Instruction: Generate impression based on findings.

Input: History of prior spine surgery now with increasing low back pain and lower extremity paresthesias. The vertebral body heights are preserved. Alignment is anatomic. There is decreased signal and loss of disc height at L4-5 and L5-S1 compatible with disc degeneration. Reactive endplate marrow signal is present in the L4-S1 vertebral bodies. The conus medullaris terminates at the mid L2 level. Partially visualized mass within the right paraspinal musculature at the level of T12 has fat signal characteristics. While this appears to have mildly enlarged since 2004, it did not enhance on the previous study and is compatible with an intramuscular lipoma.Level by level findings are as follows: T12-L1: No disc bulge. Moderate facet arthropathy and hypertrophy of the ligamentum flavum. No significant spinal canal or neural foraminal stenosis.L1-L2: Mild facet arthropathy. No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: Diffuse disc bulge, moderate facet arthropathy and hypertrophy of the ligamentum flavum creates mild bilateral neural foraminal stenosis. Mild to moderate spinal canal stenosis accentuated by epidural fat. L3-L4: Moderate bilateral facet arthropathy. No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L4-L5: Post surgical changes from bilateral laminectomy. Moderate diffuse disc bulge. Moderate to severe facet hypertrophy. Moderate left and severe right neural foraminal stenosis. No significant spinal canal stenosis.L5-S1: Post surgical changes from bilateral laminectomy. Mild diffuse disc bulge. Moderate facet hypertrophy. Moderate right and severe left neural foraminal stenosis. No significant spinal canal stenosis.

Output: 1. Post surgical changes from prior L4 and L5 bilateral laminectomies.2. Multilevel degenerative disc disease and degenerative arthritic changes which create multilevel neural foraminal stenoses. This is most severe involving the right L4-5 and left L5-S1 neural foramen.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, unspecified sideClinical question: back and hip pain, abnormal plain x-rays 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 loss of disk space height, disk dessication, subacute endplate reactive change and a broad based right lateral recess disk extrusion encroaching on the nerve roots at the right lateral recess and to a lesser degree nerve roots at the left lateral recess. There is mild encroachment of the nerve roots within the left neural foramen at this level due to disk material. There is mild facet hypertrophy at this level.At L4-5 there is loss of disk space height, disk dessication and a small broad based central disk protrusion. There is mild narrowing of the spinal canal at this level but there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L3-4 there is loss of disk space height and disk dessication. There is mild narrowing of the spinal canal at this level but there is no significant compromise to spinal canal or neural foramina. There is facet and ligamentum flavum hypertrophy at this level.At L2-3 there is loss of disk space height, disk dessication and a diffuse disk bulge. There are some chronic appearing endplate reactive changes present. There is narrowing of the spinal canal with crowding of the nerve roots within the thecal sac at this level but there is no significant compromise to the exiting nerve roots within the neural foramina. Overall there is moderate spinal stenosis present. There is facet and ligamentum flavum hypertrophy at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.At T12-L1 there is loss of disk space height, disk dessication and a diffuse disk bulge associated with end plate reactive changes. There is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present.2.There is moderate spinal stenosis at L2-3 .3.There is a broad- based disk extrusion at L5-S1 encroaching on the nerve roots at the right lateral recess and to a lesser degree nerve roots at the left lateral recess and right neural foramen.


Instruction: Generate impression based on findings.

Input: 24 year-old man with an inter-atrial shunt noted on saline contrast imaging. Sent for CMR to rule out ASD and quantify RV volumes. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 209 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 99 ml (normal range 47+/-19), the LV mass index is 60 g/m2 (normal range 85+/-15), and the LV mass is 134 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a localized subepicardial area of increased signal intensity noted in the basal inferoseptal wall which could represent a small area of late gadolinium enhancement or alternatively an artefact resulting form partial volume due to underlying coronary sinus. An orthogonal plane was not obtained to better characterize this finding. Otherwise there is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal size. No evidence of inter-atrial communication on first-pass perfusion.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 203 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 91 ml (normal range 54+/-17).Right AtriumThe right atrium is normal size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic 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 (25 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%. Localized subepicardial area of increased signal intensity in the basal inferoseptum partial volume from underlying coronary sinus versus small area of late gadolinium enhancement. Otherwise there is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%3. There is no evidence a hemodynamically significant atrial septal defect. Qp: Qs = 1.1


Instruction: Generate impression based on findings.

Input: 75-year-old female patient with medial knee pain. Question of chondromalacia, meniscal tear. MENISCI: The posterior horn of the medial meniscus is abnormally small in size with increased signal intensity consistent with degeneration and fragmentation. Increased signal intensity within the body of the medial meniscus likely represents complex tearing. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is loss of the articular cartilage of the medial femoral condyle overlying the posterior horn of the medial meniscus, which extends over a 1.6 cm distance. This appears to have progressed from the prior examination. Furthermore, there is thinning of the articular cartilage anteriorly as well. There is diffuse thinning of the articular cartilage of the lateral femoral condyle with a 0.5 cm full-thickness defect posteriorly. There is fraying/fissuring of the articular cartilage of the lateral patellar facet and median eminence, without full thickness defect, with underlying subchondral cystic change, appearing similar to the prior study.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Tearing and degeneration of the medial meniscus as described above.2. Chondromalacia, most predominately affecting the medial compartment, which appears slightly progressed from the prior study.


Instruction: Generate impression based on findings.

Input: Clinical question: metastatic Prostate cancer, Biopsy needed form a metastatic site for a study from L4 (approved by Dr Christoforidis)Signs and Symptoms: metastatic site biopsy Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: L4 vertebral bone biopsy under CT guidance. A total of six samples were delivered to for analysis.


Instruction: Generate impression based on findings.

Input: CTLA4 deficiency autoimmune disease, inflammatory arthritis, AIHA status post splenectomy on Rapamune, pulmonary nodules, now presenting with new onset severe headache and nausea/vomiting. There are multiple infiltrative cortical and white matter enhancing lesions with high T2 signal within the right frontal lobe, bilateral parietal lobes, occipital lobes, left insula, and right cerebellum, which are generally more prominent. In addition, there is a newly apparent subcortical enhancing lesion in the left middle frontal lobe. The lesions display minimal mass effect and there is no midline shift. There are no associated susceptibility or restricted diffusion. There is an unchanged linear T2 hyperintense lesion in the superior right frontal white matter without associated enhancement. The ventricles and basal cisterns are normal in size and configuration. There is diffuse paranasal sinus mucosal thickening and fluid levels in the maxillary sinuses. There are partially-imaged prominent cervical lymph nodes, particularly on the left side. The orbits are unremarkable.

Output: 1. Slightly increased prominence of multiple supratentorial and infratentorial lesions may represent lymphocytic infiltration associated with CTLA4 deficiency rather than conventional central nervous system lymphoma. 2. Partially-imaged prominent cervical lymph nodes, particularly on the left side may also be related to the autoimmune disorder.3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: 78 years, Female. Reason: Dobbhoff placement Feeding tube tip in the distribution of the proximal gastric body. Mild gaseous distention of the partially imaged bowel loops. Inferior pelvis is excluded from the field-of-view. Small left pleural effusion.

Output: Feeding tube tip in the distribution of the proximal gastric body. Mild gaseous distention of the partially imaged bowel loops.


Instruction: Generate impression based on findings.

Input: MVC, continued pain, noncompliant with J collar: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. No evidence of epidural hematoma. Major cervical ligaments are intact.There is no significant disc disease or spinal canal or neural foraminal stenosis at any level. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: MRI cervical spine without evidence of traumatic injury.


Instruction: Generate impression based on findings.

Input: 36 year old male with right temporal lobe epilepsy with generalization. Please evaluate for MTS. There is an ovoid T1 hypointense and T2 hyperintense lesion that measures up to 7 mm along the medial aspect of the right hypothalamus, just superior to the mammillary body. The lesion is exophytic into the third ventricle. The the hippocampi are unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The pituitary appears unremarkable. There is no evidence of hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: An ovoid T1 hypointense and T2 hyperintense lesion that measures up to 7 mm along the medial aspect of the right hypothalamus and may represent a neoplasm or hamartoma for example. Further evaluation via an MRI with contrast may be useful. Otherwise, the hippocampi are unremarkable.


Instruction: Generate impression based on findings.

Input: Male, 49 years old, history of metastatic lung cancer to the brain status post radiation and multiple chemotherapy regimens, now status post two cycles of Alectinib. Innumerable T2 hyperintense, enhancing lesions are redemonstrated both supra- and infratentorially, most of which demonstrate some degree of hemosiderin staining. Since the prior examination, a majority of these lesions show a several-mm interval decrease in size both on post contrast and T2 weighted images. Some of the smaller lesions which were evident on the prior examination are no longer distinctly seen. No evidence of significant generalized mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricular system is stable in size and morphology.

Output: A majority of the known innumerable brain metastases demonstrate an interval decrease in size on the order of several millimeters. Some of the smaller lesions which were evident on the prior examination are no longer clearly seen.


Instruction: Generate impression based on findings.

Input: 17 month old female. Rule out mass lesion for possible seizure No areas of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No evidence of a mass is identified on this non-infused exam.The cortical sulci in the left anterior temporal tip appear minimally more pronounced compared to the right side. This finding may be secondary to slice positioning and angulation of the head within the scanner. Further follow-up with an MRI examination is recommended.The cortical sulci, ventricular system and all of the CSF cisterns are otherwise unremarkable.Calvarium, limited view of paranasal sinuses and mastoid air cells are also unremarkable.

Output: No definitive abnormality however please see above comments.


Instruction: Generate impression based on findings.

Input: Reason: labral tear History: r hip pain ACETABULAR LABRUM: Intra-articular gadolinium enters the anterior superior acetabular labrum at the 2 o'clock position, indicating a tear.ARTICULAR CARTILAGE AND BONE: The alpha angle measures 55 degrees which is borderline. No bone marrow signal abnormality is identified.SOFT TISSUES: The imaged musculature of the pelvis is unremarkable. ADDITIONAL

Output: Anterior superior acetabular labral tear with borderline alpha angle as described above.


Instruction: Generate impression based on findings.

Input: 73-year-old woman with history of seizures and left medial temporal lesion. In the left medial temporal lobe (5/19) there is a 6mm area of low T1 and T2 signal. There is minimal surrounding T2 hyperintensity but no significant mass effect. No clear abnormal vasculature is seen in this region. There is mild susceptibility artifact corresponding to this lesion on diffusion images but, as specific susceptibility weighted images were not obtained on this seizure protocol, the possibility of additional small or subtle susceptibility inducing lesions cannot be excluded.The medial temporal lobes are otherwise normal in size and configuration. There is no restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. The brain parenchyma is otherwise unremarkable for age.Sella and orbits are grossly within normal limits. There is a mucous retention cyst in the left maxillary sinus, otherwise the paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRA BRAIN

Output: 1. A small, low T1 and T2 signal lesion is evident in the left medial temporal lobe without evidence of significant associated edema or mass effect. The signal characteristics are suggestive of the presence of hemosiderin or perhaps calcification/mineralization. The findings favor a long-standing chronic process and the differential would include a small cavernous malformation, as well as sequelae of prior inflammation or injury. 2. Very small incidental aneurysm of the right PCA origin.3. Mild atherosclerotic disease involving the carotid bifurcations.


Instruction: Generate impression based on findings.

Input: 31 years Male (DOB:6/8/1984)Reason: Eval for structural lesions History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are a couple subcortical punctate T2 and FLAIR hyperintense lesions in the right frontal lobe.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 partial opacification of the left frontal sinus and some mild mucosal thickening in the maxillary sinuses.. 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. There is mild reversal of the normal cervical curvature which could be positional or related to spasm. There is mild disc desiccation present at C3-4, C4-5 and C5-6.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 no significant compromise to the spinal canal or neural foramina. There are only minor degenerative changes present this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No abnormal mass lesions are appreciated intracranially or within the cervical spinal cord to account for the patient's paresthesias.2.A couple punctate subcortical white matter lesions are probably of little clinical significance.


Instruction: Generate impression based on findings.

Input: High risk for breast cancer screening, strong family history of breast and ovarian cancer. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal 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: Other malaise and fatigue [780.79] / Altered mental status [780.97], Reason for Study: ^Reason: 15yo M with Factor 5 Leiden deficiency and acute facial droop and slurred speech History: slurred speech, facial droop Brain MRIThere are multifocal subarachnoid space high signal intensity lesions on FLAIR images on left superior frontal sulcus, left pre central sulcus, right post central sulcus with relatively large (about 4mm diameter) lesion on the junction of the left superior frontal sulcus and pre-central sulcus. These lesions show susceptibility artifacts on Gradient Echo images indicating possible blood products. There is focal enlargement of subarachnoid space on the left frontal lobe superior frontal sulcus posterior aspect (16.2mm x 10.9mm) indicating possible small arachnoid cyst, no change since prior scan.There is 9.8mm x 18.1mm sized CSF containing lesion, no change in size and configuration since prior scan. The lesion has surrounding parenchymal high signal intensity on FLAIR images, thus this lesion could be related to prior insult related encephalomalacia. There is a small high signal intensity on the left frontal lobe periventricular white matter on FLAIR image which is non specific. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate very small right transverse sinus without showing MR evidence of intra-sinus filling defect. The right sigmoid sinus appears to be normal. Superior sagittal sinus, torcular, left transverse sinus, sigmoid sinus and bilateral jugular bulbs appear to be normal.Deep venous drainage system including bilateral internal cerebral veins, vein of Galen and straight sinus appear to be normal.

Output: 1. FLAIR high signal intensity lesions on bilateral hemispheres likely represent subarachnoid blood products, possible underlying causes include venous sinus thrombosis with resolving thrombus, cerebral vasculitis, trauma or dural arteriovenous shunting. 2.Hypoplastic right transverse sinus as described above, otherwise unremarkable brain MRV.Comment: considering the patient's history of Factor V Leiden positive, most likely explanation for bihemispheric subarachnoid blood products would be venous thrombosis. Therefore, follow up imaging to verify the resolution of the subarachnoid blood was suggested. And if there is any clinic doubt on the possibility of vasculitis or dural arteriovenous shunting or non-resolution of subarachnoid bloods on follow up, diagnostic catheter angiography needs to be considered. This was discussed with Dr. Marucucilli at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Reason: pain, difficulty with ambulation History: pain MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The medial and lateral compartment cartilage appears intact without evidence of a full-thickness or near full-thickness articular cartilage defects. There is superficial fraying and partial thickness fissuring of the articular cartilage along the lateral facet of the patella as well as along the median eminence of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is increased signal abnormality within the proximal fibers of the lateral collateral ligament proper which may reflect a mild sprain. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Subcutaneously edema interposed between the iliotibial band and lateral femoral condyle may reflect a mild sprain injury. Alternatively, this could represent the sequela of iliotibial band friction syndrome, particularly if the patient is an avid runner.2. Superficial fraying and partial-thickness articular cartilage fissuring along the lateral facet of the patella with elevated tibial tubercle trochlear groove distance. These findings can be seen in patellofemoral instability.


Instruction: Generate impression based on findings.

Input: 63-year-old female patient with chronic neck pain. Vertebral body heights are maintained. Anterior osteophyte formation is noted at C2-C3, C4-C5, C5-C6, and C6-C7. There is mild multilevel disc space narrowing. There is no significant neuroforaminal narrowing.

Output: Multilevel osteoarthritis in the cervical spine, as above.


Instruction: Generate impression based on findings.

Input: 76 years old, Male, Reason: eval for structural lesions History: AMS MRI:Redemonstration of a left thalamic hematoma, stable in size and morphology, with intraventricular extension. There is a moderate amount of surrounding edema in the thalamus, which does not appear significantly changed from the most recent CT. There is continued rightward midline shift secondary to mass effect of the hemorrhage and surrounding edema measuring up to 6 mm. There is dissection of this hematoma into the ventricular systems with subacute blood products layering in the occipital horns of the lateral ventricles. Patchy periventricular T2 hyperintensities indicates age indeterminate small vessel ischemic disease. Ventricular volumes appear mildly prominent, unchanged.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRA: Motion limits fine detail. There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. In the area of the hemorrhage, hyperintense T1 signal is secondary to subacute blood products and there is no definite evidence of AVM. No arterial occlusions, arteriovenous malformations, or aneurysms are identified elsewhere within the brain. There is mild atherosclerotic narrowing of the right cavernous ICA, which may be artifactual.

Output: 1. Expected evolution of left thalamic hematoma, surrounding edema and mass effect with mildly decreased rightward midline shift.2. No underlying structural lesion such as AVM or mass causing the left thalamic hematoma.


Instruction: Generate impression based on findings.

Input: Reason: 15-year-old female with history of alveolar rhabdomyosarcoma, evaluate. PELVIS:UTERUS, ADNEXA: Stable mild T2 hyperintensity and enhancement of the labia.BLADDER: No significant abnormality noted.LYMPH NODES: Reference right inguinal lymph node measures 11 x 7 mm on image 9 of series 601 and is unchanged. BOWEL, MESENTERY: The imaged bowel appears normal.BONES, SOFT TISSUES: Previously noted area of increased STIR/T2 bone marrow signal abnormality in the right femoral head and neck is no longer visualized.Stable size and enhancement at the resection bed in the pelvis, including the right obturator internus muscle.OTHER: Diminished caliber of the right iliac and right femoral vein persists. Small amount of free pelvic fluid, likely physiologic in a patient of this age.

Output: 1. Interval resolution of the bone marrow edema of the right femoral head and neck.2. Post surgical changes in the pelvis with no evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with neck pain. Slight reversal of the normal cervical lordosis is seen. Trace stepwise retrolistheses are seen of C3 on C4, C4 on C5 and C5 on C6.Bone marrow signal characteristics are heterogeneous which reflects advanced endplate degenerative signal alteration.C2-3: Facet hypertrophy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis without significant cord impingement. No significant foraminal narrowing.C3-4: Advanced facet hypertrophy. Posterior disc-osteophyte complex formation. Moderately severe generalized spinal canal stenosis with cord impingement. Minimal central T2 hyperintensity is evident within the cord at the C4 level. Moderate to severe neuroforaminal narrowing. C4-5: Advanced facet hypertrophy. Posterior disc-osteophyte complex formation. Moderately severe generalized spinal canal stenosis with cord impingement. Moderate to severe neuroforaminal narrowing.C5-6: Facet hypertrophy and ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Moderately severe generalized spinal canal stenosis with cord impingement. Moderate to severe neuroforaminal narrowing. C6-7: Advanced facet hypertrophy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis with very slight cord impingement. Moderate left and mild right foraminal narrowing. C7-T1: Advanced facet hypertrophy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Moderately severe generalized spinal canal stenosis without significant cord impingement. Moderate left and mild right foraminal narrowing.A heterogeneous T2 hyperintense right thyroid lesion is seen. Sphenoid sinusitis is also demonstrated.

Output: 1.Multilevel moderately severe spinal canal stenoses with cord impingement throughout a majority of the cervical spine, due to a combination of disc degeneration and posterior element hypertrophy. Only at the C4 level is there evidence of some abnormal signal within the cord and even this is minimal.2.Scattered foraminal narrowing as above, severe at some levels.3.Incidental right thyroid lesion which can be better assessed with dedicated ultrasound if clinically warranted.


Instruction: Generate impression based on findings.

Input: 17-year-old male with left knee pain and swelling s/p ACL recon and lateral meniscal repair by Dr. Leland. MENISCI: There is a complex tear which includes a vertical component of the posterior horn of the lateral meniscus. Although this may be due to postsurgical changes, it more likely represents a re-tear of the lateral meniscus. The medial meniscus is intact with no evidence of tear.ARTICULAR CARTILAGE AND BONE: Intact with no abnormal signal noted. LIGAMENTS: There has been interval reconstruction of the ACL with the ACL graft intact and in anatomic alignment. The other ligaments are intact with no abnormal signal or tear evident.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tear with a vertical component of the posterior horn of the lateral meniscus may be due to postsurgical changes however it more likely represents a tear of the lateral meniscus. Joint effusion about the knee.


Instruction: Generate impression based on findings.

Input: Lower back pain with multiple visits and radiating down left leg. Evaluate for cord compression. There is no evidence of cord compression. Degenerative changes are seen in the cervical spine with disc osteophyte complexes at C3-C4, C4-C5, C5-C6, and C6-C7. There is mild to moderate degree of cervical spinal canal stenosis without evidence of frank cord compression. No obvious cord signal abnormality within the limitations of technique.Schmorl's nodes are noted at the T11-L1 endplates. There is minimal anterior wedging of the T11 and T12 vertebral bodies which maybe physiologic. No associated edema. Vertebral body heights are otherwise maintained. No significant spinal canal is stenosis is evident in the lumbar spine. Degenerative changes include multilevel neural foraminal narrowing including mild to moderate stenosis at the left L3-L4 and L4-L5 levels. There is also up to moderate right-sided foraminal stenosis at the L3-L4, L4-L5, and L5-S1 levels. These changes can be better assessed on dedicated lumbar spine study including axial images. There is grade 1 anterolisthesis of L4 and L5.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.There is evidence of multilevel bilateral neural foraminal stenosis in the lumbar spine which may be contributing to the given history of pain radiating down the left leg. Consider dedicated lumbar spine MRI for better evaluation.


Instruction: Generate impression based on findings.

Input: Aphasia following cerebral infarction [I69.320], Reason for Study: ^Reason: s/p L mca History: L mca , global aphasia Brain MRI:There is evidence of restricted diffusion on the left frontal and parietal lobes as well as insular cortex and left side basal ganglia with some susceptibility effect especially on the left insular cortex and basal ganglia indicating acute/subacute ischemic infarct with focal hemorrhage transformation.Tubular susceptibility lesion on the left sylvian fissure indicating left MCA with thrombus.There is evidence of minimal midline shift toward the right side measured about 1 to 2 mm at the level of foramen of Monro.The ventricles, sulci and cisterns are symmetric and unremarkable. The cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Bilateral maxillary sinus shows mucosal thickening, in addition, there is a air-fluid level on the right maxillary sinus.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate complete occlusion of left MCA proximal M1 segment.Otherwise bilateral ICA, bilateral ACAs and vertebrobasilar system appear to be normal.

Output: 1. Acute/subacute ischemic infarct on the left MCA territory with focal hemorrhagic transformation especially on the left side facial cortex and basal ganglia as described above with minimal mass effect.2. MR angiogram shows complete occlusion of the left MCA proximal M1 segment just after the left ICA bifurcation.


Instruction: Generate impression based on findings.

Input: Clinical question: Spinal stenosis or demyelinating disease. Signs and symptoms: Spinal stenosis, demyelinating disease of CNS. Nonenhanced cervical spine MRI:Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 is unremarkable.C5-C6 demonstrate moderate to advanced disc disease, loss of disc height and mild facet and ligamentum flavum degenerative/hypertrophic changes. There is resultant mild reversal of cervical lordosis at this level. Findings also result in mild central spinal stenosis with moderate the right and mild to moderate left neural foraminal compromise.There is a tiny focus of T2 hyperintensity in the anterior aspect of cervical cord posterior to the body of C6 suspicious for myositis likely secondary to degenerative changes at this level. The findings demonstrate no significant change since prior exam from 2014.The signal intensity of the cervical and upper most visualized thoracic cord remains normal otherwise.C6-C7 is unremarkable.C7-T1 is unremarkable.Upper most visualized thoracic spine demonstrate no spinal stenosis or neural foraminal compromise.

Output: 1.Moderate degenerative disease only at C5-C6 level with resultant mild central spinal stenosis and bilateral neural foraminal (right greater than left) compromise as detailed. Small focus of T2 hyperintensity in the anterior cord at this level is believed to represent related myelitis.2.There is no detectable additional foci of cord signal abnormality.3.There is no evidence of any significant degenerative changes at other levels and no detectable spinal canal or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with essential tremor. DBS implantation scheduled. Scattered small foci of T2 hyperintensity are evident in the subcortical and periventricular white matter. Prominence of the sulci is compatible with some degree of parenchymal volume loss. A 6 x 5 mm extra-axial enhancing nodule is evident along the right posterior planum sphenoidale. No other enhancing lesions are seen. The ventricles are normal in size and configuration. No pathologic fluid collections are seen.

Output: 1.Scattered small white matter lesions are nonspecific but may reflect sequelae of microvascular ischemic disease.2.Some degree of parenchymal volume loss is suspected.3.An incidental small extra-axial mass presumed to represent a meningioma is evident along the posterior right planum sphenoidale.


Instruction: Generate impression based on findings.

Input: Non-secretory pituitary macroadenoma s/p XRT. There is an unchanged enhancing pituitary mass that measures 17 AP x 24 RL x 24 SI mm. There is unchanged extension of the mass into the left cavernous sinus without compromise of the left cavernous carotid artery. There is also unchanged mass effect upon the optic apparatus. There is unchanged thinning of the dorsum sella, but no extension of the mass into the prepontine cistern.

Output: No significant interval change in the pituitary macroadenoma with associated extension into the left cavernous sinus and mass effect upon the optic apparatus.


Instruction: Generate impression based on findings.

Input: 64-year-old male with a history of chronic of lower back pain with new leg weakness and decreased sensation. Evaluate for cord compression. There is trace prominence of the central canal in the mid to lower cervical cord, as seen on prior spine MRI exam from 3/29/2016. The vertebral body heights in the cervical spine are normal. Again seen is partial fusion of the C3 and C4 vertebral bodies. There is mild reversal of cervical lordosis with the apex at the C3-C4 level. There is mild spinal canal stenosis at the C3-C4 and C4-C5 levels similar to prior.The thoracic vertebral body heights and alignment are maintained. No significant spinal canal stenosis is evident. Intraspinal catheter is again noted.Redemonstrated is a severe compression fracture involving the L3 vertebral body with evidence of cement augmentation. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia, stable in appearance.Volume loss is again seen involving the spinal cord at the L3-4 level indicating myelomalacia. The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Septations/adhesions are again noted in the thecal sac from the L5 to S1 levels similar to prior. A lipoma within the thecal sac at the right lateral S1 level is again seen as well as along the distal aspect of the filum in the midline at the S2 level. These findings are stable in appearance.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. 2.No high-grade spinal canal stenosis in the cervical or thoracic spine. Mild spinal canal stenosis at C4-C5 again seen. 3.Trace prominence of the central canal/tiny syrinx in the cervical and thoracic cord, which appears not significantly changed.4.No significant change in the severe L3 vertebral body compression fracture with evidence of cement augmentation is unchanged in appearance. No change in the moderate to severe spinal canal stenosis and volume loss in the cord at the this level, consistent with myelomalacia.5.Unchanged appearance of the low-lying conus which extends to the L5 level with adhesions within the distal thecal sac as well as residual lipoma involving the right lateral aspect of the thecal sac at the S1 level and to a minimal degree along the distal filum terminale at the S2 level.6.Degenerative changes at additional levels are assessed on sagittal sequences only but appear grossly unchanged compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule-out brain hemorrhage. Signs and symptoms: Fall and alteration of mental status. Nonenhanced head CT:No detectable acute intracranial hemorrhage, edema, mass effect, mass, midline shift or hydrocephalus.There is a focus of low-attenuation in the left posterior temporal subcortical and periventricular white matter with no involvement of overlapping cortex. This finding demonstrates no mass effect on the adjacent parenchyma or the ventricle. The finding likely represents a focus of encephalomalacia. Two entirely evaluate this finding recommend follow-up with an MRI exam. This finding could represent an area of chronic ischemic stroke however further evaluation is recommended.Calvarium is intact.Visualized paranasal sinuses, mastoid air cells and orbits are unremarkable.

Output: 1.No acute intracranial findings. CT is insensitive for early detection of acute ischemic strokes.2.Focus of low attenuation in the left posterior temporal subcortical/periventricular white matter could represent a focus of encephalomalacia however follow-up with an MRI is highly recommended to exclude other possibilities.


Instruction: Generate impression based on findings.

Input: Left hip femoral acetabular impingement. ACETABULAR LABRUM: The labrum appears intact without discrete tears.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage is grossly unremarkable.SOFT TISSUES: The visualized musculature and soft tissues are within normal limits. ADDITIONAL

Output: 1.No labral tear identified.2.Please see CT 6/16/2015 for details regarding femoral acetabular impingement.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is redemonstration of persistent patchy areas of abnormal T2/STIR hyperintensity throughout the cervical cord with associated volume most conspicuous spanning the C2 level and at C4-C5 and C6-C7.There are stable minimal disc bulges at C5-C6 and C6-C7 without stenosis.Partial visualization of left maxillary sinus mucosal retention cyst or polyp. Additional areas of patchy abnormal signal are seen in the upper thoracic cord, incompletely evaluated.LUMBAR SPINE

Output: 1.Redemonstration of scattered cord lesions with associated volume loss consistent with chronic demyelinating disease. No definite new cervical cord lesion.2.Interval significant regression of previously identified left paracentral/foraminal disc extrusion at L5-S1, with now only minimal shallow central disc protrusion remaining and no significant stenosis at any level.3.Stable appearance of right foraminal/far lateral prominence of the disc bulge at L4-L5 which abuts the exiting right L4 nerve root. Slight asymmetric enlargement suggested of the exiting nerve root which may indicate inflammatory change. Please correlate with patient's symptoms.


Instruction: Generate impression based on findings.

Input: Re-evaluate disease status following discontinuation of immunotherapy: Stage III melanoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged minimal nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged, including a probable hemangioma in the left parietal calvarium.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. Evaluation is mildly limited by dielectric artifact due to ascites and patient body habitusABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology. Normally distended gallbladder with trace nonspecific gallbladder wall thickening. No intra or extrahepatic biliary ductal dilatation. Large volume of perihepatic ascites.Segment 5 ablation cavity is slightly increased in size following 7/20/2016 ablation with reference measurements as below. Increased intrinsically T1 hyperintense material within the cavity is compatible with blood products/treatment change. The previously seen arterially enhancing focus along the anterior medial and caudal aspect of the ablation cavity is no longer seen. There is no significant arterial enhancement associated with the ablation cavity to suggest marginal recurrence.In segment 7/8, there is a new lesion with reference measurements below. The lesion demonstrates a rim of increased T2 signal, isointense T1 signal, restricted diffusion, as well as arterial peripheral enhancement which fades but does not definitely washout and with relative hypoenhancement centrally.In segment 3, there is a new lesion with reference measurements below. The lesion demonstrates a rim of increased T2 signal, slightly decreased T1 signal, restricted diffusion, as well as arterial peripheral enhancement which fades but does not definitely washout and with relative hypoenhancement centrally.In segment 7, there is redemonstration of a lesion, slightly increased in size, with reference measurements below. The lesion demonstrates isointense T1 signal, decreased T2 signal, and relative hypoenhancement on more delayed images but lacks definite arterial enhancement or washout. SPLEEN: The spleen measures 13.7 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume ascites.BONES, SOFT TISSUES: Left greater than right pleural effusions.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/16/2016 07:59:30)SEGMENT 7/8 LESION: 1.4 x 1.1 cm (Image 22, Series 1203).SEGMENT 7 LESION: 1.3 x 1.3 cm (Image 22, Series 1203); 1.3 x 1.0 cm on prior (6/16/2016) (Image 31, Series 10).SEGMENT 5 ABLATION CAVITY: (Image 11, Series 10); (Image 22, Series 1200); 4.0 x 2.2 cm (Image 39, Series 1202); 3.0 x 1.9 cm on prior (6/16/2016) (Image 43, Series 10).SEGMENT 3 LESION: 2.4 x 2.4 cm (Image 34, Series 1201).

Output: 1.Examination is mildly limited by dielectric artifact which is exacerbated by abdominal ascites; paracentesis can be considered prior to the subsequent follow-up examination.2.Interval ablation of arterial enhancing lesion along segment 5 ablation cavity without evidence of residual disease or marginal recurrence at this site.3.Slight increase in size of segment 7 lesion which demonstrates imaging features most suggestive of a dysplastic nodule.4.New lesions in segments 3 and 7/8 which demonstrate somewhat atypical imaging features but which are suspicious for hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Acute ischemic infarct with hemorrhagic component. Signs and symptoms: Left MCA syndrome. Nonenhanced brain MRI:Diffusion weighted images demonstrate acute hematoma in the left basal ganglia. Additionally there are small punctate and linear restricted diffusion involving the cortex of the left anterior frontal as well as left periventricular white matter in the lenticulostriate distribution medial to the hematoma.The left nasal ganglia acute hematoma and its surrounding vasogenic edema results in mass effect on the left lateral ventricle and with trace distribution of midline to the right without significant change since prior exam.Additionally the study demonstrate findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.The signal void of major intracranial arterial branches are present.The signal intensity of the intracranial venous sinuses are within normal.Calvarium, orbits and paranasal sinuses are unremarkable.

Output: 1.Punctate cortical and linear left basal ganglia restricted diffusion as detailed above.2.Acute hematoma in left basal ganglia, surrounding vasogenic edema and trace deviation of midline to the right demonstrate no significant change since prior exam.3.Mild chronic nonhemorrhagic small vessel ischemic strokes are also noted primarily in the supratentorial brain parenchyma.


Instruction: Generate impression based on findings.

Input: Evaluate right hepatic dome lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.Previously described intrinsically T1 weighted hyperintense focus in the right hepatic dome is not clearly seen on today's study. No suspicious arterial enhancing or washout lesion.TIPS catheter noted with associated susceptibility artifact.SPLEEN: The spleen measures 11 cm in craniocaudal dimension without a focal lesion. Stable 1.5 cm splenic artery aneurysm.PANCREAS: Punctate cystic focus in the pancreatic tail measuring 3 mm and is too small to characterize. Likely present on 2014 and is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Previously noted right hepatic dome punctate focus is not seen on today's study. Cirrhosis without a suspicious liver lesion.Stable splenic artery 1.5 cm aneurysm.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cord compression. Signs and symptoms: Back pain, UMN signs. Pre- and post enhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild disc desiccation, minimal asymmetric moderate right facet hypertrophic changes and mild facet disease on the left. There is resultant significant right and mild left neural foraminal compromise and no central spinal stenosis.C4-C5 demonstrate mild disc disease and loss of disc height, moderate (L>R) facet hypertrophic changes and mild broad-based bulging disc. Constellation of findings results in significant (L>R) neural foraminal compromise and no central spinal stenosis. There is minute anterolisthesis at this level.C5-C6 demonstrate advanced disc disease and loss of disc height, mild bilateral facet hypertrophic changes. Constellation of changes results in significant right and moderate left neural foraminal compromise and no central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, mild bulging disc and mild bilateral facet disease. Constellation of findings results in moderate to significant (R>L) neural foraminal compromise and no central spinal stenosis.C7-T1 demonstrates moderate disc disease and loss of disc height, shallow broad-based bulging disc and no significant facet or ligamentum flavum hypertrophy. Mild bilateral (R>L)neural foraminal compromise and no central spinal stenosis.Post enhanced images demonstrate only expected enhancement of degenerative changes of the spine and unremarkable otherwise.Pre and post enhanced thoracic MRI:Examination demonstrates normal signal intensity and alignment of vertebral column.There is normal signal intensity and caliber of the thoracic cord.There is no evidence of spinal canal or neural foraminal compromise at any level.There is no detectable abnormal enhancement the vertebral column, thoracic cord, leptomeninges or the paraspinal soft tissues. No its any x-ray for any active inflammation but not usually present in the lateralPre and post enhanced lumbar MRI:The signal intensity of vertebral column demonstrate changes related to degenerative disease and unremarkable otherwise.The alignment of vertebral column remains anatomical.T12-L1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate moderate disc disease and loss of disc height and mild hypertrophic changes of posterior elements. There is a left lateral and far lateral broad-based disc protrusion at this level with resultant moderate left lateral recess compromise and mild central spinal stenosis. Bilateral neural foraminal remain patent.L2-L3 demonstrate mild to moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy and shallow broad-based bulging disc. Constellation of findings results in moderate central spinal stenosis, moderate right and mild left neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, diffuse bulging disc, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in significant central spinal stenosis and severe bilateral neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, shallow broad-based bulging disc, mild bilateral facet hypertrophy and suggestion of a prior left-sided laminectomy with focal expansion of thecal sac. Degenerative changes at this level results in mild central spinal stenosis and moderate to severe bilateral neural foraminal compromise (R>L).L5-S1 demonstrate moderate disc disease and loss of disc height, mild bilateral facet hypertrophy. There is no spinal stenosis and no significant neural foraminal compromise.No detectable. Spinal soft tissue abnormalities.Post enhanced images demonstrate expected enhancement of hypertrophic changes of posterior elements and unremarkable otherwise.

Output: 1.Pre and post enhanced cervical MRI demonstrated normal signal intensity and caliber of cervical cord without abnormal enhancement, no evidence of a spinal stenosis however there are multilevel neural foraminal compromise (mostly significantly) as detailed. Level above.2.Pre- and post enhanced MRI of thoracic spine is unremarkable.3.Pre and post enhanced lumbar MRI demonstrate degenerative changes of the lumbar spine with resultant significant central spinal stenosis at L3-L4 level and to a lesser degree at L1-L2 and L2-L3 levels as detailed. Left sided disc protrusion at the L1-L2 with resultant left lateral recess compromise. Multilevel neural foraminal compromise as detailed per level above. Unremarkable post enhanced images other than expected enhancement of hypertrophic changes. Normal signal intensity of the conus and the cauda equina without abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder pain, fall, s/p labral repair 2012 History: right shoulder pain, fall. ROTATOR CUFF: Mild supraspinatus, infraspinatus, and subscapularis tendinopathy with no discrete tears. The teres minor is intact. No muscle atrophy or edema.SUPRASPINATUS OUTLET: Mild to moderate AC joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Previously seen SLAP tear is no longer visualized with postsurgical changes of the superior labrum compatible with history of labral repair. No discrete tears are visualized.Mild osteoarthritis affects the glenohumeral joint.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.Postsurgical changes of the superior labrum compatible with history of repair. No discrete labral tears. 2.Mild rotator cuff tendinopathy.3.Mild to moderate AC and glenohumeral joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: 63 year-old female with BRCA gene mutation who presents for MRI guided biopsy of the right breast nonmass enhancement. Nonmass enhancement is identified in the medial aspect of the right breast, corresponding to the findings on the outside MRI breast, which is the target for today's MRI guided biopsy.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor with the aid of DynaCad software. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 6 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen digital radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a right unilateral digital mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed in the right breast at 2 o'clock position, which is approximately 1 cm lateral to the biopsy cavity. Benign calcifications are noted anterior and posterior to the biopsy cavity. No evidence of any complications due to the procedure. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Wang under direct supervision of Dr. Schacht who was present throughout the procedure.

Output: Successful MR guided core needle biopsy of the enhancing lesion at 3 o'clock in the right breast. The biopsy clip is approximately 1 cm lateral to the biopsy cavity. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: 78 years Female (DOB:9/23/1937)Reason: Evaluate for stenosis History: EMG shows multi-level lumbar radiculopathyReferring Attending: NAOUM P ISSA L5 appears to be a transitional vertebra and is partially sacralized there are 5 nonrib-bearing vertebrae present. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. There is mild anterior subluxation of L4 and L5. 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 a disc bulge present this level. There is right-sided facet hypertrophy present and to lesser degree left-sided facet hypertrophy.At L4-5 there is some loss of disc space height, disc desiccation and a diffuse disc bulge associated with ligamentum flavum hypertrophy and crowding of the nerve roots within the thecal sac. Overall there is a mild to moderate degree of spinal stenosis present at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is disc desiccation, loss of disc space height and a disc bulge associated with ligamentum flavum hypertrophy. There is crowding of the nerve roots at this level and overall a mild to moderate degree of spinal stenosis the fat at the lateral recesses is effaced bilaterally at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is infiltration of the pelvic fat planes associated with some pelvic fluid. This could represent a site is or inflammatory process. Correlating to a CT from 6/15/2016 and appears that a similar appearance was present.

Output: 1.There is infiltration of the pelvic fat planes associated with some pelvic fluid. This could represent a site is or inflammatory process or related to the patient's neoplasm. This is similar appearance to the CT of the abdomen from 6/15/2016. Please correlate with patient's clinical symptoms.2.No obvious lesions appreciated in the lumbar plexus. Please note however the sensitivity of MRI of the lumbar plexus without contrast is significantly lower than that with contrast for detection of carcinomatosis. As a result carcinomatosis cannot be adequately excluded.3.There are degenerative changes present in the lower lumbar spine with a mild to moderate spinal stenosis at L4-5 and L3-4.4.Please note that there is a transitional vertebra present with partial sacralization of L5.


Instruction: Generate impression based on findings.

Input: Right-sided acoustic neuroma, status post resection: yearly surveillance. Internal Auditory Canals: There are postoperative findings related to right retrosigmoid craniotomy, with mild right cerebellar hemisphere encephalomalacia. There is persistent enhancing tissue within the right internal auditory canal, with adjacent dural enhancement. The right inner ear structures are unremarkable. The left internal auditory canal and inner ear structures are unremarkable.Brain: There is no evidence of acute intracranial hemorrhage or acute infarct. There is minimal nonspecific scattered cerebral white matter T2 hyperintensity. 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 are grossly unremarkable. There is mucosal thickening and secretions in the right maxillary sinus.

Output: 1. Postoperative findings related to right vestibular schwannoma resection, without significant change in the appearance of the surgical bed.2. Findings suggestive of acute right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: Male, 56 years old. Reason: patient with known left thyroid PTC, please evaluate lateral and central lymph nodes for abnormality RIGHT LOBE MEASUREMENTS: 5.8 x 1.1 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.7 x 1.9 x 1.4 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Mildly heterogeneous echotexture. A nodule at the lateral aspect of the right thyroid lobe measures approximately 0.5 x 0.4 cm, mixed cystic and solid, incompletely characterized and nonspecific.LEFT LOBE: Mildly heterogeneous echotexture. A left lower pole nodule measures 0.9 x 0.6 x 0.7 cm, solid, isoechoic with calcifications and a hypoechoic rim, and internal vascularity.ISTHMUS: Mildly heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 5 lymph node measures 0.9 x 0.4 x 0.6 cm, with a fatty hilum. A left level 3 lymph node measures 0.6 x 0.3 x 1.3 cm, with suggestion of fatty hilum. An additional left level 3 lymph node measures 0.5 x 0.6 x 1.5 cm, with a fatty hilum. An additional left level 3 lymph node measures 1.1 x 0.6 x 0.9 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: 1.A subcentimeter solid left thyroid nodule correlates with a known history of capillary thyroid cancer.2.An additional subcentimeter mixed cystic and solid nodule at the lateral aspect of the right thyroid lobe is incompletely characterized and nonspecific.3.Subcentimeter cervical lymph nodes, most with fatty hila, as detailed above.


Instruction: Generate impression based on findings.

Input: 5-year-old female with unknown fall concern for NAT, requiring intubation at OSH with small left SDH with no mass effect on CT. Evaluate for DAI and other trauma. MRI brain:There is extensive cortically based restricted diffusion in the cerebral hemispheres, particularly involving the left greater than right frontoparietal, occipital and posterior temporal regions. There is relatively more symmetric extensive restricted diffusion involving the deep gray nuclei and brain stem, particularly the midbrain but also minimally the pons. Punctate foci of restricted diffusion in various areas including the splenium of the corpus callosum and fornix probably reflect additional areas of ischemic injury with shear injury a less likely consideration.Again seen is a stable trace left acute subdural hematoma with unchanged 3-5 mm of rightward midline shift and evidence of evolving small amount of subarachnoid hemorrhage along the left frontal lobe sulci. The ventricles are probably slightly reduced in caliber but patent. The basal cisterns are visualized and there is no frank herniation at this point. The major cerebral flow voids are intact. There is left maxillary sinus mucosal thickening.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Extensive diffuse anoxic ischemic injury, involving the left more than right cerebral cortices, and the bilateral deep gray nuclei and brainstem. There is no evidence of herniation.Stable evolving trace 3 mm left convexity subdural hematoma and minimal left frontal region subarachnoid hemorrhage.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain Mild osteoarthritis for the left hip. In addition, there is patchy lucency and sclerosis in both femoral heads that may represent avascular necrosis. This could be further evaluated with MRI if clinically warranted. Facet joint osteoarthritis affects the lower lumbar spine.

Output: Mild osteoarthritis of the left hip and possible bilateral femoral head avascular necrosis which could be further evaluated with MRI if clinically warranted.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other convulsionsClinical question: Evaluate for etiology of seizuresSigns and Symptoms: R and L temporal lobe seizuresComments: Please perform Friday 7/18/2015 after the EEG leads have been discontinued - Seizure 2 protocol with coronal FLAIR | The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The hippocampi are symmetric with no signal abnormality.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.Incidental note is made of partial empty sella.

Output: 1.Several periventricular and subcortical white matter punctate signal changes are nonspecific and likely of little clinical significance given their small number.2.No evidence for mesial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: Ms. Ward is a 40 year old female presenting for MRI evaluation of a mammographically/sonographically detected abnormality in the left upper outer breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Although there is marked background parenchymal enhancement noted bilaterally, no discrete abnormality is seen to correspond to the mammographically and sonographically detected abnormality in the left upper outer breast.Multiple scattered T2 hyperintense nonenhancing cysts are identified bilaterally, the largest of which is identified in the left lateral breast measuring up to 1.5 cm.No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Marked background parenchymal enhancement, which limits the sensitivity of this examination.(2) No discrete abnormal MR enhancement seen in the left upper outer breast to correspond to the mammographically and sonographically detected abnormality. The patient is scheduled for an ultrasound-guided biopsy immediately following this MRI.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: 75-year-old male with persistent left-sided back pain in the lower thoracic and high lumbar region. Signs and symptoms: As above. Nonenhanced thoracic MRI:Examination demonstrates multiple foci of marrow signal replacement consistent with metastatic disease throughout the thoracic spine and partially visualized C7. Findings involve the vertebral bodies and posterior elements. The largest metastatic lesion involves the vertebral body of T9 which also extends to bilateral posterior elements and articulating facets (left greater than right). There is evidence of significant epidural spread of tumor at this level on the left both posteriorly and anteriorly which results in significant mass effect on the cord and central spinal stenosis. The signal intensity of the cord cannot be properly assessed due to significant mass effect. Tumor at this level also extensively involves the T8-T9 and T9-T10 neural foraminal on the left and patent neural foramen on the right.All other small metastatic lesions remain intraosseous and without detectable spread into the epidural space or perispinal soft tissues. Metastatic lesions are present in vertebral body of C7, vertebral body of T3 and its posterior elements, posterior element of T5, vertebral body of T7, vertebral body of T8 and its posterior elements, vertebral body of T10, vertebral body of T11, vertebral body of T10 and its posterior elements. No evidence of spinal canal compromise at any other level.Nonenhanced lumbar MRI:This examination also demonstrates extensive osseous metastatic lesions involving vertebral bodies and posterior elements. The lesion appear to be entirely intraosseous and without convincing evidence of spread into the epidural space on this nonenhanced exam. The largest metastatic lesion involves vertebral body of T5. There are however metastatic lesions present throughout the lumbar and visualized sacral spine.There is no evidence of central spinal stenosis at any level. Moderate to advanced degenerative disc disease and moderate to significant hypertrophic changes of posterior elements in the lower lumbar spine is noted. There is significant right neural foraminal compromise at L4-L5 secondary to degenerative changes.DR. Amid Patel patient's cardiologist and Dr. Susan Hong primary care physician covering for Dr. Diane L. Altkorn were notified by phone of the findings and concerns on this study at the time of review of exam.

Output: 1.Nonenhanced MRI of the thoracic spine demonstrate extensive osseous metastatic lesions involving vertebral bodies and the posterior elements as detailed. The largest metastatic lesion involves extensively the T9 vertebrae and with extension posteriorly into bilateral pedicles and articulating facets (left greater than right). Epidural extension of tumor on the left with resultant significant central spinal stenosis and mass effect on the cord as detailed. None of the other diffuse metastatic lesion demonstrate extension into the spinal canal and no central spinal stenosis. Please review detailed report above.2.Nonenhanced MRI of lumbar spine demonstrate diffuse osseous metastatic lesions of the vertebral bodies and posterior elements without convincing evidence of extraosseous spread into the spinal canal or the perispinal soft tissues. Extensive degenerative changes of lumbar spine without convincing evidence of central spinal stenosis. Neural foraminal compromise however is detected.


Instruction: Generate impression based on findings.

Input: Diagnosis: Chronic post-traumatic headache, intractableClinical question: Workup for post concussion syndrome and chronic migraines that are slowly evolving to accompany lethargy, lightheadedness, vertigo, hyperacusis on Rt 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.A couple punctate left frontal periventricular white matter lesions are present which in isolation are of little clinical significance.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 anterior cerebral artery at the A2 segment appears to be azygos. The right A1 segment appears larger than the left A1 segment.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: MRI of the brain is within normal limits. A couple punctate lesions in the left frontal lobe are likely of little clinical significance.


Instruction: Generate impression based on findings.

Input: Abdominal pain, cholangiocarcinoma and perforated gallbladder status post IR drain ABDOMEN:LIVER, BILIARY TRACT: Interval removal of cholecystostomy and perihepatic collection drains. No loculated perihepatic fluid collections. Mild intra and extrahepatic biliary ductal dilation. There is mild biliary wall thickening just below the Klatskin point. The patient's known tumor may be obscured by the common bile duct stent. However, there is hazy soft tissue posterior to the common bile duct, which appears to encase a replaced right hepatic artery and abuts the anterior margin of the portal vein without definite vessel invasion (series 11, image 56). No evidence of liver metastases.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Interval removal of cholecystostomy and perihepatic collection drains with resolution of perihepatic fluid collection.2.Hazy soft tissue posterior to the common bile duct, which encases the right hepatic artery and abuts the anterior margin of the portal vein without discrete vessel invasion.3.Replaced right hepatic artery.


Instruction: Generate impression based on findings.

Input: 19-year-old male with pain and instability, evaluate for ACL/meniscal tear MENISCI: The medial meniscus is intact. There is increased linear signal within the posterior horn of the lateral meniscus which does not definitively reach the surface. No definite lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: No abnormal marrow signal. The articular cartilage is intact.LIGAMENTS: The ACL is not well visualized and likely torn. The PCL is intact. The MCL and lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: ACL tear.


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: s/p hepatic resection now with ?fluid collection and elevated bili History: elevated bili ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from resection of the left hepatic lobe. There is a fluid collection measuring 6.5 x 5.7 cm adjacent to the surgical resection margin. The collection has some internal debris.There is some mild intrahepatic biliary ductal dilatation on the right. Common bile duct measures 8 mm.No suspicious lesions in the right hepatic lobe.Status post cholecystectomy.SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense right renal lesion likely represents a proteinaceous cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a left lower lobe pulmonary nodule partially imaged.

Output: 1.6.5 cm collection adjacent to the surgical resection margin. Fissure considerations include postsurgical collection vs. biloma. On the delayed imaging, no Eovist contrast is noted within the lesion reducing the likelihood this is a biloma.2.Left lower lobe pulmonary nodule follow-up is recommended.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (5/17/16) performed at Magnetic Resonance Imaging Center. For comparison, outside studies of digital mammographic images (4/21/16), ultrasound images of left breast (4/21/2016), a specimen radiograph and left digital mammographic images (5/5/2016) are available. BREAST MRI (5/17/16):Breast MRI was performed with a protocol outlined in the outside radiology report.There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.There is a susceptibility artifact from a marker clip of recent DCIS biopsy at posterior far-lateral, superior aspect in the left breast. Because of strong parenchymal enhancement, no discrete enhancement around the marker clip is identified.No abnormal lymph nodes are identified in either axillary region.

Output: Non-diagnostic MRI due to marked parenchymal enhancement. If clinically indicated, repeat MRI at University of Chicago utilizing high temporal resolution technique can be performed.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Transphenoidal surgery for Cushing syndrome and foramen decompression for Chiari malformation. Pituitary: There has been expected interval evolution of postoperative findings related to transsphenoidal surgery. There is no definite evidence of a discrete pituitary mass. The remaining pituitary gland is not enlarged and there is no mass effect upon the optic apparatus. The infundibulum is intact and not significantly deviated. The cavernous sinuses are intact. Brain: There are stable postoperative findings related to Chiari decompression with an unchanged position and configuration of the cerebellar tonsils. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchymal signal appears unremarkable. The ventricles are stable in size and configuration, with asymmetric lateral ventricles in which the left is slightly smaller than the right. The major cerebral flow voids are intact. There is a small left maxillary sinus retention cyst. The skull and extracranial soft tissues are otherwise unremarkable.

Output: 1. Postoperative findings related to transsphenoidal surgery without definite evidence of residual or recurrent pituitary tumor.2. Expected postoperative findings related to foramen magnum decompression for Chiari malformation.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with pain and paresthesias. Neck pain radiating to the upper extremities, right more than left. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or marrow replacement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or foraminal narrowing. C3-4: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe left foraminal narrowing. C4-5: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. C5-6: Left greater than right facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or foraminal narrowing.C6-7: Left facet arthropathy. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Relatively mild degenerative findings are seen with no areas of high-grade spinal canal stenosis. Facet arthropathy and minimal disc osteophyte formation do, however, contribute to a moderate to severe narrowing of the left C3-4 neural foramen.


Instruction: Generate impression based on findings.

Input: Clinical question: Dementia. Signs and symptoms: Dementia. Nonenhanced brain MRI:No diffusion-weighted abnormalities.There are few punctate nonspecific foci of FLAIR and T2 hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Considering patient's stated age of 77 findings likely representing minute chronic nonhemorrhagic small vessel ischemic strokes.The signal intensity of brain is otherwise within normal on all MRI sequence.There is however diffuse prominence of cortical sulci and supratentorial ventricular system which although could be within upper normal range considering patient's age, possibility of underlying parenchymal volume loss is also of concern. Images through posterior fossa are unremarkable.The signal void of all major intracranial vasculature is identified.Calvarium and scalp are unremarkable.Images through the orbits are unremarkable.Paranasal sinuses and mastoid air cells age well pneumatized.

Output: 1.No acute findings.2.Prominence of cortical sulci and the supratentorial ventricles concerning for volume loss. See above comments.3.Findings suggestive of minute chronic nonhemorrhagic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Reason: prostate cancer; please evaluate for high risk features on MRI History: prostate canerBiopsy 6/23/2014: right apex Gleason 7 adenocarcinoma PELVIS:PROSTATE:Prostate Size: 5.0 x 3.2 x 4.0 cmPeripheral Zone: Right apical lesion which is T2/ADC dark measures 1.3 x 0.9 cm (703/264), suspicious for prostate adenocarcinoma.Central Gland: Few small BPH nodulesSeminal Vesicles: No evidence of seminal vascular invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diverticulosis without evidence

Output: 1.Lesion at the right apex peripheral zone is suspicious for prostatic adenocarcinoma.2.No pelvic adenopathy or evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Reason: ms progression History: pain, leg weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular white matter lesions which are bright on T2 and flair sequences as well as lesions extending to the corpus callosum at the callosocingulate junction. Punctate lesions are also present in the right thalamus and left thalamus. Comparing to the previous exam the number and distribution of these lesions has not changed. One in particular along the trigone of the left lateral ventricle is less conspicuous on the current exam when compared to the prior examNo 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 demonstrate partial opacification of the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate prolapse of some of the left orbital fat into the maxillary sinus suggestive of a prior left orbital wall which has not changed since the prior exam.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There is redemonstration of a lesion which is hyperintense on T2-weighted imaging located along the right posterior and lateral aspect of the spinal cord at the C2-3 level which measures 10 mm superior inferior dimension. There is redemonstration of a lesion which is hyperintense on T2-weighted imaging located in the left hemicord posteriorly measuring 2 x 5 mm axial dimensions and 9 mm superior inferior length. This is also stable compared with prior exam.There is a 10-mm T1 hyperintense lesion within the T1 vertebral body most likely represent a vertebral body hemangioma.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 no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present 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: 1.There are multiple lesions scattered in the supratentorial brain which are relatively stable when compared to prior exam with the exception of a left periventricular white matter lesion adjacent to the trigone of the left lateral ventricle which has regressed since the prior exam. No new lesions are appreciated. This is compatible with patient's clinical history of demyelinating disorder2.There are couple lesions in the cervical spinal cord which are stable since the prior exam and compatible with patient's clinical history of demyelinating disorder.3.Old left orbital blowout fracture.


Instruction: Generate impression based on findings.

Input: 69-year-old female presented with left hand paresthesias, ataxia, and left-sided dysmetria, evaluate for stroke. Please note that the exam is limited by significant motion artifact, with nondiagnostic SWI sequence. There are several foci of restricted diffusion within the right medial occipital lobe and right thalamus. These areas demonstrate some degree of associated T2/FLAIR hyperintensity and are compatible with an acute/subacute right posterior cerebral artery territory infarct. Scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter are consistent with mild chronic small vessel ischemic changes. There is no evidence intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. Redemonstration of partial opacification of the right maxillary sinus.

Output: 1. Motion limited exam. Acute to subacute right posterior cerebral artery territory infarct involving the right medial occipital lobe and right thalamus.2. Mild chronic small vessel ischemic changes. The above findings were communicated via telephone to Reza Kanani, MD (Neurology ROC) by Dr. Danial Jilani at 10:45 AM on 12/28/2015.


Instruction: Generate impression based on findings.

Input: Migraine with aura, not intractable, without status migrainosus [G43.109], Reason for Study: ^Reason: intracranial process explaining worsening headaches History: severe headaches bilateral temporal, localizing to L. Temporal, nocturnal awakening. No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.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. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cysts is on the left maxillary sinus.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Low back pain and left leg pain. There is mild bilateral ligamentum flavum thickening and loss of disc space height and fluid signal at L5-S1 with a small annular fissure and slight disc bulging with slight bilateral neural foramen narrowing, but no significant spinal canal stenosis. There is no significant disc bulge or herniation at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged portions of the spinal cord and cauda equina nerve roots appear to be intact. The paravertebral soft tissues are unremarkable.

Output: Disc desiccation at L5-S1 with a small annular fissure and slight disc bulging with slight bilateral neural foramen narrowing, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Other convulsions [780.39], Reason for Study: ^Reason: STROKE History: SEIZURE There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Small high signal intensity foci on the left temporal lobe anterior pole on FLAIR images is non specific including focal lacunar infarction, or other demyelination lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Air fluid level on the right maxillary sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion.Non specific focal high signal intensity on the left temporal lobe anterior pole, otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: History of breast cancer with newly diagnosed right parietal brain lesion, status post recent right tumor resection. There are recent postoperative findings related to right precuneus tumor resection, with blood products in the treatment bed region. There is enhancement along the margins of the resection cavity, particularly the superior and inferior margins, measuring up to 10 mm in thickness. There is also confluent T2 hyperintensity surrounding the resection cavity. There is an extradural fluid collection deep to the craniotomy flap that measures up to 5 mm in thickness. There is also overlying diffuse scalp swelling and fluid. There is no evidence of acute territorial infarct. There are mild scattered nonspecific foci of T2 hyperintensity. 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 are grossly unremarkable.

Output: Recent postoperative findings related to right parietal lobe tumor resection, with what likely represent residual tumor along portions of the surgical margins and persistent surrounding vasogenic edema.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Multifocal 3+4 cancer. PELVIS:PROSTATE:Prostate Size: 2.4 x 4.4 x 3.5Peripheral Zone: Multifocal sites of signal abnormality with the dominant lesion in the left peripheral mid gland there is T2-weighted hypointensity with associated postcontrast enhancement extending to the apex and base of the prostate measuring up to 1.5 x 1.1 cm (series 1101/14) compatible with patient's prostatic adenocarcinoma. Central Gland: BPHSeminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: There is extra prostatic extension along the anterolateral aspect of the left peripheral zone adjacent to the dominant lesion.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent right external iliac lymph node noted measuring 6 mm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multifocal prostatic adenocarcinoma with suspected extraprostatic extension along the anterolateral aspect of the left peripheral zone mid gland lesion.2.No pelvic lymphadenopathy by size criteria.3.No evidence of seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of meninges, unspecified [D32.9], Reason for Study: ^Reason: Eval for clival/sphenoid meningioma History: H/O meningioma followed by scans, eval for change/growth No evidence of acute ischemic or hemorrhagic lesion.Minimal nonspecific small vessel ischemic disease, unchanged.Diffuse dural thickening and enhancement along the clivus extends along bilateral prepontine cistern indicating possible meningioma are redemonstrated, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Right maxillary sinus retention cyst is seen.

Output: Unchanged dural thickening and enhancement at clivus and bilateral petrous apex areas indicating meningioma since prior scan.No acute ischemic or hemorrhagic lesion.No other abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Some sequences are motion degraded, limiting fine detail. No significant susceptibility is identified in the area of concern. In the surgical defect along the lateral left maxillary alveolar process, there is ill-defined low T1 signal mild and associated effacement of the fat, as well as mild ill-defined enhancement which is nonspecific and may be postoperative in etiology or represent an inflammatory process. There is otherwise no discernible abscess or fistula tract, although some areas of subtle irregular perhaps minimally linear enhancement might be suggested in this area on prior CT. There are several absent left maxillary teeth.There is minimal mucosal thickening of the maxillary sinuses bilaterally. There is trace mucosal thickening in the anterior ethmoid air cells. There is mild leftward deviation of the nasal septum. There is fluid in the mastoid air cells bilaterally, right greater than left.

Output: 1.Ill-defined low T1 signal and mild enhancement in the surgical defect correlates with asymmetry in same area on previous CT, and may be postoperative in etiology or represent an inflammatory process. 2.No definite evidence of abscess or sinus tract as clinically questioned.


Instruction: Generate impression based on findings.

Input: 57 year old with newly diagnosed left breast DCIS and dense breasts. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, somewhat of a limitation.In the left lower central breast, there is non-mass enhancement with adjacent foci of enhancement greater than the extent of calcifications on mammography. This is located primarily lateral to the biopsy site/artifact from the biopsy clip. Mild enhancement is noted around the biopsy site. Inclusive of the biopsy site, the area measures 3.5 x 2.3 x 2.9 cm (AP x LM x oblique CC). In the right outer breast near 9:00, an oval enhancing mass measuring 1.4 x 0.6 x 0.7 cm is present. This has predominately high T2 signal, typically benign persistent enhancement and may represent a fibroadenoma. No abnormal lymph nodes are identified in either axillary region.A hiatal hernia is noted.

Output: 1. Area of suspicious enhancement in the left inferior breast measuring up to 3.5 cm located primarily just lateral to the biopsy site changes.2. 1.4 cm mass in the right outer breast is probably benign. An MRI directed ultrasound is recommended. As long as the ultrasound finding is concordant with a benign mass, imaging follow up in 6 months would be appropriate. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Baseline MRI prior to starting systemic chemotherapy treatment. Compared to study from 3 -- 5 -- 15. Signs and symptoms: Pre-and post-enhanced brain MRI:Examination demonstrate postoperative changes of a large right cerebellar resection. The CSF signal intensity surgical cavity without interval change in size is again noted. There is a very thin partial rim enhancement of the surgical cavity without convincing evidence of tumor residual or recurrence with interval improvement since prior study.Supratentorially examination demonstrate significant interval increase in parenchymal and leptomeningeal enhancement extending from left anterior temporal posteriorly at the site of previously resected tumor and highly concerning for recurrence. A very faint focus of enhancement at the site superficially in the left anterior temporal which measured 9 times 10-mm in size demonstrate significant interval increased size in an irregular fashion. There is also or increased ventricular thick rim enhancement of the left posterior temporal surgical cavity. In addition a new single parenchymal focus of enhancement in the periventricular white matter of left trigone of lateral ventricle (axial post enhanced series 1501 image 17) is concerning for new metastatic lesion. This finding measures approximately 5.9 x 6.5-mm and demonstrate restriction on diffusion weighted series.Expected postoperative changes of a large left frontal temporal craniotomy with mild epidural thickening under the craniotomy flap and with expected dural thickening and enhancement.

Output: 1.Significant interval increase enhancement of parenchyma and the leptomeninges in the left anterior and mid temporal lobe as well as surrounding the left temporal surgical cavity concerning for progression of disease. New small focus of enhancement in the periventricular white matter left trigone as mentioned above.2.Stable post operative changes right cerebellar without evidence of residual or recurrence.3.Stable dilated left lateral ventricle and mildly prominent right lateral ventricle with maintained midline.4.Expected postoperative changes of larger left frontal -- temporal craniotomy as detailed.