Instruction: Generate impression based on findings.

Input: 85 year old patient with left pontine infarct in bilateral cerebellar lesions please evaluate patient has right hemiparesis and gaze deviation to the rightTechnique: Contiguous axial images of the brain. Subsequently high resolution contiguous axial images were obtained through the lower half of the head and neck and aortic arch during bolus injection of intravenous contrast.The patient was brought back to the CT area later on the date of the exam for repetition of the exam due to poor timing of the initial contrast bolus. On the noncontrast head CT a hypodense focus corresponding to the MRI abnormality along the left cerebellar hemisphere measuring 25 x 15 mm axial dimensions is present and not clearly evident on the prior exam. Hypodense foci in the lower mid brain and upper pons predominant involving the left upper pons and lower midbrain were also not readily identified on the prior exam. There are punctate lesions present along the right posterior inferior cerebellar artery territory and to a lesser degree left posterior inferior cerebellar artery territory.There is opacification of both distal vertebral arteries along their cervical segments. The right vertebral artery is somewhat smaller than the left intracranially and along the cervical segment. The right posterior inferior cerebellar artery does display contrast enhancement as does the left, however, the right vertebral artery does not opacify distal to the posterior inferior cerebellar artery suggesting that it is likely either highly stenotic or occluded. The basilar artery, therefore fills from the left vertebral artery. There are some mural calcifications associated with luminal narrowing as the left vertebral artery enters the subarachnoid space. The left anterior inferior cerebellar artery is larger than its right counterpart. The basilar artery is highly attenuated distal to the AICA origins and suspected to be occluded below the level of the superior cerebellar arteries. The posterior communicating arteries are of similar in size to the P2 segments. The P1 segments are asymmetric right larger than left. The right P1 segment is about the same size as the posterior communicating artery on the right side the left one is smaller than the left P2 segment. It is and therefore considered that the superior cerebellar arteries fill from the anterior circulation as do the posterior cerebral arteries in this patient.There are atherosclerotic calcifications along the distal internal carotid arteries bilaterally. No significant stenosis is appreciated along the anterior or posterior cerebral arteries. The anterior communicating artery is identified and is relatively small compared to the A1 segments which are approximately equal in size. There are atherosclerotic calcifications present along the carotid bifurcations however on the basis of NASCETcriteria no significant stenosis is present along the carotid bifurcations. There is some mild narrowing of the left internal card artery just distal to its origin but approximately a 40%.The left vertebral artery is significantly narrowed at its origin with approximately an 80% stenosis along its cervical segment there are foci of narrowing along the mid cervical vertebral artery with approximately 60% stenosis at the C4-5 disk space level. View right vertebral artery is small and intracranially essentially only supplies the right posterior inferior cerebellar artery which is otherwise disconnected. There is some mild prominent muscular branch is present along the the tube in segment collateralization to the left occipital artery is unknown basis of this exam.The patient is intubated both endotracheally and nasogastric.Some atherosclerotic calcifications are present along the aorta and some of the branches. There is atherosclerotic in narrowing of the innominate artery by approximately 75%. There are degenerative changes present along the cervical spine at C6-7 with left sided neural foraminal narrowing, and c3-4 with right sided neural foraminal narrowing.

Output: 1.Subacute foci of infarction in the left cerebellar hemisphere more than the right as well is within the upper pons and lower midbrain left worse than right. No evidence for hemorrhagic conversion2.Occlusion or near occlusion of the right vertebral artery distal to the origin of the posterior inferior cerebellar artery.3.High-grade stenosis at the origin of the left vertebral artery with a tandem lesion along the mid cervical segment of the left vertebral artery and atherosclerotic in narrowing of the left internal artery as it enters the subarachnoid space. 4.There is occlusion or near occlusion of the basilar artery between the anterior inferior cerebellar artery and the superior cerebellar artery origins.5.The posterior communicating arteries are fairly large as described above. The anterior circulation appears to be the dominant supply for the posterior cerebral arteries as well is the superior cerebellar arteries. 6.High-grade stenosis (approximately 75%) of the innominate artery due to atherosclerotic narrowing7.Mild narrowing at the left internal carotid artery origin as described above. no significant stenosis at the carotid bifurcations on the basiss of NASCET criteria.8.If clinically appropriate, a more detailed assessment of the supply to the posterior circulation may be provided via conventional angiography to confirm or exclude complete occlusion of right vertebral artery and basilar artery and to provide a more accurate description of the percent of stenoses described above, assess circulation time and to identify any collateralization from the external circulation to the intracranial circulation - which cannot be identified on this exam.9.Degenerative changes are present in the cervical spine as indicacated above. Please correlate with clinical symptoms.


Instruction: Generate impression based on findings.

Input: A 57 year old female hospitalized because of chest pain, positive troponin, ST segment elevation on the EKG, a left catheterization showed apical ballooning and no coronary artery disease. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function with mild apical hypokinesis. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 124 ml (normal range 109+/-23), the LV end systolic volume index is 44 ml/m2 (normal range 18+/-5), the LVESV is 68 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 90 g (normal range 114+/-24). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native myocardial T1-times are significantly increased (~1100-1150ms). While the global relative enhancement ratio and the T2-STIR edema ratio are increased, the extracellular volume fraction is in the upper normal limit. No myocardial iron overload was seen.No intracavitary thrombus was seenGlobal Relative Enhancement4.1Normal <4T2 STIR Edema Ratio (ER)3.4Normal <2T1 MOLLI Pre contrast myocardium1233Normal <1,050msT1 MOLLI Pre contrast blood pool1668Extracellular volume fraction29.7normal 20-30%Left AtriumThe left atrium is normal in size. The LA volume is 74 ml.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 103 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 52 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 45%. There is mild apical hypokinesis without late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. These findings support the diagnosis of Takotsubo's cardiomyopathy.2. The right ventricle is normal in size and systolic function, the RVEF is 50%. 3. There is mild 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: History of pancreatic cyst. Presents for follow-up. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a suspicious lesion. No biliary ductal dilatation. Normal partially contracted gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum anatomy.The cystic lesion in the uncinate process measures 1.9 x 1.4 cm (series 601/60), compared to 1.5 x 1.0 cm previously. It contains a thin septation without suspicious postcontrast imaging features. It appears to communicate with the ventricle pancreatic duct.The pancreatic neck cystic lesion measures 8 x 6 mm (series 601/55), compared to 7 x 6 mm previously. This appears to communicate with the main pancreatic duct.The pancreatic tail cystic lesion now measures 8 x 5 mm (series 601/92), compared to a few millimeters previously. This lesion communicates with the main pancreatic duct.Stable additional pancreatic body punctate cystic lesion. None of these lesions demonstrate suspicious postcontrast imaging features. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal superior pole cyst.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: Multiple sidebranch IPMNs, some of which demonstrate mild interval increase in size without suspicious post-contrast enhancing components.


Instruction: Generate impression based on findings.

Input: 78 years, Male, Reason: liver and adrenal lesions History: liver and adrenal lesions. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Diffuse loss of signal on out of phase images indicates hepatic steatosis. Cholelithiasis. Multiple small simple cysts correspond to hypodensity seen on prior CT.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 2-cm left adrenal lesion loses signal on out of phase images, compatible with an adenoma.KIDNEYS, URETERS: Multiple simple renal cysts on the left.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left adrenal adenoma.2.Multiple simple hepatic cysts.


Instruction: Generate impression based on findings.

Input: Reason: assess stress fractures noted on MRI History: pain/ swelling BLE stress fx on MRI Right hip: There is poorly defined band like sclerosis of the medial aspect of the femoral neck, which likely represents a chronic stress fracture as seen on recent MRI. Mild osteoarthritis affects the right hip.Left hip: Mild osteoarthritis affects the left hip.Pelvis: The bones appear demineralized. There is a lucency traversing the left inferior pubic ramus corresponding to fracture seen on MRI. Faint bone formation adjacent to the right superior and inferior pubic rami probably represents healing stress fractures as seen on recent MRI. The remaining fractures seen on recent MRI are not evident on this study.

Output: Multiple stress fractures of the pelvis including those involving the left inferior pubic ramus, right superior and inferior pubic rami, and right femoral neck. Additional fractures are better seen on recent MRI.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with left leg pain and swelling, history of lumbar laminectomy complicated by CSF leaking. Postoperative findings are demonstrated compatible with recent laminotomy and facetectomy on the left at L4-5 and L5-S1. The overlying paraspinal soft tissues are edematous and show diffuse ill-defined enhancement compatible with recent surgery. Within the laminotomy bed at L5-S1, a fluid collection is evident measuring 20 x 16 x 11 mm. No encroachment on the spinal canal is seen. No epidural collections are detected. Thickening and mild anterior displacement of the left posterolateral dura at this level is likely postoperative.Enhancement of at least the left S2 nerve root and perhaps several other left-sided nerve roots is seen extending from the conus down to the operative region.Edema and enhancement within the sacrum is partially visualized along with engorgement of the presacral venous plexus.Elsewhere vertebral body signal characteristics are unremarkable. Vertebral body height and morphology are within normal limits.L1-2: Facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Facet arthropathy. Minimal disc bulging asymmetric to the left. No significant spinal canal stenosis. Minimal left foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Mild disc bulging with a central annular fissure and small central protrusion. No significant spinal canal stenosis. Postoperative changes as above. Moderate right and mild left foraminal narrowing. L5-S1: Facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Postoperative changes as above. No significant foraminal narrowing. Hydronephrosis and hydroureter is evident on the left. The left renal parenchyma is atrophic.

Output: 1.Findings are demonstrated compatible with recent left L4-5 and L5-S1 laminotomy and facetectomy. A small fluid collection within the L5-S1 laminotomy bed is compatible with a pseudomeningocele. Edema and enhancement in the overlying paraspinal soft tissues are likely within expected limits given recent surgery.2.Diffuse enhancement of at least the left S2 nerve root and perhaps of several other intrathecal nerve roots is seen. This could represent a reactive arachnoiditis related to surgery. Alternately, radiculitis from chronic nerve root impingement can also occasionally produce enhancement.3.Edema and enhancement are partially visualized within the sacrum. This is of uncertain etiology but could reflect an occult sacral insufficiency fracture. Pelvic CT can be considered as an initial follow-up exam. This finding was communicated to Dr. Ramos via email at 11:00 AM on 7/1/16. 4.Left hydronephrosis and hydroureter are redemonstrated with associated renal atrophy.


Instruction: Generate impression based on findings.

Input: 36 years, Female, Reason: 36yo female with possible small bowel inflammation on outside CT and bloating. Evaluate for small bowel Crohn's disease History: bloating. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter right hepatic cyst.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: No bowel wall thickening, abnormal enhancement or diffusion restriction. No evidence of obstruction. No fistulas or abscesses.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis is likely physiologic.

Output: No evidence of small bowel inflammation or sequela of chronic inflammation.


Instruction: Generate impression based on findings.

Input: Syncope and collapse. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Incidental right cerebellar hemisphere developmental venous anomaly, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Images are limited by patient motion. Since the prior outside exam, there has been interval progression of previously seen osseous neoplastic disease at the S1 level. There is now diffuse abnormal signal involving the S1 vertebral body, with more confluent involvement of the right aspect of the sacrum. There is a prominent ventral epidural soft tissue component of tumor with loss of the inferior dorsal cortex of the S1 vertebral body. The epidural tissue measures up to 10 mm in greatest thickness, with near complete effacement of ventral epidural fat and complete effacement of the tapering distal thecal sac at these levels. The abnormal soft tissue spans the L5-S1 to lower S2 levels. Tumor encroaches upon the inferior aspect of the right L5-S1 foramen and appears to efface the right S1-S2 and probable S2-S3 foramina.There is a new area of abnormal signal in the posterior inferior L4 vertebral body system with additional osseous neoplastic disease. More ill-defined lesions are again seen along the superior endplate of L4 anteriorly. Multiple areas of abnormal signal are seen in the L5 vertebral body which appear progressed, with a focal concavity of the superior endplate appears unchanged. A discrete osseous lesion is also present in the L1 vertebral body. There is also a discrete rounded lesion in the left sacrum at the S2-S3 level which appears grossly unchanged.The spine is in normal alignment. There is mild disc narrowing at L4-L5 with loss of normal T2 hyperintense signal. There is also disc narrowing and desiccation at L1-L2. The vertebral body and disk heights are otherwise well-maintained. The spinal cord is of normal caliber and grossly normal signal. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is mild developmental narrowing of the mid to distal lumbar spinal canal due to shortened pedicles and prominence of ventral epidural fat.The bladder is severely distended. There is a prominent component of the mass which is presacral in location although incompletely evaluated.

Output: 1.Compared to outside exam, there has been interval new thickening progression of osseous neoplastic disease centered at the S1 level, with now a large soft tissue component of ventral epidural tumor which completely effaces the distal thecal sac at this level. This likely accounts for the patient's cauda equina syndrome. Dedicated MRI of the lumbar spine with and without contrast recommended for a full evaluation, when able to tolerate.2.Tumor extends into the right S1-S2 and likely S2-S3 foramina which are completely effaced but incompletely assessed.3.Additional progression of osseous neoplastic disease elsewhere in the lumbar spine. No evidence of other significant central spinal canal stenosis or cord compression, although there is a mildly developmentally slender distal spinal canal.4.Severely enlarged bladder.Dr. Veronesi discussed these findings over the telephone with Dr. Christina Kim on 3/24/2016 12:15 AM, when a preliminary read was requested.


Instruction: Generate impression based on findings.

Input: 50 year old female with hypertension, new LBBB, ?syncope, and family history of early coronary disease. She is referred to evaluate for ischemia and scar.MEDICATIONS: HCTZ First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 151 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 61 ml (normal range 31+/-10), the LV mass index is 52 g/m2, and the LV mass is 103 g. Abnormal septal motion consistent with LBBB.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 62%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 149 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 57 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 60%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 62%).


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate for infectionSigns and Symptoms: mental status changes s/p cranioplasty The patient is status post left-sided cranioplasty. There is a free flap present along the left scalp. There is heterogeneous enhancement present within the scalp tissues.There is a small fluid collection present along the anterior aspect of the craniotomy site associated with peripheral enhancement infiltration of adjacent fat planes. It is medial to the inferior aspect of a large bone fragment presumably originating from the squamous left temporal bone. There is associated enhancement along the cranioplasty site.Foci of encephalomalacia are present in the left frontal lobe and left parietal lobe as well as the left temporal lobe. There is some pachymeningeal enhancement present anteriorly. There is a 5 mm dural based nodule adjacent to the left temporal lobe at the inferior aspect of the craniotomy site.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 demonstrate some minor opacities- left more than right. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is a small fluid collection present along the anterior aspect of the craniotomy site underneath the inferior and anterior aspect of residual squamous portion of the left temporal bone . It's quite possible this may represent infection with small abscess. It is associated with enhancement along the cranioplasty site raising the question of (but not confirming)spread of infection immediately adjacent to the dura. There is no obvious leptomeningeal involvement.2.Status post left-sided craniotomy with cranioplasty and reconstruction. 3.Foci of encephalomalacia are present in the left frontal parietal and temporal lobes.4.Pachymeningeal enhancement is nonspecific. It could simply be a reactive change5.A small extra-axial nodular focus is present. It measures approximate 5 mm. One possibility is that this may relate to a small meningioma or reactive change.


Instruction: Generate impression based on findings.

Input: Reason: pain with flexion/extension, eval for tendonitis History: pain A marker was placed along the dorsum of the hand between the distal diaphysis of the second and third metacarpals. We see no abnormalities of the extensor tendon deep to this marker. The flexor tendons likewise are normal in appearance. There is minimal enhancement of the tendon sheath of the flexor pollicis longus as it courses along the proximal phalanx of the thumb. While this may represent a very mild tenosynovitis, this is of uncertain clinical significance. There is mild enhancement of the distal radioulnar joint. There is mild enhancement of the compartments of the wrist suggesting a mild synovitis. There are small foci of nonenhancing signal abnormality within several carpal bones which may represent small cysts but are of doubtful clinical significance. The imaged musculature of the wrist and hand appears normal.

Output: Minimal enhancement of the sheath of the flexor hallucis longus tendon which may represent a tenosynovitis, but is of questionable significance. Mild wrist synovitis. We otherwise see no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: Left antero-medial knee mass, please evaluate etiology of mass MENISCI: Medial and lateral menisci are normal in signal characteristics and morphology.ARTICULAR CARTILAGE AND BONE: There is no abnormal bone marrow signal intensity. Osseous alignments are within normal limits. The articular cartilage appear normal.LIGAMENTS: Cruciate ligaments and collateral ligaments are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are within normal limits.ADDITIONAL

Output: Small fluid collection anterior to the patella, which may be traumatic, inflammatory, or perhaps a Morel Lavallee injury. No discrete enhancing mass is identified.


Instruction: Generate impression based on findings.

Input: Other intervertebral disc displacement, thoracic region [M51.24] / Radiculopathy, lumbar region [M54.16], Reason for Study: Thoracic spineThere is normal thoracic kyphosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. Minimal bulging of discs at the level of T8-T9, T9-T10, and T10-T11.L Spine:Scoliotic posture of lumbar spine was seen.Spinal cord signal is normal and the conus medullaris terminates at the level of T12-L1Degenerative changes are specified by the intervertebral level as follows: L1-L2: minimal bulging of disc with bilateral ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L2-L3: disc dessication, diffuse bulging of disc with focal disc bulging toward left side neural foramen associated with left side ligamentum flavum thickening results left side neuroforaminal narrowing. L3-L4: disc dessication, Diffuse bulging of disc with broad based disc bulging toward the left side neural foramen results mild neuroforaminal stenosis. Bilateral ligamentum flavum were thickened. No evidence of spinal stenosis. L4-L5: disc dessication, diffuse bulging of disc, bilateral ligamentum flavum thickening with facet hypertrophy result bilateral mild neuroforaminal narrowing. No spinal stenosis. L5-S1: disc dessication, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Spinal cord signal intensity is normal.2. Mild bulging of disc on multiple thoracic levels without evidence of spinal canal stenosis.3. Degenerative changes of lumbar spine with scoliotic changes.4. Multilevel lumbar level intervertebral disc degeneration with various degree neural foraminal stenosis especially on the left side as described above.


Instruction: Generate impression based on findings.

Input: 28-year-old male with Crohn's disease flare. Abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The liver is diffusely enlarged with a craniocaudal dimension of 20.7 cm.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: Findings consistent with Crohn's disease identified throughout the colon including attenuated caliber, post-inflammatory polyps and global loss of haustration. Distal ileum and cecum and descending colon wall thickening are best demonstrated on coronal image 50/71. The wall thickening is most pronounced at the splenic flexure seen best at the splenic flexure on axial image 45/147 of series 3 and coronal image 27/71.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free or loculated fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a small collection of air in the right perianal region with fluid density and may represent a fissure and tract seen best on axial image 128/147 and coronal image 22/71. This may be further evaluated with an MRI examination if indicated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Diffuse changes in the colon compatible with long-standing Crohn's disease. Wall thickening is most pronounced at the distal ileum, cecum, ascending colon, and splenic flexure. Probable right sided perianal fissure and tract. See above.


Instruction: Generate impression based on findings.

Input: Male, 43 years old,spinal cord syrinx, 6 month follow-up. Thoracic:There is significant volume loss involving the thoracic cord the level of the syrinx as well as of the mid thoracic cord above the syrinx. Again demonstrated is a syrinx extending from the T8 to T10 levels which is overall not significantly changed since 12/18/2014. At the T9 level syrinx is slightly smaller measuring 5.9 x 5.6 mm, previously approximately 7.6 x 6.6 mm. At the T8 level there is a locule in the right aspect of the syrinx previously measuring 4.8 x 4.1 mm and now larger, at 7.5 x 6.6 mm. Exaggerated thoracic kyphosis is redemonstrated. Again seen are multilevel laminectomies. Syrinx shunt catheter is poorly visualized. Fatty endplate signal change is seen at the superior endplate of T7, unchanged. No areas of high-grade spinal canal or neuroforaminal stenosis are appreciated.Lumbar:The conus and cauda equina are within normal limits. The conus tip terminates at the upper margin of L2 which is normal limits.Vertebral body heights are normal. Bone marrow signal is benign. Grade 1 retrolisthesis of L4 relative to L5 is again seen. Alignment is otherwise unremarkable. Edematous endplate marrow signal changes at L5-S1 are again noted. Disc desiccation at L3-L4, L4-L5, and L5-S1 is again seen with particular loss of disc height at the L5-S1 level. Individual levels as below: L1-2: No spinal canal stenosis or neuroforaminal narrowing. L2-3: No spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet hypertrophy. Mild bulging disk. No significant spinal canal or neuroforaminal stenosis. No interval changes.L4-5: Facet hypertrophy. Disc bulge. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.L5-S1: Facet hypertrophy. Diffuse disc bulge again seen including involvement of the neural foramina. No significant spinal canal stenosis. Moderate bilateral neural foraminal stenosis.

Output: 1. Overall no significant change in size and extent of lower thoracic syrinx with small areas appearing slightly larger or smaller compared to 12/18/2014 as detailed above.2. Significant parenchymal volume loss involving the thoracic cord at the level of the syrinx as well as above it involving the mid thoracic cord. The mid thoracic cord volume loss has mildly progressed when compared to remote MRI from 2009. 3. Degenerative changes in the lumbar spine, worst at L5-S1 where there is up to moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Dizziness, lightheadedness. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: paresthesias There is redemonstration of multiple signal hyperintense lesions throughout the brain. One in the anterior aspect of the left medulla and one in the posterior lateral aspect of the right medulla were present were also present on the prior exam. One in the right cerebellar hemisphere and another in the left middle cerebellar peduncle are also unchanged. Confluent periventricular white matter lesions are perpendicularly oriented to the lateral ventricles are also redemonstrated and have not changed substantially. There is extension into the aspect of the corpus callosum. Additionally there are lesions extending down to the centrum semiovale and additional lesions in the subcortical white matter of the frontal lobesNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus and a large mucous retention cyst in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Extensive periventricular, subcortical, brainstem and cerebellar lesions are stable compared to the prior exam from 4/27/1915. These are compatible with patient's diagnosis of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Examination is mildly motion degraded. There are mild scattered areas of narrowing in the intracranial vasculature including the right supraclinoid internal carotid artery, right distal vertebral artery, as well as mild to moderate stenosis involving the mid basilar artery. The intracranial internal carotid, anterior, and middle cerebral arteries demonstrate no high-grade stenosis. Vertebral, basilar, and posterior cerebral arteries also demonstrate no high-grade stenosis. Left posterior cerebral artery is fetal in origin. No evidence of aneurysms or vascular malformations.

Output: Mildly motion degraded exam without evidence of high-grade stenosis or occlusion in the intracranial vasculature. There are mild scattered areas of stenoses described above with artifact limiting assessment.


Instruction: Generate impression based on findings.

Input: Ms. Adamson is a 58 year old female with biopsy proven malignancy of the right breast, undergoing neoadjuvant chemotherapy. She presents for MRI to assess treatment response. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST: Susceptibility artifact from biopsy marker clip is identified in the right lateral breast, at site of biopsy-proven malignancy. Other than minimal architectural distortion, there is no abnormal enhancement identified at this area. There is no additional abnormal enhancement seen in the remainder of the right breast.LEFT BREAST: There is no abnormal enhancement seen in the left breast.No abnormal axillary lymph nodes are identified in either axillary region. Vascular port seen in the left medial chest.

Output: (1) No residual enhancement at site of biopsy proven malignancy in the right breast. (2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Headache and presyncope. Evaluate for vascular malformation. MRI BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right frontal lobe developmental venous anomaly. There is also prominence of the caliber of the superificial cerebral veins in the right anterior temporal and left parietal regions which is of uncertain significance but favored to be a developmental variation. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are mucus retention cysts in the bilateral maxillary sinuses. The skull and extracranial soft tissues are unremarkable. MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. MRI of the brain is essentially within normal limits. No evidence of intracranial hemorrhage, infarct, or mass. There is a prominent right frontal lobe developmental venous anomaly which is an incidental finding. There is also prominence of the caliber of the superificial cerebral veins (particularly left vein of Trolard and the right superficial middle cerebral vein) which is of uncertain significance but favored to be a developmental variation. Please note entities such as dural arteriovenous fistula cannot be excluded by MRI and further evaluation could be considered if there is specific clinical suspicion.2. Unremarkable MRA without flow-limiting stenosis or aneurysm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 41-year-old female with a mass with calcifications in the right breast presents for Alan Penn research study before ultrasound-guided biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the posterior right breast, 10:00 position, there is a circumscribed enhancing mass with high T2 signal intensity, which measures 1 x 1.5 x 1.5 cm (LR x AP X SI). This corresponds to the ultrasound finding. In addition, there is a small subcentimeter mildly enhancing mass in the inferior left central breast that has high internal T2 signal. Most likely this represents a cluster of cysts versus a small fibroadenoma.No additional suspicious enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. 1.5 cm circumscribed enhancing mass with associated T2 high signal intensity in the right breast 10:00 position corresponding to the known mammographic and ultrasound finding. Ultrasound-guided biopsy will be performed today.2. Subcentimeter mildly enhancing mass in the inferior left central breast is likely benign and probably represents a cyst or fibroadenoma. This was further characterized with ultrasound today.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Right lower extremity pain and difficulty ambulation Osseous structures: There is no evidence of acute fracture or marrow replacement.Soft tissues/muscles: A tear of the myotendinous junction of the medial head of the gastrocnemius is noted distally. A small amount of fluid signal between the gastrocnemius and the soleus is noted with associated edema within the medial head of the gastrocnemius and overlying soft tissues. The remaining tendons and musculature are intact.

Output: Tearing of the myotendinous junction of the medial head of the gastrocnemius distally with associated subcutaneous fluid and edema. The remaining musculature and tendons are intact.


Instruction: Generate impression based on findings.

Input: Known L4-5 spinal canal stenosis, sciatica. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is grade 1 spondylolisthesis of L4 on L5.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation, minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation, diffuse bulging of disc weight bilateral ligamentum flavum thickening demonstrate mild spinal canal narrowing.L4-L5: Disc desiccation, severe spinal canal stenosis due to spondylolisthesis as well as associated diffuse bulging of disc and bilateral ligamentum flavum thickening. Bilateral facet joints fluid collection with the subchondrosclerosis indicate facet osteoarthritis. L5-S1: Disc desiccation, diffuse bulging of disc, mild spinal canal stenosis.

Output: Degenerative spondylosis as described above.Grade 1 spondylolisthesis of L4 on L5 with severe spinal canal stenosis at the level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 29 years old. Follow-up femoral neck stress fracture. Continued pain despite healed femoral neck fracture on x-ray and immobility. ACETABULAR LABRUM: Acetabular labrum is intact without evidence of tear.ARTICULAR CARTILAGE AND BONE: At the level of the lesser trochanter, there is decreased signal on T1 sequences which likely represents sclerosis with a punctate focus of increased signal (series 801, image 10) which may represent a nidus. Adjacent to the presumed sclerosis is bone marrow edema along the medial femoral neck. Alignment of the hip joint is anatomic. The articular cartilage is intact. SOFT TISSUES: The visualized soft tissues are unremarkable. ADDITIONAL

Output: Apparent sclerosis along the medial femoral neck with a possible small nidus and adjacent bone marrow edema. Given that the patient's symptoms do not correlate with activity and have not improved with rest, these findings are highly suspicious for an osteoid osteoma or less likely a persistent stress fracture of the femoral neck.


Instruction: Generate impression based on findings.

Input: Clinical question: Migrational disorder. Signs and symptoms: Seizure. Nonenhanced brain MRI:Negative diffusion weighted series.There is normal signal intensity of brain parenchymal on all MRI sequences.There is subtle uniform prominence of cortical sulci and vermian folia for age. This pattern however could be within normal limits.The morphology of brain parenchyma is otherwise within normal limits and without evidence of migratory disorder as is questioned clinically.Signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.No evidence of congenital anatomical abnormality and including migratory disorders.3.Subtle prominence of cortical sulci and vermian folia which may be within normal range and unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: New onset seizure. There is no evidence of hippocampal sclerosis, gross cortical malformation, hamartoma, heterotopia, intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a prominent left occipital arachnoid granulation. Otherwise, the skull, orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: 49-year-old male with history of PSC, cirrhosis, ascites. Evaluate biliary and vessel patency. HCC screening. PSC pre-OLT evaluation. Exam is limited by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: The liver measures 18.5 cm in craniocaudal dimension. There is mild fissural widening. The umbilical vein is recanalized and there are mild gastroesophageal varices indicating portal hypertension. Mild upper abdominal ascites. Stable enlargement of gastrohepatic and portacaval lymph nodes.There is again heterogeneous enhancement of the liver during the arterial phase. The arterial phase on today's exam was obtained with greater delay on the prior exam and the entire portal vein is opacified. No discrete arterially enhancing lesion or lesions with washout are identified. Mild attenuation of the hepatic veins and IVC is again noted however the hepatic vasculature appears patent.MRCP images are degraded by extensive motion artifact within this limitation, there is no significant biliary ductal dilatation mild biliary irregularity is suggested centrally at the level of the confluence. No dominant stricture or enhancing lesion. Cholelithiasis within a normally distended gallbladder.SPLEEN: The spleen measures 13 cm in craniocaudal dimension.PANCREAS: No pancreatic ductal dilatation. The pancreas enhances normally.ADRENAL GLANDS: Nonspecific nodularity of the left adrenal gland is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild gastroesophageal varices and mild upper abdominal ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild hepatosplenomegaly with mild ascites and stigmata of portal hypertension. No suspicious hepatic lesions are identified. Again noted is arterial phase perfusional variant of uncertain etiology, with diffuse heterogeneous enhancement of liver visualized.2.Sensitivity is limited on MRCP images due to extensive motion artifact with resultant severe image degradation. Mild biliary ductal irregularity is seen centrally at the level of the confluence. No dominant stricture or enhancing lesion delineated.


Instruction: Generate impression based on findings.

Input: Male, 46 years old, with chronic low back pain. Trace anterolisthesis of L4 relative to L5 is seen. Spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No marrow edema or marrow replacement is suspected.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Mild facet arthropathy. No significant spinal canal stenosis or neuroforaminal narrowing. L4-5: Advanced facet arthropathy. Loss of disc height with mild disc bulging. Moderate generalized narrowing of the spinal canal. Mild bilateral foraminal narrowing. L5-S1: Mild facet arthropathy. Disc bulging with a superimposed central protrusion. No significant spinal canal or foraminal stenosis.

Output: 1.Disc degeneration at L4-5 results in a moderate spinal canal stenosis and mild narrowing of the neural foramina. 2.Disc degeneration is also seen at L5-S1, but without significant associated spinal canal or foraminal compromise.3.Advanced facet arthropathy is demonstrated at L4-5.


Instruction: Generate impression based on findings.

Input: There are no T2/FLAIR abnormalities. There are no diffusion or susceptibility abnormalities. Ventricular size is normal without midline shift. Basal cisterns are patent. No evidence of herniation. Vascular flow voids are unremarkable.Partially empty sella is noted which can be a normal variant. There is prominence of the CSF spaces at the posterior fossa with minimal if any effacement of the adjacent cerebellar parenchyma. There is also a small arachnoid cyst involving the right middle cranial fossa abutting the right anterior temporal pole.There is mild mucosal thickening of the right maxillary sinus and minimal opacification elsewhere. Calvarium and extra cranial soft tissues are unremarkable.

Output: There is prominence of the CSF spaces at the foramen magnum which may represent a mega cisterna magna or an arachnoid cyst. Finding is of doubtful clinical significance. Partially empty sella is also noted which can be a normal variant. Small right middle cranial fossa arachnoid cyst is also incidentally noted. Brain MRI is otherwise unremarkable without evidence of suspicious intracranial masses, edema, hemorrhage, or herniation.


Instruction: Generate impression based on findings.

Input: 50 year-old female with multiple myeloma since 2007. On chemo. Fever of unknown origin on imipenem and vancomycin. Also new onset right upper quadrant pain. Evaluate for source of infection. CHEST:LUNGS AND PLEURA: Multifocal partially solid and ground glass nodular opacities are identified within both lungs. Some of these have a more solid appearance and some are more predominantly groundglass. These effect all lobes of the lung. The majority are in the periphery and are predominantly pleural-based. Small pleural effusion on the right.MEDIASTINUM AND HILA: Heart size normal. No mediastinal lymphadenopathy.CHEST WALL: Multiple lytic lesions are identified with adjacent soft tissue components. This includes a destructive lesion within the sternum with soft tissue component that extends posteriorly near the aortic arch. This soft tissue mass is central low attenuation which is likely due to necrosis. A lytic lesion with soft tissue component is identified in the anterior right fourth rib as well as the posterior right 10th rib. There is compressive atelectasis and consolidation adjacent to the lesion in the right 10th rib. There is right -sided axillary lymphadenopathy. The largest single node measures 1.4 x 1.3 cm (image 23/25 of series number 9).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: Subcentimeter punctate hypodense lesions in the kidneys are too small to characterize but likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions within the thoracic and lumbar spine at the patient's known myeloma. These extend into the spinal canal and appear grossly to have decreased compared with the patient's MRI on 11/5/2008. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Large inguinal lymph nodes identified. The largest single lymph node measures 2.9 x 1.8 cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are lytic lesions identified within the sacrum and pelvis consistent with multiple myeloma. A large lesion within the right iliac wing has a soft tissue component which measures 3.3 by 2.8 cm. Some of the lesions in the sacrum enter into the spinal canal.

Output: 1. Mixed groundglass and solid nodules in both lungs are nonspecific in etiology. They may represent infection, possibly fungal, drug reaction or less likely metastatic lesions.2. Multifocal lytic lesions with soft tissue component in the chest, abdomen and pelvis due to the patient's multiple myeloma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Anesthesia of skinClinical question: mass lesion or demyelinating disease causing right sided face, arm and leg numbness, tingling, weaknessSigns and Symptoms: right sided face, arm and leg numbness, tingling, weakness MRI brain: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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There is no evidence for cord compression and no evidence for intracranial mass lesion or other lesion to explain the patient's numbness and weakness.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, and there are no areas of abnormal signal. The midline structures and craniocervical junction are within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No abnormal extra-axial fluid collection is identified. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA HEAD

Output: Unremarkable MRI and MRA of the brain with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 75 years Female (DOB:4/16/1941)Reason: AVM brain, evaluate for changes, please do on the 3T scanner with CCM protocol for through evaluation. History: AVM brainPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD 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.There is a 17 x 20 mm axial dimension mass adjacent to the right frontal lobe abutting the postcentral gyrus just lateral to the hand motor area. It is associated with adjacent dural thickening. The meningioma is bright signal on FLAIR and T2. It enhances homogeneouslyThere is a second extra-axial mass abutting the right temporal lobe measuring 13 x 26 mm axial dimensions which is associated with the adjacent bony hypertrophy. This meningioma extends into the right transverse sinus. It is associated with a dural tail.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Time resolved MRA demonstrates early opacification of the right transverse sinus and sigmoid sinus with drainage into the jugular vein and condylar vein.There is a meningioma present adjacent to and involving the right transverse sinus which is supplied from right middle meningeal artery branches, right occipital artery , right ascending pharyngeal artery and posterior reticular artery branches. It drains primarily into the sigmoid sinus which subsequently drains out the jugular vein and condylar vein.The right frontal meningioma is associated with enlarged right middle meningeal artery branches.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There are two small meningiomas identified. One of meningioma is located adjacent to the right temporal lobe and extends into the right transverse sinus. It has associated osseous thickening. There is no associated brain edema appreciated. It is supplied by external carotid artery branches and drains primarily into the sigmoid sinus with an arteriovenous fistula appearance. There is no convincing evidence for reversible venous flow based on this exam. It is not clear whether the transverse sinus is completely occluded. The second meningioma is adjacent to the right precentral gyrus and is not associated with early venous shunting.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. These are not unusual in number or distribution.3. No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Other amnesia [R41.3], Reason for Study: ^Reason: eval frontal lesion History: memory loss, personality change No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. 3+3 disease in the right and left base. 3+4 disease in the left apex. PELVIS:PROSTATE:Prostate Size: 4.7 x 5.0 x 5.4 cmPeripheral Zone: The peripheral zone is diffusely thinned and heterogeneous with multiple foci of T2-weighted signal hypointensity including the left apex (series 1000 1/14) and left and right base (image 20). The dominant lesion is in the left apex measuring approximately 1.1 x 0.5 cm (series 1001/13). It appears to have early enhancement as well.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No specific evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific 5 mm right obturator lymph node. 6 mm left external iliac lymph node.BONES, SOFT TISSUES: T1 hyperintense left femoral head focus is nonspecific. Similar smaller focus on the right.OTHER: No significant abnormality noted.

Output: 1.Dominant 1.1 cm lesion in the left apex.2.No specific MR evidence of seminal vesicle invasion or extraprostatic extension. No pelvic lymphadenopathy.3.Intrinsically hyperintense left femoral head punctate osseous focus is nonspecific; likely a benign synovial herniation pit.4.Nonspecific small pelvic lymph nodes.


Instruction: Generate impression based on findings.

Input: 33 year old female with hidradenitis suppurativa, seronegative arthropathy, possible GERD and LVEF 49% on TTE. Referred for MRI to reassess LV function and evaluate for possible infiltrative diseases. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%. The LVEDV is 173 ml (normal range 109+/-23), LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), LVESV is 80 ml (normal range 31+/-10), and LV end systolic volume index is 35 ml/m2 (normal range 18+/-5). The LV mass is 93 g (normal range 114+/-24) and the LV mass index is 41 g/m2 (normal range 67+/-11). 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.The native T1 myocardial relaxation time is <1000 ms suggestive of the absence of underlying diffuse fibrosis or infiltration.There is no LV thrombus. 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 58%, the RVEDV is 163 ml (normal range 110+/-24), the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVESV is 68 ml (normal range 35+/-13), and the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 FindingsAsymmetric left axillary skin thickening and mildly enlarged lymph nodes compatible with patient's history of hydradenitis.Presence of multiple stones is noted in the gallbladder. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.____________

Output: 1.The left ventricle is normal in size with normal systolic function. LVEF 54%. Other quantitative values are noted above.2.The right ventricle is normal in size with normal systolic function. RVEF 58%.3.No findings to suggest prior ischemic damage or infiltrative process.4.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: Reason: rule out abscess History: pain, no onset reason identified Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There is multilevel disk desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild of this desiccation and a disk bulge at this level. There is a small amount of patchy enhancement present along the left lateral aspect of the endplates and immediately adjacent disk . There is partial effacement of fat planes adjacent to the left-sided exiting nerve root after it exits the neural foramen which is associated with subtle contrast enhancement. There is mild loss of disk space height at this level associated with disk desiccation.At L4-5 there is no significant compromise to spinal canal or neural foramina. There are endplate reactive changes present associated with loss of disk space height compared there is a increased T1 signal on the adjacent vertebral bodies which suppresses on the STIR images. There is moderate loss of disk space height at this level associated with disk desiccation. There is a small amount of patchy enhancement present along the posterior aspect of the L4-5 disk.At L3-4 there is no significant compromise to spinal canal or neural foramina. Are endplate reactive changes here as which are bright signal on T1. There is mild loss of disk space height at this level associated with disk desiccationAt 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 are acute/subacute inflammatory changes present along the left lateral aspect of the endplates at L5-S1 superimposed on chronic degenerative changes. The cause could very well be acute/subacute degenerative change. The possibility that this represents a very early infection cannot be excluded. These inflammatory changes abut the left-sided exiting nerve root after it exits the neural foramen.2.There are acute/subacute inflammatory changes present along the posterior aspect of the L4-5 disk superimposed on chronic degenerative changes. The cause could very well be acute/subacute degenerative change. The possibility that this represents a very early infection cannot be excluded. 3.There are chronic degenerative changes present at L3-4, L4-5 and L5-S1.4.No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified transient cerebral ischemiaClinical question: Reversal of vascular stenoses seen in May and June?Signs and Symptoms: Occasional headachesComments: SCD, SAH with ? vasospasm changes in May 2015. | MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery is medium-sized. There is extracranial origin of the left posterior inferior cerebral artery. The posterior communicating arteries are identified and are small. Curiously the right posterior communicating artery is smaller on the current exam than it was 11/6/2013 and 5/24/2015 exam exam.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There are small hypointense lesions present in the caudate nuclei bilaterally as well as the periventricular white matter and some encephalomalacia in the left middle frontal gyrus which are probably better appreciated on recent MRI exam.

Output: There is no evidence for intracranial aneurysm or intracranial cerebrovascular occlusive disease. Curiously compared to the prior exams the caliber of the right posterior communicating artery has decreased.


Instruction: Generate impression based on findings.

Input: 72-year-old woman with history of HBV cirrhosis and HCC status post multiple RFA's. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with hypertrophied left lobe and widened fissures.Posttreatment changes are seen in segment 5 (4/20) without evidence of residual arterial enhancement. A small amount of precontrast T1 hyperintensity in the ablation zone (10/55) is stable and may represent blood products. Segment 7 cyst noted.The portal vein appears patent.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: 9 millimeter T2 hyperintense round lesion in the uncinate process of the pancreas (4/37) appears unchanged. 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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Posttreatment changes in the segment 5 ablation zone without evidence of recurrent tumor.2.Stable uncinate process lesion, likely a side branch IPMN.3.Contrast extravasation as described above.


Instruction: Generate impression based on findings.

Input: 61 years Female (DOB:10/15/1954)Reason: r/o subacute CVA. Previous CVA 1999, new onset symptoms 2 weeks ago. CTH negative History: Slurred speech, unilateral R hand weaknessPROVIDER/ATTENDING NAME: MINDY L JACOBS TIPU S PURI There is redemonstration of confluent periventricular white matter T2 and FLAIR signal hyperintensity which was also present on the prior exam but has progressed.There is redemonstration of a focus of encephalomalacia centered along the right middle frontal gyrus which is associated with ex vacuo effect along the right lateral ventricle and a predominantly subcortical white matter signal hyperintensity on T2 and FLAIR MRI. This has not changed since the previous examThere are multiple punctate foci of T2 and FLAIR signal hyperintensity in the basal ganglia thalami and brainstem. These were also present on the prior exam and have not changed substantially.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam periventricular white matter lesions have progressed. At this age these are most likely vascular related.2.Encephalomalacia in the right middle frontal gyrus is most likely related to prior infarction.3.There are multiple lesions in the basal ganglia, thalami, internal capsules and brainstem which likely represent prior lacunar infarcts4.There is no evidence for acute or subacute cerebral infarction.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: eval for etiology of back pain History: scoliosis, back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is broad based left side neural foraminal and far lateral disc protrusion at the level of L34 and L45 with mild disc dessication.Diffuse bulging of disc at the level of L5S1 is also seen.Other levels' intervertebral discs appear to be normal. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The conus medullaris terminates at the T12-L1 level.

Output: Disc protrusions toward left side neural foramen and far laterally at the level of L34 and L45 as described above.Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Neuroblastoma. Pre-stem cell transplant workup. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The cerebellar tonsils are elongated, peg-shaped and extend up to 9 mm below the level of foramen magnum, compatible with Chiari I malformation. There is mild-moderate crowding at this level. There is no ventricular dilatation. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. Specifically, the questions abnormality on recent CT is not appreciated. Myelination is appropriate for age. There is no abnormal intracranial enhancement. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Normal brain MRI without brain metastasis.No definite pituitary abnormality, although please correlate with serum hormone levels, and if clinically indicated, dedicated MR of the pituitary gland can be obtained.Incidental finding of Chiari I malformation.


Instruction: Generate impression based on findings.

Input: Sensory disturbances on the leg. Multiple scattered high signal intensity white matter lesions on FLAIR images. However, those lesions are likely non specific and are not specific to other white matter lesions such as MS.No evidence of acute ischemic or hemorrhagic lesion on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Scattered non specific high signal intensity lesions on FLAIR images.


Instruction: Generate impression based on findings.

Input: Unspecified disturbances of skin sensation [R20.9], Reason for Study: ^Reason: cervical myelopathy History: R sided numbness There is broad based disc extrusion at the level of C56 which compressed thecal sac and severely narrows the right side lateral recess.There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: there disc-ligament complex abutting thecal sac which results mild spinal canal stenosis.C4-C5: there is central to slightly right disc protrusion which indents and abuts thecal sac results mild spinal canal stenosis. C5-C6: there is extrusion of disc toward right side neuroforamen results moderate spinal stenosis and significant right lateral recess stenosis. C6-C7: there is broad based disc protrusion central to left laterally which indents thecal sac. C7-T1: no neuroforaminal narrowing or spinal stenosis. T12-L1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Disc herniations at the level of C45, C56 and C67 as described above. Among them, the C56 disc demonstrates disc extrusion which results severe narrowing of the right lateral recess.2. Normal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: 39 years, Male, left-sided weakness, left facial droop. Previously seen infarcts in the right inferior parietal lobule as well as a left anterior corpus callosum have evolved in the interval. There has however been development of restricted diffusion consistent with acute infarct involving the right parietal lobe anterior, superior, and medial to the previously seen infarct. The acute infarct also extends into the right posterior frontal lobe, including inferior extension to the right frontal operculum, as well as the right insular cortex. There is also a punctate focus of restricted diffusion involving the left mid body of the corpus callosum which is also new since prior. Extensive patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter is also again seen, which may reflect small vessel ischemic disease, but is unusual for age. Chronic blood products involving the left anterior corpus callosum again seen. Chronic lacunar infarct involving the right pons is again evident. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. Major flow-voids are preserved. Small left maxillary mucus retention cyst. Mastoid air cells are opacified. Calvarium and extracranial soft tissues are otherwise unremarkable.

Output: Multiple infarcts of different ages are seen. There is evolution of prior right inferior parietal and left callosal genu infarcts and development of acute infarcts in the right parietal and posterior frontal lobes, right insular cortex, as well as the body of the corpus callosum on the left. Additional chronic infarcts as described above.


Instruction: Generate impression based on findings.

Input: Seizures and new onset headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of T2 hyperintensity in the cerebral white matter. The hippocampi are intact and there is no evidence of heterotopia. 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: Mild scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example, Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 60 year old with history of left ventricular dysfunction, hypertension, obesity and pulmonary sarcoidosis presenting for pre-operative stress and evaluation of LV function. MEDICATIONS: aspirin, nifedipine First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is moderately enlarged quantitively (severely when indexed to BSA)with mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 211 ml (normal range 109+/-23), the LV end systolic volume index is 63 ml/m2 (normal range 18+/-5), the LVESV is 120 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 90 g. The LV dysfunction is global. Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is mildly enlarged with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 191 ml (normal range 110+/-24), the RV end systolic volume index is 54 ml/m2 (normal range 22+/-8), and the RVESV is 103 ml (normal range 35+/-13). Right AtriumThe right atrium is Mildly dilated. 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 mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMultiple right renal cysts. 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. No perfusion defects/ "ischemia" present during hyperemia. 2. No prior myocardial infarction. The entire myocardium is viable.3. Moderately dilated LV with mildly reduced systolic function (LVEF 43%).4. Mildly enlarged RV size with mildly reduced systolic function (RVEF 46%).


Instruction: Generate impression based on findings.

Input: Male 63 years old Reason: eval for intrahepatic lesion History: worsening Bili ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Status post drainage using a metallic common bile duct stent. There is residual mild intrahepatic biliary ductal dilatation. There is soft tissue infiltrating along the portal triads from the porta hepatis into the liver. This causes some mild extrinsic compression upon the portal triads. The common bile duct stent appears patent.There are few scattered lesions within the liver the largest near the dome of the liver measuring 1.7 x 1.5 cm with imaging features compatible with metastases.Hepatic and portal veins are patent.SPLEEN: Scattered splenic lesions may represent subcentimeter metastatic deposits.PANCREAS: No pancreatic ductal dilatation. There is mild interstitial edema involving the pancreas body suggestive of mild pancreatitis. There are few scattered cystic foci in the pancreatic head which may represent small branch type PMNs.ADRENAL GLANDS: Left adrenal gland mass measures 4.5 x 3.5 cm and has imaging features compatible with metastases.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Necrotic adenopathy posterior to the head of the pancreas measures 2.5 x 2.4 cm.Extensive necrotic mesenteric lymphadenopathy.BOWEL, MESENTERY: Status post subtotal colectomy. There is extensive mesenteric necrotic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post decompression of the biliary tree with mild residual intrahepatic biliary ductal dilatation without focal stricture.2.Hepatic metastases with infiltrative changes along to the portal triads which may represent infiltrative metastatic disease along the portal triads.3.Necrotic left adrenal, mesenteric and peripancreatic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 44-year-old female with back pain and metastases seen on lumbar spine images. Evaluate for right iliac and left sacroiliac joint metastases. BONE MARROW: Note is made of a 4.5 x 3.6 cm focus of increased signal abnormality within the left sacrum about the sacroiliac joint, which enhances on postcontrast sequences consistent with osseous metastatic disease. There is associated extension to the level of the left S2 neural foramen as well as soft tissue extension into the left sacroiliac joint. Additionally, there is increased signal abnormality on fluid sensitive sequences replacing a large portion of the right iliac bone extending to the level of the superior, medial and posterior right acetabulum with associated enhancement on postcontrast sequences, consistent with an additional focus of osseous metastatic disease. There is an associated enhancing soft tissue component within the right gluteus minimus and right iliopsoas musculature consistent with soft tissue extension of metastatic disease. The imaged musculature of the pelvis is otherwise normal in appearance. There is nonspecific peritrochanteric inflammation bilaterally, left greater than right. SOFT TISSUES: There is a nonspecific 1.5 cm focus of fluid signal intensity within the subcutaneous tissue along the posterior aspect of the left iliac bone which does not demonstrate any definitive enhancement on postcontrast sequences.JOINTS: The alignment is anatomic.ADDITIONAL

Output: Multiple foci of osseous metastatic disease with soft tissue extension as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Neck pain, abnormal neck EMG. Evaluate for structural lesions and paraspinal enhancement/abnormalities. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. There is no abnormal enhancement within the spine. No abnormal edema or enhancement within the paraspinous musculature.The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or left neural foramen. Mild right neural foraminal narrowing related to uncovertebral hypertrophy.C4-5: There is uncovertebral hypertrophy on the right with small foraminal disc protrusion associated with mild right-sided neural foraminal stenosis. No significant compromise to the spinal canal or left neural foramen.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Left-sided thyroid nodules noted.

Output: 1. Mild degenerative changes with mild right C3-C4 and mild right C4-C5 neural foraminal stenosis. Cervical spine examination is otherwise unremarkable. No significant spinal canal stenosis at any level or cord signal abnormality. No abnormal enhancement in the spine or paraspinous soft tissues.2. Small left thyroid nodules.


Instruction: Generate impression based on findings.

Input: Images are moderately limited by patient motion. Postoperative changes are again seen from previous Chiari decompression with tonsillopexy. The cervical syrinx has significantly improved, now essentially collapsed, measuring 7 x 2 mm in greatest axial dimensions at the lower C6 level. It previously measured up to 6 mm AP at the same level on prior available sagittal cervical spine images. The syrinx was most conspicuous spanning the C2 and C3 levels where it measured up to 7 mm AP, now essentially barely visualized. Discontinuous syrinx remains visualized down to the lower C7 level, similar in extent to previous exam. Additional upper thoracic component is not well assessed on the current images, but likely is grossly similar.The fourth ventricle previously measured 3.2 cm AP on 4/19/2016, now only 2.1 cm. There is also slight decreased size of the fourth ventricle compared to the more recent 4/26/2016 exam. There is interval resolution of dorsal bulging of the upper cervical cord at the level of the neo-foramen magnum, with now well visualized dorsal CSF space caudal to the remaining cerebellar tissue. Previous heterogeneous signal dorsally at the level of the neo-foramen magnum has resolved, likely postoperative. Upon CSF flow imaging, biphasic flow is identified through the third ventriculostomy site into the prepontine cistern, as well as in the cerebral aqueduct, fourth ventricle, and minimally dorsal to the cervicomedullary junction, although flow is slightly asynchronous. There has been improvement in flow along the dorsal aspect of the upper cervical cord.A curvilinear structure is seen along the superior margin of the right lateral ventricle which may represent granulation tissue or debris, as it is located just deep to an area of linear hyperintensity in the overlying brain parenchyma suggesting a possible surgical tract. The previous ventriculostomy catheter has been removed. Lateral and third ventricles are grossly stable in size.

Output: 1.Previous ventricular catheter has been removed. Evidence of third ventriculostomy with biphasic flow through the surgical defect. Lateral and third ventricles are grossly stable in size, with interval decreased dilatation of the fourth ventricle.2.Interval expected evolution of postoperative changes at the neo-foramen magnum improved visualization of dorsal CSF space at this level. Previously noted subtle bulging of the upper cervical cord has resolved. Overall, improved visualization of biphasic CSF flow at this level.3.Significant improvement in cervical syrinx, with grossly similar upper thoracic component suggest, incompletely assessed.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: No restricted diffusion to suggest acute ischemia in the brain. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits. Partially empty sella, which may be a normal variant.MRI ORBITS: The right maxillary sinus is small which may related to hypoplasia or atelectasis from prior chronic sinus disease. There appears to be minimal mucosal thickening. There is no enophthalmos or significant downward displacement of right intraorbital contents. No abnormal mass or abnormal enhancement is seen in the orbits. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Minimal chronic small vessel ischemic changes in the brain, which is otherwise unremarkable for age.2. No abnormal signal in the optic nerves or chiasm. 3. Small right maxillary sinus which may be related to atelectasis from prior chronic sinusitis versus hypoplasia. No additional imaging findings to suggest silent sinus syndrome. CT can better assess bony anatomy if clinically warranted.


Instruction: Generate impression based on findings.

Input: Medial knee pain following injury The examination is limited by motion artifact and the patient's body habitus which prevented the use of a standard knee coil.MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the knee.


Instruction: Generate impression based on findings.

Input: Evaluate for growth of GBM. S/P RT and TMZ. Patient on TMZ. Again seen are postsurgical changes of left frontal craniotomy for tumor resection with chronic blood products along the surgical tract extending to the basal ganglia. Compared to 4/9/2015, there is mild increase in T2/FLAIR hyperintensity in the right frontal periventricular white matter and no significant change in the FLAIR hyperintensity surrounding the resection cavity, left frontoparietal corona radiata, and left temporal stem. There is mild decrease in FLAIR hyperintensity involving the right superior frontal gyrus associated with the enhancing lesion. Right superior frontal gyrus enhancing lesion measures approximately 4 mm and is slightly smaller than before and more noticeably smaller when compared to remote priors. Focus of enhancement involving the left middle frontal gyrus adjacent to the resection cavity also continues to decrease in size.No new mass or suspicious enhancement is appreciated. No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus. Left maxillary mucus retention cyst.

Output: No evidence of tumor progression. There is continued decrease in foci of enhancement in the left and right frontal lobes. FLAIR hyperintensity involving the left greater than right cerebral white matter is compatible with posttreatment change.


Instruction: Generate impression based on findings.

Input: 18-year-old female with history of Crohn's disease with right lower quadrant abdominal pain and fullness. 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: There has been interval decrease in extent of inflammation and thickening of the terminal ileum with residual thickening of the terminal ileum. There are linear enhancing tract extending between the distal ileum and cecum which raises suspicion a fistulous network in the region of prior inflammation. No fluid collection or abscess is present.There is no evidence of small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral cystic adnexal lesions are likely physiologic follicles. Arcuate uterus.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.Interval decrease in extent of small bowel inflammation and thickening of the terminal ileum. Residual thickening of a shorter segment of terminal ileum is present. No evidence of small bowel obstruction.2.Linear enhancing tract extending between the distal ileum and cecum which raises suspicion a fistulous network in the region of prior inflammation. No fluid collection or abscess is present.


Instruction: Generate impression based on findings.

Input: 4-year-old female patient with cyclic vomiting and precocious puberty. Evaluate pituitary. Pituitary: The pituitary enhances homogeneously and is normal in size. There is no evidence of pituitary tumors. The posterior pituitary bright spot and infundibulum are intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellum appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No gross evidence of pituitary or brainstem lesions.


Instruction: Generate impression based on findings.

Input: Buttock pain. Radiculopathy, neurogenic claudication. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There are small Schmorl's nodes involving the superior and inferior endplate of L4 with mild associated edema at the superior L4 endplate. There is grade 1 anterolisthesis of L4 and L5 and to a minimal degree also at the L3-L4 level. Alignment is otherwise maintained. There is a nonspecific lesion involving the L2 level with low T1 and low T2 signal. There are multiple additional foci of T1 hyperintensity compatible with foci of fat or small hemangiomas. 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: Minimal disc bulge, ligamentum flavum thickening, and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge, ligamentum flavum thickening, and moderate facet arthropathy with distention of the facet joints. There is moderate to severe spinal canal stenosis and mild bilateral neural foraminal stenosis.L4-L5: There is disc uncovering as well as right paracentral protrusion which effaces the lateral recesses, right greater than left. There is overall moderate to severe central canal stenosis. There is moderate bilateral facet arthropathy with distention of the facet joints. There is mild bilateral neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy with mild facet distention of the left.Small synovial cysts are noted associated with the facet arthropathy at the L3-L4 and L4-5 levels, primarily posterior to the facet joints although there is a tiny, probable synovial cyst in the dorsal epidural space at the L4-L5 level. Paraspinous soft tissues are otherwise within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine with moderate to severe spinal canal stenosis at the L3-L4 and L4-L5 levels.2. Grade 1 degenerative spondylolisthesis of L4 on L5 and to a lesser degree L3 on L4. Facet arthropathy with distended facet joints at these levels.3. Relatively mild neural foraminal stenoses as described above.