Instruction: Generate impression based on findings.

Input: 86 years Male (DOB:4/21/1930)Reason: r/o mass lesion History: acute mental status changePROVIDER/ATTENDING NAME: NAOUM ISSA ELBERT S. HUANG Brain MRIThere is restricted diffusion lesion on the left globus pallidus and the genu of left internal capsule with patchy enhancement on post Gadolinium enhancement indicating subacute ischemic infarction with surrounding minimal edema. Punctate susceptibility lesions are seen on bilateral globus pallidi which likely represent parenchymal mineralization. However, the left side globus pallidus shows asymmetrically more prominent susceptibility nodular lesions. Since these susceptibility lesions are overlapping with restricted diffusion lesion, the possibility of focal petechial hemorrhagic lesions cannot be completely excluded. There are multifocal somewhat patchy T2/FLAIR high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. There is no mass, midline shift. 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. Diffuse segmental narrowing of the distal right vertebral artery is seen with about 30% luminal stenosis likely related to atherosclerotic change, otherwise vertebrobasilar system are unremarkable.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There are about 10% luminal narrowing on the left carotid bulb, otherwise extracranial carotid arterial system appears to be unremarkable. Specifically, there is no evidence of significant luminal stenosis or arterial occlusion.

Output: 1. Subacute ischemic infarction involving the left globus pallidus and the genu of left side internal capsule with minimal surrounding edema.2. Asymmetric susceptibility lesions on the left globus pallidus which overlap with restricted diffusion lesion could represent parenchymal mineralization. However, the possibility of focal petechial hemorrhagic conversion cannot be completely excluded.3. Non specific small vessel ischemic disease.4. Atherosclerotic changes of intracranial and extracranial arterial system without evidence of significant (more than 50%) luminal stenosis or evidence of large vessel occlusion. No intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: Clinical question: 67 year old male with RA, COPD and hypertension. Admitted with cavitary pulmonary lesion with confusion. Signs and symptoms: Confusion. Non-enhanced CT of brain:Examination demonstrates no evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. There is only a suspect a single focus of low-attenuation in the subcortical white matter of the right frontal lobe (image 21 of 32). Considering clinical history of hypertension this may represent a small subcortical stroke of indeterminate age. Follow-up with an MRI is recommended.Calvarium is intact. Mastoid air cells are well pneumatized. Extensive sinus disease of visualized paranasal sinuses

Output: 1.With the exception of a very small foci of low-attenuation in subcortical white matter of right frontal lobe this is study is within normal limits. This finding may represent small vessels stroke of indeterminate age.2.Extensive sinusitis all visualized paranasal sinuses.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with brain lesion, stereotactic examination requested for preoperative planning. An enhancing nodule with central necrosis or cystic material is redemonstrated within the right occipital lobe showing no significant interval change from the prior examination. As before, the lesion is suspected to be intra-axial but it does abut the dura. The lesion induces moderate local mass effect.No additional pathologic intracranial enhancement is suspected. Confluent extensive periventricular T2 hyperintensity is unchanged. An enhancing lesion within the right parieto-occipital calvarium is also unchanged.

Output: Presurgical planning examination redemonstrates an enhancing lesion within the right occipital lobe showing no significant interval change.


Instruction: Generate impression based on findings.

Input: 72-year-old female with hepatitis C cirrhosis. HCC screening. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mildly nodular contour to the liver, consistent with cirrhosis. Heterogeneous arterial enhancement of the right hepatic lobe on arterial phase images with multiple nodular and peripheral areas of increased enhancement. No corresponding lesions on the remainder of the sequences. This is most likely related to transient hepatic arterial differences (THAD). No suspicious hepatic lesions. No biliary ductal dilatation. Hepatic vessels are patent. SPLEEN: Multiple splenic varices with evidence of spleno-renal shunting, similar prior study. Mild splenomegaly measuring 12.7-cm, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild calcific atherosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES:Mild degenerative changes in the thoracolumbar spine.OTHER: No significant abnormality noted

Output: 1. No suspicious hepatic lesions.2. Splenic varices with mild splenomegaly consistent with portal hypertension.


Instruction: Generate impression based on findings.

Input: Small cell lung cancer. Restaging. Rule out brain metastasis. A tiny focus of contrast enhancement in the lateral most aspect of the right putamen (best seen in the axial fat-saturated postcontrast sequence; on image #18 of series #12) is related to one of the lenticulostriate vessels as evident on the 3D T1 postcontrast axial images. There is no abnormal brain or leptomeningeal contrast enhancement. There is no space-occupying brain lesion or mass-effect. There is also no abnormal brain diffusion restriction.Moderate periventricular T2-hyperintense signal without diffusion restriction is compatible with chronic microvascular ischemia and was present on the previous CT had. Similar changes are present in the dorsal pons. In addition, focal parenchymal loss and adjacent abnormal signal, compatible with encephalomalacia, in the right frontal lobe is unchanged from previous CT scan and probably relates to chronic infarct. The ventricles and the other CSF-containing spaces are moderately enlarged, reflective of global volume loss. Accounting for a small intracranial right vertebral artery, the major intracranial vascular flow voids are preserved, reflecting gross patency. Fluid in the mastoid air cells can be congestive. There is no destructive skull lesion.

Output: 1.There is no space-occupying or contrast-enhancing brain or leptomeningeal abnormality to indicate intracranial metastasis.2.Findings of moderate chronic microvascular ischemia and diffuse brain volume loss as well as chronic right frontal infarct remain unchanged.


Instruction: Generate impression based on findings.

Input: History of abdominal pain nausea and vomiting. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, and signal intensity. No biliary ductal dilatation. Normally distended gallbladder. No focal suspicious lesion. The vessels are patent.SPLEEN: The spleen is normal in morphology and size without a discrete lesion.PANCREAS: The pancreas is normal in morphology without a discrete lesion or pancreatic ductal dilatation.ADRENAL GLANDS: The adrenal glands are normal in appearance without a discrete lesion.KIDNEYS, URETERS: Symmetrically enhancing kidneys without hydroureteronephrosis or discrete lesion.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The bowel fold pattern is unremarkable. The bowel is normal in caliber and wall thickness without adjacent mesenteric inflammatory changes. No fibrofatty proliferation, abnormal postcontrast enhancement or restricted diffusion. No evidence of sinus tract or fistula formation. No significant mesenteric lymphadenopathy. No free or loculated fluid.The colon is normal in caliber and wall thickness without a discrete abnormality.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal MR enterography without specific findings to account for the patient's abdominal pain, nausea and vomiting.


Instruction: Generate impression based on findings.

Input: Back pain. History of breast carcinoma. Lytic lesions in the vertebral body of L1 levels are seen, correlating with abnormalities seen on prior MRI. The lesion at L1 involves both anterior and posterior elements. There is pathological fracture of L1, with retropulsion and epidural mass causing spinal canal stenosis. These findings are better seen on the prior MRI study. In addition, there are also lytic lesions involving the right transverse process, pedicle and facet of L4, extending into the right neural foramen. There are multiple lesions in bilateral iliac bones.There is no evidence of kyphoplasty changes in the lumbar spine. The uterus appears bulky, with calcifications.There is a 4 mm hypodense lesion at the inferior pole of the left kidney, too small to categorize.

Output: 1. Lytic lesions in multiple vertebral levels and pelvis, consistent with metastasis. Pathological fracture of L1 with epidural mass, causing compromise of the spinal canal.2. Bulky uterus with calcifications, which may be secondary to fibroids. Please correlate with pelvic ultrasound if clinically indicated.3. Small hyperdense left renal lesion, too small to characterize. This may represent a small hyperdense cyst, and can correlated with ultrasound.


Instruction: Generate impression based on findings.

Input: Status post prostatectomy. Evaluate for recurrence. History of her buttock-assisted laparoscopic radical prostatectomy and bilateral pelvic lymph node dissection 10/07/2015. No recent PSA in the system. PELVIS:PROSTATE: Status post radical prostatectomy. There is mild asymmetric hyperemia of the right anterior vesicourethral anastomosis (series 1901/40 and 1801/37) which may be physiologic/post-surgical without discrete nodular enhancement. BLADDER: No significant abnormality noted.LYMPH NODES: Small external iliac and inguinal lymph nodes are not pathologically enlarged.BONES, SOFT TISSUES: Partially imaged infrarenal abdominal aortic aneurysm; see prior CT for further characterization.OTHER: Duplicated left collecting system is partially imaged.

Output: Mild asymmetric hyperemia of the right anterior vesicourethral anastomosis (series 1901/40 and 1801/37) which is favored to be physiologic/post-surgical, no discrete nodular enhancement.


Instruction: Generate impression based on findings.

Input: There is mild apex leftward spinal curvature centered at T3-T4 and lack of the usual cervical lordosis. There is multilevel disc desiccation. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are a few unchanged scattered foci of encephalomalacia in the right inferior cerebellar hemisphere.C2-C3: There is a small central disc osteophyte complex without significant spinal canal or neural foramen stenosis.C3-C4: There is a small central disc osteophyte complex as well as facet arthropathy without significant spinal canal or neural foramen stenosis.C4-C5: There is a broad posterior disc osteophyte complex as well as left uncovertebral joint arthropathy and facet arthropathy that results in moderate left neural foramen stenosis, but no significant spinal canal stenosis.C5-C6: There is a posterior disc osteophyte complex as well as left uncovertebral joint arthropathy and left facet arthropathy. These findings result in mild spinal canal stenosis and moderate left neural foramen stenosis.C6-C7: There is near complete loss of disc height with mild endplate degenerative change, as well as mild facet arthropathy without significant spinal canal or neural foramen stenosis.C7-T1: There is no significant spinal canal or neural foramen stenosis.

Output: 1.Multilevel cervical spine degenerative spondylosis resulting in at most mild spinal canal stenosis at C5-C6 and left neural foramen stenosis at C4-C5 and C5-C6.2.No evidence of syrinx or other spinal cord lesions.3.A few scattered foci of encephalomalacia in the right inferior cerebellar hemisphere may represent chronic infarcts.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: eval supraspinatus, subscapularis, biceps tendon History: pain, bruising. ROTATOR CUFF: Moderate supraspinatus tendinopathy with full-thickness tear of the supraspinatus tendon with retraction measuring at least 2.6 cm, similar to prior. Small full-thickness tear of the anterior fibers of the infraspinatus, approximately 30% of the tendon, similar to prior. Full thickness tear of the supraspinatus tendon, predominantly involving the superior fibers, with retraction, similar to prior. Associated fatty atrophy rotator cuff muscles, slightly increased compared to prior. The teres minor is intact.SUPRASPINATUS OUTLET: Severe osteoarthritis of the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate amount of fluid within the glenohumeral joint. New loose bodies within the inferior aspect of the joint.Mild glenohumeral joint osteoarthritis. Increased subcortical cyst formation along the superior aspect of the humeral head. Degeneration of the superior labrum. BICEPS TENDON: Severe biceps tendinopathy with near full thickness tearing of the intraarticular biceps tendon.ADDITIONAL

Output: 1.Full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons appear similar to prior. Fatty atrophy of the rotator cuff muscles has slightly increased compared to prior.2.Severe biceps tendinopathy with near full thickness tearing of the intraarticular biceps tendon. 3.Severe AC and mild glenohumeral joint osteoarthritis. Increased subcortical humeral head cyst formation. 4.Superior labral degeneration. 5.Moderate joint effusion. 6.New loose bodies within the inferior glenohumeral joint.


Instruction: Generate impression based on findings.

Input: Proximal progressive muscle weakness There is diffusely increased T2 signal throughout the pelvic and thigh musculature most notably involving the vastus muscles and hamstrings. There is diffuse fatty replacement of the pelvic and lower extremity musculature particularly involving the gluteal muscles and posterior compartment although the adductor compartment appears relatively normal in caliber relative to the remaining musculature. Similar abnormal muscle signal is identified in the right lower extremity on the coronal sequence. The sciatic nerve is mildly enlarged and demonstrates slightly increased signal intensity.The marrow signal of the femur is normal.Cystic focus within the urinary bladder may relate to prior surgical reimplantation.

Output: Diffuse edema and fatty replacement of the pelvic and thigh musculature consistent with known history of muscular dystrophy.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with epilepsy, preoperative planning examination with grids in place. Precontrast T1-weighted imaging demonstrates evidence of left sided craniotomy for placement of intracranial grids which drape over the left frontal and parietal lobes. A layer of extra-axial fluid is seen along the craniotomy and grids which is within expected limits. The left-sided cerebral sulci are effaced and the midline is shifted slightly to the right, again as expected. An area of cystic change or encephalomalacia is redemonstrated in the left opercular tissues.

Output: Limited imaging for surgical guidance demonstrates left-sided craniotomy with placement of intracranial EEG grids.


Instruction: Generate impression based on findings.

Input: Reason: eval meniscus History: pain Suboptimal evaluation secondary to the inability to use the high-definition coil due to the patient's body habitus.MENISCI: There is ghosting of the inner half of the posterior horn of the medial meniscus that corresponds to a linear defect seen on the coronal and axial images compatible with a partial thickness radial tear. There is also high signal intensity within the inferior fibers of the peripheral half of the posterior horn of the medial meniscus that we suspect represents a horizontally oriented undersurface tear. The anterior horn appears intact. There is blunting of the free edge of the body of the lateral meniscus suggesting fraying and there is perhaps slight lateral extrusion of the body, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is a small full-thickness defect of the articular cartilage of the medial femoral condyle above the posterior horn of the medial meniscus. There is superficial fissuring of the articular cartilage of the patella, centrally, as well as a near full-thickness defect of the articular cartilage of the medial facet of the femoral trochlea. There is near full-thickness fissuring of the articular cartilage of the lateral femoral condyle just above the periphery of the posterior horn of the lateral meniscus. There are small tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Medial meniscal tears and lateral meniscus fraying as described above.2. Osteoarthritis as described above.3. Joint effusion and small Baker's cyst. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for bleed. Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrates multiple patchy areas of low attenuation in bilateral cerebral hemispheres. Some regions demonstrate mass effect evidence by effacement of adjacent cortical sulci. There is also a focus of low-attenuation with well-demarcated margin in the right mid temporal lobe that has the appearance of a cyst. There is no evidence of hemorrhage as clinically is questioned. The ventricular system are within normal range of size and not significantly changed since prior exam. Areas of low attenuation described above correspond with areas of peritumoral vasogenic edema noted on prior MRI examination from 2 -- 22 -- 11. There is however suggestion of interval increase in the amount of edema which may indicate further progression of disease. Recommend follow-up with an infused head CT or unenhanced MRI of brain. No evidence of abnormality of posterior fossa and stable since prior exam.

Output: Multiple large areas of peritumoral vasogenic edema with subtle associated mass-effect and with interval worsening since prior MRI examination from 2 -- 22 -- 11.


Instruction: Generate impression based on findings.

Input: There is grade 1 anterolisthesis of L4 on L5 measuring up to 6 mm. The vertebral body heights are well-maintained. There is loss of disc height most pronounced at L1/2, L2/3, L4/5 and L5/S1. There is increased T2 signal at the endplates at multiple levels consistent with degenerative changes. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. At T12/L1, there is no significant spinal canal or neural foraminal stenosis. At L1-L2, there is a disc bulge with a protrusion eccentric to the right with moderate right neural foraminal and left lateral recess stenosis, but no left neural foraminal stenosis. At L2-L3, there is a a disc bulge with facet hypertrophy and ligamentum flavum thickening without significant spinal canal or neural foraminal stenosis. At L3-L4, there is facet hypertrophy and ligamentum flavum thickening without significant spinal canal or neural foraminal stenosis. At L4-L5, there is degenerative anterolisthesis with facet hypertrophy and ligamentum flavum thickening causing severe spinal canal stenosis with compression and buckling of the nerve roots and moderate right and severe left neural foraminal stenosis. At L5-S1, there is facet hypertrophy and ligamentum flavum thickening without significant spinal canal or neural foraminal stenosis.

Output: Multilevel degenerative spondylosis that is most pronounced at L4-5 with severe spinal canal stenosis, moderate right and severe left neural foraminal stenosis, and grade 1 anterolisthesis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified site of unspecified female breast [C50.919] / Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: Hx: metastatic breast cancer to the brain. Compare to prior MRI for brain mets, s/p WBRT The enhancing lesion located at slightly right side of anterior aspect of pons is again seen, unchanged in terms of size, and MR characteristics since prior scan.Relatively thick linear enhancement along the resection cavity of the right cerebellar hemisphere as well as T2/FLAIR high signal intensity lesions on the left frontal lobe and the right frontal lobe are again seen, unchanged.Nodular enhancing lesion on the right anterior aspect of occipital lobe does not show any significant interval change since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Unchanged pontine and right occipital lobe enhancing lesions since prior scan.2. Unchanged relatively thick linear enhancing lesions of the right cerebellar resection cavity since prior scan.3. Unchanged bilateral frontal T2/FLAIR high signal intensity lesions since prior scan.4. No evidence of new abnormal enhancing lesion.5. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Male 71 years old with NASH cirrhosis. IPMN and HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour, widening of the fissures and left lobe hypertrophy are consistent with cirrhosis. There is trace perihepatic ascites. No focal hepatic lesion.Improved but small residual nonocclusive superior mesenteric vein thrombosis. The portal vein is patent.Cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly and subcentimeter splenic cyst. Splenic varices and splenorenal shunting are redemonstrated.PANCREAS: There are two dominant multilobulated cystic lesions extending exophytically from the pancreatic head measuring 3.2 x 2.7 cm (series 5, image 36 and) and 1.7 x 1.6 cm (series 5, image 30). Additional, much smaller cystic foci are also seen. The main pancreatic duct appears normal in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal sinus and parenchymal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild thickening of the hepatic flexure suggestive of portal colopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with splenic varices and splenorenal shunting. No focal liver lesion.2.Improved nonocclusive superior mesenteric vein thrombosis.3.Thickening of the hepatic flexure suggestive of portal colopathy.4.Interval increase in size of cystic pancreatic head lesions. Based on size criteria, cyst aspiration should be considered for the 3.2 cm cyst.


Instruction: Generate impression based on findings.

Input: History of breast cancer with progressive fatigue and lethargy for the past two months. Evaluate for central cause out fatigue and lethargy. There is no evidence of acute intracranial hemorrhage, acute infarct or enhancing intracranial mass. There are scattered T2 hyperintensities within the periventricular and subcortical white matter as well as the pons. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is scattered opacification of the bilateral mastoid air cells. There is fairly symmetric mild marrow enhancement of the bilateral parietal bones corresponding to osseous thickening on the prior CT without evidence of an aggressive or destructive process. The extracranial soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, acute infarct or enhancing intracranial mass.2. Nonspecific scattered T2 hyperintensities within the periventricular and subcortical white matter, which likely represent mild chronic small vessel ischemic changes.3. No obvious findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with acute liver injury, altered mental status. Signs and symptoms: Acute liver injury and altered mental status. Non-infused CT of brain:No evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus. The gray/white matter differentiation is preserved. The ventricular system are within normal limits and no evidence of compression or midline shift. The basal cisterns remain patent. There is slight paucity of cortical sulci which may be well within normal range for patient's stated age of 28. Calvarium, paranasal sinuses and mastoid air cells are unremarkable. If clinical concern persist follow-up with a CT or an MRI is recommended.

Output: Unremarkable non-infused CT of brain.


Instruction: Generate impression based on findings.

Input: 27 year old female complaining of abdominal pain with history of Crohn's disease status post two bowel resections and planned placement of Seton tube for drainage treatment of multiply recurring high-spreading extrasphincteric perianal fistula. Evaluate for perianal abscess. ABDOMEN:LUNG BASES: No pleural effusions. LIVER, BILIARY TRACT: Periportal low attenuation compatible with periportal edema was seen on the prior exam, but this has resolved. No focal liver lesions. SPLEEN: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense lesions are too small to characterize.ADRENAL GLANDS: There is a 0.8 x 1.7 cm cystic lesion associated with the left postero-lateral adrenal limb on axial image 19/145. This was present on the prior examination and appears unchanged. If indicated, further evaluation with dedicated adrenal CT or preferably, MRI examination would be helpful to characterize this lesion.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening of the terminal ileum and cecum identified. This is near the anastomosis. No surrounding fluid collections.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:UTERUS, ADNEXA: An IUD is in place. Minimal free fluid identified within the pelvis.There is a relatively hypodense object in the right vagina / adnexa on coronal image 53/109 measuring 1.7 x 5 cm which may be a tampon or other foreign object. This appears unchanged in position and size since the prior exam. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Minimal wall thickening of the descending colon seen on the prior exam has resolved without evidence of abscess formation. No free air or pneumatosis.In the interval since the prior examination, multiple air collections which extend posteriorly towards the sacrum and extend to the left lateral aspect of the rectum have developed. These are seen best on axial image 128/145 and coronal image 41/109. No abscess was found.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New air collections in in presacral and left lateral aspect of the rectum have developed since the prior examination. No abscess was found. Exam is stable otherwise. Probable tampon in vagina - see above.


Instruction: Generate impression based on findings.

Input: Headache on steroids, history of thrombosis. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged mild scattered foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRV: There is no evidence of cerebral venous thrombosis.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. Unchanged mild scattered foci of cerebral white matter T2 hyperintensity are nonspecific, but may represent chronic small vessel ischemic disease, for example. 2. No evidence of cerebral venous thrombosis.


Instruction: Generate impression based on findings.

Input: Altered mental status, s/p PEA, difficult to extubate. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular white matter T2 hyperintensity diffusely, which is nonspecific. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the sphenoid sinuses. There is left intraocular silicone oil. There are subcentimeter T2 hyperintense nodules in the bilateral eyelids, which may represent hydradenitis. There is bilateral otomastoid fluid, which is likely related to intubation.

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


Instruction: Generate impression based on findings.

Input: Chiari malformation with syrinx. Please do CINE flow study at foramen magnum. Cervical Spine: The cerebellar tonsils display a pointed configuration and extend approximately 8 mm inferior to the level of the foramen magnum. There is impaired CSF flow across the posterior foramen magnum due to blockage by the cerebellar tonsils. However, there is relatively intact CSF flow across the anterior foramen magnum. There is a partially imaged syrinx that extends from the C1-2 level to at least inferior to the T4 level. The syrinx measures up to 9 x 15 mm in cross-section. There are posterior disc-osteophyte complexes at C5-6 and C6-7 that result in mild spinal canal stenosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.

Output: 1. Chiari I malformation with abnormal CSF flow dynamics in the craniocervical junction and associated large caliber cervicothoracic syrinx. Please refer to the prior thoracic spine MRI report for additional details.2. Disc-osteophyte complexes at C5-6 and C6-7 result in mild spinal canal stenosis. 3. No evidence of cerebral aneurysms.


Instruction: Generate impression based on findings.

Input: Neck pain, bilateral arm pain. Positive Hoffmann left, and brisk reflexes on exam. Stenosis, foraminal C6-C7 planning surgical procedure. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C5 on C6. Alignment of the cervical spine is otherwise maintained. No abnormal signal within the cervical cord is appreciated.Diffuse T2 hyperintensity is noted involving the C6 vertebral body. There are multilevel degenerative changes with disc desiccation throughout, with particular disc height loss at the C5-C6 and C6-C7 levels. Degenerative changes are also noted at the left C3-C4 facet joint with associated bone marrow edema involving the posterior elements of C3 and C4 on the left. Multilevel degenerative changes, individual levels as below: C2-3: No significant compromise to the spinal canal or right neural foramina. Minimal left neural foraminal narrowing related to facet arthropathy.C3-4: There is a small central disc protrusion which effaces the ventral thecal sac and slightly indents the ventral cord in the midline. There is mild to moderate degree of spinal canal stenosis at this level. No significant right neural foraminal stenosis. There is mild left neural foraminal stenosis.C4-5: Minimal central disc protrusion abutting the ventral cord, dorsal thecal sac is patent. Minimal left neural foraminal narrowing. No significant right neural foraminal stenosis.C5-6: Disc osteophyte complex and ligamentum flavum thickening result in moderate spinal canal stenosis relatively worse on the right aspect. There is bilateral uncovertebral hypertrophy. There is moderate to severe right neural foraminal stenosis and mild left neural foraminal narrowing.C6-7: There is disc osteophyte complex, ligament of flavum thickening, and bilateral uncovertebral hypertrophy resulting in moderate right and severe left neural foraminal stenosis. There is moderate spinal stenosis, slightly greater to the left of the midline.C7-T1: No significant spinal canal or right neural foraminal stenosis. Mild to moderate left neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There is a 1.8 cm T2 hyperintense right thyroid lobe nodule.

Output: 1. Multilevel degenerative changes in the cervical spine with moderate spinal canal stenosis at C5-C6 and C6-C7 levels. There is milder degree of stenosis at the C3-C4 level related to central disc protrusion.2. Multilevel neural foraminal stenosis which is moderate to severe on the right at C5-C6 and severe on the left at C6-C7.3. Prominent facet arthropathy at the left C3-C4 level with associated bone marrow edema.4. 1.8 cm right thyroid lobe nodule which can be further evaluated with ultrasound as clinically indicated.5. T2 hyperintensity diffusely involving the C6 vertebral body which may be related to an underlying lesion such as atypical hemangioma, but is nonspecific.


Instruction: Generate impression based on findings.

Input: Change in size of pituitary macroadenoma: Chronic left eye visual loss. There are postoperative findings related to prior frontal craniotomy with a large area of encephalomalacia of the anterior left frontal lobe and ex vacuo dilatation of left lateral ventricle. There appears to be slight interval increase in size of the heterogeneous sellar mass with extension into the cavernous sinuses, mass effect upon the optic chiasm, and invasion of the sphenoid sinuses. The tumor measures up to 45 mm in width, 34 mm in height, and 38 mm in length. There is encasement and narrowing of the left cavernous carotid and a small left cavernous carotid aneurysm.

Output: 1. Postoperative findings related to prior frontal craniotomy with a large area of encephalomalacia of the anterior left frontal lobe.2. Apparent slight interval increase in size of the heterogeneous sellar mass with extension into the cavernous sinuses, mass effect upon the optic chiasm, and invasion of the sphenoid sinuses. 3. Encasement and narrowing of the left cavernous carotid and a small left cavernous carotid aneurysm.


Instruction: Generate impression based on findings.

Input: 8-year-old male with history of neuroblastoma, 2 years post therapy. ABDOMEN:LIVER, BILIARY TRACT: Similar-appearing faintly T2 hyperintense lesions that demonstrate enhancement on the 20 minute delayed series (axial series 2001 images 68, 78, 86) and consistent with focal nodular hyperplasia. Hypointense T2 signal of the background hepatic parenchyma compatible with deposition.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: In the right retroperitoneum just proximal to the aortic bifurcation, a small 1.2 x 0.6 cm oval structure demonstrating hyperintense signal on the diffusion weighted series (axial series 408 image 32) has decreased in size since the 3/5/2014 CT exam (prior 1.5 x 0.7 cm).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See below.OTHER: No significant abnormality noted.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: Lobulated T2 hyperintense eccentric lesion of the left femoral intertrochanteric region (axial series 701 image 21, coronal series 801 image 17) likely represents a small enchondroma, unchanged.Interval development of an exostosis from the left posterior-superior iliac bone with internal signal intensity following osseous matrix, and there is a curvilinear overlying T2 hyperintense signal. In retrospect, a minimal contour deformity in this region was present on the 9/30/2015 MRI exam (prior exam series 8 image 45), and no contour deformity was seen on the 3/5/2014 CT exam. Imaging appearance of this lesion is suggestive of an osteochondroma.Stable nonspecific T2 hyperintense signal of the T9, T10, and T11 vertebral bodies (coronal series 1501 image 21) with loss of signal on T2 fat saturated sequences. The small hyperintense lesion of the T11 vertebral body on the T2 fat saturated sequence (axial series 1801 image 31) demonstrating contrast enhancement is also unchanged.OTHER: No significant abnormality noted.

Output: 1.The known 3 liver lesions are stable in size and again demonstrate contrast enhancement on the 20 minute delayed/hepatobiliary phase consistent with focal nodular hyperplasia.2.Interval development of an exostosis from the left iliac crest with imaging features suggestive of an osteochondroma. Stable appearance of a small suspected left femoral enchondroma. Follow-up plain film radiographs are recommended.3.Interval decreased size of a small 1.2 x 0.6 cm oval right retroperitoneal structure demonstrating hyperintense signal on the diffusion weighted series compared to the 3/5/2014 CT exam (prior 1.5 x 0.7 cm). This structure is of unclear etiology.4.Stable T2 hyperintense signal of the lower thoracic vertebral bodies as described above.


Instruction: Generate impression based on findings.

Input: 90-year-old female with new onset of left body weakness and numbness after fall. Left arm weakness, cramping, and numbness. There are areas of intrinsic T1 and T2 hyperintensity involving the subarachnoid space along the central sulcus on the right consistent with subacute subarachnoid hemorrhage. Areas of T2 hypointensity with more extensive areas of susceptibility in the right parietal sulci are best seen on the SWI sequence. There is minimal local expansion of the right central sulcus related to the blood products. Otherwise no mass or mass effect is seen. No restricted diffusion to suggest acute ischemia. No hydrocephalus. No subdural collections.Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic changes. Global parenchymal volume loss is noted, commensurate with patient's advanced age.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Subarachnoid hemorrhage involving the right central sulcus and adjacent right parietal lobe sulci. Subarachnoid hemorrhage in the right central sulcus is likely subacute in age with adjacent blood products appearing subacute to chronic. Given the relative peripheral distribution, this hemorrhage may be posttraumatic as indicated by the history.2. No evidence of acute infarct. No intracranial mass or mass effect. No parenchymal or subdural hemorrhage.Dr. Ali discussed findings with Dr. Bernard at 1310 hrs on 7/7/2015.


Instruction: Generate impression based on findings.

Input: Evaluate perianal fistula. History of Crohn's disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Several subcentimeter pelvic lymph nodes measuring less than 1 cm in short axis are noted and are likely reactive.BOWEL, MESENTERY: The pelvis is partially imaged. There is mild circumferential wall thickening of the imaged sigmoid colon which demonstrates restricted diffusion, hyperenhancement and perinephric stranding.BONES, SOFT TISSUES: At approximately the 2:00 position of the anal canal there is a fistula tract extending inferiorly in the intersphincteric space terminating at the left gluteal fold. There is no discrete fluid collection.OTHER: No significant abnormality noted.

Output: Intersphincteric fistula extending to the left gluteal fold without an associated fluid collection. It appears to originate at approximately the 2:00 position of the anal canal.Mild active sigmoid colitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis follow-up progression. Signs and symptoms: Facial numbness. Nonenhanced multiple sclerosis brain MRI:Examination demonstrates few scattered foci of FLAIR hyperintensity only in the subcortical and periventricular white matter of bilateral cerebral hemispheres which are nonspecific. Compared to prior exam there is suggestion of minimal interval increased number of lesions which are entirety in supratentorial brain parenchyma.Note however should be made that prior exam was performed utilizing routine brain MRI protocol with 5 mm slices and current exam with dedicated multiple sclerosis protocol with 2 mm slices which could account results in detection of more number of lesions.The cortical sulci and ventricular system as well as the CSF spaces are within normal for patient of stated age

Output: 1.Mild periventricular and subcortical foci of FLAIR hyperintensity only in the supratentorial brain parenchyma which are nonspecific and demonstrate minimal interval increased numbers since prior study from 2010 as detailed. Please see above comments.2.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Known sarcoidosis with possible biliary mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is of normal in morphology and size measuring 15 cm in craniocaudal dimension. There is mild intrahepatic biliary ductal dilatation. The common bile duct measures approximately 7 mm, within normal limits. Cholelithiasis within a normally distended gallbladder without wall thickening or pericholecystic fluid. At the gallbladder neck there is a 2.8 x 2.6 cm (series 4/19) focus which is very low signal intensity on all imaging sequences (as are the smaller gallstones) without postcontrast enhancement likely representing a large gallstone. Thrombosed residua of the pseudoaneurysm identified on the CT dated 9/6/2014 is considered unlikely. No hepatic artery pseudoaneurysm is identified compatible with the findings of the 1/12/2015 angiogram.There is a left sided percutaneous biliary drain extending through the left hepatic lobe and common bile duct into the duodenum.At the junction of segment 4A and 4B just anterior to the left sided biliary drain there is a focal masslike region of T1 hypointensity measuring approximately 3.4 x 3.2 cm (series 11/57) on the precontrast imaging which demonstrates gradual postcontrast enhancement measuring up to 2.4 x 2.3 cm (series 13/56). There may be a corresponding hypoattenuating focus in a similar region on the CT dated 9/6/2014 (series 3 image 19). This is associated with subtle T2-weighted hyperintensity and restricted diffusion (series 5/52 and series 10/12).The hepatic veins, portal vein and visualized portion of the hepatic artery are patent.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate renal cysts. No hydronephrosis. Symmetric mild perinephric fluid.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Persistent right basilar segmental consolidation/atelectasis. Cardiomegaly.

Output: 1. At the junction of segment 4A/4B there is a focal masslike region demonstrating gradual post contrast enhancement along the anterior margin of the left-sided biliary drain. Given the history of sarcoidosis and possible presence on the 2014 examination this may be secondary to hepatic sarcoidosis. However this can't be distinguished on imaging from cholangiocarcinoma which remains in the differential.2. Previously described lesion at the gallbladder neck likely represents a large gallstone. No evidence of an enhancing pseudoaneurysm.3. Persistent right basilar segmental consolidation/atelectasis.


Instruction: Generate impression based on findings.

Input: 62-year-old male with elevated PSA. Patient reports negative prior biopsy. PELVIS:PROSTATE:Prostate Size: 5.6 x 6.7 x 5.0 cmPeripheral Zone: There is a T2 hypointense left mid gland subcentimeter peripheral zone lesion with corresponding low ADC signal (series 901, image 11). There is an additional T2 hypointense lesion with corresponding low ADC signal in the left posterior mid gland measuring 1.0 x 1.0 cm (series 901, image 15) which appears to extend into the peripheral zone.Central Gland: Heterogeneous and nodular central gland compatible with prostatic hypertrophy.Seminal Vesicles: No abnormality.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: Small suspicious foci in the mid gland as detailed.


Instruction: Generate impression based on findings.

Input: History of autoimmune hepatitis with cirrhosis. Presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic lobular liver morphology with scattered reticular T2-weighted hyperintensity compatible with fibrosis.No suspicious focal lesion.Dilated gallbladder without evidence of acute inflammation.SPLEEN: Mild splenomegaly measuring 15 cm in AP dimension.PANCREAS: Normal morphology without pancreatic ductal dilatation or focal lesion.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: Small umbilical hernia containing a short segment of small bowel without complication.OTHER: No significant abnormality noted.

Output: Cirrhotic fibrotic liver without a focal lesion.


Instruction: Generate impression based on findings.

Input: Reason: eval for torn meniscus, foreign body History: right knee pain and locking MENISCI: There is medial extrusion of the body of the medial meniscus. There is globular increased signal intensity within the body of the medial meniscus representing intrasubstance degeneration with blunting of the extruded meniscus likely representing degenerative tearing. The intrasubstance degeneration and degenerative tearing extends posteriorly to involve the posterior horn of the medial meniscus with relative sparing of the anterior horn. There is globular intrasubstance signal within the lateral meniscus indicating intrasubstance degeneration with linear extension of the signal abnormality to the femoral articular surface indicating a horizontal tear of the body and posterior horn.ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritis of the medial tibiofemoral compartment with the weightbearing surface of the medial femoral condyle and medial tibial plateau essentially devoid of articular cartilage. There are also full-thickness cartilage defects involving the patellofemoral joint. There is relatively mild degeneration of the articular cartilage of the lateral compartment. No bone marrow signal abnormalities are identified.LIGAMENTS: Increased signal intensity within the ACL likely represents mucoid degeneration. The PCL and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Limited study showing severe osteoarthritis, particularly affecting the medial and patellofemoral compartments, with degeneration and tearing of both menisci and other findings as above. We see no foreign body.


Instruction: Generate impression based on findings.

Input: Hip pain following fall There is no evidence of hip fracture or dislocation. Minimal osteoarthritis affects the hips with severe degenerative disc disease affecting the lower lumbar spine. The sacroiliac joints are unremarkable for the patient's age.The musculature of the pelvis is normal in signal and caliber. Minimal peritrochanteric edema is noted bilaterally, right greater than left although this is not necessarily of any clinical significance.

Output: Degenerative disc disease of the lower lumbar spine and mild osteoarthritis of the hips with no evidence of fracture.


Instruction: Generate impression based on findings.

Input: 58-year-old female with left knee pain. Evaluate for left meniscus tear and tibial plateau fracture. MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a minimally depressed (1 mm) fracture of the lateral tibial plateau with the fracture line itself confined to the epiphysis, with bone marrow edema extending into the metaphysis. The fracture extends through the articular cartilage of the lateral tibial plateau just anterior to the posterior horn of the meniscus. Lobulated signal abnormality within the proximal fibula likely represents a benign enchondroma. There is full-thickness degeneration of the articular cartilage along the medial facet of the patella with relatively mild degeneration along the lateral facet. There is focal degeneration of the articular cartilage of the femoral trochlea, centrally. Relatively mild degeneration affects the medial compartment.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Lateral tibial plateau fracture and other findings as described above. We see no meniscal tear.


Instruction: Generate impression based on findings.

Input: 57-year-old male patient with HCV and cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour without evidence of cirrhosis. No significant fatty infiltration. No focal hepatic lesions are seen. No intra- extrahepatic biliary ductal dilatation. No cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple exophytic left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of cirrhosis, fatty infiltration, or focal hepatic lesions.2.Multiple left renal cysts.


Instruction: Generate impression based on findings.

Input: 21-year-old male with left knee pain after soccer injury on May 31, evaluate for ligamentous/meniscal injury MENISCI: There is a complex tear of the posterior horn and body of the medial meniscus, which includes a large longitudinal component that involves the posterior horn and body of the meniscus, as well as a horizontal component that extends into the peripheral fibers of the posterior horn. Furthermore, the peripheral third of the posterior horn near its root is absent, and we suspect the displaced fragment has flipped adjacent to the medial aspect of the PCL. The anterior horn of the medial meniscus is intact.There is undulation of the inner third of the anterior horn of the lateral meniscus, suggestive of a normal variant meniscal flounce. However, there is also suggestion of a partial thickness radial tear at the junction of the anterior horn and body of the lateral meniscus on axial image 17, series 3. The posterior horn of the lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is edema within the posterior aspect of the lateral tibial plateau, as well as the lateral femoral condyle just above the anterior horn of the lateral meniscus, representing bone contusions. There is also a slight depression of the articular surface of the lateral femoral condyle at the site of contusion, indicating a mild impaction fracture. Note is made of mild edema in the posterior aspect of the medial tibial plateau, likely also representing a contusion. We see no fluid -filled articular cartilage defect.LIGAMENTS: The ACL is poorly defined indicating full thickness rupture, presumably mid-substance. The PCL, medial collateral ligament, and lateral collateral ligament are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: ACL rupture with complex tear of the medial meniscus and possible partial thickness radial tear of the lateral meniscus as described above.


Instruction: Generate impression based on findings.

Input: Reason: previous knee xray which showed bone infarction, Hx of Ph+ ALL, s/p stem cell transplant, and chronic steroid use for GVHD History: Left knee pain and crepitus MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is serpentine signal abnormality within the weightbearing surface of the lateral femoral condyle as well as within the medial femoral condyle, posteriorly, consistent with avascular necrosis/osteonecrosis. There is no evidence of subchondral collapse. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Avascular necrosis/osteonecrosis of the distal femur as described above. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Foot pain There is increased signal intensity and possible thinning of the peroneus longus tendon as it courses along the lateral margin of the calcaneus anterior to the retrotrochlear eminence. This suggests tendinosis and attritional tearing. There is also mild edema in the adjacent soft tissues indicating mild peritendinitis. The signal intensity of the tendon normalizes as it enters the cuboid tunnel although a mild amount of fluid surrounds the tendon within the tunnel suggesting tenosynovitis. Proximally, the peroneus longus tendon appears intact. The peroneus brevis tendon is unremarkable. The remaining tendons of the ankle are normal.The anterior talofibular ligament appears thinned but otherwise intact. The posterior talofibular and calcaneofibular ligaments are intact. The distal tibiofibular syndesmotic complex is intact. There is loss of the normal fatty striation of the deep fibers of the deltoid suggesting prior sprain but there is no evidence of tear on this exam.There are small patchy foci of abnormal signal intensity within the cuboid which may reflect reactive edema secondary to the peroneal tendinopathy described above. There is no linear signal abnormality to confirm stress fracture however. There is minimally increased signal intensity within the talus on fluid sensitive sequences which is nonspecific and not necessarily of any clinical significance. An os trigonum is noted posterior to the talus. There is no osteochondral defect. A small amount of fluid signal intensity is noted beneath the second and third tarsometatarsal articulations as well as medial to the subtalar joint which may reflect small synovial cysts or ganglia.

Output: Increased signal intensity and probable thinning of the peroneus longus tendon suggesting tendinosis and attritional tearing. There is no evidence of a cuboid stress fracture; additional findings are described above.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with neurofibromatosis type I, with new nystagmus and worsening gait difficulty. Also problems with writing. Brain:No evidence of restricted diffusion, edema or mass effect is seen. No pathologic intracranial enhancement is observed. Predominantly periatrial white matter volume loss is seen with mild patchy T2 hyperintensity in the surrounding periventricular tissues. This is perhaps minimally progressed from prior. No tumor-like lesions are detected. No evidence of intracranial hemorrhage or any abnormal extra-axial collection is seen. Innumerable cutaneous nodules likely representing neurofibromas are demonstrated.Cervical spine:Deformity, thickening and T2 hyperintensity of the spinal cord at the C2 level are unchanged. This lesion itself does not enhance, nor did it on the prior examination. However, just above the level of this lesion, there is bilateral nodular thickening presumably affecting the exiting nerve roots, similar in size to those seen on the prior examination. These lesions do enhance mildly. Nerve root thickening is also suspected within several cervical foramina, most notably C5-6 and C6-7 bilaterally.Straightening of the cervical lordosis is seen. Sagittal alignment is unremarkable. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous, but there are no areas of definite edema or pathologic marrow replacement. Except as above, the spinal canal demonstrates normal signal characteristics and is free of pathologic enhancement.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Mild facet arthropathy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes. C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild to moderate left foraminal narrowing. No interval changes. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes. C7-T1: Very small central disc protrusion. No spinal canal stenosis. No foraminal narrowing. An enhancing nodular lesion is seen at the left tracheoesophageal groove at T1. This area was not covered on the prior examination. Innumerable cutaneous neurofibromas are present.

Output: 1.No definite acute intracranial abnormality is seen. No intracranial tumors are detected. There is white matter volume loss predominantly affecting the periatrial regions with mild associated parenchymal signal abnormality. Findings have perhaps minimally progressed from prior.2.An area of spinal cord thickening, deformity and abnormal signal is redemonstrated at the C2 level without significant interval change. This could potentially represent a benign spinal cord tumor related to neurofibromatosis.3.Additional small neurofibromas are suspected intrathecally, above the level of the C2 cord tumor, and within several of the cervical foramina. The findings are nonspecific and unchanged from prior.4.Relatively mild degenerative findings in the cervical spine are unchanged with no areas of high-grade spinal canal stenosis.5.Innumerable cutaneous neurofibromas are seen. In addition, there is a nodule along the left tracheoesophageal groove at the T1 level which is nonspecific but could potentially represent a neurofibroma.


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion. The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. There is mild diffuse disc desiccation. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.At C3-C4, there is a minimal right paracentral/proximal foraminal posterior osteophyte disk complex resulting in mild right foraminal narrowing.At C4-C5, there is a trace disc bulge without stenosis.At C5-C6, there is a minimal posterior osteophyte disk complex diffusely with bilateral uncovertebral hypertrophy resulting in mild-moderate bilateral foraminal narrowing. There is also bilateral ligamentum flavum thickening.At C6-C7, there is ligamentum flavum thickening.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the the cervical spine. Incidental near completely sella is suggested, with enlarged bony sella.

Output: 1. Very minimal cervical spondylotic changes as detailed above, with up to mild-moderate bilateral foraminal narrowing at C5-C6.2. Stable incidental near completely enlarged empty sella.


Instruction: Generate impression based on findings.

Input: Images are degraded secondary to patient motion. Given this caveat:Straightening of the cervical spine is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: There is a small midline disc protrusion without resulting stenosis.C3/4: There is a small midline disc protrusion without resulting stenosis.C4/5: There is a small midline disc protrusion without resulting stenosis. There is also right uncinate hypertrophy causing mild right neural foraminal stenosis.C5/6: There is a small midline disc protrusion without resulting stenosis.C6/7: There is a small midline disc protrusion without resulting stenosis. C7/T1: Unremarkable

Output: 1.Multilevel small disc protrusions without resulting stenosis.2.C4/5: Mild right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: stenosis? Signs and Symptoms: degenerative spondylosis. Nonenhanced lumbar MRI:T11-T12 through L2-L3 are unremarkable other than mild bilateral facet and ligamentum flavum hypertrophy.L3-L4 demonstrate mild disc dessication and moderate bilateral ligamentum flavum and facet hypertrophic changes. There is resultant moderate left and mild right neural foraminal compromise and mild central spinal stenosis.L4-L5 demonstrate moderate degenerative disc disease and loss of disc height, significant bilateral facet and ligamentum flavum with resultant grade one anterolisthesis. There is a left lateral ventral epidural defect at this level with T1 hyperintense, T2 isointense and T2 STIR hyperintense signal intensity. The finding measures approximately at 7.5 x 10 mm in transaxial dimensions (axial T2 series 8 image 29). There is resultant subtle mass effect and posterior displacement of the thecal sac to the left of midline. Although the finding could represent an extruded disc fragment it appears to be contiguous with the left L4 nerve root which also appears mildly thickened which raises the possibility of an extradural intracanalicular schwannoma as a cause as well. Follow-up exam post contrast only images is recommended for better assessment and differentiation. This finding is best appreciated on axial T2 series 8 images 27 through 30 and on all sagittal series on images 13 and 14.There is moderate bilateral neural foraminal and mild central spinal stenosis.L5-S1 demonstrate mild disc disease and mild to moderate bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis however significant left and moderate right neural foraminal compromise secondary to hypertrophic changes of posterior elements are detected.

Output: 1.Mild to moderate disc disease however disproportionate extensive hypertrophic changes of posterior elements of the mid to lower lumbar spine as detailed.2.Degenerative changes at L3-L4 results in mild central spinal stenosis and neural foraminal compromise.3.There is a left lateral well demarcated ventral epidural defect posterior to lower L4 vertebral body with apparent continuity with the thickened left L4 nerve root in the left neural foramina. It demonstrate mild mass effect on the thecal sac. This finding although could represent an extruded disc fragment possibility of a intracanicular extradural schwannoma should also be considered. Recommend follow-up with postcontrast only images for further assessment/differentiation.4.Degenerative changes at L4-L5 with disproportionate significant facet and ligamentum flavum hypertrophy results in mild central spinal stenosis and bilateral neural foraminal compromise. Please see detailed report per level above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out facet arthropathy or spondylolysis. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.Lower most visualized thoracic spine and thoracic cord is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild ligamentum flavum hypertrophy and mild facet disease. Minimal left facet effusion. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc disease and loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild bilateral (L>R) facet degenerative/hypertrophic changes. There is a lateral and far lateral shallow disc protrusion on the left at this level with resultant moderate compromise of the left neural foramina and without intravenous of central spinal stenosis. There is mild to moderate right neural foraminal compromise is also noted. L5-S1 demonstrate mild to moderate disc disease and loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild bilateral (R>L) facet degenerative changes. There is a shallow central and right para median disc protrusion with subtle indentation of thecal sac however without central spinal stenosis. Mild right neural foraminal compromise secondary to degenerative disease.

Output: 1.Mild to moderate degenerative changes (and including facets) of primarily the lower lumbar spine as detailed per level.2.No evidence of central spinal stenosis at any level.3.Left lateral/far lateral L4-L5 disc protrusion with resultant moderate left neural foraminal compromise.4.Small central and right paramedian shallow disc protrusion at L4-L5 without spinal stenosis.5.Other levels of neural foraminal compromise as detailed per level above.6.No significant facet arthropathy is detected. Please see above comments.


Instruction: Generate impression based on findings.

Input: Reason: seizure focus vs new ischemic disease. please compare to previous History: confusion, dysarthria and generalized weakness. concern for seizure MRI of the brainNo diffusion weighted abnormalities are appreciated.Much of the imaging is degraded by patient motion.There is redemonstration of small foci of encephalomalacia in the right superior parietal lobule adjacent to the interparietal sulcus, right occipital pole and cerebellar hemispheres.Taking into account differences in imaging technique, there is no interval change.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin. The right eye is elongated along the AP dimension and has a thin sclera.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left posterior communicating artery is relatively small but can be identified. The right posterior cerebral artery has fetal origin. The right p1 segment is very small. The vertebral arteries are similar in size.MRA neck:The great vessels from the aortic arch are not adequately evaluated. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The origins of the vertebral arteries are not adequately evaluated. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.The origins of the vertebral arteries and the origins of the great vessels from the aortic arch are not adequately evaluated. 3.There is redemonstration of small foci of encephalomalacia in the right superior parietal lobule, right occipital pole and cerebellar hemispheres.These are most likely ischemic in origin. Taking into account differences in imaging technique, there is no interval change compared to the prior exam from 3/14/12.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. There is no interval change compared to the prior exam from 3/14/12.5.Right eye staphyloma.6.No evidence for intracranial aneurysm.7.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with right hip pain. History of synovial cyst in 2013. Spinal alignment is anatomic. Vertebral body height and morphology are normal. No pathologic marrow replacement or edema is detected.The visualized distal spinal cord, conus and cauda equina nerve roots are unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Ligamentum flavum thickening. Minimal lateral disc bulging. No significant spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy. Ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L4-5: Advanced facet arthropathy. Bulging disc. A cystic lesion measuring up to 10 mm in diameter is evident within the right aspect of the spinal canal spanning the subarticular and lateral recesses and located primarily above the level of the disc space. This lesion appears to be more closely associated with the adjacent degenerated facet than with the disc. The lesion causes effacement of the right aspect of the thecal sac with medial displacement of nerve roots and possible impingement of the exiting right L4 nerve root. The neural foramina are mildly narrowed by facet degeneration. L5-S1: Facet arthropathy. Mild bulging disc. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing.

Output: 1.A cystic lesion is evident within the right aspect of the spinal canal at L4-5 causing effacement of the right subarticular and lateral recesses. This is favored to represent a synovial cyst rather than a sequestered disk herniation. This lesion causes leftward deviation of the cauda equina and may impinge the exiting right L4 nerve root.2.Sequelae of prior facetotomy are seen on the left at L4-5.3.No other significant spinal canal or foraminal stenosis is detected.


Instruction: Generate impression based on findings.

Input: 58-year-old female with history of a left mastectomy, now with pain and swelling along the lateral and superior aspects of the left chest wall and axilla LUNGS AND PLEURA: Minimal left apical parenchymal scarring as well as changes of discoid atelectasis in the left upper lobe are present. No pulmonary masses or nodules can be identified. There is no evidence of a pericardial or pleural effusionMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Surgical clips are identified in the left axilla. No osseous metastases can be identified. Degenerative changes are noted in the left glenohumeral joint region (see recent MRI of the left shoulder).UPPER ABDOMEN: Small hiatal hernia. Otherwise, no significant abnormalities.

Output: 1. Minimal scarring and discoid atelectasis in left upper lobe.2. No evidence of metastatic disease


Instruction: Generate impression based on findings.

Input: 82-year-old female with mass in the right neck on carotid. Question cyst versus solid mass versus carotid bulb Limited value examination due to lack of contrast infusion.Images through the basal brain demonstrates findings of old lacunar infarcts.The skull base is unremarkable. No definitive evidence of any pathologic adenopathy in the neck is detected. A mass with rim calcification within the left thyroid bed measuring approximately 27 x 26 .8-mm is noted. This is believed to represent goiter however possibility of other lesions cannot be entirely ruled out. Further evaluation with postinfusion exam, ultrasound or an MRI is recommended.Limited images through the apices of the lung are unremarkable. Bony density of area of exam is negative for any pathology.

Output: 1.Limited value examination due to lack of contrast infusion.2.Mass with rim calcification in the left lobe of thyroid as detailed above. 3.Notice of pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: CN IV palsy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a mildly prominent perivascular space in the left middle cerebral peduncle. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The cavernous sinuses and orbits are intact. The cisternal segments of the abducens or trochlear nerves bilateral appear unremarkable. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of mass lesions along the course of the right abducens or trochlear nerves or in the brainstem.


Instruction: Generate impression based on findings.

Input: septic right hip. Evaluate for osteomyelitis, periosteal or intramedullary abscess/sequestrum. There is high T2 signal within the superior portions of the right vastus lateralis and intermedius muscles and the right pectineus muscle but no discrete fluid collection to suggest abscess.There is a small right hip joint effusion with diffusely enhancing synovium. No significant right knee joint effusion however there is subtle synovial enhancement.No abnormal bone marrow signal within the pelvis or right femur to suggest osteomyelitis, abscess, or sequestrum.

Output: 1.Myositis of the right hip musculature without evidence of abscess.2.Synovitis at the right hip and right knee.3.No evidence of osteomyelitis or bone abscess/sequestrum.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with spinal cyst, follow-up examination. Cystic expansion of the dorsal CSF space is seen within the spinal canal spanning from the T4-T6 levels. The fluid in this lesion follows CSF signal on all sequences. No associated solid or enhancing tissue is demonstrated. The lesion is intradural in location and exerts mass effect upon the adjacent spinal cord causing flattening and anterior displacement of the cord. No evidence of spinal cord edema is seen. The osseous spinal canal is slightly widened to accommodate this lesion.No additional intraspinal lesions are identified. The spinal cord otherwise demonstrates normal morphology and signal characteristics. The conus terminates at the L1 level which is within normal limits.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The intervertebral discs are preserved with no significant spinal canal or foraminal stenosis.

Output: Findings are demonstrated compatible with an intradural meningeal cyst occupying the dorsal CSF space from T4 through T6. This lesion does exert mass effect upon the spinal cord which is flattened and anteriorly displaced. The lesion causes subtle widening of the osseous confines of the spinal canal which would indicate that this is a long-standing chronic process.


Instruction: Generate impression based on findings.

Input: Reason: eval for obstruction History: Lipase and Alk Phos elevation The absence of intravenous contrast limits evaluation of the solid organs and vasculature. Given those limitations, the following observations were made:ABDOMEN:LIVER, BILIARY TRACT: Mildly enlarged liver measuring 19 cm. No biliary ductal dilatation. No focal hepatic lesion is identified. Small perihepatic ascites. Small amount of pericholecystic fluid without other evidence of acute cholecystitis. No evidence of cholelithiasis or choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. There is slight increase in the pancreatic parenchymal signal on diffusion-weighted images, but no definite peripancreatic fluid, fat stranding, or other findings to suggest pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric tube tip in the antropyloric region. Mildly distended loops of bowel, partially seen, which may represent ileus.BONES, SOFT TISSUES: Extensive body wall anasarca.OTHER: Bilateral pleural effusions with adjacent atelectasis/consolidation.

Output: 1.No specific evidence of biliary obstruction or pancreatic ductal obstruction.2.Mildly enlarged liver with small amount of ascites.3.Partially seen mildly dilated loops of bowel, which may represent ileus.4.Bilateral pleural effusions with adjacent atelectasis/consolidation.


Instruction: Generate impression based on findings.

Input: Lumbar back pain with right-sided radiculopathy, evaluate for spinal stenosis, spondylolisthesis or other pathology. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is evidence of grade 1 anterolisthesis of L3 over L4. Bone marrow signal is benign. The conus medullaris is normal in position, terminating at upper L2. There is multilevel mild to moderate disc space narrowing which is worst at L3-L4.Multilevel moderate to severe degenerative changes are seen, as described below:T12-L1: There is ligamentum flavum thickening and facet arthropathy. No significant disc disease, neuroforaminal narrowing or spinal canal stenosis.L1-L2: There is facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disc bulge eccentric to the left, facet arthropathy with resultant narrowing of bilateral lateral recesses, including moderate bilateral neural foraminal narrowing. There is moderate to severe spinal canal stenosis. L3-L4: There is facet arthropathy, disc bulge eccentric to the right with resultant severe spinal canal stenosis. There is mild to moderate bilateral neural foraminal narrowing. L4-L5: There is facet arthropathy, annular fissure and disc bulge eccentric to the with right, reflecting mild spinal canal stenosis. There is moderate to severe right and mild left neural foraminal narrowing. There is dorsal epidural lipomatosis at this level. L5-S1: There is facet arthropathy left worse than right, disc extrusion which extends cranially up to 8 mm with resultant mild mass effect on the central and left lateral aspect of the thecal sac. There is narrowing of the lateral recess and mild narrowing of left neural foramen. There is no spinal canal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel advanced degenerative spondylotic changes worst at L3-L4, where there is severe spinal canal stenosis. Moderate to severe spinal canal stenosis at L2-L3 is also noted.2. At L5-S1 there is a disc extrusion with mild mass effect on the thecal sac. 3. At L4-L5, there is moderate to severe neuroforaminal narrowing.


Instruction: Generate impression based on findings.

Input: Lung cancer and head and neck cancer, for staging. There is no evidence of intracranial mass, edema, hemorrhage, or acute infarct. There is a mildly expanded and partially empty sella. There is inferior extension of cerebellar tonsils, up to 10 mm inferior to the foramen magnum. However, the tonsils maintain a normal rounded morphology. The ventricles are normal in size and configuration. The orbits and skull are grossly unremarkable.

Output: 1. No evidence of intracranial metastases.2. Partially empty sella and low-lying cerebellar tonsils, which can be manifestations of pseudotumor cerebri.3. Asymmetric enhancement in the right temporomandibular joint may represent synovitis or an anatomic variant.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 5.3 x 6.6 x 6.9 cmPeripheral Zone: The peripheral zone is markedly thinned by the patient's central gland hypertrophy.No significant lesion is evident.Central Gland: Significant benign prostatic hyperplasia. No suspicious lesion.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: Marked BPH without a significant lesion evident.


Instruction: Generate impression based on findings.

Input: 25-year-old female with seizures/epilepsy since 2012 with new onset headaches and neck pain since April 2016. Brain MRI:There is no evidence of intracranial hemorrhage, mass, or acute infarct. No pathologic enhancement is seen. The brain parenchyma appears within normal limits. No findings to suggest seizure focus are appreciated. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. 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 mild maxillary sinus mucosal thickening with a small amount of dependent fluid which could indicate sinusitis. The orbits, skull and scalp soft tissues are grossly unremarkable.C-Spine MRI:The craniovertebral junction appears within normal limits. There is slight straightening of the cervical spine nonspecific. The cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. No significant spinal canal or foraminal stenosis is seen. Paraspinous soft tissue structures appear within normal limits.

Output: No findings to suggest seizure focus or cause of the headache/neck pain are appreciated.


Instruction: Generate impression based on findings.

Input: Recent new headache associated with unilateral neurologic changes and confusional state. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

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


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer to the brain status post radiation therapy a few years ago. Abrupt hearing loss. There are multiple supratentorial and infratentorial intracranial enhancing lesions. Since 2011, some new lesions have appeared, some have increased in size, and some have involuted. The largest lesions are associated with susceptibility effect and measure up to 15 mm in the left precuneus and 14 mm in the right posterior cingulate gyrus. Additional enhancing lesions are present in the cerebellar vermis, where there is extensive vasogenic edema. There is a background of diffuse T2 signal hyperintensity in the periventricular and subcortical white matter. There is no evidence of acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. There is scattered opacification of the bilateral mastoid air cells. The skull and extracranial soft tissues are otherwise unremarkable.

Output: 1. Numerous increase intracranial metastases, a few of which are associated with probable hemorrhage and vasogenic edema superimposed upon diffuse treatment effects in the brain parenchyma.2. No evidence of acute infarct.3. Fluid within the bilateral mastoid air cells is nonspecific, but may represent mastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Meningitis, unspecified [G03.9], Reason for Study: ^Reason: known c3-c7 signal abnormality , change? Enhancement? History: meningeal signs, RUE flaccid weakness and Left sided increased tone Previously seen T2/STIR high signal intensity lesions in the cervical spinal cord from C3 to C7 level are not as conspicuous as prior. In addition, subtle expansion of the cervical cord from C3 and C7 level has been resolved. There is no evidence of abnormal enhancement within the spinal cord.Leptomeningeal enhancements of cervical spinal cord slightly prominent that normal which is seen again and are unchanged since prior. Minimal bulge of disc at the level of C45 is seen. Central to left minimal bulging of disc is seen at the level of C56 without evidence of lateral recess stenosis.There 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.

Output: 1. Interval improvement of C3 to C7 spinal cord T2 high signal intensity and subtle spinal cord expansion since prior scan. Diagnostic possibility include transient congestive myelopathy. The possibility of demyelinating disease is slim.2. Slightly prominent leptomeningeal enhancement indicate possible meningitis, unchanged since prior scan. 3. Degenerative disc disease seen at the level of C45 and C56.


Instruction: Generate impression based on findings.

Input: right side numbness. Multifocal restricted diffusion lesions on the left thalamus, parahippocampal gyrus and occipital lobes implying the left PCA territorial ischemic infarctions. Post enhancement scan shows diffuse enhancement of pituitary gland and linear non nodular dural enhancement on the clivus. The size of pituitary gland is about 8.2mm x 10.3mm with demonstrating upward bulging. However there is no discrete mass or mass like lesion is identified. These findings suggest possible pituitary hyperplasia but could be a normal range of postmenopausal woman. Thus, if clinically indicated, further evaluation through endocrinological review/investigation can be considered.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Acute ischemic infarctions on the left PCA territory without evidence of hemorrhagic transformation. Further evaluation for intracranial arterial system especially focused on posterior fossa is recommended using head and neck CTA.2. 8mm x10mm homogeneously enhancing pituitary gland without evidence of discrete mass, could indicate pituitary hyperplasia or upper normal range of pituitary gland size.3. Dural enhancement of clivus could represent dural lesions such as meningioma, tumor or inflammatory infiltration or non specific.


Instruction: Generate impression based on findings.

Input: 37-year-old female with history of pituitary tumor and meningioma, yearly follow-up. Evaluate for changes. Pituitary: Again seen is a pituitary macroadenoma measuring up to 15 mm craniocaudally (series 1901, image 10), 16 mm in the AP dimension and 22 mm in the transverse dimension (series 2101, image 15). There is mass effect with expansion of the sella and superior extension into the suprasellar cistern. There is minimal elevation of the optic chiasm but no mass effect upon the cavernous sinuses. The signal intensity, morphology and extent of this tumor is unchanged when compared to the prior exam.Brain: There is interval increase in size of well demarcated, dural based enhancing lesion along the right parietal region measuring 6 x 9 mm (series 2101, image 23), previously measuring 4 x 6 mm. Punctate focus of increased T2/FLAIR hyperintensity in the subcortical white matter of the left parietal lobe is a nonspecific finding and has remained stable since at least 5/30/2009.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. There is partial opacification of the left maxillary sinus. The orbits, skull, remaining paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Unchanged pituitary macroadenoma.2. Interval increase in size of extra-axial right parietal dural based enhancing mass, likely representing a meningioma.2. Punctate focus of nonspecific T2/FLAIR hyperintensity in the left parietal lobe is unchanged.


Instruction: Generate impression based on findings.

Input: Dizziness, lightheadedness. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: There is uncovertebral hypertrophy at C3-4 causing severe right neural foraminal narrowing, but no significant spinal canal stenosis. There is uncovertebral hypertrophy, a disc-osteophyte complex, and a superimposed disc protrusion at C4-5 with impingement upon the spinal cord and moderate left and severe right neural foraminal stenosis. The spinal cord signal is otherwise preserved. There is also a disc-osteophyte complex eccentric to the right at C5-6 causing mild right neural foraminal stenosis. There appears to be diffuse mild posterior longitudinal ligament ossification, but no significant degenerative spondylosis at C2-3, C6-7 or C7-T1. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. The imaged intracranial structures are unremarkable.

Output: Multilevel degenerative spondylosis with severe right neural foraminal narrowing at C3-4, impingement upon the spinal cord and moderate left and severe right neural foraminal stenosis at C4-5, and mild right neural foraminal stenosis at C5-6. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 38-year-old female from Dubai by presenting for multiple sclerosis. Compared to images dated 4/2/2015, the foci of T2/FLAIR hyperintensity appears similar in size and morphology. For example, the most prominent lesion is visualized in the right internal capsule and appears similar to April, 2015 and decreased in size compared to 2013 MRI. These findings are nonspecific but compatible with the given clinical history of multiple sclerosis.There is no evidence of intracranial mass. The brain parenchyma and pituitary gland appear unremarkable. 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.No abnormal parenchymal or meningeal enhancement.

Output: There are approximately 10-15 periventricular and subcortical white matter punctate lesions which are nonspecific but under the clinical circumstances most likely related to demyelination. There is a larger lesion present along the posterior limb of the right internal capsule which on a prior MR from 2013 was in the subacute phase. Compared to the prior exam from 4/2/2015 there is not appear to be any significant change in the number of lesions within the white matter.


Instruction: Generate impression based on findings.

Input: New-onset bilateral leg weakness of unknown etiology currently undergoing work-up with differential including GBS, transverse myelitis, spinal mass, hemiplegic migraine, or trauma. Brain: Many of the sequences are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The lateral ventricles are mildly asymmetric, which can represent a developmental variant. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.Spine: Many of the sequences are degraded by patient motion. The mild prominence of the central canal throughout much of the thoracic spinal cord is incompletely characterized on this exam. The conus medullaris is located at approximately the L1 level. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is no abnormal enhancement or mass lesions within the spine. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or Chiari malformation.2. No evidence of mass lesions in the spine or transverse myelitis.3. The mild prominence of the central canal throughout much of the thoracic spinal cord is incompletely characterized on this exam. Please refer to the recent prior thoracic spine MRI for additional details.


Instruction: Generate impression based on findings.

Input: 59-year-old woman with history of ulcerative colitis status post total colectomy and ileostomy, now with right-sided pain and fluid collection on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: Spleen appears normal.PANCREAS: Pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a subcentimeter right lower pole renal cyst and the calyces are mildly prominent. Otherwise, the kidneys are normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post total colectomy with a right lower quadrant ostomy. There is a ventral hernia containing loops of bowel without evidence of incarceration.In the right lower quadrant adjacent to the ileum (series 18, image 33), there is a 48 x 48 mm multilobulated collection which enhances peripherally and demonstrates restricted diffusion. This collection abuts the right psoas muscle and extends superiorly, abutting the right lobe of the liver. The walls of the adjacent small bowel loops are mildly increased in enhancement suggesting inflammation, however no tract is seen extending to the bowel lumen.Mildly prominent lymph nodes are seen at the root of the mesentery, likely reactive.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right lower quadrant abscess as described above. Finding was discussed with Dr. MIKOLAJCZYK by phone at 13:34 on 10/28/2015.


Instruction: Generate impression based on findings.

Input: 57 year old female with a history of myelofibrosis on clinical trial protocol IRB 12-2179. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions.SPLEEN: Marked splenomegaly with the spleen measuring up to 23 cm in length, similar to prior exam. Multiple foci of increased T2 signal abnormality without enhancement are too small to characterize but may represent hemangiomas or cysts, similar to prior exam. Mild perisplenic ascites noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts are identified in the kidneys bilaterally, similar to prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple T1 hyperintense foci within the L2 and L3 vertebral bodies, likely representing hemangiomas and similar to prior exam.OTHER: No significant abnormality noted.

Output: Marked splenomegaly is not significantly changed.