Instruction: Generate impression based on findings.

Input: Headache. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left sphenoid sinus retention cyst.Pituitary: The pituitary is not enlarged or atrophic. There is no evidence of pituitary or parasellar tumors. The infundibulum is situated in the midline. The cavernous sinuses and optic apparatus are intact.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. The pituitary gland is unremarkable.


Instruction: Generate impression based on findings.

Input: History of cirrhosis and CML. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology and contour. Perihepatic ascites. No biliary ductal dilatation.Normally distended gallbladder with sludge and small gallstones.No suspicious liver lesion.SPLEEN: Mild splenomegaly measuring 16 cm in craniocaudal dimension. Small siderotic nodules.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: IVC filter. Large volume of abdominopelvic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with stigmata of portal hypertension including mild splenomegaly and large volume abdominopelvic ascites.2.No suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Ms. Lettiere is a 35-year-old female with a strong family history of breast cancer in her mom, maternal aunt, maternal grandmother, and two maternal cousins. Known BRCA1 mutation carrier. History of left cyst aspiration in 2011. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Evaluate for tumor recurrence status post ganglioglioma: yearly follow up for changes. There are postoperative findings related to left temporal lobe tumor resection. There is unchanged mild T2 hyperintensity along the margins of the resection cavity. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No evidence of left temporal lobe tumor progression.


Instruction: Generate impression based on findings.

Input: Female, 84 years old, gait problems. The thoracic kyphosis is slightly exaggerated. Otherwise, sagittal alignment is within normal limits. Vertebral body heights are preserved. No evidence of marrow edema or marrow replacement is seen.Loss of disc height and disc bulging is evident at almost every level in the thoracic spine. At most levels, this results in mild to moderate spinal canal stenosis without significant cord deformation. At T8-9, however, disc bulging in combination with posterior element hypertrophy results in a moderate to severe stenosis with complete effacement of CSF and mild impingement of the spinal cord. The cord at this level demonstrates mild T2 hyperintensity. Elsewhere, no spinal cord signal abnormality is detected. No epidural collections are seen. The paraspinal soft tissues are within normal limits.The neural foramina are are narrowed on the right at T4-5 and bilaterally from T8-9 through T10-11. Perineural root sleeve cysts are noted incidentally in several of the foramina.

Output: Degenerative disc disease is seen at almost every level in the thoracic spine with loss of disc height and disc bulging. At T8-9, disc bulging in combination with posterior element hypertrophy results in a moderate to severe spinal canal stenosis with mild impingement of the spinal cord. Subtle cord signal abnormally at this location could indicate either edema or myelomalacia. At most other levels, degenerative disease results in mild to moderate spinal canal stenosis without significant cord impingement.


Instruction: Generate impression based on findings.

Input: 56 year old male with history if ischemic heart disease, s/p orthotopic heart transplant, with shortness of breath recent back pain, leg pain and diabetic keto-acidosis associated with decreased LVEF to 31%. Evaluation for infection vs graft rejection. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 22%. The LVEDV is 231 ml (normal range 142+/-34), the LV end diastolic volume index is 119 ml/m2 (normal range: 74+/-15), the LVESV is 180 ml (normal range 47+/-19) and the LV end systolic volume index is 93 ml/m2 (normal range 25+/-9). The LV mass is 248 g (normal range 164+/-36) and the LV mass index is 128 g/m2 (normal range 85+/-15). There is global hypokinesis. The T2-ratio and global relative enhancement ratios are both within normal range. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no LV thrombus. Left AtriumThe left atrium has transplant morphology. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%. The RVEDV is 143 ml (normal range 142+/-31), RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVESV is 97 ml (normal range 54+/-17), and the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild left ventricular dilation with severely reduced systolic function (LVEF 22%). No evidence of elevated T2-ratio, global relative enhancement, or late gadolinium enhancement which suggest the absence of myocardial inflammation, infiltration, or fibrosis. Unfortunately, T1-mapping was not available during today's scan because of a scanner software upgrade. If clinically indicated, patient can be brought back for T1-mapping at no cost to the patient after the upgrade is completed next week .2. Normal right ventricular size with moderate systolic dysfunction (RVEF 32%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 59 year old man with history of anterior mediastinal neuroendocrine tumor with metastatic disease, found to have a right atrial mass on previous imaging, referred for cardiac MRI to better evaluate for etiology. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 44 ml/m2 (normal range: 74+/-15), the LVEDV is 85 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 35 ml (normal range 47+/-19), the LV mass index is 36 g/m2 (normal range 85+/-15), and the LV mass is 68 g (normal range 164+/-36). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. The interatrial septum is aneurysmal.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVEDV is 115 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 46 ml (normal range 54+/-17).Right AtriumThe right atrium is at least mildly dilated. There is thickening which appears to be contiguous with the RA free wall which takes up contrast on first-pass perfusion, suggesting some component of vascularity. On late gadolinium enhancement imaging, there is partial contrast uptake, the appearance of which is not consistent with thrombus. Native T1 time in the region of this mass is 1280ms (normal myocardium was 1090ms). Of note, this was seen on previous CT Chest performed in March 2015. In the right atrial appendage, however, there is a more rounded density which does not exhibit late gadolinium uptake; this is suggestive of thrombus.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are drain normally into the right atrium. There is compression of the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a 30 x 30 mm nodule in the right lower lobe adjacent to the right costophrenic angle. There is right pleural thickening and nodularity. There is significant mediastinal soft tissue mass present, the largest of which measures 33 x 22mm with compression of the superior vena cava. There are changes consistent with previous sternotomy. There are numerous vertebral body lesions. There are cystic appearing lesions in the liver. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. Suggest review of previous CT imaging for more detailed description.

Output: 1. Normal sized left ventricle with normal systolic function (EF 58%).2. Normal sized right ventricle with normal systolic function (EF 60%).3. There is thickening which appears to be contiguous with the RA free wall which takes up contrast with first-pass perfusion, suggesting some component of vascularity. On late gadolinium enhancement imaging, there is partial contrast uptake, the appearance of which is not consistent with thrombus but the etiology of the mass is otherwise difficult to discern. Native T1 time in the region of this mass is 1280ms (normal myocardium was 1090ms). 4. In the right atrial appendage there is a more rounded density which does not exhibit late gadolinium uptake; this is suggestive of thrombus.5. Mild aortic regurgitation. 6. Mild biatrial dilation. 7. This constellation of findings suggest thrombus within the right atrial appendage. Given the clinical history of metastatic neuroendocrine disease, as well as evidence of partial vascularity of the mass and differential tissue characteristics from myocardium, differential diagnosis for the RA free wall finding includes malignant invasion of the RA wall versus thickening of the RA wall. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A 72 year old female with hypertension, hyperlipidemia, breast cancer, s/p chemotherapy and now on herceptin, family history of premature coronary artery disease. The electrocardiogram showed anterior ST-T abnormalities and the echocardiography (6/30/2015) showed LVEF of 30% with normal LV function. Referred to cardiac MRI for further evaluation MEDICATIONS: vitamin D3, clonazepam, metoprolol, zolpidem. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 119 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 85 g. There are no regional wall motion abnormalities present. No intracardiac thrombus. Left AtriumThe left atrium is normal size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is normal size. Aortic ValveThe aortic valve is trileaflet and opens widely. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta is non aneurysmal, measuring 3.6 x 3.7 cm (non orthogonal measurement).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is an incidental lipoma of the right subscapularis musculature.A 2.6 x 3.2cm T2 high signal lesion occupies the left breast with surrounding striations, favoring appearance of post operative seroma that is unchanged from recent ultrasound.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and systolic function (RVEF 59%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 19 year-old female. Ankle pain, swelling. Evaluate for OCD. TENDONS: Normal signal intensity and morphology of the ankle tendons.LIGAMENTS: Ligaments are intact. ARTICULAR SURFACES AND BONE: Focal small area of edema in the middle facet of the talus (series 901, image 15), decreased from prior. There is new mild edema in the calcaneus at the middle facet articulation. Mild sclerosis at the middle facet joint consistent with mild osteoarthritis. No fracture or osteochondral defect is identified. Articular cartilage of the ankle is intact. Small bone cyst in the calcaneus, unchanged. ADDITIONAL

Output: No evidence of an osteochondral defect. Small area of focal edema in the middle facet of the talus, decreased from prior. Mild sclerosis at the middle talar facet joint is consistent with mild osteoarthritis.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with bilateral hand and arm weakness. Alignment is anatomic. Vertebral body height and morphology are normal. Marrow signal characteristics are within normal limits. No pathologic marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed below. No pathologic intramedullary or leptomeningeal enhancement is seen.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild facet hypertrophy. Otherwise unremarkable. C5-6: Mild facet hypertrophy. Left uncovertebral hypertrophy. Central disk extrusion extending both above and below the level of the disk space. Effacement of the ventral thecal sac with minimal flattening of the ventral cord, but no frank cord compression and no pathologic cord signal. Moderate left foraminal narrowing. C6-7: Mild facet hypertrophy. Mild uncovertebral hypertrophy and disk osteophyte formation. Slight effacement of the ventral thecal sac. No significant spinal canal stenosis. Moderate left foraminal narrowing. C7-T1: Unremarkable.

Output: 1.Disk extrusion at C5-6 resulting in mild deformation of the ventral cord but no significant cord compression or evidence of cord edema. The left neural foramen is at least moderately narrowed at this level secondary to facet and uncovertebral hypertrophy.2.Mild disk osteophyte formation at C6-7 without significant spinal canal stenosis. The left neural foramen is at least moderately narrowed at this level secondary to facet and uncovertebral hypertrophy.


Instruction: Generate impression based on findings.

Input: 41-year-old female with multiple sclerosis experiencing paresthesias Limited study secondary to special protocol requirements.Redemonstrated are multiple hyperintense FLAIR signal abnormality in the periventricular and subcortical white matter in supratentorial region as well as in the corpus callosum, which have been relatively stable since prior exam. No new lesion is identified, although some lesions appear larger and others smaller.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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. Normal flow voids are identified in the major intracranial vessels.The paranasal sinuses and mastoid air cells are clear.

Output: Relatively cerebral white matter signal abnormality. Findings are compatible with multiple sclerosis.


Instruction: Generate impression based on findings.

Input: A 26 year old male with Ebstein's anomaly and suspected interatrial shunt by a recent echocardiography. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 55 ml/m2 (normal range: 74+/-15), the LVEDV is 94 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 38 ml (normal range 47+/-19), the LV mass index is 33 g/m2 (normal range 85+/-15), and the LV mass is 57 g (normal range 164+/-36). There is flattening of the interventricular septum in diastole. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Right VentricleThe non-atrialized portion of the right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 123 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 62 ml/m2 (normal range 31+/-9), and the RVESV is 106 ml (normal range 54+/-17).AtriumsThe left atrium is normal in size (36ml).The right atrium is severely dilated (201ml), when the atrialized portion of the RV is included as RA volume.No atrial septal defect was seen. No obvious right to left or left to right shunt is seen on first pass contrast imaging, and Qp/Qs is within normal limits.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe tricuspid regurgitation. The septal leaflet is apically displaced with the coaptation point occurring at the mid-RV level.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trace pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 60%. There is flattening of the interventricular septum in diastole. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The non-atrialized portion of the right ventricle is mildly dilated with normal systolic function, the RVEF is 50%. 3. The right atrium is severely dilated (201ml), when the atrialized portion of the RV is included as RA volume.4. No atrial septal defect or anomalous pulmonary venous drainage is noted.5. The tricuspid valve is consistent with Ebstein's anomaly and has severe regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 18 months old, with history of Guillain-Barre syndrome, presenting with nausea, asymmetric reflexes. Assess for transverse myelitis. Assess for an inflammatory process in the cerebellum. Brain:Brain parenchymal morphology is within normal limits. No areas of abnormal signal or enhancement are detected, including within the cerebellum. No edema or mass effect is observed. There are no findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology. The pattern of white matter myelination is appropriate for age.Spine:The previously seen T2 hyperintensity affecting the cervical spinal cord has resolved. In addition, the previously seen mild cauda equina enhancement has improved with at most minimal residual scattered enhancement. No focal spinal cord lesions are detected. No epidural abnormalities are seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No compromise of the spinal canal or neural foramina is detected. Atelectasis and/or patchy opacities are seen in the posterior lungs.

Output: 1.Unremarkable evaluation of the brain with no specific findings to account for the patient's symptoms.2.Abnormal signal intensity within the cervical spinal cord seen on the prior examination has resolved. No new focal spinal cord lesions are detected.3.Subtle enhancement of the cauda equina nerve roots seen on the prior examination has nearly completely resolved. At most, there may be minimal residual scattered enhancement but even this is equivocal.


Instruction: Generate impression based on findings.

Input: history of leukemia s/p BMT. History of chronic steroid use. History: Lucency and sclerosis at the medial talar dome which may represent osteochondritis dissecans Right ankle: There are vertically oriented linear T1 dark signals through the body/neck of the talus (series 7 image 13) and anterior process of the talus (series 7 image 17), likely representing nondisplaced fractures. There is diffuse bone marrow edema of the talus and subchondral fluid in the talar dome. There is heterogeneous bone marrow edema in the epiphysis and metaphysis of the distal tibia, likely representing bone infarction. There is small joint effusion and ankle soft tissue edema.Left ankle: Crescentic low T1 signal in the talar dome, probably representing osteochondritis dissecans (series 9 image 14). There is diffuse underlying bone marrow edema of the talus. There is heterogeneous bone marrow edema in the epiphysis and metaphysis of the distal tibia, likely representing bone infarction. There is small joint effusion.

Output: 1. Nondisplaced fractures through the right talus.2. Osteochondritis dissecans of the left talar dome. 3. Likely bone infarctions of bilateral distal tibia.


Instruction: Generate impression based on findings.

Input: Other extrapyramidal disease and abnormal movement disorder [333.99], Reason for Study: ^Reason: movement disorder, abnormal LFTs History: limb dystonia No evidence of acute ischemic or hemorrhagic lesion on the scan.There are scattered several high signal intensity foci bilateral hemispheric white matter indicating nonspecific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Nonspecific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: 83-year-old male with multiple myeloma. Presents with low back pain. Rule out bony disease. Evaluate for degenerative disk disease. Signs and symptoms: Moderate to severe low back pain. Constipation. Nonenhanced CT of lumbar spine girl inaxial 3 -mm continuous CT images of the entire lumbosacral spine were obtained. Sagittal and coronal 2-D reformatted images were also obtained.Examination demonstrates severely osteopenic lumbosacral vertebral column. The alignment of the vertebral column is within normal limits. Partially visualized lower T10 vertebrae demonstrate extensive lytic changes which considering patient's history likely represents multiple myeloma. The alignment and morphology the vertebral column from T11 through L5 remains within normal. No evidence of a destructive bony lesion is identified.There is a large irregularly-shaped lytic lesion in the vertebral body of S1 on the left which is also suspected from a myoma. Very large similar lesions within bilateral iliac wings and the ala of the sacrum and is also present.There is no significant degenerative disk disease on this exam. There is mild to moderate degenerative changes of posterior elements of both facets and ligamentum flavum.There is no definitive bony central canal stenosis. There is highly suspected neural foramina compromise bilaterally at at L4 -- L5 level mild neural foramina compromise at L3 -- L4 is also suspected. No definitive neural foramina compromise at any other level.For more detailed evaluation of degenerative disk disease, central spinal stenosis or neural frontal compromise an MRI examination is recommended. MRI can also better visualized the extent of changes of multiple myeloma which due to very severe osteopenia may be difficult to assess on CT.

Output: 1.Severe osteopenia results in very poor visualization of bony structures of lumbosacral spine.2.There is a destructive lytic lesion in partially visualized vertebral body of T10.3.Large irregularly-shaped lytic lesion is noted involving the vertebral body of S1. Likely secondary to multiple myeloma.4.Extensive lytic changes of the iliac wings bilaterally (left greater than right cortical and central ala (left greater than right) consistent with patient's history of multiple myeloma.5.Mild degenerative disk disease and hypertrophic changes of posterior elements are noted. No evidence of any bony central canal stenosis. Mild compromise of bilateral neural foramina at L4 -- L5 and to a lesser degree at L3 -- L4 level is suspected.


Instruction: Generate impression based on findings.

Input: History of low back pain for 2 years status post fall from standing. Patient reports possible T11-T12 fracture. Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris is normal in appearance and terminates at the inferior L2 level.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is moderate facet hypertrophy. There is no significant compromise to spinal canal or neural foramina.L4-5: There is moderate to marked facet hypertrophy, with moderate spinal canal stenosis. Mild bilateral foraminal disc bulge with minimal neural foraminal narrowing.L5-S1: Moderate to severe facet hypertrophy. There is no significant compromise to spinal canal or neural foramina.

Output: Multilevel moderate to marked facet hypertrophy, with moderate spinal canal stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5] / Other chronic pain [G89.29], Reason for Study: ^Reason: back pain History: same 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 epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1 level. 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: Minimal left side foraminal and far lateral bulging of disc results minimal left side neuroforaminal minimal narrowing. No spinal stenosis. L4-L5: Diffuse bulging of disc which abuts thecal sac with bilateral ligamentum flavum thickening. Minimal neuroforaminal narrowing at this level. L5-S1: Bilateral ligamentum flavum thickening, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multilevel minimal degenerative changes of lumbar spine.2. No evidence of disc herniation.3. No obvious spinal canal stenosis.4. Minimal neuroforaminal stenosis at the level of L34 left side, otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Presurgical epilepsy evaluation: left temporal lobe epilepsy. There is redemonstration of abnormal signal and volume loss involving the left hippocampal head. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with an asymmetrically larger left lateral ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Stigmata of left hippocampal sclerosis.


Instruction: Generate impression based on findings.

Input: Female, 14 years old. History of SLE, chronic HA. Ophthalmologic exam on 9/2/15 showed possible bilateral disc swelling vs pseudopapilledema. BRAIN:There is no evidence of intracranial hemorrhage, mass effect, midline shift, or acute infarct. Mild prominence of the ventricles and sulci appear similar to the prior study, compatible with global volume loss. The basal cisterns remain patent. The midline structures and craniocervical junction are within normal limits. Small areas of T2 hyperintensity within the left paramedian parietal lobe and anterior left frontal lobe are unchanged from the prior study dated 08/2014, without associated diffusion restriction or enhancement. There is no abnormal parenchymal or leptomeningeal enhancement. There is no diffusion abnormality.ORBITS:No abnormal mass or abnormal enhancement is seen. The optic nerves are normal in size and signal intensity. There is no definite elevation of the optic nerve head. No retrobulbar, chiasmatic, or parasellar abnormality is seen. The extraocular muscles are unremarkable.MRA:The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRV:The 2-D MRV sequences are somewhat limited, and there is better evaluation of the venous structures on phase contrast images and 3-D T1 postcontrast images of the brain. The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.

Output: 1.Nonspecific small areas of T2 hyperintensity in the left paramedian parietal lobe and left frontal lobe are unchanged from the prior study.2.Normal MR appearance of the orbits, without morphologic or signal abnormality involving the optic nerves.3.The intracranial arterial and venous structures are normal, without aneurysm, flow-limiting stenosis, or thrombosis.


Instruction: Generate impression based on findings.

Input: 18-year-old male with left knee pain. MENISCI: The menisci appear intact. ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: No findings to account for the patient's pain. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: hx of prostate cancer, evaluate extent of disease, scheduled for RALP History: see above. PELVIS:PROSTATE:Prostate Size: 3 x 4.7 x 3.5 cmPeripheral Zone: Multifocal extensive tumor bilaterally, predominantly involving the right. Large dominant tumor involving the right apex with extension into the left apex and right mid measures 2.5 x 2.3 cm. There is right apical extracapsular extension. Smaller tumors involving the right anterior mid and left posterior mid. Central Gland: No significant abnormality. Seminal Vesicles: No significant abnormality. Extracapsular Extension: Mild extracapsular extension of large right apical tumor. BLADDER: No significant abnormality noted.LYMPH NODES: Small right pelvic side wall lymph nod measures 4 mm. Small nonenlarged right external iliac chain lymph node. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal tumor with large dominant right apical tumor with extracapsular extension. 4 mm right pelvic side wall lymph node; metastases cannot be excluded.


Instruction: Generate impression based on findings.

Input: 77-year-old male with sacral mass and known metastases.Additional clinical history from service includes left-sided buttock pain. There is a mass occupying the majority of the right half of the S2 vertebra with focal extension across the sacroiliac joint. It measures about 5.2 x 4.2 x 4.5 cm, similar to prior study. Although the size of the mass appears similar to the prior study, there is now only peripheral enhancement following IV contrast, indicating treatment effect. The mass contacts the right S1, S2, and S3 neuroforamina, appearing similar to prior study. There are multiple, small enhancing foci within the bones of the pelvis bilaterally, likely representing metastatic disease. For reference purposes, a lesion in the anterior left iliac wing measures approximately 1.2 cm in greatest transverse dimension and corresponds to area of increased uptake on prior PET scan. We also see small focus within the right sacral wing.There is mild edema within the left sacral wing with a poorly defined linear low signal component anteriorly which may represent a stress fracture.Osteoarthritis affects the right greater than left hips. Degenerative disc disease affects the lumbar spine, most severely at the L4-L5 level.Incidentally noted left bladder diverticulum.

Output: 1.Right-sided sacral mass with multiple small metastatic foci within the bones of the pelvis bilaterally.2.Edema within the left sacral wing associated with a linear low signal component anteriorly suggestive of a developing stress fracture.3.Osteoarthritis and other findings as above.These findings were discussed with Joyce Tang at 11:20 AM on 7/29/2016 by telephone.


Instruction: Generate impression based on findings.

Input: Headache and dizzy spells. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered mild paranasal sinus mucosal thickening.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 13-year-old female with right knee stiffness and pain after fall. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: There is fraying and discontinuity of the anterior cruciate ligament. However, many fibers appear intact. The PCL and LCL appear intact. There is minimal irregularity of the junction of the medial meniscus and MCL inferiorly with a tiny amount of joint fluid seen dissecting superiorly (series #9, image 12).EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Partial tearing of the ACL with mild irregularity of the MCL/medial meniscal interface.


Instruction: Generate impression based on findings.

Input: 31 years year-old Female with multiple sclerosis.INDICATIONS: Reason: MS; f/u progression History: weakness. There is redemonstration of numerous bilateral periventricular and subcortical T2 hyperintense and T1 hypointense white matter lesions. Disease is also redemonstrated within the corpus callosum and scattered within the brainstem and middle cerebellar peduncle. There is stable mild enlargement of ventricles and sulci, consistent with global volume loss much greater than expected for age, although stable.There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Stable appearance of previously demonstrated demyelinating plaques. There is moderate T1 and T2 burden of disease, including infratentorial lesions.Stable diffuse global volume loss.


Instruction: Generate impression based on findings.

Input: Bilateral upper extremity weakness. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific T2 hyperintensity in the bilateral putamina and trace periventricular T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brachial Plexus: There are disc-osteophyte complexes at C3 though C7, with indentation upon the spinal cord at C3 though C6, but no evidence of abnormal spinal cord signal. The brachial plexus appears unremarkable bilaterally, without evidence of tumors. There is mild dextrosclerosis of centered in the upper thoracic spine. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable, aside from a mid thoracic hemangioma or focal fat. The paravertebral soft tissues are unremarkable. The thyroid gland appears to be mildly enlarged and heterogeneous.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Disc-osteophyte complexes at C3 though C7, with indentation upon the spinal cord at C3 though C6, but no evidence of abnormal spinal cord signal. Please refer to the recent cervical spine MRI report for additional details.3. The brachial plexus appears unremarkable bilaterally.4. The thyroid gland appears to be mildly enlarged and heterogeneous, which is nonspecific.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, with metastatic melanoma, screening examination for brain metastases. A 2 mm focus of enhancement is seen within the left inferior cerebellum. There is no associated T2 signal abnormality or edema.A small developmental venous anomaly is evident within the right postcentral gyrus. No additional pathologic intracranial enhancement is observed.No restricted diffusion is seen. Numerous scattered foci of periventricular and subcortical FLAIR hyperintensity are demonstrated without edema or mass effect.No findings are seen to suggest intracranial hemorrhage or any abnormal extra axial fluid collections. The ventricles are normal in size and morphology.Opacification of the sphenoid sinuses is demonstrated.

Output: 1.A 2 mm focus of enhancement is evident within the left inferior cerebellum. As this is the only pathologic intracranial enhancement detected, the finding is nonspecific but metastatic disease would be in the differential diagnosis. Close interval follow-up should be considered.2.Evidence of chronic microvascular ischemia is seen.


Instruction: Generate impression based on findings.

Input: 45-year-old female. Reason: 3 t scanner ccm protocol qsm/permiability Known CCMs and DVAs, prior hx of bleeds in 1997, 2008, and 2012. Gamma Knife resection in 2002 of cavernoma. 2008 resection. Second CCM in the L parietal region found in 2012. History: yearly surveillance for ccms Redemonstrated is stable a 7 x 7 mm T2 hypointense, central T1 hyperintense and peripherally T1 hypointense lesion in the posterior left middle temporal gyrus, consistent with a cavernous venous malformation. There is associated blooming on susceptibility weighted imaging. Adjacent prominent vessel, which extends to the margin of the left lateral ventricle, is consistent with an associated developmental venous anomaly. There is no perilesional edemaFocal deformity of the left inferior occipital bone with underlying hemosiderin staining and associated volume loss of the left cerebellar hemisphere, is compatible with prior surgery. There is a resection cavity in the left cerebellum, with associated atrophy of the inferior and middle cerebellar peduncles. There is a prominent associated vessel running posterior and lateral to the resection cavity, which likely represent an associated developmental venous abnormality of the resected cavernoma. These findings are stable in appearance.A tiny developmental venous anomaly is again noted involving the posterior right superior frontal gyrus.There is no restricted diffusion seen to suggest acute infarction. There is mild ex vacuo dilatation of the fourth ventricle; but otherwise, the ventricles and basal cisterns are normal. There is no midline shift or herniation. Few scattered punctate T2 hyperintense foci in the subcortical white matter are nonspecific and stable. Intrinsic T1 hyperintensity in the dentate nuclei are seen bilaterally, likely relating to mineralization.

Output: 1.Stable cavernous malformation and developmental venous anomaly in the left posterior temporal lobe. 2.Stable postsurgical changes consistent with reported history of prior cerebral cavernous venous malformation resection in the left cerebellar hemisphere, with probable associated developmental venous anomaly.3.A tiny developmental venous anomaly is again noted involving the posterior right superior frontal gyrus.


Instruction: Generate impression based on findings.

Input: 69-year-old male with history of cholangiocarcinoma status post chemotherapy. Evaluate for treatment response. ABDOMEN:LIVER, BILIARY TRACT: There is redemonstration of a lobulated segment 7 mass which has increased T2 signal and restricted diffusion. The mass has peripheral arterial enhancement with gradual fill in delayed images compatible with a cholangiocarcinoma. This measures 4.9 x 4.5 cm, previously 4.9 x 4.1 cm. Again similar to prior there is inferior extension of the tumor into segment 5.Additional small focus of arterial enhancement previously noted in segment 6 is not identified. Scattered punctate foci of increased T2 signal without enhancement compatible with small cysts.Also similar to prior, the right hepatic vein and the posterior segment of the right portal vein are poorly visualized and likely thrombosed. The remaining hepatic veins, portal vein branches, and hepatic arteries are patent.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is mildly atrophic but maintains normal signal. The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy in the upper abdomen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged enhancement and increased T2 signal adjacent to L3 vertebral body inferior endplate irregularity is presumed degenerative in etiology.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in size of the patient's segment 7 mass. No specific evidence of disease elsewhere in the upper abdomen.


Instruction: Generate impression based on findings.

Input: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and ligamentum flavum thickening. There is mild narrowing of the spinal canal. No significant neural foraminal stenosis.C4-5: Disc osteophyte complex and ligamentum flavum thickening result in moderate to severe spinal canal stenosis with flattening of the cord. There is suggestion of volume loss. There is adjacent cord signal abnormality at the upper C5 level involving the cord bilaterally. There is moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy. C5-6: Disc osteophyte complex and ligamentum flavum thickening result in moderate spinal canal stenosis and mild deformity of the cord. There is severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C6-7: Disc osteophyte complex and ligamentum flavum thickening result in mild to moderate spinal canal stenosis. There is mild to moderate neural foraminal stenosis on the right related to osteophyte. Mild left neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.LUMBAR SPINE

Output: 1. Multilevel degenerative changes in the cervical spine with disc osteophyte complexes and ligamentum flavum thickening at C3-C4, C4-C5, C5-C6, and C6-C7 which is associated with significant spinal canal stenosis as described above. Findings are most severe at the C4-C5 level where there is flattening of the cord and T2 hyperintensity which is favored to be related to myelomalacia. 2. Multilevel degenerative changes in the lumbar spine with moderate spinal canal stenosis at L2-L3, L3-L4, and L4-L5 related to combination of degenerative changes and prominence of the epidural fat. Additional details as above.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.Surrounding the tip of the T1 spinous process, there is ill-defined enhancement and corresponding T1 hypointensity. There is no significant STIR hyperintensity within the marrow at this level. The cortex of the spinous process tip is somewhat ill-defined on 1201/16.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. There is a nonenhancing oval lesion in the anterior interpolar right kidney which appears grossly similar to previous MRI lumbar spine images. This is nonspecific but most likely represents a small cyst.

Output: 1. Subtle ill-defined enhancement associated with the T1 spinous process tip with questioned ill-defined cortical margin, although no marrow signal abnormality is appreciated. CT could be obtained to evaluate for subtle osseous changes, or bone scan could be considered as clinically indicated.2. No definite T4 level abnormality appreciated.


Instruction: Generate impression based on findings.

Input: right side weakness and right partial retinal artery occlusion. No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered small high signal intensities on bilateral hemispheres on FLAIR images indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Epilepsy with seizure semiology that is suggestive of right frontal midline lesion. Assess for structural abnormality. There is no focal cortical thickening or poor definition of the gray-white-matter interface. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact, with nondominant right vertebral artery. The pituitary gland appears unremarkable. Mild mucosal thickening in the paranasal sinuses is nonspecific. The mastoid air cells are clear. There is no destructive skull lesion. The orbits are unremarkable. There are small lymph nodes in the upper neck, which is a common finding in this age group.

Output: No MR findings to suggest malformation of cortical development or other structural procedure focus.


Instruction: Generate impression based on findings.

Input: 59-year-old female with biopsy proven IDC and DCIS of the right breast, spanning approximately 7.3 cm on the prior MRI dated 12/14/2015 and 6.6 cm on the MRI dated 3/9/2016. Patient is currently undergoing neoadjuvant chemotherapy. She presents today for the repeat MRI to assess the imaging evaluation to treatment response. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:There has been interval decrease in size and enhancement of the biopsy-proven heterogeneously enhancing mass in the right upper outer breast, far posterior depth, which now measures 0.7 x 0.8 x 1.6 cm (AP x LR x CC), previously measuring 2.1 x 1.5 x 1.8 cm. There continues to be a thin fat plane between this mass and the pectoralis muscle on T2-weighted images.The previously described nonmass enhancement extending anteriorly from the above mass in the right upper outer quadrant has become less conspicuous and decreased in size and enhancement. Of note, this nonmass enhancement corresponded to the linear calcifications on the prior mammogram, which are likely to persist on mammograms. Overall measurement including mass and mild non-mass enhancement is approximately 1.3 x 3 cm, which previously was 6.6 x 2.3 cm on the prior.LEFT BREAST:No abnormal enhancement is seen in the left breast.Axillae:No abnormal lymph nodes are identified in either axillary region.

Output: 1. Continued decrease in size and enhancement of the index malignancy in the right upper outer breast with residual enhancement measuring up to 3 cm in the oblique AP dimension (previously 6.6 cm). It is expected that the known extensive calcifications persist on mammography. 2. No MRI evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Metastasis to spine from prostate cancer. Presented with new bilateral leg numbness and weakness of 4 days duration. A limited examination with only sagittal T1 and STIR sequences was obtained through the spine to rule out spinal cord compression. There are postoperative findings related to previous decompressive T5-T7 laminectomies. The abnormal marrow signal in T5-T8 has progressed and is associated with new 50% anterior compression fracture of T7 vertebral body. There is also increased extraosseous, paraspinal soft tissue component that involves also the laminectomy site and causes increased deformity and signal abnormality of the spinal cord. Apparent central T2-hyperintense signal throughout the length of the spinal cord may represent artifact versus a presyrinx. There is also soft tissue infiltration into the left T5-T9 and the right T6-T7 neural foramina. A lesion in T9 vertebral body has increased in size, but there is no associated pathologic fracture. The extensive abnormal signal without significant expansion involving the T1, L1, and L5 vertebrae and sacrum has not significantly changed and is not associated with spinal canal stenosis. The mild, predominantly right-sided posterior/central L5 vertebral body compression has not changed. Degenerative spinal canal narrowing at C4-C5 and C5-C6 may have minimally increased since December 2015, mildly indenting the spinal cord. The clival metastasis is only partially imaged. A large left pleural effusion and superior mediastinal and retroperitoneal lymphadenopathy are also only partly imaged.

Output: 1.Progressed metastatic involvement of T5-T8 with increased extraosseous soft tissue component and spinal cord compression. 2.New anterior T7 vertebral body compression fracture.3.A lesion in the T9 vertebral body has progressed. Otherwise, lesions T1, L1, and L5 vertebrae and sacrum have not significantly changed and are not associated with spinal canal stenosis.4.The clival metastasis, left pleural effusion, and mediastinal and retroperitoneal lymphadenopathy are only partially imaged.On-call radiology resident Dr. Sujay Sheth discussed the above findings with the ER staff (Jen) over the phone on January 22, 2016 at 2150 hours.


Instruction: Generate impression based on findings.

Input: question: Bleed? mass? Signs and symptoms: Acute onset of left-sided weakness. Non-infused CT of brain:Examination demonstrates well demarcated area of low attenuation of the cortex of right parietal lobe with effacement of adjacent cortical sulci highly suspected of an acute/subacute cortical stroke. There is no evidence of a hemorrhagic component. There is no evidence of mass effect on the lateral ventricle or midline shift. There is no definitive evidence of any abnormal density of the intracranial vasculature of arterial circulation or the venous sinuses. Further follow-up with dedicated MRI examination is recommended. This examination is otherwise unremarkable.Calvarium is intact.No abnormalities of the scalp is detected.Limited images of the orbits are unremarkable.Mastoid air cells and middle ear cavities are pneumatized. Limited view of paranasal sinuses demonstrate chronic sinus disease of bilateral maxillary sinuses (right greater than left).Above findings were text message to Dr. Lisa McQueen on pager number 4933 utilizing the paging tool option on a PACS system.

Output: Acute nonhemorrhagic right MCA stroke in the parietal lobe with effacement of adjacent cortical sulci. No hemorrhage, mass effect on the right lateral ventricle or midline shift.


Instruction: Generate impression based on findings.

Input: Prostate cancer with tremor and weakness. Thoracic spinal metastasis. Status post decompression and fixation. Since the prior examination, there has been T6 through T8 laminectomies along with posterior fixation with dual posterior rods and bilateral screws at T4, T5, T9 and T10 levels. At the laminectomy bed, there is heterogeneous material, which may reflect fluid mixed with blood products. Also, there has been partial resection of the epidural component of the osseous metastatic tumor, which involves mainly T7 and partially posteriorT6 and T8 vertebral bodies and pedicles. While epidural tumor tissue remains especially at T7 level. Compared to the preoperative examination, there is less retropulsion at T7 level with resolution of the mass-effect on the spinal cord and slightly wider anterior CSF space. However, the posterior CSF space at this level is slightly smaller than preoperatively, which may relate to the mass-effect caused by the fluid at the laminectomy bed. Overall, the most prominent residual epidural component involves the right anterolateral aspect of the spinal canal at the lower T7/upper T8 level. Contrast enhancement in the osseous part of the tumor is decreased compared to the preoperative examination but this likely reflects technical variation. There continues to be significant involvement of the neural foramina by the metastasis, especially on the right, at T7-T8 and to lesser extent T6-T7 and T8-T9. The other thoracic neural foramina are preserved.Also, there is no direct compression of the spinal cord at this level or the other levels. However, there is artifact, especially at the levels of the screws, mildly limiting the examination for cord compression.Acute postoperative changes are present in the surgical bed and the overlying back soft tissues.There is multilevel cervical spondylosis which is not completely assessed. This is associated with anterior subluxation of C7 relative to T1 resulting mild spinal canal but more significant neural foraminal stenosis.

Output: 1.Since the previous examination, there has been posterior T6-T8 decompression and T4-T10 posterior fixation, as described above. In addition, there has been partial debulking of the epidural component of the osseous metastasis involving mainly T7 and to a lesser extent T6 and T8 vertebral bodies and pedicles. The posterior retropulsion at T7 has improved with out definite residual direct mass-effect on the spinal cord.2.There remains near complete effacement of CSF space at the T7 level, as there is a mixed signal intensity postoperative epidural collection along the laminectomy bed.3.The residual epidural component is most pronounced right anterolaterally at T7-T8 level.4.Persistent significant involvement of the neural foramina by the metastasis, especially on the right as described above


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is sulcal FLAIR hyperintensity, likely relating to sedation and/or oxygenation. There is ill-defined FLAIR hyperintensity in the right parietal centrum semiovale and right parietal periventricular white matter. 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 skull and scalp soft tissues are unremarkable. There is mild maxillary sinus thickening. Aerated secretions are visualized in the sphenoid sinuses with patchy ethmoid opacification.The internal auditory canals are hypoplastic bilaterally, with more conspicuous narrowing of the mid to lateral left canal on the sagittal oblique images. The seventh and eighth cranial nerves are visualized on the right. The left eighth cranial nerve is visualized, although the left seventh cranial nerve is not well delineated, likely due to the small caliber of the internal auditory canal. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. No significant abnormal enhancement is seen along the facial nerves.There is incidental mild disconjugate gaze, for which correlation with physical exam is recommended.

Output: 1. Hypoplasia of both internal auditory canals, with cochlear nerves seen bilaterally. Likely due to small caliber of the IACs, the intracanalicular left facial nerve is not as well delineated. No definite facial nerve mass or abnormal enhancement.2. Nonspecific nonenhancing right parietal white matter FLAIR hyperintensity, which may represent an area of gliosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 59-year-old male with an ICD and history of CAD sent for CMR to assess for scar/late gadolinium enhancement. Wide-band imaging performed. Difficult images. Significant troubleshooting required at the MRI scanner. Extensive ICD artifact improved when patient was asked to lift arm above his head. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 234 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 121 ml (normal range 47+/-19). There is inferior/inferoseptal and inferolateral wall motion abnormalities which extend from the base of the heart to the apex. There is inferior/inferoseptal and inferolateral subendocardial late gadolinium enhancement extending from the base to mid myocardium. This is consistent with prior myocardial infarction and is of intermediate viability. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is difficult to quantify on short-axis views due to pacemaker artifact but visually appear normal in size with normal systolic function. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve could not be assessed due to ICD artifact. .Mitral ValveThe mitral valve could not be assessed due to ICD artifact. Pulmonic ValveThe pulmonic valve could not be assessed due to ICD artifact. .Tricuspid ValveThe tricuspid valve could not be assessed due to ICD artifact. .AortaThere is a left sided aortic arch. The aortic root is normal in size.Pulmonary VeinsThe pulmonary veins were not well seen.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%. There are inferior/inferoseptal and inferolateral wall motion abnormalities which extend from the base of the heart to the apex. There is inferior/inferoseptal and inferolateral subendocardial late gadolinium enhancement extending from the base to mid myocardium. This is consistent with prior myocardial infarction and is of intermediate viability. 2. The right ventricle is difficult to quantify on short-axis views due to pacemaker artifact but visually appear normal in size with normal systolic function.3. ICD-related artifact limited evaluation of valves.


Instruction: Generate impression based on findings.

Input: 71 year-old female with substernal goiter with airway deviation. Evaluate for nodules. RIGHT LOBE MEASUREMENTS: 1.8 x 2.0 x 6.0 cmLEFT LOBE MEASUREMENTS: 13.4 x 8.8 x 6.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The right thyroid lobe is homogeneous in echotexture without focal lesions.LEFT LOBE: The left thyroid lobe is heterogeneous in echotexture and markedly enlarged; findings consistent with goiter.ISTHMUS: The isthmus is homogenous in echotexture without focal lesion. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing right level 3 lymph node measures 0.9 x 0.8 x 0.4 cm and left level 3 lymph node measures 2.4 x 0.9 x 0.4 cm.OTHER: Deviation of the airway to the right is noted.

Output: Left thyroid goiter with rightward deviation of the airway.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:5/27/1953)Reason: stroke syndrome History: 2198PROVIDER/ATTENDING NAME: THOMAS F SPIEGEL KOUROSH A REZANIA There is a area of diffusion restriction present which involves the lateral aspect of the right postcentral gyrus and extends into the right centrum semiovale. There is also involvement of the posterior aspect of the right some central lobule as well as the posterior aspect of the right insular cortex. There is associated T2 and FLAIR signal hyperintensity.A couple punctate foci of T2 and FLAIR signal hyperintensity are present within the thalami bilaterallyThere is a focus of loss of signal on susceptibility imaging within the right dentate nucleus of the cerebellum.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR MRI signal hyperintense foci are present in the cerebellar hemispheres and brainstem.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with acute infarction involving the lateral aspect of the right postcentral gyrus and adjacent centrum semiovale and insular cortex2.Small hemorrhagic lesion is present in the dentate nucleus of the right cerebellar hemisphere3.Findings are compatible with the old lacunar infarcts involving the thalami.4.Punctate lesions in the brainstem and cerebellum are most likely vascular related at this age.5.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for potential tumor History: Elevated PSA and negative biopsy x3. PELVIS:PROSTATE: Prostate Size: 3.9 x 5.3 x 4.4 centimeters.Peripheral Zone: Involvement of the right apical and mid gland peripheral zone by large transitional zone tumor as described below. Central Gland: Large dominant tumor involving the right greater than left anterior apical and mid transitional zone with extension into the right peripheral zone. There is T2 hypointense signal, restricted diffusion, and early enhancement. This tumor measures 2.9 x 3.8 x 2.2 cm (AP x TR x CC; series 1201 x image 14, series 1101 image 13). There is bulging of the prostate contour anteriorly, suspicious for extracapsular extension. There is invasion of the anterior fibromuscular stroma. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Extracapsular extension of tumor suspected anteriorly. BLADDER: No significant abnormality noted.LYMPH NODES: Prominent right pelvic sidewall lymph node with rounded configuration measures 1.6 x 1 cm (series 3201 image 62).BONES, SOFT TISSUES: Left fat-containing inguinal hernia. Mild deformity and abnormal signal involving the right inferior pubic ramus, may be a chronic healed fracture. OTHER: No significant abnormality noted.

Output: 1.Large anterior tumor involving the transitional zone of the right greater than left apex and mid prostate with extension into the anterior fibromuscular stroma and right apical and mid peripheral zone. Extracapsular extension suspected.2.Mildly enlarged right pelvic sidewall lymph node.3.Mild deformity and abnormal signal involving the right inferior pubic ramus, may be a chronic healed fracture. However, if there is clinical concern for metastatic disease, this would be better assessed with dedicated nuclear medicine bone scintigraphy.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, status post resection of a brain metastasis, status post whole brain RT, surveillance imaging. Postoperative findings are again seen compatible with resection of a tumor from the left frontal lobe. A small area of rim enhancement within the operative bed has further decreased in size. Mild surrounding edema persists.Numerous additional enhancing lesions both supratentorially and infratentorially are seen. A lesion along the posterior medial right temporal lobe has slightly increased in size from prior though it remains smaller than on earlier exams. Two subcentimeter foci of enhancement in the cerebellar vermis, and one slightly more laterally in the hemisphere, are new from prior and were not clearly present on pretreatment exams. A lesion in the left cerebellum is stable to minimally increased in size. A lesion in the left temporal lobe has probably not changed significantly.The above-mentioned lesions produce at most mild local edema. No significant generalized mass effect is seen. No abnormal extra-axial collections are detected. Ventricular size and morphology remain within normal limits. Mucous retention cysts are seen in the maxillary sinuses. A suspected calcified meningioma is redemonstrated at the left vertex along the posterior craniotomy margin.

Output: 1.Redemonstration of postoperative findings in the left frontal lobe without evidence of recurrent tumor.2.Multiple enhancing lesions are seen elsewhere supratentorially and infratentorially. When compared to the immediate prior examination, a lesion along the posterior medial right temporal lobe is slightly larger, and three small enhancing lesions in the cerebellum may be new.


Instruction: Generate impression based on findings.

Input: 61 year old woman with history of mixed chest pain syndrome with typical and atypical features, and negative previous stress test, but persistent exertional dyspnea and chest tightness referred for cardiac MRI vasodilator stress test.MEDICATIONS: none First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 59 ml/m2 (normal range: 65+/-11), the LVEDV is 101 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV is 36 ml (normal range 31+/-10), the LV mass index is 55 g/m2, and the LV mass is 93 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 101 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 36 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 64%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Normal RV size and systolic function (RVEF 64%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right arm numbness. There is a subcentimeter focus of restricted diffusion and high T2 signal in the left thalamus. There is T2 hyperintensity in the right paramedian pons without associated restricted diffusion. There is also scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Punctate acute infarct in the left thalamus.2. Chronic right pontine lacunar infarct.3. Probable chronic small vessel white matter disease.Discussed with Dr. Rubeiz at 10:30 AM on 3/10/15.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis; follow-up progression. Signs and symptoms: Paresthesia. Nonenhanced MRI:Precise comparison is difficult due to significant differences in technique between the current standard brain MRI 4 mm slices compared to prior dedicated MS protocol with 2 mm slices.Examination is severely limited due to poor quality images related to technical issue with the equipment. Patient was moved to a different scanner however repeat images of brain MRI were not obtained due to patient's concern of missing her clinic appointment.Within this severe limitation of the exam there is suggestion of progression of demyelinating disease. There is a new right frontal periventricular white matter lesion best appreciated on axial FLAIR series 11 image 11 and sagittal FLAIR series 4 image 17. There is a new left mid temporal periventricular white matter lesion on axial FLAIR series 11 image 20 and sagittal FLAIR series 4 image 7. Interval new right periventricular white matter lesion in the right posterior temporal best appreciated on axial FLAIR series 11 image 15. Images through posterior fossa are suboptimal and the lesions from prior exam are not identified and no convincing evidence of new lesion.Nonenhanced cervical MRI:Examination was performed utilizing a different MRI scanner. Images on sagittal T2 and STIR are severely degraded due to motion artifact.Similar to prior study there are diffuse foci of T2 hyperintensity throughout the cervical cord without convincing evidence of any significant change. Degenerative changes at C5-C6 is again noted. There is a central disc protrusion with slight bulge into the spinal canal and subtle flattening deformity of the cord and mild central spinal stenosis. There is interval progression of degenerative changes.There is a visualization of a tiny left paramedian annular fissure at C6-C7 level similar to prior exam.Nonenhanced thoracic MRI:There is diffuse confluent T2/T2 STIR hyperintensity throughout the thoracic cord with uniformly smaller than expected caliber of the cord and consistent with patient's diagnosis of demyelinating disease. There is no convincing evidence of interval change since prior exam.The signal intensity in the alignment of vertebral column remains within normal. There is no evidence of spinal stenosis.

Output: 1.Nonenhanced brain MRI is severely compromised due to technical issue with the equipment. Within this limitation there is suggestion of interval progression of disease with multiple new supratentorial lesions as detailed above.2.Suboptimal nonenhanced MRI of cervical spine redemonstrate diffuse patchy T2 hyperintensity of the cervical cord consistent with demyelinating disease without convincing evidence of change since prior exam. Degenerative changes at C5/C6 is again noted with evidence of a small central disc protrusion contributing to mild central spinal stenosis.3.Nonenhanced MRI of thoracic spine demonstrate extensive confluent foci of T2/T2 STIR hyperintensity involving nearly the entire cord and without convincing detectable interval change since prior study. Mild degenerative changes of thoracic spine however without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: 5-month-old female with a history of VACTERL syndrome (cloaca, multicystic dysplastic right kidney, low lying left kidney, and tethered spinal cord on MRI, left thumb hypoplasia, esophageal atresia s/p TEF repair, (PFO/PDA) with tethered cord release 8/22. What is anatomy of anorectal malformation?EXAMINATION: MR pelvis without and with intravenous contrast material 08/23/16 Each slip of the levator ani measures less than 2 mm in thickness.A tubular duplication to the left of the rectum contains air and measures approximately 1.4 cm in length. The prepubertal uterus and cervix are normal in appearance. The bladder is normal in appearance. The vagina and urethra appear to converge close to the peritoneal surface. It is difficult to identify where the rectum joins the common channel.The ovaries are normal in appearance.The lower pole of the left kidney is normal in appearance. The right kidney is composed of cysts.Changes from the recent spinal cord detethering are noted.

Output: Levator ani musculature is diminutive. Probable short common channel of the cloacal malformation. Tubular rectal duplication cyst.


Instruction: Generate impression based on findings.

Input: Newly diagnosed right retroareolar breast cancer for staging. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The proven cancer in the right retroareolar region is seen as an enhancing mass measuring 2.0 x 1.4 x 1.4 cm. This measurement is inclusive of the nipple, which enhances and is included within the mass. There are a few enhancing foci extending 1.5 cm behind the nipple/mass. These are asymmetric compared to the left side. Including these foci, the total AP extent is 2.9 cm. No abnormal enhancement is seen in the left breast. No suspicious lymph nodes are identified in either axillary region. The largest right axillary node has a uniform mildly thickened cortex and maintains it's fatty hilum, findings more suggestive of a benign node.

Output: Enhancing right breast mass includes the nipple and measures up to 2.0 cm. There are a few asymmetric foci immediately behind the mass for an AP extent of 2.9 cm. It is suspected that the largest measurement of the index lesion on the outside ultrasound (4.8 cm) may have been a measurement that included some normal retroareolar tissues given the smaller size on this study. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 63 years, Male, with history of malignant melanoma. There is a 7 mm enhancing lesion with a mild amount of surrounding edema in the high right posterior frontal lobe/paracentral lobule (series 1001 image 29). No additional enhancing lesions are seen intracranially.No restricted diffusion is present to suggest acute ischemia. No intracranial hemorrhage. The ventricles and other CSF spaces are mildly prominent, compatible with mild parenchymal volume loss.A perivascular space or small chronic lacunar infarct is noted in the left globus pallidus. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. No abnormal dural or leptomeningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 7 mm enhancing lesion in the high right paracentral lobule concerning for metastatic disease.


Instruction: Generate impression based on findings.

Input: 27-year-old female with pain ROTATOR CUFF: High T2 signal at the undersurface of the supraspinatus tendon approximately 1 cm from its insertion. Normal muscle bulk. No fatty infiltration.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: High T2 signal through the inferior aspect of the glenoid and labrum at the six o'clock position may represent a minimally displaced fracture. Intermediate signal at the inferior glenoid labrum compatible with granulation tissue possibly from prior surgery. Additional linear high T2 signal at the anterior inferior aspect of the glenoid labrum at approximately the 4 o'clock position. There is an additional associated nondisplaced fracture line.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Inferior labral tear tears with presumable chronic inferior glenoid fractures at the six o'clock and four o'clock positions as described above.2.Abnormal signal along the undersurface of the supraspinatus may represent partial undersurface tearing or tendinosis of the supraspinatus.


Instruction: Generate impression based on findings.

Input: Vascular dementia, with questionable new right pronator drift from last visit. Please assess for new interval stroke. There are scattered areas of cerebral and pontine T2 hyperintensity. There are unchanged punctate foci of susceptibility effect in the bilateral frontal lobe, which may represent chronic microhemorrhages. However, there is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Chronic scattered white matter small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Absent cough and gag reflexes. Evaluate for encephalopathy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffusely diminished white matter volume. There is diffuse thinning of the corpus collusum. Myelination appears within normal limits for age. There is mild prominence of the extraaxial CSF spaces which can be a normal variant in this age group. There is a cavum vergae. No hydrocephalus. There is no midline shift or herniation. There is mild asymmetric flattening of the left parieto-occipital calvarium, which may be related to positional plagiocephaly. The skull and extracranial soft tissues are otherwise unremarkable.

Output: 1. No evidence of acute ischemia, mass or mass effect. No abnormal enhancement.2. Diffusely diminished supratentorial white matter volume with associated thinning of the corpus callosum.


Instruction: Generate impression based on findings.

Input: Autism intellectual disability and seizures. There is a T1 hypointense and T2 hyperintense subcortical lesion in the pars orbitalis region of the inferior left frontal gyrus that measures up to 5 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is dolichocephaly. The orbits are grossly unremarkable.

Output: Nonspecific subcortical lesion in the pars orbitalis region of the inferior left frontal gyrus that measures up to 5 mm. Differential considerations include a prominent perivascular space, a congenital cyst, or perhaps a cystic neoplasm. However, the lesion incompletely characterized due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Low back pain with physical exam indicating facet arthropathy and lumbar x-ray with severe degenerative disease at L5-S1. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild dextrocurvature of the lumbar spine. There is also grade 1 anterolisthesis of L4 and L5 and minimal retrolisthesis of L5 on S1. Bone marrow signal is benign. The conus medullaris is normal in position. There is haziness involving the CSF on the sagittal T2 sequences in the upper and mid aspect of the lumbar spinal canal likely reflective of nerve root redundancy and vascular congestion related to spinal canal stenosis described below. Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge and bilateral facet arthropathy. No spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is mild narrowing of the spinal canal and neural foramina.L3-L4: Disc bulge, ligamentum flavum thickening, facet arthropathy, and prominence of the epidural fat resulting in moderate spinal canal stenosis. There is mild to moderate right and moderate left neural foraminal stenosis.L4-L5: Grade 1 anterolisthesis, disc bulge, ligamentum flavum thickening, advanced bilateral facet arthropathy, and prominence of the dorsal epidural fat. There is moderate spinal canal stenosis. Moderate left greater than right bilateral neural foraminal stenosis.L5-S1: Severe loss of disc height, vacuum phenomena, and subchondral cyst formation along the endplates. There is a disc bulge with a right paracentral disc protrusion component. There is bilateral facet arthropathy. There is effacement of the right lateral recess. Mild narrowing of the central canal. There is moderate right and mild to moderate left neural foraminal stenosis.

Output: 1. Multilevel degenerative changes in the lumbar spine with moderate spinal canal stenosis at the L3-L4 and L4-L5 levels related to degenerative changes and prominence of the dorsal epidural fat.2. Multilevel neural foraminal stenoses as described above.3. Advanced facet arthropathy at the L4-L5 and L5-S1 levels. Advanced disc-endplate degenerative changes at the L5-S1 level.


Instruction: Generate impression based on findings.

Input: 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 a diffuse disc bulge present associated with bilateral facet and ligamentum flavum hypertrophy. There is bilateral narrowing of neural foramina and encroachment of exiting nerve roots within the neural foramina. There is partial effacement of the fat at the lateral recesses bilaterally at this level. Cystic lesions behind the right L5-S1 facet joint probably represents synovial cysts.At L4-5 there is diffuse disc bulge associated with bilateral facet and ligamentum flavum hypertrophy as well as a mild degree of anterior subluxation of L4 on L5. There is effacement of the fat at the lateral recess bilaterally and narrowing of the neural foramina bilaterally with mild encroachment of the right-sided exiting nerve roots within the neural foramina. Overall there is a moderate to severe degree spinal stenosis at this level.At L3-4 there is a diffuse disc bulge present associated with mild ligamentum flavum hypertrophy. There is narrowing of the neural foramina at this level. Overall there is a mild degree of spinal stenosis at this level. The exiting nerve roots are surrounded by fat within the neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation and a diffuse disc bulge at this level there is mild narrowing of the spinal canal at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a disc bulge at this level .1.

Output: 2.There is a moderate to severe degree of spinal stenosis present at L4-5 associated with some mild encroachment of the right-sided exiting nerve roots within the neural foramen at this level.3.There is encroachment of the exiting nerve roots within the right neural foramen at L5-S1.4.Mild degrees of spinal stenosis are present at L5-S1 and L3-4.5.There are multilevel degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis [Q85.1], Reason for Study: ^Reason: Evaluate for SEGA and SET History: 5 yo with tuberous sclerosis There are multifocal bihemispheric T2/FLAIR high signal intensity lesions involving cortical, subcortical gray matter and periventricular white matter indicating tuberous sclerosis related cortical tubers. The number, size and MR characteristics including non-enhancing nature do not show any significant interval change since prior scan.There are multiple variable sized enhancing nodules following ependymal lining with most of them demonstrate susceptibility artifacts indicating possible internal mineralization. Those lesions are measured from submillimeter to about 10mm which the largest one at the left lateral ventricle. Comparing to prior scan, those lesions do not show any interval changes in terms of number and maximum diameter. There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal cortical, subcortical and white matter T2/FLAIR high signal intensity lesions without evidence of enhancement consisted with cortical/subcortical tubers, unchanged since prior scan.2. Multiple bilateral ependymal nodular lesions with most of them enhancing and some show susceptibility artifacts without evidence of interval enlargement in maximum diameter.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Back pain, evaluate for epidural abscess Examination is technically degraded. Vertebral body heights are within normal limits. There is straightening of the lumbar curvature, with otherwise preserved alignment. Diffusely low T1 and T2 signal are noted throughout the bone marrow without focal destructive osseous lesions. The conus medullaris is normal in position. 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.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Prominent paraspinous collateral vessels are noted. Ascites.

Output: 1. Examination is technically degraded (artifact possible related to extensive ascites) and absence of contrast limits evaluation for small lesions. However, there are no findings to suggest discitis- osteomyelitis, and no epidural or paraspinous collections are apparent to suggest abscess.2. Diffusely low T1 and T2 marrow signal which is nonspecific but can be seen with conditions such as chronic anemia or renal osteodystrophy.


Instruction: Generate impression based on findings.

Input: 71-year-old female patient with lateral meniscal pain and joint laxity status post twisting injury four weeks ago. Evaluate for left lateral meniscal tear. Due to the patient's large body habitus, the high definition knee coil could not be used. An alternative coil was used instead which results in suboptimal image quality.MENISCI: There is intrasubstance signal within the lateral meniscus indicating degeneration, particularly within the root of the anterior horn which appears thickened. The remainder of the anterior horn appears flattened and there is slight lateral extrusion of the body of the lateral meniscus. There is intrasubstance degeneration of the medial meniscus with fraying/mild degenerative tearing of the inner fibers of the posterior horn, but we see no findings suggesting an unstable tear.ARTICULAR CARTILAGE AND BONE: There is tricompartmental cartilage degeneration with scattered small full-thickness defects. Subjectively, there is narrowing of the lateral tibiofemoral compartment likely due to diffuse cartilage degeneration.LIGAMENTS: There is intermediate signal intensity within the distal fibers of the anterior cruciate ligament which may reflect degeneration or prior sprain. The posterior cruciate ligament is intact. The popliteus muscle/tendon is intact. The collateral ligaments are intact. There is a 1 cm focus of signal void posterior to the proximal attachment of the fibulofemoral ligament likely representing calcium hydroxyapatite deposition of questionable current clinical significance, or less likely a loose body.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Degeneration and mild degenerative tearing of the menisci as described above; we see no unstable tear.2. Tricompartmental cartilage degeneration.3. Mild increased signal intensity in the distal fibers of the anterior cruciate ligament may represent degeneration or mild sprain.4. Focus of calcium hydroxyapatite adjacent to the lateral collateral ligament is of questionable clinical significance.5. Joint effusion, small Baker's cyst, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.7 x 3.8 cm.Peripheral Zone: Within the mid peripheral zone, there is a 4.4 x 3.5 mm T2 hypointense lesion which restricts diffusion, which is equivocal. No additional lesion is identified.Central Gland: The transition zone is nodular in appearance, compatible with benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality identified. No evidence of seminal vesicle invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter perirectal lymph nodes. No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Equivocal mid peripheral zone T2 hypointense lesion which restricts diffusion, with no seminal vesicle invasion or extracapsular extension.