Instruction: Generate impression based on findings.

Input: Male, 61 years old, with altered mental status. Image quality is degraded by motion artifact.No restricted diffusion is seen. There is a large region of encephalomalacia involving the left frontal lobe. More mild signal abnormality and encephalomalacia affect the posterior left parietal lobe. Nonspecific periventricular T2 hyperintensity is also seen.No large parenchymal or extra-axial hemorrhage is suspected, though image quality is not adequate to exclude the possibility of microhemorrhage. The ventricular system is within normal limits for size and morphology.

Output: Within the limitations of a significantly motion degraded exam, no definite acute intracranial abnormality is detected.Areas of encephalomalacia and signal abnormality involving the left frontal and, to a lesser degree, the left parietal lobe suggest prior ischemic injury.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: CVA. Unenhanced head CT:Two very small right cerebral cortical strokes are again identified. Images through posterior fossa are otherwise unremarkable and stable.Images through supratentorial space demonstrate a large area of vasogenic edema in the left posterior frontal area is some mass effect on the adjacent cortical sulci. There is no evidence of hemorrhage. Finding is highly suspected for malignancy and recommend further follow up with unenhanced brain MRI. Review of patient's prior PET scan from 5 -- 18 -- 11 indicates hypermetabolic tumor in the left upper lobe which makes the findings on this head CT more suspected for metastatic disease.Very few additional subcortical areas of low attenuation may represent small was ischemic strokes of indeterminate age. Possibility of additional metastatic foci however cannot be entirely excluded.The ventricular system are within normal size and midline is maintained.Calvarium, paranasal sinuses and mastoid air cells are unremarkable. There is evidence of an old blow out fracture of right lamina papyracea. This finding is best appreciated on coronal reformatted image 16.Above findings were reported to Dr. White Nicole #2663 via paging tool at the time of review of exam.

Output: 1.New vasogenic edema in the left posterior frontal lobe with focal mass effect. Finding is highly suspected of a metastatic lesion and recommend follow-up with enhanced imaging.2.Minimal small vessel disease.3.Calvarium is intact.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with severe spinal stenosis at C6-7 seen on MRI with right-sided neck pain. Status post prior neck fusion from C2 through C4. Evidence of posterior instrumented fusion is seen from C3 through C6, as well as laminectomy and spinal canal decompression from C3-4 to C5-6. The cervical lordosis is reversed. Findings are all similar to that seen on prior CT from 2011.Fusion of the C4 and C5 vertebral bodies is seen with waist-like narrowing at the level of the disc space. There may also be some partial fusion of the C5 and C6 vertebrae. No evidence of marrow edema or pathologic marrow replacement is seen. Artifact from the orthopedic instruments does limit the postcontrast images to some degree, but where evaluable, no evidence of pathologic marrow enhancement is seen.T2 hyperintensity is evident centrally within the cord at the C4 and C5 levels. Morphologically, this appears to represent myelomalacia involving the ventral and mid portions of the spinal cord. The cord is closely positioned to the ventral thecal sac which may indicate scarring or tethering. There are no findings to suggest active cord edema. Visualization of the spinal cord at the C4-5 level on postcontrast images is unfortunately obscured by metallic artifact. Elsewhere, no pathologic spinal cord enhancement is observed.A flap reconstruction of the pharynx is partially visualized.C2-3: Mild facet arthropathy. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Fusion across the disc space. Surgical decompression of the spinal canal. Moderate right and mild left neuroforaminal narrowing. C5-6: Perhaps partial fusion across the disc space. Minimal disc bulging and osteophytic ridging. Surgical decompression of the spinal canal. Both neural foramina may be narrowed, but they are not well assessed due to artifact. C6-7: Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild spinal canal stenosis without cord deformation. Mild to moderate bilateral foraminal narrowing. C7-T1: No significant spinal canal or foraminal stenosis.

Output: 1.Findings are seen compatible with posterior instrumented fusion and spinal canal decompression. The spinal canal is patent except at C6-7, where a combination of disc degeneration and ligamentum flavum thickening causes mild spinal canal stenosis.2.Spinal cord signal abnormality is seen at the C4-5 level. This appears to represent myelomalacia with perhaps a component of cord scarring or tethering to the ventral thecal sac. No prior MRI examination is available for comparison, but these findings are favored to be chronic in nature. The etiology is uncertain but lesions of this sort could potentially arise from prior cord impingement, prior surgery, ischemia or postradiation effect.


Instruction: Generate impression based on findings.

Input: Evaluate for spinal cord malformations: Capillary malformation over gluteal cleft with sacral dimple. 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 situated at the L1 vertebral body level. The paravertebral soft tissues are unremarkable.

Output: No evidence of malformations involving the lumbar spine. The capillary malformation in the gluteal cleft region is not discernible.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, with persistent bacteremia, history of discitis. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow edema or marrow replacement is detected. A right paracentral, superiorly directed disc extrusion at C3-4 impinges upon the spinal cord but causes no clear spinal cord edema. Elsewhere in the cervical region, only minimal disc degeneration is seen without high-grade spinal canal stenosis or cord impingement. Neuroforaminal narrowing is evident bilaterally at C3-4, on the left at C6, and on the left at C6-7. The spinal cord shows normal signal intensity throughout.Thoracic:On comparison with the prior examination, there is new T2 signal abnormality within the T8-9 intervertebral disc as well as new irregularity of the adjacent endplates along with worsened edema within the T8 and T9 vertebral bodies. There is edema in the adjacent left paraspinal soft tissues, but no discrete fluid collection is identified. Bulging of the T8-9 disc causes slight effacement of the ventral thecal sac but no high-grade spinal canal stenosis. The T8-9 neural foramina are narrowed. No discrete epidural fluid collection is seen. Minimal nonspecific signal abnormality is seen along the inferior T10 endplate. Vertebral body heights are preserved. Spinal alignment is anatomic. Incidental note is made of 13 rib bearing vertebral bodies. The spinal cord demonstrates normal signal intensity and morphology.Lumbar:Mild edema within the L2-3 vertebral bodies appears similar to the prior examination. The intervening disc, however, shows some loss of height with persistent abnormal disc T2 signal. No evidence of an associated epidural fluid collection is seen. The psoas musculature is less edematous and the previously demonstrated small fluid collection within the left psoas is no longer clearly appreciated. No new paraspinal collections are seen. No new areas of marrow or disc signal abnormality are detected. A right paracentral/foraminal disc protrusion at L2-3 is again seen. Facet arthropathy, ligamentum flavum thickening and disc bulging result in moderate spinal canal stenosis at L3-4 and moderate to severe canal stenosis at L4-5. Significant bilateral foraminal narrowing is demonstrated from L2-3 through L4-5. Alignment is anatomic. The kidneys are small and contain numerous cysts.

Output: 1.Persistent signal abnormality is seen within the L2-3 disc and vertebral bodies compatible with discitis-osteomyelitis. Although the disc demonstrates some interval loss of height, the overall extent of involvement is unchanged. A small suspected abscess within the left psoas muscle has resolved.2.Since the prior examination, findings consistent with discitis osteomyelitis have developed at the T8-9 level. No epidural or paraspinal abscess is suspected at this level.3.The cervical spine shows no evidence of infectious involvement. A disc extrusion at C3-4 is noted incidentally with associated mild spinal cord impingement.


Instruction: Generate impression based on findings.

Input: 22-year-old male with right leg weakness and lower lumbar midline tenderness to palpation. Concern for disk herniation.IMAGE ACQUISITIONS: CT lumbar spine without contrast. The exam is limited secondary to excessive amount of noise within the images, due to patient's large body habitus.Alignment is anatomic. Vertebral body heights are preserved. Partially visualized is a nonspecific lucency in the right aspect of the T11 vertebral body. MRI can be considered for further evaluation if clinically warranted.At L5/S1 there is a left paramedian disk protrusion that causes stenosis of the left lateral recess and likely impingement of the left S1 nerve root. Please correlate with clinical history and exam.

Output: 1. Left paramedian disk protrusion at L5/S1 causing spinal stenosis likely impinging the left S1 nerve root. Please correlate with clinical history and exam. MRI will be helpful for further evaluation of this level and the rest of the lumbar spine.2. Nonspecific lucency in the right aspect of the T11 vertebral body. MRI can be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for spinal stenosis or neural foraminal compromise. Signs and symptoms: Lower back pain worse on the right and radicular pain down right leg. Nonenhanced lumbar MRI:Examination demonstrates normal anatomical alignment of the vertebral column without change since prior exam.There is a new however chronic mild compression deformity of the superior endplate of L1 and L2 since prior exam.Lower most visualized thoracic spine demonstrate mild degenerative changes at T9-T10 and T10-T11 levels. There is mild right neural foraminal compromise at T10-T11 and left neural foraminal compromise at T9-T10 level.T11-T12 is unremarkable.T12-L1 demonstrate minimal degenerative changes and unremarkable otherwise.L1-L2 demonstrate mild degenerative changes with resultant mild left neural foraminal compromise.L2-L3 demonstrate mild disc disease and moderate left facet and bilateral ligamentum flavum hypertrophy. There is mild central spinal stenosis, significant left neural foraminal and mild right neural foraminal compromise. There is interval progression of disease at this level since prior study.L3-L4 demonstrate mild disc disease and loss of disc height, significant left facet and moderate right facet hypertrophy changes and moderate symmetrical bilateral ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis, significant left and mild right neural foraminal compromise. There is mild interval progression of disease at this level since prior study.L4-L5 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy, moderate left facet hypertrophy and mild on the right. There is no central spinal stenosis or neural foraminal compromise. There is slight progression of disease at this level and including increased T2 signal intensity of the articulating facet on the left and a small synovial cyst projecting lateral to the left facet complex.L5-S1 demonstrate mild to moderate disc disease and loss of disc height, mild bilateral ligamentum flavum and articulating facet hypertrophic changes. No central spinal stenosis however moderate left and mild to moderate right neural foraminal compromise is present. Mild progression of disease at this level since prior exam.

Output: 1.There is interval progression of degenerative disc disease and hypertrophic changes of posterior elements since prior exam.2.There are new however chronic mild compression deformities of the superior endplates of L1 and L2 since prior study.3.Degenerative changes at L3-L4 results in moderate central spinal stenosis with mild interval progression since prior exam. Significant left and mild right neural foraminal compromise is also present.4.At L2-L3 there is mild progression of degenerative disease with mild central spinal stenosis, significant left and mild right neural foraminal compromise.5.No spinal stenosis at other levels.6.Please review detailed report above regarding neural foraminal compromise in the lower most visualized thoracic spine and lumbar spine.


Instruction: Generate impression based on findings.

Input: Nontraumatic subdural hemorrhage. 4-month-old with macrocephaly, hydrocephalus and hypertonia. Evaluate for stroke, infection and hemorrhage. There is again marked enlargement of the lateral, third and fourth ventricles, with layering oblique collections within the occipital horns of the lateral ventricles and the fourth ventricle which restrict diffusion, with obliquity probably related to prior head position given plagiocephaly along the right occiput. There is no hemosiderin deposition within these collections on susceptibility weighted imaging to suggest hemorrhage. There is also diffuse ependymal enhancement.An extra-axial lentiform collection is identified along the left parietal convexity that causes mass effect on the brain parenchyma. The collection measures 12 mm in maximum thickness x approximately 3.5 cm AP, and restricts diffusion. There is a small rim of susceptibility posteromedially, which likely represents displaced and compressed vessels, rather than a small amount of blood products. There is associated localized mass effect without midline shift. There is also a trace right paramedian frontal subdural collection which restricts diffusion.There are scattered foci of susceptibility most conspicuous within the region of bilateral caudothalamic grooves and right cerebellum, that may represent microhemorrhage and/or mineralization. There is abnormal T2 hyperintensity involving the bilateral frontal, left greater than right temporal and right parietal white matter, which is difficult to evaluate due to brain compression by ventriculomegaly. No conspicuous associated volume loss is appreciated in these areas.There is abnormal T2 hyperintensity within the right cerebellum, with associated probable minimal leptomeningeal enhancement along the right cerebellar folia. This is best appreciated on the sagittal postcontrast images of the cervical spine. There is thick leptomeningeal enhancement involving the basal cisterns and along the brainstem, with prominent prepontine cistern collection. A rim enhancing collection measures approximately 25 x 10 mm, restricts diffusion and is contiguous with the dilated fourth ventricle. This collection arises just distal to the foramina of Luschka/Magendie, displaces the compressed brainstem ventrally and displaces the cerebellum superiorly. The major cerebral flow voids are intact. There is bilateral enophthalmos. There is no evidence of fracture.There is thick diffuse leptomeningeal enhancement along the entire visualized spinal cord down to at least T6, with visible extension the dorsal nerve roots especially on the upper thoracic levels. The spinal cord appears mildly expanded with abnormal diffuse central T2 hyperintense signal extending from the craniocervical junction to C5. There is heterogeneous signal throughout the subarachnoid space diffusely along the visualized spinal canal. There is focal prominence of the epidural space at C2-3 with abnormal T2 hypointense signal, although this is favored to represent engorged venous structures rather than a true epidural collection.Normal alignment of the cervical spine is maintained. The airway remains patent. The major cervical vessels are patent. There is no suspicious osseous lesion.

Output: 1.Diffuse ependymal enhancement. Thick leptomeningeal enhancement along the basal cisterns, brainstem, possibly the right cerebellar folia and along the entire visualized spinal cord down to the C6 level. Findings are most consistent with diffuse likely chronic meningitis and ventriculitis, palpable with gram-negative rods resulting from lumbar puncture. If clinically indicated, additional MR imaging of the remaining thoracic and lumbar spine may be helpful.2.Left lateral parietal epidural abscess/empyema with localized mass effect.3.Additional non-diffusion restricting peripherally enhancing collections emanating from the fourth ventricular outflow, contributing to compression of the upper cervical spinal cord and brainstem. 4.T2 hyperintense signal within a mildly expanded cord at C2-C5. Differential diagnosis includes infection/inflammation, versus less likely ischemic or demyelinating etiologies.5.Severe ventriculomegaly with layering debris demonstrating associated restricted diffusion, compatible with pus. Findings may represent a combination of obstructive and nonobstructive chronic hydrocephalus, as there is no significant transependymal edema.6.Scattered foci of susceptibility, most conspicuous in the region of the bilateral caudothalamic grooves and right cerebellum, may represent mineralization versus microhemorrhage.7.Areas of vasogenic pattern of T2 hyperintensity involving scattered cerebral white matter, which may represent a combination of gliosis and/or edema. More focal abnormal signal and the right cerebellum may represent additional parenchymal infection/inflammation associated given associated mild leptomeningeal enhancement.8.Probable enophthalmos, correlate clinically.Findings discussed with Dr. Lander at 8:30 AM on 10/18/2016.


Instruction: Generate impression based on findings.

Input: Right cerebellopontine angle cistern tumor treatment planning. There is an extraaxial, enhancing mass centered in the right cerebellopontine angle cistern, with extension into the internal auditory canal, which measures 20 mm AP x 28 mm RL x 15 mm SI. There is mild mass effect upon the right brainstem and cerebellar hemisphere. There is encephalomalacia in the left middle and inferior frontal gyri, small areas of encephalomalacia in the bilateral basal ganglia and corona radiata, and patchy areas of periventricular white matter T2 hyperintensity in the bilateral frontal lobes. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: 1. Preoperative planning MRI for a right vestibular schwannoma that measures up to 28 mm.2. Chronic left frontal lobe and bilateral corona radiata and basal ganglia lacunar infarcts, superimposed upon an background of probable chronic small vessel ischemic disease, although incompletely characterized on this limit planning MRI.


Instruction: Generate impression based on findings.

Input: 50 year old man with heart/kidney transplant on 10/22/15, referred for serial MRI as part screening for cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. Normal LV wall thickness (9mm), which is less than the last study. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the is 142 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 50 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 133 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Quantitatively, the myocardial to skeletal T2-enhancement ratio is 1.42, which is in the normal range. The global relative enhancement is 2.9, which is in the normal range. The native myocardial T1 time in the interventricular septum is 1140ms, which is elevated and may indicate edema or fibrosis, but this value measures lower than on the previous study. The extra-cellular volume fraction (ECV) is 31%, which is elevated but decreased from previously. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 145 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is a possible SVC catheter versus laminar thrombus noted.PericardiumThere is a trivial pericardial effusion. There is increased signal in the pericardium on T2-STIR and late gadolinium imaging which suggests edema and inflammation of the pericardium, consistent with a post-surgical state. Extracardiac FindingsSternal wires are present. There is diffuse low signal of the liver and spleen, which was seen on the previous study. 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 with normal systolic function. The overall LV ejection fraction is 65%. This is unchanged compared to the previous exam.2. The myocardial to skeletal T2 ratio and global relative enhancement are normal. There is no late gadolinium enhancement. These findings all speak against acute rejection. The wall thickness is now also normal. The native myocardial T1 time and the extracellular volume fraction are elevated but improving as expected in the early post-transplant period. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%. This is unchanged compared to the previous exam. 4. Possible SVC catheter versus thrombus. 5. Increased T2-STIR signal and gadolinium enhancement of the pericardium, possibly consistent with post-surgical pericarditis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 82 year old with history of hypothyroidism, T2DM, ?amyloid (hyperglobulinemia) who presents from OSH for workup heart failure. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. There is LV hypertrophy (14-17 mm). The overall LV ejection fraction is 36%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 115 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19). The left ventricular dysfunction is global. The late gadolinium enhancement images reveal diffuse transmural Gd enhancement. This is a finding that is typical for amyloidosis. Additional supportive findings include: Inability to completely null the myocardium on LL series. Elevated native T1 times at 1174 ms (normal < 1050 ms). MArked delayed enhancement of the atrial wall. Delayed enhancement in the RV wall.Left AtriumThe left atrium is moderate-severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function . There is right ventricular hypertrophy. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary Veins3 pulmonary veins drain normally into the left atrium (LUPV not well seen)Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsBilateral interstitial markings at lung bases. 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 with moderately reduced systolic function and severe LVH (LVEF 36%) The left ventricular dysfunction is global. The late gadolinium enhancement images reveal diffuse transmural Gd enhancement. This is a finding that is typical for amyloidosis. Additional supportive findings include: Inability to completely null the myocardium on LL series. Elevated native T1 times at 1174 ms (normal < 1050 ms). MArked delayed enhancement of the atrial wall. Delayed enhancement in the RV wall.2. The right ventricle is normal in size with moderately reduced systolic function . There is right ventricular hypertrophy. The overall RV ejection fraction is 31%. 3. There is a small pericardial effusion


Instruction: Generate impression based on findings.

Input: 60 years Male (DOB:7/24/1955)Reason: Acute ishcmeic stroke History: acute ischemic strokePROVIDER/ATTENDING NAME: IMRE T NOTH IMRE T NOTH MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Patchy foci of diffusion restriction associated with FLAIR signal hyperintensity are present along the watershed zones of both right and left hemispheres. The infarctions are larger on the right versus the left side. Several punctate foci of diffusion restriction are present in the right temporal lobe and left temporal lobe.There is redemonstration of a 9mm signal hypointense nodule at the anterior superior aspect of the third ventricle.Several punctate foci of T2 and FLAIR signal hyperintensity are present in the thalami, brainstem and basal ganglia.A punctate focus of decreased signal on SWI imaging is present most likely representing an isolated microhemorrhage.The left ICA flow void is partially absent on the left.Normal vascular flow voids are present in the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 a central disk protrusion associated with ligamentum flavum hypertrophy and effacement of CSF ventral and posterior to the spinal cord. Overall there is mild to moderate spinal stenosis at this level.At C4-5 there is a central disk extrusion associated with ligamentum flavum hypertrophy and effacement of CSF ventral and posterior to the spinal cord. There is mild deformity of the cord at this level. Overall there is moderate spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal. There is a disk bulge at this level. There is loss of disk space height at this level. There are end-plate and uncovertebral osteophytes at this level with encroachment of exiting nerve roots bilaterally.At C6-7 there is no significant compromise to the spinal canal .There are end-plate and uncovertebral osteophytes at this level with encroachment of the left exiting nerve roots. There is a disk bulge at this level. At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Bilateral acute watershed distribution infarctions involving the left hemisphere more than the right primarily involving frontal and parietal lobes with minor involvement of the right temporal lobe and left temporal lobe.2.Colloid cyst has been demonstrated on prior exam.3.Multilevel degenerative changes mainly due to disk disease resulting in moderate stenosis at C4-5 and mild to moderate stenosis at C3-4 and encroachment of exiting nerve roots on the left at C6-7 and bilaterally at C5-64.Small lesions in the thalami, brainstem and basal ganglia are most likely vascular related.5.Findings raise the question of inctracranial left ICA stenosis/occlusion. MRA or CT may be helpful in further evaluating this.


Instruction: Generate impression based on findings.

Input: Left lower extremity weakness. Evaluate for hematoma. Thoracic: There is mild loss of height/compression deformity involving the T7 vertebral body including Schmorl's node in its superior aspect, similar to prior and without evidence of edema. Thoracic vertebral body heights are otherwise maintained. Alignment is maintained with mild kyphosis with apex at the T7 level. Bone marrow signal is benign with no suspicious lesions. Mild degenerative changes are seen with trace disc bulges at the T7-T8 and T6-T7 levels with mild spinal canal stenosis at this level. No findings to suggest high-grade spinal canal stenosis at any level in the thoracic spine. Thoracic cord is normal in signal and contour. There is moderate left and mild right neural foraminal stenosis at the T10-T11 level. Remainder of the neural foramina are patent.Lumbar: Five lumbar type vertebral bodies are presumed to be present. Postsurgical changes of laminectomy and fusion are seen from L2 to L5 with posterior spinal fusion hardware and interbody spacers grossly appearing in adequate position. There is mild stenosis/effacement of the thecal sac at the L3-L4 and moderate at L4-L5 level which is suboptimally assessed due to artifact from the hardware. There is no higher grade spinal canal stenosis in the lumbar spine. No epidural hematoma is evident within the limitations of the artifact.Neural foramina also not well evaluated due to susceptibility artifact related to the pedicle screws. The bilateral L1-L2, L2-L3, and L5-S1 neural foramina are patent. Mild to moderate neural foraminal stenosis is suspected at L3-4 and L4-L5 related to mild disc bulge and facet arthropathy.Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Paraspinous soft tissues demonstrate expected postsurgical changes without large fluid collections or hematomas.

Output: 1. Interval postsurgical changes of L2 to L5 lumbar fusion. No epidural hematoma is evident. 2. Compared to MRI from 4/29/2015, there appears to be some increased (mild to moderate) narrowing of the spinal canal at L3-L4 and L4-L5 levels related to combination of epidural fat, facet arthropathy, and congenital narrowing, with susceptibility artifact from hardware also contributing to the apparent worsened stenosis. Patient has had decompressive laminectomies at these levels previously. Mild to moderate neural foraminal narrowing at L3-L4 and L4-L5 is also suspected bilaterally but not well evaluated due to susceptibility artifact from the hardware.3. Mild spinal canal stenosis at the T7-T8 level related to combination of congenital narrowing, small disc bulge, and kyphosis. No high-grade spinal canal stenosis is evident. No cord signal abnormality. There is moderate left T10-T11 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. At L3-L4, there is been interval development of mild disc desiccation and disc bulge as well as mild facet arthropathy and ligamentum flavum thickening but without spinal canal or neural foramen stenosis. At L4-L5, there is slightly worsened disc desiccation, unchanged rightward disc bulge, and slightly progressed facet arthropathy but without significant spinal canal or neural foramen stenosis. At L5-S1 there is slightly progressed disc desiccation and loss of disc height, unchanged leftward disc bulge and a superimposed small central disc extrusion, and slightly progressed facet arthropathy. These findings result in unchanged mild left neural foramen stenosis but no significant spinal canal stenosis.

Output: 1. No evidence of demyelinating lesions in the inferior spinal cord.2. Overall slightly progressed lumbar spine degenerative changes most pronounced at L5-S1 where there is a grossly unchanged small central disc extrusion.


Instruction: Generate impression based on findings.

Input: 51-year-old female with ulnar-sided pain. Evaluate triangular fibrocartilage complex. Evaluation of the wrist, including the triangular fibrocartilage complex, is extremely limited due to metallic susceptibility artifact from an orthopedic screw affixing the scaphoid and lunate. On T1-weighted images, the radial fibers of the articular disc of the triangular fibrocartilage are distorted by metallic susceptibility artifact; the ulnar fibers are largely replaced with intermediate signal intensity, likely representing extensive degeneration or tearing. The triangular fibrocartilage complex is not well visualized on the fluid sensitive sequences on account of the aforementioned metallic susceptibility artifact. There is a small amount of fluid within the distal radioulnar joint. Evaluation of the intrinsic ligaments is limited due to metallic susceptibility artifact. The visualized bone marrow signal intensity is within normal limits.

Output: Extremely limited study due to extensive metallic susceptibility artifact. The ulnar fibers of the articular disc of the triangular fibrocartilage are replaced with intermediate signal on the T1-weighted images suggesting tearing or severe degeneration.


Instruction: Generate impression based on findings.

Input: 20-year-old male with hypertension ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No adrenal mass is evident.KIDNEYS, URETERS: Suboptimal MRA reveals no significant stenosis of the renal arteries bilaterally. The kidneys enhance symmetrically. No focal lesions or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel caliber is within normal limits without evidence of obstruction. The appendix is well visualized and within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suboptimal MRA reveals no significant stenosis of the renal arteries bilaterally. The patient can be asked to return for reimaging at no additional cost.2.No adrenal mass is evident. The kidneys are symmetric and normal in appearance.


Instruction: Generate impression based on findings.

Input: New thoracic and lumbar spine pain. History of heart transplant in 2012. Thoracic:Thoracic vertebral body heights are maintained. Alignment is maintained. Bone marrow signal is benign with no suspicious lesions. There are minimal degenerative changes including mild facet arthropathy in the lower thoracic spine.Thoracic cord is normal in signal and contour. No significant spinal canal or neural foraminal stenosis is seen. Lumbar:Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disk bulge eccentric to the right with minimal right neural foraminal stenosis. No spinal canal or left neural foraminal stenosis.L4-L5: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L5-S1: Minimal disk bulge. No spinal canal or neural foraminal stenosis. Minimal facet arthropathy in the lumbar spine. Paraspinous soft tissues are within normal limits.

Output: Minimal degenerative changes in the thoracic and lumbar spine as described above within normal limits for age. Examination is otherwise unremarkable. No significant spinal canal or neural foramina stenosis. No compression fractures.


Instruction: Generate impression based on findings.

Input: Seizures. There is a punctate lesion in the left anteromedial thalamus. There is no evidence of intracranial hemorrhage or acute infarct. 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: Nonspecific punctate lesion in the left anteromedial thalamus. Follow up via a brain MRI with contrast may be useful for further characterization.


Instruction: Generate impression based on findings.

Input: Recurrent events suggestive of brainstem ischemia. Most recently double vision for two weeks. Enhanced CTA of intracranial circulation :65 cc of Omnipaque 350 is administered.3-D reformatted images were obtained utilizing an independent workstation and where utilized for interpretation.There are patent and normal appearing bilateral intracranial vertebral arteries, bilateral pica branches, basilar artery, posterior cerebral arteries and superior cerebellar arteries.There is normal anatomical variation of the left superior cerebellar artery arising from proximal left posterior cerebral artery.There are also patent bilateral internal carotid arteries across the skull base. The supraclinoid components of internal carotid arteries are unremarkable. Both anterior and middle cerebral arteries are visualized. There is focal slight ectasia of the proximal A2 components of the left anterior cerebral artery. The exact etiology of this finding is not clear. There is also no evidence of any additional foci of muscular cavitation. The finding could be secondary to atherosclerotic disease. Recommend follow-up.CTA of neck:Limited view of lower tic arch and the origins of the major vessels are unremarkable. There is anatomical variation a bovine arch evident by left common carotid artery arising from the cephalic branch.There are normal bilateral common carotid arteries, internal carotid arteries and including their origins.There is also normal appearing bilateral vertebral arteries and including their origins.Nonenhanced head CT:There is no detectable intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns all remain within normal limits. There are bilateral parietal subtle linear low attenuation that are suspected for perivascular spaces. Remote possibility of small vessel ischemic disease cannot be ruled out.Considering provided clinical data recommend an MRI examination for better evaluation.

Output: 1.Non-infused head CT is unremarkable. Considering provided clinical data and patient's symptomatology recommend brain MRI examination for further assessment.2.Unremarkable CTA of neck.3.CTA of intracranial circulation demonstrates a focal segmental dilatation of proximal left A2 segment of anterior cerebral artery. The exact etiology of this finding is not clear. Finding however could represent atherosclerotic disease. Recommend further follow.4.Unremarkable CTA of intracranial circulation otherwise.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology. Normally distended gallbladder. No intra or extrahepatic biliary ductal dilatation. Large volume of perihepatic ascites.Interval segment 5 ablation with the ablation cavity measuring approximately 3.0 x 1.9 cm (series 10/43). Along the anteromedial and caudal aspect of the ablation cavity there is a 2.0 x 1.6 cm arterial enhancing lesion (series 9/46) which demonstrates subtle washout (series 10/44) compatible with residual tumor.In segment 7 of the liver there is a 1.3 x 1.0 cm lesion seen on 3 minute delayed phase imaging as a hypointense lesion with a subtle capsule (series 10/31). In retrospect it may have been present previously but is increased in size. No definite arterial enhancement.SPLEEN: The spleen measures 13.6 cm in craniocaudal dimension.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: Large volume ascites.BONES, SOFT TISSUES: Bilateral at least moderate size pleural effusions.OTHER: No significant abnormality noted.

Output: 1.Status post segment 5 ablation with a marginal 2.0 cm lesion with features meeting imaging criteria for HCC.2.Increased size of a segment 7 1.3 x 1.0 cm lesion which is hypointense on delayed phase imaging with a subtle capsule but no definite arterial enhancement. Although this does not meet HCC imaging criteria it is nevertheless highly suspicious for HCC (A small subset of HCC present with washout without arterial enhancement).3.Cirrhosis with stigmata of portal hypertension including mild splenomegaly and large volume ascites.


Instruction: Generate impression based on findings.

Input: Known breast cancer brain metastasis follow-up. Interval increase the extent of high signal intensities around metastatic nodules on FLAIR images especially on the left parietal lobe inferior parietal lobule lesions and superior parietal lobule on the left postcentral gyrus.The left inferior parietal lobule, supramarginal gyrus enhancing lesion shows subtle interval increase in size (7.7mm x 15mm from 6.4mm x 11.1mm) and increased extent of susceptibility artifacts on gradient echo images. Another left parietal lobe metastatic lesion just adjacent to the left parieto-occipital sulcus shows more prominent susceptibility artifacts indicating possible increased extent of intralesional hemorrhages.Other multiple scattered bihemispheric metastatic nodules appear to be stable in terms of size and enhancement pattern as well as other MR characteristics.Multiple patch high signal intensities around periventricular white matter indicating nonspecific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval increase in size of metastatic nodules, development of intralesional hemorrhages with increased extent of surrounding edema on the left parietal lobe lesions on both superior and inferior parietal lobule as described above.2. Other metastatic lesions appear to be stable in terms of size and MR characteristics.3. No change of non specific small vessel disease.


Instruction: Generate impression based on findings.

Input: 73 year-old male pancreatic lesion incidentally found a chest CT ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. No suspicious lesions. No intra or extrahepatic biliary ductal dictation. SPLEEN: No significant abnormality.PANCREAS: Cystic lesion within the far distal pancreatic tail appears to communicate with the pancreatic duct measuring 1.1 x 0.6 cm (4/18). Lesion appears to arise as extension of the duct. There is an additional 3 mm lesion within the pancreatic body adjacent to the duct (9/33). No associated enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent portacaval node measuring 1.3 x 1.0 cm.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cystic lesion seen on prior CT most likely represents an IPMN. The lesion appears to arise as an extension of the duct, therefore the differentiation of side branch and main duct type IPMN is difficult. Recommend imaging follow-up in 6 months.


Instruction: Generate impression based on findings.

Input: 65-year-old man with painful left side Horner's syndrome. History of lung cancer status post surgery, chemotherapy and radiation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged scattered punctate foci of white matter T2 hyperintensity. There is unchanged encephalomalacia in the left occipital lobe. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact.Neck: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is an asymmetric appearance of the left internal carotid artery flow void, with areas of higher intraluminal signal. The osseous structures are unremarkable. The airways are patent. There is left apical scarring.

Output: 1.No evidence of metastatic disease in the head or neck, although portion of the neck are obscured by artifact on certain sequences.2.Unchanged minimal chronic small vessel ischemic disease and left occipital lobe cortical encephalomalacia.3. Asymmetric appearance of the left internal carotid artery flow void may be attributable to artifact or atherosclerotic plaque, although a dissection cannot be excluded. However, if there is persistent concern for dissection, dedicated vascular imaging is recommended.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, with history of lung cancer and new complaint of spinal pain. Cervical:Progressive marrow replacing signal abnormality is seen within the right occipital condyle and adjacent lateral mass of C1, as well as the bilateral C2 laminae and spinous process, with additional areas of marrow replacement in at least the C5 and C7 vertebral bodies. No evidence of pathologic epidural or intrathecal enhancement is seen.Trace retrolisthesis of C4 relative to C5 and C5 relative to C6 are demonstrated. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved.C2-3: Central disk extrusion without significant generalized spinal canal and neuroforaminal stenosis. No interval changes.C3-4: Left facet hypertrophy. Posterior disk osteophyte slightly asymmetric to the right with perhaps a small central protrusion. No significant generalized spinal canal stenosis. Mild right neuroforaminal narrowing. No interval changes.C4-5: Posterior disk osteophyte complex asymmetric to the left with a superimposed central protrusion. Mild to moderate spinal canal stenosis is seen with minimal ventral cord deformation, not changed from prior. Moderate left and mild right neuroforaminal narrowing. No interval changes.C5-6: Facet hypertrophy. Posterior disk osteophyte complex. Moderate generalized spinal canal stenosis with flattening of ventral cord. Moderate to severe bilateral foraminal narrowing. No interval changes.C6-7: Posterior disk osteophyte complex. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No interval changes.C7-T1: Facet hypertrophy. No significant disk disease, spinal canal or neuroforaminal stenosis. Thoracic:Progression of metastatic disease is again seen with new or larger areas of marrow replacing signal abnormality in most of the thoracic vertebral bodies. This includes essentially complete replacement of the T4 and T6 vertebral body marrow, with significant involvement of T7, T8, T10 and T12 as well. Mild compressions of the T4 through T6 and T12 vertebral bodies are probably not significantly changed.On postcontrast imaging, there is the suggestion of minimal ventral epidural tumor spread at least on the left at T6, and on the right at T8-9. These suspected areas of epidural involvement cause no significant canal stenosis or mass effect on the cord.Significant level specific findings are as follows:T1-2: Small right paracentral disk protrusion. No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes.T2-3: Facet hypertrophy on the left with mild left neuroforaminal narrowing. No interval changes.T7-8: Central disk extrusion without significant spinal canal or neuroforaminal stenosis. No interval changes. T8-9: Central disk extrusion without significant spinal canal or neuroforaminal stenosis. No interval changes. Progressive mediastinal adenopathy is also seen, including a subcarinal mass which measures 30 x 20 mm on the present study which was not detectable on the prior study. Lumbar:Multiple areas of marrow replacing signal abnormality are demonstrated, most conspicuously within the L2 vertebral body and pedicle on the left and within the left aspect of the S1 S1 vertebral body where there are multiple foci on both sides. A lesion is also partially visualized in the right iliac bone. Numerous smaller lesions are also suspected within the remaining vertebral levels and elsewhere in the visualized pelvis. While disease in the L2 vertebral body may not have significantly progressed, disease in the sacrum and small foci scattered throughout remaining levels have clearly progressed.On postcontrast images, no definite evidence of significant epidural disease extension is seen. However, a new subcentimeter nodule of enhancement is evident within the left aspect of the cauda equina at the L2 level, and also probably more inferiorly at the L4-5 level.Spinal alignment is anatomic. Vertebral body heights are preserved. Disk heights are grossly preserved. Facet and ligamentum flavum hypertrophy develop at lower levels becoming quite severe at L5-S1. Disk bulging is seen at L3-4 and L4-5. This results in narrowing of the left lateral recess and moderate bilateral foraminal narrowing at L4-5, but no significant generalized spinal canal stenosis. Small renal cystic lesions are demonstrated in the left.

Output: 1. Progression of marrow space metastatic disease as discussed above.2. Minimal epidural tumor extension is suspected in the thoracic spine without significant spinal canal encroachment.3. Two new intradural enhancing nodules are evident along the nerve roots of the cauda equina at the L2 and L4-5 levels concerning for intradural metastases.4. Progressive mediastinal adenopathy.


Instruction: Generate impression based on findings.

Input: 84-year-old female with history of hypertension, history of craniotomy with vascular clipping. Presents with aphasia. Rule out acute stroke. Large vessel intracranial vascular calcification is noted. Extensive metallic artifact limiting from the aneurysm clip on the left is again identified which obscures large area of the study. There is a new large area of low-density within the right thalamus and possibly in the right periventricular frontal which are suspected for acute stroke. Further evaluation with an MRI is recommended.No hemorrhage, mass-effect, hydrocephalus or midline shift is present. The above findings were relayed to pager number 3648 at the time of interpretation.

Output: Suspect nonhemorrhagic acute right thalamic and right frontal periventricular white matter infarcts.


Instruction: Generate impression based on findings.

Input: There are findings compatible with Klippel-Feil syndrome with multilevel cervical fusion anomalies including butterfly and hemivertebrae, as well as multiple vertebrae that are shortened in the anteroposterior dimension. There is also multilevel level segmentation anomaly involving the mid thoracic spine with two hemivertebra. There is a mild apex rightward curvature centered at the cervicothoracic junction. There appear to be 12 ribs bilaterally. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at the inferior L2 endplate level. There are postoperative findings related to prior cord untethering with a transected fibrofatty filum. There is a partly imaged horseshoe kidney. The paravertebral soft tissues are otherwise unremarkable.

Output: 1. Multilevel cervical and thoracic segmental and fusion anomalies related to Klippel-Feil syndrome with associated scoliosis, but no significant spinal stenosis.2. Postoperative findings related to prior cord untethering with a transected fibrofatty filum.3. Horseshoe kidney.


Instruction: Generate impression based on findings.

Input: 70 year-old female with left upper extremity weakness. Evaluate for stroke. Again noted is a linear hypodensity in the region of the body of the left caudate which appears unchanged when compared to the previous study. This likely represents an old lacunar infarct of indeterminate age. Additional hypoattenuating areas near the right basal ganglia and in the periventricular white matter are again noted which appear unchanged when compared to the previous study. These findings are nonspecific but likely represent mild small vessel ischemic disease of indeterminate age. Additionally, there is severe atherosclerotic changes of the vertebral arteries bilaterally and the cavernous internal carotid arteries.Hypodensity in the high convexity of the right frontoparietal lobe as well as in the right posterior temporal lobe. These findings are age indeterminate but likely represent subacute ischemic infarct in the territory of the right cerebral artery. Further evaluation with MRI is recommended. There is no evidence of intracranial hemorrhage, midline shift or mass. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Hypodensities in the right frontoparietal lobe as well as in the right posterior temporal lobe. These findings are age indeterminate but are consistent with early to late subacute ischemic infarct in the territory of the right cerebral artery. Further evaluation with MRI is recommended if clinically indicated. There is no evidence of intracranial hemorrhage, midline shift or mass. These findings were relayed to Dr. Beverage via direct phone call at the time of dictation.2. Lacunar infarct involving the right basal ganglia which appears unchanged compared to previous study.3. Hypoattenuating areas near the right basal ganglia and in the periventricular white matter which appear unchanged when compared to the previous study. These findings are nonspecific but likely represent mild small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 73-year-old female with neck pain. Evaluate for osteoarthritis. 6 views of the cervical spine are provided. There is moderate degenerative disk disease throughout the cervical spine from C3-T1. There is mild multilevel facet degenerative disease. There is grade 1 anterolisthesis of C3 on C4. There is also multilevel mild-moderate neuroforaminal narrowing bilaterally.

Output: Degenerative arthritic changes as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out hemorrhage. Signs and symptoms: Facial droop. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.All visualized paranasal sinuses and bilateral mastoid air cells/middle ear cavities are well pneumatized.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on findings.

Input: 18-year-old male with pineal mass, primarily germinoma of the pineal gland. There has been no significant interval change in the irregular residual pineal gland region enhancement, which again measures up to approximately 9 mm. In maximal dimension (as measured on sagittal T1 postcontrast technique) There are postoperative findings related to endoscopic third ventriculostomy. There is redemonstration of a small stable area of susceptibility along the body of the right lateral ventricle and the adjacent periventricular white matter with a linear tract extending up to the right frontal burr hole with marginal FLAIR hyperintensity, consistent with previous biopsy. Foci of susceptibility are also identified along the right ventricular atrium, unchanged, likely relating to chronic hemosiderin deposition. The ventricles are unchanged in size and configuration. Patchy areas of T2/FLAIR hyperintensity within the periventricular white matter bilaterally are unchanged, which may in part relate to prominent perivascular spaces and associated minimal gliosis. There is no evidence of acute infarction. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: There has been no significant interval change in the irregular residual pineal gland region enhancement.


Instruction: Generate impression based on findings.

Input: 59-year-old female with history of pain in the first metatarsal of the right foot with mass visualized at fibular sesamoid on plain radiographs. Bone marrow signal is normal. On postcontrast imaging, there is no evidence of enhancing lesion, specifically within the sesamoids. Soft tissues are within normal limits. Mild degenerative changes are present at the first metatarsophalangeal joint.

Output: Mild degenerative changes without evidence of enhancing mass.


Instruction: Generate impression based on findings.

Input: A 48 year old female with history of hypertension, obesity, asthma and depression, now hospitalized with new biventricular systolic dysfunction. A chest CT showed suspected right atrial clot. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 113 ml/m2 (normal range: 65+/-11), the LVEDV is 257 ml (normal range 109+/-23), the LV end systolic volume index is 83 ml/m2 (normal range 18+/-5), the LVESV is 190 ml (normal range 31+/-10), the LV mass index is 79 g/m2 (normal range 67+/-11), and the LV mass is 180 g (normal range 114+/-24). There is global severe hypokinesis. There is a focus of enhancement at the apical two thirds of the inferior wall. A channel containing contrast is not visualized on the study state free precession cine images and; therefore, does not appear to represent a diverticulum. It is suspicious for a focal infarct, approximately 70% wall thickness.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 25%, the RV end diastolic volume index is 124 ml/m2 (normal range 69+/-14), the RVEDV is 282 ml (normal range 110+/-24), the RV end systolic volume index is 93 ml/m2 (normal range 22+/-8), and the RVESV is 211 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Particular attention is paid to the abnormality recently identified on the chest CT at the posterior wall of the right atrium. While dedicated, contiguous cine 4 chamber images were performed, the patient requested the examination to be terminated before further characterization of this structure could be made. On axial cine series 1601, image 414, this appears to be a single, pedunculated structure arising from the posterior wall of the right atrium, adjacent to trabeculation (8 x 11 mm). A separate crista terminalis is not visualized. Therefore, the differential considerations include a prominent crista terminalis. Less likely, this may represent a small myxoma or a sessile thrombus, if the patient has had indwelling previous catheter. If further dedicated imaging is requested, this can be performed with a cardiac MRI at no additional charge to the patient. Alternatively, an ECG gated CT with limited z-axis coverage can be performed.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsRight sided pulmonary high signal within the parenchyma is suggestive of pneumonia, better characterized on recent CT. Minimal left-sided perihilar high signal may represent additional focus of infection. There is evidence of right hilar lymphadenopathy. Small right pleural effusion.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function, the LVEF is 26%. There is global severe hypokinesis. 2. Focus of high signal on delayed viability sequences at the apical two thirds of the inferior wall is most suggestive of infarct, approximately 75% wall thickness.3. The right atrium is severely dilated. There is a pedunculated structure arising from the posterior wall of the right atrium. A separate crista terminalis is not visualized. Differential considerations include a prominent crista terminalis. If the patient has had indwelling catheter, a sessile thrombus may be considered but is considered less likely. A small myxoma can have a similar appearance but is also considered less likely. If further imaging is required, either dedicated MR imaging or a motility axis ECG gated CT imaging can be performed. The left atrium is moderately dilated. 4. The right ventricle is severely dilated with severely reduced systolic function, the RVEF is 25%. 5. There is mild tricuspid regurgitation.


Instruction: Generate impression based on findings.

Input: Female, 27 years old, 27 weeks gestational age, with fetal brain lesion identified on ultrasound. A space occupying lesion is present centered on the right ambient cistern measuring 22 x 18 x 16 mm. The lesion displaces adjacent structures including the right thalamus, internal cerebral veins, right medial temporal lobe, and brainstem, without clearly arising from any of them. As such, the lesion could potentially be extra-axial. The margins of the lesion are well circumscribed without evidence of parenchymal infiltration or edema. Internally, the lesion is homogeneously T2 hyperintense and markedly T1 hyperintense, with a moderate degree of restricted diffusion. The margins of the lesion show susceptibility effect, with little if any susceptibility internally.Brain parenchymal morphology, and the degree of sulcal development, are appropriate for gestational age. The corpus callosum is present and within normal limits. The cavum septum pellucidum is present. The left ventricular atrium measures top normal in size at 10 mm, but the remainder of the ventricular system is within normal limits. The posterior fossa structures are unremarkable. The right globe is hypoplastic or absent with dysmorphic or rudimentary orbital structures.

Output: A well circumscribed, space occupying lesion is present centered on the right ambient cistern. The lesion displaces adjacent structures without infiltration or parenchymal edema. The origin of the lesion is not clear, but it could potentially be extra-axial. Internally, the lesion is homogeneous and T2 hyperintense, but also markedly T1 hyperintense with rim susceptibility. This could indicate hemorrhagic products, fatty material, or viscous/proteinaceous material.The differential for this lesion remains broad, but overall, the characteristics are relatively non-aggressive, and as such, a benign etiology is favored. The lesion could represent pure hemorrhage, or a hemorrhagic cyst. Developmental cysts including epidermoid and dermoid should be considered as well. A neoplastic process is not excluded, though the imaging features on the present study are not typical of a teratoma, which would be the most common fetal tumor. Also noted is hypoplasia or absence of the right globe, with dysmorphic/rudimentary orbital structures. Please note that this interpretation is made without the benefit of comparison to ultrasound images. As soon as these images can be obtained, a comparison will be made, and if a change to the interpretation is warranted, an addendum to this report will be issued.


Instruction: Generate impression based on findings.

Input: Meningeal irritation, evaluate for infectious process, structural cause for subdural hematoma, evaluate for aneurysm or other vascular abnormality, evaluate for extracranial vascular abnormalities MRI brain: There are bilateral subdural hematomas left larger than right with mild diffuse prominence of the overlying dura. There local mass effect and sulcal effacement and slight midline shift to the right of approximately 4 mm. There is no diffusion restriction or thick rim enhancement of the subdural collections. There is a nonspecific punctate focus of susceptibility effect in the left cerebellum, which may be from prior microhemorrhage. There is no evidence of acute cerebral infarction. The brain parenchyma appears grossly unremarkable. There is no evidence of intracranial mass lesions. There is no abnormal leptomeningeal enhancement. There is mild mucosal thickening in the paranasal sinuses. The orbits are unremarkable.MRA brain: The intracranial arteries appear intact without evidence of aneurysm, stenosis, or dissection. The left vertebral artery terminates in the PICA, which represents a normal variant.MRA neck: There is conventional origin of the arch vessels. The carotid and vertebral arteries appear intact without aneurysm, stenosis, or dissection.

Output: 1. Bilateral subacute subdural hematomas with no change in associated midline shift.2. Mild dural reaction overlying the subdural hematomas, but no evidence of abnormal leptomeningeal enhancement or cerebral abscess.3. No evidence of aneurysm, stenosis, or dissection of the intracranial and cervical arteriesI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left temporal skull mass and pain. History of neurofibromatosis type I. There is a well-circumscribed, lobulated left temporal scalp mass. The mass is closely related to or within the temporalis muscle. The main bulk of the mass is composed of multiple smaller nodules that are peripherally T2 hyperintense and centrally T1-hypointense (target sign). The nodules show intense, heterogeneous contrast enhancement. The main bulk of the mass collectively measures in the axial plane 4.9 cm x 1.6 cm and craniocaudally 4.4 cm. Smaller similar masses are present superficial to the temporalis muscle. In addition to this well-circumscribed component, the left temporalis muscle shows diffuse abnormal signal and contrast enhancement which tapers distally, perhaps though not definitively reflective of infiltration. While the underlying skull is not infiltrated/invaded, the mass extends inferiorly to cause chronic remodeling of the lateral aspect of the temporal bone without deep infiltration. It causes mass effect on the external auditory canal as well. The brain shows no abnormality but this is a limited assessment. The dural venous sinuses are patent. Major intracranial arteries are patent as well. There is no orbital abnormality. There are no signs of sphenoid wing dysplasia. The paranasal sinuses are clear.

Output: Left temporal scalp mass as described above compatible with neurofibroma. In addition to the main component of discrete nodular lesions, there is an infiltrative pattern of enhancement which tapers more distally in the left scalp. This could represent subtle tumor infiltration or a reactive phenomenon. While there is no gross osseous invasion, there is chronic remodeling of the mastoid air cells as described above.


Instruction: Generate impression based on findings.

Input: Recurrent neuroblastoma post radiation therapy; assess for progression of disease. Cervical Spine: There is a partially imaged enhancing mass in the left supraclavicular region, which abuts the proximal left vertebral artery and measures up to approximately 35 mm. There is no extension of the mass into the spinal canal. Indeed, there is no significant spinal canal stenosis. The cervical spine alignment, vertebral body heights are bone marrow signal are within normal limits. The spinal cord displays normal signal and morphology. Thoracic Spine: The cervical spine alignment, vertebral body heights are bone marrow signal are within normal limits. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is no evidence of mass lesions or abnormal enhancement in the thoracic spine.

Output: 1. No significant interval change in size of the treated neuroblastoma metastasis in the left supraclavicular region with encasement of the proximal left vertebral artery. 2. No evidence of tumor in the thoracic spine region.


Instruction: Generate impression based on findings.

Input: Status post transsphenoidal surgery on 4/21/16 for lymphoplasmacytic inflammatory infiltrates suggestive of lymphocytic panhypophysitis in a young, pregnant/postpartum woman. There has been interval evolution of findings related to transphenoidal surgery, with mild heterogeneity of the pituitary gland. The pituitary gland measures up to 8 mm in craniocaudal dimension and does not exert mass effect upon the optic apparatus. The pituitary infundibulum is intact. The posterior pituitary bright spot is no apparent on this scan. There are secretions in the left sphenoid sinus. The imaged portions of the brain are unremarkable.

Output: Expected postoperative findings related to transphenoidal surgery, with mild heterogeneity of the pituitary gland.


Instruction: Generate impression based on findings.

Input: 50 year-old male with history of angiosarcoma diagnosed 12 -- 07 of the face. Status post neck/head radiation and chemotherapy. Please evaluate. Images through the skull base and including cavernous sinuses remain within normal limits. Paranasal sinuses demonstrate a small retention cyst within the dependent portion of left maxillary sinus and otherwise are unremarkable.Minimal soft tissue thickening at the level of the nasal bridge on the left which appears to extend to the eye lid and over the right zygoma Is again identified. In comparison with the prior examination there is evidence of reduction in the volume of this area of increased soft tissue density. After discussion of the findings with the referring physician, Dr.Undevia it is believed to identified findings are likely post therapy changes and less likely residual tumor. Further follow-up exams is recommended. This area can be better evaluated with an MRI exam.No definitive evidence of any additional area of abnormal soft tissue to suggest angiosarcoma is detected. Extensive bilateral calcifications within the pinna remains a stable. These findings are not believed to be angiosarcoma.No evidence of any bony changes with above-described findings. The right globe, retro-orbital fat and extraocular musculature as well as right lacrimal gland remains within normal limits.No evidence of pathologic adenopathy in the neck.CT of brain with infusion.This examination is essentially within normal limits for patient's stated age of 49. No hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. No abnormal enhancement the brain parenchyma or leptomeninges. Calvarium remains intact.

Output: 1.Negative CT of brain with infusion.2.Slight interval reduction in the size of the edematous soft tissue thickening of the right face as detailed above.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type I, evaluate for change in glioma and right medullary mass. Again noted is nonenhancing expansile T2/FLAIR hyperintense mass within the right dorsal medulla. This continues to measure 12 x 13 mm on 801/19, unchanged from the most recent comparison. However, comparing back to the baseline exam, there appears to be decreased extent of involvement in the right upper cervical cord as well as the right ventral medulla.There is redemonstration of multiple foci of nonenhancing nonenhancing T2/FLAIR hyperintensity within the within the globus pallidus bilaterally, with less well-defined abnormal signal extending into the right cerebral peduncle. The lesions in the left global globus pallidus again appears slightly larger, more confluent and conspicuous compared to prior while the remaining lesions are not significantly changed. Similarly, nonenhancing T2 foci in the right greater than left cerebellar hemispheres are again seen, with perhaps slight decreased confluence of abnormal signal on the right especially when comparing back to more remote exams.There is persistent enlargement of the cisternal left optic nerve measuring up to 14 mm, which appears minimally progressed since the previous exam where it measured 13 mm, with also increased confluence of abnormal enhancement now measuring 1.4 x 1.3 cm in greatest axial dimensions.Ventricles and sulci are stable. Mild mucosal thickening is noted within the sphenoid and maxillary sinuses.

Output: 1. Further slight interval increase in overall size and degree of confluence of enhancing component of the patient's known left optic nerve glioma. 2. Redemonstration of nonenhancing FASI, presumably related to neurofibromatosis. Slight interval further increase in size and confluence of the lesions in the left basal ganglia. Slight interval decreased prominence of abnormal signal in the right The remaining lesions are not significantly changed.3. No significant interval change in nonenhancing expansile right dorsal medullary mass compared to more recent exams, although overall decreased ventral and caudal extent compared to more remote exam.


Instruction: Generate impression based on findings.

Input: History of brain metastasis. Status post craniotomy. Examination demonstrates postoperative change of the left parietal craniotomy, including blood products at the surgical site of the left posterior parietal lobe and left frontal pneumocephalus. Surrounding the surgical site, there is diffuse edema. There is a redemonstration periventricular small vessel ischemic disease. No other hemorrhage, midline shift or abnormal extra-axial fluid collection is identified. The ventricles and sulci appear prominent but symmetric. There is effacement of the left occipital horn.The previously MRI identified masses are not visualized on the present non-infused exam.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Expected postoperative changes of the left parietal craniotomy including blood products at the surgical site and pneumocephalus. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Smoldering multiple myeloma There is a variegated/'salt-and-pepper' pattern of the bone marrow on T1-weighted imaging involving the pelvis, lower lumbar spine, and to a lesser degree, the proximal femora. Although this pattern has been described in patients with multiple myeloma it is nonspecific and we see no dominant enhancing focus to confirm multiple myeloma. There is normal marrow signal on fat-suppressed T2-weighted images and on postcontrast sequences. Mild osteoarthritis affects both hips. There is no evidence of synovitis or other areas of abnormal enhancement following contrast. The muscles of the pelvis appear normal in caliber and signal.

Output: Variegated/salt-and-pepper pattern of bone marrow on T1 images which has been described in patients with multiple myeloma but is nonspecific. There are no focal dominant or enhancing lesion to confirm multiple myeloma.


Instruction: Generate impression based on findings.

Input: 41 year old with history of left breast cancer, status post left mastectomy and right prophylactic mastectomy. Status post bilateral mastectomies.There is no residual breast tissue in either breast.No abnormal enhancement is seen in either mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Status post bilateral mastectomies, no residual breast tissue.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: NSCLC with brain metastases status post SRS. There has been interval increase in size of the posterior left fusiform gyrus lesion, which measures up to 8 mm, previously 6 mm. The surrounding edema has increased in extent as well. In addition, there has been interval increase in size of an enhancing lesion in the left posterior cingulate sulcus, measuring up to 8 mm, previously 4 mm. Furthermore, an enhancing lesion along the anterior aspect of the right precentral gyrus measures up to 4 mm, previously 1 mm, and an enhancing lesion in the right middle frontal gyrus measures up to 5 mm, previously 3 mm. There is also a new subependymal enhancing lesion along the lateral aspect of the left lateral ventricle, measuring up to 5 mm. On the other hand, the lesion in the left flocculus has decreased in size now measures up to 8 mm, previously 11 mm, and a lesion in the right anterior frontal lobe now measures 2 mm, previously 4 mm. In addition, a previously demonstrated lesion in the right superior frontal gyrus is no longer discernible. There is no evidence of acute infarct. There are subcentimeter foci of encephalomalacia in the bilateral thalami and adjacent to the left frontal horn of the lateral ventricle. There is also an unchanged background of nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged, including an enhancing nodule in the right parietal scalp, which measures up to 3 mm in width. There are bilateral mastoid air cell effusions.

Output: 1. Apparent mixed response of the intracranial metastases.2. Unchanged nonspecific punctate right parietal scalp lesion.3. Chronic lacunar infarcts and probable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Redemonstrated is T2 hyperintensity throughout the white matter, which is progressed since the 2006 MRI, now appearing confluent in several locations. As demonstrated on the more recent head CT, there are regions of encephalomalacia within the bilateral basal ganglia, corona radiata, the right cerebellum, and the left parietal lobe, from chronic ischemia. There is no restricted diffusion to suggest current acute ischemia. Signal abnormality within the left distal internal carotid flow void is again noted. There are no findings of hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear.

Output: 1.There is no restricted diffusion to suggest the presence of acute ischemia.2.Chronic ischemic changes with foci of encephalomalacia as described in detail above.


Instruction: Generate impression based on findings.

Input: Female, 3 years old, with cerebellar ataxia and slurred speech. Brain parenchymal morphology is within normal limits. The volume of the cerebral hemispheres, brainstem and cerebellum is within normal limits. No focal lesions or areas of signal abnormality are detected. No evidence of any migrational anomaly is seen. There are no findings to suggest acute intracranial hemorrhage. No abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology. The pattern of white matter myelination is appropriate for age and mature appearing.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 35-year-old male patient with primary sclerosing cholangitis. Evaluate for stricturing/disease progression. ABDOMEN:LIVER, BILIARY TRACT: A T2 hyperintense lesion within segment 4A which demonstrates progressive peripheral discontinuous enhancement measures 2.1 x 2.0 cm (image 27, series 12), unchanged in size. An additional enhancing geographic focus in the subcapsular region of segment 8 is not significantly changed.There is narrowing of the distal hepatic duct along with mild, irregular intrahepatic biliary duct dilatation without new stricture or focal lesion.SPLEEN: There is mild splenomegaly. A subcentimeter T2 hyperintense focus within the spleen likely represents a cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant change in the biliary ductal appearance with strictures and mild dilatation.2.Stable appearance of a segment 4 lesion, which likely represents a hemangioma.3.Stable enhancing focus within segment 8, which is possibly vascular in etiology.


Instruction: Generate impression based on findings.

Input: There has been interval expected evolution of postoperative changes centered at the L1-L2 level from previous cord untethering. There is again perhaps subtle clumping of dorsal nerve roots at the L1-L2 level, greater on the left side. The current sagittal supine images include a decreased cranial extent of the T11 vertebral level as compared to prior exam, although on prone imaging there is perhaps suggestion of subtle decrease in the previously noted kinking of the distal cord at the upper T11 level. There is otherwise no significant change in the appearance of the ventrally positioned lower thoracic cord compared to preoperative imaging. The conus more inferiorly remains more dorsally positioned at the L1 level, with appropriate ventral motion of the cauda equina roots upon prone imaging. Previously, the conus termination was noted to be at L1-L2, now at the lower L1 level. There is no definite delineation of the reported split cord appearance seen at time of surgery appreciated on MRI.The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. The bladder is significantly distended. There is extensive air distention of the visualized colon and rectum.

Output: 1. Interval expected evolution of previously seen postoperative changes related to cord untethering. Overall appearance of the thoracolumbar spinal canal and distal cord/conus is similar except for questioned slight decreased focal kinking at the T12 level although somewhat incompletely evaluated. The conus also appears slightly more cranially positioned than on prior exams.2. Prone images again demonstrate appropriate ventral motion of the cauda equina nerve roots without significant conus position change.3. Stable subtle clumping of the left greater than right cauda equina nerve roots at the L1-L2 level likely relating to mild postsurgical arachnoiditis.


Instruction: Generate impression based on findings.

Input: History of giant cell tumor status post multiple resections to spine, presenting with severe back pain and lower extremity weakness There is evidence of prior postsurgical changes with laminectomy and spinal fusion hardware extending from the T9 to the L3 levels, counting from the lumbosacral junction. There is corpectomy of T12 with placement of strut graft as well as partial posterior corpectomy of the L1 vertebral body. Noted is diminutive disc space at T2-T3 which is likely developmental. There is also abnormal morphology of the T2 vertebral body with suggestion of a block vertebra.Susceptibility artifact from hardware slightly limits evaluation. There is however no evidence of cord compression or high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine.

Output: 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 evidence of high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine. No evidence of cord compression.Postsurgical changes and developmental anomalies as above.


Instruction: Generate impression based on findings.

Input: There is mild straightening of the normal lumbar lordosis and suggestion of incomplete formation of the posterior elements at S2 and S3. The vertebral body and disc heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L2 level. There is no evidence of fibrofatty filum. There is mild lumbosacral epidural lipomatosis with prominence of the epidural venous plexus, but no significant disc bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. The paraspinal soft tissues and subcutaneous tissues are unremarkable.

Output: 1. Suggestion of mild spina bifida occulta at S2 and S3. A focused CT of this region may be useful for further characterization, if clinically indicated.2. No evidence of myelomeningocele or fibrofatty filum.3. Mild lumbosacral epidural lipomatosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Acinic cell carcinoma that originated in the right parotid gland, with extension to the skull base, status post treatment and osteonecrosis. There are postsurgical findings related to prior right lateral temporal bone resection and parotidectomy. There is unchanged patchy heterogeneous enhancement involving the right basiocciput, petrous ridge, condylar and squamous portions of the occipital bone, and the right lateral mass of C1, with a small soft tissue component in the upper carotid space, all appearing similar to prior examinations. Intracranially, no new or suspicious lesions are seen. There are a few unchanged punctate foci of enhancement within the right lateral cerebellum, immediately adjacent to the abnormal skull base, with surrounding T2 hyperintensity. Supratentorially, there are several scattered foci of nonspecific T2 hyperintensity, which appear unchanged. Otherwise, there are no new enhancing intracranial lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles remain normal in size and morphology. There is a small left maxillary sinus retention cyst.

Output: Findings related to right lateral temporal bone resection and parotidectomy without significant change in the treated right skull base and right craniocervical junction tumor, as well as the abnormality along the inferior right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Knee pain following injury Evaluation is slightly limited secondary to motion artifact particularly on the sagittal PD sequence.MENISCI: There is attenuation and blunting of the body of the medial meniscus compatible with a radial tear. There is also undulation of the free edge fibers of the body of the medial meniscus that likely represent the sequela of additional tearing, although could in part be due to flounce. There is horizontal signal abnormality at the junction of the posterior horn and body which extends to the tibial articular surface with additional attenuation of the posterior horn itself which both likely reflect additional tearing. There is intermediate signal intensity replacing the much of the body of the meniscus suggestive of degeneration.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the medial compartment with much of the weightbearing portions of the medial femoral condyle and medial tibial plateau devoid of articular cartilage. There is flattening of the weightbearing articular surface of the medial femoral condyle with underlying subchondral sclerosis and edema. Similar but less pronounced changes affect the medial tibial plateau. There is full-thickness loss of the articular cartilage along the lateral tibial spine with degenerative signal abnormality in the underlying subchondral bone. There is diffuse articular cartilage loss of the undersurface of the patella with foci of full thickness loss particularly along the medial facet. There is degeneration of the articular cartilage of the femoral trochlea inferiorly.LIGAMENTS: There is thickening and increased signal intensity of the ACL likely representing mucoid degeneration. There is perhaps mild mucoid degeneration of the PCL as well. There is mild edema along the superficial band of MCL and perhaps within the proximal substance of the ligament itself which could represent a sprain in the appropriate clinical context but may simply relate to the adjacent medial compartment pathology. The lateral collateral ligament is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tearing of the medial meniscus and severe osteoarthritic changes of the knee with other findings described above.


Instruction: Generate impression based on findings.

Input: Clinical question: left-sided torticollis from the age of 9 months unknown cause, abnormal alignment of her head on her neck, 1mm cuts T1/T2/Flair per Dr Frim and Dr Katzman peds conferenceSigns and Symptoms: torticollis, abnormal alignment of her head on her neck, tenderness over the paraspinal muscles in the cervical region MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There is anterior subluxation of C1 relative to C2 and some basilar invagination. C1 is partially incorporated into the skull base. The right lateral mass of C1 is incorporated into the skull base whereas the left half of C1 appears to be hypoplastic. C2 is rotated relative to C1. The distance between the odontoid and C1 is approximately 6 mm. The anterior arch of C1 appears to be bifid anteriorly. These findings also appear to been present on the 8/13/2015 exam.The right vertebral artery appears to narrow as it courses through these anomalies and appears to have an aberrant course.The cervical vertebral bodies are appropriate in overall height.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.

Output: 1.Findings suggest a congenital anomaly in the upper cervical spine with partial incorporation of C1 to the skull base and the malformation of C1. Additionally there is rotatory subluxation of C1 and C2 and basilar invagination. There is aberrant course of the right vertebral artery. The occipital condyles have also malformed and are asymmetric. If clinically appropriate a CT of the upper cervical spine and skull base would help further define these anomalies as well as the subluxation.


Instruction: Generate impression based on findings.

Input: Recurrent squamous cell carcinoma of the scalp, status post treatment, with new intracranial abnormalities depicted on CT. There are postoperative findings related to left occipital craniectomy and skin flap reconstruction, where there is a complex fluid collection measuring 5 cm in length deep to the inferior aspect of the skin flap overlying the left cerebellar hemisphere. There is diffuse stranding and enhancement of the overlying subcutaneous tissues and non-specific ill-defined soft tissue along the surgical margins. There regional pachymeningeal thickening and enhancement, as well as lack of left transverse sinus opacification. In addition, there is thick enhancing tissue overlying the dura in portions of the surgical bed, measuring up to 15 mm in thickness along the inferior surgical margin. There are several rim-enhancing fluid collections with restricted diffusion measuring up to approximately 20 mm and extensive surrounding vasogenic edema in the left occipital lobe and left cerebellum, where there are also patchy areas of susceptibility effect. There is associated effacement of the fourth ventricle and distortion of the brainstem and mild prominence of the third and lateral ventricles. There are small foci of high T2 signal in the right corona radiata and left thalamus superimposed on scattered foci of T2 hyperintensity in the cerebral white matter. There is fluid within the left mastoid air cells. There are bilateral lens implants. There is a left maxillary sinus retention cyst.

Output: 1. Postoperative findings related to left occipital craniectomy and skin flap reconstruction, with a new collection in the resection bed overlying the posterior fossa dura, increased dural thickening, and overlying subcutaneous fat stranding may represent abscess with pachymeningitis and cellulitis, with thrombosis of the left transverse sinus Superimposed recurrent tumor along the dura in the surgical bed is also a likely consideration, particularly given the history of positive margins at the prior resection. MRI is recommended for further evaluation.2. New hypoattenuation and swelling in the left occipital lobe and cerebellum may represent cerebritis and abscess formation perhaps with superimposed areas of neoplasm in areas closer to the overlying dura, with what may represent blood products in the inferior left cerebellar hemisphere and mild obstructive hydrocephalus.3. New fluid in the left mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: monthly headaches for 6 years, now increasing frequency x 2 months associated with blurry vision. Assess for etiology History: monthly headaches for 6 years, now increasing frequency x 2 months associated with No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.There are 2 small developmental venous anomalies, one at the left anterior aspect of supra marginal gyrus (series 1103, image107/200) and another at the left inferior temporal gyrus (series 1103, image 76/200)Several FLAIR/T2 high signal intensity lesions on bilateral subcortical white matter are seen which are non specific.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst on the left maxillary sinus.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion.2.No evidence of abnormal enhancement