Instruction: Generate impression based on findings.

Input: Reason: 71 yo with hepatomegaly and edema History: edema ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Moderate hepatomegaly. Diffuse loss of signal on out of phase images suggests steatosis.SPLEEN: No significant abnormality noted.PANCREAS: Mild prominence of the main pancreatic duct in the body and tail appear similar to the prior exam. No suspicious lesions evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatomegaly and steatosis without focal lesions.2.Mild prominence of the main pancreatic duct in the body and tail without focal lesion evident.


Instruction: Generate impression based on findings.

Input: 75-year-old male with history of cortical ribboning. Evaluate for etiology of altered mental status - want to get ONLY DWI and DTI sequence. Again seen is relatively symmetric cortically based mild restricted diffusion involving the bilateral parietal and occipital lobes and to a lesser degree the frontal and temporal lobes. The intensity of the diffusion restriction appears to have diminished on comparison with the prior examination. No new areas of restricted diffusion are seen.

Output: Areas of bilateral cortical restricted diffusion, primarily in the parietal and occipital lobes, are again demonstrated. There has been no significant change in the geographic distribution of these lesions, though the intensity of the diffusion restriction has diminished.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Note that the examination is limited by patient motion artifact. Note that the lack of intravenous contrast limits sensitivity for small lesions.Thoracic spine: There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. Given the limitation of the lack of intravenous contrast, no masses or lesions are seen.Lumbar spine: Limited examination secondary to patient intolerance and motion with sagittal sequences only. Alignment is anatomic. The marrow signal is benign. No masses or lesions seen given the limitation of the lack of intravenous contrast.

Output: 1.Motion degraded examination of the thoracic and lumbar spine with limited sagittal sequences of the lumbar spine obtained. There are no appreciable masses within the spinal canal or neuroforamina, given the caveat of limited sensitivity for small lesions due to the lack of intravenous contrast.2.Please refer to separate report for details of cervical spine, soft tissues of the neck, and brain.


Instruction: Generate impression based on findings.

Input: Persistent lower back, right leg and shoulder pain after a 55 mph MVC on 3/26/16. There are slight left foraminal disc protrusions and mild facet arthropathy bilaterally at L3-4 and L4-5, without apparent nerve root impingement or significant spinal canal stenosis. There is no appreciable intervertebral disc disease at T12 through L3 and L5-S1. 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 spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Slight left foraminal disc protrusions and mild facet joint arthropathy bilaterally at L3-4 and L4-5, without apparent nerve root impingement or significant spinal canal stenosis. No appreciable intervertebral disc disease at T12 through L3 and L5-S1.


Instruction: Generate impression based on findings.

Input: There is evidence of Chiari I malformation with 7 mm herniation of the cerebellar tonsils through the foramen magnum.The remainder of the brain demonstrates no abnormal T2/FLAIR signal. Ventricular size is normal. There is no midline shift. Basal cisterns are normal.The visualized cervical spine demonstrates no evidence of syrinx.There are normal vascular flow voids.Flow study demonstrates normal bidirectional flow in the anterior and the posterior aspects of the foramen magnum.

Output: 1. Chiari 1 malformation with 7 mm herniation of the cerebellar tonsils.2. Normal ventricular size. No evidence of hydrocephalus. 3. No evidence of syrinx in the imaged cervical spine.4. Normal bidirectional flow in the anterior and the posterior aspects of the foramen magnum.


Instruction: Generate impression based on findings.

Input: 70 year-old male with syncope and fall; rule out ICH versus fracture BRAIN:There is no evidence of intracranial hemorrhage, significant mass effect or midline shift. Right basal ganglia lacunar infarcts. Patchy hypoattenuating foci are seen in the periventricular and subcortical white matter which are nonspecific but most likely represent small vessel ischemic disease of indeterminate age.There is hyperdensity overlying the left frontal operculum which corresponds to the left frontal lobe cavernoma seen on previous MRI and likely represents dystrophic calcifications. The ventricles and basal cisterns are prominent, consistent with age-related volume loss. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Left phthisis bulbi is noted.CERVICAL SPINE:The cervical spine alignment is anatomic. Vertebral body heights are maintained without evidence of fracture. Paravertebral soft tissues are unremarkable. Moderate degenerative disease affects the cervical spine with multilevel disk protrusions, most prominently affecting C3-C4 and C4-C5, as well as uncovertebral joint hypertrophy. Extensive atherosclerotic calcifications are noted in the carotid and vertebral arteries.

Output: 1. No acute intercranial hemorrhage. 2. Likely small vessel ischemic disease of indeterminate age. 3. Left frontal hyperdensity likely corresponds to the cavernous malformation seen on the prior MRI.4. No fracture or malalignment is identified. If clinical concern for ligamentous or cord injury, MRI may be obtained for further evaluation.5. Degenerative changes of the cervical spine as above.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer needs evaluation prior to starting trial. There are two enhancing lesions in the right cerebellar hemisphere that measure up to 7 mm and an enhancing lesions in the anterior left frontal lobe that measures up to 8 mm. There is negligible associated surrounding edema. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: Subcentimeter supratentorial and infratentorial lesions likely represent metastases.


Instruction: Generate impression based on findings.

Input: New headaches x 2 months. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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.

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


Instruction: Generate impression based on findings.

Input: Newly diagnosed breast cancer. Hepatic lesions suspicious for metastatic disease. Back pain but neurologically nonfocal. There are 7 cervical, 12 thoracic, 4 lumbar, and 1 lumbosacral transitional vertebra. This transitional vertebra is labeled L5 for the purposes of this dictation.There is normal curvature and alignment of the spine. There is no fracture or loss of height of the vertebra. However, there is hypodensity within the right C3 vertebra and the left C5 vertebra (series 8051 images 16 and 20 respectively). Also question of focal lesion within right T1 vertebra (series 8050 image 19). These lesions are nonspecific and enhancement pattern cannot be accurately characterized by CT. However, they could represent metastatic disease in this patient who has breast cancer newly diagnosed. Bone scan may be helpful for confirming active bone remodelling and detecting occult lesions elsewhere.Detection of intracanalicular and paravertebral metastatic disease is extremely difficult based on CT. However, there is no gross intracanalicular mass lesion that can be identified based on CT. The morphology of the cord and conus medullaris appear grossly normal. In this circumstance, clinical correlation is essential.Moderate cervical spine degenerative change is present. Findings are specified level by level:C2-C3: No disk herniation, thecal sac effacement, or foraminal narrowing.C3-C4: Left sided disk osteophyte complex and uncovertebral hypertrophy. As a result, there is mild narrowing of the ventral thecal sac on the left and moderate left foraminal narrowing.C4-C5: Questionable disk protrusion with at most partial ventral thecal sac effacement. Minimal foraminal narrowing secondary to uncovertebral hypertrophy and facet hypertrophy. There is acquired fusion of the right facet articulation at this level.C5-C6: Posterior disk osteophyte complex results in partial sac effacement. There is also severe right and minimal left foraminal narrowing secondary to uncovertebral hypertrophy and facet hypertrophy.C6-C7: Minimal posterior disk osteophyte complex with at most partial ventral thecal sac effacement. Mild bilateral foraminal narrowing secondary to uncovertebral hypertrophy.C7-T1: No gross disk herniation, thecal sac effacement, or foraminal narrowing. However, streak artifact obscures detail at this level.In the thoracic spine, there is no gross disk herniation or thecal sac effacement apart from some mild dorsal thecal sac partial effacement at right T8-T9 and T10-T11 from calcified ligamentum flavum hypertrophy. There is no osseous encroachment upon the neural foramina though small disk herniations could be easily obscured given image quality. There is endplate sclerosis and anterior osteophyte seen between T3 and T12.In the lumbar spine, there is minimal degenerative change. Findings are specified level by level:L1-L2: No disk herniation, thecal sac effacement, or convincing foraminal encroachment.L2-L3: Minimal diffuse disk bulge. No central canal stenosis or foraminal narrowing.L3-L4: Mild diffuse disk bulge eccentric to the left. While there is no central canal stenosis, there is mild to moderate left foraminal narrowing from the disk herniation. Also minimal facet hypertrophy.L4-L5: Mild diffuse disk bulge with some questionable encroachment on the lateral recesses. No central canal stenosis. Probably some mild foraminal narrowing bilaterally.L5-S1: Partially fused disk space. No disk herniation, central canal stenosis, or foraminal narrowing.In the extraspinal soft tissue structures, there is elevation of the right hypopharynx from retropharyngeal carotid. No cervical lymph nodes. There is a right pleural effusion with passive atelectasis and a calcified subcarinal lymph nodes and right hilar lymph nodes, better evaluated on earlier chest CT. The nodularity of the liver is not well demonstrated on this examination which is motion degraded and has a more circumscribed field-of-view; hepatomegaly still evident. Slice intracranial contents are unremarkable apart from some mild intracranial vasculature ossification. Hypodensity seen in the middle cerebellar peduncles is felt to be most likely artifactual.

Output: 1. Areas of hypodensity/bone lysis within the right C3 and possibly left C5, right T1 vertebra. At least the C3 lesion is suspicious for metastatic disease--correlative bone scan (nuclear medicine) may be of value. No other destructive osseous lesions and no compression fractures.2. This study is poorly sensitive for intracanalicular metastatic disease and paravertebrally metastatic disease. However, no gross compression of the cord or conus is seen. If there is strong concern for leptomeningeal disease, suggest CSF puncture. 3. Mild to moderate spinal degenerative changes. Small and subtle findings are potentially obscured given poor image quality.4. Chest and abdominal findings were better seen on prior dedicated imaging. Slightly increased right pleural effusion.Findings discussed with and acknowledged by Dr. Laffin 10/27/2012 11:38 AM .


Instruction: Generate impression based on findings.

Input: Male, 75 years old. Patient with hearing loss and gait disturbance. Prior MRI findings of an acoustic neuroma. History of cardiac defibrillator. Review of patient's chart indicates history of right intracanalicular acoustic neuroma measuring approximately 7 mm. A subtle area of asymmetric intracanalicular enhancement identified in the right IAC that likely corresponds to small schwannoma referenced patient's clinical history. The lesion measures approximately 4 x 9 mm (image 72, axial series 80832; image 105, coronal series 80833).Nonspecific white matter hypoattenuating foci are seen in bilateral cerebral white matter and the brainstem likely secondary to chronic small vessel disease. No other areas of abnormal enhancement are identified. Mucosal thickening identified in the ethmoid air cells and frontoethmoid recess. The ventricles and basal cisterns are normal in size and configuration.

Output: Subtle area of intracanicular enhancement in the right internal auditory canal likely corresponding to patient's schwannoma per the clinical history.


Instruction: Generate impression based on findings.

Input: Ms. Schreiber is a 58 year old female with a personal history of left breast mastectomy with reconstruction in 2012 for IDC followed by chemoradiation and arimidex therapy. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. A cyst is present in the right upper outer breast, confirmed by prior MRI. A few scattered benign calcifications are present.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Suprasellar meningioma, follow up MRI No evidence of acute ischemic or hemorrhagic lesion.There is about 9mm x 10mm sized left high frontal extra axial enhancing lesion which does not show any significant interval change since prior exam in terms of size, configuration and enhancement patter. This lesion is likely to be a benign lesion such as meningioma.Previously described encephalomalacia on the right anterior and inferior frontal, right anterior temporal lobes do not show any significant interval changes since prior exam.About 9mm length tubular signal void lesion within the left transverse sinus indicate possible arachnoid granulation or fibrous nodular septae, no change since prior exam. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, 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 mastoid air cells are clear.There is a retention cyst on the right maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. No change of left high frontal extra axial mass since prior exam.3. No change of right frontal and temporal encephalomalacia since prior exam.


Instruction: Generate impression based on findings.

Input: Reason: Ms. Hayenga is a 47 year old woman with UC s/p TAC with EI (7/9/15 at UCMC) please evaluate for small bowel abnormalities History: now with complaints of feeling full with some bloating and pressure feeling with increased pain throughout the day, no vomiting ABDOMEN: Please note that there is suboptimal enteric contrast within the proximal small bowel.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Cystic lesion in the spleen, likely a cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Peripheral T2 hyperintensity within the left kidney likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post total colectomy with a right lower quadrant end ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Low back pain, left lower extremity neuropathic pain Five lumbar type vertebral bodies are present. Bilateral 12th ribs are hypoplastic. There is lumbar levoscoliosis with apex at the L2-L3 level. There is severe compression deformity involving the L4 vertebral body with approximately 70 to 80% loss of height. No edema seen within the vertebral body. There is also mild wedging involving the left superior endplate of the L3 vertebral body, which also remains unchanged since 2007.Round enhancing lesion is seen within the L4 vertebral body corresponding to focus with sclerotic rim on prior CT from 12/2013 and while nonspecific is favored to be benign. There is a larger focus of T1 hyperintensity involving the L3 vertebral body likely representing a hemangioma.Multilevel degenerative changes are seen, as described below:L1-L2: Diminished disk height with vacuum disk phenomena. There is mild bulge without significant spinal canal or left neural foramina stenosis. There is mild right neural foraminal narrowing.L2-L3: There is loss of disk height with vacuum disk phenomenon. There is mild disk bulge and mild to moderate right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing.L3-L4: There is disk bulge and mild osseous retropulsion related to the chronic compression fracture. There is also ligamentum flavum thickening. There is resulting moderate spinal canal stenosis including the left lateral recess and the central canal. There is severe right neural foraminal narrowing. There is also moderate left neural foraminal narrowing.L4-L5: There is loss of disk height and vacuum disk phenomena. There is mild disk bulge. No significant central spinal canal narrowing. There is moderate left neural foraminal stenosis and mild right neural foramina stenosis.L5-S1: There is loss of disk height and vacuum disk phenomena. There is bilateral facet arthropathy. There is moderate to severe left and mild right neural foramina stenosis. No significant spinal canal stenosis.Again seen is chronic dissection involving the abdominal aorta, better assessed on prior CT angiogram. Visualized conus imaged on the axial images from from the lower T12 level is unremarkable. There is questionable T2 signal at the T11 level dorsally on the sagittal sequence, which may be artifactual or related to reported cord infarct.

Output: 1. Advanced degenerative changes in the lumbar spine with levoscoliosis with apex at the L2-L3 level similar to priors.2. Severe chronic compression fracture involving the L4 vertebral body and mild depression of the superior endplate involving the L3 vertebral body, which remain unchanged. No vertebral body edema.3. Moderate spinal canal stenosis at L3-L4 which is not significantly changed since 2007. Otherwise no significant spinal canal stenosis in the lumbar spine.4. Moderate to severe neural foraminal stenosis at multiple levels as detailed above including right greater than left at L3-L4, and on the left at L4-L5 and L5-S1 levels. 5. Visualized conus imaged on the axial images below the lower T12 level is unremarkable. There is questionable T2 signal abnormality at the T11 level dorsally which is not imaged on the axial lumbar sequence. Prior lower thoracic cord infarct was seen on prior MRI from 2004. If clinically warranted thoracic MRI can be obtained.


Instruction: Generate impression based on findings.

Input: Reason: hx of testicular cancer, evaluate for metastatic disease History: see above ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Reference lesion seen previously is no longer visualized.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.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: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 57 years Female (DOB:7/10/1959)Reason: possible right sciatica History: right sciaticaPROVIDER/ATTENDING NAME: MINDY ALYCE SCHWARTZ MINDY ALYCE SCHWARTZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is mild disc desiccation present at L3-4 and L4-5. Incidental note is made of small Tarlov perineural cysts in the sacrumAt L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There are minor degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Rule out PCL tear in a patient with posterior knee pain/tearing sensation. MENISCI: There is intrasubstance degeneration and degeneration of the root of the medial meniscus.ARTICULAR CARTILAGE AND BONE: Lateral patellar and lateral femoral trochlear chondromalacia with bone on bone apposition and adjacent bony contusions. Adjacent to the degenerative changes of the root of the medial meniscus is a bony contusion of the tibial plateau.LIGAMENTS: The ACL, PCL, MCL, and LCL complex appear intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Severe patellofemoral osteoarthritis and degenerative changes of the medial meniscus described above.


Instruction: Generate impression based on findings.

Input: 2-year-old female with LCH, parietal skull lesionVIEWS: Skull, AP and lateral (two views) 2/26/15 15:53 Small residual lucent lesion along the left parietal skull is improved from the prior exam. No new lesions. A right port catheter is only partially visualized.

Output: Small residual lucent lesion involving the left parietal bone, decreased in size from the prior exam.


Instruction: Generate impression based on findings.

Input: 8-year-old male with type I neurofibromatosis and persistent low thoracic back pain. The thoracic vertebrae demonstrate normal alignment without evidence of fracture or subluxation. There is no evidence of cord signal abnormality or stigmata of neurofibromatosis 1. There is no compromise to the central spinal canal or neural foramina.There is a small oval focus of enhancement along the upper mediastinum on the right side, which likely represents a paratracheal lymph node and does not appear pathologically enlarged. An incidental splenule is also noted.

Output: Normal MRI of the thoracic spine.


Instruction: Generate impression based on findings.

Input: 68-year-old female with pancreatic cancer status post resection (2006), evaluate uncinate process and distal pancreatic body hypoattenuating lesions. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. There is a T2 hyperintense cystic lesion communicating with the pancreatic duct the distal pancreas compatible with a sidebranch IPMN. Multiseptated, elongated and round cystic structure in the uncinate process with communication with the MPD is compatible with a sidebranch IMPN now measuring up to 3.2 cm in length, increased in size when compared to prior MR dated 6/22/10.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with sidebranch IPMNs in the distal pancreas and uncinate process, both demonstrating interval increase in size when compared to prior examinations. Cyst aspiration of the uncinate process IPMN should be considered based on size criteria if not already performed.


Instruction: Generate impression based on findings.

Input: Paralysis agitans [332.0], Reason for Study: ^Reason: concern for stroke as cause for gait disorder History: hx Parkinsons, now worsening gait, left hemiparesis No evidence of acute ischemic or hemorrhagic lesion.Small age indeterminate likely chronic lacunar infarcts on the bilateral caudate nucleus and bilateral basal ganglia are seen.There are scattered multifocal patch high signal intensity lesions on bilateral periventricular white matter and deep white matter on FLAIR imaging indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal nonspecific small vessel ischemic disease and several chronic lacunar infarctions.


Instruction: Generate impression based on findings.

Input: Left nasal hyalinizing clear cell carcinoma treated with left partial rhinectomy (re-resection after recurrence after previous surgery and XRT) and left neck dissection on 7/28/2016 and delayed reconstruction. There are postoperative findings related to left partial rhinectomy and flap reconstruction. There is a small amount of amorphous enhancing soft tissue along the posterior aspect of the surgical bed, projecting into the nasal vestibule, but otherwise no evidence of measurable tumor. There is mild swelling and enhancement in the right glabellar region skin donor site. There is a peripherally enhancing fluid signal lesion in the left nasoalveolar recess that measures 5 mm in diameter. There is minimal diffuse mucosal thickening in the bilateral ethmoid sinuses anteriorly, but the rest of the paranasal sinuses and nasal cavity are unremarkable. There is no evidence of upper cervical lymphadenopathy. The parotid glands and orbits are unremarkable. There are scattered nonspecific cerebral white matter T2 hyperintense lesions bilaterally, which may represent chronic small vessel ischemic disease.

Output: 1. Postoperative findings related to left partial rhinectomy and flap reconstruction, with a small amount of amorphous enhancing soft tissue along the posterior aspect of the surgical bed, projecting into the nasal vestibule, which may represent mucosal inflammation or granulation tissue, but otherwise no evidence of measurable tumor. 2. Small left nasoalveolar cyst or postoperative fluid collection.


Instruction: Generate impression based on findings.

Input: 56-year-old male with suspicious lesion on native kidney ABDOMEN:LIVER, BILIARY TRACT: Loss of fat plane between the inferior border of the liver and the mass.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic native kidneys. Large complex heterogeneous masslesion arising from the right native kidney measures 9.6 x 8.7 cm in transaxial plane and 10.2 cm in craniocaudal dimension. Lesion demonstrates extensive T1 hyperintense signal, consistent with hemorrhage or proteinaceous material. Multiple intralesional thin enhancing septations seen. No macroscopic fat is identified in lesion.Additional mildly enhancing mass (T1 isointense and T2 hypointense; see image 30 series 7) arising from the right kidney measuring 1.5 x 1.5 cm, suspicious for small renal cell carcinoma. Intralesional microscopic fat suggested on image 51 series 9. Atrophic left native kidney with exophytic subcentimeter mildly enhancing lesion in the interpolar region measures 7 mm. Additional bilateral T2 hyperintense renal lesions seen consistent with simple cysts.Transplant right iliac fossa kidney is partially imaged. Mild fullness of the visualized calyxes. Superior pole parenchymal scarring.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large right native kidney masslesion as described above. With application of Bosniak classification, imaging features consistent with a Bosniak 2F lesion.2.Right native kidney exophytic lesion with mild enhancement suspicious for malignancy (given T2 hypointensity and lesser degree of enhancement, especially concerning for papillary subtype). 3.Left native kidney exophytic subcentimeter lesion also showing mild enhancement is concerning for an additional neoplastic focus.


Instruction: Generate impression based on findings.

Input: CERVICAL: There is moderate motion artifact limiting evaluation, despite of acquiring multiple repeat sequences. There are unchanged postoperative findings related to Chiari decompression. The alignment and vertebral body heights are grossly preserved. The disk heights and signal are grossly unremarkable. There is no definite cord signal abnormality or syrinx. Evaluation of the flow-voids in the neck is limited due to motion artifact. There is a stable posterior fossa arachnoid cyst partly imaged as compared to 7/15/2014 causing stable mass-effect on the left cerebellar hemisphere posteriorly. There is no significant spinal canal or neural foraminal stenosis is seen, although evaluation is limited.LUMBAR: The last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. There is desiccation of L2-3, and L4-5 disks with loss of disk height. Vertebral body heights are preserved. The osseous marrow signal is within normal limits. The conus terminates at L1-2.T12-L1: No disk herniation or spinal stenosis.L1-2: Minimal disk bulge with no spinal stenosis.L2-3: Moderate central/left paracentral disk protrusion and disk bulge, bilateral facet arthropathy causing moderate spinal canal stenosis with encroachment upon the left greater than right subarticular recesses. No significant foraminal stenosis.L3-4: Diffuse disk bulge with tiny central disk protrusion, and bilateral facet arthropathy causing no significant spinal canal stenosis or neural foraminal stenosis.L4-5: Diffuse disk bulge, annular fissure with small central disk protrusion and facet arthropathy causing mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.L5-S1: Diffuse disk bulge with no spinal stenosis.

Output: 1.Moderate central/left paracentral disk protrusion at L2-3 superimposed on disk bulge and bilateral facet arthropathy causing moderate spinal canal stenosis with encroachment upon the bilateral subarticular recesses (greater on the left). 2.Mild bilateral neural foraminal stenosis at L4-5.3.Motion limited cervical spine with no significant interval change.


Instruction: Generate impression based on findings.

Input: Male, 12 years old, with headache. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. In particular, the cerebellum is morphologically unremarkable with no areas of signal abnormality. The cerebellar tonsils terminate above the level of the foramen magnum. No restricted diffusion is seen. No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected. The major intracranial vascular flow voids are identified indicating patency.

Output: No acute intracranial abnormality or other specific finding to account for the patient's headaches.


Instruction: Generate impression based on findings.

Input: 62 year old woman with history of metastatic squamous cell cancer. Presents with neutropenic fever and hemoptysis. Also thrombocytopenic. Evaluate for bleed, metastasis. There is no evidence of intracranial hemorrhage, mass or edema. If high suspicion exists for metastasis, contrast enhanced MRI would be more sensitive.The ventricles are unchanged in size from prior studies. The basilar cisterns are preserved.The calvaria and skull base are radiographically normal. Minimal air-fluid levels are present in the maxillary sinuses bilaterally. Mastoid air cells are partially opacified bilaterally.

Output: No CT evidence of hemorrhage or metastasis.


Instruction: Generate impression based on findings.

Input: Ms. Wolfson is a 43 year old female with newly diagnosed DCIS of the left breast. She presents for MRI staging evaluation. There is scattered fibroglandular tissue in both breasts. Minimal background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Specifically, there is no abnormal enhancement identified at the site of biopsy proven malignancy in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.Subcentimeter non-enhancing hepatic cyst identified.

Output: (1) No abnormal enhancement at site of biopsy proven malignancy in the left breast. If breast conservation therapy is desired, the biopsy clip/residual calcifications can be used as the target for preoperative surgical guidance. Of note, the clip is slightly inferiorly displaced.(2) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 29 years old, with burning sensation in the hands and face. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No pathologic parenchymal or extra-axial enhancement is detected. A very small developmental venous anomaly is evident in the inferior right frontal lobe.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.Cervical spine:The spinal cord demonstrates normal signal intensity and morphology throughout. No discrete lesions are seen. No pathologic intramedullary or leptomeningeal enhancement is detected.Spinal alignment is anatomic. Vertebral body morphology is normal. No worrisome marrow signal abnormality or pathologic enhancement is detected.The intervertebral discs are preserved. No significant spinal canal or neuroforaminal stenosis is detected.

Output: Unremarkable evaluations of the brain and cervical spine. No specific findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Pain in the right shoulder Patient motion artifact limits multiple sequences.ROTATOR CUFF: There is complete rupture of the supraspinatus tendon at the level of its insertion on the greater tuberosity with approximately 2 cm of retraction of the proximal tendon fragment. There is extension of this tear to involve the anterior fibers of the infraspinatus. There is also interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is thickening and intermediate signal intensity within the retracted supraspinatus tendon fragment indicating moderate tendinosis. The supraspinatus and infraspinatus muscles appear intact with minimal fatty infiltration at the level of the myotendinous junction. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Note is made of multiple foci of low signal intensity internally which may reflect a mild bursitis or debris. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity of the posterior superior labrum likely representing degeneration. There is separation of the labrum from the underlying glenoid at the 2 o'clock position which may represent a normal variant sublabral foramen within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Complete rupture of the supraspinatus tendon with retraction and extension of the tear to involve the anterior fibers of the infraspinatus.2. Findings indicating a subacromial subdeltoid bursitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 54-year-old female presents with right knee pain. MENISCI: There is a radial tear near the posterior root of the medial meniscus. Lateral meniscus is normal in appearance.ARTICULAR CARTILAGE AND BONE: Full-thickness cartilage loss in the weightbearing zone of the medial compartment as well as full-thickness loss particularly along the medial facet of the patellofemoral cartilage.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Posterior root radial tear of the medial meniscus with full-thickness cartilage loss in the medial tibiofemoral compartment and medial facet of the patellofemoral cartilage.


Instruction: Generate impression based on findings.

Input: Female 63 years old Reason: eval for osteomyelitis History: ischemia of digits 1-3 Irregularity of the cortex of the distal tuft of the great toe corresponding to osteomyelitis on subsequent MRI. The bones appear demineralized.

Output: Irregularity of the distal tuft of the great toe corresponding to osteomyelitis on subsequent MRI.


Instruction: Generate impression based on findings.

Input: 47-year-old male with history of shoulder pain. Evaluate for rotator cuff tear. ROTATOR CUFF: There is thickening and increased signal abnormality of the supraspinatus tendon at its insertion with a longitudinal linear component at the two o'clock position (posterior/superior) extending through most of the tendon compatible with a full-thickness longitudinal tear. The supraspinatus muscle is unremarkable. There is no evidence of tendon retraction. Mild tendinosis affects the remainder of the rotator cuff.SUPRASPINATUS OUTLET: There is a small amount of fluid within the acromioclavicular articulation. There is no fluid within the subacromial or subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior and superior glenoid labrum appear attenuated and of mildly increased signal intensity likely representing degeneration and probable attritional tearing. Bone marrow signal intensity is unremarkable.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Full-thickness longitudinal split tear of the supraspinatus tendon near its insertion in the background of moderate tendinosis. Other findings as above.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB: 7/2/1961)Reason: any cervical disk herniation or stenosis? History: dysphagia and hyperreflexiaPROVIDER NAME: BETTY C. SOLIVEN BETTY C. SOLIVEN MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Given the small number of lesions in the patient's stated age these are likely of little clinical significance.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion at this level. There is some left-sided facet hypertrophy at this level associated with mild narrowing of the left neural foramen and mild encroachment of the left exiting nerve roots..At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small broad-based right paramedian disc protrusion at this level. There is mild encroachment of the right-sided exiting nerve roots at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are some mild degenerative changes present in the cervical spine without significant compromise to spinal canal or exiting nerve roots.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. Given the small number of lesions and the patient's stated age these are likely of little clinical significance.


Instruction: Generate impression based on findings.

Input: Renal cancer with questionable base of skull lesion on CT. The sella and pituitary gland appears to be grossly unremarkable. There is fatty bone marrow within the clivus, which is normal. There is diffuse patchy cerebral and pontine white matter T2 hyperintensity. 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 susceptibility artifact related to metal in the skin overlying the right frontal process of the maxilla that obscures surrounding structures.

Output: 1. No evidence of pituitary or central skull base lesions, within the limitations of non-contrast technique.2. Diffuse patchy cerebral and pontine white matter T2 hyperintensity may be related to chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, history of spinal abscess. Follow-up exam post antibiotics. Since the prior examination, ventral epidural thickening and enhancement along the L5 and S1 vertebral bodies has significantly improved with relief of spinal canal narrowing seen previously. No evidence of any residual epidural or paraspinal fluid collection is seen.Hyperintense STIR signal persists within the L5 and S1 vertebral bodies similar to the prior examination. Further degeneration of the L5-S1 disc space is also noted with slight progression of retrolisthesis of L5 relative to S1. The L5-S1 neural foramina demonstrate significant narrowing which has worsened, likely related to the progressive spondylolisthesis.No new areas of marrow signal abnormality are detected. Degenerative marrow signal change is seen anteriorly at the L3-4 endplates.Vertebral body heights are largely preserved. Except as above, spinal alignment is unremarkable. The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits.

Output: 1.Significant improvement in the degree of ventral epidural thickening and enhancement seen previously along the L5 and S1 vertebral bodies. No evidence of any residual epidural collection is seen. There is no longer any significant spinal canal stenosis at these levels.2.Persistent abnormal signal is noted within the L5 and S1 vertebral bodies. In addition, further destruction of the L5-S1 disc space with slight progression of spondylolisthesis is demonstrated. These findings are compatible with the chronic sequelae of osteomyelitis discitis.3.No new epidural or marrow space lesions are seen.


Instruction: Generate impression based on findings.

Input: 68-year-old male with bilateral lower extremity weakness after a fall. Evaluate for etiology of the weakness. The vertebral column alignment is within normal limits. The vertebral body heights are preserved without evidence of fracture. There is multilevel disc desiccation involving the lower lumbar spine as well as severe disc height loss at the L3-4 and L5-S1 levels. At these levels there are endplate degenerative changes. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: Right greater than left disc bulge with mild right-sided neural foraminal stenosis. No left foraminal or spinal canal stenosis.L2-L3: Diffuse disc bulge with a small left paracentral disc protrusion which effaces the ventral thecal sac on the left and causes mild narrowing of the left lateral recess. There is also mild spinal canal stenosis and mild bilateral neural foraminal stenosis.L3-L4: Severe disc disease and disc bulge as well as facet hypertrophy which causes moderate bilateral neural foraminal and spinal canal stenosis. L4-5: Diffuse disc bulge with a left lateral annular fissure as well as facet arthropathy. There is no significant spinal canal or neural foraminal stenosis.L5-S1: Severe disc disease with lobular fatty material in the epidural space of the right anterior spinal canal at the L5-S1 level. The lesion abuts the disc and adjacent facet joint but does not clearly arise from either. Signal characteristics are entirely different from disc and there is no evidence of enhancement. This displaces the S1 nerve root posteriorly along with the other transiting sacral nerves. There are additional degenerative changes, a bulging disc with osteophyte formation and facet arthropathy which contributes to mild bilateral neural foraminal stenosis.

Output: 1.Lobular fatty material in the epidural space of the right anterior spinal canal at the L5-S1 level. The lesion abuts the disc and adjacent facet joint but does not clearly arise from either. Signal characteristics are entirely different from disc and there is no evidence of enhancement. This, along with additional degenerative changes, contributes to S1 nerve root displacement posteriorly along with the other sacral nerves. The differential includes a lipoma, dermoid cyst, or fatty degeneration of some other benign lesion.2.Severe disc disease and disc bulge at the L3-4 level as well as facet hypertrophy which causes moderate bilateral neural foraminal and spinal canal stenosis. 3.Diffuse disc bulge at the L2-3 level with a small left paracentral disc protrusion which effaces the ventral thecal sac on the left and causes mild narrowing of the left lateral recess. There is also mild spinal canal stenosis and mild bilateral neural foraminal stenosis at this level.


Instruction: Generate impression based on findings.

Input: Reason: labral re-tear History: s/p shoulder dislocation. ROTATOR CUFF: The rotator cuff tendons and muscles are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. No fluid or gadolinium within the subacromial subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Postsurgical changes with metallic artifact involving the anterior inferior glenoid. There is blunting of the anterior inferior labrum which may be postsurgical, but no evidence of gadolinium entering the labrum. Bone marrow edema involving the superior posterior humeral head compatible with contusion. No evidence of fracture.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: 1.Postsurgical changes of the anterior inferior glenoid. Blunting of the anterior inferior labrum, which may be postsurgical in etiology. No definite evidence of labral tear.2.Bone contusion involving the superior posterior humeral head without fracture.


Instruction: Generate impression based on findings.

Input: 63-year-old female patient with pain in right knee. Question of right knee chondromalacia. MENISCI: There is increased signal within the posterior horn of the medial meniscus. Additionally, there is linear increased T2 signal within the body of the medial meniscus which may represent a horizontal cleavage tear (image 19, series 1301). The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness loss of the cartilage of the weightbearing portion of the medial femoral condyle. There are partial-thickness defects of the lateral and medial facets of the patella with a full-thickness fissure more superiorly within the medial facet with T2 signal abnormality within the underlying bone. There is mild thinning of the weightbearing portion of the articular cartilage of the lateral femoral condyle.A subcentimeter lesion within the proximal tibia with high T2 signal likely represents a benign enchondroma.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Chondromalacia of the right knee, most predominantly affecting the medial tibiofemoral compartment.2. Questioned horizontal cleavage tear of the body of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for RUE and R facial weakness and hemorrhagic transformation of medial L thalamus and splenium of corpus callosum History: pls see above1/4/193878 yearsMale MRI of the brainThere is redemonstration of multiple small subcentimeter foci of diffusion restriction located along the right occipital pole, the right thalamus and to a lesser degree the left occipital pole in the cerebellar hemispheres bilaterally. These are less conspicuous on the current exam when compared to the prior exam from 1/20/2016. No new foci of diffusion restriction are appreciated.There is redemonstration of a hemorrhagic focus located in the left thalamus associated with surrounding T2 and FLAIR signal hyperintensity which signal hyperintensity extends into the left midbrain, left thalamus and left internal capsule. This hemorrhagic focus was smaller on the 1/20/2016 exam but is similar in size relative to the CT scan from 1/23/2016.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple foci of punctate signal hypointensity within the subcortical white matter.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.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 posterior communicating arteries are intact. The left vertebral artery slightly larger than the right vertebral artery.MRA neck:The MR angiography of the neck is suboptimal and that provides little information.

Output: 1.There is redemonstration of multiple small foci of infarction in the occipital lobes, thalami and cerebellar hemispheres which continue to evolve and are less conspicuous on the current exam.2.There is redemonstration of a small hemorrhage in the left thalamus associated with surrounding brainstem and internal capsule edema which is stable compared to the prior CT exam from 1/23/2016 but appears larger than the MRI exam from 1/20/2016.3.There is no evidence for intracranial cerebrovascular occlusive disease.4.The MR angiogram of the neck is suboptimal. Little information can be gleaned from it with regards to carotid and vertebral arteries. Perhaps a CT angiogram of the neck could be more successful in evaluating the cervical portions of the vertebral and carotid arteries.5.There are multiple subcortical white matter foci of microhemorrhage present. This pattern is in combination with the foci of hemorrhage in the thalamus is nonspecific. It is possible the patient also has amyloid angiopathy in addition to hypertensive type hemorrhage.


Instruction: Generate impression based on findings.

Input: Female, 84 years old, with altered mental status. A lobular, homogeneously enhancing extra-axial mass is present encroaching on the left frontal lobe with a base of attachment along the left pterion and sphenoid wing. The lesion measures up to 55 x 45 x 30 mm.The lesion induces relatively modest vasogenic edema in the surrounding frontal lobe parenchyma. However, the lesion does produce significant mass effect with effacement of the left frontal horn, posterior displacement and compression of the left basal ganglia, regional sulcal effacement and midline shift to the right. The left aspect of the suprasellar cistern is partially effaced. However, no other evidence of frank brain herniation is seen.The pituitary gland is somewhat dysmorphic with questionable thickening and enhancement along the left sella and cavernous sinus. No additional enhancing lesions are seen. No findings to suggest acute ischemia are demonstrated. Extensive confluent periventricular and scattered juxtacortical FLAIR hyperintense foci are demonstrated. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. Apart from effacement of the left frontal horn, the ventricular system is unremarkable.

Output: 1.Findings are seen most suggestive of a large left sphenoid wing meningioma.2.Questionable thickening along the left aspect of the sella and cavernous sinus could represent an additional pituitary or sellar lesion. However, this area is not adequately visualized on the present study. If clinical concern warrants, dedicated pituitary imaging can be considered.3.Extensive white matter FLAIR hyperintensity is seen which statistically most likely represents chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: There is no diffusion abnormality to suggest acute infarct. Again seen are areas of encephalomalacia/gliosis in the left MCA territory primarily involving the left frontal lobe likely related to prior ischemic injury. Additional area of FLAIR hyperintensity is seen more diffusely involving the bilateral periventricular and subcortical white matter. Small focus of T2 hyperintensity likely representing a lacunar infarct involving the right caudate head is again seen. There are multiple areas of nonsuppression of CSF on the FLAIR sequence consistent with subarachnoid hemorrhage. These are predominantly peripheral in distribution There is mild ex vacuo dilatation of the left lateral ventricle. Diminished size of the left cerebral peduncles compatible with Wallerian degeneration along the corticospinal tracts. Again seen is vertebral artery coursing along the surface of the medulla with contour deformity of the medulla, finding which is of doubtful clinical significance.No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Small right maxillary mucus retention cyst. Diffuse low T1 marrow signal is nonspecific and can be seen with conditions such as chronic anemias.MRA HEAD

Output: 1. Again seen is subarachnoid hemorrhage predominately in a peripheral distribution similar to recent CT. No evidence of acute infarct, intracranial mass, or mass effect.2. Extensive encephalomalacia involving the left frontal lobe cortex is again seen consistent with chronic infarct. Additional bilateral areas of FLAIR hyperintensity in the periventricular white matter, which while nonspecific is also favored to be vascular in etiology and not significantly changed. Chronic lacunar infarct in the right caudate head also again seen and not significantly changed since prior exam from 11/6/2013.3. Intracranial vasculature demonstrates areas of ectasia, such as at proximal right A2 and beyond the left MCA bifurcation involving the superior division, without discrete aneurysm. No high-grade stenosis is demonstrated in the intracranial vasculature.4. MR venogram without contrast is technically degraded. Major venous structures are better evaluated on recent CTA from 5/22/2015 and appear patent.


Instruction: Generate impression based on findings.

Input: 73-year-old female with history of recurrent/progressive GBM status post resection and radiation Again seen are post operative changes of a right posterior temporal-parietal craniotomy. Surgical resection cavity with CSF signal intensity in the right superior temporal gyrus measures 23 x 20 mm, previously 25 x 20 mm, not significantly changed from prior exam. Surrounding FLAIR hyperintensity is not significantly changed. On post enhanced images the previously noted linear inhomogeneous enhancement along the posterior surgical cavity wall is not significantly changed and demonstrates restricted diffusion, intrinsic T1 shortening, and evidence of blood products. Additional focus of enhancement along the anterior inferior aspect of the surgical cavity measuring approximately 5 mm is also unchanged. 4 mm focus of enhancement along the supermedial wall of the resection cavity is also unchanged. There are no new intracranial lesions or abnormal enhancement noted. No new mass effect, herniation, or hydrocephalus.

Output: Compared to 5/12/2015, there is no evidence of interval tumor progression. Specifically, 5 mm focus of nodular enhancement along the anterior margin of the resection cavity and 4 mm focus along the superomedial aspect of the resection cavity are not significantly changed. Additional less suspicious areas of enhancement posteriorly also remains unchanged.


Instruction: Generate impression based on findings.

Input: 28-year-old female with right shoulder pain ROTATOR CUFF: The supraspinatus tendon and muscle are within normal limits. The infraspinatus tendon and muscle are within normal limits. The teres minor tendon and muscle are within normal limits. The subscapularis tendon and muscle are within normal limits.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. No fluid or gadolinium is present within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. The labrum and cartilage are within normal limits.BICEPS TENDON: The long head of the biceps tendon is within the bicipital groove.

Output: Normal appearing shoulder without specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Female 47 years old; Reason: Evaluate AML for change History: Tuberous Sclerosis, renal AML ABDOMEN:Evaluation suboptimal without IV contrast and sequences degraded by patient motion artifact. Additionally per MRI technologist multiple issues were experienced with respiratory triggering during the exam and as a result alternative sequences were acquired and also included in study.LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Diffuse hepatic steatosis with small sparing seen near gallbladder fossa. Cholelithiasis. No secondary signs of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilaterally seen are multiple macroscopic fat-containing renal lesions, appearance compatible with angiomyolipomas. Accounting for differences in technique these lesions are without significant change. Largest discernible lesion seen extending exophytically from anterior aspect of mid pole of left kidney on image 33 series 8, lesion measures 4.4 x 2.8 cm on image 33 series 8, previously measured 4.5 x 3 cm. Additional T2 hyperintense foci seen compatible with 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. Evaluation suboptimal without IV contrast.2. Without significant change are bilateral renal angiomyolipomas, largest seen extending exophytically from mid pole of left kidney as above. (Please note that the size above which treatment, e.g., embolization, is recommended due to an increased risk of bleeding is 4 cm.)


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is increased signal within the posterior horn of the medial meniscus however there is no discrete extension of this signal to either articular surface. The anterior horn is intact. The lateral meniscus is normal.ARTICULAR CARTILAGE AND BONE: A focus of increased T2 signal is identified within the posterior portion of the medial femoral condyle. There is moderate thinning of the articular cartilage of the patella with the remaining compartments appearing intact. There is no evidence of a full-thickness cartilage defect.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Intrasubstance degeneration of the medial meniscus without discrete lateral or medial meniscal tear.2. Focus of edema within the posterior medial femoral condyle may represent a bony contusion.


Instruction: Generate impression based on findings.

Input: History of bilateral optic gliomas s/p chemotherapy and changes on 9/2014 MRI. There are post-treatment findings for an optic glioma. There is no significant change in size of the optic glioma and associated punctate focus of enhancement within the left optic pathway. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is fluid within the left middle ear and mastoid air cells.

Output: 1. No significant interval change in the optic glioma.2. Fluid within the left middle ear and mastoid air cells may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: Right acoustic neuroma, SRS planning MRI: tinnitus and dizziness. There is a mass within the right cerebellopontine angle cistern with extension into the right internal auditory canal that measures up to 18 mm. There is negligible mass effect upon the adjacent right middle cerebellar peduncle. There is no evidence of intracranial hemorrhage. The ventricles are normal in size. The skull and extracranial soft tissues appear grossly unremarkable.

Output: Pretreatment planning MRI demonstrates a right vestibular schwannoma that measures up to 18 mm.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [728.87], Reason for Study: ^Reason: rule out stroke History: left sided hemiparesis, ataxia, vertigo No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is a arachnoid cyst on the right middle cranial fossa anterior to temporal pole, no change of size since prior CT scan. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on bilateral maxillary sinus as well as both ethmoid and frontal sinus opacifications indicating pansinusitis

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Sinus opacifications as described above.


Instruction: Generate impression based on findings.

Input: Pain, swelling, aspiration of frank blood. Recent fall injury, status post right knee arthroscopy. MENISCI: A majority of the posterior horn of the medial meniscus is absent, which is likely post-surgical. Of the remaining posterior horn, there are multiple defects along the undersurface which likely represents tearing. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is thinning and fraying of the cartilage of the femoral trochlea. No full thickness chondral defect is evident. There is a focal abnormal T2 signal in the patellar cartilage which likely represents a focal tear. The cartilage of the medial and lateral compartments appears intact.There is linear T1 signal with minimal cortical offset of the lateral tibial plateau along with associated abnormal T2 signal; this is compatible with a non-displaced fracture. There are other patchy areas of abnormal T2 signal within the anterior and posterior regions of the femoral head and tibial plateau. LIGAMENTS: The collateral and cruciate ligaments are intact. The popliteus muscle/tendon appear intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Non-displaced fracture of the lateral tibia plateau. 2. Post-surgical changes of the posterior horn of the medial meniscus with probable undersurface tearing of the posterior horn remnant. 3. Thinning and fraying of the femoral trochlear cartilage without full thickness defect.4. Small joint effusion.5. No evidence of ligamentous injury.


Instruction: Generate impression based on findings.

Input: Breast cancer. There appears to be a small area of enhancement in the left middle frontal gyrus subcortical white matter. Otherwise, there is no evidence of intracranial hemorrhage or acute infarct. There are scattered foci of cerebral white matter T2 hyperintensity without associated enhancement. There is intrinsic T1 hyperintensity in the dentate nuclei and basal ganglia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: An apparent small area of enhancement in the left middle frontal gyrus subcortical white matter may be vascular in nature or represent metastatic disease. Otherwise, no evidence of intracranial metastases elsewhere. Scattered foci of nonspecific white matter lesions may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: r/o intracranial abnormality History: nystagmus, headache, dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a punctate T2 hyperintense lesion present along the inferior aspect of the right lentiform nuclei which is hypointense on T1 imaging and does not enhance following contrast administration.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucus retention cyst in the left maxillary sinus and a smaller one in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A small lesion along the inferior aspect of the right basal ganglia is nonspecific. Although most likely this is a benign lesion and of little clinical significance, a follow up exam would help confirm this.


Instruction: Generate impression based on findings.

Input: Male 14 months old Reason: IVH, born 25 wk gestation, one of triplets. There is a large oval CSF signal intensity structure centered in the right parietal region representing a porencephalic cyst which communicates with the body of the right lateral ventricle. There is associated loss of parenchymal tissue involving a majority of the right parietal lobe, a portion of the posterior right frontal lobe, as well as the right corpus callosum, distal to the anterior body. This cyst measures 5.7 cm in craniocaudal dimension and 5.9 x 2.7 cm in axial dimensions, and results in mild localized mass effect. There are more focal areas of encephalomalacia along the posterior aspect of the cyst as well as susceptibility artifact consistent with hemosiderin staining suggesting prior hemorrhage.There is mild-moderate dilatation of the lateral and third ventricles, as well as anterior subarachnoid spaces. Susceptibility in the occipital horns in noted, consistent with history of intraventricular blood products. The distal right anterior cerebral artery flow void is absent. Otherwise the major cerebral flow voids are intact.With regard to corrected age, the visualized white matter appears somewhat delayed in myelination pattern on T2 imaging. However on T1 imaging the white matter appears more compatible with expected appearance although the arborization is somewhat decreased, likely secondary to diffuse paucity of white matter. The cerebellum is somewhat dysplastic with crossing folia suggesting some degree of rhomboencephalosynapsis. There is also hypoplasia of the inferior aspect of the cerebellum. There are a few scattered punctate foci of susceptibility in the cerebellum suggesting possible prior punctate hemorrhage.

Output: 1.Large right porencephalic cyst with associated parenchymal loss of white matter and cortex of the majority of the right parietal lobe and a portion of the posterior right frontal lobe as detailed above. Evidence of hemosiderin deposition along the severely encephalomalacic right posterior parietal region indicating previous hemorrhage. Mild localized mass effect.2.Dysplastic cerebellum with suggestion of rhomboencephalosynapsis.3.Heart absence of the posterior right corpus callosum.4.Mildly delayed myelination pattern on T2-weighted images with overall significant possibly of white matter volume.5.Prominence of ventricles and anterior subarachnoid spaces which may in part relate to the generalized volume loss as well as superimposed benign enlargement of subarachnoid spaces of infancy which should resolve by 2 years of age.6.Trace hemosiderin in the occipital horns dependently, relating to previous intraventricular blood products.


Instruction: Generate impression based on findings.

Input: The cervical spinal canal is small on a congenital basis. The overall alignment is straightened. 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.There are mild multilevel degenerative changes throughout the mid to lower cervical spine without significant resultant spinal canal or neural foraminal stenosis.

Output: 1. No evidence of cord compression or abnormal cord signal.2. Mild multilevel degenerative changes without high-grade spinal canal or neural foraminal stenoses, as detailed above.


Instruction: Generate impression based on findings.

Input: 46-year-old male with history of primary sclerosing cholangitis. Patient presents for cholangiocarcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver without evidence of a suspicious mass. Unchanged regions of right hepatic lobe fibrosis. Irregular biliary ductal beading and intrahepatic strictures compatible with patient's known history of primary sclerosing cholangitis is again seen. The confluence of the hepatic ducts is diminutive in caliber. No dominant stricture is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst is again noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in biliary ductal irregularity compatible with known primary sclerosing cholangitis.2.Cirrhotic hepatic morphology without interval development of a dominant stricture, biliary ductal dilatation or suspicious hepatobiliary lesions.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, with multiple myeloma and worsening lumbar L1 pain for one week. Spinal alignment is grossly anatomic. Endplate concavity and a Schmorl's node deformity superiorly along L1 are unchanged. The remaining vertebral bodies demonstrate preserved height. Minimal edema is seen along the posterior superior L5 endplate, likely degenerative in nature. No focal marrow replacing lesions are seen. The visualized distal spinal cord and conus are within normal limits. The nerve roots of the cauda equina disperse evenly through the thecal sac. No epidural lesions are suspected.L1-2: Facet arthropathy. Ligamentum flavum thickening. No spinal canal or foraminal stenosis. No interval changes. L2-3: Facet arthropathy. Ligamentum flavum thickening. No spinal canal or foraminal stenosis. No interval changes. L3-4: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulging and minimal superimposed central protrusion. No significant spinal canal or foraminal stenosis. No interval changes. L4-5: Facet arthropathy. Ligamentum flavum thickening. Disc bulging asymmetric to the left. Effacement of the left lateral recess, perhaps slightly worse than on the prior exam. Mild left foraminal narrowing. L5-S1: Facet arthropathy. Ligamentum flavum thickening. Mild disc bulging with perhaps a right paracentral protrusion. No spinal canal stenosis. Moderate right and mild left foraminal narrowing. No interval changes. Edema and streak-like lesions are seen within the left iliac bone which may be related to bone marrow aspiration.

Output: 1.No definite evidence of any focal myelomatous disease is seen.2.Endplate concavity and a Schmorl's node deformity superiorly at L1 are unchanged.3.Relatively mild disc degeneration and posterior element hypertrophy are seen. No high-grade spinal canal stenosis is detected. Moderate foraminal narrowing is seen on the right at L5-S1.


Instruction: Generate impression based on findings.

Input: There is mild diffuse thinning of the corpus callosum which is otherwise fully formed. No intracranial mass or mass effect. No cortical abnormality is appreciated. No findings to suggest cortical dysplasia or migrational abnormality. No focal parenchymal signal abnormalities. Bilateral hippocampi appear within normal limits. Myelination appears within normal limits for age. There are no diffusion or susceptibility abnormalities. Vascular flow voids are preserved.

Output: 1. No structural lesions to suggest seizure focus are appreciated.2. Mild thinning of the corpus callosum which is otherwise fully formed and may be a normal variant.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with history of multiple myeloma and new neck pain radiating down the right arm. Radiographs of the cervical spine show severe DJD and narrowing. Trace retrolisthesis of C5 relative to C6 is seen. There is a mild focal kyphotic angulation centered at the C5-6 level. Otherwise, alignment is unremarkable.Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed below. No pathologic cord signal abnormality or enhancement is seen. No epidural abnormalities are suspected.C2-3: Mild left facet hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing. C3-4: Unremarkable. C4-5: Unremarkable. C5-6: Loss of disc height with disc osteophyte formation. Mild effacement of the ventral thecal sac and perhaps mild flattening of the ventral cord. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. C6-7: Loss of disc height with disc osteophyte formation. Mild effacement of the ventral thecal sac with perhaps minimal flattening of the ventral cord. Mild generalized spinal canal narrowing. Severe bilateral foraminal narrowing.C7-T1: Unremarkable.

Output: 1.Disc degeneration is evident at C5-6 and C6-7 with loss of disc height, disc osteophyte formation and mild narrowing of the spinal canal. At C6-7, however, there is severe bilateral foraminal narrowing.2.No evidence of active myelomatous disease in the cervical spine.


Instruction: Generate impression based on findings.

Input: Dizziness, tinnitus, and left hearing loss. Audiogram revealed moderate rising to mild sensorineural hearing loss at 250-1500Hz, rising to normal limits 2-8kHz. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. However, there is apparent paucity of bone overlying the left superior semicircular canal. The right-sided inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells also appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Possible left superior semicircular canal. Further evaluation via a temporal bone CT may be useful.


Instruction: Generate impression based on findings.

Input: 26-year-old male. Right knee pain x 3 months following ski injury. MENISCI: Horizontal tear through the body of a discoid lateral meniscus. There is globular signal abnormality within this meniscus consistent with intrasubstance degeneration. Medial meniscus is normal in signal intensity and morphology without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Edema type signal in the lateral tibial plateau consistent with a bone contusion. Tibiofemoral and patellofemoral compartment cartilage is intact.LIGAMENTS: ACL, PCL, MCL, and lateral collateral ligament complex is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Horizontal degenerative tear of a discoid lateral meniscus.2. Bone contusion of the lateral tibial plateau.


Instruction: Generate impression based on findings.

Input: Female 49 years old; Reason: Evaluate for ligament or meniscal abnormalities, any bony abnormalities History: one month of knee pain, large joint effusion MENISCI: There is focal blunting of the free edge of the posterior horn of the medial meniscus, indicating a partial thickness radial tear. Linear increased signal intensity in the peripheral fibers of the posterior horn of the medial meniscus extending to the femoral articular surface likely represent an interface with an intracapsular ligament rather than a true tear. There is mild blunting of the free edge of the body of the medial meniscus, likely reflecting chronic attritional tearing, as well as globular increased signal reflecting intrasubstance degeneration. The medial meniscus is mildly extruded medially. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the medial compartment, particularly along the weight-bearing surface of the medial femoral condyle, with small foci of full-thickness cartilage degeneration. Tiny near-full-thickness to full-thickness defects are present in the articular cartilage of the medial tibial plateau. Underlying edema-type signal is present in the medial tibial plateau and medial femoral condyle. Partial-thickness cartilage degeneration is present along the medial facet of the patella. Near-full-thickness to full-thickness focal cartilage defects are noted along the medial facet of the femoral trochlea.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Osteoarthritic changes of the knee, particularly at the medial tibiofemoral and patellofemoral compartments, with small foci of full-thickness cartilage degeneration.2. Partial-thickness radial tear of the posterior horn of the medial meniscus with medial extrusion of the body of the medial meniscus.3. Normal-appearing ligaments.4. Moderate to large joint effusion.


Instruction: Generate impression based on findings.

Input: 69-year-old male with left renal lesion seen on CT. History of colon cancer. ABDOMEN:LIVER, BILIARY TRACT: 3 cm left hepatic lobe cyst. Additional and scattered subcentimeter cysts. No suspicious focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The 1.6 x 1.6 cm round circumscribed exophytic mass arising from the inferior pole of the left kidney is unchanged in size compared to the recent prior CT, though is slightly enlarged compared to the CT on 10/16/2014. This lesion is slightly hypointense to the renal cortex on T2 images and slightly hyperintense to the renal cortex on T1 images. Postcontrast images show internal septation enhancement. Subcentimeter left renal cysts noted. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: T2 hypointense 1.6 cm mass at the inferior pole of the left kidney with internal enhancement as above, suspicious for renal cell carcinoma, particularly papillary subtype given background of T2 hypointense signal.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient with poorly controlled hypertension presenting with occipital headache x 1 week. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is concern for an acute stroke, an MRI may be considered for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there is concern for an acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: New onset seizure comprising of 5-10 sec arrest of activity with staring raising both arms, watery eyes, and drooling, with accompanying occipital headaches, loss of vision, and out of body experience per EPIC. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, without evidence of heterotopia, medial temporal sclerosis, or gross cortical malformation. The pituitary and pineal glands also 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.

Output: No evidence of gross seizure foci.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: Met Breast Cancer, known spine mets, s/p xrt L2-l4 and L3 kyphoplasty History: lower back pain Again seen are bilateral pars defects with grade 1 anterolisthesis of L5 on S1 which is unchanged compared to the exam from 9/19/2014. The remainder of the alignment of the lumbar spine is within normal limits. Redemonstrated is an L3 compression fracture with approximately 50% loss of height. There is evidence of kyphoplasty material within the vertebral body of L3 which is better seen on the recent CT from 2/2/2016. The remainder of the vertebral body heights are preserved. There is variable disc desiccation and severe loss of disc height involving the L5-S1 level which is unchanged. There is mild loss of disc height at the remainder of the lumbar levels. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2, L2-3: No disc bulge. Mild facet arthropathy. No spinal canal foraminal stenosis.L3-4: No disc bulge. Mild facet arthropathy. With comparison to the prior CT, kyphoplasty cement is visualized in the anterior left epidural region with effacement of the left lateral recess which is unchanged. No significant spinal canal or neural foraminal stenosis.L4-5: No disc bulge. Severe facet arthropathy. No spinal canal or neural foraminal stenosis.L5-S1: Again seen is grade 1 anterolisthesis of L5 on S1 with uncovering of the disc and moderate facet hypertrophy which causes severe bilateral neuroforaminal stenosis. There is mild spinal canal stenosis.

Output: 1.No evidence of new osseous metastatic disease.2.Degenerative changes most severe at the L5-S1 level where there is grade 1 anterolisthesis, severe bilateral neural foraminal stenosis and mild spinal canal stenosis which is not significantly changed from the previous exam.3.Interval kyphoplasty of the L3 vertebral body with no change in the degree of height loss. With comparison to the prior CT, kyphoplasty cement is visualized in the anterior left epidural region with effacement of the left lateral recess, a finding which is unchanged. There is no significant spinal canal or neural foraminal stenosis at this level.


Instruction: Generate impression based on findings.

Input: 89-year-old female with history of hip fracture, status post right hip replacement, now with left hip pain, inability to ambulate. Evaluate for fracture.IMAGE ACQUISITIONS: Routine high-resolution CT of the left hip was performed without intravenous contrast. There is a nondisplaced fracture the left femoral neck with minimal impaction, which is likely subacute, given lack of effusion or associated soft tissue abnormality. MRI could be considered for further evaluation. Corticated linear lucency through the inferior acetabulum (coronal image 47/93), is consistent with prior fracture. Additional cleft in the articular surface of the superior acetabulum (coronal image 39/93), may also represent prior fracture deformity.Bones are diffusely demineralized. Moderate degenerative changes affect the left hip.Arterial atherosclerotic calcifications are present. Small paraumbilical fat containing hernia is seen.

Output: Left femoral neck fracture is likely subacute. Additional prior acetabular fractures, as described above.


Instruction: Generate impression based on findings.

Input: Right knee pain and swelling. Evaluate right knee for lateral meniscus tear versus chondromalacia. MENISCI: There is increased intrasubstance signal within the lateral meniscus indicating mild mucoid degeneration. Within the body of the lateral meniscus, the signal appears to extend to the femoral articular surface near the free edge of the meniscus suggesting inner edge fraying or mild inner edge tearing. We see no findings to suggest an unstable lateral meniscus tear. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is both superficial fraying as well as near full thickness to full-thickness fissuring of the articular cartilage of the medial facet of the patella. There is mild heterogeneity of the the cartilage of the lateral facet of the patella suggesting relatively mild degeneration. There is near full-thickness degeneration of the articular cartilage of the medial femoral condyle along the weight-bearing portion between the meniscal horns. There is also perhaps mild superficial degeneration of the articular cartilage of the anterior aspect of the medial tibial plateau. The lateral compartment articular cartilage is intactLIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Cartilage degeneration as described above affecting the patella and medial compartments.2. Lateral meniscal degeneration with possible degenerative fraying/tearing along the free edge of the body, but we see no specific features to suggest an unstable tear.


Instruction: Generate impression based on findings.

Input: 72 years Male (DOB:12/27/1943)Reason: Known L3 L4 compression, worsening symptoms History: as abovePROVIDER/ATTENDING NAME: RITA M ROSSI-FOULKES RITA M ROSSI-FOULKES Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level. Disc material abuts the nerve root at the left lateral recess at this level, however, the exiting nerve root as a fat pad behind it.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level.At L3-4 there is loss of disc space height, desiccation and a disc bulge associated with the left paramedian disc protrusion which abuts the nerve root at the left lateral recess and mildly encroaches on the nerve root at the left lateral recess. This encroachment of the nerve root at the left lateral recesses developed since the prior exam. There is also some facet and ligamentum flavum hypertrophy at this level.At L2-3 there is loss of disc space height, disc desiccation, disc bulge, endplate reactive changes and bilateral facet hypertrophy. Facet hypertrophy is greater on the right side versus the left side. There is a encroachment of the thecal sac at this level with obliteration of the spinal fluid surrounding the nerve roots at this level. Overall there is a moderate to marked degree of spinal stenosis at this level. This appearance was also present on the prior exam and has not changed significantly. There is narrowing of the right neural foramen at this level with some encroachment of the right-sided exiting nerve root within the neural foramen.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are multilevel degenerative changes present in the lumbar spine worse at L2-3 where there is moderate to severe spinal stenosis and encroachment of the right-sided exiting nerve roots. This is stable compared to the previous exam from 2015.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis with slurred speech and weakness. Also recent sore throat with fevers. There are numerous, greater than 10, T2 hyperintense lesions involving the cerebral white matter, predominantly in a periventricular distribution. There are also T2 hyperintense lesion in the pons and bilateral middle cerebellar peduncles. Many of the lesions are also T1 hypointense, but there is no discernible associated enhancement. There may also be a T2 hyperintense lesion in the imaged upper cervical spine. There are nonspecific areas of susceptibility effect in the bilateral basal ganglia. However, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and sulci are diffusely prominent due to mild cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, mastoid air cells, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is diffuse thickening of the calvarium.There is mild prominence of the adenoids and there is a small amount of secretions in the nasopharynx.

Output: 1. Stigmata of multiple sclerosis, but no evidence of acute intracranial hemorrhage, abscess, or acute infarct. 2. Mild prominence of the adenoids and a small amount of secretions in the nasopharynx may be attributable to an upper respiratory tract infection.


Instruction: Generate impression based on findings.

Input: Male 78 years old with neuroendocrine tumor of the head of the pancreas. Evaluate for liver metastases. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. There are at least 4 mildly T2 hyperintense lesions the largest in segment 6 of the liver measuring 2.3 x 1.8 cm. Previously the lesion measured 1.2 x 1.1 cm. The other lesions have also grown in size.SPLEEN: No significant abnormality noted.PANCREAS: There is a large T2 hyperintense mass involving the pancreatic body. The mass measures 6.2 x 6.6 cm previously, 6.1 x 6.1 cm. The tail is atrophic. Pancreatic duct in the head of the pancreas is normal. Common bile duct is normal in caliber. There are subtle T2 hyperintense foci within the pancreatic head which may represent small branch type IPMN's.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left pleural effusion and ascites.INDEX LESION MEASUREMENTS (Current exam date/time: 9/8/2016 14:43:00)PANCREATIC BODY MASS: 6.2 x 6.6 cm (Image 34, Series 16); 6.1 x 6.1 cm on prior (7/29/2016) (Image 65, Series 19).SEGMENT 6 LESION: 2.3 x 1.8 cm (Image 17, Series 11); 1.2 x 1.1 cm on prior (7/29/2016) (Image 73, Series 19).

Output: 1.Findings of a 6.6 cm pancreatic body mass which is slightly increased in size from prior.2.Increase in the size of the liver lesions.3.Given the lack of intravenous contrast the liver lesions or pancreatic lesion cannot be fully characterized however, given the pancreatic mass shows size increase and increase in the size of the liver lesions these are most compatible with metastatic disease.