Instruction: Generate impression based on findings.

Input: 27-year-old female with history of cholecystectomy in 2010 with laparoscopic duodenal switch in 2013 and laparoscopic small bowel resection for blind loop syndrome who quickly developed choledocholithiasis now presenting with right upper quadrant. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions with evidence of periportal edema. There is mild dilatation of the common bile duct measuring up to 8 mm, likely sequela of cholecystectomy. Mild intrahepatic biliary ductal dilatation. Cystic duct remnant is noted. No evidence of choledocholithiasis. SPLEEN: No significant abnormality noted.PANCREAS: Pancreas demonstrates normal intrinsic T1 hyperintensity. The main pancreatic duct crosses over the common bile duct and drains into the minor papilla.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.Common bile duct dilatation likely sequela of prior cholecystectomy without evidence of choledocholithiasis. Mild intrahepatic biliary ductal dilatation.2.Pancreatic divisum.3.Mild periportal edema.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with high-grade astrocytic neoplasm, follow-up examination. A rim-enhancing mass within the posterior aspect of the right frontal lobe is again seen with evidence of prior biopsy. The overall size of the lesion has increased from the immediate prior examination, now measuring 36 x 35 mm, previously 34 x 30 mm, when measured in the axial plane. The enhancing rim has become thicker. The degree of T2 hyperintensity surrounding this lesion has also increased. More anteriorly, patchy foci of enhancement have become larger within the right operculum, along with associated T2 signal abnormality. Likewise, foci of enhancement within the corpus callosum and the left centrum semiovale white matter have become larger.rCBV mapping shows elevated blood volume correlating with both the dominant right frontal lesion and the scattered additional areas of patchy enhancement.Ill-defined nonenhancing T2 hyperintensity within the bilateral frontal white matter is not significantly changed. Likewise, nonenhancing T2 hyperintense cortical and subcortical thickening involving the anterior right temporal lobe, amygdala and hippocampal head are not significantly changed.No significant generalized mass effect or brain herniation is seen. The ventricles maintain a relatively normal morphology and configuration.

Output: 1.Mild interval increase in the size of a dominant right posterior frontal mass with associated increased edema.2.Scattered additional foci of enhancement within the right opercular tissues, the corpus callosum and the left centrum semiovale white matter have also increased.3.Other areas of nonenhancing signal abnormality remain relatively stable.4.The overall impression, in conjunction with rCBV mapping, is that of slowly progressing disease including within the contralateral hemisphere.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: HA worse with exertion x 2 weeks, assess for lesion, bleed, or vascular abnormality History: HA worse with exertion x 2 weeks, assess for lesion, bleed, or vascular abnormality No evidence of acute ischemic or hemorrhagic lesion.Previously noticed right side sellar floor lesion is partially visualized and appears to be stable unchanged since prior scan.Small pineal gland cyst is again seen, unchanged.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Unchanged right sellar floor lesion and small pineal gland cyst since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: BRAIN: The endovascular coil adjacent to the right internal carotid communicating segment is not well seen. A right frontal ventriculostomy catheter is again present with its tip in the region of the foramen of the Monroe just past the midline. There is once again mild ventriculomegaly of the lateral and third ventricles, not significantly changed compared to 8/29/2015 CT. FLAIR and GRE signal abnormalities are again compatible with diffuse subarachnoid hemorrhage with intraventricular redistribution. Blooming artifact around the ventriculostomy catheter suggests a small amount of blood products around the catheter. Additional T1 and T2 hyperintense material within the anterior aspect of the sella turcica and within the prepontine cistern likely reflects additional blood products. There is no territorially restricted diffusion to suggest acute ischemic infarction. There is a single non-specific punctate focus of abnormal increased T2/FLAIR signal within the left periventricular white matter. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is mild mucosal thickening within the ethmoid air cells. MRA HEAD: There is mild narrowing of the proximal intracranial arteries including the basilar artery, bilateral proximal ICAs, M1 segments of the middle cranial arteries, A1 segments of the anterior cerebral arteries, and P1 segments of the posterior cerebral arteries compatible with mild vasospasm. No recurrent right internal carotid communicating segment aneurysm is identified. No other aneurysms are identified. No high-grade stenosis is identified. There is a fetal origin of the posterior cerebral arteries bilaterally.

Output: 1.Postsurgical changes related to coiling of right internal carotid communicating segment aneurysm without evidence of recurrent aneurysm.2.Mild vasospasm of the proximal intracranial arteries.3.Stable mild ventriculomegaly with ventriculostomy catheter in place.4.Diffuse subarachnoid hemorrhage with intraventricular extension.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine without aura, not intractable, without status migrainosusClinical question: lesion/mass, causing severe headachesSigns and Symptoms: new onset headaches 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.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.A pharyngeal mucosal space 5mm cystic lesion is present in the nasopharynx. This is most likely benign.There are multiple foci of susceptibility artifact along the right parietal and frontal scalp centered at the skin surface.

Output: 1.No intracranial mass or lesion is identified.2.There are multiple foci of susceptibility artifact along the right parietal and frontal scalp centered at the skin surface. Please correlate with visual inspection. This area is obscured on MRI.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: assess for stenosis History: BL LE weakness (proximal worse than distal, R > L) and suppressed reflexes at right knee and ankle. History of prostate cancer. Thoracic MRI:Postoperative (colpectomy and external fixation) between T10-L1 and kyphoplasty at L2.Multiple metastatic lesions on cervical, thoracic and lumbar vertebral bodies as well as ribs. The extent of involvement appears to be unchanged since Dec 1 2015 but progressed since Mar 26 2015.Multifocal various degreed height loss (compression fractures) of thoracic vertebral bodies are again seen, no change since Dec 1 2015.Thoracic spinal cord signal intensity is normal.Lumbar spine:Redemonstration of multiple metastatic lesions on lumbar vertebral bodies, sacrum and bilateral ilium, no change since prior scan.Previously noted undulating shape epidural lesion appears to be stable in size and configuration.Spinal cord signal intensity appears to be normal.The conus medullaris terminates at the L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: external fixation using screw is seen, no neuroforaminal narrowing or spinal stenosis. L1-L2: about 20-30% height reduction with bone cement within the vertebral body indicating post kyphoplasty status, no neuroforaminal narrowing or spinal stenosis. About 2 mm thickness intrathecal lesion on the right posterolateral aspect of the thecal sac.L2-L3: about 3mm thickness intrathecal lesion on the left posterolateral aspect of the thecal sac with subtle mass effect toward spinal cord. No neuroforaminal narrowing or spinal stenosis. L3-L4: diffuse bulging of disc with bilateral ligamentum flavum thickening result mild spinal canal stenosis, there is about 2mm thickness intrathecal lesion midline posterior aspect of the thecal sac. No neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc with central broad based disc protrusion result moderate to severe spinal canal stenosis, no neuroforaminal narrowing or spinal stenosis. L5-S1: there is curvilinear intrathecal lesion on the right posterolateral aspect of the thecal sac with mild mass effects toward spinal cord, no neuroforaminal narrowing or spinal stenosis.

Output: 1. No change of multifocal metastatic lesions on thoracic spine, lumbar spine, ribs, sacrum and bilateral ilium.2. Intra thecal fluid collecting lesions likely represent subdural space along lumbar spine with various degree mass effects toward spinal cord as described above, no change in extent, size and configuration since prior scan.3. Degenerative changes of lumbar spine especially at the level of L45, there is moderate to severe spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Asphyxiation due to hanging, undetermined, initial encounter [T71.164A], Reason for Study: ^Reason: Evaluate for seizure focus History: 12 yo M s/p hanging injury and seizures Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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 ethmoid sinus and small retention cyst on the left maxillary sinus.Neck MRA:3D time of flight MRA neck images with maximum intensity projections of the neck vessels demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. C-Spine MRIThere is loss of normal cervical lordosis. The cranial-cervical junction is normal. Spinal cord signal intensity is normal. Vertebral body signal intensity is normal. Paravertebral soft tissues appear to be normal.There is no evidence of spinal canal or neural foraminal stenosis.

Output: Normal brain MRI, Normal Neck MRA and Normal C spine MRI


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer with leptomeningeal disease treated with Alectinib x 2 cycles. There has been interval decrease in the degree of leptomeningeal carcinomatosis and associated vasogenic edema. There is also interval appearance of sulcal susceptibility effect in the right central sulcus, where there is persistent enhancement. There is an unchanged focus of susceptibility effect in the right superior frontal gyrus where there is also residual enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions and mucosal thickening in the right sphenoid sinus.

Output: Interval decrease in the degree of leptomeningeal carcinomatosis and associated vasogenic edema.


Instruction: Generate impression based on findings.

Input: 57 years Female (DOB:7/9/1959)Reason: stroke History: aphasia and right sided weaknessPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the previous examination patient developed new foci of diffusion restriction in the left middle frontal gyrus and along the left subcentral lobule, adjacent pre and postcentral gyri and lateral aspect of the postcentral gyrus. The patient's previous foci of infarction in the left precentral gyrus have evolved.. There is redemonstration of small foci of encephalomalacia in the watershed distribution between the left anterior and middle cerebral artery territoriesThere is T2 signal hyperintensity within the petrous segment of the left internal carotid artery. There is FLAIR signal hyperintensity present in the left sylvian fissure and a couple branches of the middle cerebral artery.Normal vascular flow voids are present in the distal right carotid arteries, distal bilateral vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.New foci of acute infarction are present in the left middle cerebral artery territory involving the left middle frontal gyrus, left subcentral lobule extending to adjacent pre and postcentral gyri as well as left postcentral gyrus.2.Findings raise the question of new occlusion of a couple branches of the left middle cerebral artery at the M2 and M3 segments in the sylvian fissure which correspond to the areas of infarction. If clinically appropriate CT angiogram or an MR angiogram may be helpful to further evaluate this.3.There is redemonstration of watershed distribution foci of infarction in the left hemisphere which are in a more chronic stage on the current exam.4.Findings suggest left internal carotid artery occlusion.


Instruction: Generate impression based on findings.

Input: History of Chiari malformation, thoracic syrinx, and tethered cord. Follow-up exam. Again seen are postoperative changes in the lumbar spine with discontinuous fatty filum compatible with prior fatty filar transection and tethered cord release. There is no new cord signal abnormality or syrinx in the visualized lower thoracic cord. The lumbar spine is in normal alignment with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris terminates at the lower L1 level. There is 1 to 2 mm of ventral motion of the conus on prone images although this is not well evaluated due to motion.At L3-4 there is mild disc bulge and minimal right greater than left neural foraminal stenosis. At L4-5 there is mild disc bulge with mild bilateral neural foraminal stenosis. There is no significant spinal canal or foraminal narrowing at any other level within the lumbar spine.

Output: 1.Postsurgical findings from tethered cord release and fatty filum/lipoma are unchanged. No new cord signal abnormality or syrinx in the visualized lower thoracic cord. There appears to be 1-2 mm ventral motion of the conus on the prone images. 2.Minimal spondylosis at L3-4 and L4-5 with mild neural foraminal stenosis at these levels.


Instruction: Generate impression based on findings.

Input: Please note the patient requested the study be finished before all sequence acquisitions could be completed. Unable to obtain the DTI, T1 3-D SPGR, and VenBOLD.Brain MRI:There are foci of T2 hyperintensity without restricted diffusion throughout the white matter, both subcortical and periventricular, as well as within the cerebellar hemispheres. Additionally, there is a small cortical focus of encephalomalacia with gliosis involving the right postcentral gyrus from past ischemia. Small foci of encephalomalacia within the cerebellar hemispheres are consistent with remote small infarcts.The ventricles and sulci are normal in size for age. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA:There is focal loss of flow related signal on the time-of-flight images involving both vertebral arteries (left greater than right) at the level of C1/2, where the vessels have an in-plane of acquisition position. Thus, this may be artifactual due to loss of in-plane flow signal although stenosis cannot be excluded.Otherwise, there is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified.

Output: 1.The patient requested the study be finished before all sequence acquisitions could be completed. Unable to obtain the DTI, T1 3-D SPGR, and VenBOLD.2.Chronic supratentorial and infratentorial ischemia without acute infarction.3.There is focal loss of flow related signal on the time-of-flight images involving both vertebral arteries (left greater than right) at the level of C1/2, where the vessels have an in-plane of acquisition position. Thus, this may be artifactual due to loss of in-plane flow signal although stenosis cannot be excluded.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:1/17/1944)Reason: SAH? Prior SAH/aneurysm, now vomiting/presyncope History: vomitingPROVIDER/ATTENDING NAME: NATHAN S TRUEGER NATHAN S TRUEGER MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images without associated DWI abnormalities.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 demonstrate a minor mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 redemonstration of recanalization at the aneurysm base apparently covered by coils (helmet effect) measuring 1.2 mm.There is asymmetry in the A1 segments right larger than left. The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.

Output: 1.The examination is stable compared to the 6/2014 exam. There is redemonstration of early recanalization into the aneurysm coils at the base of the ACOMA aneurysm by approximately a millimeter.2.Redemonstration and no change of periventricular and subcortical white matter changes of a mild degree are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on findings.

Input: History of left renal spindle cell sarcoma status post nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small splenules with adjacent surgical clip.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy without evidence of recurrent or residual disease in the nephrectomy bed.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: No evidence of recurrent or metastatic disease in the upper abdomen.


Instruction: Generate impression based on findings.

Input: 54-year-old female with history of cervical/uterine neoplasm who presents for evaluation. PELVIS:UTERUS, ADNEXA: There is a T1/T2 heterogeneous mass within the cervix and the uterus with extension into the upper vagina. When compared to the 2/26/2016 MRI examination, there has been interval increase in the heterogeneity of the mass, likely related to radiation treatment. As compared on the sagittal images, there has been interval decrease in the tumor bulk which measures 2.1 x 3.6 (series 401, image 45) on the current examination and previously measuring 8.3 x 3.4 cm. The bulk of the tumor is hypoenhancing making it difficult to demarcate to the uterine portion of the tumor.In the region of the right ovary, there are T1 hyperintense, T2 low to intermediate signal, nonenhancing foci with the largest measuring 3.0 x 3.5 cm (series 801, image 29), previously measuring 3.3 x 3.2 cm (series 9, image 38). The signal characteristics of these 2 foci are not significantly changed compared to the previous examination. BLADDER: No significant abnormality noted.LYMPH NODES: No definite lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval treatment/radiation make difficult to demarcate the cervical/uterine tumor. However, as compared on the sagittal images, there has been significant reduction in the tumor bulk as detailed above.2.In the region of the right adnexa, T1 hyperintense, nonenhancing foci are identified as detailed above. Differential considerations include hemorrhagic cyst versus endometriomas.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: Cancer eval for mets History: Cancer eval for mets Previously seen right precentral gyrus (6mm was 2mm) and at least 3 left cerebellar enhancing lesions are again seen but appear to be more conspicuous and slightly increased in size since prior scan.There is no evidence of new abnormal enhancing lesion on the scan.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. About 5mm sized downward tonsilar displacement through the foramen magnum are again seen, unchanged.The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. More conspicuous and slightly increased in size of right frontal lobe pre central gyrus and left cerebellar hemispheric enhancing nodular lesions since prior scan.2. No new abnormal enhancement is seen.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 22-year-old female with tuberous sclerosis. Evaluate subependymal giant cell astrocytoma. Redemonstrated is a large enhancing mass/giant cell astrocytoma at the left foramen of Monro, which measures 16 x 14 x 17 mm (AP x TR x CC), previously 15 x 14 x 18 mm and 17 x 13 x 16 mm on 5/12/2005. There is no significant interval change in the size and configuration of the ventricles and sulci. Again seen are several small enhancing subependymal nodules, which are unchanged in size. The larger ones at right foramen of Monro measures up to 4 mm and at the level of the right lateral ventricle trigone measures up to 6 mm, which are unchanged. There are also multiple foci of increased T2/FLAIR signal within the cortical and subcortical regions, which are unchanged from the prior study. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Findings are consistent with known tuberous sclerosis with stable subependymal giant cell astrocytoma, subependymal nodules, cortical/subcortical tubers and radial migrational lines. 2. Stable size of the ventricular system without evidence of ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Right lumbar back pain radiating to the foot, not improving with PT. There is an eccentric right disc extrusion at L5-S1 that measures up to 2 cm in the anteroposterior dimension and is associated with compression of the cauda equina nerve roots in the right lateral recess and mild right L5-S1 neural foramen stenosis. There is no significant disc disease involving the other levels of the lumbar spine. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Large eccentric right disc extrusion at L5-S1associated with compression of the adjacent cauda equina nerve roots.


Instruction: Generate impression based on findings.

Input: Anoxic brain injury. History of myoclonus and decrease level of consciousness. Patchy and confluent areas of restricted diffusion are seen within the cortex and white matter of the bilateral cerebral hemispheres, symmetrically involving the posterior frontal and parietal lobes and the corona radiata down to the posterior limbs of the internal capsules. There is also mild restricted diffusion involving the globus pallidi with conspicuous T2 hyperintensity of the globus pallidi and putamina. There is no evidence of intracranial hemorrhage or mass. 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 fluid seen in the bilateral maxillary sinuses with air-fluid levels as well as complete filling of the sphenoid sinuses and near complete filling of the ethmoid sinuses fluid.

Output: 1. Patchy and confluent areas of restricted diffusion and T2 signal abnormality involving the bilateral cerebral hemispheres, including cortex, white matter and deep gray nuclei, compatible with anoxic brain injury.2. Severe paranasal sinus inflammation.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with history of multiple sclerosis, presenting with numbness and weakness. Evaluate for MS FLAIR. Brain:Numerous T2 hyperintense lesions are redemonstrated involving the corpus callosum, the periventricular white matter, the juxtacortical white matter and the cerebellum. Most of these T2 lesions are unchanged in size, but there are new T2 lesions within the left parietal operculum and within the right gyrus rectus, both of which enhance. Many of the pre-existing lesions are also demonstrate new enhancement when compared to prior exams.Brain morphology is otherwise unremarkable. No intracranial hemorrhage or abnormal extra-axial fluid is detected. Ventricular size and morphology are unchanged.Cervical spine:Image quality is degraded by motion artifact. Within this limitation, ill-defined areas of cord T2 hyperintensity are redemonstrated in the upper to mid cervical region without significant interval change. More focal appearing cord lesions from C6 through T1 are new or have progressed when compared to the prior examination. These lesions demonstrate corresponding enhancement. Mild left lateral cord enhancement is also seen at the C2 level.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. No significant compromise of the spinal canal or neural foramina is noted.Thoracic spine:Image quality is reduced by motion artifact. A few scattered vague areas of cord T2 signal abnormality are seen in thoracic region without significant interval change from the prior examination. Except at the T1 level as discussed above, no additional areas of pathologic cord enhancement are seen in the thoracic region.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. No significant compromise of the spinal canal or neural foramina is noted.

Output: 1.Findings are seen compatible with a multiple sclerosis FLAIR in the brain. This includes the presence of lesions which are new from the prior exam, and new enhancement within pre-existing lesions.2.New lesions are also evident within the spinal cord, most notably at the cervicothoracic junction.


Instruction: Generate impression based on findings.

Input: There is reversal of normal cervical lordosis with smooth kyphosis with apex at C5. There are no fractures or subluxations. Vertebral body heights are maintained. Degenerative changes are noted from C2-C3 through C6-C7. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: There is mild bilateral neural foraminal narrowing. There is no significant spinal canal stenosis.C3/4: There is mild bilateral neural foraminal narrowing. There is a small posterior disk osteophyte complex without significant spinal canal stenosis.C4/5: There is mild bilateral neural foraminal narrowing and posterior disk osteophyte complex. There is no significant spinal canal narrowing.C5/6: There is moderate bilateral neural foraminal narrowing relatively worse on the left related to uncovertebral hypertrophy. Small posterior disk osteophyte complex with mild spinal canal narrowing.C6/7: There is severe bilateral neural foraminal narrowing related to uncovertebral hypertrophy. There is a small posterior disk osteophyte complex with mild spinal canal narrowing.C7/T1: There is mild bilateral neural foraminal narrowing. No significant spinal canal narrowing.

Output: Bilateral neural foraminal narrowing most significant at the C5-6 and C6-C7 levels as detailed above.Mild spinal canal narrowing at C5-C6 and C6-C7 related to kyphotic angulation and small disc osteophyte complexes. No spinal cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Male 38 years old Reason: shoulder dislocations History: shoulder dislocations ROTATOR CUFF: There is interstitial and undersurface tearing of the supraspinatus near its insertion in a sitting of moderate tendinosis.. The tear is less than 50% thickness of the tendon thickness. There is a small subchondral cyst in the greater tubercle measuring 5 mm that communicates with the joint space. There is tendinosis and articular surface fraying of the infraspinatus. The subscapularis and teres minor tendons are intact. No muscle atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There are postsurgical changes from a labral repair. There is chronic tearing of the anterior and inferior glenoid labrum with granulation tissue. Portions of the anterior inferior glenoid are flattened compatible with prior Bankart injury.There are degenerative changes involving the superior labrum.BICEPS TENDON: There is some tendinosis of the intra-articular biceps tendon. ADDITIONAL

Output: 1.Findings of recurrent anterior and inferior labral tearing with chronic granulation tissue. 2.Large Hill-Sachs deformity.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [R40.4], Reason for Study: ^Reason: evaluate for stroke History: R neglect, L gaze, aphasia, R arm drift No evidence of acute ischemic or hemorrhagic lesion on the scan.Mild to moderate brain atrophy with patchy FLAIR high signal intensities on bilateral periventricular white matter and centrum semiovale indicating diffuse bihemispheric nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Mild to moderate brain atrophy with nonspecific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion on scan.


Instruction: Generate impression based on findings.

Input: History of pineal abnormality, comparison. The pineal contains cystic component that measures up to 13 mm is unchanged. This lesion again causes slight flattening of the tectal plate, however the cerebral aqueduct remains patent. The brain parenchyma is unremarkable. The ventricles are normal in size and configuration.

Output: The cystic pineal gland appears unchanged dating back to 3/2/2012.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 50 year-old male with chronic headache, cranial nerve dysfunction, known brain metastases, and intracranial hemorrhage presents with deteriorating mental status. There is interval increase in the size of the left thalamic hematoma to 2.7 x 2.2 x 3.2 cm (AP x TR x CC image 14; series 4) from 2.4 x 2.1 x 2.3 cm. This enlargement extends the hematoma further into the midbrain. There is probably also some increase in the amount of vasogenic edema in the surrounding area even allowing for technique differences: Edema and hematoma measure together 4.1 cm in diameter (15; series 4) compared to 3.5 cm on February 20. There is associated distortion and rightward displacement of the third ventricle which is stable. However, there has been slight interval enlargement of the lateral ventricles bilaterally. The temporal horn of the left lateral ventricle measures 9 mm, previously 6 mm. There is interval narrowing of the basal cisterns without evidence of frank brain herniation. There is no evidence of extra-axial fluid collection. Multiple mass lesions within the cerebral hemispheres are noted, some of them hyperdense consistent with petechial hemorrhage or mineralization. Findings are consistent with known metastatic lesions and appear grossly stable. The area of dominant left frontal lobe and right cerebellar hypoattenuation also appear grossly similar to the recent brain MRI. No new parenchymal lesions or hematomas are noted. However, MRI would be more sensitive if status of metastatic disease is of particular concern.The visualized mastoid air cells and paranasal sinuses are clear. The visualized orbits are unremarkable.

Output: 1. Interval enlargement of left thalamic hematoma with further extension into the midbrain. Additionally, there is probably an interval increase in the amount of vasogenic edema in the surrounding area. Although there is stable distortion of the third ventricle (rightward shift of 4mm), the lateral ventricles have enlarged slightly and there is slightly greater basal cistern narrowing compared to the prior study. Still no frank brain herniation. 2. Redemonstration of multiple metastatic intraparenchymal brain lesions better visualized on recent MRI examination. No evidence of new parenchymal lesions or sites of hemorrhage. Findings discussed with Dr. Bergl via direct phone call at the time of dictation 5:05 pm 2/22/12.


Instruction: Generate impression based on findings.

Input: Sacral decubitus ulcer The exam is markedly limited by extensive motion artifact, a lack of intravenous gadolinium, and the patient's body habitus.A large decubitus ulcer is seen posterior to the right gluteus maximus muscle with extension to the gluteal cleft. Abnormal signal intensity extends from the ulcer through the subcutaneous fat to the rectum. This abnormal signal intensity may reflect edema and/or scarring but we see no focal fluid collection to suggest abscess in this area.There is no abnormal marrow signal intensity of the sacrum to suggest osteomyelitis. The marrow signal intensity of the upper coccyx also appears normal on T1 sequences arguing against active osteomyelitis. More distally, the coccyx is not seen which may be secondary to chronic erosion from long-standing infection. The bone marrow of the remaining pelvis and proximal femora is unremarkable.There is severe degenerative disc disease of the lower lumbar spine with disc protrusion of L4-L5 and anterolisthesis of L4. There is diffuse subcutaneous edema with combined atrophy and edema of much of the visualized pelvic musculature which is nonspecific in nature. A Foley catheter is noted. There is osteoarthritis of the hips but there are no large hip joint effusions.

Output: Markedly limited exam demonstrates large decubitus ulceration overlying the right gluteus maximus muscle. We see no abnormal signal intensity within the sacrum or proximal coccyx to suggest active osteomyelitis. The lower coccyx is not seen which may reflect chronic erosion from long-standing infection.


Instruction: Generate impression based on findings.

Input: Squamous cell carcinoma of the left base of tongue, T1N2b. There are recent postoperative findings in the left oropharynx, with what may represent residual tumor or edematous tissue in the left tongue base that measures up to approximately 10 mm, and interval left tonsillectomy. There is persistent left level 2 lymphadenopathy, measuring up to 16 x 19 mm in axial cross-section. There is also a mildly prominent right level 2A lymph node, which measures 10 x 11 mm. There is herniation of the left sublingual gland through a mylohyoid defect. The other salivary glands are unremarkable. There is scattered paranasal sinus mucosal thickening. There is mild multilevel degenerative cervical spondylosis. The orbits and imaged intracranial structures are grossly unremarkable.

Output: Postoperative findings in the left oropharynx, with what may represent residual tumor or edematous tissue in the left tongue base that measures up to approximately 10 mm, as well as persistent associated cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 33-year-old female with recent C-section delivery with fetal demise. Patient with hepatic lesions who presents for MRI evaluation. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense, T1 hypointense lesions within the right and left lobes demonstrating peripheral nodular discontiguous enhancement. The largest in the right hepatic lobe measures 11 x 14 cm (series 1001, image 401). Findings compatible with hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple hepatic hemangiomas with the largest measuring 14 cm in the right hepatic lobe.


Instruction: Generate impression based on findings.

Input: Evaluate for gallbladder pathology. Elevated LFTs. Several imaging sequences are severely limited by respiratory motion.ABDOMEN:LIVER, BILIARY TRACT: Hepatic morphology suggestive of cirrhosis including left lobar hypertrophy and lobular contour. Enlarged hepatic veins likely related to elevated right-sided heart pressures.The clinical service the patient has a history of cardiac cirrhosis.No focal liver lesion is identified.The MRCP images are nondiagnostic. No intrahepatic biliary ductal dilatation. The common bile duct is somewhat poorly visualized but appears normal in caliber. No filling defect is seen but cannot be entirely excluded.Normally distended gallbladder without evidence of acute cholecystitis or gallstones.The portal vein appears patent.Stigmata of portal hypertension including perihepatic ascites and para esophageal varices.SPLEEN: Borderline slightly measuring 13 cm in the craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Limited evaluation of the bowel is unremarkable.BONES, SOFT TISSUES: Anasarca.OTHER: Large pericardial effusion. Right hilar and apical consolidation/mass, better evaluated on prior chest CT.

Output: 1.Limited examination as discussed above without biliary ductal dilatation or specific findings of cholangitis. Evaluation for a small filling defect is limited.2.Cirrhotic liver morphology with findings of portal hypertension.3.Large pericardial effusion. Cardiomegaly.4.Right hilar and apical lung mass is better characterized on recent CT.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Assess for disease progression. Both, the current and the previous examinations are limited by patient motion which limits comparison and detect small lesions.CERVICAL SPINE:Note lesions in the spinal cord are more conspicuous on the proton density sequence as the other sequences are more motion degraded.The posteriorly located midline T2-hyperintense lesion in the upper cervical spinal cord, at C2 level, is smaller than it was previously with resolution of the associated edema and mild cord expansion, consistent with evolution. Of note, the lesion was previously contrast-enhancing.A smaller midline posterior lesion at the upper C4 level remains unchanged since the prior examination.There is an additional small, more anteriorly located at midline lesion at C1, which is unchanged.Overall volume of the cervical spinal cord is preserved. The included brainstem and posterior fossa structures are unremarkable.There is mild multilevel degenerative cervical spondylosis manifested by shallow ventral indentations of the thecal sac by degenerative disc-osteophyte complexes at C4-C5, C5-C6 and C6-C7. There is no significant spinal canal stenosis, however. There is mild left C3-C4 and C4-C5 neural foraminal stenosis.THORACIC SPINE:There is a posteriorly located lesion at midline at T9-T10 level, which is unchanged. A more centrally located lesion at T6-T7 is also unchanged. A small left posterior-lateral lesion at the upper T4 level is difficult to reproduce on the prior examination but this may relate to the small size of the lesion.Otherwise, alignment is anatomic. The vertebral bodies are preserved in height. There is no suspicious marrow lesion. There is a small ventral indentation of the thecal sac by the T11-T12 disc associated with spinal canal narrowing. There is also significant neural foraminal stenosis.A small T2-hyperintense lesion in the right kidney is not completely assessed but may represent a cyst.

Output: Current and prior outside examinations are significantly motion degraded. A few cervical and thoracic spinal cord lesions are not significantly changed since the prior examination. The largest lesion, at C2 level, shows resolution of the associated mild edema and cord expansion since the prior examination in 2011, when the lesion was contrast-enhancing, which is consistent with evolution. A small lesion at the upper T4 level cannot be discerned on the previous examination but this may relate to its small size. There is no clear evidence of interval progression of demyelinating disease in the cord.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 60 year old with history of hypertension, coronary artery disease s/p CABG, aortic pseudoaneurysm s/p repair. MEDICATIONS: coumadin, lisinopril, furosemide, atorvastatin, and metoprolol First Pass PerfusionDuring hyperemia, there are perfusion abnormalities in the basal and mid anterior, anteroseptum, inferoseptal, and inferior walls; and in the apical inferior wall. Viability/ Myocardial ScarThere is a transmural (>50%) late gadolinium enhancement noted involving much of the inferior wall in a pattern consistent with prior myocardial infarction. This area of infarction is unlikely to be viable, however remaining myocardium is viable. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. There is left ventricular hypertrophy that is asymmetric (ventricular septum 14 mm, posterior wall 11mm) The overall LV ejection fraction is 46%, the LV end diastolic volume index is 121 ml/m2 (normal range: 74+/-15), the LVEDV is 256 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 139 ml (normal range 47+/-19), the LV mass index is 89 g/m2, and the LV mass is 189 g. There is severe hypokinesis of the mid-basal inferior and inferoseptal walls. The remaining wall motion appears normal. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 111 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is at least moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. Beyond the sinus of Valsalva the ascending aorta is poorly seen due to artifact. Pulmonary VeinsThe right sided pulmonary veins drain normally into the left atrium. The left upper pulmonary vein drains normally into the left atrium and the left inferior pulmonary vein is not clearly seen due to artifact. Pulmonary ArteryThe pulmonary artery and its proximal branches are obscured by artifact. Venous AnatomyThe SVC and IVC drain normally into the right atrium. The IVC appears to be enlarged. PericardiumThere is no obvious pericardial disease. The previously noted abscess is no longer present.Extracardiac FindingsThere appears to be mesenteric fat extending into the superior portion of the mediastinum through a ventral diaphragmatic hernia. There are sternal wires present. There is metallic artifact in the ascending aorta obscuring the PA and the entire ascending aorta consistent with patient's dissection repair with multiple occluder devices. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There are 2 ischemic territories. The perfusion defect in the right coronary artery territory is secondary to an inferior wall transmural myocardial infarction and the territory is not likely to be viable. The 2nd defect involves much of the LAD territory and is likely to be viable. 2. Moderately dilated LV with mildly reduced systolic function (LVEF 46%) with severe hypokinesis of the basal to mid inferior and inferoseptal walls.3. Normal RV size with mildly reduced systolic function (RVEF 41%).4. At least moderate aortic insufficiency. 5. See extra-cardiac findings.When compared to the prior study from 7/20/2010, the pericardial abscess is no longer present.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of left ILC status post mastectomy. There is scattered fibroglandular tissue in the right breast. The patient is status post left mastectomy. Minimal parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the right breast. No abnormal chest wall enhancement on the left.No abnormal lymph nodes are identified in either axillary region. Scarring is the left axilla likely relates to prior surgery. Right chest wall Port-a-cath is noted.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of brain [D49.6] / Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: eval for CVA, worsening mental status History: worsening mental status Post gadolinium contrast portion of the exam was performed.Again irregular shaped cerebellar lesion resection cavity is seen with the surrounding ill-defined enhancing areas.Especially surrounding enhancing areas appear to be increasing in its extent especially right anterior and left posterior aspect of the resection cavity compared to prior scan.The ventricles, sulci and cisterns are unremarkable. There is no other abnormal contrast enhancement.

Output: 1. Interval increase in extent of the peri-resection cavity enhancing lesions comparing to prior scan performed on August 24, 2016.2. No other abnormal enhancing lesion is seen.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:11/25/1952)Reason: eval brain mass, preop History: eval brain mass preopPROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE The examination is degraded by patient motion.Patient is status post prior craniotomy for brain tumor removal. There are several subcentimeter nodular foci enhancement present at the margins of the tumor resection site at the right parietal lobe and in the involved periventricular white matter on the right side. There is ill-defined T1 hypointensity present in the right parietal lobe and medial temporal lobe. There is associated mass effect with effacement of the trigone of the right lateral ventricle and effacement of the right parietal lobe sulci. Tumor resection cavity is present in the right parietal lobe.

Output: Exam is markedly degraded due to patient motion. The patient is status post resection for right parietal lobe tumor. There is an infiltrating mass present at the right parietal lobe tumor resection site adjacent to the right lateral ventricle extending to the right medial temporal lobe. This is suspicious for tumor recurrence. An alphanumeric page was sent to Dr. Warnke at the time of this exam interpretation.


Instruction: Generate impression based on findings.

Input: Suspected CC fistula History: blood in Schlemm's canal, evidence of elevated episcleral venous pressure, and pulsatile tinnitus. Brain MRI: The cavernous sinuses are unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst. There is also an adenoidal retention cyst. There is a mildly prominent right retropharyngeal lymph node that measures 6 mm in short axis. There is a nasal septal defect. Brain MRA: There is an anomalous origin of the right opthalmic artery from the right middle meningeal artery. Otherwise, there is no evidence of significant steno-occlusive lesions, arteriovenous malformations, or cerebral aneurysms.Orbit MRI: There is mild prominence of the bilateral superior opthalmic veins. Intraocular hemorrhage cannot be resolved on this exam. The ocular adnexa appear to be intact bilaterally. There is no evidence of intraorbital mas or abnormal enhancement.

Output: 1. Nonspecific mild prominence of the bilateral superior opthalmic veins without discernible evidence of a large dural atriovenous fistula, although MRA has limited sensitivity for arteriovenous fistulas. 2. Intraocular hemorrhage cannot be resolved on this exam, but there is no evidence of intraorbital mass lesions. 3. Mildly prominent right retropharyngeal lymph node, which is nonspecific. Perhaps dedicated neck imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: There has been no significant interval change in the abnormal fatty bone marrow and endplate irregularity involving the L4 and L5 vertebrae related to previous discitis-osteomyelitis. Likewise, the there is persistent mild loss of vertebral body height at L4 and L5. Enhancement involving the right L3-L4 foramen and posterior to the right L3-L4 facet extending along the spinous process is unchanged, but there is no discrete abnormal signal or pathological enhancement within the facet joint. Degenerative spondylosis at L4-L5 and L5-S1 appears similar as before, with mild to moderate narrowing of the lower lumbar neural foramina, except for moderate severe narrowing of the left L5-S1 foramen, with nerve root impingement. There is no significant central spinal canal stenosis. There is redemonstration irregularity and abnormal marrow signal within the left sacrum and iliac bone, with predominantly fatty marrow characteristics. There is again significant irregularity of the left sacroiliac joint consistent with prior sacroiliitis. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The distal spinal cord appears unremarkable.

Output: 1. Redemonstration of sequela of prior discitis-osteomyelitis at L4-L5 with vertebral body height loss and endplate irregularity, but no evidence of epidural abscess. 2. Degenerative spondylosis in the lower lumbar spine with left neural foraminal narrowing and nerve root impingement at L5-S1. In addition, persistent mild enhancement along the posterior aspect of the right L3-L4 facet may be be degenerative in nature.3. Redemonstration of sequela of previous left sacroiliitis.


Instruction: Generate impression based on findings.

Input: 47 year old male with metastatic squamous cell carcinoma in October 2014 (to brain, lung, liver and bones) s/p 6 cycles of Cisplatin/Docetaxel, resection of right temporal brain metastasis on 5/20/15, and adjuvant SRS on 6/9/15. Back pain. The study is limited by patient motion. Five lumbar type vertebral bodies are presumed to be present. Lumbar spine alignment is near anatomic. There is diffuse low T1 signal involving the L3 vertebral body with involvement of the left pedicle, and diffuse enhancement consistent with metastasis. Posterior elements are otherwise intact. There is a Schmorl's node along the superior endplate of L3 vertebral body, without significant overall loss of vertebral body height at L3 or elsewhere in the lumbar spine.There is a subcentimeter T1 hypointensity, with questionable enhancement along the anterior aspect of S1 vertebral body, which is nonspecific but may represent additional metastasis. There is a 13 mm T1 hypointensity in the left iliac bone with minimal enhancement also concerning for metastasis.No evidence of epidural tumor or leptomeningeal enhancement. There is evidence of multilevel disc desiccation. The disc space heights are maintained. The distal spinal cord and the conus medullaris is normal in position and shows normal signal intensity.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disc protrusion with mild spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: There is minimal disc bulge with small annular fissure, resulting in mild right neural foraminal narrowing. No left neural foraminal narrowing. There is mild spinal canal stenosis.L4-L5: There is disc bulge with indentation of the anterior thecal sac. There is mild facet arthropathy, ligamentum flavum thickening and epidural lipomatosis also contribution to mild to moderate spinal canal stenosis. No significant neural foraminal stenosis. L5-S1: There is minimal disc bulge. No significant spinal canal or neural foraminal stenosis. There is mild facet arthropathy and ligament flavum thickening.Paraspinous soft tissues are within normal limits.

Output: 1. Metastatic lesion involving L3 vertebral body extending into the left pedicle. Additional 13 mm lesion involving left iliac bone and a subcentimeter focus along the S1 vertebral body are more nonspecific, but may represent additional metastases. Bone scan may be considered to assess the overall burden of metastases if clinically indicated. No evidence of epidural tumor, pathologic compression fractures, or leptomeningeal disease.2. Multilevel degenerative changes as described above with mild-to-moderate spinal canal stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: Metastatic urothelial cancer. Lumbar metastatic disease. Evaluate for disease in cervical spine. Prior study from 7/7/2015 was severely motion degraded. Cervical spine: Examination of the cervical spine is mildly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is straightening of the cervical spine, alignment is otherwise maintained. The cervical spinal cord has normal signal characteristics and overall morphology. Bone marrow signal appears within normal limits. No suspicious lesions to suggest metastatic disease are appreciated.Cervical spinal canal appears congenitally narrow with superimposed mild degenerative changes including mild disc bulges at C3-C4, C5-C6, and C6-C7. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild spinal canal narrowing with effacement of the ventral and dorsal thecal sac. No significant neural foraminal stenosis.C4-5: Mild spinal canal narrowing with effacement of the ventral and dorsal thecal sac. No significant neural foraminal stenosis.C5-6: Mild spinal canal narrowing with effacement of the ventral and dorsal thecal sac. No significant neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or left neural foramina. Mild right-sided neural foraminal narrowing related to eccentric disc bulge.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Thoracic spine:There is heterogeneous bone marrow signal abnormality involving the T12 vertebral body likely representing metastatic disease. Motion degradation limits evaluation for small lesions; within this limitation, no additional osseous within the remainder of the thoracic spine are appreciated.There is enhancing epidural tumor extending superiorly from the upper T11 level and extending inferiorly into the upper lumbar spine. Epidural tumor predominantly involve the right lateral aspect of the spinal canal with significant mass effect on the thoracic cord at the T11 and T12 levels. Examination is suboptimal for evaluation of cord signal however no definite cord signal abnormality is appreciated. There is severe narrowing with tumor filling the right T11-T12 and T12-L1 neural foramina due to tumor.Vertebral body heights and alignment are maintained. No significant spinal canal narrowing in the remainder of the thoracic spine is appreciated.Please refer to recent CT for findings of extensive metastatic disease in the chest and abdomen.

Output: 1. Please note motion degradation limits evaluation for small lesions. Metastatic osseous lesion involving the T12 vertebral body is again seen. No suspicious lesions within the cervical spine or the remainder of the thoracic spine are appreciated. No pathologic fractures.2. Epidural tumor involving the right lateral aspect of the spinal canal with severe spinal canal stenosis and mass effect on the cord at the T11 and T12 levels. Tumor is also noted to fill the right T11-T12 and T12-L1 neural foramina.3. Mild degenerative changes in the cervical spine with mild spinal canal stenosis, as detailed above.4. Please refer to separate CT report for findings of extensive metastatic disease in the chest, abdomen, and pelvis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cord compression. Signs and symptoms: Back pain, weakness. Nonenhanced complete spine MRI:Examination is performed utilizing cord compression protocol which is a limited exam.There is no normal signal intensity and caliber of cervical and thoracic cord without detectable mass effect on the cord.The signal intensity in the alignment of vertebral column is unremarkable.Mild degenerative changes of discs and the posterior elements of the cervical spine results in mild central spinal stenosis. Note should be made that there are no axial images for more precise assessment.There is no detectable perispinal soft tissue abnormality.

Output: No evidence of cord compression.


Instruction: Generate impression based on findings.

Input: History of pancreatic mass now with pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. Single punctate focus of increased T2 signal in the right lobe of the liver is likely a benign cyst.Status post cholecystectomy with associated minimal prominence of the intrahepatic and extrahepatic bile ducts. The common bile duct measures 9 mm in diameter.The splenic vein is poorly visualized and presumed thrombosed. The remaining hepatic vascular structures are patent.SPLEEN: No significant abnormality noted.PANCREAS: There is marked atrophy of the pancreas. The main duct is nondilated. There are 2 cystic foci in the distal body and tail measuring 7 mm in maximum diameter (series 901 image 24) that do not enhance. These may represent small side branch type IPMNs or residual dilated side branch ducts related to chronic pancreatitis.There is redemonstration of the soft tissue nodule in the pancreatic head which has mildly increased T1 signal and low T2 signal, but does not demonstrate enhancement or restricted diffusion. While this may represent a residual island of pancreatic tissue, an islet cell cannot be excluded.ADRENAL GLANDS: Subtle nodularity of the left adrenal gland is too small to characterize.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered normally sized retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes are noted in the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Soft tissue nodule in the region of the pancreatic head as described. While this may represent a residual island of pancreatic tissue, an islet cell cannot be excluded. EUS and biopsy may be useful for further characterization.2.2, 7 mm cystic foci in the pancreas may represent residual dilated side branch ducts or side branch type IPMNs.3.No pancreatic ductal or biliary ductal abnormality.


Instruction: Generate impression based on findings.

Input: 49-year-old female with history of multiple PEs/DVTs. Noted to have right lower lobe nodule on MRI/M.R.C.P. Remainder of the requisition is illegible. CHEST:LUNGS AND PLEURA: In the left lung base there are multiple focal areas of groundglass opacity. The largest area measures 8 mm in greatest dimension. Additionally there is scarring at the left lung base. While these may represent post inflammatory changes, 6 month follow up is recommended for further evaluation. This may necessitate long-term follow-up if there is no resolution of the 6 months. No abnormality is seen at the right lung base. This may have represented atelectasis on the recent MRI.MEDIASTINUM AND HILA: There is a small hiatal hernia. No other abnormalities noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted. Cholecystostomy clips are present in the right upper quadrant.

Output: 1. Ground glass nodules in the left lung base for which further follow-up is recommended.2. No right lower lung nodule as seen on the recent MR. The abnormality seen in the right lung base may have represented atelectasis.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with left frontal meningioma and right pons lesions. A 9 x 7 mm extra-axial enhancing nodule along the paramedian left frontal lobe shows no significant interval change. This lesion results in minimal indentation of the adjacent parenchyma without evidence of parenchymal edema.As on the prior examination, and ill-defined blush of enhancement is seen within the lower right pons with subtle associated FLAIR hyperintensity and susceptibility. The appearance of this lesion has not significantly changed from prior.No new enhancing lesions are detected. A few scattered small foci of white matter T2 hyperintensity are nonspecific and unchanged. No parenchymal edema is detected. No abnormal extra-axial collections are seen. The ventricles are normal in size and morphology.

Output: 1.Stable presumed left frontal meningioma.2.Stable subtly enhancing lesion in the right pons which may represent a capillary telangiectasia or other vascular anomaly.


Instruction: Generate impression based on findings.

Input: Young man with NF1 and odd tumor of the right calf. Please define borders of tumor on right calf. It is purely superficial. There is a mass within the subcutaneous fat of the leg situated medial to the proximal tibial diaphysis. It is approximately 4.7 x 4.2 cm in transverse dimension and approximately 8.1 cm in craniocaudal dimension. I suspect that it abuts the peripheral deep fascia, however there is no invasion of the underlying musculature. The mass is homogeneously isointense to skeletal muscle on T1-weighted images. It is predominantly of increased signal intensity on T2-weighted images with relatively ow signal intensity foci centrally within the mass - findings are that are compatible with a nerve sheath tumor.A mass of similar signal intensity characteristics is noted between the medial and lateral heads of the gastrocnemius posterior to the distal femur; however it is not included in its entirety on the field-of-view of this tibia/fibula study. Several additional smaller cutaneous/subcutaneous foci of signal abnormality are noted presumably representing additional nerve sheath tumors. A string of nerve sheath tumors is noted adjacent to the proximal fibula extending into the peroneal musculature. A few small nerve sheath tumors are also noted affecting the left leg as seen on the large field-of-view images.

Output: Nerve sheath tumors as described above.


Instruction: Generate impression based on findings.

Input: AIH with cirrhosis, OLT evaluation ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Discrete hepatic segment 3 lesion measuring 2.1 x 1.8 cm (image 317 series 1006/image 317 series 1002), demonstrating apparent mild internal enhancement (however, evaluation suboptimal due to the later timing of the IV contrast bolus in sequence labeled arterial phase) with possible mild washout on subsequent delayed imaging, no corresponding restricted diffusion delineated. Signal drop out seen on opposed phase sequence, suggesting intravoxel fat within lesion. Lesion is mildly T1 hyperintense and T2 hypointense. Status post cholecystectomy. Patent portal veins, hepatic veins and hepatic arteries. Patent splenic vein and SMV. Dilatation of IVC, nonspecific, may be seen in setting of underlying heart failure. Incidentally visualized retroaortic left renal vein. Multiple upper abdominal varices. Moderate ascites.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.BOWEL, MESENTERY: Thickening of colon particularly on the right suggested, may reflect underlying portal colopathy, generalized bowel wall thickening may also be seen in setting of hypoalbuminemia and ascites.BONES, SOFT TISSUES: Susceptibility artifact from postsurgical material in ventral abdominal wall.OTHER: Basilar atelectasis, small pleural effusions.

Output: 1. Cirrhotic liver with discrete hepatic segment 3 lesion as described, lesion does not meet the strict criteria for an HCC, imaging characteristics are suggestive of a dysplastic nodule. Tissue sampling suggested for more definitive characterization.2. Stigmata of hepatic cirrhosis and portal hypertension as above, including splenomegaly, variceal formation and diffuse bowel thickening. Thickening of colon particularly on the right suggested, may reflect underlying portal colopathy, generalized bowel wall thickening may also be seen in setting of hypoalbuminemia and ascites. Please note that thickening seen in region of patient's neoterminal ileum on prior CT imaging not well assessed on current exam.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with new right lower extremity weakness. Assess for etiology. A subcentimeter focus of diffusion restriction is seen within the left corona radiata immediately adjacent to the body of the left lateral ventricle. Correlating ADC abnormality has nearly resolved. This lesion is associated with corresponding T2 hyperintensity. Also noted is T2 hyperintensity just below within the posterior limb of the left internal capsule.Numerous patchy areas of T2 hyperintensity are seen within the periventricular white matter bilaterally. No significant parenchymal edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles and sulci are mildly prominent compatible with underlying parenchymal volume loss.

Output: 1.Small area of ischemia within the left corona radiata, likely late subacute, potentially affecting the left corticospinal tract. No significant associated edema or hemorrhage is detected. Findings were discussed with Dr. Hong at approximately 3:00 PM on 10/26/2015.2.Evidence of moderately extensive chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 53 years, Male, right facial pain and lip numbness. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is prominent susceptibility effect and T1 shortening indicating mineralization involving the bilateral thalami and to a lesser extent basal ganglia, primarily involving the globi pallidi. There is also mild T1 hypointensity and T2 hyperintensity involving the globi pallidi. No significant brain parenchymal signal abnormalities are otherwise appreciated.There is no abnormal parenchymal or meningeal enhancement. No abnormal cranial nerve enhancement. There is contact of the right superior cerebellar artery with the trigeminal nerve in the anterior cisternal segment and along the posterior aspect of the right Meckel's cave. No lesions within the brainstem are appreciated.There is minimal scattered paranasal sinus opacification. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Prominent mineralization/calcification of the bilateral thalami and to a lesser degree basal ganglia which is nonspecific and can be seen with a variety of acquired and inherited metabolic disorders as well as toxic injuries.2. There is contact of the right superior cerebellar artery with the proximal right trigeminal nerve. Otherwise no masses or lesions within the brainstem or visualized course of the trigeminal nerves are appreciated. Remainder of the brain parenchyma is also unremarkable.


Instruction: Generate impression based on findings.

Input: Left parapharyngeal space mass. The dominant left deep parotid cystic lesion has decreased in size, measuring up to 10 mm, previously 16 mm. There is diffuse background of subcentimeter cystic nodularity within the bilateral parotid and submandibular glands. There is no significant cervical lymphadenopathy. The parapharyngeal, retropharyngeal, and paravertebral spaces are intact. The thyroid gland is grossly unremarkable. There is a small right sphenoid sinuses retention cyst. The imaged intracranial structures and orbits are unremarkable. There is multilevel degenerative cervical spondylosis.

Output: Multiple cystic lesion in the bilateral parotid and submandibular glands, including a dominant deep left parotid lesion, which has decreased in size. These findings may be related to Sjogren disease.


Instruction: Generate impression based on findings.

Input: Female, 21 years old, with diplopia and headaches. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of enhancement is within normal limits.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. There may be a small incidental choroidal fissure cyst on the right. The cerebellar tonsils terminate at the level of the foramen magnum but maintain a normal round contour.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected. The odontoid process is mildly retroflexed and there seems to be a slight anterior shift of C2 relative to C3, findings which likely reflect normal variation.

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


Instruction: Generate impression based on findings.

Input: Reason: Left hip pain for several months, evaluate for labral tear, PLEASE INJECT WITH KENALOG 40MG AT TIME OF ARTHROGRAM History: LEFT HIP PAIN Metallic susceptibility artifact from the patient's right total hip arthroplasty device limits evaluation of the right hip and right hemipelvis on the large field-of-view images.ACETABULAR LABRUM: There is linear increased signal abnormality traversing the anterior superior acetabular labrum at the 2 o'clock position indicating a tear, best seen on the direct sagittal sequence series 801 image 20.ARTICULAR CARTILAGE AND BONE: Heterogeneous bone marrow signal abnormality likely residual islands of red marrow. There is articular cartilage degeneration along the superior aspect of the acetabulum with underlying subchondral cysts formation and subchondral signal abnormality. No CAM deformity is identified. The alpha angle measures 53 degrees, within normal limits. There is no evidence of cranial acetabular retroversion.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance ADDITIONAL

Output: Osteoarthritis of the left hip and tearing of the anterior superior acetabular labrum as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: rule out. Signs and symptoms: Astrocytoma with increased weakness. Unenhanced CT of brain:Examination demonstrates no evidence of hemorrhage.Lesion isointense with cortex involving the left basal ganglia and periventricular white matter of left hemisphere measures approximately 33 x 22.5-mm in transaxial dimensions. There is no evidence of surrounding edema or any associated mass effect with this finding. Considering provided clinical date out of astrocytoma this finding could represent tumor. There are no old studies and follow-up with an MRI is recommended. There is no evidence of hemorrhage, edema, significant mass effect or midline shift or hydrocephalus. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial findings.2.Isodense mass in the left hemispheric white matter which may represent patient's known astrocytoma. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 47-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.9 x 5 x 4.8 cm.Peripheral Zone: Mild heterogeneous T2 signal in the right mid gland may reflect an area of prior inflammation or correlate with biopsy proven PIN. However, no dominant focal lesion is evident.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No dominant focal lesion is evident.


Instruction: Generate impression based on findings.

Input: Clinical question: Left chest pain around T10. Signs and symptoms: As above. Nonenhanced thoracic MRI:There is normal anatomical alignment of vertebral column and the normal signal intensity on all MRI sequences.T1-T2 is unremarkable.T2-T3 is unremarkable.T3-T4 demonstrate mild disc disease and loss of disc height without spinal stenosis or neural foraminal compromise.T4-T5 demonstrate no spinal stenosis or neural foraminal compromise. Very subtle compression deformity of superior endplate of T5 without associated marrow signal changes could be an anatomical variation or a remote mild compression fracture.T5-T6 demonstrate mild degenerative disease without spinal stenosis or neural foraminal compromise. Very subtle flattening of the superior endplate of T6 without associated marrow signal changes is of questionable clinical significance.T6-T7 demonstrate minimal degenerative changes and unremarkable otherwise.T7-T8 demonstrate mild degenerative changes without spinal stenosis however mild left neural foraminal compromise is detected questionable clinical significance.T8-T9 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.T9-T10 demonstrate mild degenerative disc disease and mild facet/ligamentum flavum hypertrophy. There is a tiny central disc protrusion which is best appreciated on axial T2 series 7 image 31. The finding minimally effaces the ventral subarachnoid space however without mass effect on the cord or central spinal stenosis. Mild left neural foraminal compromise secondary to degenerative disease however is detected (sagittal T2 series 5 image 12).T10-T11 demonstrate mild degenerative disease without spinal stenosis. Mild bilateral neural foraminal compromise (left greater than right) however is noted (sagittal T2 series 500 images 11 and 12 on the right and image 6 on the left). There is however no detectable mass effect on the exiting nerve root on either side.T11-T12 and T12-L1 levels are unremarkable.The signal intensity and caliber of the thoracic cord is unremarkable.Perispinal soft tissues are unremarkable.

Output: 1.Very mild degenerative changes of the thoracic spine are noted without evidence of central spinal stenosis at any level.2.Mild neural foraminal compromise without mass effect on the nerve roots at T7-T8 through T10-T11 levels are noted as detailed above.3.Normal caliber and signal intensity of the cord.4.Unremarkable paraspinal soft tissues.


Instruction: Generate impression based on findings.

Input: 59-year-old female with left knee pain. Intra-articular loose body is noted within the posterior aspect of the left knee joint as seen on prior MRI. No joint effusion is evident. Cortical depression along the anterior lateral femoral condyle appearing similar to prior MRI.Mild to moderate osteoarthritis changes affect both knees with medial joint space narrowing and tricompartmental osteophyte formation. No acute fracture or malalignment is evident.

Output: 1. Mild to moderate osteoarthritis with no acute fracture or malalignment.2. Intra-articular loose body within the left knee joint as well as a lateral femoral notch sign similar to prior MRI.


Instruction: Generate impression based on findings.

Input: Right knee pain Due to the patient's body habitus the knee would not fit into the conventional knee coil. A large torso coil was used instead, resulting in suboptimal image quality.MENISCI: Best seen on the coronal image 13 of series 1301 is abnormal signal intensity within the undersurface fibers of the body of the medial meniscus indicating an undersurface tear. Furthermore, there is low signal intensity within the medial gutter adjacent to the inferior aspect of the body of the medial meniscus that we suspect reflects a flipped meniscal fragment. There is additional intrasubstance degeneration within the posterior horn of the medial meniscus. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The evaluation of the articular cartilage is limited. Subjectively, there is moderate to severe thinning of the articular cartilage of the weightbearing portion of the medial tibiofemoral compartment. The lateral compartment articular cartilage appears relatively intact. There is a full-thickness cleft extending through the articular cartilage of the median eminence of the patella. Tricompartmental osteophytes are noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Limited study as described above.2. Medial meniscal tear with probable flipped fragment into the medial gutter.3. Cartilage degeneration most severely affecting the medial compartment.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are scattered foci of T2 hyperintensity within subcortical white matter without associated mass effect, restricted diffusion, or susceptibility abnormality. There is no similar appearing foci within the posterior fossa. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Note is made of falcine calcifications.Cervical spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Right facet hypertrophy encroaches the right neural foramen however without significant resulting stenosis.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and mild bilateral facet hypertrophy. There are no significant stenoses.C4/5: Posterior osteophyte disc complex causes anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and mild bilateral facet hypertrophy. There is no significant central stenosis, however there is mild bilateral neural foraminal stenosis.C5/6: UnremarkableC6/7: Mild bilateral uncinate hypertrophy and slight ligamentum flavum thickening. There are no significant stenoses.C7/T1: There is lateral left facet hypertrophy and mild right facet hypertrophy. There is mild left neural foraminal stenosis.

Output: 1.There are scattered nonspecific foci of T2 hyperintensity within subcortical white matter without associated mass effect, restricted diffusion, or susceptibility abnormality. This MR appearance is most suggestive of small vessel ischemic disease and the differential diagnosis would most likely include migraine sequelae. Given the lack of susceptibility abnormality, residua from previous head trauma is felt to be less likely. Given lesional morphology and location, a myelination is felt to be unlikely.2.C4/5: Posterior osteophyte disc complex causes anterior cord flattening without intrinsic cord signal abnormality. There is also mild bilateral neural foraminal stenosis.3.C7/T1: Mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: questioning bilateral pain History: Bilateral shoulder pain Examination is limited by patient motion artifact.ROTATOR CUFF: There is diffuse mild muscle atrophy, which may be an age-related finding. There is marked atrophy of the supraspinatus muscle, with increased signal within the supraspinatus tendon compatible with tendinopathy. No rotator cuff tear is evident.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Diffuse mild muscle atrophy, and marked atrophy of the supraspinatus muscle, but with no discrete rotator cuff tear evident.2. Moderate osteoarthritis of the acromioclavicular and glenohumeral joints.


Instruction: Generate impression based on findings.

Input: Numbness, tingling. Rule out myelopathy. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis and suggestion of dextrocurvature. Alignment of the cervical spine is otherwise maintained. Bone marrow signal is benign. Examination is motion degraded however no evidence of high-grade spinal canal stenosis at any level is appreciated. The cervical spinal cord also has grossly normal signal characteristics. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal. Mild neural foraminal narrowing bilaterally related to uncovertebral hypertrophyC5-6: Small disc osteophyte complex without significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing. C6-C7: No significant compromise to the spinal canal or neural foramina.C6-7: Small disc osteophyte complex and uncovertebral hypertrophy on the left. No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.Mild nonspecific opacification of the left mastoid air cells which are partially imaged. Thoracic: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. No obvious cord signal abnormality. Post gadolinium images are severely motion degraded.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: Examination is limited to motion degradation. There is however no significant spinal canal stenosis in the cervical spine or thoracic spine. No obvious cord signal abnormality is appreciated. Post gadolinium sequences are particularly degraded but demonstrate no obvious abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: history of metastatic melanoma with multiple brain metastases s/p SRS to L occipital lesion; surveillance exam. Signs and Symptoms: brain mets. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.A right frontal cingulate virus enhancing metastatic lesion measuring at 7.2 x 9.3, 9.9 times mm demonstrates subtle interval increase in size since prior study measurements of 5.4 x 8.4 x 5.9 mm no appreciable surrounding vasogenic edema and with stable nonenhancing cystic-appearing component.A right superior occipital 2.2 mm enhancing metastatic lesion demonstrates subtle interval increase since prior study measurement of approximately 1.7 mm.A left posterior temporal-occipital metastatic lesion measuring at 3.2 x 4 mm demonstrate also subtle interval increased size since prior study measurement of approximately 3.1 x 3.1 mm. There is no surrounding edema or mass effect. No additional new foci of parenchymal or leptomeningeal enhancement since prior exam.Stable cortical sulci, ventricular system and CSF spaces for patient's stated age.A tiny right posterior frontal developmental venous anomaly is again identified and without change since multiple prior exams.A small cyst with very thin rim of enhancement in the pineal cistern remains identical to multiple prior studies.Calvarium and soft tissues of the scalp demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Very minimal interval increased size of multiple supratentorial metastatic lesions as detailed/measurement above. No evidence of new metastatic lesions.3.Stable tiny right posterior frontal developmental venous anomaly and a small cyst of the pineal region.4.Unremarkable calvarium, orbits, mastoid air cells and middle ear cavities.5.Stable mild bilateral (right greater than left chronic maxillary sinus disease and unremarkable other paranasal sinuses.


Instruction: Generate impression based on findings.

Input: History of multiple myeloma with hepatic lesion suspicious for metastatic deposits. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: There is diffusely decreased hepatic and splenic parenchymal signal which is more pronounced on the in phase images compatible with secondary hemachromatosis. The liver is mildly enlarged measuring 18.4 cm in length.There has been interval decrease in size of a mildly T2 bright enhancing lesion within the right hepatic lobe. This now measures 2.0 x 1.8 centimeters (series 3 image 15), previously 4.8 x 3.2 cm.Numerous gallstones. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Diffusely decreased parenchymal signal compatible with iron deposition.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Redemonstration of multiple enlarged abdominal lymph nodes. A porta hepatis lymph node measures 2.8 x 2.3 cm, previously 2.6 x 2.0 cm. A left para-aortic lymph node measures 4.2 x 2.5 cm, previously 3.4 x 2.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No focal osseous lesion. Broad-based umbilical hernia.OTHER: No significant abnormality noted.

Output: 1.Interval decrease in size of enhancing lesion in the right lobe of the liver compatible with a metastatic lesion.2.Stable to minimal increase in intra-abdominal lymphadenopathy.3.Findings compatible with secondary hemachromatosis.


Instruction: Generate impression based on findings.

Input: 52 years Female (DOB:11/25/1963)Reason: recurrent stenosis History: right arm pain numbnessPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG The patient status post anterior corpectomy and fusion, including bone graft with anterior side plate and screw device spanning from C3 through C5 is present. The patient is also status post anterior fusion at C5-6. There is osseous bridging essentially extending from C3 down to C5. There is no evidence of hardware loosening. No fractures are identified in the cervical spine. The patient status post laminectomies at C2, C3, 4 and C5.At C2-3 there is calcification along the posterior longitudinal ligament extending from the body of C3 superiorly, to the level of C2. There is associated effacement of the spinal fluid ventral to the cord, which at least produces moderate spinal stenosis. This lesion has not progressed significantly since the 2014 exam. There is no significant compromise to neural foramina evidentAt C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is endplate osteophyte formation as well as small uncovertebral osteophyte formation associated with disc material and narrowing of the cervical spinal canal. There is effacement of spinal fluid ventral and posterior the spinal cord with mild flattening of the spinal cord at this level resulting in moderate degree of spinal stenosis. There is narrowing of the neural foramina bilaterally with mild to moderate encroachment of the exiting nerve roots within the neural foramina with greater encroachment on the right versus the left side.At C7-T1 there is endplate osteophyte formation associated with some ossification along the posterior longitudinal ligament. There is partial effacement of spinal fluid ventral to the spinal cord at this levelThere is a small syrinx present at the T2-3 level.

Output: 1.There are degenerative changes present cervical spine worse at C6-7 where there is moderate spinal stenosis and mild to moderate encroachment of the exiting nerve roots within the neural foramina bilaterally but worse on the right side relative to the left.2.There is osteophyte formation present at C2-3 with some narrowing of the spinal canal without significant compromise to the spinal cord.3.Status post anterior cervical fusion from C3 through C6 with corpectomy at C3-C5 and laminectomies from C3 through C5.4.Small syrinx at T2-3.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified site of right female breast [C50.911], Reason for Study: ^Reason: DIZZINESS, METASTATIC BREAST CANCER History: ABOVE There is an approximately 1.8 x 1.2 cm enhancing and ill-defined lesion within the medullary space of the right frontal calvarium. There is a suggestion of adjacent dural thickening. The cortical sulci are in proportion to cerebral ventricles. A few scattered foci of T2/FLAIR hyperintensity are demonstrated in the periventricular white matter without restricted diffusion. No midline shift or mass effect is appreciated. No abnormal parenchymal enhancing lesions are identified. There is no diffusion restriction abnormality. No intracranial hemorrhage is identified. The paranasal sinuses are grossly unremarkable.

Output: 1. There is an approximately 1.8 cm x 1.2 enhancing and ill-defined lesion in the right frontal calvarium with possible adjacent dural thickening, suspicious for metastasis.2. A few foci of T2/FLAIR hyperintensity in the periventricular white matter are most likely secondary to mild chronic microvascular ischemic change.


Instruction: Generate impression based on findings.

Input: Female, 49 years old. Reason: thyroid abnormalities noted on CT chest, please evaluate for nodules and characteristics History: history of autoimmune thyroid disease RIGHT LOBE MEASUREMENTS: 2.1 x 3.0 x 6.5 cmLEFT LOBE MEASUREMENTS: 2.0 x 2.5 x 6.1 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Heterogeneous echotexture. 0.2 x 0.4 x 0.2 cm ovoid calcification is noted in the inferior right lobe. A right midpole nodule measures 0.3 x 0.3 x 0 .5 cm, spongiform, without significant internal vascularity.LEFT LOBE: Heterogeneous echotexture. A posterior lower pole nodule measures 0.5 x 0.4 x 0.3 cm, spongiform, without significant internal vascularity.ISTHMUS: Heterogeneous echotexture. No focal lesions.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A right level 2 lymph node measures 0.8 x 0.3 x 1.1 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: Thyromegaly. Bilateral subcentimeter nodularity and dystrophic calcifications as described above. No dominant nodule.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. 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.Note is made of an ovoid focus of T1 and T2 hyperintensity within the posterior elements of C2 which demonstrates signal loss with STIR imaging. This is consistent with a fat containing lesion, most likely either an intraosseous lipoma versus focal fatty deposit.Note is made of T2 hyperintense cystic foci within the bilateral thyroid lobes. Comparison of prior studies would be helpful. If this area has not been imaged previously, dedicated thyroid ultrasound would be recommended.C2/3: UnremarkableC3/4: Uncinate hypertrophy causes mild bilateral neural foraminal stenosis.C4/5: UnremarkableC5/6: A broad-based disc herniation causes anterior cord flattening, without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy. Overall there is moderate central and moderate to severe bilateral neural foraminal stenosis.C6/7: Mild posterior osteophyte disc complex without significant resulting stenosis.C7/T1: Unremarkable

Output: 1.Note is made of T2 hyperintense cystic foci within the bilateral thyroid lobes. Comparison of prior studies would be helpful. If this area has not been imaged previously, dedicated thyroid ultrasound would be recommended.2.C3/4: Mild bilateral neural foraminal stenosis.3.C5/6: A broad-based disc herniation causes anterior cord flattening, without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy. Overall there is moderate central and moderate to severe bilateral neural foraminal stenosis.