Instruction: Generate impression based on findings.

Input: BRAIN: There is no suspicious intracranial enhancement, acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. CERVICAL: There is normal alignment of the cervical spine with preserved vertebral body heights and intervertebral disk heights. There is normal osseous marrow and disk signal. The cord caliber and signal are within normal limits. There is no disk herniation or spinal stenosis the cervical spine. There is no suspicious enhancement within the cervical spine.THORACIC: There are the usual complement the 12 thoracic vertebral bodies. There is normal alignment of the thoracic spine with preserved vertebral body heights and intervertebral disk heights. There is normal osseous marrow and disk signal. The cord caliber and signal are within normal limits. There is no disk herniation or spinal stenosis the thoracic spine. There is no suspicious enhancement within the thoracic spine.LUMBAR: There are the usual complement the 5 lumbar type vertebral bodies, with the last well formed disk space referred to as L5-S1. There is minimal straightening of lumbar lordosis with preserved vertebral body heights and intervertebral disk heights. There is normal osseous marrow and disk signal. The conus shows normal caliber and signal intensity and terminates at L1-2, within normal limits. There is a nonenhancing high T1 signal intensity thin linear structure extending from T12, lying anterior to the conus, and exiting through the right L5-S1 neural foramen, likely representing a thin vessel. There is no suspicious enhancement within the thoracic spine.There is no significant disk herniation or spinal stenosis in the lumbar spine. There is a minimal disk bulge at L3-4 and L4-5 without spinal stenosis. There are tiny posterior annular fissures at L4-5 and L5-S1 disks centrally.

Output: Unremarkable examinations of the brain and the spine with no mass or suspicious enhancement.


Instruction: Generate impression based on findings.

Input: Patient presenting with sensation of dysequilibrium, with concern for cerebellar findings on examination. History: Difficulty with tandem gait. Finger to nose with concern for ataxia on the left. Reflexes in the left biceps and left brachioradialis slightly increased compared to the right. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are patchy areas of T2 hyperintensity scattered in the bilateral cerebral hemispheres. There is a small left superior frontal gyrus developmental venous anomaly. The cerebellum and brainstem are 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Background of probable chronic microvascular ischemic disease with no evidence of acute intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 43 year old woman with history of breast cancer and dyspnea on exertion, with incidentally noted right-sided aortic arch on previous chest CT. She was referred for cardiac MRI to evaluate her aortic anatomy and for any concomitant congenital cardiac lesions. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), the LVEDV is 126 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 50 ml (normal range 31+/-10). The wall thickness is normal. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 118 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 42 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. No atrial septal defect is noted. 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 (28mm). There is a right sided aortic arch with all for brachiocephalic vessels originating independently from the aortic arch. The most proximal vessel is the left carotid artery, followed by the right carotid and right subclavian artery. The left subclavian artery originates from the right sided descending aorta and travels posterior to the trachea and esophagus. It appears to be mildly compressing the trachea. The left coronary artery arises from the left aortic cusp, and the right coronary artery arises from the right aortic cusp.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC is normal in size and drain normally into the right atrium. The innominate vein is significantly narrowed near the junction of the SVC. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral breast implants are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with normal systolic function (EF = 60%).2. Normal RV size with hyperdynamic systolic function (EF = 65%).3. Right sided aortic arch. The left subclavian artery originates from the right sided descending aorta and travels posterior to the trachea and esophagus. It appears to be mildly compressing the trachea. 4. Innominate vein is significantly narrowed at the junction of the SVC. 5. No cardiac shunts are noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 27-year-old male with abdominal pain. Evaluate for small bowel inflammation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant bowel wall thickening or enhancement.


Instruction: Generate impression based on findings.

Input: There is markedly bone marrow which is of slightly lower signal intensity than expected on T1 and T2 weighted imaging. There are multiple enhancing lesions within thoracic vertebral bodies. The largest of these involve T8, T10, and T11. At T11 there is minimal disruption of the posterior vertebral body cortex without significant epidural extension. There is also a mildly enhancing right paraspinal mass centered at T7-T8 that measures 5 x 36 mm in the axial plane. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The imaged spinal cord displays normal signal and morphology. There is a T2 hyperintense nonenhancing well-defined nodule in the posterior subcutaneous soft tissues at the T6 level that likely represents a cyst.

Output: 1.Thoracic vertebral body and paraspinal metastases with minimal posterior cortical disruption at T11 but without significant epidural extension or spinal canal stenosis.2.Heterogeneous and altered bone marrow signal intensity may be related to treatment effects.


Instruction: Generate impression based on findings.

Input: Developmental delay and Sandifer's syndrome. Evaluate for sequela of HIE versus dysplastic brain. There is no significant interval change in the dysplastic appearance of the brain. Again seen is asymmetric dilatation of the right lateral ventricle. The left putamen appears enlarged and abnormally shapred, and the lentiform nuclei on the left collectively seem to wrap around the left frontal horn suggesting dysplasia. There are several foci of T2 hyperintensity in the periventricular white matter of the bilateral cerebral hemispheres are well as subcortical white matter of the bilateral anterior frontal lobes, left greater than right. The gyration pattern of the cerebral hemisphere is otherwise grossly unremarkable. The myelination pattern is appropriate for age. The brainstem is hypoplastic and most pronounced in the pons. In addition, the right half of the brainstem appears to be slightly larger than the left side. There is a left choroidal fissure cyst.The cerebellum also appears to be dysplastic, in which the right hemisphere is larger than the left and associated anomalous foliation pattern. The inferior cerebellar vermis lobules also appear somewhat underdeveloped. The fourth ventricle appears enlarged. The corpus callosum is fully formed, but appears to be slightly smaller than normal. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The major cerebral flow voids appear to be grossly intact. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No significant interval change in the appearance of abnormal brain morphology, which is likely at least partly congenital and related to dysplasia or maldevelopment.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with history of chronic lumbar pain and spinal stenosis. A dextroscoliosis of the lumbar spine is seen centered at L3-4. There may also be a slight anterolisthesis of L4 relative to L5. The L5 vertebral body demonstrates a transitional morphology.No evidence of concerning marrow replacement or significant marrow edema is seen. Degenerative endplate irregularity is pronounced at L3-4 and L4-5. All lumbar discs, with the exception of L5-S1, show some reduction in height and T2 signal intensity.Visualized spinal cord and conus are unremarkable. The nerve roots of the cauda equina are crowded at several levels due to degenerative disease and prominence of the epidural fat as detailed below.T12-L1: Facet hypertrophy. Right greater than left ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis.L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disc asymmetric to the left. Prominence of the epidural fat. Generalized mild spinal canal narrowing with particular narrowing of the left lateral recess. Moderate bilateral foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Prominence of the epidural fat. Moderate generalized spinal canal narrowing with crowding of the cauda equina. Moderate bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Prominence of the epidural fat. Severe generalized canal stenosis with crowding of the cauda equina. Severe left and moderate right foraminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening, particularly on the left but there is a facet effusion . Bulging disc. Severe generalized spinal canal stenosis with crowding of the cauda equina. Severe bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Prominence of the epidural fat. Moderate spinal canal narrowing with some crowding of the cauda equina nerve roots. Severe right and moderate left foraminal narrowing.

Output: 1.Dextroscoliosis of the lumbar spine.2.Advanced disc degeneration at L3-4 and L4-5. Disc disease as well as posterior element hypertrophy and prominence of the epidural fat contribute to severe narrowing of the thecal sac and crowding of the cauda equina. Significant neuroforaminal narrowing is also evident at these levels.3.The remaining lumbar levels show a less severe reduction in spinal canal caliber, again due to disc degeneration, posterior element hypertrophy and prominence of the epidural fat.


Instruction: Generate impression based on findings.

Input: Thoracic: There is a severe compression fracture involving the T11 vertebral body with approximately 80% loss of height. There is no associated edema. There is mild compression fracture involving the T12 vertebral body with also evidence of a Schmorl's node involving the superior endplate. Small Schmorl's node is also evident involving the superior endplate of T6. These findings are all not significantly changed since CT dated 8/14/2015. Remainder of the thoracic vertebral body heights are normal. There is exaggerated thoracic kyphosis at the T11 level. There is severe disc height loss at the T10-T11 level above the severe compression fracture with partial fusion across the anterior aspect of the disc space better seen on prior CT. Mild multilevel degenerative changes are present in the remainder of the thoracic spine including minimal disc bulges and mild multilevel facet arthropathy and ligamentum flavum thickening. There is no significant spinal canal stenosis at any level. No high-grade neural foraminal stenosis is evident.Bone marrow signal is benign. No cord signal abnormality. Lumbar: There is a compression fracture involving the L2 vertebral body with up to 40% loss of height. There is edema within the vertebral body consistent with recent height loss. The compression fracture is new since CT dated 11/16/2016. There is a Schmorl's mode involving the anterior superior endplate of L5 with minimal loss of height involving the ventral aspect of the L5 vertebral body. Remainder of the vertebral body heights are maintained. Bone marrow signal is benign. Conus is in normal position.There is no significant spinal canal stenosis at any level in the lumbar spine. There is exaggeration of lumbar lordosis, levocurvature of the lower lumbar spine as well as grade 1 anterolisthesis of L4 and L5. There is mild to moderate right-sided and minimal left neural foraminal stenosis at the L4-L5 level related to severe facet arthropathy at this level, grade 1 anterolisthesis, disc bulge eccentric to the right and scoliosis. Moderate to severe facet arthropathy is also present bilaterally at the L5-S1 level and to a mild degree in the upper lumbar spine.There are bilateral renal cysts.

Output: 1. Multiple benign-appearing thoracic and lumbar compression fractures. The L2 vertebral body compression fracture is new since CT dated 11/16/2016 and appears slightly worse since radiograph dated 12/6/2016. There is edema within the L2 vertebral body. 2. There is a severe chronic compression fracture involving the T11 vertebral body with associated exaggerated kyphosis of the lower thoracic spine. Mild chronic compression fractures are present at T12 and L5 levels. There is no edema associated with these vertebral body compression fractures.3. Additional degenerative changes as described above. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: There are 5 lumbar type vertebral bodies. There is cement within the T11 and T12 vertebral bodies. There are unchanged moderate to severe compression deformities of the T11-L4 vertebral bodies. There is also mild compression deformity of the L5 vertebral body. There is a focal kyphosis at the T12-L1 level, where there is retropulsion of the T12 vertebral body into the spinal canal with slight indentation of the spinal cord, but there is no abnormal signal within the spinal cord. There is no bone marrow edema to suggest acute vertebral body fracture. Furthermore, there has been interval involution of a sacral lesion. There is multilevel degenerative spondylosis, with variable degrees of neural foraminal and spinal canal narrowing at multiple levels. The paraspinal contents are unremarkable. There is a subcentimeter probable cyst in the right kidney. There appear to be gallstones.

Output: 1.Retropulsion of the T12 vertebral body fracture fragment into the spinal canal with slight indentation of the spinal cord, which appears to have minimally progressed since 2013.2.Chronic vertebral body compression deformities without evidence of acute fracture.3.Interval involution of a sacral lesion.4.Multilevel degenerative spondylosis, with variable degrees of neural foraminal and spinal canal narrowing at multiple levels. 5.Cholelithiasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Altered mental status, check for masses, fluid. There is a subcentimeter focus of susceptibility weighted artifact with surrounding hyperintensity is seen along the left centrum semiovale. There is also a subcentimeter lesion in the right posterior corpus callosum. There is no midline shift. There is no evidence of acute infarction. The ventricles, sulci, and cisterns are within normal limits in size and configuration.

Output: Abridged MRI due to inability of the patient to complete the prescribed sequences. Two subcentimeter brain lesions are incompletely evaluated; however, given the patient's history of malignancy, these may represent metastatic lesions and further evaluation with complete MRI brain with and without intravenous contrast is recommended once the patient is able to tolerate the exam.


Instruction: Generate impression based on findings.

Input: History of low back pain, evaluate for lymphadenopathy. There is levorotoscoliosis centered at L2-3. There is grade 1 anterolisthesis of L4 over L5. The imaged portions of the spinal cord is unremarkable. There vertebral body heights are preserved and the vertebral bone marrow signal is unremarkable, including focal fat or hemangiomas. There is mild lower lumbar epidural lipomatosis. There is multilevel vacuum disc phenomenon. At T12-L1, there is no significant spinal canal or neural foramen stenosis. At L1-L2, there is ligamental thickening and facet arthropathy and a disc bulge with mild right neural foraminal stenosis, but no spinal canal or neural foraminal stenosis. At L2-L3, there is a disc bulge, ligamentum flavum hypertrophy, and facet arthropathy with moderate right neural foraminal narrowing and slight spinal canal narrowing. At L3-L4, there is a disc bulge, ligamentum flavum hypertrophy, and facet arthropathy with severe left foraminal stenosis and mild right foraminal stenosis, as well as mild narrowing of the spinal canal. At L4-L5, there is a disc bulge with mild narrowing of the left neural foramina and moderate to severe narrowing of the spinal canal, but no significant narrowing of the right neural foramen. At L5-S1, there is a disc bulge, ligamentum flavum hypertrophy, and facet arthropathy with moderate narrowing of the left neural foramen and mild to moderate spinal canal stenosis. There is diffuse paraspinal muscle atrophy.

Output: 1. Levorotoscoliosis and grade 1 anterolisthesis of L4 on L5.2. Multilevel degenerative spondylosis that is most pronounced at the L3-4 and L4-5 levels.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Recent Chiari surgery: apnea. There are postoperative findings related to Chiari decompression surgery. There is minimal high T2 signal in the inferior cerebellar hemispheres bilaterally. There is no evidence of acute infarct. The supratentorial brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to Chiari decompression surgery without evidence of brainstem lesions.


Instruction: Generate impression based on findings.

Input: 67 years Female (DOB:1/19/1949)Reason: r/o stroke History: slurred speech, mouth autotomatismsPROVIDER/ATTENDING NAME: ANTON M CHIVU MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is small. The posterior communicating arteries are very small. The vertebral arteries are similar in size. There is extracranial origin of the left posterior inferior cerebellar artery present.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for intracranial or extracranial cerebrovascular occlusive disease.2.No evidence for acute ischemic cerebral infarction.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Gliomatosis cerebri. The peripheral enhancement associated with a small lesion in the left thalamus has resolved and there is minimal residual T2 hyperintensity in this location. Otherwise, there are stable post-treatment findings in the brain and unchanged diffuse T2 hyperintensity involving the anterior cerebral hemispheres bilaterally with multiple cystic cavities. There is no evidence of associated abnormal intraparenchymal enhancement. There is a subcentimeter T1 hyperintense lesion in the left posterior body of the corpus callosum, which is compatible with a cavernous malformation. A punctate focus of susceptibility effect in the right posterior corpus callosum may also represent a cavernous malformation. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with diffuse cerebral volume loss. There is no midline shift or herniation. The skull appears unchanged. There is scattered paranasal sinus mucosal thickening and secretions.

Output: 1. The peripheral enhancement associated with a small lesion in the left thalamus has resolved and there is minimal residual T2 hyperintensity in this location, suggesting that this may have been a prior subacute lacunar infarct or evolving radiation necrosis. Stable post-treatment findings without evidence of tumor progression.2. Suggestion of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Stated history of lower abdominal wall hernia.The patient this is adjacent to the umbilicus. The patient is a weightlifter. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a very small 8 mm facial defect at the level of the umbilicus compatible with a small hernia without evidence of complication. OTHER: Note is made of right lower lobe consolidation suspicious for infection.

Output: 1.Right lower lobe consolidation suspicious for pneumonia. This incidental finding was discussed with the ordering provider Kristen Lipstreuer at 1000 on 11/18/2015. The patient was also informed of the finding and was recommended to see his physician. 2.Very small 8 mm umbilical hernia without evidence of complication on this non-stress examination.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect or midline shift. There is an enhancing region in the left anterior temporal lobe measuring 6 mm compared to 8 mm previously and more homogeneously enhancing internally. A second left anterior temporal lobe focus of enhancement more inferiorly is less well defined and probably unchanged. There are numerous scattered bilateral punctate to small foci of susceptibility effect are grossly unchanged. There is an unchanged 6 x 5 mm left intraconal orbital enhancing metastasis. There are multiple calvarial metastases including a lesion at the vertex of the skull, left frontal bone and the left pterion which are unchanged in size; however the left frontal lesion and lesion at the vertex enhance significantly less compared to the prior exam. There is persistent left greater than right mastoid opacification which is overall decreased.

Output: 1.No new intracranial metastases.2.Stable to slightly smaller metastases in the left anterior temporal lobe and the calvarium (in terms of size), but with different enhancement characteristics as described above.3.Stable small left intraconal orbital metastatic nodule.4.No acute infarct, mass effect or midline shift.


Instruction: Generate impression based on findings.

Input: 60 yo M with h/o AML with relapsed disease now with lower worsening back pain x 1 month after recent BM bx on L posterior iliac. 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. In general the marrow signal is low diffusely.At L5-S1 there is anterior subluxation of L5 on S1 associated with elongation of the AP dimension of the spinal canal, disc desiccation, uncovering of the disc and narrowing of the neural foramina bilaterally. L5 is subluxed approximately 16 mm anteriorly relative to S1.There is T2 signal hyperintensity present in the adjacent vertebral bodies and some mild enhancement of the tissue surrounding the S1 segment and of the L5-S1 disc space. There is ligamentum flavum hypertrophy present at this level There is encroachment of the exiting nerve roots bilaterally within the neural foramina at this level and narrowing of the width of the spinal canal resulting in an element of spinal stenosis from left to right. At L4-5 there is no significant compromise to neural foramina. There is a disc bulge present at this level as well as bilateral facet hypertrophy there is narrowing of the spinal canal and partial effacement of the fat at the lateral recesses at this level with associated mild-to-moderate spinal stenosis.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level as well as bilateral facet hypertrophy which is worse on the right compared to the left.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a spondylolysis with spondylolisthesis present at L5-S1 associated bilateral neural foramen encroachment and spinal canal stenosis. L5 is subluxed approximately 16 mm anteriorly relative to S1. There are associated inflammatory type change at this level.2.There is mild to moderate spinal stenosis at L4-5 related to facet hypertrophy and to a lesser degree disc bulge.3.There is diffuse marrow replacement present which is a nonspecific finding. Given the patient's history of AML this is the most likely cause.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained.  DynaCad was used to localize the right base of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the right side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the right base prostate gland lesion.


Instruction: Generate impression based on findings.

Input: TIA symptoms: facial droop. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered bilateral cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. Mild scattered bilateral cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syringomyelia and syringobulbiaClinical question: hx of lumbar syringomyelia, assess for any changesSigns and Symptoms: lower back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The distal spinal cord demonstrates a syrinx at the T11 and T12 vertebral levels measuring approximately 3 x 1.5 mm axial dimensions on the current exam and the same on the 10/16/2015 exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: The patient has a known small syrinx measuring approximately 3 mm x 1.5 mm axial dimensions in the distal spinal cord is stable compared to the 10/16/2015 exam.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:9/15/1980)Reason: Please evaluate for obstruction or hydrocephalus History: Intractable migraine headaches, history of epileptic seizures, current pseudoseizuresPROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Several nodules in the right and left parotid gland appears stable when compared to the prior exam.

Output: 1.There is no evidence for ventriculomegaly and no intracranial mass lesion to explain the patient's seizures or headaches.2.Parotid gland nodules are stable compared to the prior exam and most likely represent normal sized lymph nodes.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of right frontotemporal craniotomy for resection of sphenoid wing meningioma. Again seen is dural based thickening in the right middle cranial fossa measuring 7 to 8 mm in thickness, extending medially into the right paraclinoid region, and abutting the superior and inferior orbital fissures as well as the foramen rotundum on the right. The lesion demonstrates mild gradual enlargement especially when compared to 2/3/2015. In its medial aspect, the lesion measures 8x11 mm in the AP and CC dimension, 4 mm x 10 mm in this location on study from 2/3/2015.Again seen is encephalomalacia involving the right anterior temporal lobe similar to prior as well as a tiny focus involving the right anterior frontal lobe which is likely postsurgical. Remainder of the brain parenchyma appears unremarkable. No hydrocephalus. No extra-axial collections. Aside from aforementioned postsurgical changes, calvarium and extracranial soft tissues are unremarkable.

Output: Compared to 2/3/2015 and 9/9/2015, there is mild gradual enlargement of the previously seen residual meningioma in the right middle cranial fossa extending into the paraclinoid region, particularly in its medial aspect.


Instruction: Generate impression based on findings.

Input: 51-year-old female with right shoulder pain and clinical concern for rotator cuff tear. ROTATOR CUFF: There is intermediate signal intensity within the distal fibers of the supraspinatus tendon near its insertion as well as a small amount of fluid within the subacromial/subdeltoid bursa indicating a full-thickness tear. Additionally, there is undersurface fraying of the supraspinatus tendon. There is no evidence of tendon retraction.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The posterior labrum appears somewhat diminutive, but there is no evidence of labral tear.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Supraspinatus tendinosis and full-thickness tear without evidence of tendon retraction. Grossly intact glenoid labrum.


Instruction: Generate impression based on findings.

Input: A 30 year old female with suspected post-partum cardiomyopathy and complaints of palpitations and PVCs on the ECG. Referred to cardiac MRI to evaluate etiology Left VentricleThe left ventricle is normal in size with borderline systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 159 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 79 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 82 g (normal range 114+/-24). There is global mild hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 135 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 65 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is mild pericardial fat.Extracardiac FindingsBilateral enlarged kidneys multiple cysts of various sizes. Several T2 sigh signal lesions occupy the liver, none in the pancreas. Recommend dedicated renal MRI to further characterize.

Output: 1. The left ventricle is normal in size with borderline systolic function. The LVEF is 50%. There is global mild hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size and systolic function. The RVEF is 54%.3. Bilateral enlarged kidneys with cysts of various sizes, along with multiple cysts in in the hepatic parenchyma. Recommend dedicated renal MRI, as polycystic kidney disease is suspected.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of pituitary glandClinical question: pituitary adenomaSigns and Symptoms: headaches There is a 6 mm x 7 mm T1 and T2 hyperintense lesion present within the right half of the pituitary gland centered within a nonenhancing cystic-appearing mass which was described on the prior exam.The pituitary gland is appropriate in overall height. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally.

Output: Findings suggest subacute hemorrhage within the previously noted pituitary lesion. Please correlate with clinical symptoms for possible pituitary apoplexy.


Instruction: Generate impression based on findings.

Input: History of partial small bowel obstruction and prior CT. History of colonic ulcers. Evaluate for small bowel inflammation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is adequately distended with oral contrast. It is normal in caliber, wall thickness and without adjacent inflammatory changes. No abnormal restricted diffusion or postcontrast enhancement. No free or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of small bowel inflammation.


Instruction: Generate impression based on findings.

Input: Female, 47 years old. Reason: thyroid nodule on left lobe RIGHT LOBE MEASUREMENTS: 5.6 x 1.6 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.7 x 1.6 x 2.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Marked diffuse heterogeneity, with decreased vascularity.LEFT LOBE: Marked diffuse heterogeneity, with decreased vascularity. A left lower pole nodule measures 1.9 x 1.2 x 1.6 cm, predominately solid with cystic component and a hypoechoic rim, noncalcified, with peripheral vascularity.ISTHMUS: Marked diffuse heterogeneity, with decreased vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Nonenlarged cervical lymph nodes are identified. A right level 5 lymph node measures 1.6 x 0.5 x 1.0 cm. A left level 5 lymph node measures 1.8 to 0.4 x 0.8 cm.OTHER: No significant abnormality noted.

Output: 1.A 1-2 cm left lower pole thyroid nodule is amenable to biopsy if clinically indicated.2.Marked diffuse heterogeneity of the thyroid gland suggestive of thyroiditis. Hypovascularity of the gland suggests non-active phase of the disease.


Instruction: Generate impression based on findings.

Input: 47 years Male (DOB:12/19/1968)Reason: please do dr javed MS protocol History: MS worsening gaitPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD SERVICES ANCILLARY The thoracic vertebral bodies are appropriate in the overall alignment and height. There is CSF flow artifact, phase encoding artifact and breathing artifact which is superimposed on the spinal cord and may obscure underlying lesions. Example and distal spinal cord there is signal hyperintensity superimposed on the T2 sagittal images which are not readily appreciated on the axial T2 images. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: To the extent of visualization no abnormal lesions are clearly appreciated in the thoracic spine though there is a significant amount of artifact which may obscure some lesions. For example is not clear whether there is a distal spinal cord lesion present.


Instruction: Generate impression based on findings.

Input: Reason: prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.0 x 4.1 x 4.4 cm.Peripheral Zone: There is diffusely decreased T2 and ADC signal throughout the bilateral peripheral zones compatible with neoplasm.Central Gland: Punctate foci of intrinsic T1 shortening within the left side of the central gland likely related to blood products from prior biopsy. There is heterogeneously decreased T2 and ADC signal throughout the central gland compatible with neoplasm.Seminal Vesicles: There is abnormal signal within the inferior portions of the bilateral seminal vesicles compatible with neoplastic infiltration.Extracapsular Extension: The posterior prostatic capsule is indistinct in several areas bilaterally suggestive of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: There is a nonspecific 7 x 7 mm right internal iliac lymph node.BONES, SOFT TISSUES: The bone marrow is somewhat heterogeneous, but no focal discrete lesions are identified.OTHER: Colonic diverticulosis.

Output: Abnormal signal throughout the prostate compatible with neoplasm with extension into the bilateral seminal vesicles as well as probable extracapsular extension.


Instruction: Generate impression based on findings.

Input: History of dysuria and vaginal pain. Evaluate extent of disease. History of ovarian cancer status post hysterectomy and renal therapy. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. In the right aspect of the vaginal cuff there is a 2.9 x 2.3 x 2.9 cm soft tissue mass (series 401/25) demonstrating heterogeneous postcontrast enhancement compatible with local tumor recurrence. The mass invades the anterior wall of the rectum. The lesion encases the bilateral ureters which contain nephroureteral stents. Additionally the tumor invades the dorsal wall of the urinary bladder. The margins demonstrate soft tissue spiculation.BLADDER: See discussion aboveLYMPH NODES: Small left inguinal lymph nodes.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 2.9 cm vaginal cuff tumor recurrence invading the anterior wall of the rectum, dorsal wall of the urinary bladder and encasing the ureters.


Instruction: Generate impression based on findings.

Input: 63-year-old female with history of pancreatic cyst, evaluate for changes and/or abnormalities ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Nonenhancing cystic lesion in the distal pancreatic body measuring up to 7 mm (series 8, image 14), which appears to communicate with the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cystic pancreatic lesion in the distal pancreatic body; favor an IPMN.


Instruction: Generate impression based on findings.

Input: 57 year old female patient with new diagnosis of breast cancer. Bilateral breast reduction. Family history of breast and ovarian cancer. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are scattered cysts in the bilateral breasts. There is an enhancing focus in the 11:30 position of the right breast that measures 2 x 4 x 4 mm (AP x ML x CC) corresponding to patient's known cancer. There is a clip along the posterolateral aspect of the focus.There is a lobulated gradually enhancing lesion in the central right breast with dark internal septations that measures 9 x 8 x 10 mm (AP x ML x CC) consistent with a fibroadenoma. A similar benign morphology focus in the 9 o'clock position of the left breast is noted with a hypointense correlate on T2 weighted sequences. No suspicious abnormal enhancement is seen in the right breast.No abnormal lymph nodes are identified in either axillary region.There are two T2 hyperintense lesions in the right lobe of the liver that most likely represent cysts or hemangiomas.

Output: 1.Enhancing focus measuring 2 x 4 x 4 mm in the 11:30 position of the right breast with clip along the posterolateral aspect correlates with patient's known cancer. No abnormal lymphadenopathy noted.2.Benign morphology lesions most likely representing fibroadenomas are seen bilaterally.3.Two T2 hyperintense lesions in the right lobe of the liver most likely represent cysts or hemangiomas.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 37 year-old male, unable to bear weight with pain at rest and with internal rotation, history of skiing injury MENISCI: There is obliquely oriented signal abnormality within the posterior horn of the lateral meniscus extending to the tibial articular surface consistent with a tear.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. There is mild edema within the posterolateral tibial condyle and anterolateral femoral condyle.LIGAMENTS: The ACL is torn. The PCL is intact. There extensive edema along the posterolateral knee extending along the femoral fibular ligament, which is at least partially torn. The popliteal fibular ligament is also likely torn. The posterolateral joint capsule appears disrupted. Edema extends along the lateral fascia and within the adjacent muscles. There is edema extending along the medial collateral ligament consistent with a sprain, with some fibers remaining intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. ACL tear.2. Findings consistent with a posterolateral corner injury as described above as well as an MCL sprain.3. Obliquely oriented tear within the posterior horn of the lateral meniscus.4. Large joint effusion


Instruction: Generate impression based on findings.

Input: 8 years of low back pain, assess for stenosis or nerve compression. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: 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: There is a right paracentral disc extrusion with mild superior migration. There is partial effacement of the right lateral recess but no significant central spinal canal stenosis. Neural foramina are also patent. There is suggestion of a tiny, 2 mm, cyst (possibly synovial cyst) adjacent to the ligamentum flavum on the left with minimal, if any mass effect on the adjacent cauda equina nerve roots.L5-S1: Small central/right paracentral disc protrusion. No significant spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Right paracentral disc extrusion at the L4-L5 level and smaller disc protrusion at the L5-S1 level. There is partial effacement of the right lateral recess at the L4-L5 level. Central spinal canal and neural foramina in the lumbar spine remain patent.


Instruction: Generate impression based on findings.

Input: 72-year-old man with history of prostate cancer status post prostatectomy, please evaluate for recurrence or regional lymphadenopathy. PELVIS:PROSTATE: Patient is status post prostatectomy. There is slight distortion in the left base of penis but no evidence of local recurrence.BLADDER: No significant abnormality noted of the bladder neck or urethra.LYMPH NODES: Small lymph nodes are noted measuring up to 1 cm in short axis.BONES, SOFT TISSUES: There is enhancement at the origin of the hamstring muscles on the right initial tuberosity (series 1801, image 63). No osseous lesions are identified.OTHER: No significant abnormality noted.

Output: 1.No evidence of local recurrence or regional lymphadenopathy.2.Enhancement at the right hamstring origin, likely tendinopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: Right eye optic neuritis symptoms, history of MS, right arm numbness. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination redemonstrates minimal chronic nonenhancing changes of demyelinating disease and supratentorial brain parenchyma without convincing evidence of change/progression since prior study. Unremarkable anatomical morphology and signal intensity of brain parenchyma otherwise on all MRI sequences and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.Normal signal intensity of the calvarium and soft tissues of the scalp without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Pre and post enhanced cervical MRI:Examination is degraded due to motion artifact and suboptimal for detection of subtle findings.Within this limitation there is normal signal intensity and caliber of cervical and without enhancement.The upper most visualized thoracic cord however demonstrate a focus of T2 hyperintensity in the anteriorly at T3-T4 disc level (sagittal T2 STIR series 1701 image 11). This finding demonstrate no change in the caliber of the cord or abnormal enhancement. Prior cervical MRI from 2013 did not include this region and there are no prior thoracic spine MRIs.There is normal signal intensity and alignment of vertebral column without spinal stenosis or neural foraminal compromise.

Output: 1.Brain MRI demonstrate stable mild chronic findings of demyelinating disease in the supratentorial brain parenchyma and unremarkable otherwise.2.Cervical MRI demonstrate a single nonenhancing lesion in the anterior thoracic cord at T3-T4 disc level and unremarkable otherwise.


Instruction: Generate impression based on findings.

Input: History of discitis osteomyelitis with antibiotic treatment for 8 weeks. There is diffuse edema and enhancement involving the T7 and T8 vertebral bodies. The vertebral body heights are preserved. There is enhancement of the surrounding paraspinal soft tissues as well as a small amount of enhancement extending into the epidural space, improved since prior examination. The T7-8 intervertebral disc demonstrates mild postcontrast enhancement however edema within the disc space has improved. The thoracic spinal cord demonstrates normal signal and morphology.The thoracic kyphosis is preserved. The vertebral body heights are maintained. There is mild extrusion of the T7-8 intervertebral disc resulting in mild effacement of the ventral thecal sac and mild right neuroforaminal stenosis. There is a small T8-9 disc protrusion without significant spinal or neuroforaminal stenosis.Scout views of the lumbar spine demonstrate large superior endplate Schmorl's nodes are visualized in the thoracolumbar spine. There is an approximately 50% chronic appearing compression deformity of the L4 vertebral body seen only on scout views. There is mild anterolisthesis of L5 over S1. Multilevel disc herniations are visualized throughout the lumbar spine. There is a probable hemangioma in the L1 vertebral body.

Output: 1.Findings consistent with T7-8 osteomyelitis. There has been improvement of paraspinal and epidural enhancement consistent with treatment related change. The T7-8 intervertebral disc demonstrates only mild enhancement with improved edema which was only mild on the original examination. With this constellation of imaging features tuberculous osteomyelitis is included within the infectious differential diagnosis for discitis/osteomyelitis.2.There is an approximately 50% chronic appearing compression deformity of the L4 vertebral body seen only on scout views. Multiple large Schmorl's nodes are visualized in the thoracolumbar spine. There are multilevel degenerative changes throughout the lumbar spine which can be further evaluated with dedicated lumbar spine MRI.


Instruction: Generate impression based on findings.

Input: 77-year-old female with history of lung cancer and probable metastases in left anterior pons Previously described on the recent MRI left anterior pons hemorrhagic lesion appears hyperdense on the nonenhanced CT and it is associated with extensive areas of hypoattenuation involving the pons, mid brain, cerebellum, left thalamus, and posterior limb of the internal capsule. There is no evidence of other hemorrhagic foci in the brain parenchyma. There is no evidence of extra axial fluid collection/hemorrhage or midline shift. The ventricles and basal cisterns are normal in size and configuration.Again noted diffuse calvarial diploic widening, coarsened trabecula and thick cortices with focal areas of sclerotic lesions that are stable compared to prior examination compatible with Paget's disease. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.Stable hyperdense lesion in anterior pons associated with extensive vasogenic edema corresponding to the hemorrhagic lesions seen on recent MRI. No other foci of intraparenchymal high density suggestive of hemorrhage are identified.2.Paget's disease involving the skull.


Instruction: Generate impression based on findings.

Input: 61-year-old female with severe pain and swelling on Humira. History of RA. Assess for synovitis. MENISCI: There is increased signal abnormality and blunting of the posterior horn of the medial meniscus which extends to the tibial articular surface consistent with degeneration/tearing which extends to the body of the meniscus. The anterior horn appears intact. There is linear increased signal abnormality which traverses a blunted anterior horn of the lateral meniscus extending to the tibial and femoral articular surface consistent with degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is subjective thinning of the articular cartilage of the lateral tibiofemoral compartment. There is subchondral signal abnormality within the lateral tibial plateau and lateral femoral condyle, likely degenerative in etiology.There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle. There is subchondral signal abnormality within the medial femoral condyle and medial tibial plateau, likely degenerative in etiologyThere is a partial-thickness articular cartilage cleft along the lateral facet of the patella. There is near full articular cartilage degeneration along the medial facet of the patella and medial facet of the femoral trochlea with underlying subchondral signal abnormality, likely degenerative in etiology.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings consistent with synovitis with a moderate sized joint effusion. Degeneration/tearing of the medial and lateral meniscus as described above. Full-thickness articular cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Male, 34 years old. Reason: Rotator cuff tear? History: Pain > 90 ROTATOR CUFF: There is mild edema within the superficial aspects of the supraspinatus and infraspinatus muscles, more prominently near the myotendinous junction. There is minimal tendinopathy of the infraspinatus tendon, but no discrete tear is identified. The supraspinatus tendon is intact. The subscapularis and teres minor muscles and tendons are intact.SUPRASPINATUS OUTLET: There is marked bone marrow edema involving the clavicular head and the acromion process, with associated thickening and increased signal of the superior aspect of the acromioclavicular ligament.GLENOHUMERAL JOINT AND GLENOID LABRUM: The ABER view is nondiagnostic. The articular cartilage and glenoid labrum are grossly intact, within the limits of nonarthrogram study.BICEPS TENDON: The tendon of the long head of the biceps is normal. ADDITIONAL

Output: 1.Marked bone marrow edema at the acromioclavicular joint is nonspecific but may be due to repeated trauma or inflammatory process. If symptoms are unilateral, this increases concern for a more acute process such as infection.2.Mild edema involving the superficial aspects of the supraspinatus and infraspinatus muscles of uncertain etiology, but may be secondary to adjacent inflammatory changes from the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: 71-year-old male with acute altered mental status. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. No evidence of acute cortical ischemia. Multifocal regions of patchy low attenuation throughout the periventricular and subcortical deep white matter, nonspecific, however most likely secondary to small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.Focal region of encephalomalacia along the left temporoparietal region, not grossly changed compared with the previous examination of 4/23/2005.The ventricles and basal cisterns are mildly enlarged secondary to volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute cortical infarction. Left temporoparietal encephalomalacia secondary to previous infarction. Diffuse white matter change most likely secondary to small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.3. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 63 year old male with a history of coronary artery disease, hypertension, hyperlipidemia, diabetes. Patient is s/p myocardial infarction in 7/2016 s/p PCI to LAD, s/p PCI to left circumflex in 8/2016, chronic total occlusion of RCA. Left VentricleThe left ventricle is moderately dilated and severely reduced systolic function. The overall LV ejection fraction is 25%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 274 ml (normal range 142+/-34), the LV end systolic volume index is 98 ml/m2 (normal range 25+/-9), the LVESV is 206 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 107 g (normal range 164+/-36). There is global hypokinesis with akinesis of the mid anteroseptum and the apical anterior and septal walls. There is a transmural myocardial infarction involving the mid anteroseptum and apical anterior and septal walls. These segments are not likely to be viable. There is another small focal basal anterior myocardial infarction which is transmural and not likely to be viable. There is also third region of late gadolinium enhancement which involves the epicardium of the basal 2cm of the inferior and inferolateral walls. The pattern of late gadolinium enhancement is not consistent with prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There are large territories of myocardium which are free of myocardial infarction and likely to be viable (Most of RCA and LCX territory and most of the proximal and LAD territory). The native myocardial T1 relaxation times are mild to moderately increased (1100-1200msec suggesting diffuse myocardial fibrosis). There is no evidence of myocardial iron overload. No LV thrombus noted. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 134 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 61 ml (normal range 54+/-17).Right AtriumThe right atrium is normal sized.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with severely reduced systolic function (LVEF 25%). The LV dysfunction is likely due to a dual pathology (ischemic and non-ischemic). There is a small transmural myocardial infarction in the basal anterior wall and a second larger transmural myocardial infarction involving the distal LAD territory. These territories are not likely to be viable. The remainder of the myocardium (most of RCA and LCx and some of proximal and mid LAD territory) is free of myocardial infarction and likely to be viable. There is also epicardial late gadolinium enhancement involving the basal 2cm of the inferior and inferolateral walls. This pattern is not consistent with prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is normal in size and systolic function (RVEF 55%). 3. There is mild to moderate mitral 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: 28-year-old female with foot pain. Evaluate for talus or metatarsal fracture. TENDONS: The flexor and extensor tendons appear intact.LIGAMENTS: The lateral collateral ligament complex and distal tibiofibular syndesmosis appear intact. The deltoid ligament is within normal limits.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No acute fracture is seen. The talar dome is normal in appearance. No evidence to suggest an osteochondral defect.ADDITIONAL

Output: Diffuse increased signal abnormality within the muscle belly of the flexor hallucis longus is nonspecific but can be seen in myositis. No evidence of acute fracture, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Reason: amenorrhea; evaluated for pituitary, hypothalamic mass History: amenorrhea Exam aborted due to patient claustrophobia and only limited T1 weighted axial and sagittal images were obtained. There is no obvious large mass in the suprasellar cistern or large pituitary macroadenoma, however evaluation is severely limited due to lack of T2 and postcontrast sequences. Ventricles are grossly normal in configuration. Midline structures are intact.

Output: Exam aborted due to patient claustrophobia and only limited sequences obtained. No obvious abnormality on this severely limited exam, however a microadenoma cannot be evaluated with these sequences.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is trace fluid within the subacromial/subdeltoid bursa of doubtful significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a tear of the superior labrum with paralabral cyst formation along the posterior superior aspect of the glenoid. The glenohumeral joint alignment is within normal limits. The articular cartilage appears intact. There is no effusion.BICEPS TENDON: There may be mild tendinosis of the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular sulcus.ADDITIONAL

Output: Superior labral tear with paralabral cyst formation.


Instruction: Generate impression based on findings.

Input: Reason: ap lateral views flexion and extension. history of fracture History: history of fracture of l5 Mild leftward curvature affects the lumbar spine. There appear to be 5 lumbar-type vertebral bodies. Of note, what was previously identified as the L5 vertebral body actually appears to be the L4 vertebral body. Partial collapse of the L4 vertebral body reflects prior fracture and does not appear significantly changed compared to the prior MRI. A distinct fracture line is not visible, suggesting healing. The vertebral body heights are otherwise maintained. The L4 vertebral body appears stable on the flexion and extension views. There is grade 1 retrolisthesis L1 over L2. Moderate facet joint osteoarthritis and degenerative disc disease affects the lower lumbar spine.

Output: Stable healing fracture of the L4 vertebral body as above.


Instruction: Generate impression based on findings.

Input: Reason: r/o ligamentous tear History: persistent pain and swelling after fall two months ago MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness degeneration of the articular cartilage of the patella, centrally, with possible full-thickness fissuring/delamination. There is subchondral signal abnormality in the underlying bone which is likely degenerative. There is relative sparing of the medial and lateral compartment articular cartilage.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. There is increased signal intensity between the prepatellar fibers of the rectus femoris and the underlying patella that may represent mild stripping. ADDITIONAL

Output: 1. Heterogeneous collection within the subcutaneous fat anterior to the patella likely representing a hematoma or perhaps a chronic bursitis with additional subcutaneous edema extending along the patellar tendon into the anterior soft tissues of the leg.2. Degeneration of the articular cartilage of the patella and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: concern for rotator cuff tear History: Pain Some sequences are limited by patient motion artifact.ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus and infraspinatus tendons suggesting mild tendinosis, but we see no tear. On the fat suppressed T2-weighted images, there is slight increase in signal intensity of the infraspinatus as well as the proximal belly of the supraspinatus, and to a lesser degree the posterior fibers of the deltoid musculature. We see no frank fatty atrophy on the T1-weighted images. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is mild edema type signal within the subdeltoid bursa which may reflect mild inflammation.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior inferior labrum is replaced with intermediate signal intensity suggesting degeneration. The anterior superior labrum is detached from the underlying glenoid which may represent a normal variant sublabral foramen. There is no glenohumeral joint effusion. There are small cysts in the humeral head just above the lesser tuberosity.BICEPS TENDON: The tendon of the long head of the biceps appears intact ADDITIONAL

Output: 1. Mild signal abnormality within the supraspinatus, infraspinatus, and posterior deltoid musculature which is nonspecific and could reflect early denervation atrophy. Parsonage-Turner is also included in the differential diagnosis.2. Mild osteoarthritis affects the acromioclavicular joint and there is mild inflammation of the subdeltoid bursa.3. Minimal supraspinatus and infraspinatus tendinosis, but no rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 85 year-old female with sudden onset of aphasia. Acute stroke. Extensive small vessel disease of indeterminate age is noted. No meniscal hemorrhage, edema, mass-effect, midline shift or hydrocephalus is seen. Images through posterior fossa demonstrate the foci of low-attenuation in the right paramedian pons believed to represent an old focal infarct. Follow-up with an MRI is recommended.

Output: Advanced small vessel disease.


Instruction: Generate impression based on findings.

Input: Reason: 55yo M with AML, thrombocytopenia/neutropenia with new headache and also R eye twitching, please eval for any mass lesion such as abscess. Artifact related to dental hardware markedly limits evaluation of the frontal and temporal lobes, particularly on the gradient echo based sequences. There is no evidence of restricted diffusion within the non obscured portions of the brain to suggest acute ischemic infarction. There are several subcentimeter foci of parenchymal susceptibility artifact within the left superior frontal gyrus, left inferior frontal gyrus, left cingulate gyrus, and right hippocampus without associated edema or mass effect compatible with chronic microhemorrhages in a nonspecific distribution. Otherwise, no parenchymal signal abnormalities are detected. No intraparenchymal pathological enhancement is identified. 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 minimal downward displacement of the cerebellar tonsils, which may be a normal variant. There is mild mucosal thickening within the ethmoid air cells and partially visualized left maxillary sinus. There is diffuse marrow replacement compatible with clinical history of leukemia.

Output: 1.Dental hardware artifact obscures portions of the frontal and temporal lobes. Within this limitation:2.No evidence of acute infarction, mass effect, or abscess as clinically questioned.3.Few scattered small chronic appearing microhemorrhages in a distribution involving predominantly subcortical white matter without evidence of associated edema or mass effect. This is nonspecific. Although it may relate to the patient's known thrombocytopenia it remains nonspecific.4.Mild mucosal thickening within the paranasal sinuses.5.Diffuse marrow replacement compatible with clinical history of leukemia.


Instruction: Generate impression based on findings.

Input: 72-year-old male status post right hemicolectomy for colon cancer and prostate cancer presenting abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatic cysts near the dome are unchanged. New, ill-defined, hypodense lesion in segment 8 measuring 9 by 8mm image number 34, series number 4. This lesion is suspicious for a small metastatic disease, however, it's too small to definitely characterize. Alternatively, this represent a Opitz of focal fatty infiltration. MRI of the liver may be helpful for further information. Previous described possible hemangioma in the left lobe is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening and fat stranding around the ileocolonic anastomosis.BONES, SOFT TISSUES: Sclerotic lesions involving the thoracic and lumber spine consistent with metastatic disease, stable.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Thrombose of the right internal iliac vein. Minimal fat stranding in the pelvis of unknown significance.

Output: Right internal iliac vein thrombosis.Sclerotic bone metastases are stable.New subcentimeter lesion in the liver. This lesion is too small to characterize and may represent a small metastases versus focal fatty infiltration. MRI of the liver may provide further characterization.Mild wall thickening and fat stranding around the ileocolonic anastomosis without evidence of any abscess.These findings were discussed with Dr.Kalscheur at the time of dictation.


Instruction: Generate impression based on findings.

Input: 56 year old with known right breast cancer undergoing neoadjuvant chemotherapy presents for evaluation of chemo effect. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right Breast: The index cancer in the right breast at 10:00 position measures 12 x 17 x 15 mm (AP x LR x CC, previously 29 x 26 x 33 mm). A possible satellite located medially from the index mass on the prior study is no longer visualized. Total extent of the non-mass enhancement extending from the index mass to the nipple measures 67 x 32 x 22 mm (previously 70 x 45 x 53 mm).Left Breast: There are no areas of abnormal enhancement in the left breast.Axilla: No abnormal lymph nodes are identified in either axillary region.

Output: Decrease in size of the biopsy proven cancer and possible satellite in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: 47 yo male with h/o colo-rectal cancer, initially resected 12/2003, Recurrent disease in small bowel 9/2015. Found to have liver metastasis and abdominal wall metastasis 4/2016. Has completed chemotherapy. Needs MRI to evaluate extent of disease. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal morphology. There is a T2 hyperintense lesion within hepatic segment 7 which demonstrates restricted diffusion and peripheral enhancement which is compatible with a metastatic lesion with reference measurements below. There is a 1 mm T2 hyperintense cyst within hepatic segment 6, favor benign. No additional focal hepatic lesions are identified.The hepatic vasculature appears patent.Cholelithiasis. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate right hydroureteronephrosis appearing similar to recent CT scan. Subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: Few nonspecific mildly prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes to the anterior abdominal wall. On the outside 8/12/2016 CT, there is an area of nodularity along the deep margin of the inferior portion of the left rectus muscle which could correspond to the reported abdominal wall metastasis in the clinical history. Today's MRI examination of the liver does not include this area within the field-of-view.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/1/2016 11:00:00)SEGMENT 7 HEPATIC LESION: 1.4 x 1.1 cm (Image 405, Series 14).

Output: 1.Hepatic segment 7 lesion compatible with metastasis. No other suspicious hepatic lesions are identified.2.Moderate right hydroureteronephrosis appearing similar to recent CT scan.


Instruction: Generate impression based on findings.

Input: 66-year-old female with low back pain, right calf pain. History of lumbar fusion. Evaluate for stenosis or abnormality. Examination is limited by significant hardware artifact spanning L2-L5. Five lumbar type vertebral bodies are presumed to be present. Alignment appears to be anatomic however this is obscured by hardware artifact. At T12-L1 there is disc desiccation with broad-based protrusion of disc abutting the thecal sac associated with moderate narrowing of the spinal canal this level. Spinal cord signal appears to be unremarkable at this level. There are Modic type II vertebral endplate changes at this level consistent with acute to subacute endplate degenerative changes. There is mild ligamentum flavum and facet hypertrophy. There is moderate left neural foraminal stenosis and mild-to-moderate right neural foraminal stenosis at this level.At L1-L2 the neural foramina cannot be evaluated. The spinal canal is also not well evaluated however there does not appear to be significant spinal canal stenosis.At L2-3 the neural foramina cannot be evaluated. The spinal canal is also not well evaluated however there does not appear to be significant spinal canal stenosis.At L3-L4 the neural foraminal and spinal canal cannot be evaluated. At L4-L5 the neural foraminal and spinal canal cannot be evaluated.L5-S1 the neural foramina and spinal canal cannot be evaluated.No abnormal paraspinal mass lesions are identified.

Output: 1. Exam is markedly limited by artifact related to spinal fusion instrumentation which obscures evaluation of the neural foramina and spinal canal most prominent at mid lumbar level to the lumbosacral spine. At L1-L2 and L2-L3 the spinal canal is not well evaluated however there does not appear to be significant spinal canal stenosis.2. Worsening degenerative changes at the T12-L1 level demonstrating disc desiccation and broad-based protrusion of disc abutting the thecal sac associated with moderate narrowing of the spinal canal at this level. The spinal cord signal appears to be unremarkable at this level. There are new Modic type II vertebral endplate changes at this level consistent with acute to subacute endplate degenerative changes. There is moderate left neural foraminal stenosis and mild-to-moderate right neural foraminal stenosis at this level.


Instruction: Generate impression based on findings.

Input: 37-year-old man with history of peritoneal mesothelioma status post 4 cycles of chemotherapy CHEST: LUNGS AND PLEURA: There are small right and trace left pleural effusion with subsegmental right basilar and lingular atelectasis. There is residual right pneumothorax (7/18), grossly stable in size. No pleural masses or nodules noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal in signal and morphology. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is distended and normal.SPLEEN: The spleen appears normal.PANCREAS: The pancreas is normal. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The visualized small bowel and colon appear normal without evidence of obstruction.There is extensive enhancing soft tissue within the omentum, predominantly within the anterior left hemiabdomen (25/348). The thickness of this omental soft tissue measures approximately 23 mm in thickness, previously 21 mm in thickness.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of ascites noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of free pelvic fluid noted.

Output: 1.Peritoneal soft tissue thickening/carcinomatosis predominantly in the left hemiabdomen stable in size compared to the prior CT accounting for differences in technique.2.Persistent right pneumothorax.3.Ascites and small pleural effusions.


Instruction: Generate impression based on findings.

Input: There is trace degenerative anterolisthesis of L3 with respect to L4 and trace degenerative anterolisthesis of L4 with respect to L5. Lumbar spine alignment is otherwise within normal limits. Vertebral body and heights are preserved. A few scattered foci of increased T1 and T2 signal within the bone marrow are compatible with benign hemangiomas or focal fat deposition. Mild type II degenerative endplate changes are present at L4-L5 and L5-S1. No suspicious bone marrow replacing lesions are identified. There is moderate loss of disc height at L4-L5 and mild loss of disc height at L2-L3, L3-L4, and L5-S1. The lumbar discs are desiccated. The visualized spinal cord displays normal signal and morphology. The tip of the conus is at L1-L2. The paravertebral soft tissues are unremarkable.At T11-T12 as seen only on the sagittal images, there is a disc bulge with possible extruded component without apparent significant stenosis.L1-L2: Mild disc bulge without significant central canal or foraminal stenosis.L2-L3: Mild disc bulge and facet hypertrophy without significant central canal or foraminal stenosis.L3-L4: Mild disc bulge with superimposed central disc extrusion. The extruded component extends approximately 6 mm above the disc space and appears to remain in continuity with the disc. Mild facet hypertrophy. Mild central canal stenosis. Mild left and minimal right foraminal stenosis.L4-L5: Mild disc bulge and advanced facet arthropathy. Mild central canal stenosis. Mild left foraminal stenosis.L5-S1: Mild disc bulge and advanced facet arthropathy. No significant central canal stenosis. Moderate left greater than right bilateral foraminal stenosis.

Output: Multilevel degenerative changes of the lumbar spine as described above. Mild central canal stenosis at L3-L4 and L4-L5. No high-grade central canal stenosis at any level. Up to moderate foraminal narrowing most prominent at L5-S1. Advanced facet arthropathy at L4-L5 and L5-S1.


Instruction: Generate impression based on findings.

Input: 50 year-old woman with right hemiparesis. Status post recent aneurysm coiling, remote history of intracranial hemorrhage. Evaluate for ICH / stroke. There is no evidence of acute intracranial hemorrhage, mass or edema. There are midline metallic densities consistent patient's known history of aneurysm coiling. There are periventricular hypodensities which are more pronounced on the left as well as focal regions of hypodensity in the subcortical regions and basal ganglia bilaterally. These findings are consistent with age-indeterminate small vessel ischemic disease and lacunar strokes, respectively. Areas of encephalomalacia are present in the distribution of the bilateral anterior cerebral arteries (series 5 image 24) consistent with prior stroke. There are no definite CT findings of acute stroke. However, if acute stroke remains clinical concern recommend MRI.The left lateral ventricle is larger than the right. There is a shunt which enters through the frontal bone to the right of the midline and terminates in the region of the third ventricle. There is a region of encephalomalacia adjacent to the shunt.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT findings of acute intracranial hemorrhage.2. No definite CT findings of acute stroke. If stroke remains clinical concern, recommend further evaluation with MRI.3. Metallic densities consistent with prior aneurysm coiling and ventricular shunt with adjacent encephalomalacia.4. Age-indeterminate findings of small vessel ischemic disease.5. Midline frontal and parietal regions of encephalomalacia consistent with prior stroke in bilateral ACA distribution.


Instruction: Generate impression based on findings.

Input: 44-year-old woman with history of cervical cancer. PELVIS:UTERUS, CERVIX: There are bilateral clusters of small, T2 bright lesions in the cervix representing nabothian cysts (series 901, image 31). The cervix is otherwise T2 hypointense and normal in signal. No focus of abnormal signal is identified.The junctional zone of the uterus is at the upper limits of normal in size and there are small, T2 hyperintense areas within the myometrium.OVARIES: There are small ovarian cysts on the right and a 5.5 cm ovarian cyst on the left. Additionally there is a peripherally enhancing 2.0 cm cystic structure in the left ovary which likely represents an involuting corpus luteum.BLADDER: The bladder is unremarkable.LYMPH NODES: Subcentimeter lymph nodes are seen scattered in the pelvis bilaterally up to the level of the aortic bifurcation.BOWEL, MESENTERY: The rectosigmoid colon appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A small amount of free pelvic fluid is likely physiologic.

Output: 1.No imaging evidence of cervical malignancy.2.Borderline findings of uterine adenomyomatosis.


Instruction: Generate impression based on findings.

Input: Arachnoid cyst, surveillance. Compared to 9/24/2014, there is no significant change in arachnoid cyst involving the right middle cranial fossa measuring approximately 40 x 30 x 51 mm in the AP, transverse, and craniocaudal dimensions. There is unchanged mild mass effect on the right anterior temporal lobe and mild expansion of the right middle cranial fossa from chronic remodeling of the skull. There are dilated perivascular spaces in the left parietal lobe. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No other intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Anomalies involving the inner ears are better assessed on prior study. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Unchanged arachnoid cyst involving the right middle cranial fossa with mild local mass effect.


Instruction: Generate impression based on findings.

Input: Back and leg pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5 which was also present on prior radiographs. Alignment is otherwise maintained. Bone marrow signal is benign with areas of T1 hyperintensity at multiple levels compatible with hemangiomas or foci of fat.. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge with tiny central protrusion. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.L4-L5: Grade 1 anterolisthesis with disc uncovering. There is advanced bilateral facet arthropathy as well as ligamentum flavum thickening. There is resulting moderate spinal canal stenosis. There is moderate left and mild right neural foraminal stenosis.L5-S1: Minimal disc bulge and moderate bilateral facet arthropathy. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level where there is advanced facet arthropathy and grade 1 anterolisthesis with associated moderate spinal canal stenosis as well as moderate left and mild right neural foraminal stenosis.2. Additional levels as above.


Instruction: Generate impression based on findings.

Input: Male, 11 years old, with altered mental status, status post cardiac arrest. Evaluate for HIE. History of spinal muscular atrophy type 1. Mild, bilaterally symmetric restricted diffusion is evident within the precentral cortex, bodies of the caudate nuclei, the posterior lateral putamina and the ventromedial thalami. Mild gyriform restricted diffusion is also suspected within the occipital cortex and questionably along the left hippocampal formation.The background brain demonstrates marked bilateral cerebral white matter loss with widening of the ventricles and sulci. The degree of white matter loss seems to have progressed when compared to a prior head CT from 2005. Small areas of cavitation are also evident along the right frontal horn.The corpus callosum is thinned. Although the quantity of white matter is deficient, the pattern of myelination is essentially mature. The brainstem may be somewhat slender but is otherwise normally formed. The cerebellar vermis and cerebellar hemispheres are unremarkable.No evidence of significant intracranial hemorrhage is seen. Prominence of the CSF spaces anterior to the temporal lobes could represent volume loss or, less likely, the presence of arachnoid cysts.Layering fluid is evident within the nasal cavity and nasopharynx.

Output: 1.Findings are seen compatible with hypoxic ischemic injury involving the peri-Rolandic cortex, basal ganglia and thalami, the occipital cortex, and possibly the left hippocampus.2.These findings exist on a background of extensive white matter volume loss which seems to have progressed from a 2005 examination.


Instruction: Generate impression based on findings.

Input: 26-year-old man with history of Crohn's disease on Infliximab, evaluate for active disease. ABDOMEN:LIVER, BILIARY TRACT: A few, scattered subcentimeter hepatic cysts noted. The liver is otherwise normal in signal and morphology.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct normal in caliber. No focal parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No focal renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is short segment focal thickening and enhancement of the ileocecal valve (18/90) without upstream dilatation. The distal ileum appears relatively normal. Multiple areas of circumferential small bowel wall thickening with enhancement (4/13 and 4/21) are present in the mid ileum over a length of approximately 20 cm. Within this abnormally thickened small bowel, there are areas of luminal narrowing measuring 6.5 cm and 3.5 cm in length. The upstream bowel is dilated measuring up to 3.7 cm. There is fibrofatty perforation of the right lower quadrant mesentery.The colon appears relatively normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Approximately 20 cm of thickened, enhancing mid-ileum with areas of stricturing and dilatation suggestive of active inflammation.2.Short segment thickening and enhancement of the ileocecal valve also suggestive of active inflammation.


Instruction: Generate impression based on findings.

Input: Several sequences are motion degraded. Given this caveat:There is a small, focal area of restricted diffusion with matching ADC hypointensity based at the posterior limb of the left internal capsule without enhancement. There are non restricting foci of T2 hyperintensity within the periventricular and subcortical white matter, confluent in several locations, with similar findings to a lesser degree within the pons. These are not associated with mass effect, enhancement, or susceptibility abnormality. A tiny focus of encephalomalacia within the right inferior cerebellar hemisphere is consistent with a remote age small vessel infarct. There is mild diffuse volume loss without a specific lobar predominant atrophy pattern. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Redemonstrated is a partial empty sella. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is is made of a 4.3 cm transverse dimension benign lipoma overlying the right paramedian suboccipital scalp.

Output: 1.There is a small, focal area of acute infarction based at the posterior limb of the left internal capsule.2.Advanced chronic small vessel ischemic disease.3.Mild diffuse volume loss without a specific lobar predominant atrophy pattern.


Instruction: Generate impression based on findings.

Input: Melanoma of skin. Status post craniotomy for tumor resection. There are post-operative findings related to a right frontal craniotomy for tumor resection with mild rim enhancement of the surgical cavity. There are small foci of pneumocephalus, dural thickening and enhancement and a fluid collection subjacent to the craniotomy flap measuring 9 x 30 mm. There is unchanged mass effect on the right frontal horn with mild midline shift towards the left. There is evidence of a remote left frontal craniotomy with redemonstration of a resection cavity at the left frontal lobe convexity, which appears unchanged. There is T2 signal abnormality in the right frontal lobe as well as around the left frontal resection cavity, which is unchanged. There are additional scattered punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter, which are non-specific. There is minimal amount of restricted diffusion in the right frontal lobe resection cavity inferiorly. There is restricted diffusion in the right precuneus, which corresponds to a lesion with intrinsic T1 shortening and susceptibility artifact. There are multiple areas of susceptibility artifact throughout the bilateral cerebral hemispheres and right cerebellum, consistent with hemosiderin deposition. There is soft tissue swelling of the scalp, predominantly of the right side.

Output: 1. Expected post-operative findings related to a right frontal craniotomy for tumor resection with minimal enhancement surrounding the resection cavity margin. This study can serve as a baseline study.2. No significant interval change in the appearance of the right parietal precuneus hemorrhagic lesion as well as left posterior frontal resection cavity.


Instruction: Generate impression based on findings.

Input: Ms. Duran is a 46 year old female with a personal history of left breast lumpectomy in 2011 for IDC and DCIS. Patient received radiation, chemotherapy, and hormonal therapy. There is posterior bilateral benign MR guided biopsies in 2010 (left breast-fibrotic breast tissue, right breast-papilloma). Family history of breast cancer in her maternal aunt. She has no current breast related complaints. Three standard views of both breasts and a left laterally exaggerated CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution.A linear marker is placed on the scar overlying the left breast. There are stable post-lumpectomy changes present in the left breast, including architectural distortion, increased density, and surgical clips. Bilateral clips from benign MRI biopsies are present. There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in either breast.

Output: Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Female; 41 years old. Reason: uterine fibroids, menorrhagia History: menorrhagia PELVIS:UTERUS, ADNEXA: Enlarged uterus due to multiple uterine fibroids. The uterus measures up to 11.6 x 8.3 x 20.1 cm. The uterus is slightly retroverted and retroflexed.Largest uterine fibroid measures 7.4 x 7.8 x 8.5 cm (series 601/17 and 701/20). This fibroid is likely subendometrial and located in the lower uterine segment. It demonstrates homogeneous contrast enhancement.Second-largest uterine fibroid measures 6.1 x 7.3 x 8 cm (series 601/33 and 701/18). This fibroid is myometrial and located at the fundus posteriorly. It demonstrates patchy contrast enhancement.Three additional smaller, myometrial fibroids are seen in the uterine body, each demonstrating nearly homogeneous contrast enhancement.Cervical nabothian cysts noted.Small bilateral ovarian cysts/follicles with probable left corpus luteal cyst (series 1305/212).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid, likely physiologic.

Output: Multiple uterine fibroids as detailed above.