Instruction: Generate impression based on findings.

Input: Diagnosed with meningitis following presenting with headache and vomiting. Gait is drifting toward the right side. Assess for focal brain abnormality. There are subtle scattered punctate foci of cortical diffusion restriction, some of which correlate with T2/FLAIR hyperintensity. For example, a focus involving the left hippocampus is seen on axial diffusion image #191, FLAIR images #17. Punctate foci in the paramedian frontal lobes are seen on diffusion image #182. There is no large territorial diffusion restriction or intracranial hemorrhage. There is no abnormal parenchymal or leptomeningeal contrast enhancement. There is no abnormal extra-axial fluid collection. The ventricles and other CSF-containing spaces are normal in size. There is no midline shift or brain herniation. Major intracranial vascular flow voids are preserved, reflecting gross patency.There is no gross orbital abnormality. There is no destructive skull lesion. The mastoid air cells are clear. Very minimal ethmoid sinus mucosal thickening is nonspecific.

Output: 1.There is no evidence of intracranial abscess or empyema.2.Subtle, scattered cortical punctate foci of diffusion restriction, some of which demonstrate T2 FLAIR hyperintensity may relate to the known infection. Embolic disease and seizure-related foci are additional possibilities but atypical.


Instruction: Generate impression based on findings.

Input: Wrist pain LIGAMENTS: No significant abnormality noted. Specifically the scapholunate ligament appears intact.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Unremarkable MRI of the left wrist.


Instruction: Generate impression based on findings.

Input: History of left breast cancer status post mastectomy. The patient is status post left mastectomy with reconstruction. No abnormal enhancement is present along the left reconstructed breast or within the left axillary region. Minimal background parenchymal enhancement is noted in the right breast. There is no abnormal enhancement identified. Three mildly enlarged right axillary lymph nodes are present, adjacent to the pectoralis minor. These all measure just over 1 cm in size, but are increased compared to previous sizes. No abnormal left axillary lymph nodes are present.

Output: Mildly enlarged right axillary lymph nodes. These should be further evaluated with axillary ultrasound and possible biopsy. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Evaluate liver mass identified on CT and biliary ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour and normal in morphology. There is mild common bile duct dilatation with smooth tapering. No obstructing lesion is identified. Within segment 7, there is a T2 hypointense lesion measuring 2.3 x 1.3 cm (series 13, image 215) with peripheral nodular enhancement, probable hemangioma. The gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is normal in caliber. No focal lesion is identified.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: Resolution of previously identified right lower lobe pneumonia.

Output: Segment 7 T2 hypointense lesion with peripheral nodular enhancement, represents a probable hemangioma.


Instruction: Generate impression based on findings.

Input: 50-year-old man with history of metastatic lung cancer. There are several subcentimeter foci of abnormal enhancement within the supratentorial and infratentorial compartments consistent with metastatic disease, not significantly changed compared to the 7/18/2016 examination. The largest lesion is in the right parietal lobe (1103/111) which measures 4 x 5 mm, unchanged. Additional lesions are present within the right periventricular white matter, right occipital lobe, right frontal lobe, and left cerebellum along the folia. None of these lesions appear significantly changed. No new lesions are identified. There is no significant associated perilesional edema or mass effect.There is no evidence of intracranial hemorrhage or acute territorial infarction. The ventricles, sulci and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is moderate mucosal thickening within the right maxillary sinus and mild mucosal thickening within the left maxillary sinus.

Output: Scattered small cerebral and cerebellar metastases, not significantly changed allowing for slight differences in technique. No significant associated perilesional edema or mass effect.


Instruction: Generate impression based on findings.

Input: 43 years Male (DOB:9/6/1973)Reason: neck pain, cervical radiculopathy History: as abovePROVIDER/ATTENDING NAME: KAMALA GULLAPALLI COTTS KAMALA GULLAPALLI COTTS The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is disc desiccation associated with a broad-based right lateral recess disc extrusion and endplate and uncovertebral osteophytes with encroachment of the right-sided exiting nerve roots and effacement of spinal fluid ventral and posterior to the spinal cord creating a moderate degree of spinal stenosis involving the right hemicord more than the left hemicord.At C6-7 there is disc desiccation present associated with a left lateral recess disc extrusion extending into the left neural foramen and encroaching the left-sided exiting nerve roots. Material extends into the spinal canal and effaces spinal fluid ventral and posterior the spinal cord. There is mild flattening of the spinal cord at this level. There is encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are degenerative changes present in the cervical spine which are worse at C5-6 and C6-7 where there is moderate spinal stenosis and encroachment of the right-sided exiting nerve roots at C5-6 and left-sided exiting nerve roots at C6-7. The worst level appears to be C6-7.


Instruction: Generate impression based on findings.

Input: 76 year-old woman with history of adenocarcinoma of the lung, status post right lower lobectomy CHEST:LUNGS AND PLEURA: Areas of consolidation and ground glass opacities are identified in the lingular segment of the left upper lobe as well as in multiple locations in the residual right right lung. These demonstrate significant interval increase compared to the prior outside exam and may represent multiple sites of bronchiolo - alveolar carcinoma. Multifocal infection is considered less likely.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy is identified.Cardiac size is normal without evidence of pericardial effusion. Pacemaker lead wires are noted.CHEST WALL: Right-sided pacer.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodensities, which may represent hepatic metastases. Dedicated imaging of the liver with CT and/or MRI is recommended.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes within the thoracic and lumbar spine.OTHER: No significant abnormality noted

Output: 1.Multifocal areas of mixed solid and ground glass opacities bilaterally, compatible with multiple sites of bronchiolo - alveolar carcinoma.2.Multiple hepatic hypodensities, which may represent hepatic metastases. Dedicated CT and/or MRI imaging of the liver is recommended. In addition, PET scanning may be of value.


Instruction: Generate impression based on findings.

Input: 65-year-old female with left lateral hip mass. Evaluate for solitary fibrous tumor. Note is made of a 3.5 x 6.0 x 4.9 cm (TR by AP by CC) round encapsulated mass within the subcutaneous tissue along the lateral aspect of the left hip which demonstrates heterogeneous decreased T1 signal abnormality and heterogeneous increased signal abnormality on fluid sensitive sequences. There is heterogeneous but predominantly avid contrast enhancement. There is a large draining vein situated anteriorly. Additionally there is a large draining vein situated posterior to the aforementioned mass. No additional enhancing mass lesions are identified. There is no evidence of lymphadenopathy. There is mild fatty atrophy of the imaged musculature of the left hip. The musculature of the left hip otherwise appears normal. There is no bone marrow signal abnormality in the surrounding area.

Output: Nonspecific 6.0 cm enhancing mass in the subcutaneous tissue along the lateral aspect of the left hip which appears similar to the prior examinations when allowing for differences in technique. Differential considerations include a solitary fibrous tumor/hemangiopericytoma with a soft tissue sarcoma considered a less likely possibility given the apparent stability.


Instruction: Generate impression based on findings.

Input: Transient cerebral ischemic attack, unspecified [G45.9], Reason for Study: ^Reason: assess for ischemic changes History: TIA Brain MRIRight centrum semiovale (right parietal white matter) restricted diffusion lesion indicating acute ischemic infarction. No evidence of hemorrhagic conversion.Multifocal patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.There are multifocal chronic ischemic infarct with tissue loss involving bilateral cerebellar hemispheres and the right side of upper pons.Right side medulla shows focal susceptibility lesion indicating hemosiderin deposition or parenchymal calcification.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Relatively small left maxillary sinus with mucosal thickening indicating possible prior surgery and/or chronic inflammation.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. The right PCA is fetal origin.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are not well visualized, thus cannot access precisely.There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid. Bilateral vertebral arteries are poorly visualized.

Output: 1. Focal acute ischemic infarction at the right side centrum semiovale without evidence of hemorrhagic conversion.2. Chronic ischemic infarctions with tissue losses involving bilateral cerebellar hemispheres and right side of pons.3. Non specific small vessel ischemic disease.4. No evidence of significant (more than 50%) arterial luminal stenosis on both intracranial and extracranial arterial system. No intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Female, 13 years old. Bleeding, vaginal mass. Assess for mullerian abnormality, imperforate hymen. PELVIS:UTERUS, ADNEXA: The vaginal vault is distended and filled with layering fluid, debris, and gas. A small amount of fluid extends into the cervix, but there is no significant fluid distending the uterine cavity. No significant surrounding inflammatory changes throughout the pelvis. The uterus is normal in size and configuration. Both ovaries are identified and appear normal. Trace pelvic free fluid is likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No specific evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Both kidneys are visualized and are grossly normal in size and position.

Output: 1.Hydrometrocolpos, most likely due to imperforate hymen.2.Otherwise normal appearance of the uterus and ovaries, without evidence of mullerian abnormality.


Instruction: Generate impression based on findings.

Input: Diplopia. Evaluate for CNS mass. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderately advanced chronic small vessel ischemic changes. Prominent perivascular spaces in the basal ganglia are seen compatible with etat crible. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Moderately advanced chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 55-year-old female. Cirrhosis. Screen for HCC. ABDOMEN:LIVER, BILIARY TRACT: Liver contour: Nodular consistent with a cirrhotic morphologyFeatures of portal hypertension: Small esophageal and perigastric varices, ascites, and borderline splenomegaly. Portal vein: Patent proximal to the TIPS.Hepatic artery: PatentHepatic vein: Middle and left are patent. Right vein not well visualized due to artifact from TIPS.Lesions: 9 x 9 mm lesion (image 23, series 10; previously 9 x 8 mm) in the right hepatic dome, arterial enhancement - faint; washout - no; peripheral rim enhancement - no.Interval placement of TIPS, patency of which cannot be evaluated due to shunt artifact. New peripheral wedge-shaped arterially enhancing foci at the distal end of the TIPS in the hepatic dome with persistent contrast enhancement on delayed phases and no corresponding T2 signal abnormality, likely a perfusion abnormality.SPLEEN: Borderline splenomegaly measuring 12 cm. 1.8-cm distal splenic artery aneurysm (series 3, image 20), unchangedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Dilated retroperitoneal lymphatics, which may be due to cirrhosis and hypoalbuminemia, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of abdominopelvic ascites. Small hiatal hernia with loculated pocket of fluid at the GE junction, unchanged.

Output: 1.Stable nonspecific right hepatic dome lesion with enhancement characteristics that do not meet strict criteria for HCC. No new worrisome lesion.2.Interval TIPS placement, patency of which cannot be evaluated due to shunt artifact. Small amount of ascites.3.1.8 cm distal splenic artery aneurysm, unchanged. Consultation with IR for possible embolization is suggested.


Instruction: Generate impression based on findings.

Input: Ms. Christie is a 33 year old female with a family history of breast cancer in two paternal aunts and ovarian cancer in mother. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 22-year-old male. Crohn's of the jejunum and TI. Follow-up. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Approximately 18 cm long segment of distal jejunum/proximal ileum that shows wall thickening and cord-like enhancement consistent with acute on chronic inflammatory bowel disease. This segment is narrowed and small bowel proximally is focally dilated (series 5, image 15). Very mild thickening of a short segment of terminal ileum suggestive of quiescent disease. No abscess or fistulae are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Crohn's disease involving an approximately 15 cm long segment of distal jejunum/proximal ileum and short segment of most distal terminal ileum.


Instruction: Generate impression based on findings.

Input: 74-year-old male with history of left renal lesion seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter nonenhancing cysts. No intrahepatic biliary ductal dilatation.Cholelithiasis.SPLEEN: Splenic varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a homogeneously T2 hypointense and T1 isointense lesion within the left interpolar region demonstrating mild enhancement measuring 2.9 x 1.9 cm. This lesion correlates to prior CT findings.Left upper pole cystic lesion measures 4.6 x 3.4 cm and contains a thin nonenhancing septations.Additional nonenhancing cystic lesions are present bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 11 mm enhancing right retroperitoneal nodule (image 2 of series 801).

Output: 1. Enhancing left interpolar solid renal lesion compatible with renal cell carcinoma, likely papillary type given imaging characteristics.2. Enlarging nonspecific enhancing retroperitoneal nodule likely related to lymphoma.


Instruction: Generate impression based on findings.

Input: 43-year-old woman with history of SLE presents with right knee pain. Evaluate for avascular necrosis of the distal femur and proximal tibia. MENISCI: There is slight blunting of the posterior horn of the lateral meniscus, consistent with a tear. The medial meniscus is normal in appearance. ARTICULAR CARTILAGE AND BONE: There is geographic signal abnormality in the distal femoral metaphysis, which features serpiginous signal abnormality, representing bone infarction. Additionally, there is a small region of infarct within the medial condyle of the femur, posteriorly. There are no defects of the articular cartilage of the knee. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Bone infarction of the distal femur as described above.


Instruction: Generate impression based on findings.

Input: Progressive neuropathy, assess for lumbar radiculopathy, neurolymphomatosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is straightening of the lumbar spine curvature and minimal L5 on S1 retrolisthesis. Alignment is otherwise maintained. Advanced degenerative changes are seen throughout the lumbar spine with moderate loss of height at all levels. Associated fatty endplate marrow signal changes are noted. No destructive lesions are demonstrated. There is a focus of susceptibility at the posterior-inferior aspect of the L3 vertebral body consistent with gas and likely on a degenerative basis. The conus medullaris is normal in position.Individual levels as described below:L1-L2: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening. No significant spinal canal stenosis. There is mild bilateral neural foraminal narrowing. L2-L3: Mild disc bulge, epidural lipomatosis, facet arthropathy, and ligamentum flavum thickening resulting in moderate spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L3-L4: There is disc bulge with small right paracentral protrusion and osteophyte resulting in effacement of the right lateral recess. There is also facet arthropathy and ligamentum flavum thickening which contribute to mild-to-moderate central canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: There is disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy resulting in moderate spinal canal stenosis. There is moderate right and moderate to severe left neural foraminal stenosis.L5-S1: Minimal disc bulge and endplate osteophytes result in effacement of the left lateral recess. No significant central canal stenosis. There is mild right and moderate left neural foraminal stenosis. There is bilateral facet arthropathy.Paraspinous soft tissues are within normal limits. No soft tissue masses are seen.

Output: 1. Advanced degenerative changes in the lumbar spine with moderate spinal canal stenosis at L2-L3 and L4-L5. There is also significant neural foraminal stenosis at multiple levels, as detailed above.2. No masses or abnormal enhancement involving the lumbar spine or spinal canal/cauda equina nerve roots to suggest lymphomatous involvement.`


Instruction: Generate impression based on findings.

Input: There are findings related to left temporal craniotomy, including fluid and swelling of the overlying scalp and periorbital tissues. There has been interval resection of previously demonstrated cavernous malformation in the left temporal lobe. There is an area of intrinsic high T1 signal intensity and corresponding susceptibility effect in the resection bed in the left temporal lobe. There are also residual areas of curvilinear susceptibility effect along the margins of the resection cavity that correspond to preoperative hemosiderin deposits. There is no evidence of acute territorial infarction. The ventricles and sulci are within normal limits in size and configuration. There is no midline shift.

Output: Status post recent gross total resection of a left temporal lobe cavernous malformation with residual areas of hemosiderin staining along the periphery of the resection cavity.


Instruction: Generate impression based on findings.

Input: History of Cushing's (ACTH-producing adenoma) resected in 12/2013, now returning for follow-up. There are postoperative findings related to transphenoidal surgery. There is an unchanged punctate hypoenhancing focus within the posterior pituitary. The infundibulum is intact. There is no mass effect upon the regional optic apparatus. The cavernous sinuses and adjacent internal carotid artery flow voids are intact.

Output: Postoperative findings related to transsphenoidal surgery with unchanged nonspecific hypoenhancing focus within the posterior pituitary.


Instruction: Generate impression based on findings.

Input: Male 59 years old Reason: 59 yo with HBV, cirrhosis, small lesion seen near spleen. Please followup ABDOMEN:LIVER, BILIARY TRACT: The liver is heterogenous with a nodular contour consistent with liver cirrhosis. No significant interval change in the previously described multiple nodules throughout the liver that demonstrate intrinsic T1 hyperintense signal, without arterial enhancement or corresponding T2 hyperintensity. These are most consistent with dysplastic nodules. None of these lesions meet strict criteria for an HCC. No intra or extrahepatic biliary duct dilatation. The portal vein is patent. No ascites.SPLEEN: No significant interval change in the reference enhancing lesion along the inferior margin of the spleen that measures 1.2 x 1.5 cm, previously 1.3 x 1.5 cm (series 904; image 144), which is nonspecific. This lesion at times appears isointense to the splenic parenchyma on postcontrast imaging, however, the lesion does not consistently match the spleen on every sequence and thus the appearance is not diagnostic for a splenule, there is also associated increased peripheral T2 signal abnormality on the fat saturated T2 weighted sequences. 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.

Output: 1. Stable reference lesion along the inferior margin of the spleen. Lesion remains indeterminate, may be an atypical splenule, a splenic hemangioma is also a differential consideration given the increased T2 signal abnormality. Further evaluation with a dedicated damaged RBC nuclear medicine scintigraphic examination with SPECT images may be considered for confirmation if clinically indicated. 2. Cirrhotic liver morphology with multiple lesions that are most consistent with dysplastic nodules. No lesion is identified that meets the strict criteria for an HCC however close surveillance is warranted. Patent hepatic vasculature.


Instruction: Generate impression based on findings.

Input: Low back pain x14 years. Patient has difficultly lying flat due to pain, but is willing to try for this test. The less time the better. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and a diffuse disk bulge at this level. There is T2 signal hyperintensity within the posterior half of the disk. Disk material minimally abuts the nerve root sleeve at the right lateral recess at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and a broad-based small central disk protrusion at this level. There is T2 signal hyperintensity within the disk protrusion.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Incidental note is made of fatty filum distally.

Output: There is degenerative disk disease present in the lower lumbar spine which is worse at L5-S1 without significant compromise to the spinal canal or nerve roots as detailed above.


Instruction: Generate impression based on findings.

Input: Procedure: MRI CERVICAL SPINE WWODiagnosis: Abnormal reflexClinical question: assess for cause of hyperreflexiaSigns and Symptoms: hyperreflexia The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. The patient is status post anterior fusion from C4 through C7 with anterior plate and screws. There is osseous fusion at C4-5, C5-6 and C6-7. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild loss of disc space height, disc desiccation, diffuse disc bulge, endplate and uncovertebral osteophytes as well as mild posterior ligamentous hypertrophy at this level..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. There are some endplate osteophytes and uncovertebral osteophytes present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are bilateral uncovertebral osteophytes at this level with narrowing of the neural foramina and some encroachment of the exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. The vertebral artery flow voids appear to be intact.Incidental note is made of partial empty sella.The thyroid gland is asymmetric signal in size. The left lobe is larger than the right. There are cystic type lesions versus nodule in the left thyroid gland lobe.

Output: 1.The patient is status post anterior fusion. There is some mild degenerative changes present in the cervical spine.2.Left lobe of the thyroid is enlarged and contains lesions within it possibly representing either nodules or cysts. Please correlate with patient's clinical history.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with right lower back pain. Image quality is degraded by motion artifact. Within this limitation, there may be mild endplate enhancement at T11-12, likely degenerative in nature. No other areas of pathologic marrow enhancement are seen. Mild enhancement of the facets and the ligamenta flava are noted in the lower lumbar region. No pathologic intradural enhancement is suspected. Vertebral body heights are preserved. There is a grade 1 anterolisthesis of L4 relative to L5. Sagittal alignment is otherwise unremarkable.At L1-2, there is a bulging disc asymmetric to the right. No significant spinal canal stenosis. Possible mild right foraminal narrowing.At L2-3, no significant spinal canal or foraminal stenosis is seen.At L3-4, there is mild disc bulging but no significant generalized spinal canal stenosis. The ligamenta flava are thickened.At L4-5, disc bulging and a central disc protrusion are demonstrated. Facet arthropathy and ligamenta flava thickening is also seen. A moderate generalized spinal canal stenosis is noted with moderate left and mild right foraminal narrowing.L5-S1, mild disc bulging is seen without significant spinal canal stenosis. Facet arthropathy and ligamenta flava thickening is noted. Mild right foraminal narrowing is seen.

Output: 1.Endplate enhancement at T11-12 is favored to be degenerative in etiology. Enhancement of the facets and ligamenta flava in the lower lumbar spine is also likely degenerative. No pathologic intradural enhancement is seen.2.Disc and posterior element degeneration is seen at multiple levels as discussed above. L4-5 appears to be the most severely affected level where there is a moderate generalized spinal canal stenosis and at least moderate left foraminal narrowing.


Instruction: Generate impression based on findings.

Input: There is a stable right frontal approach Ommaya catheter with mild associated susceptibility artifact. The tip is located in the posterior left frontal horn. Corresponding to the area of abnormal low density in the right frontal lobe, there is extensive T2/FLAIR hyperintensity, again significantly enlarged since the most recent MRI of 12/19/2015. This remains vasogenic pattern. There is mild localized mass effect on the anterior right lateral ventricle as well as overlying sulci.The ventricles and sulci are otherwise within normal limits. The cisterns remain patent. There is no midline shift. There are no areas of pathological enhancement. No definite leptomeningeal enhancement is appreciated. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is severe fluid opacification of the right mastoid air cells

Output: 1.Prominent area of T2/FLAIR hyperintensity in the right frontal subcortical and deep white matter along the right frontal approach Ommaya catheter tract corresponding to low-density abnormality on CT, without associated enhancement. This again appears vasogenic in pattern with preservation of cortex, with localized mass effect. Again, the area of T2 abnormality is significantly progressed since that of the 12/19/2015 MRI. Please evaluate for catheter dysfunction, especially in relation to most recent chemotherapy administration of 12/22/2015.2.No definite leptomeningeal enhancement appreciated.3.Severe right mastoid air cell fluid opacification which is nonspecific. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Reason: pre op planning for pituitary tumor, T2 and T1 post thin cuts please. needs fiducials History: pre-op planning for pituitary tumor There is redemonstration of a 19 x 34 mm sagittal dimension mass involving the pituitary fossa and suprasellar cistern which expands the pituitary fossa and extends laterally into the cavernous sinus regions. Superiorly it displaces the optic chiasm superiorly and impresses upon the inferior aspect of the hypothalamus - left more than rightNormal 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.

Output: 1.Sellar and suprasellar mass is consistent with pituitary adenoma. It is unchanged in dimensions and compared to the prior exam from October.2.Examination was obtained for stereotactic guidance.


Instruction: Generate impression based on findings.

Input: 50-year-old female with multiple myeloma and new onset pain. Please evaluate for new myelomatous lesions. There is diffuse signal abnormality of the bone marrow of the pelvis and the proximal left femur on the T1-weighted images. Evaluation of the proximal right femur is limited due to susceptibility artifact from orthopedic fixation of a subtrochanteric fracture of the proximal femur. On the fat-saturated T2 weighted images there is multifocal abnormal signal intensity throughout the proximal left femur as well as multiple foci of signal abnormality throughout the pelvis, many of which enhance following gadolinium administration. These findings are compatible with diffuse myelomatous disease, although evaluation of interval change is difficult as no prior MR study is available for comparison. Osteoarthritis affects both hip joints and sacroiliac joints, and severe degenerative disc disease affects L5-S1. There is a grade 2 anterolisthesis of L5. There are mild inflammatory changes about the right proximal femur presumably related to rod placement, but we see no fluid collections in the soft tissues to suggest abscess. There is a degenerating uterine fibroid.

Output: Diffuse myelomatous involvement of the bones of the pelvis with particular involvement of the proximal left femur.


Instruction: Generate impression based on findings.

Input: 28-year-old pregnant female with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is normal in caliber without evidence of obstruction. The appendix is nondilated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: An intrauterine pregnancy is present. The adnexa are within normal limits.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is normal in caliber without evidence of obstruction. The appendix is nondilated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A small amount of pelvic free fluid is present.

Output: 1.No specific evidence of appendicitis or other acute findings to account for the patient's pain.2.Intrauterine pregnancy.


Instruction: Generate impression based on findings.

Input: 25 years Female (DOB:8/3/1991)Reason: rule out demyelination, MS History: numbness in extremitiesPROVIDER/ATTENDING NAME: GABRIELLA L BORRELLI GABRIELLA L BORRELLI 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.

Output: There are no lesions within the brain parenchyma to suggest demyelinating disorder. Please note that in and of itself MRI of the brain does not exclude the diagnosis of multiple sclerosis. MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: 34-year-old male with tingling, numbness, and left deltoid muscle atrophy. The cranial-cervical junction is normal. There is loss of normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow demonstrates low signal on T1, which is likely related to the patient's age and predominance of red marrow. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. There is mild developmental narrowing of the entire cervical spinal canal due to shortened pedicles. Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is mild central spinal canal stenosis. There is mild left uncovertebral hypertrophy with associated mild neural foraminal narrowing.C3-C4: There is mild central spinal canal stenosis. There is moderate left and mild-to-moderate right neuroforaminal stenosis. C4-C5: There is mild central spinal canal stenosis. There is bilateral facet arthropathy and moderate bilateral neuroforaminal stenosis, left greater than right.C5-C6: There is mild central spinal canal stenosis. There is no significant neuroforaminal stenosis.C6-C7: There is mild central spinal canal stenosis. There is mild diffuse disc osteophyte formation with superimposed left neuroforaminal disc protrusion resulting in severe stenosis. There is moderate narrowing of the right neuroforaminal canal.C7-T1: No neuroforaminal narrowing or spinal stenosis.

Output: Mild multilevel degenerative changes as detailed above with left neuroforaminal disc protrusion resulting in severe stenosis which may account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 61-year-old with history of left breast ILC status post partial mastectomy and complete axillary lymph node dissection. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. There are a few high T2 signal cysts in the right breast. No suspicious enhancement is seen in either breast. Postsurgical changes in the left upper inner breast are stable. Enhancing foci in both breast are stable to less prominent today. Area of enhancement in the right lower outer breast, posterior depth, is also stable to less enhancing. No abnormal lymph nodes are identified in either axillary region. Postsurgical changes in the left axilla are stable.

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


Instruction: Generate impression based on findings.

Input: Reason: THis is a 26 y/o male with sickle cell disease with h/o iron deposition from multiple transfusions. Referred for cardiovascular MRI to evaluate for iron deposition on cardiac muscle Left VentricleThe left ventricle is severely enlarged with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 140 ml/m2 (normal range: 74+/-15), the LVEDV is 267 ml (normal range 142+/-34), the LV end systolic volume index is 59 ml/m2 (normal range 25+/-9), the LVESV is 112 ml (normal range 47+/-19), the LV mass index is 98 g/m2 (normal range 85+/-15), and the LV mass is 187 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is moderate enlarged. Right VentricleThe right ventricle is moderately enlarged with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 135 ml/m2 (normal range 82+/-16), the RVEDV is 258 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 111 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. Mitral valve leaflets are mildly thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are trace bilateral pleural effusions. There is severe iron overload in the liver based on T2* imaging. Small pleural effusions.

Output: 1. Severely dilated left ventricle with normal systolic function (LVEF 58%). There is no evidence of iron overload in the myocardium. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process2. Moderately dilated right ventricle with normal systolic function (RVEF 57%)3. Severe iron overload in the liver.4. Moderately dilated right and left atria.5. Small pericardial effusion and trace bilateral pleural effusions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for CVA or hemorrhage. Examination demonstrates infarcts in the left parietal lobe. Since prior brain MRI, the infarcts have increased in size. No intracranial hemorrhage, mass, midline shift or abnormal extraaxial fluid collection is identified. The periventricular small vessel ischemic disease and right cerebellar encephalomalacia are again identified. The ventricles are normal in volume and are symmetric.The visualized paranasal sinuses mastoid air cells are normally pneumatized.

Output: 1.Interval increase in size of the left parietal stroke with no evidence of intracranial hemorrhage.2.Small vessel ischemic disease and right cerebellar encephalomalacia.


Instruction: Generate impression based on findings.

Input: 54 years Male (DOB:2/12/1962)Reason: central explanation for pain History: UE and LE weakness, pain, and locking symptomsPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI There is a 28 mm with x 16 mm x 33 mm peripherally enhancing septated cystic type lesion within the occipital bone just behind the superior sagittal sinus at the level of the right occipital sulcus associated with focal calvarial thickening. There is some adjacent marrow replacement present. There is no associated diffusion restriction. There is associated bony remodeling.There is a perforation present along the calvarium along the midline associated with the venous drainage and suspected communication superior sagittal sinus..No mass lesions are identified in 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 mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a lesion within the midline of the occipital calvarium present at the midline. It is not certain what this represents. One possibility is that this may represent an arachnoid granulation. It is not clear what this represents. A follow- up exam may be helpful. CT may help further characterize it. 2.There is a fenestration along the midline at the junction of the parietal bones which appears to be associated with sinus pericranii. This can be confirmed with CTV.3.No brain lesions are identified to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate back pain. Signs and symptoms: Persistent back pain. Pre and post enhanced cervical MRI:.Similar to prior brain MRI exam from3/4/2015 there is redemonstration of mild dorsiflexion of the dens and suggestion of subtle platybasia without change since prior exam.Similar to prior brain MRI examination there is 5.5 mm space between the anterior arch of C1 and dens with fatty signal intensity within this space. The measurement is at the upper limits of normal. Clinical significance of this finding is questionable. If patient has symptoms relevant to this region further evaluation and including flexion and extension views would be helpful for further assessment. Also unusual for patient's stated age of 11 there are tiny linear T2stir hyperintensity within the annulus of the disc at C4-C5 and C5-C6 levels (sagittal T2 STIR series 501 images 8 and 9) which demonstrate subtle enhancement. This appearance in adult population represents annular fissure and unusual for pediatric age group. Clinical significance of this finding also remains questionable.No detectable abnormality at the level of foramen magnum. The alignment of cervical spine is anatomical. The signal intensity and caliber of the cervical cord is within normal.No evidence of spinal canal or neural foraminal compromise at any level. Post enhanced images are unremarkable other than above mentioned finding.Pre and post enhanced thoracic MRI:There is normal anatomical development, signal intensity and alignment of the vertebral column. No spinal stenosis or neural foraminal compromise at any level.Normal signal intensity and caliber of the cord. No abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges.No detectable paraspinal soft tissue abnormalities.Pre and post enhanced lumbar MRI:There is normal anatomical development, normal signal intensity and alignment of lumbar spine. No spinal stenosis or neural foraminal compromise at any level.There is normal signal intensity of the lower most visualized thoracic cord and conus. There is termination of the cord at L1 level.There is a tiny uniform linear fatty signal intensity of the filum terminale extending from L1-L2 disc level inferiorly to L4-L5 disc level which is best appreciated on axial T1 series 2401.Although there is normal termination of the cord at L1 level to entirely exclude possibility of tethered cord follow up with prone sagittal T2-weighted images is recommended.

Output: 1.MRI of cervical spine demonstrate normal signal intensity and caliber of the cord without abnormal enhancement. No spinal stenosis or neural foraminal compromise. Mild platybasia, 5.5 mm space between the anterior arch of C1 and dens at the upper limits of normal, tiny signal changes and enhancement in the annulus of the disc at C4-C5 and C5-C6 levels consistent with annular fissure which is an unusual finding for this age group. Please see above comments.2.MRI of thoracic spine is unremarkable.3.Pre- and post enhanced MRI of lumbar spine demonstrate a tiny uniform fatty signal intensity of the filum terminale extending from L1-L2 disc level inferiorly to L4-L5 disc level. There is termination of the cord at upper L1 level. Unremarkable lumbar MRI otherwise. To entirely exclude possibility of tethered cord follow-up with prone sagittal T2-weighted images is recommended.


Instruction: Generate impression based on findings.

Input: Chiari , headaches, neck pain, numbness tingling both hands and arms: 3 month follow up. Brain: There are stable postoperative findings related to Chiari decompression and fourth ventricular stenting. The cerebellum displays an unchanged morphology and signal characteristics. 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 and paranasal sinuses are grossly unremarkable.Spine: There is a posterior disc-osteophyte complex that indents the spinal cord and results in mild bilateral neural foramen stenosis. Otherwise, there is no evidence of spinal cord signal abnormality or syrinx. There is no significant neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unchanged.

Output: 1. Stable postoperative findings related to Chiari decompression and fourth ventricular stenting without evidence of syringohydromyelia or ventriculomegaly.2. A posterior disc-osteophyte complex at C6-7 indents the spinal cord and results in mild bilateral neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with GBM, presumably IDH wild type, MGMT promotor unmethylated, status post two prior resections and TMZ/RT, PD 2 cycles of IDO pathway inhibitor immunotherapy. Evidence of bilateral frontal craniotomy is seen. A CSF signal intensity cavity is redemonstrated within the left frontal lobe showing no significant interval change. A much smaller resection cavity is also redemonstrated in the right frontal lobe which is similar in size to the prior examination.Extensive abnormal T2/FLAIR signal abnormality is seen affecting the entire right frontal lobe, the insula, basal ganglia, and a small portion of the anterior right temporal lobe. A large portion of the affected right frontal lobe also demonstrates heterogeneous, irregularly marginated enhancement. Although the geographic territory involved with this enhancement has not changed substantially, some individual enhancing lobules are larger, and the intensity of enhancement appears to have increased. Thickening and pathologic enhancement involves the genu of the corpus callosum and does cross to the left frontal lobe.This large lesion induces significant mass effect with effacement of sulci, effacement of the right lateral ventricle, and shift of midline to the left of approximately 10 mm, findings which have progressed.At the site of previously seen T2 FLAIR signal abnormality along the left posterior lateral fourth ventricle, a new 8 mm nodule of enhancement has developed. T2 hyperintensity at this site has progressed and now spreads along the brachium pontis and superiorly into the superior cerebellar peduncle and midbrain.No additional new pathologic enhancement is seen. Scattered foci of nonspecific parenchymal T2 hyperintensity are redemonstrated, at least one of which in the right cerebellum is new.

Output: Since the prior examination, irregular heterogeneous enhancement within the right frontal lobe, along with significant associated mass effect, have progressed. A new enhancing lesion has also developed within the left cerebellum where previously there was only nonenhancing T2/FLAIR signal abnormality. Overall, the findings are concerning for progressive disease, though there could be a minor component of treatment effect as well.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with radiculopathy persistent despite physical therapy. Evaluate for pathology. Signs and symptoms: Neck and scapular pain. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.There is mild generalized smaller than expected caliber of spinal canal which is believed to be at least partially secondary to congenitally short pedicles.Foramen magnum is unremarkable.C2-C3 demonstrate a tiny central disc protrusion best appreciated on axial T2 series 902 image 27. Mild central spinal stenosis and no convincing evidence of neural foraminal compromise.C3-C4 demonstrate mild disc desiccation and loss of disc height and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in mild central spinal stenosis and bilateral neural foraminal compromise.C4-C5 demonstrate mild disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and facet disease. There is mild central spinal stenosis and left neural foraminal compromise. There is a tiny focus of increased T2 STIR signal intensity projecting lateral to the left articulating facet suspicious for focus of effusion or a tiny synovial cyst.C5-C6 demonstrate mild degenerative disc disease with shadow bilateral (right greater than left) uncovertebral hypertrophic changes is noted. Mild central spinal stenosis, moderate left and mild right neural foraminal compromise.C6-C7 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophic changes. There is a right-sided disc-osteophyte complex at this level with resultant significant right neural foraminal compromise. Mild central spinal stenosis and moderate to severe left neural foraminal compromise is also present.C7-T1 demonstrates significant asymmetric left-sided facet and ligamentum flavum hypertrophic changes without spinal stenosis or neural foraminal compromise.Examination also demonstrates patchy foci of T2 hyperintensity within the cervical cord which is best appreciated on sagittal images and centered primarily at C5 and C6 levels. Findings are believed to represent myelitis secondary to degenerative disease.

Output: 1.Uniform generalized smaller caliber of the spinal canal believed to represent congenitally small canal.2.Multilevel mild degenerative changes in combination with congenitally small canal results in multilevel mild central spinal stenosis.3.There is a left-sided disc/osteophyte at C6-C7 level with resultant significant neural foraminal compromise.4.Multilevel neural foraminal compromise as detailed per level above.5.T2 hyperintensity of the cervical cord at C5 and C6 levels concerning for myositis secondary to degenerative disease.


Instruction: Generate impression based on findings.

Input: 58 years Male (DOB:9/2/1957)Reason: brain lesion History: brain lesionPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG There is redemonstration of a T2 heterogeneous mass within the right half of the suprasellar cistern measuring 20 x 17 mm axial dimensions which abuts and partially surrounds the right internal carotid artery supraclinoid segment and extends into the interpeduncular cistern and prepontine cistern where it abuts the basilar artery and the right posterior cerebral artery. This mass is higher signal on FLAIR MRI in the low signal on T1 and somewhat heterogeneous on T1 imaging. There is no significant susceptibility effect associated with it. It displays heterogeneous enhancement following gadolinium administration. This mass is also identified on the CT scan from 7/14/2014 and is not appear to have changed substantially in dimensions.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.

Output: There is a mass centered in the right half of the suprasellar cistern which extends into the interpeduncular cistern and prepontine cistern which partially surrounds the right internal carotid artery and abuts the basilar artery and the right posterior cerebral artery as well as the right superior cerebellar artery and the right cranial nerve III. This does not appear to have enlarged substantially since 2014. It is uncertain what this represents.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. However the post-PICA left V4 segment is diminutive. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK

Output: 1. No evidence for acute ischemia.2. Numerous foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as pons are nonspecific however may be related to chronic microvascular ischemic disease.3. MRA of the head and neck are negative for evidence of steno-occlusive disease, with limited evaluation of right common carotid origin.4. Left sphenoid sinus disease.5. Heterogeneous thyroid gland. Further evaluation with thyroid ultrasound may be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: 15-year-old boy with history of tuberous sclerosis on Afinitor, evaluate angiomyolipoma. ABDOMEN:LIVER, BILIARY TRACT: The partially visualized liver appears normal. The gallbladder is normal. No intra or extrahepatic biliary duct dilatation identified.SPLEEN: The partially visualized spleen is normal.PANCREAS: The pancreas appears normal and there is no pancreatic duct dilatation.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: Innumerable round lesions are seen bilaterally. Most of these lesions are subcentimeter, T1 hypointense, T2 hyperintense, and do not enhance. Some of these lesions are T2 hypointense but are too small to accurately characterize. Overall, the number of these lesions has decreased compared to the prior examination. The reference right renal lesion (series 501, image 16) measures 12 x 11 mm, previously 8 x 7 mm. This lesion demonstrates uniform T1 hypointensity, T2 hyperintensity, no enhancement, and no evidence of macroscopic fat on in- and out- of phase imaging. The reference left renal lesion is no longer visualized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Innumerable lesions in the kidneys bilaterally, most of which are subcentimeter cysts and some of which are new. 2.Slight increase in size of reference right renal lesion.


Instruction: Generate impression based on findings.

Input: Female, 33 years old. Pain. Contrast was injected into the radioscaphoid articulation. Contrast does not enter the distal radioulnar joint, indicating that the triangular fibrocartilage complex is intact. The mid carpal joint space is opacified with contrast, most likely secondary to lunotriquetral ligament tear. A small cyst is noted in the lunate, which is of questionable clinical significance. Otherwise, bone marrow signal is unremarkable.

Output: Findings suggestive of lunotriquetral ligament tear. The triangular fibrocartilage complex appears intact.


Instruction: Generate impression based on findings.

Input: Headache and dizziness: progressed metastatic lung cancer. There are several subcentimeter calvarial enhancing lesions, as well as incompletely imaged right mandible and anterior right C2 lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small right maxillary sinus rentention cyst. There is a nasal septal defect.

Output: 1. No evidence of intracranial metastases. 2. Multiple calvarial, right mandible, and right C2 metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: 7-year-old ex-34 week infant with ALTE requiring CPR at home. Nonenhanced head CT:There are questionable patchy areas of cortical low-attenuation in the bilateral posterior temporal and parietal lobes which considering patient's age may not be an abnormal finding however possibility of ischemic changes cannot be entirely ruled out. Please correlate with clinical exam and follow-up with an MRI study. There is no evidence of hemorrhage, mass effect, midline shift or hydrocephalus. There is no evidence of any crowding of the fontanelles. Mastoid air cells and middle ear cavities are pneumatized and unremarkable. Calvarium is intact.

Output: No definitive evidence of pathology. Questionable areas of low attenuation of the cortex and bilateral temporal and parietal lobes may be related to patient's premature brain however possibility of ischemic change cannot be entirely from out. Correlate with history and follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: Right knee pain and swelling. Evaluate for ACL tear. MENISCI: Diffusely abnormal signal within the medial meniscus particularly within the posterior horn likely represents intrasubstance degeneration (sagittal series 5, image 20). No definite tear of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Abnormal signal within the anterior tibial epiphysis likely represents a bone contusion. LIGAMENTS: Abnormal signal within the PCL at the proximal femoral insertion into the intercondylar notch. The distal portion of the PCL is normal in appearance. The ACL may be slightly thickened but is intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact. ADDITIONAL

Output: 1. Abnormal signal within the PCL at the proximal insertion into the intercondylar notch may represent a partial tear. 2. Edema within the anterior tibial epiphysis likely represents a bone contusion.3. Moderate knee joint effusion with soft tissue edema in the popliteal fossa.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis [Q85.1] / Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus [G40.219], Reason for Study: ^Reason: cortical tubers, SEN, SEGA There is an enhancing nodular lesion on the right lateral ventricle frontal horn (series 1201, image 10) and the size is measured about 3.7mm. The lesion was seen on prior scan with the same maximum diameter. Thus more likely represent subependymal hamartoma, however, follow up imaging is recommended. Otherwise there is no evidence of abnormal enhancement.Multifocal subcortical and cortical abnormal high signal intensity lesions on T2 images on bilateral frontal and left parietal lobes are again seen, unchanged.Several subependymal nodules which do not show any evidence of enhancement are redemonstrated, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickening of bilateral maxillary sinuses, ethmoid sinus and frontal sinus.Opacification of the right mastoid air cells.

Output: No change of multifocal subcortical and cortical T2 high signal intensities as well as subependymal lesions since prior scan.An enhancing lesion on the right lateral ventricle ependymal surface, no change of the maximum diameter since prior scan thus suggest subependymal hamartoma more likely, follow up imaging is indicated.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 52-year-old female with chronic pelvic pain. PELVIS:UTERUS, ADNEXA: There is a large intramural fibroid in the uterine fundus measuring 10 x 10 x 9.7 cm (series 5, image 18 and series 4, image 20). There is a smaller subserosal fibroid located anteriorly. It initially treated T1 and T2 hypointense fibroid is noted anteriorly. All three of the fibroids demonstrate enhancement.Unchanged T1 hyperintense right adnexal lesion with "T2 shading" is most compatible with an endometrioma. Smaller left adnexal lesions. Normal endometrial thickness.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged enhancing T2 hyperintense lesion in the S1 vertebral body is compatible with a hemangioma.OTHER: No significant abnormality noted.

Output: 1.Enlarged myomatous uterus containing enhancing fibroids.2.Unchanged endometrioma in the right adnexa. Similar lesion in the left adnexa is unchanged.


Instruction: Generate impression based on findings.

Input: 27 year old female with epilepsy. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical activation maps along the calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the sentence completion and rhyming paradigms. Language is left dominant. Putative Broca's area activation maps to the left inferior frontal gyrus (pars opercularis and pars triangularis). Putative Wernicke's area activation maps along the posterior aspect of the left superior temporal sulcus.

Output: Successful functional MRI for presurgical planning. The sensorimotor and primary visual cortices are well delineated. Language is left dominant. Broca's and Wernicke's areas are visualized in their customary locations.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Foot ulcer There is no evidence of osteomyelitis within the midfoot/hindfoot or ankle. There is diffuse soft tissue edema and inflammation following contrast administration overlying the lateral and dorsum of the forefoot, the extent of which is incompletely evaluated. There is no evidence of a focal fluid collection.The marrow signal of the hindfoot and ankle is normal. There is diffuse muscle atrophy and the ligamentous and tendinous structures of the ankle are otherwise grossly intact.

Output: No evidence of osteomyelitis within the hindfoot/ankle. There is diffuse soft tissue edema and inflammation overlying the lateral and dorsal foot, the extent of which is incompletely imaged on this exam.


Instruction: Generate impression based on findings.

Input: Postcontrast images are limited by patient motion. Incidental note is made of slight asymmetric prominence of the diploic veins along the right posterior parietal calvarium with no significant asymmetry in appearance of the convexity cortical veins. This is seen on 2801/8 and 3001/10, resulting in slight increased T2/FLAIR signal along this area of the calvarium. Correlating with the recent CT, there is evidence of osseous linear lucency correlating with a prominent diploic veins in this area. No abnormal arterial structures are visualized.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal parenchymal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The right intracranial venous structures are prominent and therefore larger than the left. There is slight paucity of pituitary tissue within the sella. The remainder of the midline structures and craniocervical junction are within normal limits. There is trace fluid within the right mastoid air cells.MRA HEAD

Output: 1. No evidence of vascular malformation, although whole head MRA was not obtained inadvertently. No suspicious vasculature identified on slightly motion limited postcontrast imaging.2. Incidental prominence of diploic veins along the high right parietal calvarium as detailed above. Please correlate with area of concern, although this likely would not result in an audible finding. Consideration could be made for ultrasound interrogation of the temporal scalp.3. Motion limited MRA of the neck, demonstrating no significant abnormality. Unremarkable contrast-enhanced MRI of the brain and noncontrast MRA of the circle of Willis.4. Mild right mastoid fluid, for which clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma status post treatment. There are post-treatment findings in the left frontal lobe with unchanged areas of patchy T2 hyperintensity with scattered susceptibility effect and mild ex vacuo dilatation of left frontal horn. There are also unchanged foci of high T2 signal in the right anterior frontal lobe. However, there is a new area of enhancement measuring up to 12 mm with surrounding vasogenic edema involving the right inferior frontal gyrus. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: A new area of enhancement with surrounding vasogenic edema involving the right inferior frontal gyrus likely represents recurrent lymphoma. Otherwise, unchanged post-treatment findings in the left frontal lobe.


Instruction: Generate impression based on findings.

Input: Ms. Martin is a 48 year old female with a personal history of bilateral breast mastectomy with implant-based reconstruction in 2014 for right breast IDC/DCIS. Patient now has a palpable lump in the right upper inner quadrant, which was not definitively characterized on recent diagnostic workup on 08/17/2016. Patient is status post bilateral mastectomy with implant based reconstruction.In the right upper inner breast, abutting the implant, there is a fat-containing, non-enhancing lesion measuring approximately 0.6 cm. MRI findings are compatible with benign fat necrosis. There is no abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region. A benign intramammary lymph node is seen in the right lateral reconstructed breast.

Output: Benign fat necrosis of the right breast, likely corresponding to palpable area of concern. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Barker is a 55 -year-old female with a strong family history of breast cancer in 6 maternal aunts and 4 maternal cousins and BRCA carrier. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with bilateral upper extremity twitching, and with sudden onset generalized tingling of both feet. Cervical:Straightening of the cervical lordosis is likely positional. Sagittal alignment is unremarkable. Vertebral body heights are preserved. A T1/T2 hyperintense lesion within the C4 vertebral body demonstrates imaging characteristics compatible with a benign hemangioma. No evidence of concerning marrow replacement or edema is seen. The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is noted.Lumbar:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. There may be a small benign hemangioma within the T11 vertebral body. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: 7 mm dorsally projecting cyst from the left facet joint. No significant spinal canal or foraminal compromise. L2-3: No significant spinal canal or foraminal compromise. L3-4: No significant spinal canal or foraminal compromise. L4-5: Loss of disc height and T2 signal. Mild disc bulging. No significant spinal canal compromise. Minimal left foraminal narrowing. L5-S1: Mild facet arthropathy. No significant compromise of the spinal canal or neural foramina.

Output: 1.No specific findings are seen in the cervical or lumbar spine which would account for the patient's symptoms.2.Findings of mild degenerative disc disease are seen at L4-5 without significant spinal canal compromise. A subcentimeter probable synovial cyst is evident projecting dorsally from the left L1-2 facet joint.


Instruction: Generate impression based on findings.

Input: History of T11 spinal lesion, urinary incontinence and lack of direction. There is minimal periventricular and subcortical, as well as pontine white matter T2 hyperintensity. There is a prominent perivascular space in the right caudothalamic groove. 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 mass effect. There are small left sphenoid and ethmoid sinus retention cysts. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Nonspecific white matter abnormality, which most likely represents chronic small vessel ischemic disease rather than demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Shock of unknown etiology, persistent altered mental status, and history of synthetic marijuana use. There is a mildly expansile patchy focus of high T2 signal and restricted diffusion within the midline of the splenium of the corpus callosum. There are also bilateral symmetric foci of high T2 signal with associated minimal restricted diffusion centered within the middle cerebellar peduncles. 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 mild scattered paranasal sinus mucosal thickening.

Output: Lesions involving the splenium of the corpus callosum and bilateral middle cerebellar peduncles likely represent a toxic-metabolic leukoencephalopathy and less likely thrombotic microangiopathy or hemolytic uremic syndrome.Discussed with Dr. BUERKI at 11:30 AM on 4/18/15.


Instruction: Generate impression based on findings.

Input: Reason: hx of urethral cancer s/p radical cystectomy with indiana pouch, please assess for recurrence History: see above. ABDOMEN: Examination limited by motion artifact.LIVER, BILIARY TRACT: Postsurgical changes of a cholecystectomy. Stable mild extrahepatic biliary ductal dilatation, unchanged and likely related to cholecystectomy. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimal expected bilateral hydroureteronephrosis with ureteral diversion into a right lower quadrant Indiana pouch. Within the right pelvis, there is a punctate focus of delayed enhancement, which may represent early excretion of contrast (series 103 image 81).RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes of anterior pelvic exenteration. BLADDER: Postsurgical changes cystectomy. LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine. OTHER: No significant abnormality noted.

Output: Post surgical changes with no definite evidence of recurrence or metastatic disease. Punctate focus of delayed enhancement in the right renal pelvis may represent early excretion of contrast. Recommend special attention paid on future examinations.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast imaging studies performed at Ingalls Memorial Hospital, Harvey, Illinois. For comparison,standard mammogram (8/27/12) is available. UNILATERAL MAMMOGRAM 11/3/2015: Three standard and spot magnification views of the right breast were submitted. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There is architectural distortion in the right upper-outer quadrant with associated asymmetry. There are calcifications overlapping the suspicious finding as well. There is a well-circumscribed oval mass with benign calcification in the medial right breast, unchanged from mammograms dating back to 8/27/2012. Loosely scattered calcifications are seen in all 4 quadrants, also true on the comparison study.STEREOTACTIC BIOPSY RIGHT BREAST AND POST BIOPSY MAMMOGRAM 11/3/2015: Submitted images demonstrate stereotactic biopsy targeting the right upper outer quadrant breast calcifications that are at the location of the distortion. A clip was placed at the biopsy site and there are significant residual calcifications. The clip is about 1 cm lateral to the site of distortion. Per the outside hospital records, pathology demonstrated a "small focus of infiltrating tubular carcinoma, grade 1, with atypical ductal hyperplasia."BREAST MRI 1/13/2016: Axial T1, pre and postcontrast sequences are submitted. Moderate heterogeneous fibroglandular tissue is present. Marked background parenchymal enhancement in both breasts limit the sensitivity and specificity of the exam. The sequences were unable to be uploaded on Dyna CAD for dynamic evaluation, and the submitted images are reviewed in a limited fashion without dynamic data on PACS. Right breast: In the upper outer quadrant, there is a heterogeneous masslike faint enhancement measuring 1.8 x 1.0 cm consistent with the biopsy-proven cancer (series 13, image 100). Clip artifact may be present just lateral to the enhancement. There is a benign intramammary lymph node in the right breast 3:00 position (series 13, image 100) which has a clear normal fatty hilum on the fat sensitive sequences. There are innumerable patchy and nodular areas of enhancement none of which are more dominant than the rest. These may be related to background parenchymal enhancement. A 12 month follow-up MRI is recommended for these foci to assess stability.Left breast: There are innumerable patchy and nodular areas of enhancement none of which are more dominant than the rest. These may be related to background parenchymal enhancement. A 12-month follow-up MRI is recommended for these foci to assess stability.A few normal size and morphology lymph nodes are seen in both axilla. Liver cysts are noted.ULTRASOUND BREAST 1/14/2016:Static images of both breasts are submitted.In the left breast, 8:00 position, 3 cm the nipple, there is a hypoechoic area without internal vascularity measuring 9 x 5 x 8 mm. Static images of the left breast labeled 6:00, 7:00, and 9:00 demonstrate no abnormality.Static images of the right breast upper inner quadrant 3:00 position 1 cm from the nipple demonstrate a 3 x 4 mm hypoechoic area. Static images of the right breast upper quadrant at the 12:30 position demonstrate a similar 4 mm hypoechoic area.ULTRASOUND BIOPSY AND MAMMOGRAM 1/14/2016: Ultrasound images from the left 8:00 and right 1:00 show that biopsies were performed. Postbiopsy mammograms are submitted which demonstrate a newly placed marking clip near 1:00 and postbiopsy changes in the medial right breast. The previously placed lateral biopsy clip is again noted. Per the outside hospital report, pathology report from this biopsy showed "LCIS, classic type, sclerosing adenosis and intraductal calcifications."  Postoperative changes and a lock shaped marking clip are now seen in the lower inner quadrant of the left breast. Per the outside hospital report, pathology report from this biopsy presumably at the 8:00 position of the left breast demonstrated "apical metaplasia, fibrocystic change, usual ductal hyperplasia, and intraductal microcalcifications." MAMMOGRAM 1/19/2016: Static images from stereotactic biopsy of the left breast are submitted. Calcifications in the left breast upper breast are targeted. A marking clip is noted at the biopsy site, along with postbiopsy changes. Per day outside hospital radiology report, pathology demonstrating "microcalcifications with focal LCIS, grade 1."

Output: (1) Biopsy proven malignancy in the right upper outer quadrant with enhancement on MRI measuring up to 1.8 cm. (2)Additional sites were biopsied in both breasts at the outside hospital with benign pathology reported. Given marked nodular enhancement and bilateral enhancing foci in both breasts, a 12-month follow-up MRI is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: assess for recurrence of cervical spinal stenosis History: progressive gait impairment, myelopathy CERVICAL SPINE:Findings of C3-C6 laminectomy with interval evolution of postsurgical changes including resolution of the previously seen fluid collection in surgical bed. The cranial-cervical junction is normal. There is mild kyphotic angulation of the lower cervical spine, grossly similar to the prior exam. The vertebral body heights are preserved accounting for endplate degeneration. There is near complete loss of intervertebral disc space at C6-7, which appears similar to prior. There has been interval increase in the degree of edematous signal change at C6-7. There is no definite cord signal abnormality.Degenerative changes are specified by the intervertebral level as follows: C2-3: Facet hypertrophy. Ligamentum flavum thickening. Mild posterior disk osteophyte formation. Mild to moderate spinal canal stenosis. No significant foraminal narrowing. No interval changes. C3-4: Posterior spinal canal decompression. Facet hypertrophy. Severe left and mild right foraminal narrowing, unchanged.C4-5: Posterior spinal canal decompression. Very mild posterior disk osteophyte formation. No spinal canal stenosis. Mild to moderate right and mild left neuroforaminal stenosis.C5-6: Posterior spinal canal compression. Mild posterior disk osteophyte. No spinal cord impingement. Facet hypertrophy. Moderate to severe left and mild to moderate right neuroforaminal narrowing, unchanged. C6-7: Moderate posterior disk osteophyte formation which contributes to a moderate spinal canal stenosis with mild deformation of the spinal cord but without significant cord signal abnormality. Moderate bilateral, left greater than right , foraminal narrowing. Findings are unchanged. C7-T1: No significant spinal canal or neuroforaminal stenosis. LUMBAR SPINE:Five lumbar type vertebral bodies are presumed to be present. The vertebral body heights are well-maintained. There is moderate to severe loss of the intervertebral disc space at L4-L5, which appears increased from the prior exam. There is disc desiccation at L5-S1, which was present previously. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact. A simple cyst is noted in the right kidney, unchanged.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: Mild disc bulge and ligamentum flavum hypertrophy. Minimal neuroforaminal stenosis bilaterally. There is no significant compromise to the spinal canal.L3-L4: Ligamentum flavum hypertrophy and mild facet arthropathy. Mild neuroforaminal stenosis bilaterally. There is no significant compromise to spinal canal.L4-5: Ligamentum flavum hypertrophy and severe facet arthropathy. There is grade 2 anterolisthesis of L4 on L5 with uncovering of the intervertebral disc at this level, which appears slightly increased from the previous exam. There is severe neuroforaminal stenosis, which likely results in impingement of the L4 nerve roots. Mild to moderate narrowing of the central spinal canal. There is also partial effacement of the lateral recesses, which is worse on the right.L5-S1: Ligamentum flavum hypertrophy and mild facet arthropathy. There is no significant compromise to spinal canal or neural foramina.

Output: 1. Grade 2 anterolisthesis of L4 on L5 with severe neuroforaminal stenosis and likely impingement of the L4 nerve roots. This can be further assessed with dynamic radiographs. There is mild to moderate spinal canal stenosis at this level which is slightly worse.2. Expected evolution of postsurgical findings of C3-C6 laminectomy. There is mild progression of cervical degenerative changes although the mild to moderate spinal canal stenosis at C2-C3 and up to moderate spinal canal stenosis at the C6-C7 level are not significantly changed. No new cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 52-year-old male with metastatic lung cancer, follow-up brain METs. Well demarcated T2 hyperintense lesions in the left inferior cerebellar hemisphere, gray white matter junction of the left frontal lobe, right parietal lobe, and right posterior occipital lobe are not significantly changed in size or signal characteristics. The reference left inferior cerebellar hemisphere lesion measures 7 x 9 mm and previously measured 7 x 9 mm (image 7, series 701). There is some intrinsic T1 hyperintensity at the site of these lesions but no significant enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No significant interval change in the size and signal characteristics of the cerebellar and hemispheric lesions compared with the prior exam. No new lesions identified.


Instruction: Generate impression based on findings.

Input: "Bump" in the right side of her oral cavity possibly due to a venous mass. MRI: There is an asymmetrically prominent right anterior jugular vein that courses lateral to the submandibular gland. The right internal jugular vein appears diminutive throughout the expected course of the vessel. Otherwise, the oral cavity contents are unremarkable and there is no evidence of measurable mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. MRA: There is no evidence of significant steno-occlusive lesions of the major cervical arteries.

Output: An asymmetrically prominent right anterior jugular vein that courses lateral to the submandibular gland represents an anatomic variant rather than a malformation and may be compensating for a diminutive right internal jugular vein. Otherwise, no evidence of tumors or significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dysphagia, unspecified WeaknessClinical question: met ovarian cancer with swallowing difficulty, eval for leptomeningeal diseaseSigns and Symptoms: met ovarian cancer with swallowing difficulty, eval for leptomeningeal disease MRI brain:There is a small hemorrhagic focus present along the medial aspect of the left temporal lobe which is hypointense on susceptibility weighted imaging and measures 3 mm on T2-weighted imaging. It is associated with contrast enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion present at this level.At C3-4 there is no significant compromise to the spinal canal. There is a small left lateral recess disc protrusion present at this level which mildly encroaches on the nerve roots at the left lateral recess.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a small hemorrhagic lesion present along the medial aspect of the left temporal lobe which is too small to characterize further the possibility this represents metastatic disease cannot be excluded2.There are some degenerative changes present in the cervical spine associated with some small disc protrusions in the upper cervical spine and some mild encroachment of the left-sided exiting nerve roots at C3-4.


Instruction: Generate impression based on findings.

Input: Left-sided numbness and weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.On gadolinium enhanced scan, there is a prominent vascular structure on the left frontal lobe starting from the left lateral ventricle ependymal surface appears to be connecting to the superior sagittal sinus. The course and configuration appear to be suggesting developmental venous anomaly.Patch multifocal high signal intensity on periventricular white matter on FLAIR images indicate mild to moderate nonspecific small vessel ischemic disease.There are also multifocal areas with tissue loss including left caudate nucleus right external capsule left external capsule pons right middle cerebellar peduncle and the right and basal ganglia indicating prior lacunar infarct.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate slightly irregular arterial lumen without significant luminal stenosis on ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No evidence of intracranial aneurysm. No significant luminal stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Mild to moderate nonspecific small vessel ischemic disease with multifocal chronic lacunar infarctions.3. Prominent venous structure arising from the left lateral ventricle courses through the left frontal lobe indicates possibility of developmental venous anomaly.4. Mild atherosclerotic changes of intracranial arterial system.5. No evidence of intracranial arterial aneurysm, no evidence of intracranial and extracranial arterial luminal stenosis.


Instruction: Generate impression based on findings.

Input: Secretory diarrhea. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions. Incompletely characterized right cardiophrenic angle multilobulated T2 hyperintense non-enhancing fluid signal intensity lesion measuring 3.2 x 5.8 cm (series 4 image 1), likely a pericardial cyst, as better seen on recent prior chest CT. LIVER, BILIARY TRACT: Normal liver morphology without focal suspicious lesion, biliary ductal dilatation or vascular abnormality.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: The distal small bowel loops are not well distended.The small and large bowel is normal in caliber, wall thickness and enhancement. No adjacent inflammatory changes. The ileocecal valve is normal in appearance. No abnormal bowel restricted diffusion. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Low signal intensity uterine masses are incompletely characterized, likely reflect calcified uterine fibroids. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free fluid, within physiologic limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The bowel is normal in appearance without specific findings to account for the patient's secretory diarrhea.


Instruction: Generate impression based on findings.

Input: The study is definitely degraded by motion artifacts. MRI BRAIN:There are no restricted diffusion abnormalities. There is no evidence of mass effect, or edema. Ventricular size is normal. There is no midline shift. There is a normal gray-white matter differentiation. Bleed cannot be assessed for due to motion artifacts in the susceptibility images which are nondiagnostic.FLAIR hyperintensity is seen in the periventricular white matter, which is a nonspecific finding and may be related to chronic small vessel ischemic changes.There is status post left-sided craniotomy.MRI CERVICAL SPINE:Axial images were not obtained. On the sagittal views of the cervical spine were obtained which are degraded by motion artifacts and are nondiagnostic. Narrowing of the spinal canal is suggested at the level of C4-C5 and C5-C6, that is not well delineated in this study.MRA BRAIN:The visualized internal carotid arteries, anterior, middle, and posterior cerebral arteries, the basilar and vertebral arteries are grossly patent. No significant stenosis or large aneurysm. The bilateral P-comms are not well visualized.

Output: 1. No evidence of acute infarct. Mild nonspecific FLAIR hyperintensity in the periventricular white matter, which could relate to minimal chronic small vessel ischemic changes.2. MRA demonstrates no evidence of large aneurysm or flow-limiting stenosis. 3. Nondiagnostic MRI of the cervical spine; however there is suggestion of possible spinal stenosis at the level of C4-C5 and C5-C6, that is not well delineated in this study. Repeat cervical spine MRI is recommended when able to tolerate.