Instruction: Generate impression based on findings.

Input: 13-year-old male with history of edema/erythema of the ankle and limited range of motion. Evaluate for inflammatory changes, osteomyelitis. Femur:Limited evaluation of the femur/thigh was performed due to patient's intolerance of the exam length. Edema type signal intensity is seen circumferentially within the subcutaneous fat, extending from the right hip inferiorly beyond the femur. Small amounts of edema type signal intensity is seen within the distal thigh musculature. No soft tissue gas is seen. The femora are grossly normal in morphology and signal intensity. Small knee joint effusion partially visualized. Tib-fib:Edema type signal intensity is seen circumferentially within the subcutaneous fat about the right knee, and extends distally through the level of the ankle. Additionally, abnormal high T2 signal intensity is seen within the deeper musculature about the knee and calf. Some of this edema is confluent, layering between/within the fascial planes of the deep musculature of the thigh. No soft tissue gas is seen. Abnormal bone marrow signal intensity is seen within the tibia, particularly at the proximal and distal metaphyses. Abnormally high, heterogeneous T2 signal intensity within the proximal tibial metaphysis extends from the physis distally approximately 11 cm (series 14 image 13). Abnormal signal, heterogeneous T2 signal intensity within the distal tibia metaphysis extends from the distal physis proximally approximately 9.7 cm. An additional focus of abnormal high T2 signal intensity is seen within the right tibia diaphysis (14/15) and measures approximately 3.9 x 0.6 cm, which could represent an early abscess.Overlying the posterior medial distal tibia metaphysis (22/31 and 22/32) is a loculated fluid signal intensity collection which tracks centrally from the level of the distal tibial physis over an length of approximately 3.5 cm. These loculations measure 1.3 x 0.7 and 1.2 x 0.7 cm in the axial plane. Foot:Edema type signal intensity is noted within the subcutaneous soft tissues of the foot, particularly dorsally. Additional abnormal high signal intensity is seen within the deeper compartments of the foot as well, and some of this edema is confluent. No soft tissue gas is seen. Bone marrow signal intensity of the tarsals, metatarsals and toes is within normal limits.

Output: 1.Cellulitis of the right lower extremity as above.2.Deep fascial/muscular edema and fluid from the distal thigh through the foot, suggesting fasciitis particularly in the appropriate clinical setting.3.Abnormal bone marrow signal intensity of the tibia as above, suggesting osteomyelitis.4.Small loculated fluid collection adjacent to the distal posterior medial tibia metaphysis likely to represent subperiosteal abscess. The abnormal signal within the mid diaphysis of the tibia may represent developing abscess. These findings were discussed with Dr. Bielski at the time of dictation.


Instruction: Generate impression based on findings.

Input: Several sequences are mildly limited by motion.BRAIN: Encephalomalacia involving the inferior aspect of the right cerebellar hemisphere is compatible with a chronic PICA territory stroke and appears similar to prior. No restricted diffusion to suggest acute ischemic infarction.There is no evidence of intracranial hemorrhage or mass. Several scattered foci of abnormal T2/FLAIR hyperintensity within the basal ganglia, periventricular and subcortical white matter, and cerebellum are nonspecific and likely age related. A prominent perivascular space is present along the right anterior commissure. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The posterior communicating arteries are small in caliber. There is a short segment of mild narrowing involving the right V4 segment just proximal to the basilar artery. There is a short segment of mild narrowing of the inferior aspect of the basilar artery. The posterior cerebral arteries are normal in course caliber. No aneurysms are detected.

Output: 1.Chronic right cerebellar infarct, not significantly changed compared to prior CT scan. 2.No evidence of acute ischemic cerebral infarction or hemorrhage. 3.Mild short segment narrowing involving the right intracranial vertebral and basilar arteries. No intracranial aneurysms detected.


Instruction: Generate impression based on findings.

Input: 18 day old male with history of hemorrhagic liver mass. ABDOMEN:LIVER, BILIARY TRACT: Previously seen right posterior hepatic intraparenchymal heterogeneously T2 hyperintense lesion (501/13) measures 1.5 x 2.5 x 2.1 cm, decreased in size from the previous measurement of 4.3 x 4.2 x 2.9 cm. Thin rim of peripheral enhancement about this lesion is noted, without significant internal enhancement on early or delayed images. There no significant biliary dilation or other hepatic abnormality.SPLEEN: The spleen is within normal limits.PANCREAS: No appreciable pancreatic abnormality.ADRENAL GLANDS: The adrenal glands are within normal limits.KIDNEYS, URETERS: No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild bibasilar pulmonary atelectasis. Mild abdominal ascites.

Output: Interval decrease in size of the previously seen hemorrhagic right hepatic lesion as above. Continued follow-up to resolution is advised.


Instruction: Generate impression based on findings.

Input: Secondary glioblastoma. There are post-surgical findings related to left frontal craniotomy. There is a heterogeneous, infiltrative mass surrounding the resection cavity and involving portions of the left inferior frontal lobe, insula, basal ganglia, and medial temporal lobe. There is unchanged nodular enhancement in the tumor along the inferolateral aspect of the left frontal lobe. However, there are new foci of enhancement within the portion of the tumor occupying the left basal ganglia. The otherwise non-enhancing infiltrative T2 hyperintense portions of the tumor have not significantly changed in size since the prior exam. There is no evidence of acute infarct. The ventricles are essentially unchanged in size and configuration. There is persistent subgaleal fluid overlying the craniotomy site, measuring up to 10 mm in thickness.

Output: New foci of enhancement within the tumor in the left basal ganglia region, which may represent tumor progression versus treatment effects. Otherwise, the overall size of the tumor is not significantly changed.


Instruction: Generate impression based on findings.

Input: Reason: evaluate if lymphoma causing lower extremity weakness History: LE weakness, numbness The thoracic vertebral bodies are appropriate in the overall alignment. There is an infiltrating mass present in the left perivertebral space extending from approximately T6 down to T8 which infiltrates from the left pleural space and to the left perivertebral space through the left T6-7, T7-8 and T8-9 neural foramina into the spinal canal and into the epidural space where it surrounds and encases the thecal sac and effaces spinal fluid surrounding the spinal cord. Spinal cord is displaced toward the right and deformed at this level. There is associated infiltration into the adjacent osseous structures along the left pedicles and posterior elements of T7 and T8 as well as the left posterior inferior aspect of the T6 vertebral body and the left posterior lateral aspect of the T7 and T8 vertebral bodies.There is a right sided pleural effusion and pleural thickening present. This extends along the right lung apex and through the adjacent ribs.Visualized portions of the thyroid gland appear enlargedNew marrow replacing lesions are present within the thoracic spine at T2 and T4.There is a mild compression fracture present at L1.Findings suggest a hiatal hernia .

Output: 1.There is an infiltrating left paraspinous mass present extending from T6 through T8 which infiltrated into the T6, T7 and T8 vertebrae and extends through the neural foramina into the spinal canal where it encases the thecal sac and compresses and displaces the spinal cord. It is suspicious for metastatic disease.2.Osseous-based lesions are present at T2 and T4 are consistent with metastatic disease.3.There is a right-sided pleural-based thickening present which extends to through adjacent ribs especially at the right lung apex. Please refer to CT of the soft tissues of the neck and chest from 1/ 8/15 for further comments.4.There is a mild compression fracture present at L1.5.There is thyromegaly present6.There is a hiatal hernia present7.Findings were discussed with the clinical service.


Instruction: Generate impression based on findings.

Input: 12-year-old male with suspected glomulovenous malformation of the right knee. MENISCI AND LIGAMENTS: The menisci are intact. The ACL, PCL, MCL, and lateral collateral complex are intact.BONE AND MARROW: No significant abnormality noted.SYNOVIUM: The synovium is normal in appearance.MUSCULATURE: Musculature is normal and does not appear to be involved by the venous malformation.ADDITIONAL

Output: Serpiginous enhancing vascular malformation along the lateral aspect of the knee is contained within the subcutaneous tissues and does not connect with the deep venous system.


Instruction: Generate impression based on findings.

Input: Reason: assess for rotator cuff tear History: left shoulder pain. ROTATOR CUFF: The supraspinatus tendon and muscle appear normal. The infraspinatus tendon and muscle appear normal. The teres minor tendon and muscle appear normal. There is mild increased signal intensity within the distal fibers of the subscapularis tendon, which may reflect insertional tendinosis, but the muscle appears normal.SUPRASPINATUS OUTLET: There is minimal inferior spurring of the acromion process and perhaps minimal impression upon the superior fibers of the supraspinatus tendon of questionable significance. No fluid is present within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: No joint effusion. There is attenuation of the anterior superior labrum, but this may not be of any clinical significance. Otherwise, given the limitations of a non-arthrographic study, the glenoid labrum is unremarkable. Glenohumeral joint alignment is normal. The articular cartilage is within normal limits.BICEPS TENDON: Given the limitations of a non-arthrographic study, the tendon of the long head of the biceps appears normal.ADDITIONAL

Output: 1.Possible mild insertional tendinosis of the subscapularis tendon, but we see no discrete rotator cuff tear.2.Subjectively, the anterior inferior capsular structures appear slightly thickened, but clinical significance of this is uncertain.3.Minimal spurring of the inferior aspect of the acromion process and perhaps minimal impression upon the superior fibers of the supraspinatus tendon of questionable significance.


Instruction: Generate impression based on findings.

Input: Clinical question: glioblastoma compare to last MRI and measure with bidimensional measurements mass in left operculum. Signs and Symptoms: post 2 cycles of therapy. Pre and post enhanced brain MRI:Examination demonstrates interval progression of disease since prior study.A left frontal peritoneum enhancing/necrotic GBM demonstrate interval increased size and measuring at 37 x 44 mm in transaxial dimensions compared to prior study measurements of 27 x 33 mm. There is also interval increase in surrounding vasogenic edema and regional mass effect.Previously seen post operative changes of left parietal region is again identified. There is interval better visualization of the surgical cavity and with extensive residual post operative blood products. There is also interval increased size of finding at this site since prior exam with increased surrounding edema. There is change in the pattern of enhancement at this site which now is more conspicuous in the surgical cavity wall and appears thick, irregular and nodular. Constellation of changes at this site is highly suspected of residual or recurrence of tumor. Closer follow-up is recommended.

Output: 1.Interval increased size and edema with region mass effect of a left frontal operculum tumor as detailed/measured above.2.Postoperative changes in the left posterior parietal demonstrate interval change concerning for recurrence and or residual tumor in the surgical bed as detailed above.3.Constellation of above changes results in regional mass effect in the left hemisphere without mass effect on the ventricular system or deviation of midline.


Instruction: Generate impression based on findings.

Input: Low back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild disc desiccation at T11-12 and T12-L1. Lumbar alignment is within normal limits. Bone marrow signal is diffusely heterogeneous, probably related to patient's age. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is minimal bilateral facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is minimal bilateral facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is moderate bilateral facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1.Mild degenerative changes without significant spinal canal or neural foraminal stenosis at any level. 2.Multilevel facet arthropathy, relatively worse at L5-S1, which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: 35-year-old female with left shoulder pain status post SLAP repair and acromioclavicular joint resection ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis muscles are within normal limits. Normal muscle bulk.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Postsurgical changes of a SLAP repair. No evidence of labral tear.BICEPS TENDON: The biceps tendon is well situated within the bicipital groove. ADDITIONAL

Output: 1.No evidence of rotator cuff tear. 2.Status post SLAP repair and acromioclavicular resection.


Instruction: Generate impression based on findings.

Input: 42 years Male (DOB:1/30/1974)Reason: h/o brain abscess. This will be 6 weeks into treatment to assess for resolution. History: headache, mass on MRIPROVIDER/ATTENDING NAME: EMILY M LANDON EMILY M LANDON Since the prior exam a ring-enhancing lesion located in the left gyrus rectus and previously measuring 16 x 25 mm currently is not ring-enhancing. It appears to also enhance centrally. It currently measures 17 x 11 mm axial dimensions. There is a low signal rim present along the left gyrus rectus enhancing lesion measuring 10 x 8 mm axial dimensions on the current exam and 13 x 19 mm axial dimensions on the prior exam. There is redemonstration of surrounding vasogenic edema which has decreased since the prior exam. The T2 hyperintense signal measures approximately 26 x 57 mm on the current exam and previously measured 69 x 39 mm axial dimensions.Foci of encephalomalacia are present in medial left occipital lobe and in the left cerebellar hemisphere. These are stable compared to the prior exam.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A linear focus of T2 and FLAIR signal hyperintensity extends through the left frontal calvarial burr hole into the left frontal lobe lesion. This probably represents a prior tract for biopsy/aspiration.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.Since the prior examination a left frontal lobe abscess continues to regress in size but the MR abnormality has not resolved.2.Foci of encephalomalacia are redemonstrated in the left cerebellar hemisphere and left occipital lobe.


Instruction: Generate impression based on findings.

Input: 58 year old BRCA mutation carrier with history of right lumpectomy with adjuvant radiation therapy for DCIS in 2005 and history of a benign MRI guided biopsy for a lesion at the 3 o'clock position in the left breast in 2012. Strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Several enhancing foci in the left breast are unchanged in comparison to the prior studies. Postsurgical changes in the right 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: Worsening left-sided weakness, falls, history of MS, evaluate for demyelinating lesions Cervical spine:Alignment of the cervical spine is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is benign. Degenerative spondylosis affects the cervical spine worst at C5-6 and C6-7. There are T2 hyperintense foci involving the cervical cord along the left lateral and dorsal aspects at the C2 level and the left lateral aspect at the C3-4, similar to 2011. There are no enhancing lesions in the cervical cord. The paravertebral soft tissues are unremarkable.C2/3: Disc osteophyte complex without spinal canal or neural foraminal stenosis.C3/4: Disc osteophyte complex without spinal canal or neural foraminal stenosisC4/5: Disc osteophyte complex with minimal cord flattening but no significant overall spinal canal or neural foraminal stenosis.C5/6: Disc osteophyte complex including central disc protrusion and ventral cord deformity. There is mild overall spinal canal stenosis at this level. No significant neural foraminal stenosis. C6/7: Disc osteophyte complex including central disc protrusion and ventral cord deformity with mild overall spinal canal stenosis. No significant neural foraminal stenosis. C7/T1: No significant spinal canal or neural foraminal stenosis.Thoracic spine:Alignment of the thoracic spine is anatomic. The vertebral body heights are grossly preserved. There is mild degenerative spondylosis of the thoracic spine. There are small Schmorl's nodes in the mid thoracic spine. There is a focus of low T1 and T2 signal involving the T10 inferior endplate, which may represent focal sclerosis, but is nonspecific. No significant spinal canal stenosis or neural foraminal narrowing at any level. There are subtle T2 hyperintense lesions involving the thoracic cord suspected along the right lateral aspect at the T6-7 level and the left dorsal aspect at the T8-9 level seen both on the sagittal STIR and axial T2 sequences. There is no enhancing lesion in the thoracic cord.

Output: 1. Unchanged T2 hyperintense foci in the cervical cord compared to 8/6/2011. There are also subtle T2 hyperintense foci which are suspected in the thoracic cord; no prior thoracic MRI is available for comparison. Findings are compatible with history of demyelinating disease. No enhancing lesions to suggest active demyelination.2. Degenerative spondylosis of the cervical spine with mild spinal canal stenosis at C5-6 and C6-7.


Instruction: Generate impression based on findings.

Input: Reason: right knee pain and locking, r/o meniscus injury History: right knee pain and locking MENISCI: The majority of the anterior horn of the lateral meniscus is replaced with intermediate signal intensity, indicating extensive degeneration and degenerative tearing, which extends into the body of the meniscus as well. There is intrasubstance degeneration of the posterior horn of the lateral meniscus. There is lateral extrusion of the body of the lateral meniscus. There is intrasubstance degeneration of the posterior horn of the medial meniscus with probable fraying along its undersurface. There are small cysts posterior to the posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There are tricompartmental osteophytes. There is severe degeneration of the articular cartilage of the lateral compartment with diffuse full-thickness cartilage loss along the weightbearing surface of the lateral femoral condyle and lateral tibial plateau. There is subchondral cyst formation within the underlying lateral femoral condyle. There is also near full-thickness to full-thickness cartilage loss along the weightbearing surface of the medial femoral condyle above and anterior to the posterior horn of the medial meniscus. There is mild focal degeneration of the articular cartilage of the femoral trochlea, centrally. There is degenerative signal abnormality within the intercondylar eminence.LIGAMENTS: The ACL is indistinct, which we suspect represents a combination of mucoid degeneration and chronic tearing. The PCL appears intact. The MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Severe osteoarthritis of the knee including full-thickness articular cartilage degeneration most pronounced along the lateral tibiofemoral compartment.2. Extensive degeneration and degenerative tearing of the lateral meniscus. Degeneration and fraying of the medial meniscus.3. Mucoid degeneration and chronic tearing of the ACL.4. Moderate-sized joint effusion extending posteromedially into a small Baker's cyst.5. Septated collection between the iliotibial band and lateral femoral condyle may represent a bursitis or ganglion formation.


Instruction: Generate impression based on findings.

Input: Male, 39 years old, status post CSF leak repair with memory loss. Brain:Diffusion-weighted images are unremarkable. No evidence of parenchymal edema or mass effect is seen. No areas of encephalomalacia or parenchymal defects are detected. No pathologic parenchymal or extra-axial enhancement is observed. A small left frontal developmental venous anomaly is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial collections. The ventricles are normal in size and morphology. Partially empty sella is again seen, unchanged.Skull base:Evidence of interval CSF leak repair is again seen along the right aspect of the cribriform plate. There is no longer any obvious nasal cavity fluid contiguous on the right. On the left, a small locule of fluid below the olfactory groove is again seen appearing similar to prior. No evidence of any new pooling or collected fluid is seen in the nasal cavity.The superior ophthalmic veins are prominent, left side more than right. In addition, Meckel's caves are patulous and there appear to be prominent CSF sheaths contiguous of Meckel's cave within the foramen rotundum and foramen ovale bilaterally.

Output: 1.No acute intracranial abnormality or other specific findings which would account for the patient's memory loss.2.Findings are seen compatible with interval CSF leak repair along the right cribriform plate.3.Multiple findings are seen including partially empty sella, prominence of the superior ophthalmic veins, and prominence of Meckel's cave and contiguous CSF sheaths which may reflect idiopathic intracranial hypertension.


Instruction: Generate impression based on findings.

Input: 44-year-old female patient with myelomeningocele at birth status post tethered cord repair. Three month follow-up examination following surgery. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is a lumbar dextroscoliosis with the apex at L4/L5. Bone marrow signal is benign. The conus medullaris is low lying and terminates at the level of L2/L3. There are post-surgical changes of a laminectomy of L4 and L5. Low signal intensity on T1 and T2 weighted images in the paraspinal soft tissues at this level are consistent with scarring and post-surgical change. There is a tract of fluid in the posterior soft tissues at this level that extends superiorly, which likely represents residual post-operative seroma. There is a residual extramedullary intraspinal lipoma extending from the level of L2/L3 to L4/L5 measuring 6.0 x 1.4 x 1.8 cm in its greatest dimensions (craniocaudal x transverse x AP). The cauda equina nerve roots at the upper L4 level abut the anterior dural surface secondary to mass effect and are displaced to the left. There is no evidence of a syrinx within the visualized spinal cord. There is ventral movement of the distal spinal cord cranial to the intraspinal lipoma with prone imaging. There are mild degenerative changes in the lumbar spine including disc bulge at L2/L3 which is eccentric to the right with associated moderate right neural foraminal stenosis. There is also disc bulge eccentric to the right at L3/L4 associated with mild to moderate right neural foraminal stenosis.

Output: 1. Post-operative changes related to prior myelomeningocele repair and recent cord untethering. A residual extramedullary intraspinal lipoma is present extending from L2/L3 to L4/L5 with associated mass effect and ventral displacement of the distal spinal cord/proximal cauda equina. Prone imaging demonstrates ventral motion of the distal spinal cord proximal to the lipoma. 2. Dextroscoliosis of the lower lumbar spine and mild degenerative changes at L2/L3 and L3/L4 with disc bulge and associated right neural foraminal narrowing as described above.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, with history of sickle cell disease and old infarct on CT. Assess for areas of ischemia, evidence of new or old infarcts. MRI:Foci of T2 hyperintensity are again seen along the perfusional watershed region of the deep right cerebral white matter. Small foci of T2 hyperintensity and/or encephalomalacia are also demonstrated along the right caudate nucleus, unchanged. A 5 mm non specific focus of T2 hyperintensity within the left temporal lobe just lateral to the temporal horn is new or larger compared to the prior examination. No restricted diffusion is seen to suggest acute ischemia.The cerebellar tonsils are pointed and descends 7-8 mm below the level of the foramen magnum. There is significant crowding of the CSF space at the level of the foramen magnum. Platybasia is demonstrated. Also seen is progressive expansion of the calvarial marrow space likely related to sickle cell disease.No evidence of parenchymal edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is normal in size and morphology. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.The right periorbital soft tissues are mildly edematous.MRA:Normal flow related signal is seen within the anterior and posterior circulations. No evidence of significant vascular stenosis or occlusion is seen. A complete circle of Willis is evident with prominent ACOM and PCOM arteries.

Output: 1.No evidence of acute ischemia or any other definite acute intracranial abnormality.2.Small lesions are seen most likely representing chronic ischemia along the perfusional watershed of the deep right cerebral white matter, and within the right caudate nucleus. A subtle focus of signal abnormality within the left temporal lobe is nonspecific.3.Findings compatible with Chiari malformation are demonstrated.4.Unremarkable MRA of the brain.


Instruction: Generate impression based on findings.

Input: 71-year-old male with history of lung cancer, status post chemo, new left scapular mass, evaluate disease status CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules are again identified. Reference left lower lobe nodule (image 66, series 4) measures 13 mm x 10 mm.Reference right middle lobe nodule (image number 52, series 4) measures 9 mm x 9 mm, previously, measuring 9 mm x 8 mm.Groundglass nodule (image 49, series 4) unchanged from the previous exam.Right subpleural upper lobe nodule (image 46, series 4) 9slightly increased in size, now measuring 12 mm, previously, measuring 10 mm.Volume loss on the left, compatible with a previous left lobectomy. Centrilobular and paraseptal emphysema. MEDIASTINUM AND HILA: Stable reference precarinal lymph node (image 43 series 3) measures 14 mm x 13 mm.Reference right hilar lymph node (image 45, series 3) is stable, measuring 10 mm x 13 mm.Makes size is normal. No evidence of pericardial effusion. There are coronary artery calcifications.Central venous catheter with its tip in the SVC.CHEST WALL: New partial collapse of the T7 vertebrae. No evidence of pathologic.ABDOMEN:LIVER, BILIARY TRACT: Stable multiple small hypodensities most likely representing cysts.SPLEEN: No significant abnormality notedADRENAL GLANDS: Stable small left adrenal nodule.KIDNEYS, URETERS: Bilateral renal cysts that are stablePANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left scapular lesion noted on recent MRI exam is not identified on this exam.OTHER: Atherosclerotic disease of the aorta.

Output: 1.Multiple pulmonary nodules without significant interval change.2.Partial collapse of the T7 vertebrae. No definite evidence of metastatic involvement.


Instruction: Generate impression based on findings.

Input: 64-year-old man with chronic neck pain. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. Scattered intermediate signal within some of the intervertebral discs likely reflects degeneration. The 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:At C2-C3 there is minimal disc bulge without significant compromise to the spinal canal. There is left-sided facet arthropathy. There is mild left neural foraminal narrowing.At C3-C4 there is severe disc bulge with moderate narrowing of the central spinal canal, mild bilateral facet joint arthropathy, and mild to moderate narrowing of the bilateral neural foramina.At C4-C5 there is mild disc bulge with moderate narrowing of the central spinal canal. There is mild bilateral facet joint arthropathy and mild narrowing of the bilateral neural foramina.At C5-C6 there is mild disc bulge with mild narrowing of the central spinal canal. There is mild bilateral facet joint arthropathy and mild narrowing of the bilateral neural foramina.At C6-C7 there is mild disc bulge without significant narrowing of the central spinal canal. There is mild bilateral facet joint arthropathy and mild narrowing of the bilateral neural foramina.At C7-T1 there is no significant disc bulge. The central spinal canal is not narrowed. There is mild bilateral facet joint arthropathy and mild narrowing of the bilateral neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes affect the cervical spine, worst at the C3-C4 level.


Instruction: Generate impression based on findings.

Input: Male, 34 years old, with low back pain. Evaluate T11-12 disc herniation. Spinal alignment is anatomic. There is very minimal anterior wedging of the T11, T12 and L1 vertebral bodies, likely within normal limits. Vertebral body height and morphology are otherwise unremarkable. No pathologic marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.Small central disc protrusions are evident at T6-7 and T7-8 without cord impingement or spinal canal narrowing. A small right paracentral disc protrusion at T11-12 causes effacement of the right ventral thecal sac but no significant spinal canal stenosis. The neural foramina are patent throughout.

Output: 1.A small right paracentral disc protrusion at T11-12 causes effacement of the right ventral thecal sac but no significant spinal canal stenosis or cord impingement.2.Small central disc protrusions are evident at T6-7 and T7-8 without significant spinal canal or foraminal compromise.


Instruction: Generate impression based on findings.

Input: 71 year old male with concern for amyloid, here for further evaluation Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%. The LVEDV is 120 ml (normal range 142+/-34), the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVESV is 49 ml (normal range 47+/-19) and the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. Sigmoid septum (normal variant)The native T1 myocardial relaxation time is approximately 1050ms. These values are [within normal limits], suggestive of [no]underlying diffuse fibrosis or infiltration.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%. The RVEDV is 121 ml (normal range 142+/-31), RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVESV is 56 ml (normal range 54+/-17), and the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Tortuous descending thoracic aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsProbable basilar lung atelectasis. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%.3. The native T1 myocardial relaxation time is approximately 1050ms. These values are [within normal limits], suggestive of [no] underlying diffuse fibrosis or infiltration. Delayed enhancement not performed (patient refused contrast)I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Hip pain ACETABULAR LABRUM: Focal tear along the anterosuperior aspect at approximately 1-2 o'clock without evidence of significant displacement or additional labral findings throughout the remainder. ARTICULAR CARTILAGE AND BONE: Intact and without focal defects. No abnormal discrete signal abnormality. Marrow signal is consistent with red marrow replacement scattered throughout the pelvis and visualized portions of the proximal femur; unremarkable for age.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Antero superior labral abnormality, as described. No additional superimposed additional abnormality. Please see concomitant CT for CAM measurements.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 76-year-old female with glioblastoma. Three weeks into RT. Decreasing mental status and increasing somnolence. Recent fall. Evaluate for bleed, shift or edema Minimal edema and hemorrhage at the site of patient's known left temporal lobe tumor and postoperative site is noted. Extensive periventricular and subcortical areas of low attenuation is believed to represent advanced small vessel disease of indeterminate age. A very small area of increased density measuring approximately 3 mm in left parietal is concerning for small amount of hemorrhage. No subarachnoid hemorrhage or midline shift or hydrocephalus.Postoperative changes of calvarium are noted in calvarium is otherwise unremarkable.Limited view of paranasal sinuses and mastoid air cells are also unremarkable.

Output: 1.Diffuse a small vessel disease of indeterminate age.2.Small area of hemorrhage edema and postoperative change in the left temporal lobe which were present on prior MRI.3.Very small area of suspected hemorrhage in the parenchyma in the left parietal which is a new finding.


Instruction: Generate impression based on findings.

Input: Confusion and amnesia. Follow-up nonspecific small vessel ischemic disease. The examination is mildly limited by patient motion.There is no acute infarct. Compared to the previous examination, there are 3 new superficial foci of T1/T2-hypointense signal and susceptibility effect involving the medial left frontal lobe, left occipital lobe and superior medial right occipital lobe. These are not associated with surrounding edema. Otherwise, there is unchanged confluent periventricular and scattered subcortical/deep white-matter T2/FLAIR-hyperintense lesions that are nonspecific but probably reflect chronic microvascular ischemia.Mild dilatation of the ventricles and the other CSF-containing spaces, reflecting underlying global parenchymal loss is unchanged. In addition, there is expansion of the subarachnoid space around the left cerebellar hemisphere, which is mildly asymmetrically smaller in size but with decreased interfolial spaces which may reflect a retrocerebellar cyst or an enlarged cisterna magna with mass-effect on the left cerebellar hemisphere. This has not changed since the previous examination. Otherwise, there is no mass-effect, midline shift or brain herniation. There is mild ethmoid mucosal thickening. The right lens has been replaced. The orbits are otherwise grossly unremarkable. There is no destructive skull lesion.

Output: 1.Examination is limited by patient motion. There is no acute infarct, mass-effect or midline shift.2.Three microhemorrhages in a cortical/subcortical distribution without associated edema are probably chronic, though new since the January 2016 examination.3.Stable mild chronic microvascular ischemia.4.Stable left retrocerebellar cyst versus mega cisterna magna, with mild mass-effect on the left cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: 33-year-old male with history of treated Ewing's sarcoma. Currently off therapy for 1.5 years, assess for recurrent disease. Again seen is a pelvic mass located between the bladder and rectosigmoid colon, measuring approximately 6.2 x 5.5 cm in transverse dimension (series 601, image 23) and 5.7 cm in craniocaudal dimension (series 401, image 22), not significantly changed since the prior study. This mass demonstrates predominantly increased signal intensity on T1- and T2-weighted images, with a low signal intensity rim and no enhancement on post-contrast images. The MRI appearance is compatible with blood products of a chronic hematoma. Mild mass effect on the adjacent rectosigmoid colon is unchanged. The remaining visualized soft tissues are normal.An irregular enhancing region of signal abnormality in the anterior aspect of the left sacroiliac wing appears similar to the prior study and likely represents a small focus of bone infarction.Also redemonstrated is a small round non-enhancing focus of decreased signal intensity on T1-weighted images in the posterior aspect of the left iliac wing. While nonspecific, this could represent a treated metastasis.Patchy intermediate signal intensity within the vertebrae, pelvis, and proximal femora likely represents residual red marrow and is unchanged. Bone marrow signal intensity is otherwise within normal limits.

Output: Post-treatment changes of pelvic Ewing's sarcoma, which appear similar to the prior study. No evidence of disease progression.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval for L BG stroke and brainstem/cerebellar atrophy History: b/l chorea, athetosis, and dementia Brain MRIMotion artifacts degraded exam quality.No evidence of acute ischemic or hemorrhagic lesion on the scan.There are susceptibility artifacts on the right basal ganglia extended toward right side midbrain and the right cerebellar hemisphere indicating hemosiderin deposition due to prior hemorrhagic lesion.Patchy FLAIR high signal intensities on bilateral periventricular white matter as well as centrum semiovale indicate nonspecific small vessel ischemic disease.Multifocal tissue losses involving bilateral basal ganglia, right external capsule bilateral periventricular white matter and right cerebellar hemisphere suggest prior mixed hemorrhagic and ischemic stroke.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal various degree intracranial arterial luminal narrowings including right distal vertebral artery, basilar artery, and bilateral MCAs indicating intracranial atherosclerotic changes. The degree of stenosis on especially non contrast enhanced MRA is not accurate and most likely exaggerated but the distal right vertebral artery and right MCA proximal M2 segment appear to be about or slightly higher than 50%.The left distal vertebral artery is not seen which could be related to hypoplastic in nature or occlusion.There is no evidence of intracranial arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Hemosiderin depositions on the right basal ganglia and right cerebellar hemispheric lesion indicating prior (chronic) hemorrhagic infarction.3. Multifocal tissue losses indicate chronic ischemic infarctions.4. Non specific small vessel ischemic disease.5. Multifocal intracranial arterial luminal narrowings suggest intracranial atherosclerotic changes.


Instruction: Generate impression based on findings.

Input: 60-year-old female with history of pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Large thick-walled cystic lesion centered within the pancreatic body measuring 6.7 x 6.6 cm with a moderate amount of debris layering within the dependent aspect of the lesion. There is no appreciable enhancement after contrast administration. There is no clear communication with the main pancreatic duct however significant mass effect is present with a dilated and tortuous distal pancreatic duct measuring up to 5 mm. There is significant mass effect on the adjacent gastric antrum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Benign appearing left superior pole 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: Large cystic lesion arising from the pancreatic body which is favored to represent a pancreatic pseudocyst, however a mucinous neoplasm cannot be excluded. There is distal pancreatic ductal dilation as well as significant mass effect on the gastric antrum.


Instruction: Generate impression based on findings.

Input: 29-year-old female with persistent left shoulder pain status post injury on 6/9/2015. ROTATOR CUFF: There is minimal increased signal intensity within the supraspinatus tendon which may reflect mild tendinosis but this is equivocal. We see no discrete tear. There is minimal fatty infiltration along the myotendinous junction but the supraspinatus muscle otherwise is within normal limits. The infraspinatus tendon and muscle appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is slight inferior hooking of the anterior aspect of the acromion process. There is a small amount of fluid within the subacromial subdeltoid bursa which may represent a bursitis, but the true clinical significance of this is uncertain.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the glenohumeral joint but no large effusion is evident. Within the limitations of a non-arthrogram study, the glenoid labrum appears normal.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: 1. Minimal tendinosis of the supraspinatus tendon without evidence of a rotator cuff tear.2. Small amount of fluid within the subacromial subdeltoid bursa may represent a bursitis, but the true clinical significance of this is uncertain.3. Multilobulated cyst-like lesion within the posterior humeral head may represent an interosseous ganglion but is not necessarily of current clinical significance.


Instruction: Generate impression based on findings.

Input: There is a mixed intermediate and low signal T2 and intermediate and high signal T1 intraparenchymal hematoma centered in the right insula and basal ganglia region that measures up to approximately 6 cm. There is extension of hemorrhage into the right lateral ventricle. The surrounding vasogenic edema with unchanged mild midline shift to the left and uncal herniation. Likewise, there is persistent effacement of the third and right lateral ventricles, but dilatation of the left lateral ventricle. There is a background of diffuse cerebral white matter T2 hyperintensity and punctate foci of encephalomalacia in the pons. There is also linear T2 hyperintensity along the right corticospinal tract in the midbrain, suggestive of early Wallerian degeneration. There are punctate foci of susceptibility effect within the medial portions of the cerebellar hemispheres. The susceptibility -weighted images are otherwise degraded by patient motion. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Accounting for differences in technique, there is no significant interval change in size of the acute to early subacute intraparenchymal hemorrhage centered in the right insula and basal ganglia region, which is likely hypertensive in nature, with associated intraventricular extension of hemorrhage, and vasogenic edema, leftward midline shift, and obstructive hydrocephalus involving the left lateral ventricle. 2. Diffuse cerebral white matter small vessel ischemic disease and punctate foci of encephalomalacia in the pons, but no evidence of acute territorial infarct.3. Punctate foci of susceptibility effect within the medial portions of the cerebellar hemispheres may represent chronic hypertensive microhemorrhages.


Instruction: Generate impression based on findings.

Input: Chin numbness in patient with metastatic cancer. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Face: There is no evidence of maxillofacial tumors or abnormal enhancement. The orbits and salivary glands are unremarkable. There is no evidence of significant regional lymphadenopathy.

Output: 1. No evidence of maxillofacial tumors.2. No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:2/1/1972)Reason: assess for stroke History: left-sided weakness and dysarthriaPROVIDER/ATTENDING NAME: DAVID A HARTER JACQUELINE T. BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a developmental venous anomaly present in the right cerebellar hemisphere.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.There is a cystic lesion present in the pharyngeal mucosal space most likely representing a Thornwaldt cyst.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left parietal craniotomy for subjacent tumor resection. There is unchanged susceptibility effect within the adjacent resection cavity as well as an additional punctate focus within the right parietal lobe. There is perhaps slight decrease in the extent of confluent T2 hyperintensity adjacent to the resection cavity, as well as scattered additional small foci of T2 hyperintensity throughout the supratentorial white matter. A small focus within the right parietal lobe also appears to have slightly decreased in size. There is minimal thin linear enhancement adjacent to the resection cavity that has decreased progressively compared with the prior 2 exams (the November exam was performed on a 3T magnet and the September exam was performed on a 1.5T magnet). There is no evidence of significantly elevated relative cerebral blood volume within the enhancing or nonenhancing regions. 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.

Output: Decreased size of the left parietal glioblastoma, which may be represent true partial response or perhaps pseudo-response secondary to Avastin. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Meningioma status post CyberKnife in May 2014 and orbital pseudotumor. Brain: There are postoperative findings related to left suboccipital craniotomy for resection of a meningioma with encephalomalacia in the left cerebellar hemisphere. There is slight interval decrease in size of the tumor, which now measures up to 13 mm in thickness, previously 16 mm. There is a persistent nodular extra-axial lesion that is T2 hypointense with susceptibility effect and mild peripheral enhancement along the floor of the left posterior fossa, adjacent to the craniotomy defect that measures up to 15 mm. There is unchanged mild nonspecific periventricular T2 hyperintensity. There is no evidence of acute infarct or hemorrhage. The ventricular system is stable in size and configuration. There has been interval partial resection of a left earlobe keloid.Orbit: There are postoperative findings related to orbitozygomatic craniotomy. There is interval decrease in size of a right inferior intraconal nodular lesion, abutting the optic nerve, measuring up to 12 mm, previously 24 mm. There is persistent associated surrounding enhancement of the right orbital fat and multiple extra-ocular muscles. There is staphylomatous deformity of the bilateral globes.

Output: 1.Slight interval decrease in size of the treated left posterior fossa meningioma.2. Persistent small nodular extra-axial lesion in left posterior fossa adjacent to the craniotomy margin may represent an organizing hematoma. 3. Decrease in size of the lesion within the inferior right orbit, abutting the optic nerve.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: CVA. Brisk reflexes. Evaluate spine per radiology.Signs and Symptoms: brisk reflexes, LE clonus Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.No abnormal enhancing lesions are appreciated in the cervical spine.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. There are small uncovertebral osteophytes present at this level with mild narrowing of the left neural foramen.At C5-6 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present at this level with mild narrowing of the left neural foramen.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.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is a marrow replacing lesion which enhances following gadolinium administration within the T5 vertebral body which measures 10 mm in diameter. 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 mild compression of the left half of the L2 and L3 vertebral body. There is associated enhancement of the L2 and L3 vertebral bodies. On an abdomen CT from 9/21/2015 these appear to be sclerotic in nature. Relatively homogeneously high marrow signal within the L1, L4, L5, and sacrum suggest status post radiation to the lumbosacral spine.There is a small right-sided pleural effusion present.There is a mass which is incompletely included on this exam within the liver.

Output: 1.Enhancing masses present within the T5 vertebral body. The possibility this represents metastatic disease is raised. 2.There are compression fractures present at L2 and L3. These are presumably related to metastatic disease.3.There are multilevel degenerative changes present in the cervical spine with encroachment of the exiting nerve roots predominantly on the left side at C4-5 and C5-6.4.There is no evidence for spinal cord compression in the cervical or thoracic spine.5.There is a small right-sided pleural effusion present6.Liver mass. Please refer to CT of the abdomen for further comments.


Instruction: Generate impression based on findings.

Input: Reason: assess left foot dorsal first toe mass History: pain/swelling A marker was placed along the dorsal aspect of the skin surface dorsal to the first metatarsal head. There is a moderate hallux valgus deformity with mild to moderate osteoarthritis of the first MTP joint. There is enhancement of the first MTP joint indicating a synovitis with a synovial recess extending dorsomedially along the head of the first metatarsal, perhaps representing the palpable mass. This presumed synovial recess shows peripheral rim enhancement, but its contents are of low signal intensity on all sequences which may reflect debris rather than fluid, but we see no blooming artifact on gradient echo sequences to suggest pigmented villonodular synovitis. There are small erosions along the inferior margin of the first metatarsal head as well as mild subchondral edema within the first metatarsal head. Note is made of a bipartite medial sesamoid bone. The signal intensity of the phalanges of the great toe appears normal. The remaining visualized bones and soft tissues are unremarkable.

Output: Hallux valgus deformity with osteoarthritis and synovitis of the first MTP joint.


Instruction: Generate impression based on findings.

Input: Slurred speech. Progressive neurological symptoms.Additional clinical history from electronic medical records: PMH of stroke, HTN, DM2, OSA, prostate cancer (s/p radioactive seed implantation), who presents for alternate opinion of chronic progressive blurry vision, dizziness, gait imbalance. Main differential consideration is demyelinating process. Less likely considerations are ischemic neoplastic. CSF protein elevated to 85.3 on 4/29/16. The study is overall at least mildly limited by patient motion. The postcontrast images are markedly limited by motion.Multifocal T2/FLAIR hyperintensity are present in the cerebral white-matter, many new since the prior outside exam. The lesions are predominantly frontal in distribution. Similar lesions are present also in the corpus callosum anteriorly. Some of the lesions are round and relatively well-defined. Similar signal abnormality lesions are present in the midbrain, middle cerebellar peduncles, left superior cerebellar peduncle, and the cerebellum. Some of the lesions are associated with expansion, for example the lesions involving the cerebellar peduncles, especially a the small lesion involving the medial aspect of the left middle cerebellar peduncle with mass effect upon the fourth ventricle, which is new since April 2016. Many of the supratentorial and infratentorial lesions are associated with patchy, non-masslike contrast enhancement, while some of the lesions show more nodular contrast enhancement. FLAIR imaging shows increased signal along the superior vermian interfolial spaces, which may reflect leptomeningeal involvement.A few of these lesions are new compared to the prior examination of April 2016; such as the lesions involving the left cerebellum, left anterior corpus callosum, and left frontal operculum. There is also a smaller right temporal lobe lesion. These new lesions are the ones that show more intense, nodular contrast enhancement. Many of these lesions are new compared to the more remote prior examination from January 2016 and June 2015. Over the same time course, few of the lesions have shown improvement. For example, in January 2016, there was extensive involvement in the occipital lobes and the splenium of the corpus callosum, which is now partially resolved. There is no acute infarct or intracranial hemorrhage. There is mild dilatation of the lateral and third ventricles, probably from volume loss. The sulci are also mildly enlarged. There is no midline shift or brain herniation.There is no destructive skull lesion. There is mild scattered mucosal thickening in the paranasal sinuses.

Output: 1.The examination is limited by motion, especially the postcontrast images.2.Relatively extensive white-matter lesions, predominantly in frontal, corpus callosal and brainstem/cerebellar peduncle distribution. The lesions show patchy and nodular contrast enhancement and no diffusion restriction. There is also suggestion of leptomeningeal involvement. While there has been an overall progressive course, compared to the previous MRIs as remote as March 2015, few of the lesions did actually improve, reflecting the waxing and waning but overall progressive nature of the disease. This pattern would be most compatible with an inflammatory/demyelinating disorder. Vasculitis/angiitis and demyelinating disorders are the more likely differential diagnoses. A neoplastic process would have a more progressive course. Within this vascular/inflammatory/demyelinating differential, the frontal involvement can be suggestive of CADASIL, however the lack of significant anterior temporal lobe involvement would be atypical. For Susac syndrome, clinical correlation to assess for retinal artery branch involvement and sensorineural hearing loss can be helpful.


Instruction: Generate impression based on findings.

Input: Heel pain Tendons and ligaments: The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. The Lisfranc ligament is intact. There is no subluxation or dislocation in the tarsometatarsal articulations. The Achilles tendon is intact.Bone: There is small amount of fluid within the tibiotalar joint. There is mild osteoarthritis of the calcaneocuboid and talonavicular articulations. There is a mild amount of marrow edema within the plantar aspect of the calcaneus near the insertion of the plantar aponeurosis. There are no osteochondral lesions identified. There is normal alignment of the metatarsals. There is no fracture.Muscles: There is mild edema of the plantar musculature near the insertion upon the calcaneus.

Output: Findings consistent with mild plantar fasciitis.


Instruction: Generate impression based on findings.

Input: 60 year-old male status post lumbar spine fusion. Two views of the lumbar spine demonstrate posterior rods with screws entering the L3 through S1 vertebrae. We see no hardware complications. There are spacer devices at L3-L4, L4-L5, and L5-S1 and bone grafts at L3-L4 and L4-L5. Grade 1 retrolisthesis of L4 relative to L5. Gas within the posterior soft tissues presumably reflects recent surgery.

Output: Postoperative changes of a lumbar spine fusion as described above.


Instruction: Generate impression based on findings.

Input: Right knee pain Severe osteoarthritis affects the right knee with bone-on-bone apposition in the lateral tibiofemoral compartment and tricompartmental osteophytes. A genu valgum deformity is present. The cortex is not well seen along the lateral plateau of the proximal tibia and there is associated spiculated periosteal reaction. This would be an uncommon finding in osteoarthritis and we cannot exclude a malignant or infectious process in the absence of prior imaging. Correlation with previous outside imaging or further evaluation with MRI is recommended.

Output: Severe osteoarthritis with valgus angulation of the right knee. Spiculated periosteal reaction along the lateral aspect of the proximal tibia not typical of osteoarthritis; recommend correlation with previous outside imaging or further evaluation with MRI.


Instruction: Generate impression based on findings.

Input: Ex-31 week female with history of Intrauterine drug exposure (cocaine) and recent ALTE x 4 of unknown origin, although reflux is a consideration. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. However, there appears to be a paucity of myelination, with minimal T1 hyperintensity extending beyond portions of the brainstem, medial cerebellar hemispheres, posterior limbs of the internal capsules and portions of the perirolandic regions. There is also diffuse paucity of white matter bulk, most conspicuously manifesting as a thin corpus callosum. The ventricles otherwise display a normal 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. The reported right cheek hemangioma is not readily discernible.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L1 level. There is a linear skin indentation near the midline overlying the sacrum without communication with the spine.

Output: 1. Apparent delayed myelination even accounting for prematurity. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No discernible spine anomalies.


Instruction: Generate impression based on findings.

Input: History of brain biopsy, third ventricle and removal of EVD 3/31. Evaluate ventricles. Interval removal of right-sided ventricular catheter. A defect in the right calvarium from prior catheter placement is noted. There is stable enlargement of the lateral, third and fourth ventricles. The previously described mass in the pineal gland is of increased attenuation and measures 2.4 x 2 cm (image 13/36, series 2). When accounting for differences in technique, there is no significant change compared to the prior MRI. Calcification is seen along the superior and left anterolateral aspect of the mass.No evidence of intracranial hemorrhage or edema. No midline shift.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Pineal region mass with associated hydrocephalus. Size of ventricles appears stable compared to the prior MRI.


Instruction: Generate impression based on findings.

Input: Achilles injury There is marked signal abnormality and thickening of the Achilles tendon throughout the majority of its course but most notably beginning approximately 7.5 cm proximal to its insertion and extending for 5 cm proximal to this. Within these more proximal 5 cm, areas of near full-thickness tearing with a small fluid-filled gap is seen, best on series 1601 image 14. There is irregularity and discontinuity of the proximal soleus tendon best appreciated on axial images 1 through 13 on series 701. This extends along the majority of the course of the tendon to the level of the Achilles. Small fluid collection is identified in the area likely representing a small hematoma (series 701 image 6) and there is diffuse edema within the soleus at this level. A small amount of fluid is also seen surrounding the plantaris tendon although the tendon itself appears intact to the level of the distal Achilles. There is a mild amount of edema within the medial head of the gastrocnemius but the tendons of the gastrocnemius appear intact at least to the level of the Achilles tendon.The marrow signal of the tibia and fibula are normal.

Output: 1. Findings concerning for Achilles rupture which is superimposed upon marked tendinopathy.2. Tearing of the soleus tendon proximally with a small associated hematoma and diffuse edema of the soleus muscle.


Instruction: Generate impression based on findings.

Input: Spinal surgery with neck pain and history of thyroglossal duct cysts surgery. Neck: There are postoperative findings related to thyroglossal duct cyst resection with punctate linear T2 hyperintensity in the midline inferior tongue base, just superior to the hyoid bone. There is no evidence of mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The imaged intracranial structures are unremarkable.Cervical Spine: There are postoperative findings related to anterior fusion of C6 and C7. There is multilevel degenerative spondylosis and a congenitally narrow spinal canal. At C2-3, there is mild to moderate bilateral neural foraminal narrowing. At C3-C4, there is severe bilateral neuroforaminal stenosis. At C4-C5, there is mild left and severe right neuroforaminal stenosis. At C5-C6, there is moderate left and severe right neuroforaminal stenosis. At C6-C7, there is mild bilateral neural foraminal narrowing. At C7-T1, there is severe bilateral neuroforaminal stenosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to thyroglossal duct cyst resection with punctate linear T2 hyperintensity in the midline inferior tongue base, just superior to the hyoid bone, which may represent a residual portion of the thyroglossal duct. 2. Postoperative findings related to anterior fusion of C6 and C7. 3. Multilevel degenerative spondylosis and a congenitally narrow spinal canal and extensive neural foraminal stenoses at multiple levels, as described in the findings section.


Instruction: Generate impression based on findings.

Input: Reason: meniscus tear/loose body? History: medial pain/mechanical symptoms MENISCI: There is extrusion of the anterior horn of the medial meniscus along with fragmentation of the posterior horn of the medial meniscus. There is also blunting through the body of the lateral meniscus, consistent with additional tear.ARTICULAR CARTILAGE AND BONE: There is significant medial compartment joint space narrowing with loss of the hyaline cartilage along the medial femoral condyle as well as medial tibial plateau with associated bone marrow edema within the medial tibial plateau.There is marked thinning of the patellar cartilage with a partial-thickness defect in the lateral facet.LIGAMENTS: There is lack of visualization of the ACL, consistent with complete tear. The PCL is within normal limits. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complete right ACL tear.2.Extrusion of the anterior horn of the right medial meniscus as well as fragmentation of the posterior horn of the medial meniscus.3.Blunting through the body of the right lateral meniscus, consistent with tear.4.Osteoarthritis of the right knee particularly involving the medial and patellofemoral compartments as detailed above.


Instruction: Generate impression based on findings.

Input: Left thoracic curve scoliosis. Assess for spinal cord abnormalities. The patient did move during the examination. This have limited the ability to cross reference the images and findings between different planes. Also, the patient did refuse to complete the lumbar part of the examination. Therefore, a tethering lesion of the cord cannot be ruled out with confidence.Cervical Spine:Alignment is anatomic. Vertebral bodies are preserved in height and morphology. There is no significant marrow abnormality. The intervertebral discs are preserved in height. The spinal canal is preserved. The spinal cord shows normal morphology and signal. Included brain shows no significant abnormality. Included cervical soft tissues show no signal abnormality. Lymph nodes in the upper neck on both sides are nonspecific but likely reactive.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: There is no spinal canal or foraminal stenosis.C4-C5: There is no spinal canal or foraminal stenosis.C5-C6: There is no spinal canal or foraminal stenosis.C6-C7: There is no spinal canal or foraminal stenosis.C7-T1: There is no spinal canal or foraminal stenosis.Thoracic Spine:There is a broad-based, leftward convex curvature centered in the lower thoracic spine (T9/T10). There is a well-circumscribed, fluid-intensity (but no contrast was administered) structure that occupies and expands the right T10-T11 neural foramen and extends medially into the epidural space mildly displacing the thecal sac and spinal cord the left. However, the cord shows normal signal characteristics. Also, there is still a thin rim of fluid/subarachnoid space around the cord. This is also associated with mild scalloping of the posterior vertebral body on the right as well as thinning of the right pedicle. There is no associated marrow edema. The remainder of the thoracic spine shows preserved vertebral morphology, marrow signal and no significant degenerative disease.There is no spinal canal or foraminal stenosis, otherwise.

Output: 1.Limited examination; because of patient's motion and inability to complete the examination as described above.2.Leftward convex curvature in the lower thoracic spine without congenital, morphologic abnormality of the thoracic spine. 3.There is a cystlike structure involving the right T10-T11 neural foramen with medial extension into the epidural space causing mild mass effect on the thecal sac and spinal cord. This also causes smooth osseous scalloping without edema. This may represent an arachnoid cysts or a perineural root cyst with epidural extension but then the relationship to the scoliosis would be more difficult to explain as these are not usually associated with scoliosis unless there compression of the nerve root (are there radicular symptoms related to the right T10 nerve root?). Contrast myelography might provide additional information (regarding wall permeability) of these lesions. While a nerve sheath tumor would be difficult to reliably exclude without intravenous contrast, it seems unlikely given the signal characteristics of the lesion. This is a consideration otherwise, a contrast-enhanced examination is needed. A small lateral thoracic meningocele is an even less likely consideration unless the patient has neurofibromatosis type I.4.Cervical spine is normal. Small lymph nodes in the upper neck are nonspecific.5.The lack of lumbar spine imaging does not allow for reliable exclusion of cord tethering.


Instruction: Generate impression based on findings.

Input: compression of brain [348.4] / Headache(784.0) [784.0] / Cervicalgia [723.1], Reason for Study: ^Reason: headaches , neck pain, found Chiari on CT scan. Evaluate for Chiari and CSF flow please History: headache neck pain Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is about 3 mm tonsillar herniation through the foramen magnum.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-spine MRIThe cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.CSF flow studyPhase-contrast MR angiographies through the foramen magnum for to study of CSF flow demonstrated normal pulsatile bidirectional flow especially anterior aspect of spinal cord.Posterior aspect of spinal cord through the foramen magnum CSF flow also demonstrate first bidirectional flow.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. About 3 mm tonsillar herniation through the foramen magnum as described above.3. Normal C-spine MRI.4. Normal CSF flow study


Instruction: Generate impression based on findings.

Input: Reason: r/o cord compression History: saddle anesthesia, urinary incontinence/retention, stool incontinence Complete spine for evaluation of spinal cord compression:The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.There is narrowing of the spinal canal at C5-6 and C6-7 from what appears to be degenerative change. There is a moderate degree of facet hypertrophy associated with a disk bulge and mild subluxation at L4-5 associated with the narrowing of the spinal canal and neural foramina at this level and possibly some degree of spinal stenosis. There is a T1 vertebral body lesion measuring 12mm size which is present along the anterior and superior aspect of the T1 vertebra. It is bright on T1 weighted imaging. A similar lesions of varying sizes are present at L2, L3 L5.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is posterior ligamentous hypertrophy present at this level.At C5-6 there are endplate and uncovertebral osteophytes present associated with a diffuse disk bulge and some posterior ligamentous hypertrophy with effacement of spinal fluid ventral and posterior to the spinal cord and overall moderate degree of spinal stenosis. Additionally, there is narrowing of the neural foramina bilaterally at this level due to osteophytes and disk material with mild encroachment of the exiting nerve rootsAt C6-7 there are endplate and uncovertebral osteophytes present associated with a diffuse disk bulge and some posterior ligamentous hypertrophy with effacement of spinal fluid ventral and posterior to the spinal cord and overall moderate degree of spinal stenosis. Additionally, there is narrowing of the neural foramina bilaterally at this level due to osteophytes and disk material with mild encroachment of the exiting nerve roots.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 left thyroid lobe appears fairly large but is incompletely visualized on this exam.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.3.There are degenerative changes present in the cervical spine with a moderate degree of spinal stenosis at C5-6 and C6-7 related to osteophytes and disk material.4.Findings suggest a possible encroachment of nerve roots at L4-5 related to degenerative changes.5.The left thyroid lobe appears fairly large but is incompletely visualized on this exam.


Instruction: Generate impression based on findings.

Input: Reason: presence of small vessel ischemic disease History: transient aphasia MRI BRAIN: There is an area of restricted diffusion in the left thalamus, consistent with an acute infarct. Chronic infarcts are present in the right posterior frontal lobe extending to the operculum, left middle frontal gyrus and left inferior cerebellar hemisphere with associated areas of susceptibility, likely reflecting hemosiderin deposition. There are linear areas of mild diffusion hyperintensity just anterior to the infarct in the right frontal lobe without corresponding low signal on the ADC map, possibly representing subacute ischemia. T1 hyperintensity along the anterior aspect of the infarct in the right frontal lobe is consistent with laminar necrosis. Additional areas of encephalomalacia are noted in the right insular cortex in addition to the right anterior and posterior temporal lobe. There is no intracranial mass. There is global parenchymal volume loss. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. Partially empty sella is incidentally noted. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. There is partial opacification of the mastoid air cells, right greater than left. Bilateral lens implants are noted.MRA BRAIN: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are normal in course and caliber. The posterior cerebral arteries, vertebral arteries and basilar artery are patent. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK: The left common carotid artery originates from the brachiocephalic artery, which is a normal variant. The common and cervical internal carotid arteries are normal in course and caliber. There is mild atherosclerotic plaque at the left internal carotid artery origin, but no significant stenosis. The vertebral artery origins are widely patent. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. Small focus of of restricted diffusion in the left thalamus is consistent with an acute infarct.2. Linear areas of mild diffusion hyperintensity just anterior to the chronic infarct in the right frontal lobe without corresponding low signal on the ADC map may represent subacute ischemia. 3. Multiple supra and infratentorial chronic infarcts.4. No evidence of flow-limiting stenosis or aneurysm.Findings communicated to Dr. Choudhury at time of dictation.


Instruction: Generate impression based on findings.

Input: Reason: abnormality History: spinal stenosis with radiculopathy Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level. There is right-sided facet hypertrophy with narrowing of the right neural foramen at this level.At C3-4 there is a diffuse disk bulge present There are endplate and uncovertebral osteophytes present associated with loss of disk space height, disk desiccation and endplate reactive changes. There is effacement of spinal fluid ventral and to a lesser degree posterior to the spinal cord creating a mild/moderate degree of spondylostenosis. There is narrowing of the neural foramina right worse than left with encroachment of right-sided exiting nerve roots at this level.At C4-5 there is no significant compromise to the spinal canal. There is loss of disk space height, disk desiccation and uncovertebral osteophytes at this level associated with encroachment of the left-sided exiting nerve roots in the neural foramenAt C5-6 there is a diffuse disk bulge present There are endplate and uncovertebral osteophytes present associated with loss of disk space height, disk desiccation and endplate reactive changes. There is effacement of spinal fluid ventral and to a lesser degree posterior to the spinal cord with a mild degree of spondylostenosis. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots bilaterally at this level and a mild to moderate encroachment of the exiting nerve roots.At C6-7 there is disk desiccation and diffuse disk bulge associated with uncovertebral osteophytes and encroachment of the exiting nerve roots bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal. There is loss of disk space height, disk desiccation, diffuse disk bulge and some endplate reactive change at this level. There is narrowing of the neural foramina as a result of disk bulge with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is also some partial effacement of the fat at the left lateral recess with some mild encroachment of the nerve roots of the left lateral recess at this level .At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk desiccation and diffuse disk bulge at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild disk desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes in the cervical spine with mild to moderate spinal stenosis at C3-4 and neural foramina encroachment of exiting nerve roots bilaterally at C5-6 and C6-7 , the left side at C4-5 and on the right side at C3-4.2.There are degenerative changes present in the lower lumbar spine with some encroachment of the exiting nerve roots bilaterally at L5-S1


Instruction: Generate impression based on findings.

Input: Evaluate ventricle size. Hydrocephalus. There is a large infratentorial cystic mass posterior and superior to the cerebellar hemispheres causing mass effect on the cerebellum and the frontal lobes. The fourth ventricle is enlarged with altered configuration. The lateral and third ventricles appear normal in size. An MRI is recommended for further evaluation.There is no evidence of intracranial hemorrhage. There are questionable foci of hypodensity in the left cerebellar hemisphere of unclear clinical significance.A shunt catheter traverses the right parietal bone and with its tip located in the large cystic infratentorial mass.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Large cystic mass posterior and superior to the cerebellar hemispheres causing mass effect with enlargement of the fourth ventricle. Shunt catheter tip is within the cystic mass. An MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Multiple myeloma and T9 compression fracture with cord compression. There is redemonstration of numerous diffuse lesions throughout imaged osseous structures of the thoracic spine and ribs. In particular, there is a large lesion involving the T9 vertebral body with an associated at least 50% compression deformity. Furthermore, the lesion extends posteriorly through the posterior border of the vertebral body into the spinal canal with associated spinal cord compression. There are also compression fractures of the T3, T8 , T11, and T12 vertebral bodies, with variable degrees of height loss, but no retropulsion. There is an approximately 50% central compression deformity of the T11 vertebral body without retropulsion or spinal stenosis. The alignment of the vertebral bodies is otherwise preserved. The lung bases demonstrate linear atelectasis versus scarring. The partially imaged bilateral kidneys appear mildly atrophic with perinephric scarring. There is a nonspecific nodule in the partially imaged right thyroid gland.

Output: Extensive multiple myeloma involvement of the imaged axial skeleton with multiple pathologic compression fractures. Notably, the pathological fracture of the T9 vertebral body results in approximately 50% compression deformity and the associated epidural tumor component results in spinal cord compression, which is further delineated on the recent MRI.


Instruction: Generate impression based on findings.

Input: 56-year-old male with smoldering multiple myeloma, right thoracic pain, rule out myelomatous lesions. Vertebral body heights and disk spaces are maintained. There is a small lesion along the anterior aspect of the T4 vertebral body with increased T1 signal, slight curvilinear peripheral enhancement and osseous buttressing, most consistent with a benign hemangioma. The bone marrow signal is otherwise within normal limits. No significant neuroforaminal or spinal canal stenosis. The soft tissues appear unremarkable.

Output: No myelomatous lesion or other specific finding to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female 32 years old Reason: MRI Extremity Lower with Contrast History: Foreign Body. 2/4/2016 left knee radiograph showing subcentimeter ossicles in the posterior aspect of the joint which may represent loose bodies. Please note that this contrast enhanced study was not protocoled for detailed evaluation of meniscus/cartilage.MENISCI: Given the limitations of the study, the menisci appear intact.ARTICULAR CARTILAGE AND BONE: Severe degeneration of articular cartilage in the lateral patellar facet with areas devoid of articular cartilage with underlying areas of subchondral cyst formation. Tibiofemoral articular cartilage appears relatively intact. There is also a small focus of signal abnormality and enhancement in the lateral femoral condyle near the attachment of the popliteus tendon suggesting a small cyst or erosion but the clinical significance of this is uncertain.LIGAMENTS: Cruciate and collateral ligaments are intact EXTENSOR MECHANISM: Extensor mechanism is intactADDITIONAL

Output: 1.No evidence of foreign body.2.Osteoarthritis of the patellofemoral joint and other findings as described above.


Instruction: Generate impression based on findings.

Input: New onset panhypopituitarism on anti-cancer immune modulator with hypophysitis as side effect; rule out mets or other causes of pituitary failure There is heterogeneous enhancement of the pituitary gland without significant enlargement of the gland or the pituitary infundibulum. The posterior pituitary bright spot is intact. There is no evidence of mass lesions. The optic apparatus and cavernous sinuses are intact. The imaged intracranial structures are unremarkable.

Output: Heterogeneous enhancement of the pituitary gland may represent treatment-related necrotizing hypophysitis.


Instruction: Generate impression based on findings.

Input: 8-month-old male with complex febrile convulsions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a 5 mm pineal cyst. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No focal brain parenchymal abnormality to suggest a seizure focus. MRI appearance of the brain within normal limits for patient age.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with leg and hip pain. Grade 1/2 anterolisthesis of L4 relative to L5 is unchanged. Spinal alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. No concerning marrow replacement or marrow edema is seen.The visualized spinal cord, conus, and nerve roots of the cauda equina are unremarkable except as discussed below.T12-L1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk. No significant generalized spinal canal stenosis or neuroforaminal narrowing. No significant interval changes. L2-3: Marked left and moderate right facet hypertrophy. Ligamentum flavum thickening. Minimal bulging disk. No significant generalized spinal canal stenosis or neuroforaminal narrowing. No significant interval changes. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk with a small superimposed central disk extrusion. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes.L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Disk uncovering and disk bulging. A superimposed central disk protrusion seems to be slightly larger with increase in the moderate to severe spinal canal stenosis. A right foraminal disk protrusion also seems to be mildly larger with a greater degree of herniation into the vertebral body. Significant narrowing of the right neural foramen with likely impingement potentially is also increased slightly. The left neural foramen remains mildly narrowed similar to prior. L5-S1: Moderate facet hypertrophy. T1/T2 hyperintensity in the disk may reflect disk mineralization or proteinaceous degeneration. Disk bulging and a superimposed central/left paracentral disk extrusion are not significantly changed. Mild effacement of the left ventral thecal sac is unchanged. Mild bilateral foraminal narrowing. No significant interval changes.

Output: 1. Multilevel degenerative findings, most severely affecting the L4-5 level. Spondylolisthesis, along with a mildly progressing central disk protrusion at this level, results in a moderate-severe spinal canal stenosis, slightly worse from prior. A right foraminal protrusion at this level is also slightly worse along with resultant severe narrowing of the right L4-5 neural foramen and probable nerve root impingement.2. Less severe degenerative findings are seen at other levels as detailed above without significant change.


Instruction: Generate impression based on findings.

Input: Elbow pain LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: There is mildly increased signal within the antecubital fossa/bicipital radial bursa as well as the biceps and brachioradialis. There is no focal fluid collection. ADDITIONAL

Output: Increased signal within the bicipitoradial bursa/biceps and brachioradialis May reflect a component of mild bursitis and/or tenosynovitis. Remaining evaluation of the elbow is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 16 year old male with sickle cell disease, evaluate for stenosis or Moya Moya. There is no evidence of intracranial mass, hemorrhage or infarction. No parenchymal signal abnormality is identified. There is no restricted diffusion or enhancing abnormality. The ventricles are normal in size and shape. Diffuse mucosal thickening is seen in the paranasal sinuses and right mastoid air cells.Perfusion post processing on an independent workstation demonstrate no significant perfusion defects.MR angiography demonstrates a right periophthalmic saccular aneurysm along the lateral aspect of the cavernous carotid measuring approximately 4 x 4 mm and directed laterally. There is a suggestion of a tiny outpouching on the medial aspect of the preophthalmic left cavernous carotid. Neither of these aneurysms were evident on the comparison study, although it was performed at 1.5 Tesla and was motion degraded. Otherwise the remaining anterior, middle and posterior cerebral arteries are unremarkable without hemodynamically significant stenosis.

Output: Negative brain MRI without evidence of ischemia or perfusion defect.1.MR angiography demonstrates a right periophthalmic saccular aneurysm along the lateral aspect of the cavernous carotid measuring approximately 4 x 4 mm and directed laterally. There is a suggestion of a tiny outpouching on the medial aspect of the preophthalmic left cavernous carotid. Neither of these aneurysms were evident on the comparison study, although it was performed at 1.5 Tesla and was motion degraded.2.Attempts to discuss findings with the ordering provider on the day of image acquisition (1/24/2015) were unsuccessful. Given the findings are not urgent or emergent, another attempt will be made on Monday 1/26/2015.


Instruction: Generate impression based on findings.

Input: Female 62 years old Reason: 61 yo with cirrhosis, liver mass seen on ultrasound History: none ABDOMEN:LIVER, BILIARY TRACT: Liver has mildly widened fissures. The hepatic and portal veins are patent. There are subcentimeter nonenhancing foci in segment 8 and segment 2. No suspicious hepatic lesions. Gallbladder contains stones. No biliary ductal dilatation.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: Moderate size hiatal hernia. There are perigastric varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesion.