Instruction: Generate impression based on findings.

Input: MRI CARD WWO CNTRST, VIABLTY/SCAR IMAG.MORPH/FUNCT,W/FLOW/VELOCITY MEASURE, 8/30/2016 9:15 AM Left VentricleThe left ventricle is normal in size with normal systolic function. There is severe concentric left ventricular hypertrophy. The IVSd and PWd range between 16-19mm with the apical posterior wall being most hypertrophied. The overall LV ejection fraction is 61%. The LVEDV is 257 ml (normal range 142+/-34), the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVESV is 100 ml (normal range 47+/-19) and the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9). The LV mass is 335 g (normal range 164+/-36) and the LV mass index is 139 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying replacement fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is normal (1050 ms) in the septum; however, the inferolateral wall has mildly increased native T1 myocardial relaxation time (T1=1134ms). Elevations in native myocardial T1 relaxation time suggests the presence of underlying interstitial fibrosis. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%. The RVEDV is 259 ml (normal range 142+/-31), RV end diastolic volume index is 108 ml/m2 (normal range 82+/-16), the RVESV is 122 ml (normal range 54+/-17), and the RV end systolic volume index is 51 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. No evidence of systolic anterior motion of the mitral leaflets or dynamic LVOT obstruction. 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. No evidence of thoracic coarctation, aneurysm, or dissection. 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 obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Severe concentric left ventricular hypertrophy (16-19mm wall thickness) with normal systolic function without evidence of underlying myocardial replacement fibrosis, inflammation, or infiltration. There is, however, a mild increase in native myocardial T1 relaxation time along the inferolateral wall which may suggest presence of interstitial fibrosis. 2.No signs of infiltrative disease such as amyloid, iron overload, or Fabry's. 3.Normal-sized right ventricle with normal systolic function.4.Mild left atrial dilation. 5.Normal origin of the coronary arteries. 6.No evidence of aortic coarctation, dissection, or aneurysm. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Diabetic foot ulcer with ankle and foot pain and elevated ESR CRP History: pain Transmetatarsal amputation. Ulceration plantar to the base of the fifth metatarsal. Rim-enhancing fluid collections extend from the ulceration into the soft tissues along the lateral aspect of the base of the fifth metatarsal consistent with small, likely draining, abscess, some of them containing signal voids likely representing air. Overall collection of draining abscesses measures 4 cm in the largest dimension. Thickening and enhancement of the overlying skin and diffuse enhancement of the adjacent fat indicating cellulitis. Diffuse reticulation of subcutaneous fat of the foot indicating edema. Abnormal signal intensity and enhancement replacing much of the remaining base of the fifth metatarsal indicating osteomyelitis. Increased signal intensity seen on STIR sequences in the remaining metatarsal bases as well as bones of the midfoot suggestive of reactive osteitis rather than osteomyelitis, with relatively normal signal on T1-weighted sequences.

Output: Postoperative changes of the transmetatarsal amputation with ulceration associated with draining abscess and osteomyelitis of the remaining fifth metatarsal base.


Instruction: Generate impression based on findings.

Input: Elevated PSA (Per EPIC: PSA on finasteride between 1 and just above 3 over the last few years. Last August, PSA was 2.6 and it was 2.0 on 11/20/2014 with a 10% free/total. Prostate biopsy performed in February 2015 and benign with inflammation. ). Family history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 2.5 x 3.8 x 3.8 cm. Peripheral Zone: No suspicious focal lesion. There is a non-enhancing focus of very low signal intensity at the junction of the right lateral peripheral zone and central gland, compatible with a coarse calcification. Central Gland: No significant abnormality.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious abnormality.


Instruction: Generate impression based on findings.

Input: Locally advanced cervical cancer status post external beam radiation therapy. MRI for brachytherapy planning. PELVIS:UTERUS, ADNEXA: The uterus measures 6.8 x 3.8 cm in the sagittal plane. In the dorsal right posterior fundus there is a 3.1 x 2.3 cm well-defined T2 weighted hypointense subserosal fibroid.The endometrium/endometrial cavity is normal in thickness. The inner myometrium/junctional zone is poorly defined but is not thickened. Unremarkable bilateral ovaries appear atrophic without focal lesion.The vaginal canal is well distended by ultrasound gel. Intermediate T2-weighted signal hypointensity involves nearly the entire cervical thickness with signal abnormality extending towards the internal cervical os and lower uterine segment myometrium, measuring approximately 4.5 x 2.7 cm in maximal cross-section best seen on the postcontrast images (series 100 3/3 63). In the right parametrial soft tissues there is an enhancing lesion measuring 1.8 x 1.3 cm suspicious for parametrial soft tissue extension (series 100 3/3 88), adjacent to the non-enhancing ovary.Peripherally enhancing right obturator lesion measures 1.7 x 1.5 cm (series 100 3/4 13), suspicious for necrotic lymph node.BLADDER: No significant abnormality noted.LYMPH NODES: Peripherally enhancing right obturator lesion measures 1.7 x 1.5 cm (series 100 3/4 13), suspicious for necrotic lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cervical mass with invasion into the lower uterine segment myometrium and right parametrial/paracervical soft tissues with a peripherally enhancing centrally necrotic right obturator lymph node. These findings correspond to FDG PET avid disease on the outside hospital PET/CT.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness Smooth thickening of aortic wall from the descending aorta to the level of just below the renal arteries. The wall thickening shows high signal intensity on T2 and low signal intensity on T1 with subtle intimal enhancement. These findings can suggest possible intramural hematoma. Possibility of atherosclerotic thickening could be lower since the thickening appears to be smooth not irregular. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the L1 level.The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. Smooth aortic wall thickening from descending aorta to the level of abdominal aorta just below the renal artery. This finding may suggest possible intramural hematoma. Dedicated either CT or MRI examinations for aorta wall evaluation is recommended.2. Normal thoracic and lumbar vertebral bodies and spinal cord.


Instruction: Generate impression based on findings.

Input: 56 years, Male, Reason: Concern for CCA/stricturing that needs intervention History: PSC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT:Mild contour abnormality of the liver and heterogeneous all T2 intensity is compatible with fibrosis.Multifocal bilobar biliary strictures as are again seen, left greater than right, with focal stricturing and irregularity of the proximal common bile duct and cystic duct appearing similar to the prior exam. No focal masses evident. Multiple filling defects within the intrahepatic bile ducts likely represent stones. No new stricturing of the common bile duct.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal in caliber. A cystic lesion within the tail of the pancreas measuring 8 mm (601/43) appears to connect with the main pancreatic duct and likely represents a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Peri-portal lymphadenopathy is unchanged with a reference node measuring 2.2 x 1.4 cm (401/17).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multifocal intrahepatic and extrahepatic biliary stricturing appears similar to the prior exam and is suggestive of primary sclerosing cholangitis.2.Sidebranch IPMN in the pancreatic tail.3.Stable periportal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female 59 years old with history of paresthesias, evaluate for demyelinating lesions Motion degradation limits evaluation. Limited sequences per demyelinating protocol were obtained. There are multiple ovoid foci of T2/FLAIR hyperintensity are seen with morphology and distribution compatible with known demyelinating disease. No prior study is available for comparison. Several of these lesions demonstrate T1 hypointensity. Volume loss in the posterior inferior right cerebellum suggestive of chronic infarct. An area of volume loss within the right frontal lobe with adjacent sulcal prominence extending into the operculum and adjacent FLAIR signal abnormality is also noted. There is also an area of decreased T2 signal within the left anterior temporal lobe subcortical white matter without mass effect.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: 1. Mild to moderate burden of T2/FLAIR supratentorial white matter lesions with distribution and morphology consistent with known demyelinating disease.2. Area of low T2 signal within the left anterior temporal lobe subcortical white matter, which is incompletely evaluated due to limited sequences per demyelinating disease protocol, but may be related to chronic hemorrhage or cavernous malformation. 4. Area of volume loss within the right frontal lobe with adjacent sulcal prominence extending into the operculum and adjacent FLAIR signal abnormality. This finding may represent chronic infarct or other chronic injury. Chronic infarct in the right posterior inferior cerebellar hemisphere is also suspected.5. No comparison studies are available, recommend obtaining prior studies or consider MRI brain.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and his mother, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Midazolam and fentanyl were administered IV by the nurses during continuous hemodynamic monitoring. A localizing CT examination demonstrated an expansile lesion within the medial aspect of the right acetabulum corresponding to the findings seen on recent MRI. Using CT guidance, an 18-gauge Achieve core biopsy needle was advanced into the lesion. 4 18-gauge core biopsy specimens were obtained. The core biopsy specimens were placed in formalin. The core biopsy specimens were hand carried to the Surgical Pathology lab. A 20-gauge Chiba needle was advanced into the lesion and approximately 15 cc's of bloody fluid was aspirated from the lesion. The aspirate was handed directly to cytopathology.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc's. Dermabond as well as a Tegaderm bandage were placed on the patient’s skin.

Output: CT guided core needle biopsy of right acetabular lesion.


Instruction: Generate impression based on findings.

Input: Male, 81 years old, with left frontal hemorrhage and vasogenic edema, suspect underlying mass. Found down, Glasgow Coma Scale 3-8, C-spine clearance needed. Brain MRI:Restricted diffusion is seen within the left cingulate gyrus and to a mild degree in the right cingulate gyrus. Apart from artifactual diffusion restriction caused by intracranial hemorrhage, there are a few additional scattered small foci of diffusion restriction seen in the left parietal and temporal cortex and perhaps minimally in the right posterior frontal lobe.A large left frontal lobe parenchymal hematoma is again seen showing no significant change in size or morphology relative to prior CTs. Intraventricular extension is also demonstrated with a significant quantity of blood in the left lateral ventricle, with smaller quantities of blood in the right lateral ventricle, third and fourth ventricles. Again, the quantity and distribution of intraventricular blood product does not appear to have changed.Significant generalized mass effect persists with a midline shift to the right of 11 mm and subfalcine herniation including the ACA vessels. The suprasellar and quadrigeminal plate cisterns remain patent.On postcontrast images, no definite enhancement is seen within or around the left frontal lobe hematoma cavity apart from intrinsic T1 signal induced by the blood itself. No obvious mass lesion is detected though a small lesion could be obscured by the large hematoma. Subtle sulcal and gyriform enhancement is seen along the left cingulate gyrus corresponding to the restricted diffusion. A small focus of enhancement within the posterior right operculum is also seen correlating to restricted diffusion in this area. The superior ophthalmic veins are prominent bilaterally likely reflecting increased intracranial pressure. They were less prominent and showed no evidence of early filling on the prior CTA.A right frontal approach ventricular shunt catheter is seen in stable position. Minimal parenchymal blood product is again seen along the catheter tract. The ventricles remain dilated but similar to that seen on prior CTs.Brain MRA:Mild distal ACA narrowing was better assessed on prior CTA. No other significant intracranial vascular stenosis is seen. No aneurysm or vascular malformation is detected.Cervical spine MRI:Reversal of the cervical lordosis is noted. There is in addition a grade 1 retrolisthesis of C5 relative to C6. Vertebral body height is within normal limits. No concerning marrow replacement is seen. Minimal elevated STIR signal is seen within the C3-C6 vertebral bodies, likely degenerative. Likewise, increased T2 signal within the C3-4 through C5-6 intervertebral discs likely reflects degeneration.The paraspinal soft tissues are unremarkable. No evidence of soft tissue or ligamentous injury is seen. The spinal canal is congenitally slender. The spinal cord is chronically thinned with scattered foci of T2 hyperintensity beginning at C3 and continuing down to C6. No epidural collections are suspected.C2-3: Left facet hypertrophy. Mild posterior disc-osteophyte complex formation asymmetric to the left. No significant spinal canal stenosis. Mild right and moderate left foraminal narrowing. C3-4: Facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left. No significant generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing.C6-7: Minimal disc degeneration without significant spinal canal or foraminal stenosis. C7-T1: No significant spinal canal or foraminal stenosis.

Output: 1.Demonstration of a large left frontal lobe hematoma without significant interval change. No obvious etiology for the hemorrhage is seen, and in particular, no large mass lesion is demonstrated. Please note that small lesions may be obscured by the large quantity of hemorrhage.2.Extensive intraventricular blood product also shows no significant interval change in quantity or distribution. The ventricular system remains dilated but similar to prior.3.Extensive generalized mass effect is seen with substantial rightward midline shift and subfalcine herniation. No significant change is noted.4.Acute ischemia is seen within the ACA distributions, mostly affecting the left cingulate gyrus and to a much lesser degree the right cingulate gyrus. A few additional scattered foci of restricted diffusion are seen in both cerebral hemispheres. This ischemia may be related to subfalcine herniation and compromise of the ACA vessels.5.On dedicated MRA images, no specific vascular lesions are seen which would account for the intracranial hemorrhage.6.No evidence of any acute cervical spine osseous or soft tissue lesion is seen.7.The spinal cord demonstrates evidence of chronic myelomalacia from C3 through C6, where degenerative disc disease is at its worst.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cervical spondylosis. Signs and symptoms: Upper extremity numbness, subjective leg weakness and new hyperreflexia of lower extremity. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 is unremarkable.CT-C4 demonstrate mild degenerative disease, bilateral uncovertebral hypertrophy and moderate bilateral ligamentum flavum hypertrophy without significant facet disease. Constellation of changes results in slight flattening deformity of the cord and moderate central spinal stenosis with significant bilateral neural foraminal compromise. There is interval worsening of disease since prior exam.C4-C5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Examination at this level demonstrate a large disc and osteophyte complex in the midline and to the right with resultant mass effect, flattening and posterior displacement of the cord and moderate central spinal stenosis as well as significant right and moderate left neural foraminal compromise. There is also increased T2 signal intensity of the cord consistent with myelopathy. There is progression of degenerative changes at this level since prior exam.C5-C6 demonstrate moderate disc disease and loss of disc height, bilateral uncovertebral hypertrophic changes and mild to moderate bilateral ligamentum flavum hypertrophy. There is significant right and moderate to significant left neural foraminal compromise and mild central spinal stenosis. There is progression of degenerative disease at this level since prior exam.C6-C7 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Hypertrophic spur along the ventral aspect of the canal results in slight flattening of the cord with posterior displacement and mild central spinal stenosis. Significant bilateral neural foraminal compromise is also present.C7-T1 demonstrate moderate disc disease with resultant severe right and mild left neural foraminal compromise and no central spinal stenosis.

Output: 1.Interval progression of degenerative disease since prior exam.2.Degenerative changes at C4-C5 and including a large ventral disc-osteophyte complex results in central spinal stenosis and bilateral neural foraminal compromise. There is increased T2 signal intensity of the cord at this level consistent with myelopathy.3.Degenerative changes at C3-C4, C5-C6 and C6-C7 levels also result in varying degrees of central spinal stenosis as mentioned above.4.Multilevel bilateral neural foraminal compromise (several significantly) as detailed per level above.


Instruction: Generate impression based on findings.

Input: 25-year-old female with history of whiplash, concern for neck injury Examination is slightly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is mild straightening of the cervical spine. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. Ligamentous structures are intact.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of ligamentous injury in the cervical spine. No evidence of cord injury. 2. No spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 44-year-old male with right shoulder pain. Rule out labral versus cuff pathology. The exam is limited by motion artifact.ROTATOR CUFF: Intermediate signal in the supraspinatus tendon consistent with tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Tear is present in the posterior labrum.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Tear in the posterior glenoid labrum.2. Abnormal signal in the acromioclavicular joint with bone marrow edema in the acromion and clavicle consistent with chronic repetitive stress.3. Intermediate signal in the supraspinatus tendon consistent with tendinopathy.


Instruction: Generate impression based on findings.

Input: 64 year old man with history of ischemic cardiomyopathy and CAD with recent PCI to LAD and RCA lesions, referred for cardiac MRI to evaluate for viability. Left VentricleThe left ventricle is mild-moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 121 ml/m2 (normal range: 74+/-15), the LVEDV is 244 ml (normal range 142+/-34), the LV end systolic volume index is 70 ml/m2 (normal range 25+/-9), the LVESV is 141 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). There is global hypokinesis. There is a midwall stripe in the septum which is atypical for myocardial infarction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no subendocardial or transmural late gadolinium enhancement to suggest previous myocardial infarction. Native T1 time is borderline elevated (1060ms). Left AtriumThe left atrium is mild-moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 120ml/m2 (normal range 82+/-16), the RVEDV is 243mL (normal range 142+/-31), the RV end systolic volume index is 63ml/m2 (normal range 31+/-9), and the RVESV is 127ml (normal range 54+/-17).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (36mm at the level of bifurcation of the pulmonary artery).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild to moderately dilated left ventricle with moderately reduced systolic function (EF=42%). 2. Mildly dilated right ventricle with mildly reduced systolic function (EF=48%).3. There is late gadolinium enhancement present in a midwall stripe pattern in the septum; this is atypical for previous myocardial infarction and suggests a non-ischemic component to the patient's known cardiomyopathy. 4. At least mild mitral regurgitation. 5. Biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:8/27/1964)Reason: NSCLC brain mets. Eval new R frontal lesion in particular. History: brain mets.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is redemonstration of a extra-axial fluid collections adjacent to the frontal lobes. The right-sided extra-axial fluid collection adjacent to frontal lobe previously measured 6 mm in thickness and now measures 5 mm in thickness. A multilayered extra-axial fluid collection on the left side currently measures 8 mm in easily measured approximately the same. The extent of these fluid collections are similar between the 2 studies.Metal artifact from aneurysm clips in the right middle cranial fossa obscure visualization of the right anterior temporal lobe and right orbital gyrus on much of the imaging is especially prominent on the susceptibility weighted imaging and diffusion-weighted imaging.There is redemonstration of a focus of T2 and FLAIR signal hyperintensity in the right precentral gyrus measuring 22 x 7 mm axial dimensions. There is an associated 8 mm enhancing nodule on the current exam associated with this which previously measured 3 mm. On the 9/30/2012 exam it also measured approximately 8 mm.Another focus of FLAIR signal hyperintensity is present in the left middle frontal gyrus measuring 12 x 9 mm axial dimensions. There is no associated contrast enhancing lesion is stable compared to the prior exam.There is a lesion in the left cerebellar hemisphere measuring 21 x 23 mm axial dimension on FLAIR imaging which is stable compared to the prior exam. There is a 12 mm x 11 mm enhancing component within this lesion which previously measured 10 mm x 9 mm and in November measured 8 mm x 9 mm. There is a catheter that courses through the left occiput into this lesion with the tip at the left cerebellar medullary angle cistern. This catheter is in stable position.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Multiple punctate foci of signal loss on susceptibility imaging are redemonstrated in the periventricular white matter and subcortical white matter these were not present on the 9/30/2012 exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is diffuse pachymeningeal thickening present. This has not changed since prior exam.

Output: 1.Extra-axial fluid collections remains stable compared to the prior exam. Associated pachymeningeal thickening remains stable as well.2.There is redemonstration of a left cerebellar lesion whose enhancing component has enlarged relative to the prior exam indicating progression of this particular lesion. A ventricular catheter associated with this lesion is in stable position.3.There is a right precentral gyrus lesion present. The enhancing nodule associated with this lesion is larger on the current exam versus the prior exam. It is suspected to represent metastatic disease which has mildly enlarged since the prior exam.4.A left middle frontal gyrus lesion predominantly involving subcortical white matter is stable.5.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 6.Periventricular microhemorrhages are present. These are nonspecific. It is possible they are treatment related.7.Metal artifact partially obscures the anterior aspect of the right temporal lobe and the right orbital gyrus. Lesions in these locations would be difficult to detect.8.Status post right craniotomy for aneurysm clipping.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial bleed. Signs and symptoms: Stroke. CT of brain without infusion:Crowding of the cerebellar tonsils at the level from the magnum is again identified. Images through posterior fossa demonstrates minimal encephalomalacia along the medial aspect of right cerebellum. This area demonstrated acute stroke on prior MRI examination off January 29 of 2010. There is no evidence of any hemorrhage within the posterior fossa. Fourth ventricle remains normal and in midline. Images through the supratentorial space are essentially unremarkable and no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Paranasal sinuses, mastoid air cells, middle ear cavities and calvarium are unremarkable.

Output: 1.Small area of low attenuation likely encephalomalacia or edema in the distribution of the right pica is consistent with patient's known prior right pica stroke.2.No evidence of any new area of stroke or hemorrhage is detected.


Instruction: Generate impression based on findings.

Input: Prolonged back pain For the purposes of numbering there are 4 nonrib-bearing lumbar type vertebral bodies and a transitional segment labeled S1 for the purposes of the study. Vertebral body heights are within normal limits. Alignment is within normal limits aside from minimal L4-S1 retrolisthesis. Bone marrow signal is benign. The conus medullaris is normal in position.There is developmental narrowing of the lumbar spinal canal with prominence of the dorsal epidural fat and superimposed mild degenerative changes as described below:L1-L2: No significant disc disease. Developmental narrowing of the spinal canal. Otherwise no significant spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Developmental narrowing of the spinal canal. Otherwise no significant spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and mild bulge. Small Schmorl's nodes involving the L3 and L4 endplates. Developmental narrowing of the spinal canal. Otherwise no significant spinal canal or neural foraminal stenosis.L4-S1: Disc desiccation and mild bulge. Developmental narrowing of the spinal canal. Otherwise no significant spinal canal stenosis. Mild bilateral neural foraminal stenosis. There is mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Please note variant anatomy with 4 lumbar vertebrae and transitional segment labeled S1. 2. Developmental narrowing of the lumbar spinal canal with superimposed mild degenerative changes in the lower lumbar spine including mild disc bulges at the L3-L4 and L4-S1 levels. There is also mild bilateral L4-S1 neural foraminal stenosis. No high-grade spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 59 years, Female, Reason: hx of GB carcinoma and liver abscess History: bile duct dilatation on ultrasound, grossly abnormal Alk phos and tBILI. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There are numerous cysts occupying the majority of the right hepatic lobe. There is severe intrahepatic biliary ductal dilatation. There is ill-defined soft tissue density within the hepatic hilum at the Klatskin point suspicious for neoplasm, the margins of which are difficult to measure without intravenous contrast. The right and left intrahepatic bile ducts as well as tertiary ducts are invaded with tumor. There is a stent in the distal common bile duct.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal ascites.

Output: 1.Exam is limited as it was discontinued by the patient.2.Ill-defined soft tissue at the hepatic hilum with associated intrahepatic biliary ductal dilatation is suspicious for neoplasm.3.Numerous cysts in the right hepatic lobe are suspicious for abscess.4.Moderate abdominal ascites.


Instruction: Generate impression based on findings.

Input: Known multiple sclerosis with recent numbness of right arm and leg: decreased vibration and joint sense on the right. There are multiple T2 hyperintense cerebral white matter lesions. There appears to be a new subcentimeter lesion in the left inferior frontal gyrus deep white matter since 2011. However, a left temporal stem lesion appears to be smaller. The other lesions appear to be unchanged. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, 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 mastoid air cells are grossly unremarkable. There are several scalp nodules, which have increased in size since 2011 and likely represent inclusion or pilar cysts. The largest of these is in the right frontal scalp, which measures up to 20 mm.

Output: Stigmata of multiple sclerosis with a newly apparent subcentimeter lesion in the left inferior frontal gyrus deep white matter since 2011. However, a left temporal stem lesion appears to be smaller. The other lesions appear to be unchanged.


Instruction: Generate impression based on findings.

Input: Anisocoria right pupil greater than left, assess for aneurysm MRI BRAIN: There is diffuse prominence of the cortical sulci in proportion to the cerebral ventricles consistent with moderate global volume loss. Periventricular and subcortical areas of T2/FLAIR hyperintensity are demonstrated. The gray-white matter differentiation is otherwise preserved. No midline shift or mass effect is appreciated. There is no intracranial hemorrhage identified. There is no evidence for acute ischemia.There is a 1.1 x 0.6 cm lobulated T2 hyperintense cystic lesion involving the deep right parotid gland (series 401, image 2).MRA BRAIN:Mild irregularity is demonstrated within left greater than right internal carotid arteries without evidence for flow-limiting stenosis. The MCA's and ACAs appear unremarkable. The bilateral vertebral arteries, basilar artery, and posterior cerebral arteries appear unremarkable as well.

Output: 1. Moderate global volume loss and nonspecific subcortical and periventricular white matter changes most likely related to chronic small vessel ischemic change.2. No evidence for acute ischemia.3. MRA of the brain is negative for steno-occlusive disease or aneurysm.4. There is a 1.1 cm lobulated cystic lesion involving the deep lobe of the right parotid gland. Recommend CT of the neck with contrast for further evaluation.Findings were reported to Dr. D. Ferrington on 10/17/2016 at 10:14 AM


Instruction: Generate impression based on findings.

Input: 46 years, Female, posttraumatic stress disorder, subacute cognitive decline.. There are a few scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific. Brain parenchyma is otherwise unremarkable for age. No diffusion abnormality. No evidence of hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Tiny maxillary mucus retention cyst. Paranasal sinuses are otherwise clear. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.

Output: MRI of the brain is within normal limits for age. There are a few scattered foci of T2/FLAIR hyperintensity in the white matter which are nonspecific.


Instruction: Generate impression based on findings.

Input: 74-year-old female with cluster of IPMN in the head of the pancreas ABDOMEN:LIVER, BILIARY TRACT: Unchanged T2 hyperintense lesion in the left lobe of the liver, compatible with a cyst. Additional subcentimeter T2 hyperintense foci are also likely benign.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstrated are cystic lesions in the head of the pancreas. The largest lesion measures 10 mm, previously 9 mm (series 9, image 49). The additional reference lesion measures 7 mm, unchanged (series 9, image 58). These are essentially unchanged from the prior exam. No abnormal enhancement is present. The main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left kidney is absent.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: T2 hyperintense cystic focus in the left pelvis may be ovarian in origin, minimally increased in size when compared to prior exam dated 7/20/2010. Recommend pelvic ultrasound for further evaluation.

Output: 1.Relatively stable pancreatic head cystic lesions. The main pancreatic duct is normal in caliber.2.Absent left kidney with uterine abnormalities seen on prior CT abdomen pelvis dated 10/20/2015 raise question of Mayer-Rokitansky-Küster-Hauser syndrome. Correlation with history is recommended.


Instruction: Generate impression based on findings.

Input: Other speech disturbances [R47.89], Reason for Study: ^Reason: stroke History: stroke. Brain MRI:Multiple scattered bihemispheric patchy high signal intensity lesions on FLAIR/T2 images indicating nonspecific small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Linear susceptibility lesion with associated encephalomalacia on the posterior inferior aspect of the left thalamus indicating prior hemorrhagic infarction with associated ex focal changes of left lateral ventricle. 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. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be within normal limits with some irregularities of intracranial arterial system indicating minimal atherosclerotic changes.There is no evidence of significant intracranial arterial luminal narrowing or occlusion. No aneurysm.Bilateral Pcom arteries and Acom artery are patent. Retention cyst on the left maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Moderate to severe non specific small vessel ischemic disease.3. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: 77-year-old man with history of hematuria. ABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic cysts noted. The liver is otherwise normal in signal and morphology.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas appears normal. There is no pancreatic ductal dilatation.ADRENAL GLANDS: Adrenal glands appear normal.KIDNEYS, URETERS: Simple bilateral cysts are noted. Due to significant patient motion, small stone or mass cannot be excluded. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: The abdominal aorta is mildly aneurysmal measuring 3.1 cm, previously 2.9 cm. No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postoperative findings of ventral hernia repair.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: The prostate is enlarged and impresses upon the base of the bladder. Post TURP defect noted.BLADDER: No discrete mass is identified. There is slight irregularity along the right dome of the bladder (4/25).LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited study due to extensive patient motion artifact, small mass or stone cannot be excluded. CT may be considered for further evaluation if necessary.2.Slight irregularity along the right dome of the bladder without discrete masslesion. Findings discussed with Dr. Aizen from urology service by phone at 11:35 on 10/5/2016.3.No hydronephrosis or renal mass seen.4.Prostate enlargement with post TURP findings.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.4 x 5.8 x 5.1 cm (series 1101/15 and series 503/77)Peripheral Zone: Left peripheral zone mid gland paramedian lesion measuring 1.0 x 0.8 x 1.4 cm (series 1101/12 and series 1201/20) which is hypointense on T2-weighted imaging sequences, demonstrates restricted diffusion and early enhancement suspicious for prostate cancer.At the same level more laterally there is a 4 mm hypointense T2-weighted focus (series 1101/12) with subtle restricted diffusion suspicious for prostate cancer.Towards the apex in the right peripheral zone mid gland there is a 6 x 3 mm (series 1101/10) T2-weighted hypointense focus without definite restricted diffusion, equivocal for prostate cancer.Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The left peripheral zone mid gland lesion abuts the fibromuscular stroma laterally without clear extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific subcentimeter mesorectal fascial lymph nodes are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left peripheral zone mid gland paramedian 1.4 cm lesion suspicious for prostate cancer.Suspected 4 mm focus of prostate cancer in the posterolateral left peripheral zone mid-gland.Equivocal 6 x 3 mm focus in the right peripheral zone mid-gland.


Instruction: Generate impression based on findings.

Input: Reason: recent MRI with new emboli, possible malignancy History: cognitive problems. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are subcortical lesions are present within the brain parenchyma which are high signal on T2 and flair MRI and were also present on the prior exam and unchanged in distribution. These are distributed predominantly in the subcortical white matter of the superior frontal gyri and in true frontal gyri are also scattered in the temporal and parietal lobes elsewhere There are additional periventricular white matter lesions and signal hyperintensities are dumbly surrounding the temporal horns of lateral ventricles. Additional lesions are present along the external capsule and in the posterior limbs of internal capsules.The temporal horns of the lateral ventricles are large.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.No convincing evidence of brain metastasis.2.A mild degree of subcortical white matter lesions are present which are unchanged. These are non-specific and may relate to leukomalacia of unknown cause.3.Mild ventriculomegaly may be related to atrophy. Normal pressure hydrocephalus in the appropriate clinical setting may be an alternate consideration


Instruction: Generate impression based on findings.

Input: 50 years Male (DOB:11/15/1965)Reason: evaluate neck pain History: neck painPROVIDER/ATTENDING NAME: ANDREA H. SHASHOUA ANDREA H. SHASHOUA Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient is status post anterior fusion at C6-7. There is osseous bridging at the disc space.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal . There is a disc bulge present at this level associated with narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots which appears be slightly worse in the right when compared to the left side. This was also present on the prior exam.At C5-6 there is a disc bulge present this level associated with endplate and uncovertebral osteophytes and encroachment of the neural foramina bilaterally. There is effacement of spinal fluid ventral and posterior the spinal cord at this level and overall a mild degree of spinal stenosis. This has progressed since the prior exam from 2012.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and disc desiccation at this level associated with a disc bulge.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and disc desiccation at this level associated with a disc bulge. There is a Schmorl's node at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the cervical spine which appear to progress since the prior exam. There is now a mild degree of spinal stenosis at C5-6. There is moderate encroachment of the exiting nerve roots bilaterally at C5-6 and C4-5 related to uncovertebral osteophytes.2.There is some mild degenerative changes present in the lower lumbar spine without significant compromise to the spinal canal or exiting nerve roots


Instruction: Generate impression based on findings.

Input: There is interval decrease in the size of some of the cystic components of the craniopharyngioma. The cystic component that was noted in the previous study and indenting of the undersurface of the right frontal lobe decreased in size from 12 mm previously to 6 mm currently, deforming the lateral right cerebral peduncle has decreased in size from 19 x 13 mm previously to 11 x 7 mm currently. The cystic components along the anterior aspect of the right cerebral peduncle and along the anterior aspect of the left cerebral peduncle have also decreased in size. There continues to be involvement of the prepontine, cerebellopontine angle cistern, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. There is asymmetric volume loss of the left cerebellar hemisphere associated with increased T2 signal, which may be attributable to crossed cerebellar diaschisis versus chronic ischemic effects. The basilar artery is tortuous and encased by the tumor. There are postoperative findings related to right temporal craniotomy and stable position of right transfrontal catheter with the tip in the right prepontine cyst. The ventricular system appears to be unchanged. There are foci of susceptibility effect within the right temporal lobe resection cavity, consistent with hemosiderin deposition, and within portions of the tumor, which likely represent calcifications.

Output: Further regression of some of the peripheral cystic components of the complex suprasellar and posterior fossa craniopharyngioma. MRI P BRAIN WWO, 12/10/2015 8:30 AMHISTORY: History of craniopharyngioma: 6 month follow-up of cysts.TECHNIQUE: MRI of the brain without and with contrast. A total of 4.5 cc of MultiHance was administered intravenously. 0.5 cc was discarded.COMPARISON: MRIs of the brain dated 8/13/2015 and 5/22/2015.FINDINGS:There is interval decrease in the size of some of the cystic components of the craniopharyngioma. The cystic component that was indenting the undersurface of the right frontal lobe decreased in size from 12 mm previously to 6 mm currently, deforming the lateral right cerebral peduncle has decreased in size from 19 x 13 mm previously to 11 x 7 mm currently. The cystic components along the anterior aspect of the right cerebral peduncle and along the anterior aspect of the left cerebral peduncle have also decreased in size. There continues to be extension of tumor into the prepontine, cerebellopontine angle cistern, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. There is asymmetric volume loss of the left cerebellar hemisphere associated with increased T2 signal, which may be attributable to crossed cerebellar diaschisis versus chronic ischemic effects. The basilar artery is tortuous and encased by the tumor. There are postoperative findings related to right temporal craniotomy and stable position of right transfrontal catheter with the tip in the right prepontine cyst. The ventricular system appears to be unchanged. There are foci of susceptibility effect within the right temporal lobe resection cavity, consistent with hemosiderin deposition, and within portions of the tumor, which likely represent calcifications.


Instruction: Generate impression based on findings.

Input: 46-year-old female with history of neoadjuvant chemotherapy, left lumpectomy and radiation therapy for IDC in 2015. Prior to these treatment, the patient received a left lumpectomy and complete left axillary lymph node dissection in 2014 at outside institution, but residual left breast cancer and metastatic left interpectoral and left internal mammary lymph nodes were confirmed after surgery. History of benign biopsy of right axillary lymph node. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are post-surgical changes at the lower inner left breast.No abnormal enhancement is seen in left breast.No abnormal lymph nodes are identified in left axillary region or left retropectoral region.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.There is a small metallic artifact from marker clip within one of the right axillary nodes.

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


Instruction: Generate impression based on findings.

Input: Female, 82 years old, with upper right arm pain and right-sided neck pain. A chronic type II odontoid fracture is evident with approximately 4 mm anterior subluxation of the fracture fragment relative to the rest of the C2 vertebral body. The fracture and its orientation are unchanged when compared to prior CT exams.Straightening of the cervical lordosis is seen, but otherwise, the sagittal alignment is within normal limits. The cervical vertebral bodies demonstrate diffuse loss of height which is likely degenerative in nature. Marrow signal characteristics are heterogeneous, again likely degenerative in nature. No worrisome marrow replacement or marrow edema is observed.Except as discussed below, the visualized spinal cord is normal signal intensity and morphology. No epidural abnormalities are suspected.C1-2: Likely due to the subluxed odontoid process fracture, the posterior arch of C1 appears to be mildly anteriorly shifted. This results in a moderate generalized narrowing of the spinal canal with mild flattening of the dorsal and ventral spinal cord. No evidence of cord edema is seen.C2-3: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C3-4: Posterior disc-osteophyte complex formation. Mild spinal canal narrowing without cord deformation. Mild bilateral foraminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C5-6: No significant spinal canal or foraminal stenosis. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Facet hypertrophy contributes to mild left foraminal narrowing.

Output: 1.A chronic type II odontoid fracture is seen. Anterior subluxation of the fracture fragment and the C1 arch results in a moderate generalized spinal canal narrowing at the C1-2 level with deformation of the cord but no evidence of cord edema.2.Elsewhere, multilevel cervical spondylosis is seen resulting in mild spinal canal narrowing as discussed above.


Instruction: Generate impression based on findings.

Input: Six months of back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits without evidence of fracture. There is smooth dextrocurvature of the lumbar spine as seen on recent radiographs. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Mild dextrocurvature of the lumbar spine as seen on recent radiographs. MRI of the lumbar spine is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 3 day old infant status post cooling protocol: perinatal depression. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. Indeed, there is a normal degree of myelination. 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. There is a left parietal subgaleal hematoma that measures up to 6 mm in thickness.

Output: No evidence of acute hypoxic ischemic injury.


Instruction: Generate impression based on findings.

Input: 60 year-old male who presents with ataxia. Rule out CVA. There is mild generalized prominence of the ventricles and sulci, consistent with volume loss, which is slightly advanced for the patient's age. There is no evidence of acute intracranial hemorrhage, mass or edema. There is no evidence of extra-axial fluid collection. There is a focal area of hypoattenuation of the left lentiform nucleus in keeping with a chronic infarct (probably small vessel ischemic). Multiple age indeterminate scattered hypodensities are noted within the periventricular and deep white matter bilaterally, better seen on prior MRIs. These findings are nonspecific but most commonly represent mild small vessel ischemic disease. No CT evidence of acute territorial ischemia.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are clear. Moderate intracranial vascular calcifications are noted.

Output: 1. No acute intracranial hemorrhage, CT identifiable acute territorial ischemia or focal mass.2. Old lacunar infarct in the left lentiform nucleus.3. Multiple age indeterminate scattered hypodensities are noted within the periventricular and deep white matter bilaterally. These findings are nonspecific but most commonly represent chronic small vessel ischemic disease. We note an MRI of the brain has been subsequently performed for this patient.


Instruction: Generate impression based on findings.

Input: Knee pain, prior medial meniscectomy MENISCI: Again seen is attenuation of the body and posterior horn of the medial meniscus that likely represents a combination of prior partial meniscectomy and chronic degenerative tearing. The more discrete linear tears seen on the prior exam are not as evident on the current study and there appears to be further loss of tissue along the free edge of the body of the meniscus which could represent interval partial meniscectomy or progression of attritional tearing. The anterior horn of the medial meniscus appears intact although a small cyst is seen anterior to it.There is globular intrasubstance signal within the anterior horn of the lateral meniscus representing mucoid degeneration but this is similar to the prior exam. The body and posterior horn of the lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There has been progression of osteoarthritis of the medial compartment with regions of full-thickness cartilage loss along the medial aspect of the medial femoral condyle and new subchondral cyst formation. There is full-thickness fissuring of the articular cartilage of the patella and femoral trochlea centrally which is new from the prior exam. The articular cartilage of the lateral femoral condyle subjectively appears thinned but we see no fluid-filled full-thickness defect. Small cysts are identified within the intercondylar eminence of the tibia which are likely degenerative in nature. There are small tricompartmental osteophytes.LIGAMENTS: The ACL is thickened and ill-defined with increased signal intensity likely representing severe mucoid degeneration with prominent cruciate ganglia proximally. This appears progressed from the prior exam with new partial thickness tearing of the distal fibers of the ACL. The PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial meniscal abnormalities further detailed above which likely represent a combination of prior meniscectomy changes and progression of chronic degenerative tearing. Intrasubstance degeneration of the lateral meniscus appears similar to the prior exam.2. Progression of osteoarthritis of the medial and patellofemoral compartments.3. Progression of mucoid degeneration of the ACL with new partial-thickness tearing of the distal fibers.


Instruction: Generate impression based on findings.

Input: Clinical question: Newly diagnosed lung cancer, evaluate for metastases. Signs and symptoms: Lung cancer. Pre-and post-enhanced brain MRI: No diffusion weighted abnormalities.Examination demonstrate multiple metastatic lesions in bilateral cerebral and cerebellar hemispheres. The lesions demonstrate enhancement and some with a venous of central necrosis. There is also surrounding beaking edema. The largest parenchymal metastatic lesion is seen the right thalamus and measuring approximately at 21 x 28-mm and with areas of central necrosis and extensive surrounding edema. This lesion causes but a subtle deviation of third ventricle to the. The largest metastatic lesion in the posterior fossa is in the right inferior cerebellar and measuring at 18 times 17-mm which also demonstrate rim enhancement and central necrosis with subtle surrounding vasogenic edema and regional mass-effect.  Additionally there is a large extra axial dural based enhancing tumor arising from the right greater wing of the sphenoid and extends along the dural into the right subfrontal region along the floor of the right anterior cranial fossa. It demonstrate isointense signal on flair and T2-weighted images and with diffuse enhancement. It applies mass effect and posterior displacement of right anterior temporal lobe and superior displacement of the right frontal lobe. It measures at least 25 x 36 in transaxial and 41-mm in cranial cephalad axis. This finding is not associated with any underlying destructive bony changes. The lesion is highly suggestive of a meningioma and less likely to represent a metastatic disease.No detectable abnormal calvarial signal abnormality or enhancement to suggest metastases.Unremarkable images through the orbits including axial fat sat post enhanced series.Extensive chronic right maxillary sinus disease and unremarkable other paranasal sinuses.

Output: 1.Pre-and post enhanced brain MRI demonstrate multiple bilateral cerebral and cerebellar metastatic lesions as detailed/measured above. There is trace deviation of third ventricle to the left.2.A large well-demarcated dural based isointense mass with uniform enhancement arising from the right greater wing of sphenoid and extending along the dura to the right subfrontal region without detectable destructive bony changes as detailed. Finding is highly suggestive of a meningioma and less likely representing a metastatic lesion.


Instruction: Generate impression based on findings.

Input: Reason: 33yr old male with history of MM; post-auto stem cell transplant evaluation History: evaluate SKULL: No lytic lesions are identified.CERVICAL SPINE: No lytic lesions are identified. Mild degenerative disc disease affects the lower cervical spine.THORACIC SPINE: There is a poorly defined lucency within the T8 vertebral body with equivocal vertically oriented striations. Although we cannot exclude multiple myeloma at this level, this could represent a hemangioma and could be further evaluated with MRI, if clinically warranted. This appears identical to the prior examination. Mild to moderate degenerative disc disease affects the thoracic spine.LUMBAR SPINE: There are no focal lytic lesions in the lumbar spine. Focal ossicle along the anterior superior aspect of the L5 vertebral body likely represents a normal variant. Note is made of a transitional lumbosacral morphology.RIBS: There is a mild deformity and expansile remodeling of the lateral aspect of the left fifth rib which could represent a myelomatous deposit and/or a healed fracture, unchanged from the prior examination.PELVIS: There is a poorly defined lucency along the lateral aspect of the left iliac wing, appearing similar to the prior study, which could represent a myelomatous deposit.UPPER EXTREMITY: There are tiny lucencies within the right radial diaphysis, which are nonspecific, but could represent myelomatous deposits, unchanged from the prior study.There is a small ossicle distal to the left ulna which may represent old trauma.LOWER EXTREMITY: No definite myelomatous deposits of the femora or either tibia/fibula.

Output: 1. Poorly defined lucency within the T8 vertebral body with questionable thickened vertically oriented trabecula, appearing similar to the prior study. While we cannot exclude multiple myeloma, this could represent a hemangioma and could be further evaluated with MRI if clinically warranted.2. Deformity and expansile remodeling of the lateral aspect of the left fifth rib, which could represent a myelomatous deposit or a healed fracture, appearing similar to the prior study.3. Poorly defined lucency along the lateral aspect of the left iliac wing could represent a myelomatous deposit, appearing similar to the prior study.4. Tiny lucencies within the right radial diaphysis are nonspecific, but could represent myelomatous deposits, unchanged.


Instruction: Generate impression based on findings.

Input: Left leg radiculopathy, evaluate for stenosis Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits with minimal anterior wedging at T12 which may be physiologic. There is grade 1 anterolisthesis of L3 on L4 and L4 on L5. There is advanced bilateral facet arthropathy at L3-L4 and L4-L5. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disk bulge and prominence of the epidural fat resulting in mild spinal canal narrowing. There is also mild bilateral neural foraminal narrowing. L3-L4: There is severe spinal canal stenosis related to anterolisthesis with disc uncovering and bulge, significant thickening of the ligamentum flavum, and advanced facet arthropathy. There is mild to moderate bilateral neural foraminal narrowing. L4-L5: There is moderate to severe spinal canal stenosis related to anterolisthesis with disc uncovering and bulge, significant thickening of the ligamentum flavum, and advanced facet arthropathy. There is moderate to severe right neural foraminal narrowing and moderate left neural foraminal narrowing.L5-S1: There is disk bulge eccentric to the right with mild right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing.Paraspinous soft tissues are within normal limits. Bilateral hip arthroplasties.

Output: 1. Degenerative changes with severe spinal canal stenosis at L3-L4 and moderate to severe spinal canal stenosis at L4-L5.2. Advanced facet arthropathy at L3-L4 and L4-L5 with grade 1 anterolisthesis of L3 on L4 and L4 on L5.3. Neural foraminal stenosis at L3-L4 and L4-L5 as detailed above.


Instruction: Generate impression based on findings.

Input: 63 year old man with history of OHT, referred for evaluation of possible inflammatory/infiltrative process (possible rejection?) in setting of new LV dysfunction. Left VentricleThe left ventricle is normal in size with mildly decreased systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 104 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 55 ml (normal range 47+/-19), the LV mass index is 76 g/m2 (normal range 85+/-15), and the LV mass is 122 g (normal range 164+/-36). LV systolic dysfunction is global. There is an area of patchy late gadolinium enhancement in the basal inferior wall which may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 time in the basal septum is 1063ms and in the basal inferior wall is 1150ms (elevated). The elevation in T1 time in the basal inferior wall may also be indicative of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of significant edema on T2 STIR imaging or evidence of early gadolinium enhancement on T1 BB imaging.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 54 ml/m2 (normal range 82+/-16), the RVEDV is 86 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 45 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 "psuedo-bovine" brachiocephalic branching pattern (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThe left hemidiaphragm is elevated. There is pleural/parenchymal scarring of the right lung base. There is a 1.3cm x 0.7cm nodule in the right lung fissure, likely a parenchymal lymph node. 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 mildly decreased systolic function. The overall LV ejection fraction is 47%.2. There is an area of patchy late gadolinium enhancement in the basal inferior wall which may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 time in the basal septum is 1063ms and in the basal inferior wall is 1150ms (elevated). The elevation in T1 time in the basal inferior wall may also be indicative of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%.


Instruction: Generate impression based on findings.

Input: 65 years, Male, with nontraumatic subarachnoid hemorrhage. Additional patient history includes multiple myeloma, status post treatment four years prior, thrombocytopenia, and current bacterial endocarditis. MRI BRAIN

Output: 1. Multiple acute to subacute supra and infratentorial infarcts in multiple vascular territories, some of which are associated with scattered areas of intracranial hemorrhage and suboptimally evaluated nodular enhancement. For example restricted diffusion in the left parieto-occipital region with adjacent hemorrhage may represent hemorrhagic conversion of an embolic infarct (perhaps related to infective endocarditis). Subarachnoid hemorrhage is most evident in the left frontal and opercular regions, possibly related to thrombocytopenia. No intracranial abscess or empyema. 2. Note MRA centered at the circle of Willis does not include the entire head. No intracerebral aneurysm however is identified in the field-of-view within limits of mild motion degradation. If clinically appropriate CTA may be considered to evaluate the more peripheral vasculature (for possible pseudoaneurysms).


Instruction: Generate impression based on findings.

Input: Female, 27 years old, with sciatic neuropathy. Orthopedic screws are partially visualized traversing the left iliac bone and sacrum. Artifact originating from these screws distorts and somewhat obscures visualization of the left sided sacral foramina.Alignment is anatomic. Vertebral body height and morphology are within normal limits. No worrisome marrow replacement or marrow edema is detected.The visualized spinal cord and conus are unremarkable. At the L4-5 level, it appears that the left lateral recess is more cystic than on the right and the dura is displaced medially (see image 18 of series 9). The nerve roots of the cauda equina at this level are also relatively shifted to the middle and right aspects of the thecal sac. The left L4 nerve root is, however, visualized and appears normal as it approaches and traverses the neural foramen.At the L5-S1 level, the left lateral recess remains slightly more cystic than the right. In addition, no clear evidence of the left L5 nerve root is seen approaching or entering the neural foramina, and the left L5 dorsal root ganglion is not visualized within the neural foramen.At the S1 level, again, the neural foramen is more cystic than on the right. There does appear to be a thin linear structure traversing the neural foramen (see image 36 of series 6), though it is unclear if this reflects the nerve or a vessel.There is mild disc bulging at L5-S1. The remaining intervertebral discs are unremarkable. No significant disc herniations are seen. No significant spinal canal or neuroforaminal stenosis is evident at any level. Mild to moderate facet hypertrophy affects L4-5 and L5-S1.

Output: 1. The left lateral recess at L4-5 is more cystic than the right, and it appears that the dura is displaced medially by this process. Findings are suggestive of a posttraumatic pseudomeningocele, less likely a dilated perineural root sleeve cyst. Of note, the left L4 nerve root is visualized traversing and exiting the neural foramen.2. At the L5-S1 level, again the lateral recess on the left is more cystic than the right and there is a general displacement of nerve roots towards the middle and right aspect of the thecal sac. At this level, however, no definite evidence of an L5 nerve root is seen either approaching or within the neural foramen. This may reflect atrophy or retraction of an injured L5 nerve root.3. The left S1 neural foramen is more cystic than the right. A thin linear structure does traverse this foramen, though it is unclear if this represents an atrophied S1 nerve root or perhaps just a vascular structure. In either event, posttraumatic injury to the nerve with a possible pseudomeningocele is again suspected.


Instruction: Generate impression based on findings.

Input: Seizures and syncope. Malignant neoplasm of breast. There are postoperative findings related to right anterior temporal lobectomy with high T2 signal diffusely along the surgical margins. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Postoperative findings related to right anterior temporal lobectomy with mild gliosis along the surgical margins. 2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male, 32 years old, with headache and right posterior frontal tumor. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Activation related to the face maps to a location one gyrus posterior to the patient's right frontal lesion.Of the tested language paradigms, the most reliable language related cortical activation is seen with the sentence completion and verb generation paradigms. Language is left dominant. Putative Broca's area activity is identified on both paradigms in its customary location of the left inferior frontal gyrus, primarily pars opercularis with some activity in pars triangularis. Putative Wernicke's area activity is identified only on the sentence completion paradigm in its customary location along the left superior temporal sulcus. There does not appear to be any significant language related activity in the vicinity of the patient's right frontal lesion.

Output: 1.Technically successful functional MRI for presurgical functional mapping.2.The sensorimotor cortex is adequately visualized in its customary location.3.Language is left dominant with no significant language related activity identified in the vicinity of the patient's right frontal lesion.


Instruction: Generate impression based on findings.

Input: 59-year-old female with metastatic melanoma to the brain, planning for stereotactic radiosurgery. Status post craniotomy, tumor resection. Redemonstrated are changes from previous left posterior parietal craniotomy for tumor resection. There has been interval decrease in associated local regional mass effect as well as vasogenic edema. There has been expected evolution of postoperative cavity components, now appearing less T1 hyperintense. There remains hemosiderin staining along the posterolateral aspect of the cavity, associated with T1 hyperintense products which may represent hemorrhage and/or tumor enhancement.There is a new 4 mm nodule of enhancement and susceptibility hypointensity along the lateral cortex of the right superior frontal gyrus (best seen series 401, image 125). This appeared as a pinpoint focus of enhancement on the immediate comparison dated 7/14/2015, and thus has significantly enlarged.Ventricular system remains within normal and with maintained midline.

Output: 1.Expected postoperative changes of a left superior parietal craniotomy for tumor resection with decreased mass effect and decreased vasogenic edema.2.There is a new 4 mm nodule of enhancement and susceptibility hypointensity along the lateral cortex of the right superior frontal gyrus. This appeared as a pinpoint focus of enhancement on the immediate comparison dated 7/14/2015, and thus has significantly enlarged and now provides evidence for a second metastasis.3.No other lesions are identified.4.Findings were discussed with Dr. Pitroda on 7/27/2015 at approximately 3:35 AM.


Instruction: Generate impression based on findings.

Input: Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. Multiple lesions which demonstrate increased T2 signal are again present within the periventricular and to a lesser degree subcortical and juxtacortical white matter and appear unchanged. Several of these lesions are again perpendicularly oriented to the lateral ventricles. Several of the lesions also demonstrate associated decreased T1 signal appearing unchanged. There is a single punctate focus of increased T2/FLAIR signal within the lower left paramedian pons (series 901, image 15) which was not clearly visualized on the prior examination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. The previously seen mucosal thickening within the maxillary sinuses has improved. The midline structures and craniocervical junction are within normal limits.Cervical Spine: Postsurgical changes are present from anterior spinal fusion from C5-C7. There is mild straightening of the cervical spine. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There are several foci of increased T2 signal within the cord which appear unchanged compared to the prior exam: along the left hemicord at the cervicomedullary junction, along the posterior lateral aspect of the left hemicord at the C2 level with associated trace volume loss, within the left hemicord at the C4-5 level, and within the lateral aspect of the spinal cord at C7-T1. No new cord signal abnormalities are identified. C2-C3: No significant central or foraminal stenosis.C3-C4: No significant central or foraminal stenosis.C4-C5: Mild central disc protrusion. No significant central canal stenosis. Mild right foraminal stenosis.C5-C6: Mild left lateral recess disc protrusion. No significant central canal or foraminal stenosis.C6-C7: No significant central or foraminal stenosis.C7-T1: No significant central or foraminal stenosis.

Output: 1.Multiple lesions throughout the brain compatible with history of demyelinating disorder. There is a single punctate focus of abnormal signal within the left paramedian pons which was not clearly visualized on the prior exam which could represent a new lesion or simply may be better seen on today's exam due to differences in technique. Otherwise, no new brain lesions or significant interval change.2.Stable cervical spinal cord lesions compatible with demyelinating disorder.


Instruction: Generate impression based on findings.

Input: 47 year-old female with bilateral lower quadrant pain for 3 months following uterine biopsy with right lower quadrant pelvic pain. ABDOMEN:LUNG BASES: A left upper lobe calcified nodule represents a granuloma.LIVER, BILIARY TRACT: Three subcentimeter hypodense lesions are too small to characterize but likely represent simple hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Subcentimeter soft tissue protrusion extending from the fundus of the uterus likely represents uterine fibroid. 1.3 cm cyst adjacent to the left posterior and lateral cervix. 3-cm left adnexal cyst.The uterus is normal size, with fluid in the endometrial cavity. Otherwise unremarkable for a 47 year old female. If there is concern for gynecologic abnormality, further evaluation with transvaginal ultrasound or MRI may be helpful as clinically appropriate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No specific gynecologic abnormality, but if this is suspected, further evaluation with transvaginal ultrasound or MRI may be helpful as clinically appropriate.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 77-year-old female with pain, swelling and effusion of the right knee MENISCI: There is enlargement of the body of the lateral meniscus, which contains extensive increased globular signal intensity indicating mucoid degeneration, progressed from the prior exam. The body of the lateral meniscus is extruded. This globular signal intensity disrupts the femoral articular surface of the meniscus, likely representing degenerative tearing. Signal abnormality extends into the anterior horn of the lateral meniscus, which appears attenuated and fragmented, likely representing extensive degenerative tearing that has also progressed from the prior exam. Mucoid degeneration of the posterior horn of the lateral meniscus appears less extensive than that involving the body and anterior horn.Intrasubstance signal within the medial meniscus is compatible with mucoid degeneration. There is mild irregularity of the inner edge of the posterior horn of the medial meniscus suggesting degenerative fraying, which appears similar to the prior exam.ARTICULAR CARTILAGE AND BONE: There has been progression of osteoarthritis affecting the lateral joint compartment with the weight bearing surfaces appearing devoid of articular cartilage. Subchondral cysts and edema signal are present in the lateral femoral condyle and tibial plateau. Loss of cartilage along the weight-bearing portion of the medial femoral condyle has perhaps progressed slightly compared with the prior exam with foci of degenerative signal abnormality seen within the subchondral bone. There has been slight progression of multifocal partial thickness degeneration of the articular cartilage of the patellofemoral joint.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps tendon is intact.ADDITIONAL

Output: Progression of osteoarthritis and degeneration/degenerative tearing of the lateral meniscus, as described above.


Instruction: Generate impression based on findings.

Input: Male, 50 years old, with epilepsy, presurgical functional evaluation requested for mapping of the sensorimotor and language cortices. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. The visual cortical activation maps as expected along the calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the sentence completion and object naming paradigms. Language is left dominant. The putative Broca's area is best visualized on the object naming paradigm where cortical activation is seen in the left inferior frontal gyrus (pars triangularis). The putative Wernick's area is best visualized on the sentence completion paradigm where cortical activation is seen along the posterior aspect of the left superior temporal gyrus.

Output: 1.Sensorimotor cortical activation is visualized mapping the pre and postcentral gyri and the calcarine sulci.2.Data quality for the language portion of the examination is less than ideal but diagnostic information is still obtained. Language is left dominant. Broac'a and Wernicke's areas are identified in their customary locations.


Instruction: Generate impression based on findings.

Input: Inflammatory pseudotumor: headaches. The enhancing dural-based enhancing lesion along the left parietal convexity, deep to the craniotomy flap, appears to have increased in size, measuring 6 mm in thickness, previously 4 mm. There is unchanged superior left frontoparietal encephalomalacia and gliosis. There is no acute intracranial hemorrhage. The ventricles are unchanged in size. There is no evidence of acute infract. There is unchanged faint T1 hyperintensity in the deep cerebellar nuclei, which may be related to cumulative gadolinium-based contrast administration. There cerebellar tonsils remain slightly low-lying. There are postoperative findings related to right mastoidectomy. There is minimal left maxillary sinus mucosal thickening.

Output: Mild interval increase in thickness of the dural based pseudotumor along the left parietal convexity.


Instruction: Generate impression based on findings.

Input: Male 63 years old with elevated PSA and negative biopsies. Target potential lesions. PELVIS:PROSTATE:Prostate Size: 4.9 x 3.2 x 4.2 cmPeripheral Zone: There is a 6 x 4 mm lesion in the right mid gland (series 301, image 64) that is dark on T2 and ADC and demonstrates contrast enhancement suspicious for prostate adenocarcinoma. Additional areas in the right base and left mid gland are also suspicious for adenocarcinoma.Central Gland: Multiple BPH nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small left pelvic lymph nodes are nonspecific (series 1401, images 87 and 92).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Note is made of a 8 x 5 mm utricle cyst.

Output: Multiple foci in the transitional zone are suspicious for prostate adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system [D49.7], Reason for Study: ^Reason: 3 T SCANNER WITH CSF FLOW PLEASE History: PINEAL TUMORAdditional history from EMR: pineal parenchymal tumor of intermediate differentiation Images are limited by patient motion. There is regeneration of postoperative changes from previous partial resection of a infiltrative appearing enhancing lobulated pineal tumor, with right paramedian occipital approach. There is underlying right occipital pole encephalomalacia. Compared to the recent exam from 11/4/2016, there has been no significant interval change in the overall morphology and size of this heterogeneously enhancing mass, again measuring up to 37 mm transverse. On T2-weighted images, there is again an infiltrative appearance involving the thalami bilaterally, with more cranial extension on the right side and associated mass effect upon the posterior aspect of the third ventricle. The tectum is not discretely delineated, engulfed by the mass. The cerebral aqueduct is not well visualized.A right frontal approach ventriculostomy catheter is again seen, with tip near the septum pellucidum at the level the body of the lateral ventricles. Although third ventricular dilatation appears similar in degree, lateral ventricles are increasingly dilated and rounded in morphology especially along the atria, with the right atrium now measuring 22 mm transverse compared to previous 18 mm. There appears to be stable thickness of periventricular abnormal T2 hyperintensity. Additional patchy areas of T2 hyperintensity are seen elsewhere throughout the cerebral white matter.CSF flow imaging appears technically limited. Biphasic flow is identified only along the ventral brainstem and upper cervical cord, as well as the dorsal upper cervical spinal canal. Biphasic flow is not identified through the aqueduct ventricle.A prominent oval area of mild T2 hyperintensity seen along the left occipital scalp is nonspecific, although previous imaging demonstrated avid enhancement. This measures approximately 17 x 18 mm in greatest axial dimensions. It does appear to involve the skin surface.

Output: 1. Stable appearance of lobulated heterogeneously enhancing pineal mass with infiltrative involvement of the thalami bilaterally, greater on the right side.2. Slight interval increased dilatation of the lateral ventricles with stable right frontal approach ventriculostomy catheter. CSF flow imaging is somewhat technically limited, although appears to demonstrate lack of flow through the cerebral aqueduct and fourth ventricle, with minimal flow detected along the ventral brainstem and ventral as well as dorsal upper cervical spinal canal.3. Redemonstration of oval mildly T2 hyperintense 18 mm lesion in the left occipital scalp with heterogeneous enhancement, extending to the skin surface. Please correlate with direct inspection, although the finding has been present since baseline exam of May 2014, potentially representing a sebaceous cyst with associated infectious or inflammatory changes..


Instruction: Generate impression based on findings.

Input: 48-year-old male with right lower quadrant pain status post appendectomy. Ultrasound is negative for hernia. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.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: No abnormality to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Cervicalgia [M54.2], Reason for Study: ^Reason: Evaluate for neck pain and bilateral UE radicular pain Cervical Spine MRIThere is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. There are disc dessication on cervical intervertebral discs.Opacifications of the right mastoid air cells are seen.Degenerative changes are as follows.C23: Within normal limitsC34: Diffuse bulging of disc which abuts thecal sac. No neuroforaminal stenosis. No spinal stenosis.C45: Minimal bulging of disc otherwise unremarkable.C56: Diffuse bulging of disc which abuts thecal sac and slightly eccentric toward left side results minimal spinal canal stenosis. No neuroforaminal stenosis. C67: Central focal bulging of disc, otherwise unremarkable.C7T1: Within normal limitsLumbar Spine MRIThere is a normal lumbar lordosis and the spine alignment is anatomic.The bone marrow and end plate demonstrate normal MR signal intensity.The vertebral body height is preserved.Spinal cord signal intensity is normal. The conus medullaris terminates at the level of T12-L1.Degenerative changes are as follows:T12-L1: There is focal disc protrusion central to slightly left side abutting thecal sac. Otherwise unremarkable.L1-L2: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation. Minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc. Disc desiccation. Bilateral ligamentum flavum thickening and facet hypertrophy on the right side results minimal spinal canal stenosis. No neuroforaminal narrowing. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multilevel various degenerative disc disease on both cervical and lumbar vertebral level.2. Spinal cord signal intensity is normal. 3. Vertebral body height is preserved with normal MR signal intensity.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with history of bone cyst/hemangioma, status post cervical fusion with removal of hardware and most recently C3-C7 ACDF. Evaluate for change in cyst/meningioma. Since the prior examination, anterior instrumented cervical spine fusion has been extended and now encompasses the C3-C7 levels. An intervertebral device has been placed within the C3-4 disc space. Although the bones are not well assessed in this area due to metallic artifact, it does appear that osseous fusion has occurred at least from C4 through C7. Cervical spinal alignment is unchanged.As on the prior examinations, a well-circumscribed T2 hyperintense and fairly homogeneously enhancing lesion is redemonstrated occupying the left aspects of the fused C5, C6 and C7 vertebral bodies. There has been no significant change in the size or imaging characteristics of this lesion.A small lesion is evident within the T4 vertebral body with imaging characteristics compatible with a hemangioma, unchanged.Level specific degenerative findings are as follows:C2-3: Facet arthropathy. Mild central posterior disc-osteophyte complex formation and ligamentum flavum thickening. Mild spinal canal stenosis. No interval changes.C3-4: Facet arthropathy. Right uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes. C4-5: Obliteration of the disc space. No spinal canal or foraminal stenosis. No interval changes.C5-6: Obliteration of the disc space. No spinal canal or foraminal stenosis. No interval changes.C6-7: Obliteration of the disc space. No spinal canal or foraminal stenosis. C7-T1: Facet arthropathy. Ligamentum flavum thickening. Mild posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate left foraminal narrowing.Patchy nodular lesions are seen in the right lung apex. The recent prior MRI examinations do not cover this area, but these lesions appear to have progressed when compared to a more remote chest CT from 2014.

Output: 1.Evidence of interval extension of the anterior spinal fusion which now incorporates the C3-C7 levels.2.A well circumscribed and homogeneously enhancing lesion occupying the left aspect of the C5-C7 fused vertebrae is unchanged.3.Patchy nodular opacities are evident in the right lung apex which seem to have progressed when compared to a prior chest CT from 2014. Although these findings may be infectious/inflammatory in nature, dedicated chest imaging is recommended for better assessment.


Instruction: Generate impression based on findings.

Input: 68-year-old male with history of elevated PSA. Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The patient was placed prone on the MR table.A needle guide was placed into the rectum and under MRI guidance, 3 passes were made into the right anterior apex of the prostate using an 18-gauge core needle. The specimens were hand delivered to surgical pathology. The patient tolerated the procedure well and left the department in stable condition without any complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful MRI guided prostate biopsy.PLAN: Will monitor patient in holding for 1-2 hours then discharge home.