Instruction: Generate impression based on findings.

Input: Radiculopathy, lumbar region [M54.16], Reason for Study: ^Reason: assess for cause of LLE radiculopathy History: L L1 vs L2 radiculopathy For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: minimal disc dessication, no neuroforaminal narrowing or spinal stenosis. L1-L2: minimal disc dessication, no neuroforaminal narrowing or spinal stenosis. L2-L3: minimal disc dessication, there is left side far lateral disc herniation. no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal disc dessication, diffuse bulging of disc which abuts thecal sac, minimal bilateral neuroforaminal narrowing. L4-L5: minimal disc dessication, diffuse bulging of disc which abuts thecal sac with bilateral ligamentum flavum thickening results minimal to mild spinal canal stenosis. Bilateral mild neuroforaminal narrowing (left worse than right). L5-S1: no neuroforaminal narrowing or spinal stenosis. Prominent sclerotic changes of bilateral pars of L5 vertebral body but without definitive fracture or spondylolisthesis of L5 on S1.

Output: 1. Far lateral disc protrusion, left side of L23.2. Mild spinal stenosis and mild bilateral neuroforaminal stenosis at the level of L45. 3. Diffuse bulging of disc at the level of L34


Instruction: Generate impression based on findings.

Input: 26-year-old male with chronic swelling, evaluate for ligament or tendon injury MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears within normal limits. The bone marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patella and quadriceps tendons are intact.ADDITIONAL

Output: 1. No specific findings to account for the patient's symptoms.2. Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: Left upper extremity weakness. Question multiple sclerosis versus vasculitis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from straightening which may be positional. Bone marrow signal is benign with scattered foci of T1 hyperintensity including C6 and T1 vertebral bodies compatible with hemangiomas. Smaller but similar lesions are noted involving the posterior elements at the C3, C5, and C7 levels.The cervical spinal cord has normal signal characteristics and overall morphology with no evidence of abnormal enhancement.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: Small central disc protrusion with effacement of the ventral thecal sac. No significant compromise to the spinal canal overall or neural foraminal stenosis.C4-5: Small disc osteophyte complex with effacement of the ventral thecal sac but no significant spinal canal stenosis overall. There is mild to moderate right and mild left neural foraminal stenosis related to disc and uncovertebral hypertrophy.C5-6: Small disc osteophyte complex with partial effacement of the ventral thecal sac. No significant spinal canal stenosis. Mild left and minimal right neural foraminal narrowing.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowingThe vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There is a large heterogeneous nodule involving the left thyroid lobe measuring approximately 2.6 x 3.4 cm in the AP and transverse dimensions and 5.2 cm in the craniocaudal dimension. There is also a smaller nodule anteromedially in the left thyroid lobe.

Output: 1. No cord signal abnormality or evidence of demyelinating disease in the cervical cord.2. Mild degenerative changes in the cervical spine as described above without high-grade spinal canal or neural foraminal stenosis at any level.3. Approximately 2.6 x 3.4 x 5.2 cm heterogeneous mass/nodule at the level of the left thyroid lobe with extension into the mediastinum. Further evaluation with ultrasound is suggested.


Instruction: Generate impression based on findings.

Input: Left hip pain with long-term steroid use. Evaluate for fracture. There is serpiginous low T1 signal within the superior aspect of the bilateral femurs with a corresponding stripe of high and low T2 signal; these findings are compatible with avascular necrosis. There is no evidence of articular collapse. The remaining bone marrow signal is within normal limits.

Output: Avascular necrosis of the bilateral femoral heads without collapse.


Instruction: Generate impression based on findings.

Input: Brain: Again seen are findings of Chiari 2 malformation with herniation of the cerebellar tonsils which lie at the lower C3 level. There are findings of sub-occipital decompression. A 4th ventricular catheter is unchanged in position. A stable left parietal approach ventriculostomy catheter terminates near the midline. The 4th ventricle measures minimally larger in the AP dimension at 5 mm compared to 3-4 mm on examination from 6/30/2015 and 4 to 5 mm on 12/16/2014. The subtle differences may be related to differences in slice position. The lateral and third ventricles are also not significantly changed in size compared to recent CT and MRI studies. There is stable mild T2 hyperintensity adjacent to the occipital horns. No abnormal parenchymal or meningeal enhancement is appreciated. There is dysgenesis of the corpus collosum with absent posterior body and splenium. Again seen is enlargement of the CSF space anterior to the brainstem with clival scalloping raising possibility of arachnoid cyst but unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged prominence of the distal right internal carotid artery. Calvarium and extra cranial soft tissues are grossly unremarkable.Spine:There is syringohydromyelia which begins at the C3 level and extends inferiorly through the entire length of the spinal cord. It is unchanged in size and measures up to 4 mm in the AP dimension at the C7 level. There is significant thinning of the surrounding cervical cord parenchyma.Syrinx in the thoracic cord is similar, measuring 8x8 mm at the T4 level, previously 8x9 mm. At T6, syrinx measures 7 x 7 mm, previously 8 x 8 mm. There is severe mid-thoracic dextroscoliosis. There are posterior disc protrusions at C4-C5, C5-C6 and relatively worst at the C6-C7 where there is indentation of the spinal cord similar to prior. Dorsal thecal sac is widely patent at these levels. Enhancement of the paraspinous soft tissues is consistent with postsurgical change.Again seen is evidence of prior lumbosacral myelomeningocele repair with small stable pseudomeningocele. The distal neural placode is located along the dorsal aspect of the thecal sac and terminates at approximately the L5 level. No significant ventral motion of the distal neural tissue on the prone sequences.There is unchanged angulation of the coccyx. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are grossly unremarkable.

Output: 1. Again seen are findings related to Chiari II malformation status post decompression, VP shunt placement, fourth ventricular stent placement, as well as lumbar myelomeningocele repair. There is overall no significant change in caliber of the ventricular system or syringohydromyelia extending the length of the spinal cord. There are minimal differences in measurement as noted above. No abnormal parenchymal or meningeal enhancement in the brain or spine is appreciated.2. There is no significant change in appearance of distal cord and conus with no significant ventral motion on the prone sequences. Finding raise possibility of cord re-tethering in the appropriate clinical setting.3. Unchanged dilated caliber of the distal right internal carotid artery suspicious for aneurysm for which an MRA is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: 81 year old female with headaches and right double vision with right horizontal gaze. Evaluate for etiology of headache and recent vision changes; assess for possible pituitary mass/lesion. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild prominence of the pituitary gland for the patient's age but this is probably within normal limits. No focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk lies in the midline. The suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable. There is mild patchy periventricular and subcortical T2/Flair white matter hyperintensity which is nonspecific but likely related to the sequela of chronic small vessel ischemic disease. There are not masses or abnormal enhancement in the brain. 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: 1.No evidence of a mass or abnormal enhancement within the brain or pituitary.2.Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: There is an approximately 10 mm AP x 6 mm craniocaudal x 8 mm transverse nonenhancing lesion centered along the leftward aspect of the foramen of Monroe. This is isointense on T1 with mixed intensity on T2 (comprised of central hypointensity and peripheral hyperintensity, the so-called "black hole" effect). Ventricular sizes remain normal without evidence of obstructive hydrocephalus at this time.There are scattered punctate foci of T2 hyperintensity primarily within subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or for enhancement. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. A small amount of mucosal thickening is noted within an aerated right petrous apex air cell. There is no abnormal enhancement within the brain.

Output: 1.MRI findings consistent with a colloid cyst along the leftward aspect of the foramen of Monroe. Ventricular sizes remain normal without evidence of obstructive hydrocephalus at this time. Recommendations are made to consult neurosurgery.2.Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for left-sided weakness. Signs and symptoms: Left-sided weakness. Nonenhanced brain MRI:Examination is degraded due to motion artifact however diagnostic.Unremarkable diffusion weighted series.There is normal signal intensity of brain parenchyma on all MRI sequences.There is mild generalized prominence of cortical sulci for age which could be at the upper limits of normal. Unremarkable cerebral cortex, ventricular system, CSF spaces and brain myelination otherwise.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits. Unremarkable calvarium and soft tissues of the scalp. Paranasal sinuses demonstrate mild chronic sinusitis of the sphenoid and unremarkable otherwise.Nonenhanced cervical MRI:Examination is degraded due to extensive motion artifact.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes with mild left neural foraminal compromise.C4-C5 demonstrate moderate disc disease and loss of disc height, left uncovertebral hypertrophic changes with resultant mild left neural foraminal compromise. There is a central disc extrusion at this level with resultant flattening deformity and posterior displacement of the cord and resultant mild central spinal stenosis. There is no convincing evidence of cord signal abnormality.C6-C7 demonstrate minimal degenerative changes and unremarkable otherwise.C7-T1 is unremarkable.Unremarkable upper most visualized thoracic spine and thoracic cord.

Output: 1.Nonenhanced brain MRI is unremarkable. Please see above comments.2.Nonenhanced cervical MRI is degraded due to motion artifact. Within this limitation there is a central disc extrusion at C4-C5 with resultant indentation deformity of the cord and subtle posterior displacement with mild central spinal stenosis at C4-C5 level and with mild left neural foraminal compromise. There is no detectable signal abnormality of the cord. Please see above comments.


Instruction: Generate impression based on findings.

Input: Reason: Generalized Tonic Clonic Seizures History: Generalized Tonic Clonic Seizures Susceptibility artifact limits evaluation of the right cerebellum on DWI and susceptibility weighted images.There is no evidence of intracranial hemorrhage, mass, or acute infarct. Focal prominence of the extra-axial space along the left cerebellum with mild mass effect may represent a minimal retrocerebellar cyst or mega cisterna magna. 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.

Output: 1.No underlying structural abnormalities to explain patient's seizures.2.Focal prominence of the extra-axial space along the left cerebellum may represent a minimal retrocerebellar cyst or mega cisterna magna.


Instruction: Generate impression based on findings.

Input: There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Multilevel disc desiccation and degenerative discogenic reactive endplate changes are noted.C2/3: Left facet hypertrophy causes minimal left neural foraminal stenosis.C3/4: Trace anterolisthesis C3 on C4, mild posterior osteophyte disc complex, and left facet hypertrophy with a small left facet effusion. There is mild left neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and left facet hypertrophy. There is minimal central, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and left facet hypertrophy. There is severe left neural foraminal and moderate right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild left neural foraminal stenosis.C7/T1: UnremarkableT1/2: Posterior osteophyte disc complex and bilateral facet hypertrophy contribute to bilateral foraminal encroachment.T2/3: Disc bulge and bilateral facet hypertrophy contribute to right foraminal encroachment.T3/4: Left facet hypertrophy contributes to left foraminal encroachment.

Output: 1.C2/3: Minimal left neural foraminal stenosis.2.C3/4: Mild left neural foraminal stenosis.3.C4/5: Minimal central, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis.4.C5/6: Severe left neural foraminal and moderate right neural foraminal stenosis.5.C6/7: Mild left neural foraminal stenosis.6.T1/2: Bilateral foraminal encroachment.7.T2/3: Right foraminal encroachment.8.T3/4: Left foraminal encroachment.


Instruction: Generate impression based on findings.

Input: History of right kidney mass status post RFA 10/22/2014. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. No choledocholithiasis or biliary ductal dilatation. Stable nonenhancing T2 weighted hyperintense hepatic lesions likely represent small cysts.SPLEEN: No significant abnormality noted.PANCREAS: 8 x 6 mm non-enhancing cystic lesion adjacent to the distal pancreatic body/tail pancreatic duct, likely a side branch IPMN (series 4/17). 9 x 7 mm pancreatic head side branch IPMN (series 4/26) without mural nodular enhancement. Punctate IPMNs in the pancreatic tail. These are not significantly changed. The pancreatic parenchyma is otherwise normal in morphology.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Post-treatment changes from the prior ablation of the right renal midpole lesion. In the region of the ablation there is an expected defect and "peri-ablational halo". Along the medial margin there is a focal region of intrinsic T1-weighted hyperintensity without evidence of post-contrast enhancement, compatible with clot/proteinaceous material. Additional bilateral simple renal cysts and a left mid/lower kidney likely proteinaceous cyst are stable.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.Stable appearance of the right kidney status post ablation without evidence of recurrence.2.Stable bilateral renal cysts.3.No significant change in the pancreatic suspected side branch IPMNs.4.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Back and leg pain. There is mild disc bulging with loss of height and fluid signal, as well as facet hypertrophy at L4-5 with mild spinal canal and bilateral neural foraminal narrowing. There is no significant degenerative spondylosis at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis at L4-5 with mild spinal canal and bilateral neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: 62 years, Male, Reason: follow up for RCC History: hx of RCC. ABDOMEN:LUNG BASES: There is a nodule in the left prevertebral space, adjacent to the left posterior pleura, which likely represents a lymph node (401/152) and is unchanged in size from CT of 12/21/2014.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: Postsurgical changes of left nephrectomy. No evidence of tumor recurrence. Simple appearing cyst in the right kidney.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.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Nonenhancing lesions with increased T2 signal along the right sacral nerve roots (1901/24) measuring up to 1.3 cm in thickness.

Output: 1.Nodule adjacent to the left posterior pleura in the prevertebral space likely represents an enlarged lymph node and is stable from recent CT.2.Small lesions along the right sacral nerve roots may represent peripheral nerve sheath tumors and/or perineural cysts.


Instruction: Generate impression based on findings.

Input: left facial weakness, lower extremity weakness and sensory deficit. No evidence of acute ischemic or hemorrhagic lesion.Multifocal bihemispheric scattered high signal intensities on white matter on FLAIR images indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: chondral damage, possible non-displaced tibial plateau fx History: chondral damage, possible non-displaced tibial plateau fx MENISCI: The lateral meniscus appears normal. There is minimal poorly defined increased signal intensity within the posterior horn and body of the medial meniscus contacting the tibial articular surface, which could conceivably represent fraying but we see no fluid-filled or otherwise unstable tear. The anterior horn of the medial meniscus appears normal.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage defects. The bone marrow signal intensity is normal and we see no fracture.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Possible minimal fraying of the undersurface of the medial meniscus. Otherwise normal-appearing knee without fracture or chondral damage.


Instruction: Generate impression based on findings.

Input: Metastatic colorectal cancer. Evaluate for spine lesions. The vertebral bodies are appropriate in the overall alignment and height. Bone marrow signal is mildly heterogeneous without large destructive lesions appreciated. T1 hyperintensity involving the thoracic vertebral bodies likely related to prior thoracic radiation. No evidence of cord compression or compression of the cauda equina nerve roots is seen. Mild degenerative changes are evident including small disc herniations at C6-C7, T8-T9, T9-T10, and L5-S1 with up to mild spinal canal stenosis.Prominent venous flow-voids are noted involving the paraspinous soft tissues. Left pleural effusion.

Output: No evidence of high-grade spinal canal stenosis is identified in the cervical, thoracic, or lumbar spine. No large metastatic osseous lesions are evident. No compression fractures. No evidence of cord compression.This is a limited exam specific for the exclusion of cord compression only and does not exclude small lesions or intrinsic cord abnormalities. Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Targeted CT examination demonstrates a lucent lesion with a central sclerotic nidus in the calcaneus corresponding to the findings on recent CT and MRI examinations with the imaging characteristics most consistent with an osteoid osteoma. Using CT guidance, a 12-gauge OnControl core biopsy needle was advanced into the lesion and one 12-gauge core biopsy specimen was obtained and placed in 10% formalin. Subsequently, CT guidance was used to advance a Rita SDA RFA probe into the lesion. The lesion was heated to 90 degrees centigrade for 2 minutes at 45 W. The RFA probe was removed.The core biopsy specimen were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT-guided biopsy and radiofrequency ablation of left calcaneal presumed osteoid osteoma.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: Facial droop. Nonenhanced brain MRI:Small focus of subcortical restricted diffusion measuring approximately 6 mm in size is noted in the right precentral gyrus.Examination in addition demonstrate extensive periventricular, subcortical, basal ganglia, thymic and pontine confluent foci of flair hyperintensity with resultant mild ex vacuo dilatation of the supratentorial ventricular system consistent with advanced chronic small vessel ischemic strokes.The signal void of major intracranial arterial branches are identified. There is small caliber of right carotid artery across the skull base compared to the left. Further assessment with vascular imaging is recommended.Unremarkable calvarium and orbits. Sinusitis is noted.

Output: 1.Small focus of acute ischemic change in the right anterior parietal white matter.2.Extensive chronic small vessel ischemic strokes in the subcortical, periventricular, basal ganglia, thalami and pons as detailed.3.Small caliber of right internal carotid artery across the skull base compared to left. Evaluation with dedicated vascular imaging is recommended.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with history of meningioma status post resection. Evidence of right frontal craniotomy is again seen. Since the prior examination, acute postoperative findings status post resection of a large right frontal parafalcine meningioma have subsided. A small amount of extra-axial fluid is present beneath the craniotomy. Edema in the right frontal lobe has improved with mild encephalomalacia and hemosiderin staining of the parenchyma. Dural thickening and enhancement along the operative bed is nonspecific. There are no discretely tumor-like lesions identified. Elsewhere, scattered periventricular and subcortical FLAIR hyperintensity is redemonstrated similar to prior. No significant mass effect is observed. Ventricular size and morphology are within normal limits.

Output: Expected findings are seen compatible with resection of a large right frontal parafalcine meningioma. No definite evidence of any residual or recurrent tumor is noted.


Instruction: Generate impression based on findings.

Input: Cholangiocarcinoma status post chemotherapy. ABDOMEN:LIVER, BILIARY TRACT: A common bile duct stent is noted with mild surrounding susceptibility artifact which limits evaluation. There is moderate intrahepatic biliary ductal dilatation to the level of the stent/Klatskin's point, appearing similar to the prior. There is subtle post-contrast circumferential enhancement about the proximal aspect of the stent (series 1008, 264), likely corresponding to the patients periductal infiltrating cholangiocarcinoma. There is subtle soft tissue infiltration into the porta hepatis where there is at least partial encasement of the common hepatic artery, measuring approximately 1.3 x 1.0 cm (series 1008/254).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The patient's known cholangiocarcinoma at Klatskin's point is difficult to accurately measure with subtle circumferential enhancement about the proximal aspect of the stent and soft tissue infiltration into the porta hepatis with at least partial encasement of the common hepatic artery. The appearance is similar to the recent prior CT (peri-arterial soft tissue is seen in retrospect on series 11 of image 95).


Instruction: Generate impression based on findings.

Input: Reason: follow up indeterminate liver lesion found on recent CT History: NA. ABDOMEN:LIVER, BILIARY TRACT: Diffuse decreased signal on out of phase imaging relative to in phase imaging compatible with hepatic steatosis. Lesion seen on recent CT is not visualized on majority of sequences. It is best seen on venous phase post contrast (series 10 image 84) and measures 1.3 cm with no enhancement or other suspicious features. No additional focal hepatic lesions. No definite evidence of metastases.Cholelithiasis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sternotomy hardware results in artifact.OTHER: No significant abnormality noted.

Output: Indeterminate lesion on CT not seen on majority of MRI sequences, is suggested on postcontrast venous phase. No suspicious features demonstrated, no suspicious lesion seen.


Instruction: Generate impression based on findings.

Input: 69-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.3 x 5.2 x 5.3 cm.Peripheral Zone: At the right apex there is a T2 hypointense lesion which has mildly increased in size now measuring 7 x 7 mm (image 15 of series 1001).Central Gland: BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent lymph nodes adjacent to the prostate.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Enlarging right apical lesion now measuring 7 x 7 mm.2. Scattered mildly prominent pelvic lymph nodes.


Instruction: Generate impression based on findings.

Input: 28-year-old male with NF1 and extensive sacral and pelvic disease. Please delineate the margins of the plexiform neurofibromas in his pelvis. There are innumerable masses of low signal intensity on T1-weighted images and high signal intensity on STIR images, many having a target appearance, within the skin, subcutaneous and deep soft tissues of the pelvis compatible with nerve sheath tumors and the stated history of neurofibromatosis type I. Plexiform neurofibromas involve the lumbar and sacral nerve roots as well as both sciatic nerves, extending off the field-of-view of this study. There are also plexiform neurofibromas involving both femoral nerves, slightly prominent on the right. Additional neurofibromas are noted within the pelvis as well as the surrounding musculature but we see no single dominant lesion to suggest malignancy. Bone marrow signal intensity is within normal limits. The hip joints, sacroiliac joints and pubic symphysis are unremarkable.

Output: Findings compatible with neurofibromatosis with plexiform neurofibromas as above.


Instruction: Generate impression based on findings.

Input: There is a small focus of T2 hyperintensity and enhancement in the anterior aspect of the C7 vertebral body. The spinal cord is of normal caliber and signal. At C3-4 through C6-7 there are central to left foraminal base disc bulges with mild to moderate narrowing of the spinal canal and moderate left neural foraminal stenosis. The vertebral body heights are preserved and there is no spondylolisthesis. The paravertebral soft tissues are unremarkable.THORACIC SPINE

Output: 1.Numerous myelomatous lesions are present in the axial skeleton, without associated spinal cord compression of pathological fracture.2.Degenerative spondylosis in the cervical and lumbar spine, without associated spinal cord compression either.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 61-year-old woman with history of paresthesias, evaluate for progressive stenosis. The craniovertebral junction appears within normal limits. There is reversal of the normal cervical lordosis, particularly from C3-C7. Additionally, there is grade 1 anterolisthesis of C3 on C4, stable from the prior examination. The cervical vertebral bodies are appropriate in height. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.There is loss of intervertebral disc height and formation of disc osteophyte complexes with degenerative changes as described below, overall minimally progressed from the prior examination:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a disc osteophyte complex with mild spinal canal stenosis. There is moderate right neural foraminal narrowing and mild left neural foraminal narrowing. C4-5: There is a disc osteophyte complex resulting in mild to moderate spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.C5-6: There is a disc osteophyte complex resulting in mild to moderate spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis.C6-7: There is a disc osteophyte complex resulting in mild to moderate spinal canal stenosis. There is mild bilateral neural foraminal stenosis, left greater than right. A right perineural cyst is noted.C7-T1: There is a disc osteophyte complex without significant spinal canal or neuroforaminal stenosis.The vertebral artery flow voids appear to be intact. There are multiple bilateral T2 hyperintense thyroid nodules, otherwise the paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes, minimally progressed since 12/2014. There is up to mild-to-moderate degree of spinal canal stenosis at the C4-C5, C5-C6, and C6-C7 levels. Multilevel neural foraminal stenoses as above.


Instruction: Generate impression based on findings.

Input: 77-year-old female patient with weakness and pain in left shoulder, limited abduction. ROTATOR CUFF: There is thickening and intermediate signal intensity of the supraspinatus tendon indicating moderate to severe tendinosis with probable articular and bursal surface fraying. We see no full-thickness fluid filled supraspinatus tear. The supraspinatus muscle appears normal. There is moderate to severe tendinosis of the infraspinatus tendon with fluid signal intensity along the myotendinous junction suggesting interstitial tearing with possible extension to the bursal surface fibers. We see no full-thickness fluid-filled tear of the infraspinatus tendon. The infraspinatus muscle appears normal. The teres minor muscle and tendon appear normal. There is thickening and increased signal intensity of the distal fibers of the subscapularis tendon which likely represent a combination of tendinosis and redundancy due to the humerus held in internal rotation. Also a focus of linear increased signal intensity along the insertion of the subscapularis tendon likely represents a bursal surface tear, but we see no full-thickness tearing. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: Moderate to severe osteoarthritis affects the acromioclavicular joint which results in mild impression of the superior fibers of the supraspinatus. A small amount of fluid is noted in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint. There is a small joint effusion with fluid extending into the subscapular recess with foci of intermediate signal intensity which presumably represents synovitis or debris.BICEPS TENDON: Increased signal intensity within the biceps tendon within the rotator interval suggests tendinosis. Fluid within the biceps tendon sheath may represent extension of fluid from the glenohumeral joint rather than tenosynovitis.

Output: 1. Rotator cuff tendinosis with partial thickness tearing/fraying as described above, but we see no discrete full-thickness fluid-filled rotator cuff tear.2. Osteoarthritis of the glenohumeral and acromioclavicular joints and other findings as described above.


Instruction: Generate impression based on findings.

Input: 89-year-old female status post exploratory laparotomy for lysis of adhesions for small bowel obstruction now with right facial droop and tongue deviation. There is no evidence of intracranial hemorrhage, mass or edema. Multiple patchy hypodensities in a periventricular distribution throughout the subcortical white matter consistent with advanced small vessel disease. Small vessel disease of undetermined age may be further evaluated with an MRI if there is clinical suspicion of acute ischemia. Prominence of the sulci and ventricles are proportional. The skull base is radiographically normal. The calvaria demonstrates multiple patchy foci of high density and cortical thickening consistent with Paget's disease. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.2. Paget's disease affects the skull.


Instruction: Generate impression based on findings.

Input: Foci of T2 hyperintensity are present within the white matter without associated restricted diffusion, mass effect, susceptibility abnormality, or enhancement. A similar appearance is also found within the central pons. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Chronic deformity of the right globe is again noted.

Output: 1.Chronic small vessel ischemic disease involving the white matter and pons.2.No MRI evidence for metastatic disease.


Instruction: Generate impression based on findings.

Input: Fall on Coumadin, possible intracranial hemorrhage The examination is limited by motion artifact.The cortical sulci are in proportion to the cerebral ventricles. The previously suspected subdural hematoma anterior to the left frontal lobe is not visualized and was likely artifactual. A punctate focus of T2 hyperintensity is again demonstrated in the left centrum semiovale. The gray-white matter differentiation is preserved. No midline shift or mass effect is appreciated. There is no diffusion abnormality identified. No abnormal parenchymal susceptibility is appreciated. No fluid collections are visualized paranasal sinuses or mastoids. Nonspecific susceptibility artifact is demonstrated in the bilateral parietal scalp.There is straightening of the cervical spine with mild reversal of the cervical lordosis centered at C5-C6. There is mild retrolisthesis of C5 over C6. Anterior osteophyte formation is demonstrated at C5-C7 levels. The vertebral body heights are maintained. Mild loss of intervertebral disc space is demonstrated at C5-6 and C6-7. The spinal cord demonstrates normal caliber and signal intensity.C2-3: There is a mild disc bulge resulting in no significant spinal canal or neuroforaminal stenosis.C3-4: Posterior disc protrusion causing mild to moderate bilateral neuroforaminal stenosis.C4-C5: No significant disc herniation, neuroforaminal stenosis or spinal canal stenosis is noted at this level.C5-C6: Posterior disc osteophyte at this level causes moderate to severe bilateral neural foraminal stenosis and mild spinal canal stenosis.C6-C7: Posterior disc osteophyte causes severe bilateral neural foraminal stenosis and mild spinal canal stenosis.C7-T1: No significant disc herniation is noted at this level.

Output: 1. The previously identified subdural hematoma anterior to the left frontal lobe is not confirmed on MRI and was likely related to artifact.2. Degenerative changes of the cervical spine as described above, worse at C5-C6 and C6-C7 levels with moderate to severe bilateral neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: Chronic subdural hemorrhage since 2013 presenting with inability to walk, insomnia and urinary incontinence. There is multilevel degenerative spondylosis involving the cervical spine, with mild to moderate spinal canal narrowing at C3-4 and C4-5. Otherwise the rest of the spinal canal is patent and the spinal cord signal appears to be within normal limits. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative spondylosis involving the cervical spine, with mild to moderate spinal canal narrowing at C3-4 and C4-5. Otherwise the rest of the spinal canal is patent and the spinal cord signal appears to be within normal limits.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. 2014 biopsy was negative. 2013 biopsy revealed 3+3 less than 1 mm less than 5% left base lateral. 3+3 left mid medial and left mid lateral disease. PELVIS:PROSTATE:Prostate Size: 3.3 x 5.3 x 4.8 cmPeripheral Zone: Most conspicuous on the diffusion-weighted images is a 1.8 x 1.1 cm focus of restricted diffusion (series 503/324) associated with vague decreased T2 weighted signal in the left mid gland to apex. This lesion is primarily centered in the transition zone.5 mm focus of restricted diffusion and increased T2 weighted signal in the lateral left apex (series 901/15) is non-specific given its small size.Central Gland: Changes of BPH. Areas of ill-defined restricted diffusion without suspicious associated T2 weighted signal intensity.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The left mid gland to apex lesion described above appears to at least abut the prostatic margin on the DWI images but this may be due to adjacent artifact.BLADDER: 1.3 x 0.9 cm polypoid lesion along the right lateral bladder wall. It is difficult to assess its enhancement characteristics due to contrast in the bladder and artifact. It does not have T1-weighted signal hyperintensity to suggests a blood clot.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.8 x 1.1 cm focus of restricted diffusion in the left mid gland through apex mostly centered in the transition zone but extending into the peripheral zone, increased from the prior.2.Additional 5 mm focus in the left lateral apex of the peripheral zone is nonspecific.3.1.3 x 0.9 cm right lateral bladder wall polypoid lesion warrants cystoscopy evaluation.The incidental finding regarding the bladder wall lesion was relayed to the ordering physician (Dr. Eggener) via e-mail at 1153 03/31/2016.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. Cervical spine:Degenerative disease of cervical spine is again noted, with disk space narrowing at C6 -- C7 level. There is disk space narrowing and posterior disk-osteophyte complex at C6 -- C7 level. There are facet and uncovertebral joint arthropathic changes at multiple levels. There are no blastic or lytic metastasis identified.Thoracic spine:There is a sclerotic lesion in right posterior aspect of T10 vertebra, likely representing a metastatic focus that was also seen in prior MRI of 5/17/2011. Mild degenerative changes are also seen in thoracic spine. Lumbar spine:There are mixed lytic / blastic lesions involving L3, L4 and L5 levels, with involvement of both anterior and posterior elements. There is epidural extension, and extension into the left neural foramina at L3 -- L4 and L4 -- L5 levels, and to the left paraspinal region. These findings are better seen on prior MRI study. Findings are consistent with metastasis. There is suspicion of new lesion in S1 vertebra. Postsurgical changes in the posterior lumbar region are again present.No evidence of acute fracture is seen.Tarlov cysts are again noted at S2 level.There are multiple small nodules in bilateral lungs, consistent with lung metastasis.

Output: 1. Metastasis in T10 vertebra.2. Extensive metastatic disease at the L2 to L5 levels, with epidural extension. 3, Suspicious new lesion at S1 level. 4. Multiple metastatic pulmonary nodules. Please correlate with CT chest. Imaging findings of the thoracic and lumbar spine can be better evaluated with MRI with contrast.


Instruction: Generate impression based on findings.

Input: History of bilateral teratoma status post cystectomy 10/2015 with concern for remnant/recurrent teratoma on ultrasound. PELVIS:UTERUS, ADNEXA: Anteverted anteflexed probable arcuate uterus measuring 6.8 x 3.6 cm in the sagittal plane. The endometrium/endometrial cavity and inner myometrium/junctional zone are unremarkable. The cervix, vaginal canal and parametrial soft tissues are unremarkable.The right ovary measures 3.3 x 2.8 cm (series 401/39) with numerous follicles within physiologic limits. The left ovary is likely displaced medially somewhat near the uterine fundus and measures approximately 2.5 x 1.4 cm (series 401/37) with several follicles within physiologic limits. No evidence of residual/recurrent teratoma or other lesion.Note is made of a 1.6 cm probable fibroid near the right uterine cornu.Probable 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: The adnexa are normal in appearance without definite evidence of residual or recurrent disease. Probable arcuate uterus with a 1.6 cm fibroid near the right uterine cornu.


Instruction: Generate impression based on findings.

Input: Male, 24 years old, with severe neuropathy and radiculopathy. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The distal spinal cord, conus and nerve roots of cauda equina are unremarkable. No epidural abnormalities are noted. No pathologic spinal cord or leptomeningeal enhancement is seen.At L4-5, a mild diffuse disc bulge is seen, with a right foraminal/far lateral disc protrusion which contacts the exiting right L4 nerve root. The spinal canal and neural foramen are not significantly narrowed at this level.Elsewhere, no significant disc bulge or disc herniation is seen. No high-grade spinal canal or foraminal stenosis is detected.

Output: 1.A right foraminal/far lateral disc protrusion is evident at L4-5 which contacts the exiting right L4 nerve root.2.Elsewhere no significant disc bulge or disc herniation is seen. No high-grade spinal canal or neuroforaminal stenosis is detected. No abnormalities of the distal spinal cord or cauda equina are noted.


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain. History of hepatic lesions thought to be FNH. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. The liver is normal in size. Loss of signal intensity on out of phase imaging is compatible with diffuse fatty infiltration.Demonstrated again are numerous faintly T2 hyperintense lobular lesions demonstrating arterial enhancement and uptake of hepatobiliary agent on hepatobiliary phase imaging compatible with multiple focal nodular hyperplasia. The larger lesions demonstrate a central scar.The segment 8 lesion measures approximately 6.2 x 4.7 cm (series 10/25), compared to 7.5 x 6.1 cm previously.The segment 5 lesion with a peripheral cyst measures approximately 5.6 x 4.2 cm, compared to 6.0 x 4.0 cm previously.The right posterior segment T2 hyperintense lesion is compatible with a hemangioma measures approximately 1.6 cm, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Looped pancreatic duct, a normal variant. No focal lesion or ductal dilatation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal 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 stable to mildly decreased hepatic lesions compatible with focal nodular hyperplasia.Stable small right hepatic hemangioma.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: History of neurofibromatosis with known paraesophageal neurofibroma, evaluate for any change in size. There is no significant interval change in size of the well-defined and mildly lobulated, heterogeneously enhancing mass in the left tracheoesophageal groove region, measuring 24 x 34 mm in axial section, previously 24 x 34 mm as well. There is associated compression of the left internal jugular vein. There is a nodular enhancing lesion posterior to this mass, which measurers 7 x 12 mm in axial section. There is an enhancing right upper thoracic paraspinal and intercostal mass that measures 24 x 28 mm in axial section. There is an enhancing nodular lesion in the left lower face subcutaneous tissues, which measures 11 x 16 mm in axial section. There is a partly imaged enhancing nodular in the left occipital scalp and multiple smaller nodules elsewhere in the scalp, face, and neck subcutaneous tissues. There are partly imaged postoperative findings in the thoracic spine. There is no significant lymphadenopathy in the neck. The thyroid and salivary glands are unremarkable. There is diffuse enlargement of the optic nerves, each measuring up to 9 mm in width. The cerebellar tonsils are mildly low lying. There is a peripherally enhancing periapical cystic lesion in the right maxillary molar region that measures up to 18 mm. There is mild mucosal thickening in the right maxillary sinus.

Output: 1. No significant interval change in size of the neurofibroma in the left tracheoesophageal groove region. Multiple other neurofibromas are also present elsewhere in the head, neck, and imaged upper chest regions.2. Bilateral optic gliomas.3. A peripherally enhancing periapical cystic lesion in the right maxillary molar region may represent a dental abscess or inflamed odontogenic cyst.


Instruction: Generate impression based on findings.

Input: Lumbago Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 retrolisthesis of L5 on S1. Alignment is otherwise maintained. There is disc desiccation involving the L4-L5 and L5-S1 levels with some loss of height. Bone marrow signal is benign. There are fatty marrow signal changes involving the L5 pedicles and facets which are nonspecific. No definite pars defect is evident although can be better assessed with oblique radiographs. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation and disc bulge with small central protrusion. No spinal canal or neural foraminal stenosis.L5-S1: There is a disc bulge eccentric to the right with a small right paracentral protrusion component. There is partial effacement of the right lateral recess with contact of the descending S1 nerve root. No significant central canal stenosis. There is mild right and minimal left neural foraminal stenosis. The extra foraminal right L5 nerve root contacts the lateral disc bulge without definite evidence of impingement. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Degenerative changes at the L4-L5 and L5-S1 levels with disc protrusions. At the L5-S1 level, there is contact of the disc with the extraforaminal right L5 nerve root as well as the descending right S1 nerve root in the lateral recess. No significant central spinal canal stenosis at any level. Mild bilateral L5-S1 facet arthropathy. Please see details above.


Instruction: Generate impression based on findings.

Input: Memory loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is nonspecific fluid within the mastoid air cells.

Output: Probable mild chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: A 49 year old male with severe pulmonary arterial hypertension, systemic sarcoidosis with involvement of the lungs, skin, eyes, joints and probably of the heart. The patient is a candidate for lung transplant and is referred to cardiac MRI for further cardial assessment. Left VentricleThe left ventricle is small in size with moderate systolic dysfunction. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 122 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 43 g/m2 (normal range 85+/-15), and the LV mass is 91 g (normal range 164+/-36). The right ventricle is compressing the left ventricle, there is rightward shift of the interventricular septum ("D" shape) and the left ventricular filling is limited. There is late gadolinium enhancement with endocardial sparing involving the base and middle segments of the inferior wall as well as in the inferior hinge point of the interventricular septum. There is no intracavitary thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with severe systolic dysfunction. The overall RV ejection fraction is 26%, the RV end diastolic volume index is 162 ml/m2 (normal range 82+/-16), the RVEDV is 342 ml (normal range 142+/-31), the RV end systolic volume index is 120 ml/m2 (normal range 31+/-9), and the RVESV is 253 ml (normal range 54+/-17). There is hypertrophy.Right AtriumThe right atrium is severely 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 trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe 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 severely enlarged.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is mild mediastinal lymphadenopathy. There is mild atelectasis at the lung bases. No frank pulmonary fibrosis on pulmonary MRI. 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 small in size with moderate systolic dysfunction, the LVEF is 41%. The right ventricle is compressing the left ventricle, there is rightward shift of the interventricular septum ("D" shape) and the left ventricular filling is limited. 2. There is late gadolinium enhancement with endocardial sparing involving the base and middle segments of the inferior wall as well as the inferior hinge point of the interventricular septum. This pattern is atypical for myocardial infarction. The hinge point delayed hyperenhancement is highly suggestive of chronic RV pressure elevation likely representing chronic mechanical strain. However, the degree of delayed hyperenhancement involving the inferior wall of the LV is atypical of this phenomenon and certainly could represent cardiac sarcoidosis given history. Consider repeat MRI in 6 months to reevaluate this area.3. The right ventricle is severely dilated with severe systolic dysfunction, the RVEF is 26%. There is hypertrophy.4. The right atrium is severely dilated.5. There is severe tricuspid regurgitation.6. The main pulmonary artery is severely enlarged.


Instruction: Generate impression based on findings.

Input: SCLC s/p resection and WBRT. The images are degraded by patient motion. There are postoperative findings related to left occipital craniotomy and lesionectomy. There is newly apparent subcentimeter enhancement along the anterior medial aspect of the surgical cavity. There is persistent confluent high T2 signal surrounding the resection cavity. There is also unchanged confluent cerebral white matter T2 hyperintensity elsewhere, particularly in the corona radiata. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small left maxillary sinus retention cyst. The orbits are unremarkable.

Output: Post-treatment findings with newly apparent subcentimeter enhancement along the anterior medial aspect of the surgical cavity, which may represent tumor recurrence or treatment effects.


Instruction: Generate impression based on findings.

Input: 4-year-old female with persistent synovitis with thickening on ultrasound of the right knee, evaluate for tumor or PVNS. MENISCI AND LIGAMENTS: The medial and lateral menisci are intact. Anterior cruciate ligament, posterior cruciate ligament, and lateral collateral ligaments are intact.BONE AND MARROW: The bones demonstrate normal intensity.SYNOVIUM: Multiple intra-articular synovial based nodules are best visualized on image 8 of series 601. No significant erosions are identified. There is diffuse enhancement and thickening of the synovium.MUSCULATURE: Musculature are normal in appearance.ADDITIONAL

Output: Large joint effusion, multiple intra-articular synovial based nodules, and diffuse thickening and enhancement of the synovium most suggestive of pigmented villonodular synovitis.


Instruction: Generate impression based on findings.

Input: 66-year-old female further evaluate possible rectal abscess seen on CT. PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The rectum is has circumferential increased T2 signal and enhancement consistent with proctitis. There is a 8 x 7 mm perirectal focus of T2 hyperintensity and diffusion restriction in the 3:00 position (series 501, image 23) with no associated contrast enhancement and no evidence of fistulous tract. This corresponds with the finding on the recent CT. The remainder of the visualized bowel is unremarkable.There is a moderate amount of presacral edema.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Proctitis. No perirectal abscess or definite fistulous tract is identified.


Instruction: Generate impression based on findings.

Input: 53-year-old male with right medial joint line tenderness, evaluate for meniscal tear MENISCI: There is attenuation of the body and posterior horn of the medial meniscus, likely representing diffuse chronic attritional tearing in the absence of a history of partial meniscectomy. Additionally, there is a more focal defect along the undersurface of the body of the meniscus that is contiguous with abnormal signal within the meniscal substance suggesting a combination of degeneration and undersurface tearing. We see no displaced meniscal fragment. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Subjectively, there is thinning of the articular cartilage within the medial tibiofemoral joint compartment with no fluid-filled defect visualized. Edema type signal within the medial aspect of the medial tibial plateau is noted beneath the torn meniscus. A small focal defect of the articular cartilage along the lateral tibial plateau near the lateral tibial spine is noted with mild associated signal abnormality within the underlying bone. There is focal signal heterogeneity within the central trochlea consistent with full-thickness degeneration with cyst formation within the underlying bone. Mild heterogeneity of the cartilage along the medial facet of the patella likely represents mild degeneration. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Globular increased signal intensity within the lateral distal quadriceps tendon, as well centrally more proximally within tendon indicates mild tendinosis. The patella tendon is intact.ADDITIONAL

Output: 1. Tearing of the posterior horn and body of the medial meniscus as described above.2. Articular cartilage degeneration as described above.3. Quadriceps tendinosis and other findings as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Migraine for the last 6 months. Signs and symptoms: Migraine for the last 6 months. Pre-and post-enhanced brain MRI:Diffusion weighted series are unremarkable.The anatomical morphology as well as the signal intensity of brain parenchymal remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination of brain.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal.Post enhanced images demonstrate no detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarial or the retro-orbital spaces.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal intensity.

Output: 1.Negative pre-and post enhanced brain MRI.2.Unremarkable calvarium, well pneumatized paranasal sinuses, mastoid air cells and middle ear cavities.


Instruction: Generate impression based on findings.

Input: 53-year-old female with history of cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Surgical changes from a partial right hepatectomy. Increased size of the known fluid-filled cavity (axial series 4 image 8) measuring 9.4 x 5.6 cm (prior 7.5 x 4.5 cm). Nodular focus of T2 hyperintense signal measuring 3.6 x 1.9 cm (axial series 4 image 13) again demonstrates contrast enhancement and has increased in size (prior 1.9 x 1.4 cm). The nodule encases the middle hepatic vein. The left portal vein is patent. The segment 8 ablation cavity has decreased in size in the interval. Similar appearing portacaval lymph nodes.SPLEEN: Unchanged T2 hyperintense nonenhancing splenic lesion, probable cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Similar appearing portacaval lymph nodes.BOWEL, MESENTERY: No evidence of peritoneal disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval resolution of the small right pleural effusion.

Output: 1.Status post right partial hepatectomy and segment 8 radiofrequency ablation. Residual enhancing tumor nodule at the hepatectomy margin has increased in size. No evidence of peritoneal disease.


Instruction: Generate impression based on findings.

Input: History of lymphoma and Bell's Palsy. Please evaluate MRI for change since last. There appears to be mild diffuse asymmetric enhancement of the geniculate, tympanic, and descending segments of the right facial nerve, with sparing of the canalicular and labyrinthine segments. There also appear to be secretions in portions of the middle ear, mastoid air cells and pneumatized petrous apex on the right side. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged diffuse periventricular white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant.

Output: 1. Persistent mild diffuse enhancement of portions of the right facial nerve, as well as persistent nonspecific right otomastoid and petrous apex effusions, although comparison with the prior exam is limited due to differences in technique. Differential considerations include an inflammatory process versus perhaps lymphoma.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 74-year-old female history of CAD and S/P CABG presents with acute SOB evaluate for stroke On image 19, a small focal hypoattenuation adjacent to the right Sylvian fissure most likely due to technique difference from prior. If acute ischemic infarction is concerned, MRI exam is recommended.The images re-demonstrate chronic ischemic infarction in the right basal ganglia and the left thalamus as well as periventricular white matter small vessel disease. There is no evidence of intra-or extra axial fluid collection/hemorrhage, mass or edema.The ventricles and basal cisterns are normal in size and configuration for the patient's stated age.The calvaria and skull base are radiographically normal. Visualized paranasal sinuses and mastoid air cells are normally pneumatized. Calcified atherosclerotic disease of the vertebrobasilar system and internal carotid arteries is noticed.

Output: Small vessel ischemic disease and chronic ischemic infarction with no evidence of acute intracranial hemorrhage/ischemic change.


Instruction: Generate impression based on findings.

Input: 52-year-old male with Crohn's disease status post perianal proctectomy and resection of coccyx, urethroplasty complicated by a urethral cutaneous fistula, evaluate for osteomyelitis. Please note that this exam was protocoled for evaluation of the osseous structures and not the soft tissues of the pelvis. The coccyx has been removed. There has been interval resolution of a fluid collection adjacent to the sacrum. There is residual enhancement surrounding the distal sacrum and mild increased T2 signal in the marrow, which may be reactive in etiology.A Foley catheter extends to the bladder. Postoperative changes of the pelvis compatible with stated history of proctectomy. If there is concern for fistula, MR enterography is recommended.

Output: Postoperative changes of coccygeal resection with interval resolution of fluid collection at the base of the sacrum. There is mild residual enhancement and increased T2 signal which is likely reactive or postoperative in etiology without specific evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: Pt w/ LLE sciatic pain. History: see above Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is only a mild degree of disk desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Headache and possible meningitis. MRI obtained to evaluate for parameningeal abscess. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial abscess.


Instruction: Generate impression based on findings.

Input: Meningoma in pituitary area: surveillance. There is no significant change in size of the lobulated homogeneously enhancing mass along the right planum sphenoidale, measuring up to 14 mm. There is associated mass effect upon the adjacent brain parenchyma optic apparatus, and anterior cerebral arteries. The pituitary gland and infundibulum are intact, with trace probable par intermedia cyst.

Output: No significant change in size of the right planum sphenoidale meningioma.


Instruction: Generate impression based on findings.

Input: Acute myeloblastic leukemia, not having achieved remission [C92.00], Reason for Study: ^Reason: RULE OUT SPINE LESION History: NEW MULTIPLE LESIONS IN BRAIN. C-SpineReplacements of normal bone marrow fat are seen at C7. T1 and T2 vertebral bodies with inhomogeneous enhancement of cervical vertebral bodies from C2 to T2 indicating possible metastatic lesions or post-treatment related.There is anterolisthesis of C4 on C5 with moderate to severe spinal canal stenosis from the C34 level to C56. The spinal cord signal intensity appears to be normal.T-Spine:Inhomogenous bone marrow signal intensities on whole T spine vertebral bodies but without evidence of compression fracture or obvious focal enhancing lesion.Spine cord signal intensity appears to be normal.Normal kyphotic angulation is preserved.L-Spine:Again inhomogeneous marrow signal intensities without compression fracture of lumbar vertebral bodies. Post contrast enhancement scan shows inhomogenous and somewhat mass like enhancement especially seen at the level of L2 to S1 indicating metastatic lesions. In addition, there is focal nodular intrathecal enhancement at the level of left S1 nerve root. This lesion may suggest possible intrathecal nodular enhancement or small nerve root sheath tumor. There is no definitive evidence of cauda equina enhancement. Bilateral iliac bones and sacrum also show inhomogenous enhancing lesions indicating possible metastatic lesions.There is grade 1 spondylolisthesis of L4 on L5 with severe spinal stenosis at the level of L45.Moderate degree spinal stenosis are seen from the level of L23 to L45 with disc dessication. Spinal cord signal intensity is normal. The conus medullaris terminates at the level of L1.

Output: 1. Diffuse multifocal bone marrow replacement with inhomogenous enhancing lesions on whole spine and bilateral ilium indicating metastatic lesions as described above.2. Single nodular enhancing lesion at the level of left S1 nerve root suggesting possible intrathecal metastatic nodule or incidental nerve sheath tumor.3. Degenerative changes of C and L spine with anterolisthesis of C4 on C5 and L4 on L5 as described above. No evidence of abnormal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with history of ulcerative colitis, preoperative examination for colectomy and J-pouch. Please rule out small bowel involvement. ABDOMEN:LIVER, BILIARY TRACT: Loss of parenchymal signal on opposed phase imaging suggests mild steatosis. No focal liver lesions are identified. The gallbladder appears normal. There is no intrahepatic or extrahepatic biliary duct dilatation.SPLEEN: The spleen is atrophic. There is a 31 x 26 mm, mildly T2 hyperintense, mildly enhancing lesion in the body of the spleen (series 4, image 12).PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The small bowel including the terminal ileum (series 6, image 22) is unremarkable. The colon is distended with large amount stool, however there is no evidence of active inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral ovarian follicles are noted. There is mild cystic change within the junctional zone of the uterus, the borders of which are not well defined. A left nabothian cyst is noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: There is circumferential submucosal fat deposition in the mid rectum. Additionally, there is an approximately 8 cm segment of rectum (series 13, image 25) which is narrow in caliber and does not change throughout the examination. The proximal bowel is mildly distended, however stool is seen passing distal to this segment.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of chronic inflammation with stricture in the rectum.2.Distended, stool-filled proximal colon which may indicate element of partial obstruction.3.No evidence of small bowel inflammation, normal terminal ileum.4.Atrophic spleen with well-circumscribed lesion, mildly T2 hyperintense with minimal enhancement, may be a benign lesion such as a hamartoma (lesion does not fulfill criteria for a typical hemangioma) but is nonspecific. Attention to this lesion is warranted on follow-up imaging to assess for interval stability.5.Findings suggestive of uterine adenomyomatosis.


Instruction: Generate impression based on findings.

Input: Reported history of AVM, s/p craniotomy, intractable epilepsy. Evaluate postoperative changes. The fluid collections overlying and underlying the left pterional craniotomy flap are resolved. The associated including midline shift and mass effect on the left lateral ventricle have resolved. The dilated superficial veins overlying the left cerebral hemisphere remain unchanged. There is drainage into the superior sagittal sinus and along a dilated cortical vein. There is also dilatation of the inferior sagittal sinus which causes abnormal signal on the T2/FLAIR sequence, but enhances on post-contrast images without any intrinsic T1 hyperintensity. There is polymicrogyria along the posterior aspect of the sylvian fissure which is unchanged. The left cerebral hemisphere is slightly smaller than the right which is also unchanged. There is no significant abnormality of the remainder of the brain. There is no brain parenchymal hemorrhage.

Output: 1.Resolution of the extraaxial collection underlying the left pterional craniotomy flap.2.The underlying dilated left superficial cerebral veins remain unchanged, with now dilatation of the inferior sagittal sinus demonstrating associated flow-related artifact. There is no intraparenchymal hemorrhage.3.Left parietal polymicrogyria and associated developmental findings also remain unchanged.


Instruction: Generate impression based on findings.

Input: Female 83 years old Reason: ? source of Sx which are now dissipated. History: known severe OA- acute onset of pain with inability to walk, now improved- ? etiology ?bursitis ACETABULAR LABRUM: Degenerative tearing of the left labrum.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the left hip with extensive osteophyte formation.SOFT TISSUES: There is mild global muscle atrophy. No muscle edema. There is a cyst that extends from the left hip joint as a dumbbell-shaped mass that extends through the obturator foramen on the left. The portion of the cyst lateral to the obturator foramen measures at least 2.0 x 1.6 cm. The portion of the cyst medial to the obturator foramen measures 1.6 x 0.8 cm. The cyst passes close to the expected location of the obturator nerve.ADDITIONAL

Output: Severe osteoarthritis of the left hip without acute fracture or dislocation. Findings of a ganglion cyst that extends through the left obturator foramen. Correlation for obturator neuropathy is suggested.


Instruction: Generate impression based on findings.

Input: Lower back pain Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is mild straightening, alignment is otherwise within normal limits. Bilateral L4 spondylolysis noted as seen on recent CT. Bone marrow signal is benign with fatty signal change noted involving the pedicles at the L4 level. The conus medullaris is normal in position.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Diffuse disc desiccation and bulge, with dorsal annular fissure and central disc extrusion. Partial effacement of the right lateral recess. No significant central spinal canal stenosis. Mild bilateral neural foraminal stenosis.L5-S1: Diffuse disc desiccation and bulge, with dorsal annular fissure and central disc extrusion extending slightly inferiorly. No significant spinal canal stenosis. Minimal bilateral neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Bilateral L4 spondylolysis as seen on recent CT. No spondylolisthesis.2. Small disc extrusions at the L4-L5 and L5-S1 levels. Minimal to mild foraminal narrowing at these levels. No significant central spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Medulloblastoma s/p craniotomy, chemotherapy, and radiation therapy Off therapy evaluation There are postsurgical changes in posterior cranial fossa with encephalomalacia in the left cerebellum related to previous tumor resection. Gliosis in right frontal lobe correlating with a previous ventriculostomy tract is unchanged. There is unchanged prominence at the posterior edge of the foramen magnum and posterior arch of C1, which effaces the posterior thecal sac and mildly indents the cervical cord at the C1-C2 level. From posteriorly. All these findings are unchanged in appearance. The distal right middle cerebral artery in the sylvian fissure appears prominent, but this was also seen on prior study. There is no enhancing abnormality intracranially.The syrinx well-seen on study from 7/10/2008 is resolved, as noted on more recent studies There is no evidence of new spinal cord signal abnormality or suspicious enhancing lesion. No spinal canal or foraminal stenosis. Segmentation anomaly at C2 and C3 levels again incidentally noted. No suspicious osseous lesions.

Output: 1. Postsurgical changes in the posterior fossa without evidence of tumor recurrence.2. No evidence of drop metastases in the spine.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: MS compare to prior evaluate for progression JAVED PROTOCOL History: R sided numbness/weakness Again seen multiple high signal intensity lesions on FLAIR images including bilateral corpus callosum body extended toward cingulate gyrus, right frontal deep white matter, right side trigone area, periventricular white matter of bilateral lateral ventricle occipital horn, and left parietal lobe inferior parietal lobule. There is no evidence of enhancement on Gad infusion.Above described lesions do not show any significant interval change since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection or abnormal contrast enhancement. The mastoid air cells are clear.There is a retention cyst on the left maxillary sinus, no change since prior scan.

Output: Multifocal high signal intensity lesions involving corpus callosum, cingulate gyrus, deep white matter and periventricular white matter without evidence of contrast enhancement. No change since prior scan.


Instruction: Generate impression based on findings.

Input: Chiari malformation, torticollis, and worsening head tilt with shoulder involvement. Brain: The cerebellar tonsils extend up to approximately 20 mm inferior to the foramen magnum and display a pointed configuration with crowding of the foramen magnum in association with a relatively small posterior fossa. There is mildly narrowed column of cerebrospinal fluid flow across the foramen magnum anteriorly, but lack of flow posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.Cervical Spine: There is mild retroflexion of the dens. The cervical vertebral column is otherwise unremarkable, without evidence of subluxation. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Chiari type 1 malformation.2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: 31 years, Female, Reason: Evaluate for ischemia vs. demyelinating disease History: L sided arm and leg weakness. Brain: Brain parenchyma appears within normal limits. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Postgadolinium images are motion degraded but demonstrate no abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is an expanded, partially empty sella. Minimal opacification of the left mastoid air cells. Paranasal sinuses are clear. Bone marrow signal and extracranial soft tissues are grossly unremarkable. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is straightening of the cervical spinal curvature which may positional. Alignment is otherwise maintained. Bone marrow signal is within normal limits. There is no appreciable cord signal abnormality within the limits of motion degradation on the axial images.Individual levels 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 neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.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.

Output: 1. Brain parenchyma appears within normal limits. Specifically, no evidence of acute infarct or evidence of demyelinating disease.2. No signal abnormality involving the cervical cord is appreciated within the limits of motion degradation. There is also no significant spinal canal or neural foraminal stenosis at any level. 3. Partially empty sella which can be a normal variant or associated with intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: 52-year-old male with high-grade sarcoma of the left tibia. Evaluate prior to surgery.IMAGE ACQUISITIONS: CT of the left tibia/fibula without intravenous contrast. As seen on the recent MRI, there is a lytic lesion involving the anterolateral proximal tibial diaphysis and the anterior tibial tuberosity with associated partially mineralized soft tissue component that is consistent with the given history of high grade sarcoma. The lesion appears to be predominantly cortically based.Lack of intravenous contrast limits accurate measurement of the mass. However, it is approximately 3.7 x 5.1 cm in axial dimension (image 325, series 7) and 7.4 cm in craniocaudal dimension (image 87, series 80773). Edema and stranding in the subcutaneous fat anterior to the mass is again noted.There is mild osteoarthritis of the knee. The remainder of the leg is within normal limits.Multiple markers along the leg are presumably presurgical.

Output: Destructive, predominantly cortically based lesion of the proximal tibia, as described above.


Instruction: Generate impression based on findings.

Input: 46 year old female patient with papillary carcinoma of the left breast s/p ultrasound core needle biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a unifocal oval lesion with irregular margins and heterogenous enhancement in the 3 to 4 o'clock position in the left breast that measures 2.4 x 2.0 x 2.1 cm (AP X ML X CC) and contains biopsy clip artifact. No abnormal enhancement in the right breast.No abnormal lymph nodes are identified in either axillary region.

Output: Unifocal known cancer in the 3 to 4 o'clock position of the left breast without abnormal appearing axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for osteomyelitis, hx osteo s/p amputation left 4th and 5th toes History: dorsal foot wound The fourth and fifth toes have been amputated. There is a band of intermediate signal intensity which extends from the dorsolateral margin of the forefoot to the osteotomy margins of the fourth and fifth metatarsals, presumably representing scar tissue, which shows some enhancement following gadolinium administration. The osteotomy margins, however, appear sharp and we see no findings to suggest osteomyelitis. There is ulceration of the plantar soft tissues beneath the third metatarsal head. There is replacement of the underlying subcutaneous fat with intermediate signal intensity which likely represents a combination of edema and scarring that extends to the plantar aspect of the head of the third metatarsal. There is minimal edema within the head of the third metatarsal as well as minimal enhancement, but we suspect this represents reactive osteitis rather than osteomyelitis as the signal intensity remains relatively preserved on T1-weighted images. There is signal abnormality within the base of the second metatarsal that was present on the prior study and we suspect represents an old fracture. There is a hallux valgus deformity and mild osteoarthritis of the first MTP joint, but we see no specific findings of osteomyelitis of the bones of the first ray. There is a small amount of fluid between the second and third metatarsals which may represent a mild bursitis of questionable significance. There is increased signal intensity within the musculature of the foot on T2-weighted images with enhancement following gadolinium likely representing a combination of atrophy and inflammation, but we see no rim-enhancing fluid collection to suggest abscess formation. Mild osteoarthritis affects the midfoot.

Output: Surgical changes of fourth and fifth toe amputation with soft tissue ulceration and scarring as described above. There is mild signal abnormality and enhancement of the head of the third metatarsal which is favored to represent reactive osteitis rather than osteomyelitis. These findings were relayed to Dr. Payne by phone at 12:35 PM on 1/11/2016.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with history of migraines and pain concerning for occipital and trigeminal neuralgia. Posterior neck pain radiating to the right side of the head and face. Brain:No evidence of significant parenchymal signal abnormality is seen. At most, there may be one or two scattered small foci of nonspecific FLAIR hyperintensity. No edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is observed. There are no abnormal extra-axial fluid collections or evidence of acute intracranial hemorrhage. The ventricles are normal in size morphology. The right cerebellar tonsil descends 2-3 mm below the level of the foramen magnum.Cervical spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. A 10 mm T2-hyperintense enhancing lesion is evident within the left aspect of the T2 vertebral body. This lesion is vaguely discernible on the prior chest CT and demonstrates nonaggressive features. Elsewhere no significant marrow replacement, edema or pathologic marrow enhancement is observed.The visualized spinal cord shows normal signal intensity and morphology. No pathologic parenchymal or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.Minimal posterior disc-osteophyte complex formation is seen throughout the cervical spine with no areas of significant spinal canal or neuroforaminal compromise.

Output: 1.No significant brain parenchymal abnormalities are identified to account for the patient's symptoms. The right cerebellar tonsil is low-lying but does not meet imaging criteria for a Chiari I malformation.2.A lesion within the T2 vertebral body is favored to represent an atypical hemangioma. No other specific spinal abnormalities are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Chiari malformation decompression 3 month follow up with syrinx. Brain: There are postoperative findings related to Chiari decompression, with interval resolution of the extradural fluid collection in the surgical bed. There is deformity of the inferior cerebellum, with what appears to be adhesion formation. In addition, there is associated interval formation of a cystic space overlying the inferior medial left cerebellar hemisphere that measures up to 9 mm in thickness. There appears to be impeded flow of cerebrospinal fluid across the neo-foramen magnum. There is no evidence of acute infarct. The supratentorial brain parenchyma appears to be unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus.Cervical Spine: There is a persistent focal syrinx at the level of C2 that measures up to 2 mm in width. There is also a small amount of encephalomalacia in the anterior cervicomedullary junction. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unchanged, with what may represent a hemangioma in the C6 vertebra. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression, with interval resolution of the extradural fluid collection in the surgical bed, but evidence of adhesion formation in the posterior fossa associated interval formation of a cystic space overlying the inferior medial left cerebellar hemisphere and apparent impeded flow of cerebrospinal fluid across the neo-foramen magnum. 2. Persistent focal syrinx at the level of C2 that measures up to 2 mm in width. 3. Small amount of encephalomalacia in the anterior cervicomedullary junction.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55], Reason for Study: ^Reason: eval for structural lesions. Dr Adil Javed protocol History: pre-syncopal episodes Since there is no diffusion weighted images nor gradient echo images, it is not possible to exclude acute ischemic or hemorrhagic lesion on this scan.However, there is no evidence of abnormal signal intensity on FLAIR and T1 images. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection, 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 abnormal signal intensity on this scan.No abnormal enhancing lesion on this scan.Due to selection of the MR protocol (Multiple Sclerosis protocol for Dr.Javed), acute ischemic or hemorrhagic lesion cannot be completely excluded.


Instruction: Generate impression based on findings.

Input: Ovarian cancer status post resection and SRS. There are postoperative findings related to right parietal metastasectomy. There is no evidence of acrite intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There are cosmetic fillers in the bilateral nasolabial folds. There is diffuse mucosal thickening and secretions in the right maxillary sinus.

Output: Post-treatment findings without evidence of new or recurrent brain metastases.


Instruction: Generate impression based on findings.

Input: Squamous cell carcinoma of the right nasal bridge and left cheek with perineural invasion. Status post Mohs 9/9/2014 and radiation therapy completed 12/4/2014. Evaluate for recurrence. There are post-treatment changes in the left cheek, including a mild depression and underlying subcutaneous fat reticulation. However, there is no evidence of measurable mass lesions or significant cervical lymphadenopathy. The thyroid gland appears to be unremarkable. There is mildly asymmetric increased T2 signal diffusely within the left parotid gland, which may represent post-treatment inflammation. The other salivary glans appear unremarkable. The major cervical flow voids are grossly intact. The osseous structures are unremarkable. The orbits and imaged intracranial structures are unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is persistent fluid within the left mastoid air cells and middle ear.

Output: 1. No definite evidence of local tumor recurrence, although the assessment is limited by the lack of intravenous contrast.2. No evidence of significant lymphadenopathy in the neck.3. Persistent left mastoid air cells and middle ear effusions, which may indicate Eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: evaluate for acute stroke History: R droop, RUE weakness There is no evidence of acute ischemic or hemorrhagic lesion on the scan.On gradient echo images, there are multiple scattered focal signal voids on bilateral basal ganglia, temporal lobes and the left frontal lobe indicating age indeterminate likely chronic petechial hemorrhage or calcification.There are tissue losses likely represent chronic infarct on the pons, medulla, right frontal lobe and left corona radiata extending toward left internal capsule posterior limb.Underlying brain shows patchy high signal intensities on bilateral periventricular white matter indicate associated nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal chronic ischemic infarcts with encephalomalacia on pons, medulla, right frontal lobe and left corona radiata as described above.3. Advanced nonspecific small vessel ischemic disease.