Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural cause for radiculopathy. Signs and symptoms: S1 radiculopathy per EMG. Nonenhanced lumbar MRI:The signal intensity of vertebral column is unremarkable other than changes secondary to degenerative disease.Lower most visualized thoracic spine and thoracic cord from mid T10 inferiorly are unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Mild central spinal stenosis and moderate right neural foraminal compromise is noted.L3-L4 demonstrate mild disc desiccation, mild bilateral ligamentum flavum hypertrophy as well as mild bilateral facet hypertrophic changes (right greater than left). No convincing evidence of central spinal stenosis or clinically significant neural foraminal compromise.L4-L5 demonstrate moderate disc disease with loss of disc height, mild grade 1 retrolisthesis, significant and lateral facet hypertrophic changes and mild to moderate ligamentum flavum hypertrophy. Constellation of changes results in significant central spinal stenosis in transverse axis and moderate in AP axis. Significant bilateral (left greater than right) neural foraminal and lateral recess compromise is also present.L5-S1 demonstrate mild disc disease and significant right and moderate left facet hypertrophic changes and mild ligamentum flavum hypertrophy. No spinal stenosis, neural foraminal compromise or lateral recess compromise.

Output: 1.At L4-L5 extensive degenerative changes results in central spinal stenosis, significant bilateral neural foraminal and lateral recess compromise.2.At L2-L3 degenerative changes results in mild central spinal stenosis and moderate right neural foraminal compromise.3.No spinal stenosis or significant neural foraminal compromise at any other level however degenerative changes are present as detailed per level above.4.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and the cauda equina.


Instruction: Generate impression based on findings.

Input: Encephalopathy, unspecified [348.30], Reason for Study: ^Reason: Stem cell transplant patient with encephalopathy. History: flaccid There are restricted diffusion lesions on the posterior aspect of the left temporal superior, middle and a bit of inferior temporal gyri indicating acute ischemic infarction. There is relatively well marginated high signal intensity lesion on T1 weighted image with susceptibility artifacts on gradient echo images on the left subcentral gyrus and inferior aspect of the post-central gyrus indicating subacute hemorrhagic lesion with surrounding edema. The lesion could be hemorrhagic conversion of acute ischemic infarction considering the subacute hemorrhage area is slightly smaller than surrounding restricted diffusion lesion.There is no abnormal enhancement.There is a small susceptibility lesion on the right centrum semiovale which may indicate non specific such as either parenchymal calcification or chronic petechial hemorrhage.Underlying brain shows minimal to mild non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Acute ischemic stroke on the left posterior temporal lobe, superior, middle and inferior temporal gyri.2. Subacute intracerebral hemorrhage on the left subcentral gyrus and inferior aspect of the left post central gyrus as described above. This lesion could represent hemorrhagic conversion of acute ischemic stroke.3. No abnormal enhancement was seen.4. Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 17-year-old male with a right scaphoid fracture. Evaluate for avascular necrosis. Suboptimal evaluation secondary to extensive patient motion artifact.LIGAMENTS: There is widening of the scapholunate interval. The lunotriquetral ligament appears intact within the limitations of this arthrogram study. There is intermediate signal abnormality within and thinning of the scapholunate ligament which may represent partial thickness tearing of the membranous portion and dorsal component of the scapholunate ligament, within the limitations of this non-arthrogram study.TRIANGULAR FIBROCARTILAGE COMPLEX: There is a subcentimeter focus of fluid signal intensity along the ulnar aspect of the ulnar styloid insertion of the triangular fibrocartilage complex which may represent ganglion formation. The imaged components of the triangular fibrocartilage complex appear intact, within the limitations of this nonarthrogram study.TENDONS: The flexor and extensor tendons appear intact. BONES: There is linear decreased signal abnormality traversing the waist of the scaphoid consistent with the patient's known history of a scaphoid fracture. There is approximately 2 mm of radial displacement of the distal fracture fragment. There is increased signal abnormality on fluid sensitive sequences within both fracture fragments. There is no diffuse decreased T1 signal abnormality within the proximal fracture fragment to definitively suggest avascular necrosis. There is no fracture fragment collapse identified. Intravenous contrast was not administered on this examination. There is increased signal abnormality within the trapezium and capitate which may represent bone contusions.ADDITIONAL

Output: 1. Suboptimal evaluation demonstrating a fracture of the scaphoid without findings to suggest avascular necrosis. 2. Widening of the scapholunate interval. The scapholunate ligament appears thinned, indicating at least partial thickness tearing in the membranous portion of the ligament. 3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: S/p craniotomy for resection of a right frontal cystic mass. Examination demonstrates postoperative changes of the right frontal craniotomy. There are a surgical cavity containing fluid/blood in the right frontal lobe, where the cystic mass located previously shown on MRI. Anteriorly, there is right frontal extra-axial fluid/hemorrhage/air extending across the interhemispheric falx. The surgical cavity appears in communication with the frontal fluid collection at its lower portion. In addition, there are areas of hypoattenuation anteriorly adjacent to the surgical cavity. These likely represent either vasogenic edema or ischemia. In comparison with prior MRI, there is less midline shift and less mass effect on the lateral ventricles. The left lateral ventricle appears slightly enlarged. Bifrontal subgaleal focal emphysema is present. The brain is otherwise appears normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Postoperative changes the right frontal craniotomy for resection of a right frontal cystic mass, including fluid/hemorrhage collection in the right frontal surgical cavity and bifrontal extraaxial spaces as well as bifrontal pneumocephalus. 2. Interval reduction of the midline shift and mass effect on the lateral ventricles. 3. Right frontal hypoattenuation anteriorly adjacent to the surgical cavity likely represents either vasogenic edema or ischemia.


Instruction: Generate impression based on findings.

Input: 53 years, Female, Reason: 52F s/p lap CCY 8/2013 with congenital biliary malrotation, recurrent abdominal pain History: Abdominal pain, chills, monthly rigors. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Left hepatic cyst. Postsurgical changes of a Roux-en-Y hepaticojejunostomySPLEEN: Polysplenia.PANCREAS: There are postsurgical changes of a Roux-en-Y hepaticojejunostomy. Pancreas deviated into right abdomen. Normal pancreatic ductal caliber seen, drainage into the medial aspect of the duodenum visualized. The head of the pancreas has an abnormal position anteriorly draining separately into the duodenum. There may be mild decreased T1 signal within the tail of the pancreas. There is no apparent response to secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Right renal sinus cyst. Azygos continuation of the IVC.BOWEL, MESENTERY: Perihepatic fluid collection seen on prior CT is no longer visualized. Mildly prominent bowel loops without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Postsurgical changes of Roux-en-Y gastrojejunostomy with resolution of peripancreatic fluid collection.2.Absent response to secretin administration suggests severe exocrine dysfunction.


Instruction: Generate impression based on findings.

Input: 75 year old male patient with elevated total bilirubin. Assess for intrahepatic biliary blockage. ABDOMEN:LIVER, BILIARY TRACT: There are multiple peripherally enhancing hepatic lesions compatible with the patient's known history of metastatic disease. A left hepatic lobe lesion measures 4.7 x 5.7 cm (image 242, series 1201). There is moderate intrahepatic biliary ductal dilatation secondary to an ill-defined, infiltrative mass narrowing the proximal common bile duct over a 2 cm length. The lesion measures approximately 1.8 x 1.4 cm (image 13, series 601). The cystic duct is also partially occluded. There is sludge within the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst and additional bilateral subcentimeter T2 hyperintense foci which may also represent cysts. 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.Short segment narrowing of the proximal common bile duct secondary to a surrounding infiltrative mass with moderate intrahepatic biliary ductal dilatation. 2.Multiple hepatic lesions compatible with patient's known metastatic disease.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:9/26/1951)Reason: s/p SRS for metastasis surveillance eval History: s/p SRS for metastasis surveillance evalPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA There is a new enhancing nodule measuring 5 mm in size located along the left postcentral gyrus laterally.Previously noted punctate lesions along the left superior frontal gyrus are not readily identified on the current exam.There is an 11 x 19 mm axial dimension lesion adjacent and anterior aspects of the squamous portion of the left temporal bone which is associated with contrast enhancement and diffusion restriction. This was not present on the priorThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Punctate focus of signal loss is present in the left external capsule on susceptibility imagingNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate partial opacification of the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.A new lesion is present along the left postcentral gyrus which is suspicious for metastatic disease.2.There is a mass adjacent to the outer surface of the left squamous portion of the temporal bone which is new since prior exam. The possibility that this represents metastatic focus cannot be excluded. It is associated with adjacent thickening of the galea.3.Previously noted lesions along the left superior frontal gyrus are no longer appreciated


Instruction: Generate impression based on findings.

Input: Female 43 years old Reason: Please follow protocol IRB # 14-0288. Rectal cancer, please assess disease state post Chemo, RECIST compare to previous MRI. Overall image quality: GoodPELVIS:UTERUS, ADNEXA: The rectal mass continues to abut the posterior cervix (image 41/series 6), suspicious for invasion.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: None.Lymph nodes outside the mesorectal fascia: None.BOWEL, MESENTERY: Rectal Tumor:Size: 1.4 x 2.0 x 7.1 cm (image 41/series 6) (image 24/series 10)Tumor appearance on T2-weighted images: Circumferential tumor with large soft tissue component along the left aspect of the rectum.Tumor location: Extending from the anal verge 7.1 cm proximally, involving the rectum to the distalmost sigmoid colon.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 2.0 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Extends from the anal sphincter proximally.Circumference of the rectum involved: Complete circumferential distally but proximally occupies 180 degrees along the left aspect.Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): There is invasion of the adjacent mesorectal fat and fascia as well as invasion into the posterior wall of the upper vagina and cervix (image 41/series 6) (image 22/series 10).MRI T-stage: T4 - Tumor invades adjacent organs, as described aboveTumor Distance to Mesorectal Fascia: 0 cm (image 22/series 10).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid, likely physiologic and similar to prior.

Output: 1.Decreased size and extent of the circumferential rectal adenocarcinoma, with continued invasion of adjacent vagina and cervix.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 68 year old with history of left mastectomy for ILC. There is scattered fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.Status post left mastectomy.No abnormal enhancement is seen in right breast or left mastectomy bed. No abnormal lymph nodes are identified in either axillary region.Stable bilateral thyroidal cysts, right larger than left.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: 75F hx of chronic pancreatitis on prior EGD/EUS and family history of pancreatic cancer, evaluate pancreas for any changes. ABDOMEN:LIVER, BILIARY TRACT: There is normal signal intensity and homogeneous enhancement of the liver without focal lesion. No intra or extra hepatic biliary ductal dilatation is identified. There is a large stone in the gallbladder fundus. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No discrete pancreatic lesion is identified. There is mild atrophy of the pancreatic tail. There is slight irregularity of the main pancreatic duct but no focal stricture is identified. There is a slightly blunted response to secretin.ADRENAL GLANDS: Enhancing right adrenal nodule is again seen, measuring 1.7 x 0.9 cm, unchanged.KIDNEYS, URETERS: Status post right nephrectomy. The left kidney appears normal.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Normal bowel caliber without obstruction.BONES, SOFT TISSUES: No focal osseous lesion is identified.OTHER: No significant abnormality noted.

Output: 1.No focal pancreatic lesion is identified to suggest pancreatic malignancy.2.There is improved but mild residual peripancreatic inflammation with irregularity of the pancreatic duct and mild atrophy of the pancreatic tail. 3.There is a a slightly blunted response to secretin.4.Enhancing right adrenal nodule, which does not meet criteria for an adenoma. The differential diagnosis includes metastatic disease (given history of previous renal cell carcinoma) or a small pheochromocytoma.5.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Demyelinating disease of central nervous system, unspecifiedClinical question: assess for new MS lesionsSigns and Symptoms: acutely worsening spasticity in BL LEs Brain:Since prior exam patient has developed a new lesion in the right anterior aspect of the medulla which is high signal on T2 and FLAIR.The previously noted punctate lesion in the right centrum semiovale is not readily identified on the current exam. There is a new small T2 and FLAIR hyperintense lesion adjacent to trigone of the right lateral ventricle which was not readily appreciated on the prior exam. There is a punctate T2 and FLAIR hyperintense lesion in the left thalamus which was not readily appreciated on the prior exam. A left cerebral peduncle lesion is also more conspicuous on the current exam than on the prior. No abnormal enhancing lesions are appreciated within the brain parenchyma on the current exam.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening along the left maxillary sinus there. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.MRI thoracic spine:There are T2 hyperintense lesions present in the thoracic spinal cord. One at the T2 vertebral body level was also identified on the prior cervical spine exam. One along the posterior aspect of the T1 vertebral body level in one at C7 were not readily appreciated on the prior cervical spine exam. Additional lesions are identified at T5 along the posterior aspect of the spinal cord associated with some mild atrophy of the spinal cord approximately 18 mm in length. Another one is identified at the T8 vertebral body level measuring approximately 15 mm in length on the superior-inferior dimension. Another one is present at the T11 vertebral body level and another one is present at the conus medullary is.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. There are mild degenerative changes present in the thoracic spine with Schmorl's nodes in the lower thoracic spine.No abnormal enhancing lesions are appreciated in the thoracic spine.

Output: 1.Since prior exam patient developed new lesions in the right medulla as well as in the periventricular white matter. These are compatible with patient's diagnosis of demyelinating disorder and multiple sclerosis. Some other lesions are less conspicuous on the current exam. There is no contrast enhancing lesion to suggest subacute lesion. Overall there appears to be some progression of disease.2.Multiple lesions in the thoracic spinal cord are present some which could be identified on prior cervical spine exams and some of which appear to be new since prior cervical spine MRI. There are multiple lesions in the thoracic spinal cord to which there is no comparison thoracic spine MRI. These lesions are compatible with patient's diagnosis of demyelinating disorder and multiple sclerosis. Overall there appears to be some progression of disease.


Instruction: Generate impression based on findings.

Input: Acute cystitis without hematuria [N30.00], Reason for Study: ^Reason: metastatic lung cancer History: metastatic lung cancer Previously recognized multifocal enhancing lesions suggesting metastatic foci are not demonstrated on the scan.There is no evidence of acute ischemic or hemorrhagic lesion.Multiple bihemispheric scattered FLAIR/T2 high signal intensities of white matter indicate nonspecific small vessel ischemic disease, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Previously recognized subtle enhancing lesions are not demonstrated on today's scan.2. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.3. Nonspecific small vessel ischemic disease, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: 8 year-old female status post cervical fusion. Examination again shows postsurgical changes of an occipital-cervical fusion, with an occipital plate, screw fixation device, cerclage wire and bone fusion material. There is redemonstration two of the occipital screws protruding deep to the inner table of the occipital bone. The previously seen Halo device fixation pin traversing the full thickness of the right frontal bone and resulting in fragmentation of bone has been removed. Four new Halo device fixation pins have been placed through the frontal bone outer table, and one new Halo device fixation pin through the right parietal bone outer table. There has been also relocation of the left parietal bone Halo device fixation pins. The brain is heavily obscured by streak artifact. Within this limitation, there is no gross hemorrhage , parenchymal lesion, or extra-axial fluid collection. However, the right frontal bone fixation pin area soft tissue detail is obscured by the streak artifact. There is no evidence of generalized mass effect, midline shift or basal cistern effacement. The ventricles and sulci are unremarkable where visualized.The paranasal sinuses demonstrate mucosal thickening. The debris in the nasopharynx is expected in an intubated patient. Mastoid air cells are clear. Orbital contents are unremarkable.

Output: 1. Stable postsurgical changes of occipital-cervical fusion, with an occipital plate, screw fixation device, cerclage wire and bone fusion material. 2. Interval adjustment and new placement of Halo device fixation pins, including the one protruding deep to the right frontal bone inner table, as above. 3. Intracranial contents are heavily obscured by the streak artifact arising from the Halo device.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out bleed. Signs and symptoms: Altered mental status Nonenhanced CT of brain:Examination demonstrates no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Findings of advanced to small vessel disease with resultant underlying parenchymal volume loss is again identified. There is no definitive appreciable interval change since prior examination. If patient's clinical symptoms persist follow-up with an MRI is recommended.

Output: No interval change since prior exam. Findings consistent with advanced small vessel disease of indeterminate age with resultant parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: Reason: possible insufficiency fractures vs mets in pelvis History: possible insufficiency fractures vs mets in pelvis There is linear decreased signal abnormality traversing the right ilium adjacent to the right sacroiliac joint with associated increased signal abnormality on fluid sensitive sequences indicating a insufficiency fracture. There is enhancement about the right ilium insufficiency fracture as well on postcontrast sequences. There is also linear decreased signal abnormality within the right sacral wing with associated increased signal abnormality on fluid sensitive sequences also likely reflecting an insufficiency fracture. Additionally, there is enhancing signal abnormality within the left ilium which is associated with increased bone marrow signal abnormality on fluid sensitive sequences as well as peripheral enhancement on postcontrast sequences and soft tissue extension corresponding to the findings on recent CT examination. The imaged musculature of the pelvis are otherwise unremarkable. Note is made of foci of metallic susceptibility artifact along the midline of the lower abdomen and pelvis presumably reflecting postsurgical changes.

Output: 1. Enhancing lesion in the left ilium with associated soft tissue extension suspicious for osseous metastatic disease. 2. Multiple insufficiency fractures as described above.


Instruction: Generate impression based on findings.

Input: Left hand weakness, left face and arm numbness. Evaluate for stroke Redemonstrated chronic lacunar infarct in the right basal ganglia. Minimal periventricular and subcortical white matter T2 hyperintensities compatible with chronic small vessel ischemic changes are also not significantly changed. No restricted diffusion to indicate acute ischemia.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. Small left maxillary sinus mucous retention cyst, otherwise the paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: No areas of acute ischemia. Stable chronic right basal ganglia lacunar infarct and minimal white matter small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE

Output: 1. Marked improvement of previously described abnormal spinal cord signal with only small amounts of residual abnormal cord signal centered at the T2 dorsal cord. No evidence of ongoing pathologic intramedullary or leptomeningeal enhancement.2. Unchanged C4-5 paramedian disc extrusion with mild flattening of the anterior thecal sac. Degenerative changes of the lumbar spine appear unchanged.


Instruction: Generate impression based on findings.

Input: Clinical question: Dizziness, bidirectional nystagmus, rule out stroke. Signs and symptoms: As above. Nonenhanced brain MRI:No evidence of acute intracranial process and no acute ischemic stroke.Examination demonstrate two small foci of T2 hyperintensity in the inferior aspect of bilateral cerebellar hemispheres highly suspected of tiny chronic ischemic strokes.Additionally images through supratentorial space demonstrate minimal primarily periventricular and subcortical foci of flair hyperintensity which considering patient's stated age of 81 likely representing chronic small vessel ischemic strokes of mild degree.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise for age.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are unremarkable.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. A tiny retention cyst in the dependent left maxillary sinus is however present.

Output: 1.No acute intracranial process.2.Finding suggestive of mild small vessel ischemic strokes supratentorially and two tiny bilateral cerebellar chronic ischemic strokes are noted.3.Unremarkable nonenhanced brain MRI otherwise for the stated age of 81.


Instruction: Generate impression based on findings.

Input: Left parotid mass. There is an unchanged well-defined, lobulated cystic lesion with multiple septations in the deep lobe of the left parotid gland, which measures up to 16 mm. The rest of the left parotid gland and other salivary glands are unremarkable. There is no significant lymphadenopathy in the imaged portions of the neck. There is scattered mucosal thickening in the ethmoid sinuses. There is partially-imaged periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is a partially-empty sella. The orbits are unremarkable. There is a small left maxillary sinus retention cyst. There is degenerative spondylosis of the imaged portions of the cervical spine.

Output: Unchanged cystic lesion in the deep lobe of the left parotid gland.


Instruction: Generate impression based on findings.

Input: 35-year-old male with a history of metastatic rectal cancer with cerebellar metastases presents with a headache. Again seen are multiple, well-circumscribed, contrast-enhancing lesions involving the bilateral cerebellar hemispheres and the cerebellar vermis. The ring-enhancing lesion in the right cerebellar hemisphere measures 35 x 29 mm (series 6, image 43). The ring-enhancing lesion in the left cerebellar hemisphere measures 24 x 24 mm (series 6, image 67). The ring-enhancing lesion in the cerebellar vermis measures 20 x 18 mm (series 6, image 59). Overall, the lesions have not significantly changed since the prior outside hospital study, but have increased since the study from 10/5/2015. A fourth lesion at the junction of the cerebellar vermis and right cerebellar hemisphere (series 6, image 60) has increased in size from the prior outside study. No definite new enhancing or supratentorial lesions are identified.There is no evidence of acute intracranial hemorrhage or acute infarct. The sulci and ventricles are mildly prominent indicating volume loss, perhaps slightly progressed. There are scattered periventricular and subcortical T2 hyperintense white matter foci which are much more conspicuous compared to the prior examination. There is mild mass effect on the fourth ventricle. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a new, abnormal T1+C hyperintense, T2 hypointense lobulated soft tissue thickening in the left globe which appears mass-like in certain planes.

Output: 1. Multiple metastatic lesions in the posterior fossa are stable to slightly increased in size compared to the prior OSH study. No definite evidence of any new lesions. 2. No evidence of acute intracranial hemorrhage or hydrocephalus.3. New lobular soft tissue thickening in the left globe correlates with patient's known history of left retinal detachment, however, an underlying metastatic lesion cannot entirely be excluded.4. Scattered periventricular and subcortical T2 hyperintense white matter foci which appear much more conspicuous compared to the prior examination. Differential consideration includes vascular and demyelinating disorders.


Instruction: Generate impression based on findings.

Input: Clinical question : evaluate for interval change for punctate hemorrhage/calcification seen on outside head CT. Signs and symptoms: 21 month old with sickle cell trait, history of altered mental status, staring spells and questionable evaluate for interval change of punctate hemorrhage or calcification.COMPARISON none Nonenhanced head CT:There are relatively symmetrical punctate and linear calcifications bilateral basal ganglia calcification. There is no associated edema or encephalomalacia with these findings. The coronal and sagittal reformatted images suggest that the calcifications appear to be along a similar course as of the lenticulostriate arteries. The exact etiology of this findings are not clear. Follow-up with an enhanced MRI is recommended to better assess these findings and in particular the surrounding brain parenchyma. There may be slight prominence of cortical sulci for patient's stated age of one year. There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. There is no evidence of any additional calcification in the brain parenchymal or the subependymoma region.Calvarium is intact. Mastoid air cells, middle ear cavities and limited view of the orbits are unremarkable. The

Output: Symmetrical bilateral linear calcification of basal ganglia with no associated edema or encephalomalacia of unknown etiology. Recommend follow-up with an enhanced MRI. Please see above comments.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with seizure-like activity. Assess for metastases. History of pancreatic cancer. No evidence of focal parenchymal edema or mass effect is seen. Postcontrast images are somewhat degraded by motion artifact. Within this limitation, no pathologic parenchymal or extra-axial enhancement is observed.Small scattered foci of T2 hyperintensity are seen within the cerebral white matter, the pons and right cerebellum. No restricted diffusion is seen. A small chronic lacunar infarct in the right caudate head is evident.No evidence of acute intracranial hemorrhage is seen. No abnormal extra-axial fluid collections are detected. The ventricular system is normal in size and morphology.Bone marrow signal characteristics are unremarkable. No specific abnormalities of the paranasal sinuses are noted.

Output: 1.No evidence of intracranial metastases.2.Scattered small lesions are seen likely representing chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Gait disequilibrium, evaluate for lumbar spinal stenosis Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5 similar to prior. Alignment is otherwise maintained. Bone marrow signal is benign including hemangioma involving the L2 vertebral body. The conus medullaris is normal in position at the mid L2 level. There is fibrofatty infiltration of the filum terminale measuring less than 2 mm at the L5-S1 level. Small Schmorl's nodes are evident at the L2 level, new at the superior L2 endplate.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Disc bulge with small central protrusion which is slightly worse since prior. There is however no significant spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis.L4-L5: There is moderate bilateral facet arthropathy and minimal/grade 1 anterolisthesis. There is no significant spinal canal stenosis. There is mild right neural foraminal stenosis. Left neural foramen is patent. L5-S1: Minimal disc bulge. No spinal canal stenosis. Minimal narrowing of the neural foramina. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the lumbar spine which have minimally progressed since 9/17/2012. There is no significant spinal canal stenosis at any level. Mild neural foraminal narrowing as above, relatively worse at the right L3-L4 level.2. Moderate facet arthropathy L4-L5 with grade 1 anterolisthesis, similar to prior.3. Fibrofatty infiltration of the filum terminale with normal conus position. This finding may be seen as a normal variant.


Instruction: Generate impression based on findings.

Input: Clinical question: Seizure, history of CVA. Signs and symptoms: Seizures. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus.The cortical sulci, ventricular system and all CSF cisterns remain within normal.Subtle small foci of nonspecific low attenuation in the periventricular white matter as was noted on prior exam. Comparison is not possible due to the sensitivity of CT for detection of findings on prior MRI. There is however a single focus of low-attenuation in the right sub-insular cortex which was not present on prior MR exam. This finding could represent a corner infarct. The appearance of this lesion is suggestive of an old stroke.

Output: 1.No evidence of acute intracranial findings.2.Partial visualization of nonspecific periventricular low-attenuation asthma noted on prior MRI.3.A single focus of low-attenuation in the right basal ganglia which was not identified on prior study.


Instruction: Generate impression based on findings.

Input: Pain and swelling Osseous structures: There are destructive and erosive changes of the midfoot, tibiotalar joint, and talocalcaneal joint reflective of Charcot arthropathy. There is no definite marrow abnormality to confirm osteomyelitis. Metallic susceptibility artifact is noted in the medial aspect of the calcaneus which may reflect prior surgical intervention. There is a small anterior joint effusion which contains a probable loose body.Soft tissues: There is diffuse subcutaneous edema although no discrete fluid collection is identified. There is increased signal throughout the muscles of the foot, but particularly within the plantar muscles.

Output: 1. No definite evidence of osteomyelitis or focal abscess.2. Destructive changes of the foot described above likely relate to Charcot arthropathy given the patient's history.3. Increased signal throughout the muscles of the foot may reflect diabetic myopathy.


Instruction: Generate impression based on findings.

Input: 54-year-old female with elevated alkaline phosphatase ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense cyst in the left lower liver, segment 4A with nodular discontinuous peripheral enhancement compatible with hemangiomas.. The common bile duct is normal in caliber. Status post cholecystectomy. No choledocholithiasis.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: Scattered subcentimeter retroperitoneal and mesenteric lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Patchy nodular opacities in bilateral lower lobes (more pronounced on left side) are again demonstrated, appearing similar to that seen on the prior CT, likely infectious or inflammatory.

Output: 1.No intra- or extra-hepatic biliary ductal dilation. 2.Left liver lobe lesion compatible with a hemangioma. 3.Unchanged patchy nodular opacities in bilateral lung bases.


Instruction: Generate impression based on findings.

Input: Cognitive impairment and right sided headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity bilaterally. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with neck pain after motor vehicle collision. Evaluate for ligamentous injury and for spinal metastases. Pathologic marrow replacement and enhancement is seen throughout the visualized osseous structures. In particular, the vertebral bodies are diffusely involved including the right lateral mass of C1 and the right occipital condyle. The posterior elements are also involved to a lesser degree. Moderate compression deformities are evident at C4 and C5, with severe compression deformities at T3 and T4. None of these levels shows evidence of significant edema suggesting that deformities are chronic. The compression deformity at C4 results in mild retropulsion and at most a very mild compromise of the spinal canal. At T3 and T4, there is a more substantial retropulsion with possible epidural tumor spread resulting in moderate narrowing of the spinal canal.The cervical spine demonstrates normal signal intensity throughout. No pathologic intramedullary or leptomeningeal enhancement is appreciated.Spinal alignment in the cervical region is grossly anatomic accounting for the compression deformities. In the upper thoracic region, there is exaggeration of the normal kyphosis due to compression deformities.C2-3: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac. Moderate bilateral foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation asymmetric to the left paracentral region with effacement of the ventral thecal sac. Moderate left foraminal narrowing. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Pathologic marrow replacement and enhancement is seen throughout the osseous structures compatible with widespread osseous metastatic disease.2.At C4 and C5, there are moderate compression deformities which cause only minimal encroachment upon the spinal canal.3.At T3 and T4, there are severe compression deformities which, through retropulsion and perhaps some degree of epidural tumor spread, cause a moderate degree of spinal canal narrowing.


Instruction: Generate impression based on findings.

Input: Abdominal pain, epigastric, paraplegia compatible with anterior spinal artery syndrome The exam was limited and axial scan could not be obtained since patient refused continuing the examination.Minimal imaging studies on including only sagittal T1 and T2-weighted images were obtained.There is no evidence of spinal canal stenosis.There is no evidence of abnormal signal intensity of spinal cord.Spinal cord completes at the level of L1-2.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and 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 cord signal is normal.

Output: There is no identifiable signal abnormality on the scan.There is no evidence of spinal canal stenosis or spinal cord compression.If clinically indicated, examination can be continued without additional charge to complete all the necessary sequences.


Instruction: Generate impression based on findings.

Input: Ex 38 weeker delivered via scheduled C-section with uncomplicated delivery, 20 day old, Female, with persistent stridor. Evaluate for brain or brainstem lesion. Findings are mildly limited due to motion artifact. 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. Cavum septum pellucidum is incidentally noted. The myelination pattern is appropriate for patient's age. Brain parenchyma is unremarkable for age.No abnormal parenchymal or meningeal enhancement. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. The pharynx is not well aerated. Evaluation is limited due to open mouth positioning, with presence of probable pacifier.

Output: No evidence of acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Preop (biopsy) planning brain MRI. Redemonstration of abnormal high FLAIR signal intensity lesions involving left insular cortex, left temporal lobe pole, left temporal lobe superior and anterior transverse temporal gyrus, left side parahippocampal gyrus and left fusiform gyrus anterior aspect. No change since prior exam. The ventricles, sulci and cisterns are symmetric and unremarkable.There is midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No change of left side high signal intensity lesions on FLAIR images since prior exam.


Instruction: Generate impression based on findings.

Input: Persistent abdominal pain and elevated lipase/amylase. History of SMA stent. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. There are several T2 hyperintense lesions compatible with hepatic cysts. Right hepatic dome/Segment VIII (series 10/image 23) 8 mm intrinsically T1 weighted hyperintense lesion with T2 weighted hyperintensity. The intrinsic T1 weighted hyperintensity limits evaluation of enhancement.There is mild extrahepatic biliary ductal dilatation with the common bile duct measuring 11 mm. It tapers smoothly to the level of the ampulla. This may be related to cholecystectomy.SPLEEN: Stable nonspecific cystic lesion in the pancreas measuring 1.9 cm.PANCREAS: The pancreas is normal in morphology, signal intensity and enhancement. No peripancreatic inflammation or vascular complication. No peripancreatic fluid collections. Normal pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cyst. No hydronephrosis or suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Probable small pleural effusions.

Output: 1.No evidence of pancreatitis or related complication.2. Nonspecific 8 mm right hepatic dome intrinsically T1 hyperintense lesion. In the absence of chronic liver disease, benign etiology is favored.3. Mild biliary ductal dilatation is not unexpected in the setting of cholecystectomy. No focal mass lesion or choledocholithiasis.4. Stable nonspecific cystic splenic lesion, statistically likely benign.5. Probable small pleural effusions.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with NASH cirrhosis, complicated by hepatic encephalopathy on lactulose, still with mental slowing, particularly speech. Image quality is degraded on some sequences by motion artifact. Within this limitation, the following observations are made.Intrinsic T1 hyperintensity within the basal ganglia bilaterally, predominantly the globus pallidus, is unchanged from prior. There may in addition be scattered foci of intrinsic T1 hyperintensity within the white matter of the corona radiata and centrum semiovale which appears more prominent than on the prior examination.Patchy ill-defined T2 hyperintense lesions within the bilateral cerebral white matter are again seen. Accounting for imaging artifact and differences in technique, there does not appear to be any significant interval change.No evidence of significant parenchymal edema or mass effect is seen. No parenchymal restricted diffusion is detected. There is no evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.The bone marrow of the calvarium demonstrates diffusely hyperintense signal on diffusion-weighted and FLAIR imaging, and diffuse enhancement on postcontrast sequences, findings which seem to have progressed slightly from the prior examination.

Output: 1.Intrinsic T1 hyperintensity within the basal ganglia, and also scattered through the cerebral white matter, is seen, likely related to chronic hepatic dysfunction. The signal abnormality has perhaps progressed within the cerebral white matter though technical differences could contribute to the apparent change.2.Scattered white matter T2 signal abnormalities are again seen without significant interval change. No evidence of parenchymal edema or mass effect is identified. No enhancing parenchymal or leptomeningeal abnormality is seen.3.The marrow of the calvarium demonstrates signal characteristics suggesting elevated cellularity or infiltration. The etiology of these findings is uncertain, though in the setting of anemia, marrow reconversion could produce these findings.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of colon cancer. Rule out pilonidal cyst. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right hip arthroplasty, small right hip joint fluid. Moderate lower lumbar spondylosis. In the superficial soft tissues of the lower sacrum, there is increased T2 signal intensity (sagittal series 9 image 28) suggestive of cellulitis. No evidence for a discrete cystic structure to confirm a pilonidal cyst.OTHER: Fluid signal intensity surrounding the right ischial tuberosity (axial series 8 image 24) is incompletely characterized on this exam.

Output: 1.No evidence for pilonidal cyst. In the superficial soft tissues of the lower sacrum, there is mild increased T2 signal intensity suggestive of cellulitis.2.Fluid signal intensity surrounding the right ischial tuberosity (axial series 8 image 24) is incompletely characterized on this exam. If there is clinical concern for injury particularly of the hamstrings, a dedicated musculoskeletal MRI of the right hip is suggested for further evaluation. Right hip arthroplasty, small right hip joint fluid.


Instruction: Generate impression based on findings.

Input: Left foot ulcer There is no abnormal marrow signal to suggest osteomyelitis. There is subluxation of the interphalangeal joint of the first phalanx with absence of the distal portion of the proximal phalanx which appears chronic in nature and may be the result of prior gout or infection. A nondisplaced fracture of the head of the third metatarsal tarsal is also noted. There is increased signal within the head of the fifth metatarsal seen on the coronal PD fat sat images however on STIR sequences, the marrow signal within the fifth metatarsal head is normal suggesting this may be the result of poor fat saturation.There is diffuse subcutaneous edema with more focal areas of soft tissue irregularity along the plantar aspect of the foot at the level of the tarsometatarsal articulations. There is no focal fluid collection. Diffuse atrophy of the plantar musculature is noted.

Output: 1. No evidence of osteomyelitis. Chronic changes involving the first and third metatarsals are further described above.2. Diffuse subcutaneous edema and soft tissue/skin irregularity but without focal fluid collection.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with unspecified abnormalities of gait and mobility, paresthesias skin, cervicalgia, abnormal reflexes. Motion artifact is still present on this examination, though improved relative to the prior study.A reversal of the cervical lordosis is again seen centered at C5-6. Trace retrolisthesis of C5 relative to C6 is unchanged. Elsewhere, sagittal alignment is unremarkable.Vertebral body height and morphology are within normal limits. Degenerative endplate edema is seen at C5-6 and C6-7. Elsewhere, no marrow edema or pathologic marrow replacement is observed.No epidural abnormalities are suspected. The spinal cord shows normal signal intensity and morphology within the limitations of motion artifact.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C5-6: Posterior disc-osteophyte complex formation contributing to mild spinal canal stenosis and moderate bilateral foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation causing no significant spinal canal stenosis. Moderate bilateral foraminal narrowing.C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Disc degeneration is seen most notably affecting the C5-6 and C6-7 levels. Both levels show evidence of foraminal narrowing, and there is a mild generalized spinal canal stenosis at C5-6.


Instruction: Generate impression based on findings.

Input: 17-year-old male with history of patella alter, patellar subluxation and instability, and OCD lesion noted recent radiograph. MENISCI: The lateral and medial menisci are intact and normal in appearance.ARTICULAR CARTILAGE AND BONE: Increased bone marrow signal intensity in the anterolateral aspect of the lateral femoral condyle compatible with bone contusion, with associated thinning and irregularity of the overlying articular cartilage. There is similar increased bone marrow signal intensity of the posteromedial aspect of the medial third of the patella with thinning of the overlying articular cartilage. The patella is currently in anatomic alignment. No fracture is seen.The tibial tuberosity trochlear groove distance is 9mm, within normal limits. The Insall-Salvati ratio is 1.4 (normal is 0.8-1.2), indicating patella alta.There is an osteochondral defect of the articular surface of the lateral femoral condyle without associated articular cartilage defect. T2 signal hyperintensity peripherally may suggest instability.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex appear intact. The medial retinaculum of the knee appears intact.EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Lateral femoral condyle osteochondral defect. Bone contusion to the inferomedial patella and anterolateral aspect of the lateral femoral condyle with associated articular cartilage thinning, sequelae of lateral patellar dislocation. Small-to-moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Left upper extremity weakness and brisk reflexes at the patella Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Right-sided facet arthropathy.C3-4: Small central disc osteophyte complex and right uncovertebral hypertrophy. There is mild spinal canal narrowing at this level. There is mild right and no significant left neural foraminal stenosis. Right greater than left facet arthropathy.C4-5: Central disc osteophyte complex and ligamentum flavum thickening result in moderate spinal canal stenosis at this level. There is moderate left and mild right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C5-6: There is prominent right paracentral disc osteophyte complex which deforms the cord, right worse in left, with moderate to severe spinal canal stenosis. There is subtle T2 hyperintensity within the cervical cord in the right aspect of the cord, sagittal T2 image 8. Ligamentum flavum thickening also noted which effaces the dorsal thecal sac. There is mild right and mild to moderate left bilateral neural foraminal stenosis. Mild bilateral facet arthropathy.C6-7: There is small right paracentral disc osteophyte complex and mild ligamentum flavum thickening. There is mild to moderate spinal canal stenosis particularly involving the right aspect of the spinal canal. There is also uncovertebral hypertrophy resulting in mild to moderate bilateral neural foraminal stenosis. C7-T1: There is a right paracentral disc osteophyte complex with no significant spinal canal stenosis at this level. There is mild to moderate right and no significant left neural foraminal stenosis. Facet arthropathy on the left.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes throughout the cervical spine. There is moderate to severe spinal canal stenosis at the C5-C6 level, particularly involving the right aspect of the spinal canal. Associated subtle T2 hyperintensity within the cord is suspected. There is also moderate spinal canal stenosis at C4-C5. 2. There is also multilevel neural foraminal stenoses, relatively worst at the left C4-C5 level. Please see details above.


Instruction: Generate impression based on findings.

Input: 82-year-old male with CHF, COPD presents with shortness of breath. Recently off Coumadin with elevated d-dimer. PULMONARY ARTERIES: Technically adequate pulmonary embolus examination without evidence of pulmonary embolus.LUNGS AND PLEURA: Multiple punctate calcifications consistent with prior granulomatous disease. Emphysema affects the upper lobes bilaterally. Mild atelectasis at the lung bases bilaterally.MEDIASTINUM AND HILA: Heart size within normal limits. Pacemaker leads terminate in normal position. No pericardial effusion. Atherosclerotic disease affects the visualized aorta. No mediastinal lymphadenopathy.Within the posterolateral aspect of the trachea in a non-dependent position is a 9 mm soft tissue density which is adherent to the right aspect of the tracheal wall, best seen on image 60/115, coronal series. The soft tissue density may represent adherent mucous or debris however further evaluation with bronchoscopy, if clinically warranted, may be considered as an underlying mass cannot be entirely excluded. Emergency room physician Dr. Melinda Graber was notified of results of these findings at 10 a.m.CHEST WALL: Multiple small axillary lymph nodes are not pathologic by size criteria. Minimal gynecomastia may be due to medication or may be physiologic. Pacemaker seen within the subcutaneous tissues of the left chest wall.UPPER ABDOMEN: Multiple punctate calcifications throughout the liver and spleen spleen consistent with prior granulomatous disease. Focal hyperdensity measuring approximately 4 mm adjacent to the right renal hila likely represents vascular calcification. No evidence of hydronephrosis. A nonspecific small adrenal nodule measuring approximately 24 Hounsfield units could be secondary to adenoma. Dedicated adrenal MRI may be considered for further evaluation.

Output: 1. No evidence of pulmonary embolus.2. Tracheal soft tissue density may represent adherent mucous or debris, however, further evaluation with bronchoscopy, may be considered as an underlying mass cannot be entirely excluded. Emergency room physician Dr. Melinda Graber was notified of results of these findings at 10 a.m.


Instruction: Generate impression based on findings.

Input: 69 year old female with retropharyngeal abscess. Worsening clinical symptoms. Increasing neurological symptoms. Evaluate for spread. CT of the soft tissues of the neck.Images through the skull base including cavernous sinuses remain within normal limits.Images through the soft tissues of the neck demonstrate a prevertebral edema enhancing fluid collection which also contains air and is consistent with patient's diagnosis of prevertebral abscess in comparison with the prior exam no definitive evidence of interval change is noted however on this the study extension of the abscess to the level of left neural foramina at C6- C7 is better visualized. Prior MRI of cervical spine also demonstrate ventral epidural spread of infection at this level. There may be slight increase in the size of prevertebral abscess. Images through the apices of the lungs demonstrate significant bilateral pleural effusions that appears more pronounced (on the right side) since prior examination.CT of brain with infusion.No evidence of any abnormal enhancement of brain parenchymal or the leptomeninges is identified to suggest intracranial spread of infection. No evidence of edema, mass effect, midline shift, hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits.If worsening of neurological symptoms are relevant to the spine repeat MRI examination of cervical and thoracic spine is recommended.

Output: 1.Negative CT of brain with infusion.2.Redemonstration of prevertebral abscess with possible slight interval increase in its size.


Instruction: Generate impression based on findings.

Input: Intracerebral hemorrhage [431], Reason for Study: ^Reason: evaluate old hemorrhage v cavernoma History: susceptibility on previous MRI Redemonstration of encephalomalacia with gliotic change on the left precuneus chronic ICH. On gadolinium enhancement, there is no significant enhancement seen within or around this lesion.On gradient echo images, there are stippled susceptibility lesions within the lesion as well as surrounding low signal intensities indicating hemosiderin deposition. However, the overall MR feature of hemosiderin deposition is not usual popcorn appearance for cavernous malformation.This is unusual intra-axial hemorrhagic foci, if AVM is one of the possible diagnosis, diagnostic catheter angiogram needs to be considered. Gadolinium-enhanced MRI cannot exclude the possibility of brain AVM.There is no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. The right PCA is fetal origin. No intracranial arterial aneurysm. No intracranial arterial luminal stenosis is seen.

Output: 1. Usual evolution of left precuneus ICH with hemosiderin deposition as described above.2. No abnormal enhancement on the scan.3. No evidence of acute hemorrhagic or ischemic lesion.4. Normal brain MRA.5. Diagnostic catheter angiography need to be considered if brain AVM is a potential diagnosis.


Instruction: Generate impression based on findings.

Input: Prior history of pancreatic cancer presenting for radiation planning MRI. Abdominal pain and diarrhea. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology without a focal suspicious lesion or vascular abnormality. There is extrahepatic biliary ductal dilatation up to 1.4 cm to the level of the ampulla. There are small dependent filling defects in the common bile duct consistent with choledocholithiasis (series 8 image 28). Small amount of perihepatic ascites. Pneumobilia.SPLEEN: No significant abnormality noted.PANCREAS: Overall there is decreased T1 weighted signal intensity of the pancreatic parenchyma suggesting parenchymal dysfunction. Best appreciated on the postcontrast images there is a subtle hypoenhancing lesion at the level of the distal pancreatic body/proximal tail measuring 1.8 x 1.4 cm (series 9 image 27). There is distal pancreatic parenchymal atrophy and ductal dilatation. The lesion appears to extend towards and encase the SMA. This is better characterized on the recent prior CT. Also better appreciated on the CT is abutment and possible involvement of the distal splenic vein proximal to the SMV/splenic vein confluence.Relatively stable fluid collection anterior to the pancreatic head measuring approximately 3.9 x 2.8 (series 9 image 110). The small collection dorsal to the stomach is not appreciable on this MRI.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Heterogeneous signal of the aortic wall consistent with atherosclerotic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Subtle hypoenhancing lesion at the level of distal pancreatic body/proximal tail with distal pancreatic ductal dilatation and parenchymal atrophy. The lesion measures up to 1.8 cm and extends to and encases the SMA. Findings are consistent with the stated history of pancreatic adenocarcinoma. Refer to the recent CT for better spatial resolution.2. Common biliary ductal dilatation with choledocholithiasis.


Instruction: Generate impression based on findings.

Input: 41-year-old female with question of posterior myelitis on radiograph There is a collection measuring 2.5 x 1.9 x 4.6 cm (TR x CC x AP) (series 801, image 36 and series 601, image 15) abutting the plantar surface of the second metatarsal with destruction of the cortex and distal second metatarsal. The collection has a T1 hyperintense rim with predominantly T2 hyperintensity centrally. The lesion abuts the third metatarsal with destruction of the medial cortex. There is high T2 signal within the second and third metatarsals. Amputation of the second digit at the MTP joint.Significant soft tissue swelling particularly over the dorsum of the foot.Small subchondral cysts are noted in the calcaneus. Cysts and T2 hyperintensity and T1 hypointensity in the navicular. Moderate degenerative changes involving the tarsometatarsal joints.

Output: 1.Mixed intensity collection with partial lysis of the second and third metatarsals and surrounding inflammation/edema compatible of an abscess with small component of hemorrhage.2.Status post amputation of the second digit at the MTP joint.


Instruction: Generate impression based on findings.

Input: 45 year old woman with non ischemic cardiomyopathy and obstructive lung disease, referred for further evaluation of possible cardiac sarcoid. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 216 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 142 ml (normal range 31+/-10). LV dysfunction is global. There is no late gadolinium enhancement or myocardial edema to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%.2. There is no late gadolinium enhancement or myocardial edema to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Post concussion syndrome, gait imbalance, headache There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 63 year old patient who is BRCA positive. History of ovarian cancer in mother diagnosed at the age of 49. History of breast cancer in sister diagnosed at the age of 40 and daughter diagnosed at at the age of 24. History of ovarian cancer in paternal grandmother diagnosed at the age of 63. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 49-year-old female with history of benign biopsy of the right breast and strong family history of breast cancer in her mother presents for MRI Surveillance. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Mild motion artifacts are noted in subtraction images.Multiple cysts are present in both breasts.Focal non-mass enhancement measuring 6 x 6 x 5 mm (AP x LR x CC) is present at middle 12 o'clock position in the left breast. This lesion is stable when compared to the prior study.A 4 mm round slowly enhancing focus in the right breast 8:00 position is unchanged.No new abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: NSCLC restaging. Some of the images are degraded by patient motion. There are two punctate foci of susceptibility effect in the left frontal and parietal lobes without associated enhancement. Otherwise, there is no evidence of gross tumors. There is a small linear area of high T2 signal and restricted diffusion in the right cerebellar hemisphere. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is right maxillary sinus retention cyst formation. There is mild fluid within the right mastoid air cells.

Output: 1. Two punctate foci of susceptibility effect in the left frontal and parietal lobes without associated enhancement are nonspecific and may represent chronic microhemorrhages. No evidence of intracranial metastases otherwise. 2. Small acute infarct in the right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (8/17/15, 8/27/15), breast MRI (9/19/15) performed at Ingalls Memorial Hospital. For comparison, digital mammographic images (12/22/13, 10/4/12, 9/11/12) are available. DIGITAL MAMMOGRAPHIC IMAGES (8/17/15, 8/27/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There is a cluster of pleomorphic calcifications in the right breast at posterior upper outer quadrant.The cluster measures 20 x 8 mm (AP x LR).In the left breast, there is a stable oval mass (16 x 12 mm) at middle lower outer quadrant.No suspicious mass, microcalcifications or areas of architectural distortion are noted in left breast. BREAST MRI (9/19/15):Imaging protocol is outlined in the outside radiology report.Submitted images could not be processed by our workstation, therefore, this interpretation is made with axial images only.RIGHT BREAST:On the subtraction images, there is a linear non-mass enhancement measuring 23 x 11 mm (AP x LR) at posterior upper outer quadrant in the right breast, corresponding to the pleomorphic calcifications. A metallic artifact is present at the anterior aspect of this lesion, likely a marker clip. LEFT BREAST:In the left breast, there is a focal non mass enhancement, measuring 10 x 9 mm at upper outer quadrant.There is a lobulated cyst, measuring 14 x 8 mm at lower outer quadrant, corresponding to the stable mass seen on the mammogram. AXILLAE:No abnormal lymph nodes are identified in either axillary region.

Output: 1. Suspicious pleomorphic calcifications in the right breast at posterior upper outer quadrant. Per outside radiology report, this is a proven carcinoma.2. Focal non mass enhancement in the left breast upper outer quadrant. MR directed ultrasound is recommended. If no correlation is MR guided biopsy should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: U - Ultrasound Study Needed - No Letter.


Instruction: Generate impression based on findings.

Input: 45 year old woman with a history of an atrial septal defect and bicuspid pulmonic valve who underwent an unknown type of surgery at age 3 and then some type of pulmonic valve surgery at age 24, referred for interval follow up. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 120 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 59 ml (normal range 31+/-10), the LV mass index is 35 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). There are no regional wall motion abnormalities present, however there is abnormal septal wall motion possibly due to sternotomy. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 55 ml/m2 (normal range 69+/-14), the RVEDV is 102 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 42 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve appears to be bicuspid and dysplastic. There is mild pulmonic regurgitation (regurgitant fraction 11%). There is mild pulmonic stenosis (mean pressure gradient 8mmHg).Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe proximal main pulmonary artery is normal in size. There is mild aneurysmal dilation of the distal portion of the main pulmonary artery, 28x32 mm. The right PA size is 27x21mm. The left PA has a narrowing of the proximal portion, minimum diameter 17x14 mm. The distal LPA is normal in size and measures 23x23mm.Venous AnatomyThe SVC and IVC are drain normally into the right atrium. ShuntsThere are no obvious intracardiac or extracardiac shunts present. On first pass imaging, there is no evidence of right to left shunting at the atrial level. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. 3. There is mild aneurysmal dilation of the distal main pulmonary artery and stenosis of the proximal left pulmonary artery, unchanged from prior MRI.4. The pulmonic valve appears to be bicuspid and dysplastic. There is mild pulmonic regurgitation (regurgitant fraction 11%). There is mild pulmonic stenosis (mean pressure gradient 8mmHg).5. No evidence of intra-cardiac shunts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma with recent progression. There is an enhancing left sellar mass that extends into the left cavernous sinus with encasement of the left internal carotid artery. The mass also extends into the left sphenoid sinus. Overall, the mass measures up to approximately 2 cm. There is no mass effect upon the optic apparatus. The pituitary infundibulum is intact.

Output: No significant interval changed in the pituitary macroadenoma with extension into the left cavernous sinus, where there is encasement of the left internal carotid artery, and extension into the left sphenoid sinus.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for myelomatous lesions. Signs and symptoms: Known myomatous lesion in pelvis; 8 unsteadiness. Pre-and post enhanced cervical MRI:The examination demonstrates a focus of marrow signal T2 stair hyperintensity and hypointensity on T1 in the anterior body of C6 measuring approximately 9 mm in size. The finding also demonstrate enhancement on post infused images and is concerning for a metastatic myomatous lesion.There is a tiny focus of enhancement along the inferior endplate of C4 consistent with a tiny Schmorl's node.Degenerative changes of cervical spine results in mild central spinal stenosis at C2 -- C3, moderate central spinal stenosis at C3 -- C4, moderate to severe central spinal stenosis at C4 -- C5 , C5 -- C6 levels and mild central spinal stenosis at C7 -- T1 level. Degenerative changes also results in multilevel neural foraminal compromise. There are mild to moderate bilateral (right greater than left) neural foraminal compromise at C3 -- C4, moderate right and mild left neural foraminal compromise at C4 -- C5, significant bilateral neural foraminal compromise at C5 -- C6 and C6 -- C7 levels.The signal intensity of the cervical cord remains within normal and without abnormal enhancement.Pre-and post enhanced thoracic MRI:There is normal anatomical alignment the vertebral column. There is mild exaggeration of lumbar lordosis centered at approximately T7 level.There is a well-demarcated focus of T1 and T2 hyperintensity which demonstrate hyperintensity signal pattern on T2 stir and without evidence of enhancement. The finding is consistent with a focus of fatty deposit of no clinical significance.There is no detectable foci of signal abnormality of vertebral column or abnormal enhancement to suggest metastatic disease.The signal intensity and caliber of thoracic cord remains within normal and without abnormal enhancement.There is no evidence of spinal canal compromise or stenosis at any level.There is no evidence of neural foraminal compromise at any level. Mild degenerative changes including ligamentum flavum hypertrophic changes at multiple levels is noted.Pre-and post enhanced lumbar MRI:The signal intensity of vertebral column demonstrate subtle changes secondary to degenerative disease and unremarkable otherwise in particular for evidence of metastatic lesions. There is no detectable abnormal enhancement the vertebral column.The signal intensity of conus and cauda equina is also within normal and without abnormal enhancement.There is generalized smaller caliber of lumbar spinal canal which is believed to be at least partially secondary to congenital anatomical variation.L1 -- L2 demonstrate moderate disk disease and ligamentum flavum hypertrophy changes. There is a small left paramedian disk/osteophyte complex present. There is no central spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease and moderate to severe bilateral ligamentum flavum hypertrophy and mild hypertrophy changes of facets. Constellation of degenerative changes in combination with congenitally smaller canal at this level results in mild central spinal stenosis however without neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. There is a tiny right lateral shallow broad-based disk protrusion at this level present.Constellation of above findings results in significant central spinal stenosis at this level and no neural foramina compromise.

Output: 1.Pre-and post enhanced MRI of cervical spine demonstrate a single 9-mm focus of marrow signal change and enhancement in the body of C6 vertebrae which is nonspecific however considering patient's history could represent a focus of metastatic myomatous lesion. No additional foci of abnormal enhancement of vertebral column or enhancement of the cord to suggest malignancy. There are extensive degenerative changes of cervical spine with multilevel central spinal stenosis (most significantly at C5 -- C6) and multilevel bilateral neural foraminal compromise (some significantly as detailed per level above.2.Pre-and post enhanced MRI of thoracic spine is unremarkable.3.Pre-and post enhanced MRI of lumbar spine demonstrate no evidence of metastatic disease. There is congenitally smaller caliber of the spinal canal. This finding in combination with degenerative changes results in significant central spinal stenosis at L3 -- L4 level and to a lesser degree at L2 -- L3. No significant neural foraminal compromise. Please see above comments.


Instruction: Generate impression based on findings.

Input: Severe, the pertaining pelvic pain. Rule out cord abnormality or nerve impingement. There are 5 lumbar-type, ribless vertebrae. The last well-formed disc is at L5-S1.Alignment is anatomic accounting for straightening, which may reflect patient positioning. The vertebral bodies are preserved in height. Marrow signal also is normal as well as the disc heights and T2 signal. The spinal canal is preserved. The tip of the conus medullaris lies at the mid L1 level. The conus medullaris shows normal morphology and no abnormal signal. There is no neural foraminal stenosis. There is no edema in the posterior elements or subluxation to indicate the presence of spondylolysis. There is no abnormal contrast enhancement.

Output: Normal lumbar spine MRI.


Instruction: Generate impression based on findings.

Input: History of C4-C5 and C5-C6 cervical stenosis: history of neck pain and bilateral shoulder pain. There is slight retrolisthesis of C4 on C5 and C5 on C6 with lack of the usual cervical lordosis. There are small disc-osteophyte complexes and uncovertebral joint hypertrophy at C4-5 and C5-6 with mild-to-moderate spinal canal and bilateral neural foraminal stenoses, but no spinal cord compression or signal abnormality. There is no significant spinal canal or neural foraminal stenosis at the other cervical spine levels, but there are incompletely characterized degenerative changes in the imaged upper thoracic spine. Aside from degenerative bone marrow signal alteration at C4 and C5, the vertebral bone marrow appears to be unremarkable. Aside from endplate irregularity at C4 and C5, the vertebral body heights are preserved. The paravertebral soft tissues are unremarkable. There are bubbly secretions in the right sphenoid sinus.

Output: 1. Degenerative spondylolysis at C4-C5 and C5-C6 without spinal cord compression.2. Findings suggestive of acute right sphenoid sinusitis.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with cervical radiculopathy. The cervical lordosis is reversed. In addition, there is a grade 1 anterolisthesis of C4 relative to C5.The vertebral body heights are preserved. A 13 mm T1/T2 hypointense region within the left lateral aspect of the C7 vertebral body correlates to lucency on prior radiographs suggesting a vertebral pneumatocyst. A subcentimeter T2 bright cyst is also seen within the right C2 inferior articulating facet. No other areas of concerning marrow replacement or edema are seen.The visualized spinal cord demonstrates normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: Facet arthropathy and ligamentum flavum thickening. Posterior disc-osteophyte complex formation asymmetric to the right foraminal zone. No significant generalized spinal canal stenosis. Moderate right foraminal narrowing. C3-4: Facet arthropathy, right more than left. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation with a small superiorly directed central extrusion. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing.C5-6: Posterior disc-osteophyte complex formation asymmetric to the left foraminal zone. Mild generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Severe left and moderate right foraminal narrowing. C7-T1: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing.

Output: 1.Multilevel disc osteophyte formation is seen resulting in mild generalized spinal canal stenosis at C5-6 and C6-7.2.Scattered foraminal narrowing is demonstrated with C7-T1 the most severely affected level.3.Findings compatible with a vertebral pneumatocyst at C7, likely degenerative in etiology.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out subdural. Signs and symptoms: Status post left parietal fracture from fall. Non-enhanced CT of brain:There is no evidence of a right small hemorrhage or subarachnoid hemorrhage.The cortical sulci, ventricular system and CSF cisterns remain within normal for patient stated age of 10 weeks. There is prominence of subarachnoid space in bifrontal, temporal and parietal regions which extends into the cement fissures bilaterally. This could be within normal for patient stated age. There is some inhomogeneity of the prominent subarachnoid space which also may be secondary to motion artifact. There is no detectable mass effect on the parenchyma. The entirely exclude the possibility of isodense subdural follow-up with an MRI is recommended.Examination demonstrates a linear nondisplaced fracture of left parietal bone which is best appreciated on bone density images 23 through 27.

Output: 1.No definite abnormality of brain parenchyma or subarachnoid hemorrhage.2.Prominent subarachnoid space which could be within normal for patient's stated age however it cannot exclude possibility of isodense subdural. There is no detectable mass effect on the brain parenchyma.3.Nondisplaced fracture of left parietal bone.4.There are no old studies for comparison.5.Visualized mastoid air cells and middle ear cavities and limited view of paranasal sinuses are unremarkable.


Instruction: Generate impression based on findings.

Input: Diagnosis: AphasiaClinical question: stroke wuSigns and Symptoms: aphasia MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. On the prior exam, the distal right M1 segment at its junction with M2 segment appears narrower on this MRA exam, however, this is also associated with the tortuosity of the vessel as well as a smaller right internal carotid artery relative to the left internal carotid artery suggesting that this may very well be a flow related phenomenon rather than a stenosis.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is very small. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is 50% narrowing at the origin of the left vertebral artery.The walls of the distal cervical internal carotid arteries and distal vertebral arteries are irregular and have a cobblestone.

Output: 1.No evidence for intracranial cerebrovascular occlusive disease.2.Findings are suggestive of arterial with these such as fibromuscular dysplasia involving the distal vertebral arteries and distal cervical internal carotid arteries.3.50% narrowing at the origin of the left vertebral artery.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: 46-year-old female patient with ongoing attacks of biliary pain since 5/22/2016. Lack of IV contrast limits evaluation.ABDOMEN:LIVER, BILIARY TRACT: Scattered T2 hyperintense lesions within the liver likely represent hepatic cysts within the limitation of this noncontrast examination. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No acute findings to account for the patient's symptoms.2.Scattered T2 hyperintense hepatic lesions likely represent simple cysts within limitation of this non-contrast examination.


Instruction: Generate impression based on findings.

Input: Hypoglycemia and growth hormone deficiency. There is a small focus of T1 hyperintensity on the fat-suppressed images in the midline along the stalk of the pituitary with a relatively small posterior pituitary bright spot within the sella, compatible with partially ectopic posterior pituitary gland. There is no abnormal enlargement of the pituitary gland or focal lesion identified within the gland itself. There is apparent dilatation of the lateral and third ventricles. The fourth ventricle appears to be within normal limits. No obstructing lesion is identified. The corpus callosum appears formed, but abnormally thin. Furthermore, there is diffuse paucity of white matter bulk in the cerebral hemispheres. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the paranasal sinuses. The skull base appears to be somewhat dysplastic.

Output: 1. Findings compatible with partially ectopic posterior pituitary gland.2. Diffuse white matter deficiency with ventriculomegaly, which may be related to growth hormone deficiency. Further evaluation with a dedicated braIN MRI may be useful.3. The skull base appears to be somewhat dysplastic, which may also be related to growth hormone deficiency.


Instruction: Generate impression based on findings.

Input: Arachnoid cyst and EtOH abuse, now with unprovoked dizziness while driving. There is an unchanged arachnoid cyst overlying the left anterior temporal lobe, inferior left frontal lobe, and insula, with mass effect upon the underlying brain parenchyma. There are mild scattered foci of cerebral white matter T2 hyperintensity and a small area of encephalomalacia in the left basal ganglia. There is no evidence of acute infarct. There is no midline shift or herniation. The left internal carotid artery flow void is diminutive. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. Unchanged arachnoid cyst overlying the left anterior temporal lobe, inferior left frontal lobe, and insula, with mass effect upon the underlying brain parenchyma. 2. Mild scattered foci of cerebral white matter T2 hyperintensity. 3. Probable chronic small vessel ischemic disease and chronic left basal ganglia chronic infarct, but no evidence of acute infarct.4. The left internal carotid artery flow void is diminutive, which could indicate proximal stenosis. Dedicated neurovascular imaging of the head and neck may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Evaluate liver metastases, carcinoid syndrome ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense enhancing lesions throughout the liver appear increased in size compared to the prior examination. Reference segment 7 lesion measures 2.1 x 1.9 cm (series 301, image 27), previously 1.7 x 1.7 cm.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the anterior abdominal wall.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Multiple hepatic metastases, increasing in size.2.Pancreas divisum.


Instruction: Generate impression based on findings.

Input: Submandibular swelling right more than left: CT showed possible early calculus: worsening and difficulty swallowing. There is an external marked overlying the right submandibular gland, which appears to be mildly swollen and hyperenhancing diffusely. There is enlargement of the right submandibular ducts extending into the sublingual space, where there is a punctate T1 and T1 hypointensity. The other salivary glands appear unremarkable. There is no evidence of mass lesions or significant lymphadenopathy in the neck. The orbits and imaged intracranial structures are unremarkable. There is multilevel degenerative spondylosis, with an intervertebral disc herniation at C4.

Output: Findings suggestive of right submandibular sialoadenitis with ductal obstruction likely associated with a punctate calculus in the sublingual space.


Instruction: Generate impression based on findings.

Input: Atypical facial pain. Galactorrhea. The pituitary gland is normal in size and shape. Normal T1 shortening of the neurohypophysis is present. There is normal homogeneous postcontrast enhancement. Dynamic images demonstrate no evidence of pituitary microadenoma. The infundibulum is in the midline. The hypothalamus appears unremarkable. Remainder of the partially imaged brain is unremarkable.

Output: Normal appearing pituitary gland without evidence of pituitary microadenoma or macroadenoma.


Instruction: Generate impression based on findings.

Input: 53-year-old female with left breast cancer status post neoadjuvant chemotherapy There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Left breast: Non mass enhancement in the left breast 4:00 position measures 18 x 24 x 13 mm, previously measured 61 x 27 x 29 mm (AP x ML x SI). The enhancement is noted medial to the clip artifact. Right breast: No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.High T2 signal lesion in the left lobe of liver is most likely a hemangioma or cyst.

Output: Moderate response to neoadjuvant chemotherapy in the left breast non mass enhancement, now measuring 18 x 24 x 13 mm medial to the clip artifact. No abnormality noted in the right breast or bilateral axillary region. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Surgery and radiation therapy for prolactinoma. There are unchanged post-treatment findings in the region of the sella. In particular, there is unchanged thickening, enhancement, and rightward deviation of the pituitary stalk. There is also an unchanged nonspecific subcentimeter nodular focus of enhancement, as well as several fine linear enhancing bands in the left sella. The optic apparatus appears unchanged, with mild prolapsed and distortion likely attributable in part to adhesions. There is unchanged mild prolapse of the posterior left gyrus rectus into the enlarged sella. The cavernous internal carotid artery flow voids appear to be intact. There are partially imaged nonspecific scattered foci of cerebral white matter T2 hyperintensity.

Output: No significant interval change in the appearance of the sellar and parasellar contents with superimposed treatment findings.