable without evidence of stenosis or aneurysm.The basilar artery is severely narrowed and not visualized throughout its majority, either high-grade stenosis or occlusion. The distal V4 segment of the left vertebral is small in caliber. The left vertebral artery overall is diminutive in caliber at the V1 and V2 levels. At the V3 and proximal V4 level, the left vertebral is not visualized. The left vertebral origin is also not well visualized The right vertebral is not visualized throughout its course. Overall this suggests severe vertebrobasilar insufficiency with areas of high-grade stenosis and/or occlusion.

Output: 1.Focus of diffusion restriction in the right medulla is suspicious for an acute infarct.2.Severe vertebrobasilar narrowing including nonvisualization of the entire right vertebral artery, diminutive left vertebral artery with nonvisualization of the V3 and proximal V4 segments with likely collateralized flow accounting for visualized but diminutive V1 and V2 segments, and diminutive basilar artery with a substantial portion nonvisualized. Evaluation limited due to lack of contrast enhanced MRA neck. Overall this may represent areas of high degree stenosis and/or occlusion. These findings are likely chronic and may include underlying dissection, and CTA may be helpful for further characterization.3.A few subcortical T2 hyperintensities are nonspecific but likely represent chronic small vessel ischemic disease.4.Multiple bilateral lacunar infarcts of the cerebellum.


Instruction: Generate impression based on findings.

Input: Brain: There is continued interval decrease in size of the infiltrative enhancing mass centered within the nasopharynx and skull base, especially in the AP dimension. The tumor is ill-defined margins making distinct measurement difficult. As before, there remains nonspecific confluent enhancement extending laterally into the bilateral masticator spaces and pterygopalatine fossae as well as involving the clivus and sinonasal walls. There is persistent and unchanged involvement of the cavernous sinuses with encasement of the carotid arteries (however without evidence of luminal narrowing). There is no evidence of brain parenchymal involvement. A previously described left level 2A lymph node is only partially imaged, and better seen on the earlier neck CT, as is osseous involvement. Moderate to severe mucosal thickening is seen in the maxillary and ethmoid sinuses with near-complete opacification. Mild mucosalthickening is seen in the sphenoid sinuses. There is also complete opacification of the mastoid air cells and middle ears. Overall this represents increased opacification of the paranasal sinuses and mastoid air cells when compared with the prior MRI.There remains unchanged nonspecific patchy foci of T2 hyperintensity throughout the supratentorial white matter and pons most likely representing chronic small vessel disease. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids remain intact. Orbits: Intraorbital extension of the tumor has subsided bilaterally when compared to the presentation MRI, and unchanged when compared to the more recent MRI. Bilateral globes and intraconal contents including optic nerves are unremarkable.

Output: Post-treatment findings with continued interval decrease in size of an infiltrative nasopharyngeal carcinoma with ill-defined margins making distinct measurement difficult.


Instruction: Generate impression based on findings.

Input: Male, 66 years old, with metastatic head and neck cancer and increasing back pain. Cervical:Numerous areas of pathologic marrow replacement are demonstrated throughout the vertebral bodies and posterior elements of the cervical region. No significant compression deformities are suspected. No significant epidural disease extension is seen.Straightening of the cervical lordosis is evident. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved.Spinal cord signal intensity and morphology are unremarkable except as discussed below.C2-3: Left greater than right facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing.C3-4: Left greater than right facet hypertrophy. Posterior disk osteophyte formation. Mild spinal canal narrowing with slight ventral cord flattening but no cord signal abnormality. Mild bilateral foraminal narrowing.C4-5: Mild right facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing.C5-6: Marked bilateral facet hypertrophy. Posterior disk osteophyte formation. Moderate generalized spinal canal stenosis with mild mass effect on the cord. The cord tapers at this level and shows patchy bilateral T2 hyperintensity suggesting myelomalacia. Moderate to severe bilateral foraminal narrowing. C6-7: Facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C7-T1: Facet hypertrophy. Posterior disk osteophyte formation asymmetric towards the right. Mild spinal canal narrowing with very slight ventral cord flattening but no cord signal abnormality. Mild to moderate right foraminal narrowing. Incidental note is made of asymmetry of the floor of mouth and right tongue base along with some supraglottic and mucosal thickening likely reflecting prior therapy.Thoracic:Since the prior examination, marked interval progression of patchy marrow replacement is seen. The vertebral bodies and posterior elements are affected at every visualized level with extensive involvement of the ribs as well.Epidural disease extension is suspected on the right at T6-7 with minimal encroachment upon the thecal sac but fairly significant infiltration of the right T6-7 neural foramen. Epidural disease extension is also suspected bilaterally at T7-8 with mild encroachment upon the thecal sac but infiltration of the neural foramina bilaterally. Infiltrating soft tissue is also evident between the T7 and T8 proximal ribs.The visualized spinal cord demonstrates normal signal intensity and morphology. No areas of significant spinal canal stenosis is seen. Except as discussed above, the neural foramina are unremarkable.Vertebral body heights are preserved. Spinal alignment is within normal limits.A mass is present at the left lung base along with a pleural effusion. Small nodules are also suspected within the visualized right lung.Lumbar:Areas of marrow replacement are seen at every lumbar vertebral level including the vertebral bodies and posterior elements. Scattered lesions are also evident the partially visualized sacrum and iliac bones.Vertebral body heights are grossly maintained and alignment is within acceptable limits.The visualized conus and cauda equina nerve roots are normal. No significant epidural disease extension is suspected.L1-2: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disk. Mild generalized spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Bulging disk with a small superimposed central protrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Widespread osseous metastatic disease, with evidence of progression at least when compared to a prior thoracic spine MRI, though more recent chest CTs show evidence of widespread metastatic disease as well.2.Mild epidural disease extension is evident at T6-7 and T7-8. This largely affects the neural foramina without significant compromise of the spinal canal.3.Mild/moderate generative disease is evident as above. There are findings suggestive of myelomalacia at C5-6 which may reflect chronic stenosis and cord impingement at this level.


Instruction: Generate impression based on findings.

Input: 74-year-old female with worsening mental status, concern for CVA evolution on CT. Evaluate for possible new ischemia.. Since the prior MRI there is increased restricted diffusion involving the subcortical and periventricular white matter predominantly within the left parietal lobe and temporal lobe as well as minimally within the left occipital lobe with corresponding increased T2/FLAIR signal in these regions compatible with progressing ischemic infarcts in the left MCA territory. There is minimal effacement of the occipital horn of the left lateral ventricle without midline shift; the temporal horns are not dilated. There is a background of confluent bilateral subcortical and periventricular white matter T2/FLAIR hyperintensity consistent with extensive chronic small vessel ischemic disease. No susceptibility signal is noted to suggest hemorrhagic conversion. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Progressing ischemic infarcts within the left MCA territory. No evidence of hemorrhagic conversion. Minimal mass effect is noted with no midline shift or herniation.2. Extensive chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Pain. History of patellar tendon rupture. Four views of the left knee are provided. The margins of the patellar tendon are slightly indistinct, but I see no patella alta deformity, and recent MRI shows perhaps mild proximal patellar tendinosis but no evidence of rupture. There is a small enthesophyte along the inferior aspect of the patella that appears similar to that seen on the prior study. There may also be a small joint fusion.Tiny osteophytes are noted in the right knee as seen on the frontal view.

Output: Possible mild patellar tendinosis, but no radiographic evidence of rupture.


Instruction: Generate impression based on findings.

Input: NSCLC with brain metastases status post WBRT. There is essentially resolved vasogenic edema in the anterior right frontal lobe with minimal associated residual tumor. There is interval decrease in size of a mass centered in the right posterior cingulate gyrus with extensive persistent surrounding vasogenic edema. There is no significant interval change in the subcentimeter lesion in the right inferior temporal gyrus. There is a new punctate lesion with vasogenic edema in the right superior temporal gyrus. There is minimal midline shift to the right. There is no evidence of an acute infarct. There is diffuse prominence of the right cerebellar hemisphere folia with associated diffuse T2 hyperintensity.

Output: 1.Evidence of mixed treatment response of the intracranial metastases.2. Unchanged right cerebellar hemisphere encephalomalacia.


Instruction: Generate impression based on findings.

Input: Please evaluate response to neoadjuvant chemotherapy for breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Interval decrease in the size and enhancement characteristics of the previously mentioned 3 enhancing masses in the central lateral right breast. The largest mass is seen as a curvilinear area of enhancement along the lateral aspect, and measures 2.9 x 0.8 x 1.2 cm, previously measured 3.8 x 4.1 x 3.4 cm. The postero- lateral mass demonstrates thick rim enhancement with central area of necrosis, and now measures 1.8 x 1 x 1.6 cm, previously measured 2.2 x 2.6 x 3.0 cm. The third anteromedial mass demonstrates thin rim enhancement and now measures 0.6 x 0.8 x 0.8 cm, previously measured 1.0 x 0.9 x 1.0 cm. The most anterior mass resides approximately 1 cm posterior to the nipple. Total area of enhancement in the right breast measures 1.3 x 5.3 x 1.4 cm, previously measured 3.8 x 6.9 x 4.5 cm and extends to the lateral cutaneous surface, mid depth, and to the lateral margin of the nipple. The retraction and the lateral deviation of the nipple has improved. Enhancement of the lateral aspect of the skin where the largest mass is in close proximity still persists.Interval decrease in size of right axillary lymph nodes. The largest lymph node with susceptibility artifact from a biopsy clip now measures 2.1 cm, previously measured 2.6 cm. The previously mentioned retropectoral lymph node now measures 1.6 cm, previously measured 1.9 cm. No abnormal enhancement is seen in the left breast. Multiple normal appearing lymph nodes are present in the left axilla.Chemotherapy port projected over the left medial chest wall.

Output: Interval decrease in size of 3 masses in the right central breast and right axillary lymph nodes.No MRI evidence for malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 36 year-old female with right ankle pain TENDONS: The Achilles tendon is intact. The extensor and flexor tendons are otherwise within normal limits.LIGAMENTS: The ATFL and PTF are intact. The deltoid ligament appears within normal limits.ARTICULAR SURFACES AND BONE: There is fluid within the retrocalcaneal bursa and mild edema within the dorsal posterior calcaneus anterior to the Achilles insertion. ADDITIONAL

Output: Fluid within the retrocalcaneal bursa, which may represent bursitis and mild edema within the calcaneus anterior to the Achilles insertion with otherwise normal appearing tendon.


Instruction: Generate impression based on findings.

Input: Anosmia. No sinus drainage. Rule out abnormal sinus anatomy. There is inferior displacement and flattening of the right fovea ethmoidalis with expansion of the space between the crista gala and the right fovea ethmoidalis. The cribriform plate on the right is depressed inferiorly. There also appears to be inferior herniation of the brain parenchyma in this location.Findings are compatible with long-standing mass effect likely due to a meningocele or a encephalocele in this location. MRI is necessary for further evaluation. The paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Inferior displacement of the fovea ethmoidalis with inferior herniation of the brain parenchyma likely due to a meningocele or encephalocele. MRI examination is necessary for further evaluation.Findings discussed with Dr. A. Hong at 2pm on 3/26/2008.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with history of longitudinally extensive cervical transverse myelitis presenting with new weakness and pain. Cervical:Volume loss of the mid cervical spinal cord is seen along with patchy central cord T2 hyperintensity most conspicuous between C2-3 and C4-5. No pathologic intramedullary or leptomeningeal enhancement is seen. No areas of cord edema are detected on this examination.Straightening of the cervical lordosis is demonstrated. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are within normal limits.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac with slight flattening of the right ventral cord. No significant generalized spinal canal stenosis. Moderate left foraminal narrowing. C4-5: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation with left paracentral/foraminal focality. Effacement of the ventral thecal sac with flattening of the left ventral cord. No significant generalized spinal canal stenosis. Mild left foraminal narrowing. C5-6: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing.C6-7: Facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. Thoracic:The spinal cord is free of signal abnormality. No evidence of intramedullary or leptomeningeal enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable.Facet arthropathy is demonstrated at T5-6. A small left paracentral disc protrusion is seen at T6-7. Facet arthropathy and ligamentum flavum thickening are demonstrated on the right at T10-11. No areas of significant spinal canal or foraminal stenosis are identified.

Output: 1.Evidence of myelomalacia is seen in the mid cervical spinal cord which would correlate with the history of prior transverse myelitis.2.No evidence of cord edema or pathologic cord or leptomeningeal enhancement is seen in either the cervical or thoracic regions to suggest active inflammation.3.Scattered cervical spondylosis is demonstrated. Although no significant generalized spinal canal stenosis is seen, disc osteophytes do contact the spinal cord at several levels as above.4.Minimal spondylosis is seen in the thoracic spine without evidence of cord impingement or significant stenosis of the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 40-year-old woman with history of recurrent pancreatitis status post ERCP 9/22/2016 demonstrating high-grade minor papillary stricture. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. There is no focal hepatic lesion. Patient is status post cholecystectomy. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is bifid configuration of the pancreatic duct with dominant drainage through the minor papilla. The proximal main pancreatic duct is persistently dilated and there are is mild curvature of the main pancreatic duct (9/47). The duct of Wirsung is identified but somewhat attenuated. No significant stricture or extrinsic mass is identified. On post-secretin images, there is good exocrine function without significant change in caliber of the pancreatic duct.The pancreatic parenchyma appears normal without abnormal foci of enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No focal renal lesion. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube noted. There is a large stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Bifid configuration of the pancreatic duct with dominant drainage through the minor papilla but no stricture or extrinsic mass. 2.Normal exocrine function and drainage on post-secretin images with no significant change in ductal caliber.


Instruction: Generate impression based on findings.

Input: 18 year-old male with history of CNS PTLD. Evaluate disease response following 5 cycles of methotrexate.RADIOPHARMACEUTICAL: 6.0 mCi F-18 fluorodeoxyglucose (FDG)BLOOD GLUCOSE (FASTING): 78 mg/dL Today's CT portion grossly demonstrates right posterior parietal burr hole with right high-density focus in the posterior parietal lobe which is similar in appearance compared to the recent diagnostic CT and may represent thrombosed vessel versus blood products. Additionally, there is bilateral vasogenic edema which is not significantly changed.Today's PET examination demonstrates the following: along the posterior and inferior aspect of the right parietal lobe, medial to the right lateral ventricular atrium, there is a medium sized region of markedly hypermetabolic focus consistent with active PTLD. This focus is anteromedially adjacent to but separate from the right posterior parietal high signal focus that was demonstrated on the MRI examination. The hypermetabolic right parietal lobe lesion corresponds to a very subtle area of enhancement seen on the recent MRI exam. Additionally, there is subtle heterogeneously diffuse foci of hypermetabolic activity along the leptomeninges of both hemispheres, suspicious for additional PTLD involvement. Bilateral basal ganglia and medial aspects of the inferior cerebellum demonstrate symmetric increased relative activity compared to the remainder of the cerebrum and the cerebellum. This is of uncertain etiology although given the uniform and symmetric activity, this is unlikely to be PTLD and may be related to methotrexate treatment.

Output: 1.Right posterior parietal hypermetabolic focus consistent with active PTLD. Of note, this hypermetabolic focus is adjacent to but separate from the high signal lesion noted on the recent MRI examination.2.Additional findings highly suspicious for with diffuse additional leptomeningeal tumor involvement bilaterally.


Instruction: Generate impression based on findings.

Input: 74 years, Female, status post craniotomy for tumor resection. There are immediate postsurgical changes related to left parietal craniotomy for resection of lesion involving the left precentral gyrus. There has been resection of at least a majority of the lesion with blood products filling the resection cavity at the site of prior lesion. There is some intrinsic T1 hyperintensity and peripheral enhancement surrounding the resection cavity; note no adequate prior post gadolinium sequences are available for comparison as noted on prior preop report. There is mild restricted diffusion surrounding the resection cavity compatible with blood products and mild cytotoxic edema. Left frontoparietal vasogenic edema surrounding the resection cavity is similar to prior.Again seen are several foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter as well as the pons, which are nonspecific, but compatible with chronic small vessel ischemic disease. No additional enhancing lesions are seen elsewhere in the brain. No hydrocephalus. No midline shift or herniation. Partially empty sella incidentally noted. No suspicious lesions involving the calvarium or visualized extracranial soft tissues.

Output: Expected postsurgical changes related to resection of lesion involving the left precentral gyrus. There is peripheral rim of enhancement surrounding the resection cavity with minimal residual tumor not excluded and can be assessed on future follow-up study.


Instruction: Generate impression based on findings.

Input: Headache(784.0) [784.0] / Delirium due to conditions classified elsewhere [293.0], Reason for Study: ^Reason: Evaluate for evidence of stroke History: HA and confusion 2 days ago Multifocal scattered restricted diffusion lesions on bilateral occipital lobes and posterior temporal lobes as well as bilateral thalami indicating acute/subacute ischemic strokes. There is no evidence of hemorrhagic transformation.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal acute/subacute ischemic infarctions on bilateral occipital lobes, posterior temporal lobes and bilateral thalami without evidence of hemorrhagic transformation as described above.Discussed with Dr. E Escue at the time of this dictation.


Instruction: Generate impression based on findings.

Input: History of left breast DCIS status post surgery and radiation therapy. BRCA 2 mutation carrier. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted in the left breast with mild to moderate background enhancement on the right.No abnormal enhancement is seen in either breast. Stable postlumpectomy changes are noted in the left medial breast. Artifact from surgical clips also noted. An area of non-mass enhancement in the left central breast is stable across multiple studies. Scattered enhancing foci in the right breast are present, none uniquely enhancing than the rest. No abnormal axillary 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: There is a compression fracture of the L2 vertebral body with near complete collapse of vertebral body height and complete marrow replacement at the L2 level. Retropulsion of the remaining vertebral body and disk osteophyte complex causes severe central canal stenosis and compression of the cauda equina and tip of the conus. There is narrowing of the foramina bilaterally at L1/2 and L2/3, both from the compression and from expansile marrow replacement at the level of the pedicles. There are multiple additional vertebral body lesions suspicious for metastasis at T12, L1-4 vertebral bodies and the right L5 pedicle. Intrauterine pregnancy noted.

Output: 1.Compression fracture of L2 vertebral body with retropulsion of the remaining vertebral body and disk osteophyte complex with compression of the cauda equina and tip of the conus.2.Multiple vertebral lesions of the imaged spine compatible with metastasis.3.Intrauterine pregnancy.


Instruction: Generate impression based on findings.

Input: 60 years, Female, Reason: elevated liver enzyme, r/o gallstone History: elevated liver enzyme, abd pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Moderate intrahepatic biliary ductal dilatation is slightly increased from the prior MRI but likely unchanged from the recent CT. Status post cholecystectomy. Common bile duct is dilated to 1.3 cm (801/11), previously 1.1 cm. No choledocholithiasis. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Prominent pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of gastric bypass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Increased intrahepatic and extrahepatic biliary ductal dilatation, likely due to benign stricture at the level of the ampulla.


Instruction: Generate impression based on findings.

Input: Reason: left knee pain and instability MENISCI: There is a complex branching signal in the posterior horn of the medial meniscus with a radial tear at the root and moderate extrusion. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss of the central weightbearing zone of the medial compartment. There is also full-thickness cartilage loss of the medial patellar facet and trochlea.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact. There is a small joint effusion with mild synovial proliferation.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. Mild synovitis with likely juxta-articular ganglion cyst.


Instruction: Generate impression based on findings.

Input: There are postsurgical findings of a flap closure in the lumbosacral region. There are erosive changes, enhancement, and decreased T1 marrow signal of the L3-L5 spinous processes left posterior iliac bone with surrounding edema and enhancement of the subcutaneous tissues and posterior paraspinal muscles. There is no evidence of epidural fluid collections in the lumbosacral spine. A subcutaneous drain is partially imaged and courses posterior to the spine at the levels of L2-L4, with a nonspecific left posterior subcutaneous fluid collection that measures 5 mm in width. Disc desiccation, posterior disc osteophyte complexes, and lumbar facet degeneration is present in the lower lumbar spine, causing mild bilateral neural foraminal narrowing at the L3-L4, L4-L5, and L5-S1 levels, but no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The spinal cord and cauda equina nerve roots display normal signal and morphology. There are nonenhancing renal cysts within the right kidney.

Output: 1.Findings related to flap closure for a sacral decubitus ulcer with signs of regional cellulitis and osteomyelitis of the L3-L5 spinous processes and left posterior iliac bone without associated epidural abscess or discitis, although postoperative effects can serve as confounding factors.2.Mild degenerative changes of the lower lumbar spine without spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Hypoxemia [R09.02], Reason for Study: ^Reason: patient with embolic strokes. Further evaluate mechanism of stroke History: above Brain MRIThere are multiple scattered both supra and infra tentorial restricted diffusion lesions indicating acute/subacute ischemic infarctions. There is no evidence of hemorrhagic transformation.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.Bilateral mastoid air cells show opacifications.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral Pcom arteries and Acom artery are patent. No evidence of intracranial arterial aneurysm. No intracranial arterial luminal stenosis.

Output: 1. Multifocal supra and infratentorial acute/subacute ischemic infarctions without evidence of hemorrhagic transformation.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: 69-year-old female with hematuria and renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: There is an approximately 1.5 cm T2 hyperintense lesion in the left hepatic lobe (series 8/15), which contains a few fine internal septations and demonstrated contrast washout on the prior contrast enhanced CT examination, most likely representing a hemangioma, although remains incompletely characterized on this examination without contrast. An additional punctate T2 hyperintensity in the right hepatic lobe is too small to characterize, but most likely represents a cyst or hemangioma (series 8/32). Nonspecific focus of restricted diffusion in the right hepatic lobe (image 83/198) is seen only on one B-value and there is no correlate on other sequences, which is of uncertain significance.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Again seen is a large heterogeneous predominately T2 isointense mass arising from the interpolar region of the left kidney, which demonstrates areas of increased signal as well as internal cystic change suggesting necrosis. The mass is not significantly changed in size from the prior examination. The hepatic veins appear grossly patent. However, evaluation of the mass and vasculature is limited given the lack of intravenous contrast. Reference measurements below.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a small umbilical hernia which contains small bowel as well as fat, and laxity of the right posterior abdominal wall which contains the liver.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 10/7/2016 07:00:00)LEFT RENAL MASS: 8.5 x 6.9 cm (Image 32, Series 5); 8.7 x 7.1 cm on prior (8/12/2016) (Image 67, Series 3).

Output: 1.Heterogeneous centrally necrotic mass in the left kidney without definite renal vein invasion, although evaluation of both the mass and renal vasculature is limited without contrast.2.Hyperintense lesions in the liver, which are incompletely characterized without contrast, but are most likely benign.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with right arm pain. Evaluate for stenosis, nerve impingement, and C8 cyst for change. A grade 1 anterolisthesis of C4 relative to C5 is unchanged. Otherwise, spinal alignment is anatomic. Vertebral body heights are preserved. No concerning marrow replacement, edema or pathologic marrow enhancement is seen. The visualized spinal cord demonstrates normal signal intensity and morphology. No focal cord lesions are seen. No pathologic spinal cord or leptomeningeal enhancement is detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes. C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Small probable perineural root sleeve cysts are unchanged bilaterally.

Output: 1.Scattered mild degenerative findings are unchanged. No high-grade spinal canal stenosis is detected, though there is mild left foraminal narrowing at C4-5 and C5-6.2.Small bilateral perineural root sleeve cysts at C7-T1 are unchanged.


Instruction: Generate impression based on findings.

Input: Disorder of pituitary gland, unspecified [E23.7], Reason for Study: ^Reason: please evaluate pituitary mass seen on CT History: above There is a relatively well circumscribed, globular large sellar mass with suprasellar extension displacing optic chiasm superiorly and posteriorly. The mass is measured about 26.7mm x 40.6mm x 22.2mm with relatively homogeneous enhancement. On post contrast enhancement coronal scan, the mass appears to be extended toward right side cavernous sinus as well as right side Meckel's cave.Posterior wall of the sphenoid sinus shows anterior convexity but the sphenoid sinus does not show any evidence of fluid collection indicating direct involvement.Underlying brain shows minimal brain atrophy with non specific small vessel ischemic disease which are age appropriate. The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Large sellar mass with suprasellar extension with homogeneous enhancement indicating macroadenoma of pituitary gland most likely. Differential diagnosis include metastasis, pituitary carcinoma, meningioma and craniopharyngioma. No evidence of acute ischemic or hemorrhagic lesion.