Instruction: Generate impression based on findings.

Input: Male, 81 years old, rapid decline in cognition in patient with baseline dementia and new gait disturbance. Relatively mild scattered periventricular and subcortical T2 hyperintensities are seen, a nonspecific finding which may reflect chronic microvascular disease. No restricted diffusion is seen to suggest acute ischemia. No evidence of parenchymal edema or mass effect is detected.The ventricles and sulci are diffusely prominent compatible with volume loss. The morphology of the ventricular system is otherwise unremarkable. No evidence of intracranial of cranial hemorrhage or any abnormal extra fluid collection is seen.

Output: 1. Chronic microvascular ischemic disease and generalized parenchymal volume loss.2. No other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: There is heterogeneously enhancing lesion in the left inferior cerebellar hemisphere measuring transaxial 25 x 11 mm, and 22 mm AP with central hypoenhancement and speckled foci of internal enhancement, and a rim of irregular but somewhat more linear enhancement. While this lesion is without significant change from March 2015, it has increased in size from November 2014 where it measured 18 x 8 mm transaxial. There are a few small foci of susceptibility effect within this region which appear more prominent, and moderate surrounding T2 prolongation outlining the left dentate nucleus which is stable from more recent exam but worsened from November 2014, most likely representing combination of vasogenic edema and/or post treatment changes. There is regional mass effect with effacement of the regional cerebellar folia.There is a more prominent 8 mm nodule of enhancement in the right anterior temporal lobe without significant surrounding edema or mass-effect. This lesion measured approximately 6 mm on March 2014 exam, and is new from November 2014 exam.The flow-voids of the skull base are intact.

Output: 1.Prebiopsy exam showing heterogeneously enhancing lesion with surrounding nonspecific T2 signal abnormality in the left inferior cerebellar hemisphere which is similar to more recent outside exam from March 2015, but larger compared to November 2014 exam.2.Right anterior temporal lobe 8 mm nodular enhancement consistent with metastasis, worsened from March 2015 and new from November 2014.


Instruction: Generate impression based on findings.

Input: Worsening cognition. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a chronic lacunar infarct in the left basal ganglia and corona radiata, with a small amount of marginal hemosiderin staining. There is moderate diffuse cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution. There are a few scattered foci of susceptibility effect in the bilateral cerebral hemispheres. There is no abnormal intracranial enhancement. 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 are low T2 signal secretions in the left sphenoid sinus, which may be related to chronic proteinaceous material or fungal elements.

Output: Chronic lacunar infarct in the left basal ganglia and corona radiata and moderate cerebral white matter small vessel ischemic disease, as well as scattered foci of susceptibility effect, which may represent amyloid angiopathy, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: new lesion on MRI at T7-please bx-hx of head and neck ca History: as above Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: T7 vertebral bone biopsy under CT guidance. A total of eight samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: 56-year-old male with medial knee pain. Evaluate medial meniscus. MENISCI: There is blunting of the body and posterior horn of the medial meniscus. There is linear increased signal abnormality which extends to the tibial and femoral articular surface. These findings are consistent with complex tearing. The lateral meniscus appears intactARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle overlying the body of the meniscus with associated bone marrow edema or signal abnormality, likely degenerative in etiology. There is also articular cartilage delamination along the weightbearing surface of the medial femoral condyle. There is full-thickness articular cartilage degeneration along the medial aspect of the tibial plateau beneath the body of the meniscus with bone marrow edema in the surrounding area. There is relative sparing of the lateral compartment. There is superficial fraying of the articular cartilage of the medial lateral facets of the patella. There is a 10 mm focus of low signal intensity along the posterior aspect of the femur which may represent a loose body within the joint, appearing similar to the findings on prior radiographs.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tearing of the medial meniscus.2. Full-thickness articular cartilage degeneration as described above.3. 10 mm loose body within the joint space and other findings as described above.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:5/26/1959)Reason: stroke History: left face droopPROVIDER/ATTENDING NAME: SAROSH RANA ADIL JAVED MRI of the brainThere is a focus of diffusion restriction within the left centrum semiovale measuring approximately 16 x 18 mm in axial dimensions. There is another focus of diffusion restriction present in the left half of the splenium of the corpus callosum measuring 17 x 10 mm axial dimensions. There are corresponding FLAIR signal abnormalities.There is a moderate degree of brainstem as well as 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 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 an opacity in the right sphenoid sinus and mucosal thickening in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left posterior communicating artery is not readily identified. There appears to be a 2 mm aneurysm versus infundibulum at the expected location of the origin of the left posterior communicating artery. No right posterior communicating artery is small. The right vertebral artery is smaller than the left vertebral artery.

Output: 1.There are lacunar infarcts present in the left centrum semiovale and left splenium of the corpus callosum.2.Findings suggest either aneurysm or infundibulum at the origin of the left posterior communicating artery.3.No evidence for cerebrovascular occlusive disease.4.Periventricular and subcortical white matter lesions and patchy lesions in the brainstem of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: labral tear History: pain and apprehension ROTATOR CUFF: There is intermediate signal intensity within the distal supraspinatus tendon indicating mild tendinosis. There is subchondral cyst formation within the greater tuberosity and the surrounding area. The supraspinatus tendon appears intact. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid or intra-articular gadolinium is identified within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint with osteophyte formation along the inferior aspect of the clavicle resulting in slight impression upon the superior fibers of the supraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. No articular cartilage defects are identified. Intra-articular gadolinium enters the superior labrum at the 11 o'clock position and extends superiorly and laterally within the labrum indicating a tear. The tear extends anteriorly within the labrum indicating a SLAP tear. It also enters the labrum posterior to the expected location of the biceps anchor confirming a tear.BICEPS TENDON: There is poor visualization of the intra-articular portion of the long head of the biceps tendon. Additionally, the long head of the biceps tendon is poorly visualized/thinned within the bicipital groove. These findings are suspicious for a tear with retraction. The biceps anchor is poorly visualized also indicating a tear.ADDITIONAL

Output: 1. SLAP tear of the glenoid labrum.2. The intra-articular portion of the long head of the biceps is poorly visualized, as is the biceps anchor, indicating tearing of the long head of the biceps tendon with retraction.


Instruction: Generate impression based on findings.

Input: Ms. Hyman is a 43 year old female with left breast lumpectomy in 2013 for DCIS treated with radiation and hormonal therapy. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Previously identified foci of enhancement in the right anterior breast are stable when compared to prior MRI's dating back to 8/2015.No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [D18.02] / Heteronymous bilateral field defects [H53.47], Reason for Study: ^Reason: assess CCM resection pod#1 History: s/p CCM resection Motion artifact degraded image quality.Right pterional craniotomy status.Previously seen infero-mesial aspect of the lesion measured about 7.3mm x 7.3mm on coronal scan and 8.6mm x 7.2mm on axial scan has been resected on this scan.There is, however, residual part of the original cavernous malformation especially anterior and superior aspect. The size of the residual lesion is about 5.2mm x 6.2mm on coronal scan and 6.6mm x 5.4mm on axial scan. There are restricted diffusion lesions involving anterior aspect of the right temporal lobe and inferior aspect of the frontal lobe (inferior frontal gyrus and lateral orbital gyrus) indicating possible cytotoxic edema.There is minimal midline shift toward left side and the right lateral ventricle appears to be slightly effaced which are not unusual for postoperative status. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Postoperative status of the right inferior basal ganglia cavernous malformation.2. There is residual lesion on the superolateral aspect of the original lesion as described above.3. Possible cytotoxic edema on the right temporal lobe anterior aspect and inferoanterior aspect of the right frontal lobe as described above.


Instruction: Generate impression based on findings.

Input: 59 years Female (DOB: 10/20/1956)Reason: spinal cord impingement History: RUE tingling/ numbness and R neck painPROVIDER/ATTENDING NAME: JAMES J WALTER JAMES J WALTER The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. The exam is degraded by patient motion.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is loss of disc space height, desiccation and diffuse disc bulge associated with bilateral uncovertebral osteophytes. There is associated narrowing of the neural foramina on the right side more than the left. There is encroachment of the right-sided exiting nerve roots present. There is effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At C5-6 there is loss of disc space height, disc desiccation and a disc bulge. There are some encroachment of the right-sided exiting nerve roots at this level. There is no significant compromise to the spinal canal at this level. Overall there is a mild degree of spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. There is mild narrowing of the spinal canal at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present cervical spine with encroachment of right-sided exiting nerve roots at C4-5 and C5-6 and mild to moderate spinal stenosis at C4-5..2.Exam is degraded due to patient motion which may obscure more subtle abnormalities especially if there are intrinsic abnormalities within the spinal cord.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with history of basal cell carcinoma of the nose status post resection and reconstruction. Assess for recurrence. Evidence of prior surgery and reconstruction is again seen along the left nasal alar and nasolabial fold. This includes some mild scarring and small lobules of fatty material. There has been no significant change in the appearance of this area when compared to the prior examination. No worrisome enhancement or nodular soft tissue thickening is demonstrated at the operative site.Also unchanged is a mild cutaneous deformity of the scalp of the left forehead. A tiny 3 mm dermal lesion along the left upper lip has not changed over several prior exams. No pathologic adenopathy is detected in the neck. Intracranially, a small chronic lacunar infarct is redemonstrated in the left caudate nucleus.

Output: Stable findings compatible with the history of tumor resection and reconstruction along the left nose. No evidence of tumor recurrence is seen. No pathologic adenopathy is detected in the neck.


Instruction: Generate impression based on findings.

Input: 32-year-old woman, 34 weeks gestation, with prior C-section, low-lying placenta, and concern for placenta accreta. PELVIS:UTERUS, ADNEXA: Gravid uterus. Low-lying placenta noted with placental tissue seen within 2.5 cm of the cervical os (801, image 24), consistent with grade I placenta previa. Additionally, the placental-myometrial junction is poorly seen anteriorly, appearance compatible with placenta increta. Intraplacental heterogeneous T2 signal and T2 hypointense bands are seen (series 801, image 29). The placenta closely abuts the ventral abdominal musculature particularly the right rectus abdominis muscle with obscuration of the expected intervening plane, appearance suspicious for placenta percreta. Prior C-section scar is noted.BLADDER: The bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.FETUS: No significant abnormality noted within the brain, spinal canal, kidneys, alimentary tract, or heart of the fetus.OTHER: No significant abnormality noted.

Output: 1.Findings of abnormal placentation/increta with possible placenta percreta of involving the ventral abdominal musculature as above. 2.Inferior edge of placenta located approximately 2.5 cm from the internal cervical os, consistent with placenta previa, grade I.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a CSF intensity collection within the thoracic spinal cord, mildly expansile in appearance, extending from the T5/6 level inferiorly through the T9/10 level, measuring a maximal 5 x 6 mm transverse dimension at the T7/8 level.There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. There are no stenoses.

Output: No interval change in the size of extent of syrinx within the thoracic spinal cord extending from the T5/6 level inferiorly through the T9/10 level.If agreed upon, future follow-up could be considered with a single thin section axial T2-weighted imaging through the levels of interest as an additional sequence to the usual whole-body MR screening exam, rather than a dedicated MRI of the thoracic spine if overall scan time is desired to be shortened and if deemed feasible by involved radiologists and clinicians.


Instruction: Generate impression based on findings.

Input: 82-year-old female with fevers, abdominal pain, transaminitis. History of cholecystectomy several years ago. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Multiple large filling defects within the common bile duct compatible with choledocholithiasis. No abnormal enhancement of the biliary system. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted. Splenule is present. PANCREAS: Pancreatic divisum is present. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple, hemorrhagic, and proteinaceous cyst. No abnormal enhancementRETROPERITONEUM, 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.Multiple large filling defects within the common bile duct compatible with choledocholithiasis. No convincing evidence of cholangitis. 2.Pancreatic divisum.


Instruction: Generate impression based on findings.

Input: Reason: Lat Meniscus Tear History: left knee pain / Lat Jt Line MENISCI: There is blunting of the posterior horn of the lateral meniscus likely representing a combination of degeneration, prior tearing, and postsurgical change from prior partial meniscectomy. No fluid-filled tear is evident. There is blunting of the posterior horn of the medial meniscus which also may represent prior tearing and postsurgical change from prior partial meniscectomy, appearing similar to the prior study. No fluid-filled or unstable tear is evident.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus which has progressed slightly when compared to the prior study. There is underlying subchondral signal abnormality and cyst formation likely degenerative in etiology. There is focal decreased signal abnormality affecting the articular cartilage along the posterior aspect of the lateral femoral condyle which may represent a full-thickness articular cartilage fissure. There is relative sparing of the patellofemoral articulation cartilage. There are small osteophytes affecting the lateral tibiofemoral compartment.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. The graft appears intact. The PCL appears intact. The MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact, although the distal fibers of the patellar tendon are obscured by metal susceptibility artifact related to the patient's ACL graft reconstruction.ADDITIONAL

Output: 1. Focal full-thickness articular cartilage degeneration along the lateral femoral condyle which has progressed slightly when compared to the prior study.2. Blunting of the posterior horn of the medial and lateral meniscus likely representing a combination of prior tearing, degeneration, and postsurgical changes from prior partial meniscectomy. No fluid-filled or unstable tear is evident.3. Mild osteoarthritis of the knee affecting the lateral tibiofemoral compartment.4. Postsurgical changes of ACL graft reconstruction. The graft appears intact.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact.BRAIN: Only post-contrast sequences of the brain were performed and again show encephalomalacia within the left cerebellar hemisphere as well as the left superior and middle cerebellar peduncles. There is no abnormal intracranial enhancement. Please see the prior MRI brain report for additional findings.SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at L2-L3. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable.

Output: 1.No evidence of abnormal enhancement on the limited post-contrast brain exam. 2.Readministration of a chronic appearing left cerebellar infarct. 3.Unremarkable spine MRI.


Instruction: Generate impression based on findings.

Input: Female, 11 years old, with papilledema. Evaluate for mass, tumor. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is detected.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation with no evidence of tumor, mass effect or other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Evaluate for middle ear lesion or brain tumor: right CN V2 paresthesias. The middle ear regions appear unremarkable bilaterally. The bilateral pterygopalatine fossae, foramina rotundum, cavernous sinuses, and Meckel caves appear to be intact. A venous structure abuts the superior aspect of the cisternal segment of the right trigeminal nerve. The cisternal portions of the trigeminal nerves otherwise appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is moderate mucosal thickening within the right maxillary sinus.

Output: 1. No evidence of intracranial or temporal bone mass lesions. 2. A venous structure abuts the superior aspect of the cisternal segment of the right trigeminal nerve without discernible impingement of the nerve. Thus, this likely represents an anatomic variant rather than a vascular loop syndrome of trigeminal neuralgia. 3. Findings suggestive of right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for collateral ligament injury History: lateral elbow pain LIGAMENTS: There is increased T2 signal in the region of the lateral collateral ligament with poor visualization of the fibers distal to their insertion on the lateral epicondyle, consistent with a complete tear. The ulnar collateral ligament is intact.TENDONS: There is increased T2 signal in the common extensor tendon near its insertion on the lateral epicondyle, likely representing a partial tear or focal tendinopathy. The common flexor tendon, biceps tendon, brachioradialis tendon, and triceps tendon are intact.ARTICULAR SURFACES AND BONE: The articular surfaces and bone marrow signal appear normal.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: 1. Findings consistent with complete tearing of the lateral collateral ligament.2. Partial tear or focal tendinopathy of the common extensor tendon near its insertion on the lateral epicondyle.


Instruction: Generate impression based on findings.

Input: Clinical question: CCM? why the cyst and hemosiderin ring. Signs and symptoms: Hand 3 chest. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates several punctate foci of flair hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres. Although the findings are nonspecific considering patient's stated age of 66 possibility of chronic microvascular ischemic changes should be considered. This finding is not associated with any hemorrhagic changes.There is a slight prominence of central cortical sulci for age. The signal intensity of brain parenchyma however remains reading normal otherwise on all MRI sequences.Post-enhanced images demonstrate normal abnormal enhancement the brain parenchyma, the meninges, calvarium or the orbits.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.Pre-and post-enhanced cervical MRI:Examination demonstrate a well demarcated T2/T2 stir hyperintensity intramedullary lesion measuring at 18 mm (cc) and 9 mm in (AP) centered at C6 level. The lesion results in expansion of the cord and significant effacement of subarachnoid space/spinal stenosis. There is subtle uniform enhancement of the lesion. There is extensive surrounding cord T2/T2 stir hypointensity consistent with hemosiderin deposition/staining. There is no evidence of T2 or flair hyperintensity surrounding the lesion to suggest cord edema or myomalacia. Constellation of findings are highly suggestive of a cavernoma.Examination in addition demonstrate extensive degenerative changes of cervical spine however maintained anatomical alignment.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild to moderate degenerative changes of the disk and the posterior elements. Additionally there is a prominent broad-based disk protrusion at this level. Constellation of findings of degenerative disease and larger disk protrusion results in mass effect, flattening and posterior displacement of the cord and moderate central spinal stenosis. There is inferior migration of disk fragment posterior to the body of C4 with associated mass effect and flattening deformity of the cord and central spinal stenosis as well. There is also moderate bilateral neural foraminal compromise. There is no convincing evidence of associated cord T2 hyperintensity at this level.C4 -- C5 mild disk disease and moderate bilateral facet hypertrophic changes and mild ligamentum flavum hypertrophy. There is a small broad-based disk protrusion also present at this level which results in flattening and posterior displacement of the cord and moderate central spinal stenosis. Moderate left and mild to moderate right neural foraminal compromise is present at this level.C5 -- C6 demonstrate degenerative changes with result in mild-to-moderate left and mild right neural foraminal compromise..C6 -- C7 demonstrate moderate bilateral ligamentum flavum hypertrophy and mild disk and facet disease. No spinal stenosis or neural foraminal compromise.C7 -- T1 is unremarkable with the exception of mild facet and ligamentum flavum hypertrophy.

Output: 1.Pre-and post-enhanced brain MRI demonstrates findings suggestive of mild chronic hemorrhagic small vessel ischemic strokes and unremarkable otherwise. Please see above comments.2.Pre-and post-enhanced MRI of the cervical spine demonstrate an intramedullary mass highly suggestive of a cavernoma measuring at 18 mm (cc) and 9 mm in AP with resultant expansion of the cord and central spinal stenosis as well as diffuse adjacent cord hemosiderin deposition/staining. Degenerative changes at C3 --C4 and a large disk protrusion at this level results in significant mass effect and flattening deformity of the cord and central spinal stenosis. There is inferior migration of disk fragment posterior to C4 level which also contributes to central spinal stenosis. Small central disk protrusion at C4 -- C5 results in moderate central spinal stenosis. Multilevel neural foraminal compromise of varying degrees (some significantly) as detailed per level.


Instruction: Generate impression based on findings.

Input: Ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: The anterior talofibular ligament is indistinct perhaps reflecting prior injury. The remaining ligamentous structures of the ankle appear intact.ARTICULAR SURFACES AND BONE: There is curvilinear low signal intensity within the head and dome of the talus compatible with avascular necrosis. There is adjacent edema within the head and neck of the talus presumably representing extension/progression of AVN. There is no articular surface collapse of the talus and the articular cartilage of the talar dome is intact.There is mild nonspecific marrow edema of the navicular. A subcentimeter collection of fluid is noted dorsal to the navicular which may represent a small ganglion. There is a small tibiotalar joint effusion with additional fluid extending medially and laterally from the talonavicular joint.ADDITIONAL

Output: Avascular necrosis of the talus with other findings described above.


Instruction: Generate impression based on findings.

Input: Left oral tongue cancer. There is an enhancing mass in the left lateral oral tongue that measures 12 x 25 mm in axial section and 21 mm in craniocaudal dimension. There is no gross mandibular or tongue base invasion. The cervical lymph nodes are not enlarged by size criteria, although left level 2A and 2B lymph nodes appear relatively prominent and heterogeneous. The thyroid and salivary glands are unremarkable. There are bilateral otomastoid effusions. The imaged intracranial structures and orbits are unremarkable. There is mild degenerative cervical spondylosis.

Output: 1. The left lateral oral tongue squamous cell carcinoma measures up to 25 mm.2. The cervical lymph nodes are not enlarged by size criteria, although left level 2A and 2B lymph nodes appear slightly prominent and heterogeneous, which may represent a reactive process or perhaps a small amount of metastatic disease.


Instruction: Generate impression based on findings.

Input: Limited MRI for pre-surgical planning. The ventricles and sulci are within normal limits. The medial temporal lobes are symmetric in size. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Limited brain fusion MRI for pre-surgical planning.


Instruction: Generate impression based on findings.

Input: 33-year-old female possible cavernous reformation Redemonstrated is a lesion within the left medulla associated with peripheral susceptibility effect and tiny central foci of T2 signal hyperintensity. It has not changed appreciably when compared to the previous exam.As before, there is a subcortical white matter punctate T2 and FLAIR signal hyperintense lesion in the right frontal lobe subcortical white matter and another similar lesion in the subcortical white matter along the anterior aspect of the right insular cortex, both change in appearance. In isolation these are of little clinical significance. They were present dating back to the 3/5/2001 comparison. There are no new similar appearing foci.Normal vascular flow voids are are demonstrated. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Stable hemorrhagic lesion located in the left half of the lower medulla most likely representing a cavernous reformation


Instruction: Generate impression based on findings.

Input: History of low-grade astrocytoma, status post craniotomy and chemotherapy. Off therapy for 10 years. There is again extensive susceptibility artifact along the left side of the head secondary to ventriculostomy catheters, which limits evaluation of surrounding structures. Left frontal approach ventriculostomy and additional occipital approach catheters are stable in position.There is no significant change in the configuration of the suprasellar region which is distorted including a lesion which is isointense to gray matter on T2 and hyperintense to surrounding CSF on FLAIR sequence images. This lesion measures up to 8 x 16 mm in maximum axial AP and transverse dimension which is stable within limits of technical differences (previously 10 x 16 mm). There is also an unchanged pattern of nodular enhancement associated with suprasellar structures and adjacent the optic chiasm. An index focus of enhancement near the anterior communicating artery is stable measuring 9 x 8 x 7 mm, previously 8 x 7 x7 mm. A focus of intraparenchymal enhancement closely associated with the deep aspect of a right frontal ventriculostomy tract is significantly decreased. Minimal leptomeningeal enhancement along the central sulcus is similar to prior.There is stable dysmorphic configuration of the basal cisterns, fourth ventricle and cerebral aqueduct. There are no new enhancing foci demonstrated. There is no new intracranial mass, hemorrhage or hydrocephalus.

Output: 1.No findings to suggest tumor progression. No significant change in nodular enhancement at the suprasellar cistern and cystic lesion at the level of the frontal horns. 2.Interval decrease in focus of enhancement associated with the deep aspect of a right frontal ventriculostomy tract.3.Unchanged dysmorphic appearance of the ventricular system and position of the ventriculostomy catheters. No hydrocephalus.


Instruction: Generate impression based on findings.

Input: Abdominal pain, transaminitis and hyperbilirubinemia, evaluate for stone or obstruction Submitted M.R.C.P. images markedly suboptimal.ABDOMEN:LIVER, BILIARY TRACT: Prominent liver, measuring 19 cm in craniocaudal dimension. Tiny nonenhancing right hepatic foci, most likely cysts. No intrahepatic or extrahepatic biliary duct dilatation. Patent portal veins, splenic vein and SMV. Mildly prominent gallbladder, measuring 3.5 cm, trace pericholecystic fluid. No intraluminal signal void to suggest underlying cholelithiasis. No significant gallbladder distention or wall thickening.SPLEEN: Splenomegaly, measures 18 cm in craniocaudal dimension. Splenules.PANCREAS: Intrinsic T1 signal of pancreatic body and tail minimally decreased compared to remainder of pancreas, nonspecific. Nondilated pancreatic duct, no adjacent inflammation seen. Homogeneous enhancement of pancreas. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal T2 hyperintense foci, most likely cysts. Trace perinephric edema. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly prominent mesenteric lymph nodes around level of root, measuring up to 10 mm, mild mesenteric fat haziness, may be seen in setting of mild mesenteric adenitis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anasarca.

Output: 1. Hepatosplenomegaly. No biliary duct dilatation. 2. Mildly prominent gallbladder, measuring 3.5 cm, trace pericholecystic fluid. No intraluminal signal void to suggest underlying cholelithiasis. No additional secondary signs of acute cholecystitis, no significant gallbladder distention or wall thickening.3. Mildly prominent mesenteric lymph nodes around level of root, measuring up to 10 mm with mesenteric fat haziness, may be seen in setting of mild mesenteric adenitis.


Instruction: Generate impression based on findings.

Input: Chronic sinusitis, chronic right mastoiditis, ear drainage, hearing loss, midline jaw cyst, with midline jaw pain. Neck: There is a incisive duct cyst that measures up to 26 mm. The adenoids, tonsils, and upper cervical lymph nodes are mildly prominent. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. There are small right maxillary sinus retention cysts. The orbits and imaged intracranial structures are unremarkable. Internal Auditory Canals: There are intrinsically T1 hyperintense secretions in the right mastoid air cells. There is also nonenhancing low T1 signal material that measures up to 10 mm in the right middle ear cavity with restricted diffusion. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The left mastoid air cells and middle ears also appear unremarkable.

Output: 1. Findings suggestive of cholesteatoma in the right middle ear amidst chronic otomastoiditis.2. Large incisive canal cyst.


Instruction: Generate impression based on findings.

Input: Seizure-like activity. Examination is limited by patient motion and extensive susceptibility artifact related to patient's braces. There is no evidence of intracranial mass or mass-effect. Visualized brain parenchyma demonstrates no obvious structural abnormality to suggest a seizure focus. Sulcation appears within normal limits. Myelination appears complete. Visualized midline structures including the corpus callosum are within normal limits. The ventricles are within normal limits. No extra-axial collections. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Examination is limited due to extensive artifact related to patient's braces and patient motion. Within these limitations, MRI of the brain is unremarkable. No intracranial mass or mass-effect is appreciated. No apparent structural abnormality to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: Female 72 years old Reason: Radiation planning (HDR brachytherapy). Pt is s/p external beam course History: None PELVIS:UTERUS, ADNEXA: Postsurgical changes from a hysterectomy and bilateral oophorectomy.The previously noted soft tissue mass within the upper vagina is no longer present. There is still some focal mass like enhancement within the area. Separation from the surrounding vaginal cuff is difficult. The asymmetric enhancing soft tissue measures approximately 1.9 x 0.9 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially enhancing soft tissue mass in the left iliac musculature abutting the left ilium measures at least 3.4 x 2.3 cm. Portions of the mass do not demonstrate central enhancement suggesting areas of necrosis.OTHER: No pelvic ascites.

Output: 1.Minimal soft tissue thickening in the left vaginal cuff which may represent residual disease.2.Solid soft tissue mass in the left iliac musculature (muscle biopsied and shown to represent metastatic carcinoma).


Instruction: Generate impression based on findings.

Input: 27-year-old with history of fibrocystic disease and left bloody nipple discharge from a single duct. Mother with history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts. Numerous high T2 cysts are present bilaterally. Marked parenchymal enhancement is noted bilaterally. This is a limitation to this exam. There is also motion artifact which limits the subtraction images. There is high T1 signal fluid in bilateral retroareolar ducts, most notable in multiple ducts near the left 12:00 position. Subtraction images are limited for evaluating ductal enhancement, but when comparing pre and post T1 images at the level of the duct fluid, the degree of high T1 signal appears largely stable. Numerous benign morphology masses are present bilaterally. The largest is the biopsy proven benign mass in the right upper outer breast which measures 1.2 x 0.9 x 1.4 cm. This mass has internal artifact from a biopsy clip. No morphologically suspicious mass is seen in either breast. This imaging and follow up were discussed for consensus opinion among three breast radiologists. No abnormal lymph nodes are identified in either axillary region.

Output: Limited MRI showing multiple bilateral benign morphology masses and extensive background enhancement. High signal fluid is seen within ducts bilaterally, left greater than right. Motion artifact limits the exam, but there is no definite suspicious ductal enhancement seen. A 6 month MRI follow up is recommended to evaluate the stability of the masses, and should be performed during the second week of her menstrual cycle to maximize the utility of the follow up study. Clinical correlation for her nipple discharge is also recommended.These results and recommendations were discussed with Dr. Jaskowiak. BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Foot and ankle pain Note that the exam is significantly limited by motion artifact.TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is lobulated high T2 signal intensity within the posterior portion of the tibiotalar joint. Otherwise he articular surfaces intact.ADDITIONAL

Output: 1. Mildly increased signal and atrophy of the plantar musculature which may reflect early myopathy.2. Probable ganglion cyst within the posterior tibiotalar joint.


Instruction: Generate impression based on findings.

Input: Status post CCM resection: left temporal seizures. There are postoperative findings related to left-sided craniotomy for left temporal lobe cavernous malformation resection. There is a small amount of hemorrhage within the resection cavity. In addition, there is a residual lesion with susceptibility effect and patchy enhancement in the left hippocampus that measures up to approximately 20 mm. There is vasogenic edema in the anterior temporal lobe, inferior left basal ganglia, and left cerebral peduncle, with mild uncal medialization. There is also perhaps mild acute ischemia along the surgical margins. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. There is diffuse left scalp fluid. The orbits are grossly unremarkable.

Output: Recent postoperative findings related to resection of a left temporal lobe cavernous malformation, with a small amount of hemorrhage in the surgical cavity and what appears to be a residual portion of cavernous malformation in the left hippocampus and surrounding vasogenic edema.


Instruction: Generate impression based on findings.

Input: Clinical question: mid thoracic painSigns and Symptoms: mid thoracic pain The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are hypoplastic ribs present at T12. There is mild disc desiccation in the mid thoracic spine which is also present on the prior exams and is unchanged Along the right posterior lateral aspect of the T10 vertebral body is redemonstration of a lesion which is bright on T2 and bright on T1 and measures approximately 18 mm in diameter. There are punctate foci within it. It can be identified on scans dating back to 2012. Most likely this represents a hemangioma.There are parapelvic cysts present in the right kidney and there is a small subcentimeter intraparenchymal cyst in the left kidney.

Output: 1.There are degenerative changes present in the thoracic spine of a mild degree without significant compromise to spinal canal or neural foramina.2.The vertebral body lesion - most likely representing a hemangioma - at T10 which is stable compared to prior exams


Instruction: Generate impression based on findings.

Input: 21-year-old female with Crohn's disease with abdominal pain and loose stools. Evaluate for active terminal ileitis. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. 8 mm hemangioma in the right hepatic lobe noted (series 5/11).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is narrowing of the terminal ileum over a length of approximately 4 cm with mild-to-moderate bowel wall thickening and increased enhancement, most compatible with active inflammatory bowel disease. There is mild upstream dilation of ileum proximal to the terminal ileum. Superior to the terminal ileum, there is mild enhancing phlegmonous change within the mesenteric fat without evidence of abscess or obvious fistula. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings most compatible with active inflammatory bowel disease involving the terminal ileum with adjacent phlegmonous change without abscess or obvious fistula.


Instruction: Generate impression based on findings.

Input: Clinical question: Trauma secondary to MVA. Findings and symptoms: Headache. Nonenhanced brain MRI:No diffusion weighted abnormalities.There is normal anatomical morphology of brain. There is normal signal intensity of brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses is within normal.Calvarium and soft tissues of the scalp are unremarkable.Orbits, paranasal sinuses and mastoid air cells are unremarkable.Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with mild straightening of cervical lordosis.There is no detectable posttraumatic soft tissue or bony abnormality of vertebral column.There is mild uniform smaller than expected caliber of the spinal canal and which is highly suspected of a congenital anatomical variation of short pedicle.Foramen magnum is unremarkable.C2 -- C3 is unremarkable. C3 -- C4 demonstrate mild disk desiccation and loss of disk height, mild bilateral ( R >L) uncovertebral hypertrophy and subtle volume disk. There is mild right neural foraminal compromise. Minimal degenerative changes at this level with congenitally smaller size of the spinal canal results in mild central spinal stenosis.C4 -- C5 demonstrate mild disk disease and loss of disk height, bilateral uncovertebral hypertrophic changes and mild bulging disk is noted. Findings results in mild bilateral neural foraminal compromise and central spinal stenosis.C5 -- C6 demonstrate mild disk disease and loss of disk height, bilateral ( R > L ) uncovertebral hypertrophy is also present. Constellation of findings is seen significant right and mild to moderate left neural foraminal compromise and moderate central spinal stenosis.C6 -- C7 demonstrate minimal disk disease, mild uncovertebral hypertrophy on the left. No spinal stenosis and mild left neural foraminal compromise is noted.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine and thoracic cord through T4 is unremarkable.

Output: 1.Unremarkable nonenhanced brain MRI.2.Nonenhanced cervical MRI demonstrate congenital anatomical variation of short pedicles/small canal. Mild degenerative changes at C3 -- C4, C4 -- C5 and C5 -- C6 levels with congenitally small canal results in mild to moderate central spinal stenosis and with neural foraminal compromise as detailed per level above. There is normal signal intensity and caliber of the cervical cord. There is no detectable posttraumatic changes of vertebral column for the perispinal soft tissues.


Instruction: Generate impression based on findings.

Input: Patient with lymphoma on intrathecal rituximab Thoracic: Cervical nerve root enhancement including the right C5 and left C8 nerve roots is better seen on earlier cervical MRI from 10/5/2016. There is abnormal enhancement involving the bilateral T1 and to a lesser degree T2 nerve roots which is stable to mildly decreased since 8/5/2016. Cervical and upper thoracic nerve root enhancement is particularly improved when compared to 3/8/2016 study.There also appears to be abnormal enhancement involving the multiple thoracic nerve roots in the mid and lower thoracic spine and not significantly changed since 8/5/2016. Exaggerated thoracic kyphosis is unchanged. Sagittal alignment is otherwise anatomic. Vertebral body heights are preserved. Scattered small Schmorl's nodes again seen. No suspicious osseous lesions. The visualized spinal cord shows normal signal intensity and morphology and is free of pathologic enhancement. No significant spinal canal or foraminal stenosis is seen. The right kidney is not visualized and the left is large, similar to prior.Lumbar: Vertebral body heights and alignment in the lumbar spine are normal. There are no suspicious osseous lesions. Edema and enhancement involving the left aspect of the L3 vertebral body is nonspecific and may be on a degenerative basis. Mild multilevel degenerative changes include small disc bulges throughout the lumbar spine without significant spinal canal stenosis. Small annular fissures are also present including the L3-L4 and L4-L5 levels. There is mild left L3-L4, mild right L4-L5, and mild bilateral L5-S1 neural foraminal stenosis. There is also mild to moderate multilevel facet arthropathy.There is no evidence of epidural tumor. There is diffusely increased enhancement and thickening involving the lumbar and partially imaged sacral nerve roots extraforaminally. There is also mild enhancement of the cauda equina nerve roots allowing for slight differences in technique. There is overall no significant change since 8/5/2016.

Output: No findings to suggest lymphoma progression in the thoracic or lumbar spine. Again seen is abnormal enhancement and thickening involving multiple thoracic and lumbar nerve roots extraforaminally as well as mild enhancement involving the cauda equina nerve roots. These findings are not significantly changed since 8/5/2016 allowing for slight differences in technique. No suspicious osseous lesions or epidural tumor.


Instruction: Generate impression based on findings.

Input: VHL and multiple hemangioblastomas. The evaluation for tumors is limited due to the lack of intravenous contrast. There are postoperative findings related to left transmastoid surgery with fat grafting, suboccipital craniotomy, as well as left enucleation with prosthesis. There are unchanged areas of confluent T2 hyperintensity in the bilateral cerebellar hemispheres with sulcal effacement. There is unchanged focal expansile T2 hyperintensity in the right cerebellar tonsil. There is also an unchanged focus of T2 hyperintensity in the left medulla. There are unchanged mild scattered foci of T2 hyperintensity in the cerebral white seen matter. There is a new fluid-fluid level within the right globe. The layering fluid measures up to 7 mm in thickness and is hypointense on T2 sequences and isointense on T1-weighted sequences, likely reflecting blood products. There is a right lens implant. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The paranasal sinuses are unremarkable.

Output: 1. Persistent signal abnormality in the bilateral cerebellar hemispheres and left medulla may represent edema related to residual hemangioblastomas, although the lack of intravenous contrast limits evaluation.2. No definite evidence of recurrent endolymphatic sac tumor, although the lack of intravenous contrast limits evaluation.3. New fluid-fluid level in the right globe, which likely represents vitreous hemorrhage, perhaps related to an underlying hemangioblastoma, although the lack of intravenous contrast limits evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Known uterine cervical carcinoma, sudden loss of rectal tone evaluated possible spinal cord invasion There is no evidence of acute cord compression.There is no evidence of abnormal cord signal intensity.Spinal canal stenosis, mild degree at the level of C5-6 likely due to focal disc bulging without evidence of spinal cord signal abnormality.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. The conus medullaris terminates at the level of L1-L2. The lumbar and thoracic intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation on this scan. Previously seen pelvic mass was partially seen.

Output: 1. Mild to minimal spinal canal stenosis at the level of C56 as described above. If clinically indicated, dedicated C spine MRI scan can be considered for further evaluation.2. No evidence of cord compression. Normal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: Incidental liver lesions noted on CT of the chest. ABDOMEN:LIVER, BILIARY TRACT: There are numerous T2 hyperintense lesions throughout the liver which demonstrate peripheral nodular discontinuous enhancement which progressively fills in centrally on delayed imaging compatible with multiple hemangiomas. The largest is in segment 3 dorsally partially exophytic measuring approximately 3.5 x 3.3 cm (series 6/25).The liver is otherwise normal in morphology and size. No suspicious liver lesion. No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: Numerous T2 weighted punctate hypointensities compatible with calcified granulomata seen on CT.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The liver lesions noted on CT correspond to multiple hemangiomata the largest of which measures up to 3.5 cm.


Instruction: Generate impression based on findings.

Input: 17-year-old female with knee pain swelling and instability status post fall. MENISCI: There is a vertical tear of the posterior horn of the lateral meniscus. The anterior horn of the lateral meniscus and medial meniscus are intact.ARTICULAR CARTILAGE AND BONE: Bone contusions are present in the lateral femoral condyle and lateral tibial plateau. There is no fracture and articular cartilage is intact. LIGAMENTS: There is complete disruption of the fibers of the anterior cruciate ligament. The posterior cruciate, medial collateral and lateral collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complete tear of the ACL with associated vertical tear of the posterior horn of the lateral meniscus ("wrisberg rip") and kissing bone contusions of the lateral femoral condyle and tibial plateau.


Instruction: Generate impression based on findings.

Input: Female, 29 years old, currently approximately 24 weeks gestational age, with cerebellar splaying noted on sonography. The inferior aspect of the cerebellar vermis appears hypoplastic or absent and the superior aspect of the vermis may be mildly upwardly rotated. This gives the appearance of a widened inferior fourth ventricular outflow tract. The cerebellar hemispheres may be slightly splayed laterally.The vestigial point of the fourth ventricle is vaguely discerned which is normal for gestational age. The cerebellar hemispheres appear subjectively normal in size and the transverse cerebellar diameter is also within normal limits for gestational age. The retrocerebellar CSF space may be slightly prominent. The posterior fossa itself is of normal size and the torcular is normally positioned.The brainstem is within normal limits. The cerebellar hemispheres demonstrate normal morphology for gestational age. The corpus callosum is present. The supratentorial ventricles are not dilated. No focal parenchymal lesions are suspected. No intracranial hemorrhage or any abnormal extra-axial collection is suspected.

Output: Relatively mild anomalous cerebellar morphology is seen including a hypoplastic or absent inferior vermis with slight upward vermian rotation. This gives the appearance of a widened inferior fourth ventricular outflow pathway.Findings are suggestive of partial vermian agenesis or a very mild manifestation of the Dandy-Walker continuum such as Blake pouch cyst. This appears to be an isolated anomaly as no other intracranial abnormalities are observed.


Instruction: Generate impression based on findings.

Input: Headache. Likely CVA. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or midline shift. Patchy areas of hypodensity in the right frontal, temporal, and parietal lobes suspicious for ischemia, likely embolic in nature. An MRI is recommended for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No intracranial hemorrhage. Findings concerning for ischemia, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right knee was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 20 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 37 seconds.

Output: Successful fluoroscopic guided right knee arthrogram.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with altered mental status, left neglect and right eye deviation. No evidence of restricted diffusion is seen. No edema, mass effect or pathologic intracranial enhancement is observed. A defect in the floor of the right middle cranial fossa allows passage of presumed meninges and perhaps a small amount of brain parenchyma through the sphenoid region into the posterior right nasal cavity. This cephalocele is fluid containing as on the prior exam. New fluid opacification of the left sphenoid sinus is seen even when compared to prior exams from 11/3. The fluid signal does suppress on FLAIR images. Evidence of endoscopic sinus surgery is redemonstrated.No evidence of intracranial hemorrhage is seen. Apart from the cephalocele, no additional abnormal extra-axial collections are detected. Ventricular size and morphology remain within normal limits.

Output: 1.No new or acute findings are seen which would account for the patient's symptoms.2.Findings are redemonstrated compatible with a cephalocele. Although this is a chronic finding, it could potentially represent a source of seizure activity if seizures are in the clinical differential.3.Relatively abrupt fluid opacification of the left sphenoid sinus is seen as this finding was not present on examinations from 11/03/16. The fluid signal suppresses on FLAIR images which suggests that its consistency is close to water. While this could simply be inflammatory in nature, the possibility of a CSF leak can't be considered as well.


Instruction: Generate impression based on findings.

Input: Reason: 29 female with recurrent pancreatitis and prior stricture. Now s/p stent removal and pancreatic duct sweep, please re-evaluate stricture History: abdominal pain. MRCP images are severely limited due to patient motion and technical factors. Postcontrast images are limited; patient had difficulty tolerating the examination immediately following contrast bolus administration, so postcontrast images were delayed. ABDOMEN:LIVER, BILIARY TRACT: Liver demonstrates normal parenchymal signal intensity. There is an unchanged subcentimeter T2 hyperintensity within hepatic segment 8 which likely represents a cyst. No suspicious focal hepatic lesions are identified.The gallbladder is nondilated and lacks wall thickening. No biliary duct dilatation. No evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: There is near complete resolution of the previously seen complex fluid collection centered at the pancreatic tail. There is decreased T1 signal, mildly increased T2 signal, and mildly decreased enhancement throughout much of the pancreas with preservation of relatively normal signal within portions of the pancreatic head. There is mild residual peripancreatic fat stranding, improving from prior. There is mild residual stricturing of the proximal pancreatic duct with mild dilation of the proximal pancreatic duct in the neck and body measuring up to 3 mm, improving from prior. There is mild dilation of the distal pancreatic duct in the tail up to 3 mm, increased from prior and which may reflect new stricturing.The splenic vein is poorly evaluated due to contrast bolus timing.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.Limited examination as described above. Patient will be recalled for repeat imaging. Within these limitations:2.Resolution of previously described peripancreatic fluid collection.3.Pancreatic signal abnormality sparing portions of the pancreatic head compatible with pancreatitis.4.Mild residual dilation of the proximal pancreatic duct likely related to stricturing, improving from prior.5.New mild dilation of the distal pancreatic duct, increased from prior, and which may reflect new stricturing.


Instruction: Generate impression based on findings.

Input: 28-year-old female with chronic but sharp pain at the first tarsometatarsal joint. No acute fractures identified. The first tarsometatarsal joint is unremarkable. There is a type II accessory navicular. Very minimally increased T2 signal is identified in the accessory fragment and primary navicular bone. Findings are consistent with minimal edema due to possible bone contusion.The Achilles, flexor, extensor, and peroneal tendons are unremarkable. The deltoid and talofibular ligaments are intact. The articular cartilage of the ankle joint is within normal limits. The sinus tarsi demonstrates normal appearance. No significant joint effusion is identified.

Output: 1.Type II accessory navicular with minimal bone marrow edema suggestive of contusion.2.No articular or soft tissue injury identified.


Instruction: Generate impression based on findings.

Input: Li Fraumeni Syndrome: surveillance. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is an 8 mm wide left temporomandibular joint synovial cyst.

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


Instruction: Generate impression based on findings.

Input: 57 year old with biopsy proven left breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is extensive malignant enhancement through much of the left lower inner quadrant, as well as a few additional enhancing areas in the left breast that enhance more than any area in the right breast. The biopsy proven index lesion is seen as an irregular enhancing mass with internal artifact from the Hydromark biopsy clip and measures 3.8 x 2.2 x 2.1 cm. Immediately inferior to the mass is an area of mixed non-mass and mass like enhancement measuring 4.1 x 3.4 x 0.9 cm. In total, these two areas measure up to 5.2 x 3.9 x 4.1 cm. Extending anterior to the index lesion is thin linear non-mass enhancement terminating in a 5 mm focus of enhancement that is located 0.9 cm from the nipple. With the inclusion of this finding, the AP extent of disease is up to 6.5 cm. Additionally, in the left upper outer breast, there is a 1.5 cm area of linear non-mass enhancement. As well, a 4 mm focus in the left lower outer quadrant at mid depth has mixed kinetics.No suspicious enhancement is seen in the right breast.No suspicious lymph nodes are identified in either axillary region.

Output: 1. Extensive abnormal enhancement in the left breast. The large area of conglomerate enhancement inclusive of the index lesion and adjacent non-mass enhancement and focus measures up to 6.5 cm in AP extent and extends within 0.9 cm of the nipple. 2. Findings in other quadrants of the left breast as detailed above may not require further work-up depending on surgical/treatment plans. 3. No suspicious axillary lymph node.4. No suspicious enhancement in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Johnsen is a 43 year old female with a strong family history of breast cancer including her mother (diagnosed at the age of 37) and maternal aunt (diagnosed in her 60's). She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.Stable enhancing mass identified in the left inferior breast, likely representing a fibroadenoma. No abnormal enhancement is seen in either breast. Scattered non-enhancing T2-hyperintense cysts are identified bilaterally, the largest of which measures approximately 1.1 cm in the left superior 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: 63-year-old female with pain. Evaluate for meniscal tear. MENISCI: There is increased signal abnormality and deformity of the posterior horn of the medial meniscus consistent with intrasubstance degeneration and complex degenerative tearing. There is, however, a focus of linear signal abnormality traversing the posterior horn, extending to the tibial articular surface, indicating a horizontal tear that extends to the body of the meniscus. There is a subcentimeter focus of fluid signal abnormality along the posterior aspect of the posterior horn of the medial meniscus indicating a parameniscal cyst. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration affecting the patellofemoral joint with areas of the lateral facet of the patella and femoral trochlea completely devoid of articular cartilage with underlying degenerative subchondral signal abnormality. There is subjective thinning of the articular cartilage of the medial and lateral compartments. There is a nonspecific focus of bone marrow signal abnormality within the proximal fibula which may reflect degenerative change. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Degeneration and tearing of the medial meniscus as described above.2. Osteoarthritis of the left knee with full-thickness articular cartilage degeneration most pronounced along the patellofemoral joint as described above.


Instruction: Generate impression based on findings.

Input: Dementia, cerebral atrophy, evaluate for progressive dementia. Diffuse cerebral parenchymal volume loss is again seen which has minimally progressed since 12/17/2010. Prominent CSF space the level of the parieto-occipital sulcus and calcarine fissure are again noted. No disproportional volume loss involving the hippocampi is appreciated. There is prominence of the ventricular system which is minimally larger compared to 12/17/2010. Again seen are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic changes and minimally progressed since 12/17/2010. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Major flow-voids are preserved.There is moderate mucosal thickening involving the bilateral maxillary sinuses and minimal thickening elsewhere. Bone marrow signal and extracranial soft tissues are within normal limits. Evidence of intraocular lens replacement bilaterally.

Output: 1. No intracranial mass or mass effect.2. Mild to moderate chronic small vessel ischemic changes have minimally progressed since 12/17/2010.3. Nonspecific pattern of diffuse cerebral parenchymal volume loss has minimally progressed since 12/17/2010, with relatively greater involvement of the bilateral frontal and parietal lobes and unchanged focal prominence of the CSF spaces at the parieto-occipital sulcus and calcarine fissure. Possible disproportional prominence of the ventricles for the degree of volume loss and aforementioned focal CSF spaces raises possibility of communicating hydrocephalus/NPH, in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Flexion contracture status post trigger release. Evaluate A2 pulley of right index and long fingers. The A2 pulley of the index finger appears intact. The flexor tendon apparatus of the index finger appears normal. The extensor tendon is difficult to visualize dorsal to the middle phalanx; however, its insertion on the middle and distal phalanges appear intact. Mild osteoarthritis affects the second metacarpophalangeal joint. Bone marrow signal intensity is normal.The A2 pulley of the middle finger appears intact. There is mild edema-type signal along the volar margin of the flexor tendon apparatus at the level of the third metacarpal head, which may reflect surgical changes of trigger finger release. The flexor digitorum superior superficialis and profundus tendons appear slightly thickened as they course of volar to the proximal phalanx suggesting tendinosis and perhaps mild interstitial tearing, but I see no frank tendon rupture. A small amount of fluid in the tendon sheath at this same location suggests a mild tenosynovitis. There is also a small amount of fluid in the soft tissues along the volar aspect of the A2 pulley, but again, the underlying pulley itself appears intact. The extensor tendon is difficult to visualize dorsal to the middle phalanx; however, its insertion on the bases of the distal and middle phalanges appear intact. Moderate osteoarthritis affects the third metacarpophalangeal joint with small cysts in the third metacarpal head and base of the third proximal phalanx. Bone marrow signal intensity is otherwise unremarkable.

Output: 1.Normal-appearing A2 pulleys of the index and middle fingers.2.Mild tendinosis and tenosynovitis of the flexor tendon apparatus of the middle finger.3.Osteoarthritis of the second and third MCP joints - a pattern that can be seen in patients with CPPD arthropathy.


Instruction: Generate impression based on findings.

Input: Compared to 12/10/2015, there is interval decrease in the size of some of the cystic components of the craniopharyngioma. The cystic component involving the left prepontine cistern demonstrates decrease in size from approximately 12 x 14 mm to 5 x 9 mm. There is improvement in mass effect on the left aspect of the pons. Previously seen fluid level within this component is no longer appreciated. In the right ambient cistern, a cystic component with T1 hyperintensity measures 10 x 10 mm which is overall not significantly changed in size however there is susceptibility effect and increased areas of T1 hyperintensity compatible with evolution of blood products and perhaps component of proteinaceous material. There is no new mass effect. There continues to be involvement of the prepontine, cerebellopontine angle, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. No enlarging enhancing component. Leftward displacement of the pons and contour deformity involving the right lateral aspect of the midbrain is not significantly changed. There is unchanged volume loss of the left cerebellar hemisphere associated with increased T2 signal, which may be attributable to crossed cerebellar diaschisis versus chronic injury. The basilar artery is tortuous and encased by the tumor. There is stable position of right transfrontal catheter with the tip in the right prepontine cyst. The ventricular system appears to be unchanged. There are foci of susceptibility effect within the right temporal lobe resection cavity, consistent with hemosiderin deposition, and within portions of the tumor particularly in the suprasellar cistern, which likely represent calcifications.

Output: Compared to 12/10/2015, there is further regression of some of the peripheral cystic components of the complex suprasellar and posterior fossa craniopharyngioma, particularly in the left prepontine region where there is associated improvement in mass effect.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with history of C6-7 disc replacement and worsening left upper extremity pain. Artifact from surgical instrumentation at C6-7 obscures the adjacent vertebral bodies and spinal canal.Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of edema, replacement or pathologic enhancement is seen. The visualized portions of the cervical spinal cord show normal signal characteristics and are likewise free of pathologic enhancement. No epidural collections are detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Minimal disc bulge. No spinal canal or foraminal stenosis. No interval changes. C5-6: The spinal canal is partially obscured by artifact, more so than on the prior exam. No definite foraminal narrowing is seen. C6-7: The spinal canal and parts of the neural foramina are obscured by artifact. The lateralmost aspects of the neural foramina are patent. C7-T1: Minimal central disc protrusion. No spinal canal or foraminal stenosis.

Output: Within the limitations of artifact related to the patient's orthopedic instrumentation, no definite new findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 21-year-old female with C2 -- C3 neurofibroma. Preplanning for surgical resection. Images through the skull base including cavernous sinuses are unremarkable. Calcific and atrophic right globe is noted. Paranasal sinuses and mastoid air cells are unremarkable.Images through the soft tissues of the neck demonstrate a very large non-enhancing mass on the right side of the neck measuring approximately 37 mm in transverse axials and 26-mm in AP axis (axial image 49). This mass extends into the right C3 -- C4 neural foramina with significant expansion and remodeling of the bone. There is also extension of mass into the vertebral body of C4 as well as C4 -- C5 neural foramina which also demonstrates significant expansion. There is suggestion of significant extension of mass into the spinal canal at C3 -- C4 and C4 there C5 the findings are consistent the patient's known neurofibroma. Multiple additional small nonenhancing masses consistent with patient's known neurofibromatosis is also noted. None of these lesions demonstrate any significant enhancement.These findings are better visualized on MRI examination of soft tissues of the neck.

Output: Findings consistent with neurofibromatosis as detailed above.


Instruction: Generate impression based on findings.

Input: 66 year old female with left sided headaches for one month. History of colon cancer, MET to the brain status post resection 2006. Stable extensive areas of encephalomalacia within bilateral cerebral hemispheres, left greater than right. There is also stable left craniotomy. There is no evidence of acute intracranial hemorrhage, mass, or abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial hemorrhage, mass, or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 49-year-old male with intermittent abdominal pain status post second renal transplant in November 2015. Patient now with persistent abdominal pain presents for evaluation of biliary etiology. Limited examination given that the patient was claustrophobic during the examination.ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Gallbladder is distended measuring up to 5.7 cm. Gallbladder sludge with gallbladder wall thickening and evidence of restricted diffusion. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Adrenal glands are normal in size and morphology bilaterally.KIDNEYS, URETERS: Atrophic native kidneys with numerous T2 hyperintense lesions most likely cysts; however, these are incompletely evaluated without contrast enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality.BONES, SOFT TISSUES: Incompletely visualized large retroperitoneal collections with intermediate T2 signal. The retroperitoneal collection measures up to 7 cm. The more lateral fluid collection measures up to 5.6 cm. Both collections demonstrate diffusion restriction but are incompletely evaluated on this limited examination.OTHER: No significant abnormality noted.

Output: Limited examination given patient claustrophobia and lack of contrast enhancement.1.Findings concerning for acute gallbladder infection.2.Incompletely visualized and incompletely characterized left retroperitoneal and iliac fossa fluid collections; these demonstrate restricted diffusion and raise suspicion for abscesses.Findings relayed to Dr. Concordia over the phone at approximately 10:08 AM.


Instruction: Generate impression based on findings.

Input: Male, 4 years old, with intracranial mass and ICH. Assess mass and postoperative changes. Brain:Sequelae of wide right sided craniectomy are again seen. A resection cavity is present along the right inferior temporal gyrus at least partially encompassing the previously seen area of focal cortical thickening and T2 hyperintensity. The resection cavity is hemosiderin stained and there is scattered susceptibility and T1 shortening within the adjacent parenchyma and sulci likely reflecting blood product from tumoral hemorrhage and related to surgery. Apart from blood product, there is probably also some irregular enhancement along the posterior margin of the resection cavityProgressive cortical thickening and T2 hyperintensity is seen within the right posterior cingulate gyrus, precuneus and lingual gyrus of the occipital lobe. These lesions show patchy associated enhancement which was not evident on the prior exam. Progressive cortical thickening and T2 hyperintensity without enhancement is seen involving the anterior right temporal lobe including the amygdala, the insula, and the perisylvian cortex. Relatively discrete foci of nonenhancing T2 hyperintensity are evident within the posterior right putamen, the right thalamus, right cerebral peduncle and left midbrain, new from the prior exam. Many of these described areas of cortical thickening and/or signal abnormality show mild associated restricted diffusion.Much of the mass effect seen on recent prior CTs has been relieved. There remains some degree of sulcal effacement in the right cerebral hemisphere and the right lateral ventricle is mildly effaced relative to the left. A very slight protrusion of the enhancing right lingual gyrus is seen across the tentorial incisure. The left lateral ventricle, third and fourth ventricles remain within normal limits.Spine:The visualized spinal cord, conus and cauda equina are within normal limits. No evidence of intramedullary or leptomeningeal enhancement is seen. The conus tip terminates at the T12-L1 level which is normal.A normal complement of vertebral bodies is present. Vertebral body morphology and signal characteristics are within normal limits. Spinal alignment is anatomic. No compromise of the spinal canal or neural foramina is suspected.Airspace opacity is seen at the lung bases bilaterally which may reflect atelectasis. Fluid is evident within the gallbladder fossa and there may be a small amount of gallbladder sludge layering dependently. The urinary bladder is distended with a catheter in place.

Output: 1.Sequelae of wide right-sided craniectomy are redemonstrated. Significant generalized cerebral mass effect seen on recent prior CTs has substantially improved.2.A resection cavity is evident along the right inferior temporal gyrus at least partially encompassing the region of cortical thickening and abnormal signal seen on the prior MRI. The resection cavity in the surrounding parenchyma and sulci show evidence of T1 shortening and hemosiderin staining compatible with residual tumoral and and procedure-related hemorrhage.3.Progressive cortical thickening, abnormal signal and patchy enhancement are now seen involving the right posterior cingulate gyrus, precuneus and lingual gyrus. These areas demonstrated less conspicuous abnormal signal and no enhancement on the prior examination.4.Also seen is progressive nonenhancing signal abnormality and cortical thickening involving the right anterior temporal lobe, insula and perisylvian cortex.5.Relatively discrete areas of new abnormal signal within the posterior right putamen, right thalamus, right cerebral peduncle and left midbrain are of uncertain significance. These could represent additional new sites of disease or they could perhaps reflect compressive or ischemic injury from the previously seen mass effect.6.Taken in total, the above findings likely reflect interval progression of high-grade tumor with multiple radiologically discontiguous sites of disease affecting the right cerebral hemisphere. As above, signal abnormality within the left midbrain is of uncertain significance at this point. No definite evidence of disease is seen within the left cerebral hemisphere or the cerebellum.7.Imaging of the spine reveals no evidence of leptomeningeal dissemination.8.Incidental findings include bilateral basilar airspace opacity which may reflect atelectasis, and fluid within the gallbladder fossa with mild layering gallbladder sludge.


Instruction: Generate impression based on findings.

Input: Abdominal and back pain. Evaluate for sacroiliitis. There is sclerosis along the sacroiliac joints bilaterally, predominantly involving the ilia. While this could represent osteitis condensans ilii, the sacroiliac joints do appear slightly narrowed, raising the possibility of a chronic sacroiliitis. These findings appear to have slightly progressed compared with the previous study. If further imaging is clinically warranted, MRI with and without contrast may be considered. An IUD is noted in the pelvis. A curvilinear metallic density overlying the right lower quadrant of the abdomen may represent a staple.

Output: Extensive sclerosis along the sacroiliac joints, which may represent osteitis condensans ilii, however the sacroiliac joints themselves appear slightly narrowed, suggesting chronic sacroiliitis. If clinically indicated, this can be further evaluated with MRI of the sacroiliac joints with and without contrast.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for hemorrhage. Signs and symptoms: Status-post grids in for seizure focus resection. Non-infused CT of brain:There is evidence of a large right temporal and frontal -- parietal craniotomy. Expected extra axial (epidural) air and fluid collection under the craniotomy flap is noted. There is overall increase mass effect in the right hemisphere with effacement of sulci and approximately 1 to 2-mm midline shift. There is evidence of a placement of epidural electrodes extending from the level of the floor of the right middle cranial fossa superiorly to above the level of lateral ventricles. Electrodes cover part of the right temporal lobe and extends superiorly into the parietal lobe. There is medial extension of electrodes which is best appreciated on axial image 11. The cortical sulci are not well visualized due to technique however I believe this component of electrodes are within the right sylvian fissure. There is no evidence of any parenchymal edema or hemorrhage. There is no evidence of ventriculomegaly. There is a focal area of CSF density within the expected level of right sylvian fissure noted on axial image 13. This corresponds with focal area widening of the sylvian fissure that was present on prior MRI examination. This is believed to represent a focal area of encephalomalacia of the operculum of right temporal lobe deep within the sylvian fissure. This is best appreciated on coronal T2 weighted images 15 through 17. No evidence of hemorrhage, edema, hydrocephalus is noted.

Output: 1.Expected postoperative changes of right craniotomy for placement of epidural electrodes over the right temporal and frontal lobes.2.Focal area of encephalomalacia believed to be within the operculum of right temporal lobe deep within the right sylvian fissure.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a tiny incidental right frontal developmental venous anomaly. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: Unremarkable MRI Brain/MRA head.


Instruction: Generate impression based on findings.

Input: 39-year-old male with severe foot cellulitis. Evaluate for osteomyelitis. TENDONS: There is circumferential fluid signal about the flexor hallucis longus and flexor digitorum tendons which may represent a tenosynovitis.ARTICULAR SURFACES AND BONE: There is increased signal abnormality on fluid sensitive sequences within the proximal and distal phalanx of the first digit/great toe of the right foot. There is no decreased T1 signal abnormality or enhancement on postcontrast sequences associated with this finding, which likely represents reactive osteitis. No evidence of cortical destruction or other findings to suggest osteomyelitis.ADDITIONAL

Output: Findings consistent with stated history of soft tissue ulceration along the plantar aspect of the great toe with extensive inflammatory change in the surrounding area, without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Recurrent pituitary adenoma, transsphenoidal resection, 6 month follow up. Pituitary: There are postoperative findings related to transsphenoidal surgery. There is an enhancing mass in the pituitary mass that encases the right cavernous carotid artery and extends into the suprasellar cistern, where there is mass effect upon the optic apparatus, which displays volume loss. The mass measures approximately 24 AP x 32 RL x 21 SI mm, previously 23 AP x 32 RL x 20 SI mm, and the tumor has gradually increased in size over the course of several years. The infundibulum is deviated to the left.Brain: There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged nonspecific mild cerebral white matter T2 hyperintensity. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged, including postoperative findings in the right parotid region.

Output: Gradual increase in size of the recurrent pituitary adenoma that encases the right cavernous carotid artery and extends into the suprasellar cistern, where there is mass effect upon the optic apparatus.


Instruction: Generate impression based on findings.

Input: acute ataxiamalaise and fatigueClinical question: strokeSquamous cell skin cancerHypertensionOpen wound of chest (wall), without mention of complicationAbdominal aneurysm without mention of rupture MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is a punctate lesion in the pons and one in the left thalamus which are high signal on the T2 and the FLAIR MRI sequences.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate focus of susceptibility effect in the right half of the pons.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The 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.

Output: 1.Periventricular and subcortical white matter changes of a mild to moderate degree and a small pontine lesion are nonspecific. At this age they are most likely vascular related. 2.An isolated old microhemorrhage in the right half of the pons is nonspecific.3.There is no evidence for intracranial aneurysm.4.No evidence for extracranial cerebrovascular occlusive disease5.No evidence for intracranial cerebrovascular occlusive disease


Instruction: Generate impression based on findings.

Input: Dizziness, hyperreflexia, and previous C4-C5 disc herniation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is fluid signal in the bilateral mastoid air cells, right more than left. There is a small secretion within the left posterior ethmoid sinus.Cervical Spine: There is a small posterior disc-osteophyte at C4-5 that mildly indents the spinal cord. There is a larger posterior disc-osteophyte complex at C5-6 that indents the spinal cord. There is no significant spinal canal stenosis at the other cervical levels and the spinal cord displays normal signal. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Posterior disc-osteophyte complexes at C4-5 and C5-6 with mild indentation upon the spinal cord.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. There is moderate loss of disc height at L3-L4 with endplate degenerative changes. There is severe loss of disc height at L4-5 and L5-S1 with endplate degenerative changes. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.T12-L1: No disc bulge, spinal canal and foraminal stenosis.L1-L2: Mild disc bulge with progression of right sided prominence, thickening of the ligamentum flavum and facet arthropathy, contributing to mild bilateral foraminal stenosis. No significant spinal canal stenosis.L2-L3: Disc bulge, thickening of the ligamentum flavum and facet arthropathy, contributing to moderate spinal canal stenosis and moderate bilateral foraminal stenosis. L3-L4: The previously seen left superior disc extrusion is significantly decreased in size. Disc bulge with progression of superimposed right foraminal disc protrusion, thickening of the ligamentum flavum and facet arthropathy, contributing to narrowing of the bilateral lateral recesses, moderate to severe spinal canal stenosis and severe bilateral foraminal stenosis. Again seen along the interspinous ligament is either fluid tracking back from a previous ruptured cyst versus other focal fluid.L4-L5: Disc bulge, thickening of the ligamentum flavum and facet arthropathy, contributing to moderate bilateral foraminal stenosis. No significant spinal canal stenosis.L5-S1: Disc bulge, thickening of the ligamentum flavum and facet arthropathy, contributing to severe right and moderate left foraminal stenosis. No significant spinal canal stenosis.

Output: 1. Interval significant decrease in left superior disc extrusion at L3-L4 with slight progression of right foraminal disc protrusion. 2. Otherwise, no significant interval change in degenerative lumbar spondylosis as described above, most prominent at L3-L4 with moderate to severe spinal canal stenosis and severe bilateral foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 19-year-old female patient with right knee pain, locking, clicking, and impaired flexion. Evaluate for meniscal tear. MENISCI: There is a small vertical tear of the posterior horn of the lateral meniscus (image 26, series 601). The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signals within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small vertical tear of the posterior horn of the lateral meniscus.