Instruction: Generate impression based on findings.

Input: New onset seizure. The ventricles and sulci are mildly prominent consistent with mild global parenchymal volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There is no evidence of restricted diffusion to suggest ischemic infarction. There is an area of FLAIR hyperintensity involving the right lateral temporal lobe predominantly involving the subcortical white matter of the right inferior temporal gyrus and to a lesser degree the right middle temporal gyrus. There is associated mild gyral expansion in this region. There is associated patchy enhancement as well as minimal associated susceptibility artifact suggesting possible blood products (although assessment for hemorrhage is limited). The brain parenchymal signal is otherwise within normal limits. There is no significant leptomeningeal enhancement or evidence of abscess. The major dural sinus venous sinus system appears grossly patent. 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. There is swelling involving the right frontal scalp consistent with recent trauma. The skull and paranasal sinuses appear grossly unremarkable.

Output: 1.Edema and enhancement involving the lateral aspect of the right temporal lobe which may be related to infection/encephalitis. Posttraumatic contusion seems less likely given presence of minimal if any blood products as well as degree of enhancement), Neoplasm is not excluded. Venous infarct seems much less likely. Lumbar puncture can be considered if infection is clinically suspected.2.Mild global parenchymal volume loss, prominent for age.3.Right frontal scalp swelling consistent with recent trauma.


Instruction: Generate impression based on findings.

Input: The hippocampi, parahippocampal gyri, and choroidal fissures appear normal. There is no mass, mass-effect, or structural abnormality identified. There is no susceptibility weighted abnormality to suggest hemorrhage or vascular anomaly. There is no diffusion abnormality to suspect acute stroke. The ventricles and sulci are within normal limits. The basal cisterns remain patent. No extra-axial fluid collections are identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are normal.

Output: Unremarkable MRI examination of the brain. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Left upper extremity numbness and pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small central disc protrusion is similar to prior. There is minimal narrowing of the spinal canal. Neural foramina are patent.C4-5: Disc osteophyte complex with left paracentral disc protrusion is mildly worse than prior and associated with indentation of the left aspect of the cord. There is mild to moderate degree of spinal canal stenosis at this level. Neural foramina are patent.C5-6: Small disc osteophyte complex including a left paracentral protrusion is minimally decreased in the interval. There is mild to moderate degree of spinal canal stenosis at this level. There is mild narrowing of the bilateral neural foramina. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.Small multiple bilateral perineural cysts incidentally noted. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Mild degenerative changes in the cervical spine as detailed above. There is a disc osteophyte complex at C4-C5 including a left paracentral disc protrusion which indents the left ventral aspect of the cord and mildly worse since prior cervical spine MRI from 12/24/2013. No cord signal abnormality. Disc protrusion at C5-C6 has slightly decreased in the interval.2. There is mild bilateral neural foraminal stenosis at C5-C6. No high-grade neural foraminal stenoses at any level.


Instruction: Generate impression based on findings.

Input: Male 4 years old Reason: assess bladder wall, evaluate for anatomical abnormalities History: bladder wall thickening on MRI BLADDER  Wall Thickness: Normal.  Contents: Small amount of debris is noted. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 8.2 cm Left: 8.9 cm   Mean for age: 7.5 cm  Range for age: 6.8 - 9.0 cmADDITIONAL OBSERVATIONS: Incidental note is made of ovoid hypoechoic urachal remnant at the midline anterior to the bladder.

Output: Small amount of debris is noted within the bladder. Otherwise normal exam.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on findings.

Input: Memory deterioration and history of breast cancer, evaluate for etiology. There is no evidence of acute ischemia. There are a few punctate foci of susceptibility effect in the bilateral cerebellum and right temporal occipital junction compatible with chronic microhemorrhages which may be related to chronic hypertension and/or amyloid angiopathy. There are extensive confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate to severe chronic small vessel ischemic disease and/or posttreatment-related changes.There is no abnormal parenchymal or leptomeningeal enhancement. There is mild age appropriate global parenchymal volume loss. There is no midline shift or herniation. No hydrocephalus. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening. There is mild mucosal thickening in the bilateral mastoid air cells. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Extensive T2/FLAIR signal abnormality in the periventricular and subcortical white matter which may represent advanced chronic small vessel ischemic disease and/or posttreatment-related changes (given history of chemotherapy).3. Global parenchymal volume loss which appears appropriate for patient's age.


Instruction: Generate impression based on findings.

Input: 48-year-old male with hyperreflexia. MRI brain:Within the left occipital cortex, there is a region of increased peripheral T2 signal and susceptibility with atrophy within this region. No associated diffusion restriction or enhancement. There is minimal ex vacuo dilatation of the adjacent left occipital horn. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Small chronic left corona radiata lacunar infarct is noted. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size. There is no midline shift or herniation. The major cerebral flow voids are intact. Rightward deviation of the nasal septum.MRI thoracic spine:Alignment is anatomic. Vertebral body heights and disc spaces are intact. No abnormal marrow signal. No abnormal signal within the cord. No significant spinal or neural foraminal stenosis. Small bilateral renal cysts.

Output: 1.Chronic encephalomalacia in the peripheral left occipital lobe with associated susceptibility is likely related to prior hemorrhage/trauma or other insult. Please correlate clinically.2.No significant abnormality in the thoracic spine.


Instruction: Generate impression based on findings.

Input: 38 year old female with a personal history of left breast lumpectomy in 2014 for IDC/DCIS followed by radiation and chemotherapy. Family history of breast cancer in mother and maternal aunt. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Fibroadenolipoma is again seen at medial retroareolar region in the right breast without significant changes.Post surgical scar is present in the medial left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is complex branching signal and abnormal morphology of the anterior horn of the lateral meniscus concerning for tear. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is increased marrow signal within the medial femoral condyle. A small amount of degenerative signal abnormality is seen within the tibial plateau underlying the lateral meniscus. The articular cartilage of the patellofemoral and medial compartment is intact. A full-thickness defect of the articular cartilage of the lateral femoral condyle is noted measuring approximately 1.5 cm in length. The articular cartilage of the remaining compartment is preserved. Small partial-thickness defects of the articular cartilage of the medial patellar facet are noted. Note is also made of a multipartite patella.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Abnormal signal within the anterior horn of the lateral meniscus which may reflect some tearing.2. Full-thickness cartilage defect of the medial femoral condyle superimposed upon mild diffuse thinning of the medial compartment.3. Edema within Hoffa's fat pad which may reflect a component of patellar impingement.4. Small marrow contusion of the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Sonography revealed an approximately 5 cm heterogeneously hypoechoic collection in the forefoot corresponding to the collection seen on recent MRI. A small skin incision was made along the dorsal aspect of the forefoot. A 16-gauge needle was advanced into the collection under sonographic guidance. Despite multiple repositionings of the needle tip within the collection, no frank fluid could be aspirated. A drop of dark red/brown fluid, having the appearance of old blood products, was aspirated, placed in anaerobic culture tube, and left at the ultrasound technologist workstation to be collected by a member of the clinical service.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: No pus was able to be aspirated from the forefoot collection. It is possible that this collection represents a chronic hematoma.


Instruction: Generate impression based on findings.

Input: 70 year-old female. Clinical question to be answered is stroke. Left arm and left leg numbness. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. This examination demonstrates no interval change since prior normal CT of brain from 5 -- 19 -- 2009. Follow up with an MRI is recommended considering the two consecutive negative CTs of brain and presenting clinical symptoms.

Output: Negative CT of brain and stable since prior study.


Instruction: Generate impression based on findings.

Input: 27-year-old male with elevated alkaline phosphatase, positive anti-smooth muscle antibody, and ulcerative colitis. Evaluate for primary sclerosing cholangitis. ABDOMEN:LIVER, BILIARY TRACT: Scattered areas of intrahepatic biliary ductal dilatation and stricturing. Subtle biliary ductal wall enhancement is noted on the postcontrast series. Focal stricturing is also seen about the Klatskin point. There is a short segment of smooth stricturing of the distal CBD (approximately 3 cm). No dominant hepatic mass is identified. Normal morphology of the liver.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: Subtle enhancement of the colonic mucosa compatible with the history of ulcerative colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Constellation of findings consistent with primary sclerosing cholangitis.2.No dominant hepatic lesion. No evidence of cirrhosis.3.Subtle enhancement of the colonic mucosa is compatible with the history of ulcerative colitis.


Instruction: Generate impression based on findings.

Input: Patient with right knee pain, evaluate osteochondrosis dissecans lesion. Per chart review, Patient had a repair in 2010 and had a recent injury. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: Again seen is a large osteochondral defect in the posterior aspect of the medial femoral condyle. The previously seen fragment within this defect has dislodged and now lies along the posterior rim of the medial tibial plateau. The fragment is just under 2 cm in its greatest dimension. There is cyst formation and edema within the marrow deep to the medial femoral condyle defect, which appears similar to that seen on the prior study. There is new edema within the marrow of the posterior aspect of the medial tibial condyle subjacent to the displaced osteochondral fragment.Also again seen is cyst formation within the anterior aspect of the medial femoral condyle with heterogeneity of the overlying cartilage that appears similar to that seen on the prior study, likely representing an additional osteochondral defect that we suspect is stable. There is also focal degeneration of the anterior aspect of the lateral femoral condyle with small cysts in the underlying marrow, unchanged from the prior study. Small tricompartmental osteophytes are noted.LIGAMENTS: Anterior cruciate ligament appears intact. The posterior cruciate ligament appears intact. The medial collateral ligament appears intact. The lateral collateral ligament appears intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Large osteochondral defect along the posterior aspect of the medial femoral condyle with displacement of the osteochondral fragment posterior to the medial tibial plateau and edema in the underlying posterior tibia. Additional loose bodies are noted both anteriorly and posteriorly within the joint.2.Osteochondral lesion along the anterior aspect of the distal femur appears similar as that seen on the prior study.


Instruction: Generate impression based on findings.

Input: History of stroke, left leg pain, and altered mental status. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered confluent and punctate cerebral white matter T2 hyperintensities, without restricted diffusion. In addition, there is encephalomalacia in the left parietal lobe and periventricular frontal lobe. There are few scattered foci of susceptibility effect in the periphery of the bilateral cerebral hemispheres. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is an apparent outpouching from the terminal right internal carotid artery that measures approximately up to 8 mm. There may also be a right middle cerebral artery outpouching. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter T1 and T2 hyperintense lesion in the right parietal bone, which may represent a hemangioma or lipoma.

Output: 1. No evidence of acute intracranial hemorrhage or acute infarction. 2. Chronic left parietal and frontal lobe watershed distribution infarcts and small vessel white matter disease.3. Scattered foci of susceptibility effect in a lobar distribution may represent amyloid angiopathy, for example.4. An apparent outpouching from the terminal right internal carotid artery that measures approximately 5 mm may represent an aneurysm. A possible right middle cerebral artery outpouching may represent partial volume artifact versus an aneurysm as well. Dedicated vascular imaging is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma with known brain metastasis treated with stereotactic RT. There is interval decrease in size of the left occipital lobe lesion, which now measures up to 10 mm, previously 19 mm. The lesion now contains intrinsic T1 hyperintensity and susceptibility effect, compatible with subacute blood products. There is no significant residual surrounding vasogenic edema or evidence of new intracranial tumors. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval decrease in size of the left occipital lobe metastasis containing subacute blood products, as well as interval resolution of the associated vasogenic edema.


Instruction: Generate impression based on findings.

Input: Left-sided hemiparesis. Evaluate for stroke. The patient was unable to hold still for the examination. Multiple sequences were repeated.Brain MRI without and with intravenous contrast:The right basal ganglia infarct is now associated with significant susceptibility effect indicating hemorrhagic conversion. There is surrounding diffusion restriction which involves the head of the right caudate nucleus as well as the right inferior and middle frontal gyri. There are other foci of diffusion restriction involving the right supramarginal gyrus as well. These are in the distribution of the middle cerebral arteries (including the lateral lenticulostriate arteries). There is minimal cortical diffusion restriction in the right occipital lobe along the semilunar sulcus. There are tiny foci of contrast enhancement along the inferior aspect of the infarct. There is also a tiny focus of contrast enhancement in the region of the supramarginal and occipital infarcts. The basal ganglia infarct and the associated hemorrhage result in mild to moderate mass effect compressing the frontal horn and body of the right lateral ventricle and causing mild midline shift. The overlying insula is also compressed as well as the underlying internal capsule and thalamus.. The hemorrhage does extend into the ventricular system with there is dependent blood in the occipital horns of the lateral ventricles. There is also mild dilatation of the remainder of the ventricular system compared to the previous examination. Mastoid air cells are clear. Paranasal sinuses are clear. There is a previous blowout fracture along the medial wall of left orbit associated with minimal enophthalmus. The orbits are otherwise normal.Cranial MRA without contrast:The right internal carotid artery is slightly smaller than the left but shows preserved flow. This likely congenital given the asymmetrically smaller right A1 segment. There is minimal irregularity of the right M1 segment, from which prominent lateral lenticulostriate arteries arise. The appearance might be reactive to the adjacent infarct/hemorrhage. The remainder of the middle cerebral arteries is normal. Associated with the above-described small right A1 segment, a well-developed anterior communicating artery provides preserved flow to the right A2 and more downstream segments of the right anterior cerebral artery. The posterior circulation is normal accounting for the basilar artery being dominantly supplied by the left vertebral artery. Neck MRA with contrast:The cervical common and internal carotid arteries show no significant luminal narrowing. There is focal attenuation of signal related to the right vertebral artery at its origin which may relate to artifact. The remainder of the right vertebral artery is smaller than the left which can be congenital or from ostial narrowing.

Output: 1.Hemorrhagic transformation of the right basal ganglia infarct with intraventricular extension of the hemorrhage. The infarct is associated with mass effect as described above.2.Contrast enhancement foci associated with a basal ganglia and cortical infarcts probably reflect their early subacute nature.3.Relatively unremarkable cranial MR angiography accounting for the infarct/hemorrhage reactive change along the right lateral lenticulostriate arteries.4.No significant cervical carotid stenoocclusive disease.Dr. Qandeel has discussed the hemorrhagic conversion of the infarct and the associated intraventricular hemorrhage with the neurology resident on service (Dr. Del Brutto Andrade) at noon on the day of the examination.


Instruction: Generate impression based on findings.

Input: 73 years, Male, mild cognitive complaints, memory decline. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. There is mild global parenchymal line loss, which is commensurate with patient's age. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Few scattered foci of susceptibility effect are noted including the left frontal lobe, left temporal lobe, and left cerebellar vermis compatible with chronic microhemorrhages and are in a nonspecific distribution. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Mildly prominent lymph nodes are again seen involving the occipital soft tissues as well as the left parotid gland and grossly similar to prior CT neck from 8/12/2014, allowing for differences in technique. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement.2. Mild chronic small vessel ischemic disease.3. Scattered foci of susceptibility effect compatible with chronic microhemorrhages. These are in a nonspecific distribution.4. Mild global parenchymal volume loss which appears appropriate for patient's age.5. No significant change in mildly prominent occipital and left parotid lymph nodes compared to prior CT neck allowing for differences in technique and may be related to patient's history of lymphoma.


Instruction: Generate impression based on findings.

Input: Left parapharyngeal tumor: asymmetry of left tonsil. There is a well-defined enhancing mass in the left poststyloid parapharyngeal space that measures up to approximately 4 cm in width and 5 cm in length. The mass mildly narrows and markedly displaces the left internal carotid artery anterolaterally and considerably compresses the left internal jugular vein. The other major cervical arteries are otherwise patent and there is a two vessel aortic arch. However, there is associated narrowing of the oropharyngeal airway. There is also an enhancing fusiform mass in the left mandibular body along the inferior alveolar nerve canal, which measures approximately 3 cm in length and 10 mm in width. There is no significant lymphadenopathy in the neck. The thyroid gland and salivary glands are intact. The orbits, skull, paranasal sinuses, and imaged intracranial structures are grossly unremarkable.

Output: 1. A left parapharyngeal space mass that measures up to 5 cm likely represents a peripheral nerve sheath tumor.2. Another mass in the left mandible likely represents a peripheral nerve sheath tumor.


Instruction: Generate impression based on findings.

Input: Again seen is a large right apical lung mass invading into the upper thoracic vertebra from T1 through T4. There also appears to be subtle involvement of the anterior superior aspect of the T5 vertebral body, sagittal post gadolinium image 5.The enhancing mass measures approximately 8.4 x 9.9 x 9.6 cm in the AP, transverse, and craniocaudal dimensions, and demonstrates areas of central necrosis. There is a pathologic fractures involving the T2 and T3 vertebral bodies with 60-70% height loss. There is mild associated posterior bulging of the cortex/osseous retropulsion of T2 and T3 as well as epidural tumor. There is near complete effacement of the CSF space in the thecal sac at the T2-T3 level with cord deformity. Subtle T2 hyperintensity in the thoracic cord is suspected at the T2-T3 levels.Epidural tumor is noted from the mid T1 to the lower T4 levels. Tumor obliterates the right T2-T3, T3-T4, and to a lesser degree T1-T2 neural foramina. There is infiltration of the right T2 and T3 pedicles, transverse processes, and lamina as well as the right T4 pedicle and transverse process. Also noted is invasion of the right upper thoracic ribs. There is evidence of left-sided pneumonectomy. No lesions elsewhere in the thoracic spine are appreciated.

Output: 1. Enhancing 8.4 x 9.9 x 9.6 centimeter mass involving the right lung apex with invasion into the thoracic spine from T1 to T5 as detailed above. There is epidural tumor from the mid T1 to the lower T4 levels. There is also involvement of the right T2-T3, T3-T4, and to a lesser degree T1-T2 neural foramina. There are pathologic compression fractures of T2 and T3 vertebral bodies with 60-70% height loss. There is moderate to severe spinal canal narrowing at T2-T3 level with deformity of the cord and suspected subtle cord signal abnormality.2. No additional lesions are seen elsewhere in the thoracic spine on the sagittal sequences. Please note comment in the technique section.


Instruction: Generate impression based on findings.

Input: Reason: cervical cancer; radiation planning - patient will have radiation device in place. PELVIS:UTERUS, ADNEXA: There is a faintly T2 hyperintense lesion that is anterior and left lateral to the endocervical canal. The lesion measures approximately 1.6 cm in the craniocaudal dimension by 1.1 cm in the AP dimension (series 501, image 25) by 2.0 cm in the transverse dimension, overall slightly decreased from 2 x 1.7 x 2 cm previously. The lesion again demonstrates increased contrast enhancement as well as left parametrial invasion. The bladder wall and bilateral ureters are preserved.BLADDER: Small amount of air within the bladder likely related to recent catheterization.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Sigmoid diverticulosis without evidence for acute diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis. Partially visualized infrarenal aortic aneurysm with mural plaque measuring up to 3.8 x 3.6 cm.

Output: 1.Anterolateral cervical lesion with left-sided parametrial invasion, lesion itself slightly decreased in size from 8/31/2016 (primarily in craniocaudal dimension; appearance similar to earlier study in axial plane).2.Partially imaged abdominal aortic aneurysm. If this has not been previously characterized, dedicated imaging can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: Ms. Wroblewski is a 54-year-old female with a personal history of left breast mastectomy in 2007 for IDC followed by chemotherapy and tamoxifen. Status post right breast lift and implant placement. Family history of breast cancer in maternal aunt, diagnosed at the age of 40. Recent diagnostic workup demonstrated waxing and waning fat necrosis of the reconstructed left breast. Status post left mastectomy with reconstruction. Retropectoral right saline implant is unchanged in position and contour.Heterogeneous dense breast parenchyma noted in the right breast.Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast or left reconstructed breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 16 year-old female with knee pain, evaluate for tear of the medial patellofemoral retinaculum MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is signal abnormality and surface fraying of the articular cartilage along the lateral patella facet. The patellofemoral and tibiofemoral articular cartilage are otherwise normal. No osteochondral defect.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: There is slight increased T2 signal abnormality within the lateral patellofemoral retinaculum at its attachment on the patella. No full thickness disruption of the patellofemoral retinaculum. Patellar alignment is within normal limits. The patella and quadriceps tendons are intact. ADDITIONAL

Output: 1. Signal abnormality within the lateral patellofemoral retinaculum at its attachment on the patella suggesting injury without full thickness disruption. Patella alignment is normal.2. Chondromalacia of the lateral patella facet without full thickness defect or OCD.3. Mild edema within the lateral aspect of the infra-patella fat pad may represent fat pad impingement.4. Intact menisci, cruciate and collateral ligaments.


Instruction: Generate impression based on findings.

Input: Left trap pain. Evaluate for stenosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal. There is mild uncovertebral hypertrophy with mild narrowing of the right neural foramen and minimal narrowing of the left neural foramen.C5-6: Left annular fissure and small left foraminal disc protrusion with minimal narrowing of the left neural foramen. Mild uncovertebral hypertrophy. No significant spinal canal or right neural foraminal stenosis.C6-7: There is a disc osteophyte complex including a left foraminal disc protrusion with moderate left-sided neural foraminal stenosis. Mild uncovertebral hypertrophy. There is mild effacement of the ventral thecal sac. No significant spinal canal or right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Mild nonspecific opacification of the bilateral mastoid air cells. Paraspinous soft tissue structures appear within normal limits.

Output: Mild multilevel degenerative changes in the cervical spine, relatively worse at the C5-C6 and C6-C7 levels. There is a disc osteophyte complex including a left foraminal disc protrusion at the C6-C7 level with associated moderate left neural foraminal stenosis. There may be associated impingement of the left C7 nerve root. Mild neural foraminal narrowing at right C4-C5 and left C5-C6 is also noted, as detailed above. There is mild effacement of the left ventral thecal sac at C5-C6 and C6-C7, without significant spinal canal stenosis overall at these levels or elsewhere in the cervical spine. No cervical cord signal abnormality.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Patient has a strong family history of breast cancer. Submitted for review are mammograms and targeted bilateral breast ultrasound dated 6/7/2016, bilateral ultrasound-guided breast core biopsies dated 7/5/2016, and breast MRI dated 7/20/2016 performed at St. Margaret Mercy . BILATERAL DIAGNOSTIC MAMMOGRAMS DATED 6/7/2016: Three standard views of both breasts, with additional left CC and MLO spot compression views, were obtained. The breast parenchyma is composed of scattered fibroglandular elements.Triangular marker overlying the left upper outer quadrant indicates location of palpable concern. There is an underlying isodense noncalcified mass with posteriorly indistinct margin measuring up to 3.9 cm.Within the right upper outer at posterior depth, there is a gently lobulated mainly circumscribed isodense mass measuring up to 2.5 cm. Additional smaller benign appearing masses are present in both breasts.No suspicious microcalcification or architectural distortion. Axillary lymph nodes appear normal bilaterally.BILATERAL BREAST ULTRASOUND DATED 6/7/2016:Targeted ultrasound of the left breast at the 1:00 position 8 cm from the nipple, in the area of palpable concern, reveals an oval heterogeneous predominantly hypoechoic mass measuring 4.8 x 1.6 x 4.6 cm. This mass presents mild-to-moderate internal vascularity.Additional smaller similar-appearing masses are present in the left breast, at 12:00, 2:00, 2:30, 3:00, and 9:00.Targeted ultrasound of the right breast at the 11:30 o'clock position 12 cm from the nipple presents a lobulated heterogeneous predominantly hypoechoic mass measuring 2.3 x 1.4 x 2.2 cm with internal vascularity.Additional smaller similar appearing masses are present in the right breast, specifically at 5:00, 12:00, and 11:00.BILATERAL US GUIDED CORE NEEDLE BIOPSIES DATED 7/5/2016:Ultrasound-guided biopsy of the largest mass within the right breast, at 11:30 12 cm from the nipple was performed with subsequent clip placement.Ultrasound-guided biopsy of the largest mass within the left breast, at the 1:00 position 8 cm from the nipple was performed with subsequent clip placement.Postprocedure mammogram demonstrates appropriate targeting. Percutaneously placed hydromark clip is located along the posterosuperior aspect of the biopsy cavity on the right side. Surgical pathology revealed complex fibroepithelial lesion, completed excision was recommended.Percutaneously placed butterfly clip is located along the superolateral biopsy cavity in the left side. Surgical pathology revealed fibrocystic changes including fibrosis and duct ectasia. This latter result was considered discordant with imaging findings, mainly due to presence of fibrosis, and surgical excision was recommended.BREAST MRI DATED 7/20/2016.A breast MRI was recommended prior to surgery to determine if any of the other masses detected on imaging should undergo biopsy. Heterogenous breast parenchyma noted in both breasts. There is moderate background parenchymal enhancement bilaterally.Within the right upper outer breast, at the 11:30 position approximately 9 cm from the nipple, there is a heterogeneously enhancing mass measuring 1.8 x 1.6 x 2.1 cm , with adjacent susceptibility artifact from postbiopsy clip along the posterior aspect of the mass. This finding corresponds to the site of biopsy-proven complex fibroepithelial lesion for which surgical excision was recommended.Within the right upper inner quadrant, there is a 0.7 cm oval enhancing mass with dark internal septations compatible with fibroadenoma. Smaller enhancing foci are identified throughout the right breast, demonstrating persistent kinetics.Within the left upper outer quadrant at the 1:00 position, approximately 5 cm from the nipple, there is a heterogeneously enhancing mass measuring 3.9 x 3.2 x 3.5 cm associated with susceptibility artifact from percutaneously placed biopsy clip along the lateral aspect of the mass. This finding corresponds to biopsy-proven fibrocystic changes, with fibrosis and duct ectasia for which surgical excision was recommended due to the past discordance. Other smaller benign appearing masses are visualized within the left breast with persistent kinetics, some with mammographic correlate.No suspicious lymphadenopathy.

Output: 1. Left 1:00 mass measuring up to 3.9 cm, for which surgical excision was recommended at outside hospital due to presence of fibrosis and consequent rad-path discordance. Histopathologic slides will be reviewed at the University of Chicago, and recommendations will be made once results are available.2. Right 11:30 mass measuring up to 2.1 cm, corresponding to complex fibroepithelial lesion for which surgical excision was recommended at outside hospital. Histopathologic slides will be reviewed at the University of Chicago, and recommendations will be made once results are available.3. Multiple bilateral circumscribed masses with persistent kinetics, are likely benign.4. Initial report suggested presence of nonmass enhancement in the left lower outer quadrant, for which MRI guided biopsy was recommended. On review of the study, findings are felt to most likely represent benign breast parenchyma. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: 56-year-old male with history of renal cell carcinoma. Evaluate for recurrence or metastases. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter benign cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes of left upper pole partial nephrectomy.Left mid pole T2 hypointense lesion with mild enhancement measuring 1.8 x 1.4 cm (image 34 series 3). Two additional T2 hypoattenuating lesions with mild contrast enhancement are seen in the left lower pole measuring 11 and 8 mm and are indeterminant.Right upper pole T2 hypoattenuating lesion has increased in size measuring 7 mm, previously 3 mm (image 22 of series 3). Right midpole complex cyst with enhancing septations measures 1.9 x 1.3 cm, previously 1.9 x 1.6 cm (image 21 of series 13).Additional benign-appearing cysts are present bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Left mid pole solid lesion concerning for papillary RCC, not significantly changed from prior. Additional smaller lesions in the left lower pole are indeterminant, but stable in size. 2. Interval increase in size of small right upper pole lesion which is too small to accurately characterize.3. Right sided complex cyst is stable in size and appearance.


Instruction: Generate impression based on findings.

Input: 39-year-old male. Low-grade MPNST of the right thigh s/p resection and adjuvant RT. Markers are placed along the medial aspect of the upper thigh, presumably denoting the site of the surgical scar. Bandlike signal abnormality traversing the subcutaneous fat between the two markers is consistent with a scar. There are foci of metallic susceptibility artifact along the peripheral deep fascia of the adductor musculature, reflecting prior surgery. A tiny focus of abnormal signal intensity and enhancement with the posterior aspect of the proximal muscle belly of the gracilis is less distinct than that seen on prior study and may reflect post-treatment change. We see no discrete mass to indicate tumor recurrence. The remaining musculature of the thigh is normal. The bone marrow signal intensity is normal.

Output: Post-operative changes, as described above, without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: There are postsurgical changes of thoracic spinal decompression and posterior spinal instrumentation. Screws are seen at the T7, T8, T11, and T12 levels as well as paraspinous rods extending from T7-T12. There is extensive susceptibility artifact related to the hardware which renders MR evaluation of these levels nondiagnostic. The spinal canal superior and inferior to these operated levels is patent.Limited evaluation of the cervical spine on the sagittal counting sequence demonstrates postsurgical changes of anterior cervical fusion at C5 to C6. There is mild anterolisthesis of C5 on C6. There is moderate spinal canal stenosis at this level. These findings were better assessed on recent MRI complete spine study dated 11/29/2015.

Output: Postsurgical changes of thoracic spinal canal decompression and instrumentation from T7 to T12. There is extensive susceptibility artifact related to the hardware which renders evaluation of these levels nondiagnostic. CT with contrast would be helpful for follow-up evaluation. If repeat MRI is considered, would suggest obtaining on a 1.5 Tesla scanner.


Instruction: Generate impression based on findings.

Input: Right lower extremity numbness and weakness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5, which appears worse. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position. Small perineural cyst is again incidentally noted involving the right T11-T12 neural foramen.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening. No significant spinal canal stenosis. Minimal bilateral neural foraminal narrowing.L4-L5: There is advanced bilateral facet arthropathy with fluid distending the facet joints similar to prior. Previously seen small synovial cyst projecting into the spinal canal on the right is no longer appreciated. There is grade 1 anterolisthesis which appears new since prior MRI. There is also ligamentum flavum thickening and mild disc bulge at this level, minimally worse. There is resulting moderate spinal canal stenosis including effacement of the lateral recesses, which has progressed since prior study from 9/19/2012. There is mild bilateral neural foraminal stenosis. L5-S1: There is bilateral facet arthropathy with tiny synovial cyst similar to prior. There is minimal disc bulge and ligamentum flavum thickening. No significant spinal canal or neural foraminal stenosis.

Output: Multilevel degenerative changes in the lumbar spine are again seen. Compared to 9/19/2012, there has been mild worsening of the moderate spinal canal stenosis at the L4-L5 level including effacement of the lateral recesses. There is grade 1 anterolisthesis at this level which appears new. There is mild bilateral L4-L5 neural foraminal stenosis. No high-grade neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Again seen is is atrophy of the left caudate with volume loss of the left thalamus and in the region of the left corona radiata, internal capsule and centrum semiovale. Left cerebral peduncle is smaller compared to the right slight with asymmetric atrophy of the left pons and left medulla, related to Wallerian degeneration. There is ex vacuo dilatation of the left lateral ventricle. FLAIR hyperintensity is demonstrated along the edges of the dilated left lateral ventricle, likely related to gliosis. The lateral wall of the left lateral ventricle is irregular. There is prominence of the rest of the ventricular system with the exception of the fourth ventricle. Blood degradation products better demonstrated previously along the left caudothalamic groove and lateral ventricular margin.Corpus callosum is thinned, but fully formed. There is normal myelination. Flow-voids are seen from major intracranial vascular structures.Dedicated images of the pituitary gland demonstrate absence of the normal T1 hyperintensity associated with the neurohypophysis. Visualized pituitary gland is otherwise within normal limits for age with homogeneous enhancement. No evidence of micro-or macroadenoma. Visualized optic apparatus is unremarkable. Septum pellucidum is present.

Output: 1. Compared to 2/25/2014, no significant change in atrophy in the left basal ganglia and left frontal lobe with ex vacuo dilatation of the left lateral ventricle. Findings are consistent with remote history of grade IV IVH.2. Absence of the T1 hyperintensity of the neurohypophysis (which was present on remote MRI studies from 2012), finding which can be seen in patients with central diabetes insipidus. MR appearance of the hypothalamus, infundibulum and pituitary gland is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: History of urethral cancer status post exenteration with Indiana pouch. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Fatty liver. The liver is normal morphology, size, and enhancement without a focal lesion or biliary ductal dilatation. The vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No suspicious renal lesion. Stable mild hydroureter with minimal wall thickening and enhancement without a focal lesion, not unexpected in the setting of urinary diversion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from Indiana pouch formation. No evidence of bowel obstruction or inflammation. No free fluid or loculated fluid collection.BONES, SOFT TISSUES: Multilevel degenerative changes of the lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post anterior pelvic exenteration.BLADDER: Status post anterior pelvic exenteration.LYMPH NODES: No enlarged pelvic lymphadenopathy. No free fluid or loculated fluid collection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Probable subchondral cyst in the left acetabulum, unchanged.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Contusion of the right knee. Evaluate for PCL tear. MENISCI: Menisci appear intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: There is mild increased signal throughout the ACL with minimal thickening suggesting questionable mild tendinopathy. Discrete intact fibers of the ACL are otherwise observed. Remaining cruciate and collateral ligaments are unremarkable.EXTENSOR MECHANISM: Extensive mechanism is intact.ADDITIONAL

Output: Mild increased signal throughout the ACL with minimal thickening suggesting questionable mild tendinopathy, however discrete intact fibers are otherwise observed.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral aneurysm, nonrupturedClinical question: view for hemorrhageSigns and Symptoms: s/p large vertebral aneurysm s/p embolization and clipping MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a 42x33x36mm sagittal dimension premedullary and prepontine mass (thrombosed aneurysm with coils distally and proximally) with heterogenous signal on T1 and T2 associated with flow voids. Much of the signal is hyperintense on T1WI.The brainstem is displaced and compressed posteriorly by the mass and drapes over the mass. The inferior aspect of the 4th ventricle is narrowed and the foramina of Luschka are distorted. There is mixed signal along the periphery of the mass on SWI phase imaging with some bright signal and some dark signal some of which is opposite in signal on the corresponding magnitude SWI images (suggesting peripheral calcification). The vertebral arteries and basilar artery are contiguous with this mass.A similar signal characteristic well-circumscribe mass is present in the left upper carotid space measuring 16x22xmm. It is stable compared to the prior exam.The temporal horns of the lateral ventricles are dilated. Overall there is mild enlargement of the third ventricle (10 mm width) and lateral ventricles (41mm biventricular diameter at the level of foramina of Monro).There are several supratentorial periventricular and subcortical white matter T2 and FLAIR hyperintense lesions without diffusion restriction.Normal vascular flow voids are present in 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 right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The patient is status post embolic coil occlusion of a 44x35x35mm giant vertebrobasilar aneurysm and occlusion of the LVA intracranially. Stents are present in the RVA across the origin of the aneurysm. There is a residual 2mm aneurysm at the more proximal RVA neck of the aneurysm extending superiorly. There is a 26x26x16 mm LICA cervical segment aneurysm redemonstrated which has a different opacification pattern on the current exam relative to the prior exam.The anterior communicating artery is identified. The posterior communicating arteries are identified. There is extracranial origin of the right PICA. The LVA is diminutive distally. The left PICA is not readily identified.

Output: 1.Status post stent assisted embolic coil occlusion of a vertebrobasilar junction giant aneurysm and embolic occlusion of the left vertebral artery (LVA) distal to the PICA. There is 2mm residual filling of the aneurysm at the neck of the RVA component of the aneurysm. The left PICA is not readily identified which may be a result of the field strength of the magnet. If there are referable clinical symptoms a CTA or conventional angiography may be useful.2.The overall dimensions of the aneurysm and the mass effect remain stable compared to the prior exam. The ventricles are stable.3.Stable size of LICA cervical segment dissecting aneurysm. Difference in filling pattern may be due to difference in field strength of the magnet. At some point a CTA or conventional angiography may be useful to further assess this.4.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Weakness, neck pain, evaluate for cord compression. There is an approximately 5.2 x 4.3 x 5.7 cm enhancing mass involving the posterior and right lateral elements of C3-C6. A portion of the mass extends into the epidural space and compresses the posterior cervical spinal cord. Anteriorly at C5-C6, the spinal cord is compressed against a large posterior disc osteophyte complex and there is high T2 signal in the spinal cord in this region. Additionally, there is a 4.0 x 4.4 x 7.1 cm mildly enhancing mass in the posterior mediastinum involving the esophagus. More inferiorly there appears to be a partially imaged mass and/or hiatal hernia. There is enhancement involving the C5 and C6 vertebral bodies. The thoracic spinal cord is unremarkable and there are no tumors in the thoracic or lumbar vertebrae. There is no spondylolisthesis or significant loss of vertebral body height. There are a few minimal posterior disc-osteophyte complexes in the thoracic spine and there is incompletely characterized degenerative spondylosis in the lower lumbar spine.

Output: 1. A large mass involving the posterior and right lateral elements of C3-C6 with epidural extension and associated compression of the spinal cord with edema in conjunction with a prominent disc-osteophyte complex at C5-6. The tumor appears to also involve the C5 and C6 vertebral bodies and may represent metastatic disease.2. A bulky mass involving the mid esophagus and posterior mediastinum, as well as partially imaged mass and/or hiatal hernia may represent the primary tumor and/or additional metastatic disease. Dedicated chest CT or PET may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical curvature, likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Posterior osteophyte disc complex indents the anterior cord surface. There is also bilateral uncinate hypertrophy. There is minimal central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex asymmetric to the left causes left anterior hemicord flattening. There is also bilateral uncinate hypertrophy. There is mild to moderate leftward central stenosis and mild bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex asymmetric to the left causes left anterior hemicord flattening. There is also bilateral uncinate hypertrophy. There is moderate leftward central stenosis, moderate to severe left neural foraminal, and mild right neural foraminal stenosis..C6/7: Posterior osteophyte disc complex causes anterior cord flattening. There is also bilateral uncinate hypertrophy. There is mild to moderate central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C3/4: Minimal central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.2.C4/5: Mild to moderate leftward central stenosis and mild bilateral neural foraminal stenosis.3.C5/6: Moderate leftward central stenosis, moderate to severe left neural foraminal, and mild right neural foraminal stenosis..4.C6/7: Mild to moderate central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.5.Multilevel cord flattening is present from C3/4 through C6/7 without convincing intrinsic cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Female 39 years old Reason: s/p crani History: eval for tumor.Additional history: Patient has undergone two resections of a left CP choroid plexus papilloma in 2009 and in 2011 via left suboccipital craniotomies. A third craniotomy and resection of residual tumor was performed 11/1/2016. Subsequently residual tumor is again seen and another resection was performed 11/7/2016. Postoperative findings related to recent left suboccipital craniectomy for resection of recurrent choroid plexus papilloma in the left posterior cranial fossa and cerebellopontine angle. Expected postoperative findings include scattered pneumocephalus and air-fluid levels in the resection cavity. The majority of the medial and lateral enhancing tissue in the cerebellopontine angle has been resected. There is thin enhancing tissue around the resection cavity, favored to be postsurgical. A more nodular focus located posteromedially in the resection cavity measures approximately 6 x 6 mm (series 13, image 10), which is non-specific. Again seen is extensive encephalomalacia in the left cerebellar hemisphere and middle left cerebellar peduncle. There is no evidence of acute intracranial hemorrhage or acute infarct. The lateral and third ventricles, as well as the basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Postsurgical changes related to recent left suboccipital craniectomy and resection of recurrent tumor in the left posterior cranial fossa and cerebellopontine angle. A majority of the abnormal enhancing tissue has been resected. A small amount of peripheral thin linear enhancement around the resection cavity is favored to be postsurgical in etiology. A more nodular focus of enhancement is non-specific. Attention to this area is suggested on follow-up studies.


Instruction: Generate impression based on findings.

Input: 12-year-old male with history of Crohn's. Evaluate for the presence of a perianal fistula or abscess. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No abnormal bowel wall thickening or enhancement.BONES, SOFT TISSUES: No evidence of perianal fistula or abscess. Soft tissues are normal with no inflammatory changes.OTHER: No free fluid in the pelvis.

Output: Normal exam with no evidence of perianal fistula or abscess.


Instruction: Generate impression based on findings.

Input: Limited examination secondary to motion artifact.There is marked dilatation of the lateral ventricles with a moderately dilated third ventricle and only a thin mantle of cerebral cortex, although distinct lobes are identified. A portion of the medial left posterior lateral ventricle herniates inferiorly into the posterior fossa along the medial margin of the left tentorium cerebelli. A thin septation or minimal debris is present in the inferior aspect of the left lateral ventricle extending towards midline (series 801, image 13). The fourth ventricle is normal in size. On available thin section parasagittal images, there is soft tissue fullness involving the tectal plate and the cerebral aqueduct is not well seen, concerning for obstruction.The thalami are present and appear unfused. The septum pellucidum is absent. The corpus callosum is not well assessed, but may be present perhaps significantly thinned by the enlarged ventricles. The intraorbital optic nerves are present and appear grossly unremarkable. The optic chiasm is suboptimally evaluated secondary to the diminished suprasellar cistern from the enlarged third ventricle, although is likely present as well. The pituitary gland is identified and appears within normal limits for age.No areas of diffusion restriction are seen to suggest acute or subacute ischemia. No areas of gradient susceptibility are demonstrated to suggest intracranial hemorrhage. The flow voids of the intracranial vasculature grossly unremarkable as well.Along the lower cervical cord, the sagittal T1W images of the brain appear to suggest trace T1 hypointensity centrally. The sagittal thin section images in the midline appear to suggest diminished caliber of the visualized upper thoracic cord, especially as compared to the cervical cord caliber.

Output: 1. Findings are most compatible with severe chronic hydrocephalus with concern for soft tissue prominence along the tectal plate, which may be obstructing the cerebral aqueduct. Further evaluation with CSF flow study and thin section sagittal midline 3D T2 images is recommended. Holoprosencephaly is considered unlikely given absence of fused thalami; septo-optic dysplasia is felt to be unlikely given that the pituitary gland is unremarkable and optic nerves are present. 2. Questioned trace syrinx in lower cervical cord and diminutive caliber of the upper thoracic cord, although incompletely evaluated. MRI of the cervical spine and thoracic spine recommended for a full evaluation.


Instruction: Generate impression based on findings.

Input: Chronic posterior thigh pain Five lumbar type vertebral bodies are presumed to be present. There is grade 1 anterolisthesis of L4 and L5. There is levocurvature of the lumbar spine as seen on prior radiograph. Vertebral body heights are within normal limits. Bone marrow signal is benign with small hemangiomas noted at L3 and L4. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Mild disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disk bulge, eccentric to the right. There is mild right and minimal left neural foramina narrowing. No significant spinal canal stenosis. Mild facet arthropathy.L4-L5: There is grade 1 anterolisthesis with disk uncovering and disk bulge. There is ligamentum flavum thickening and bilateral facet arthropathy. There is resulting moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.L5-S1: Disk bulge with minimal central protrusion component. There is bilateral facet arthropathy. There is minimal left and no significant right neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Mild degenerative changes at the sacroiliac joints are also noted. Perineural cyst along the left S2 nerve is incidentally noted.

Output: Degenerative changes in the lumbar spine with moderate spinal canal and moderate bilateral neural foraminal stenosis at L4-L5. There is grade 1 L4-L5 anterolisthesis likely on a degenerative basis.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, 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 left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 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: 41 seconds

Output: Successful left hip arthrogram.


Instruction: Generate impression based on findings.

Input: 31 year old man s/p microdiscectomy at L5-S1 and blood patch with persistent headache. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the normal lumbar lordosis, otherwise alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is a mild disc bulge without significant spinal canal or neural foraminal stenosis.L5-S1: There are postoperative findings of S1 left hemilaminectomy and L5/S1 partial discectomy. There is a 12 x 10 mm focus of disc extrusion which demonstrates high T2 signal suggesting a new left paracentral extruded fragment. There is thick peripheral enhancement surrounding this extruded fragment which is greater than the area of T2 signal abnormality, likely representing postoperative scar formation from recent discectomy. This protrusion causes effacement of the anterior thecal sac, left lateral recess, and compression of the left S1 nerve root.Additionally, there is a defect in the dura along the left posterolateral aspect of the spinal canal (series 6, image 42) with fluid extending through the epidural space and laminectomy into the left paraspinal muscles forming a well-defined 23 x 23 mm collection. There is circumferential CSF signal extending superiorly along the epidural space to the level of T12/L1 and extending inferiorly to S2. This epidural fluid causes mild mass effect on the anterior thecal sac. The paraspinal soft tissues are otherwise within normal limits.

Output: 1.Fluid extending from the left posterolateral aspect of the thecal sac at the surgical site through the laminectomy into the left paraspinal muscles and also circumferentially in the epidural space from T12/L1 level to S2. This finding is most compatible with postoperative CSF leak at the surgical site.2.New/recurrent left paracentral L5/S1 disc extrusion with resultant sinal stenosis, lateral recess compromise and impingement on the left S1 nerve root.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with pan right sided hemisensory loss. Symmetric T2 hyperintensity is evident within the bilateral globus pallidus. The central portion of this T2 hyperintensity suppresses on FLAIR images, but the rim remains hyperintense. Symmetric bilateral susceptibility effect is evident within the globus pallidus, but within normal limits for age.No discrete thalamic lesions are seen. Scattered small foci of T2 hyperintensity are evident within the bilateral cerebral white matter. These are nonspecific both in their morphology and distribution. No pathologic parenchymal or extra-axial enhancement is seen.No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricular system is normal in size and shape. Incidental note is made of a partially empty sella.

Output: 1.Bilateral T2 hyperintensity within the globus pallidus is seen with imaging findings suggesting chronic cavitation and minimal surrounding gliosis. The differential would include chronic injury from anoxia, toxic exposure (e.g. carbon dioxide, cyanide), and certain metabolic derangements. This may be an incidental finding unrelated to the patient's presenting symptoms.2.No evidence of any thalamic lesions or other specific abnormalities which would account for the patient's hemisensory deficits.3.No acute intracranial abnormalities are seen. Scattered nonspecific small white matter lesions are demonstrated which most commonly represent chronic microvascular ischemic disease though other etiologies including demyelination and sequelae of inflammation are also possible.


Instruction: Generate impression based on findings.

Input: Reason: eval for sesamoiditis History: medial sesamoid pain Note is made of a bipartite medial sesamoid bone of the first MTP joint, a normal anatomic variant. However, there is associated decreased signal abnormality within the medial sesamoid bones on all pulse sequences indicating sclerosis likely related to osteonecrosis. There is no increased signal abnormality and fluid sensitive sequences to suggest an acute sesamoiditis. The lateral sesamoid bone of the first MTP joint is normal in appearance. Otherwise no bone marrow signal abnormality is identified. The remainder of the imaged soft tissues of the foot are unremarkable. The flexor and extensor tendons appear intact.

Output: Findings suggestive of osteonecrosis of a bipartite medial sesamoid bone of the first MTP joint as described above.


Instruction: Generate impression based on findings.

Input: Reason: Synovial osteochondromatosis, evaluate for progression Again seen a lobulated mass occupying the anterior joint space and Hoffa's fat pad extending superiorly to the patellofemoral joint as well as posteriorly into the joint and semimembranosus gastrocnemius bursa. The mass appears to have increased in size since the prior exam, now occupying the majority of the joint space anteriorly with near-complete obliteration of Hoffa's fat pad. The mass extends along the posteromedial aspect of the proximal tibia, the pes anserine tendons, and the posterior aspect of the medial femoral condyle, similar to the prior exam. There has been an increase in size of the lesion along the tibiofemoral joint, with increased erosion of the fibular head. There is new erosion of the lateral, central, and medial tibial plateau as well as small erosions in the medial femoral condyle. The mass demonstrates abnormal increased heterogeneous signal intensity on the T2-weighted images, with peripheral nodular enhancement following gadolinium administration. Overall, these findings are consistent with progression of synovial chondromatosis.

Output: Widespread synovitis consistent with patient's known history of synovial chondromatosis, progressed since the prior exam with increased bone erosion and obliteration of the joint space.


Instruction: Generate impression based on findings.

Input: Minimal Chiari, large syrinx, and worsening pain in hands/fingers/legs /back. There are postoperative findings related to Chiari surgery. The cerebellar tonsils assume an unchanged configuration and morphology. There is intact cerebrospinal fluid flow across the foramen magnum. There is a persistent syrinx that involves the cervical and thoracic spinal cord, as well as the conus medullaris, measuring up to 6 mm in width. The tip of the conus medullaris is positioned at the T12-L1 level. 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. There are several small sacral perineural cysts. The paravertebral soft tissues are unchanged.

Output: Postoperative findings related to Chiari decompression with persistent extensive syringohydromyelia, but intact cerebrospinal fluid flow across the foramen magnum.


Instruction: Generate impression based on findings.

Input: 65 years Female (DOB:10/24/1950)Reason: patient with h/o cva, meningioma, here with worsening aphasia, want to r/o other acute strokes History: aphasiaPROVIDER/ATTENDING NAME: JOAN C MIEDEMA ANTON M CHIVU There is encephalomalacia involving the left parietal lobe as well as the adjacent left precentral gyrus, left superior temporal gyrus and adjacent left cuneus. There is associated ex vacuo effect along the left lateral ventricle. There is associated volume loss along the left cerebral peduncle and left pons. There is loss of volume of the left thalamus associated with T2 and FLAIR signal hyperintensity posteriorly and laterally.An extra-axial mass which insinuates itself into the left sylvian fissure measuring 20 x 24 mm axial dimensions.Punctate foci of T2 and FLAIR signal hyperintensity along the right cerebellar hemisphere.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is encephalomalacia involving the left parietal lobe as well as adjacent portions of the left frontal, temporal and occipital lobes. This associated with Wallerian degeneration.2.Left thalamic lesion likely is related to a prior vascular event.3.There is no evidence for acute ischemic cerebral infarction.4.Left middle cranial fossa extra-axial mass most likely represents a meningioma.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. Additional punctate lesions are present in the right cerebellar hemisphere which are also likely vascular related.


Instruction: Generate impression based on findings.

Input: 12-year-old girl with pineal abnormality, follow-up scan. There is artifact in the maxillofacial region, presumably possibly to braces, which limits evaluation of portions of the brain on some sequences. There is redemonstration of complex appearing multicystic lesion in the pineal region, with focal enhancement along the posterior aspect which may represent normal pineal tissue. The lesion again measures 9 mm transverse by 13 mm AP by 9 mm CC, essentially unchanged since baseline exam. There is again minimal if any flattening of the tectal plate; the cerebral aqueduct remains open. The brain parenchyma is grossly unremarkable within the limitations of artifact. The ventricles are normal in size and configuration.

Output: Stable mildly complex pineal cyst dating back to 3/2/2012.


Instruction: Generate impression based on findings.

Input: 54 year old female with altered mental status after craniotomy. Post-surgical changes related to bi-frontal craniotomy and and repair of right frontal encephalocele are seen, with pneumocephalus and subcutaneous emphysema consistent with recent procedure. Evidence of bilateral frontal sinus exenteration, with bone fragments and fluid present in expected locations of right and left frontal sinuses. Small amount of extra axial blood is seen in the surgical field overlying the anterior frontal lobes. Increased density overlying the anterior aspect of the superior sagittal sinus may represent blood, however, thrombosis of the sagittal sinus cannot be excluded (series 1, image 18). A small area of hypoattenuation in the right antero-inferior frontal lobe adjacent to surgical site is non-specific and may represent edema related to the surgery, however, focal infarction cannot be excluded.No evidence of intraparenchymal or subarachnoid hemorrhage. There is possibly a trace amount of subdural hemorrhage along the falx.There is crowding at the foramen of magnum related to cerebellar ectopia as seen on prior MRI.There is significant preseptal soft tissue swelling on the right, with associated mild infiltration of the extraconal and intraconal post-septal fat on the medial aspect of the right orbit as well as intraorbital gas superiorly. There is mild right proptosis and apparent stretching of the right optic nerve as well. The left preseptal and post septal soft tissues and intraorbital contents appear unremarkable. No evidence of mass or midline shift.Changes related to right ethmoidectomy and right maxillary antrostomy are seen, with persistent opacification of the partially visulized right maxillary sinus. There is persistent lateral deviation of the right maxillary sinus wall, with opacification and likely packing of the partially visualized right nasal cavity. The left maxillary sinus is partially opacified as well. Ethmoid air cells are opacified bilaterally. The mastoid air cells appear unremarkable. Sphenoid sinuses are partially opacified.

Output: 1.Postoperative changes in the anterior calvarium and floor of anterior cranial fossa, with a small amount of extra-axial blood in surgical field and expected pneumocephalus. There is a trace amount of subdural hemorrhage along the falx.2.Increased attenuation in area of anterior aspect of superior sagittal sinus is non-specific and can represent post-surgical changes or blood, however, dural venous sinus thrombosis cannot be excluded. Consider MRI braina and MRV for further evaluation if clinically indicated. 3.Hypoattenuation in antero-inferior aspect of right frontal lobe may be related to post-surgical edema, however, this is nonspecific and infarction in this location cannot be excluded. MRI may be helpful to further evaluate. 4.Soft tissue swelling in the right periorbital region, which also appears to involve post-septal soft tissues; this is concerning for orbital inflammation or infection. Follow-up is recommended; MRI with contrast may be helpful to further characterize.5.Postoperative changes in the right ethmoid air cells and partially visualized right maxillary sinus, with opacification of the maxillary sinuses, ethmoid air cells, and right nasal cavity.


Instruction: Generate impression based on findings.

Input: Starring spells. There is persist confluent T2 hyperintensity in the bilateral periventricular white matter. There is also paucity of cerebral white matter, particularly in the posterior cerebral hemispheres, as evidenced by the prominent trigones of the alteral ventricles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. There is no evidence of grey matter heterotopia. The hippocampi appear unremarkable. The corpus callosum is intact. The pituitary appears grossly unremarkable. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Stigmata of periventricular leukomalacia.


Instruction: Generate impression based on findings.

Input: Grade 2 astrocytoma, follow-up evaluation Postoperative changes are again seen from previous left frontal approach biopsy, with T2 hyperintensity and blood products along the biopsy tract. Previously biopsied left thalamic lesion overall measures 2.1 x 3.7 cm cm in greatest axial dimensions, not appreciably changed since prior exam with motion degradation on the FLAIR sequence slightly limiting current examination. There is minimal mass effect upon the third ventricle, unchanged. There is slight persistent T2/FLAIR signal abnormality in the anteromedial temporal lobe which is also not significantly changed. FLAIR hyperintensity involving the left posterior frontal corona radiata and centrum semiovale is not significantly changed since 1/13/2016 but increased since 10/16/2015, and favored to represent post treatment effect. Intrinsic T1 shortening involving the left thalamus is again noted. No suspicious enhancement is evident.The ventricles and cortical sulci are mildly prominent, unchanged. There are a few scattered and confluent cerebral white matter T2 hyperintense foci are nonspecific and similar to prior. The major cerebral flow voids are intact. There is minimal mucosal thickening in the maxillary sinuses.

Output: No findings to suggest progression of left thalamic and left anteromedial temporal lobe astrocytoma.


Instruction: Generate impression based on findings.

Input: Male 61 years old with HCV cirrhosis. Assess for HCC/suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There is no ascites. The hepatic vasculature is patent. Cholelithiasis within a normally distended gallbladder. No intra or extrahepatic biliary ductal dilatation.Again seen within segment 6 is a 6 mm mildly T2 hyperintense lesion with early arterial phase enhancement that persists on portal venous and delayed imaging (series 3, image 14). This is not significantly changed since the prior exam.Additional small arterial phase enhancing foci with no washout most likely represent perfusional anomalies and are not significantly changed.SPLEEN: Mild splenomegaly measuring 13 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged left lower pole simple renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology. The segment 6 lesion is stable in size with unchanged enhancement characteristics it may represent a hemangioma. No new suspicious lesion.


Instruction: Generate impression based on findings.

Input: Chronic low back pain without radiculopathy, status post weightlifting injury. Study is technically limited due to patient's body habitus. Five lumbar type vertebral bodies are presumed to be present. Lumbar vertebral body heights are within normal limits. Minimal anterior wedging at the T11 level may be physiologic or related to remote trauma. There is focal fatty endplate marrow signal changes involving the anterior inferior endplate of T11. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Individual levels, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation without herniation. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. There is developmental narrowing of the lumbar spinal canal without evidence of disc herniation or significant spinal canal or neural foraminal stenosis at any level. 2. Minimal anterior wedging involving the T11 vertebral body which may be physiologic or related to remote trauma. No vertebral body edema to suggest recent compression fracture. Mild degenerative endplate marrow signal changes involving the T11 inferior endplate are noted.3. Technically limited study due to patient's body habitus.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis or NMO: fatigue. Brain: There are multiple, grater than 10, scattered cerebral white matter T2 hyperintense lesions. Some of the lesions are also T1 hypointense. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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.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, aside from scattered areas of focal fat. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are small left renal cysts.

Output: 1. Findings suggestive of intracranial multiple sclerosis.2. No evidence of spinal cord lesions.


Instruction: Generate impression based on findings.

Input: The injected intra-articular contrast remains within the radiocarpal joint. No contrast is identified within the midcarpal joint or traversing the expected location of the scapholunate ligament to suggest a tear. There is perhaps slight widening of the scapholunate interval. No contrast is identified within the distal radioulnar joint to suggest disruption of the triangular fibrocartilage. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 49 seconds.

Output: Slight widening of the scapholunate interval, but contrast remains confined to the radiocarpal joint. Please refer to the subsequent MRI examination report for further information.


Instruction: Generate impression based on findings.

Input: Left biceps, triceps, deltoid weakness. Evaluate for cervical stenosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C3 on C4, C4 on C5, and C5 on C6. Alignment is otherwise maintained. Bone marrow signal is benign.Degenerative changes are seen in the cervical spine as described below:C2-3: Small disc osteophyte complex eccentric to the right and ligamentum flavum thickening. There is no significant spinal canal stenosis. There is mild right neural foraminal narrowing. Left neural foramen is patent. C3-4: Disc osteophyte complex and ligamentum flavum thickening contribute to moderate spinal canal stenosis. There is mild deformity of the cord. There is questionable T2 hyperintensity just below the level of the stenosis at the C4 level on the left on the STIR sequence and sagittal oblique T2 sequence but no definite cord signal abnormality. There is also moderate left and mild to moderate right neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. C4-5: Disc osteophyte complex and ligamentum flavum thickening result in mild to moderate spinal canal stenosis. There is severe right and moderate left neural foraminal stenosis. C5-6: Disc osteophyte complex and ligamentum flavum thickening are associated with mild spinal canal stenosis. There is severe right and mild to moderate left neural foraminal stenosis.C6-7: No significant spinal canal stenosis. There is moderate to severe right and mild to moderate left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal stenosis related to facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine. There is moderate spinal canal stenosis at the C3-C4 level with mild cord deformity. There is questionable associated subtle T2 signal involving the left lateral aspect of the cord at the C4 level, but no definite cord signal abnormality. There is also mild to moderate C4-C5 and mild C5-C6 spinal canal stenosis.2. Multilevel neural foraminal narrowing including moderate left C3-C4, severe right C4-C5 and C5-C6, and moderate to severe right C6-C7 neural foraminal stenoses. Additional levels as above.


Instruction: Generate impression based on findings.

Input: 40 year-old female with BRCA 2 positive, family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: The spinal abscess. Signs and symptoms: Acute lower back pain; fever. Pre-and post-enhanced MRI:Examination demonstrates increased T2/T2 stir signal intensity of disk space at L5 -- S1 level which is more pronounced anteriorly. There is moderate degenerative disk disease at this level with loss of disk height and with mild grade 1 anterolisthesis. There is enhancement of the intravertebral disk at this level corresponding to T2 hyperintense signal abnormality. This enhancement minimally expands into the prevertebral soft tissues anterior to disk. There is very subtle associated T2/T2 stir hyperintense endplate signal change with this finding however with questionable evidence of enhancement. Constellation of above findings are highly suspected for diskitis however without an abscess formation. The enhancement does not reach the dorsal aspect of the disk and there is no detectable extension into the spinal canal/epidural space. There is no evidence of central spinal stenosis at this level however moderate bilateral neural foraminal compromise secondary to degenerative changes are identified.Post enhanced images also demonstrate expected subtle enhancement of the hypertrophied changes of the facets and the ligamentum flavum in the lower lumbar spine. This appearance is an expected finding and not secondary to infectious process.T12 -- L1, L1 -- L2 and L2 -- L3 levels demonstrate degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy, no spinal stenosis or neural foraminal compromise.L4 -- 5 demonstrate moderate disk disease and loss of disk height, moderate to severe (right greater than left) facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. Degenerative changes at this level results in mild grade 1 anterolisthesis however without central spinal stenosis. Mild to moderate right neural foraminal compromise secondary to asymmetric right-sided facet hypertrophic changes is noted.

Output: 1.Increased T2/T2 stir signal intensity in the L5 -- S1 disk space with enhancement is suggestive of diskitis. Very subtle similar central changes of the adjacent endplates with enhancement is also noted. There is no evidence of prespinal soft tissue abscess formation or any detectable abnormal signal or enhancement in the spinal canal/epidural space to suggest an abscess. No central spinal stenosis.2.There is expected subtle enhancement of hypertrophied bilateral facets and ligamentum flavum in the lower lumber spine.3.Normal signal intensity and caliber of the cord, conus and the cauda equina without abnormal enhancement4.No evidence of central spinal stenosis at any level.5.Neuroforaminal compromise as detailed per level.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with multiple sclerosis, presenting with gait ataxia, follow-up for progression. Confluent periventricular T2 hyperintensity with corresponding moderate to marked T1 hypointensity is redemonstrated showing no significant interval change. The corpus callosum is diffusely involved and markedly thinned. Lesions are also evident within the basal ganglia, brainstem and cerebellum, also without significant interval change. No new lesions are seen. No evidence of parenchymal edema or mass effect is detected. Significant parenchymal volume loss is unchanged.

Output: Stable extensive white matter disease compatible with multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Personal history of LCIS and ALH, family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 77 years, Female, meningioma, evaluate for growth. Again seen is extra-axial enhancing mass in the right posterior fossa abutting the right sigmoid sinus, lateral cerebellar surface, and lateral aspect of the petrous temporal bone measures. Mass measures 19 x 20 x 18 mm in the AP transverse, and craniocaudal dimensions previously 18 x 18 x 18 mm. There is mild T2/FLAIR hyperintensity involving the right cerebellar hemisphere. Right transverse and sigmoid sinuses are widely patent. There is local mass effect on the adjacent cerebellar hemisphere without midline shift or herniation. Ventricles are normal in size without evidence of hydrocephalus.Remainder of the brain demonstrates multiple foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which is nonspecific but compatible with mild chronic small vessel ischemic changes. Brain parenchyma appears otherwise unremarkable for age. Calvarium and extracranial soft tissues are unremarkable.

Output: Enhancing right posterior fossa mass, which most likely represents a meningioma, measures minimally larger than on prior outside study from 5/6/2015. There is mild local mass effect on the adjacent right cerebellar hemisphere. There is mild parenchymal edema involving the right cerebellar hemisphere which is similar to prior.


Instruction: Generate impression based on findings.

Input: Assess for DAI s/p MVASpinal epidural and cervical spine fractures identified on CT. assess for associated injuries.Injury, other and unspecified, unspecified site MRI brain:Since the prior CT exam an intracranial pressure monitor has been removed.There is a subdural hematoma adjacent to the right tentorial leaf which is 1 or 2 mm in thickness. This extends adjacent to the right temporal, occipital and parietal lobes. This is stable compared to the previous exam.Multiple punctate foci of SWI signal loss are present in the frontal, parietal and temporal lobe subcortical white matterA small amount of subarachnoid space FLAIR signal hyperintensity is present along the high convexities of the parietal lobes and posterior aspect of the frontal lobes. This is most likely related to oxygen.There is redemonstration and no change in left-sided scalp soft tissue swelling The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 a left maxillary sinus opacity and scattered opacities and mucosal thickening in the ethmoid air cells. The visualized portions of the mastoid air cells demonstrate some fluid in the mastoid air cells. The patient is status post intubation. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment. The cervical spinal cord has normal signal characteristics and overall morphology. There is a compression fracture present at the C7 vertebral body involving the anterior and middle columns. There is approximately 20% loss of vertebral body height. There is very minimal posterior displacement of the left posterior aspect of the vertebral body.Findings suggest a 2 mm thick ventral epidural soft tissue mass eccentric towards the right side extending from the C5-6 disc space level to the T1-T2 disc space level. This is associated with minimal displacement of the thecal sac. The spinal fluid surrounding the spinal cord is not effaced. The size is unchanged since the prior exam.There is a nondisplaced fracture present along the right C3 inferior facet which extends into the right C3-4 facet joint.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is small relative to the left vertebral artery.Thoracic spine: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 is a right pleural effusion present.

Output: 1.There is a thin subdural hematoma present adjacent to the right tentorial leaf and right temporal, occipital and parietal lobes. This is stable compared to the prior CT exam.2.There are multiple microhemorrhages throughout the frontal, medial temporal lobes and parietal lobes which are compatible with hemorrhagic diffuse axonal injuries.3.There is scalp soft tissue swelling present.4.There is a compression fracture present at C7 with some mild retropulsion. This is stable compared to the prior exam but better visualized on CT.5.Findings are suspicious for a thin ventral epidural hematoma extending from C5 down to T1-T2. This is eccentric towards the right side and with. To involve more right-sided nerve roots and hemicord compared to the left. This is stable compared to the prior CT exam. There is no associated compression of the spinal cord appreciated. 6.There is a right-sided C3 facet fracture present with minimal displacement. This is stable compared to the prior exam but better visualized on CT.7.There is no evidence for thoracic spine fracture.8.Since the prior CT examination intracranial pressure monitor has been removed.9.There is a right pleural effusion present.