Instruction: Generate impression based on findings.

Input: 50 year-old female with recurrent large B-cell lymphoma status post extubation today. Platelets = 25. Now, with asymmetric pupils left greater than right with left poorly reactive to light. There is no evidence of intracranial hemorrhage, mass or edema. Bilateral lacrimal gland enlargement. Overall the right lacrimal gland is stable however, the left is larger when compared to the prior study.On review of the prior study, significant prominence and enhancement of the cavernous sinus was noted. MRI is recommended to rule-out tumor involvement at that location, if clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. Fluid thickening within the sphenoid and left maxillary sinus consistent with sinus disease. Retention cyst/polyp seen within the left maxillary sinus.

Output: 1. Stable, right lacrimal gland enlargement with new interval enlargement of the left lacrimal gland.2. Enhancement and prominence of the cavernous sinus noted on prior study of 12/5/07. MRI is recommended to rule out tumor involvement at this location, if clinically warranted.


Instruction: Generate impression based on findings.

Input: 45-year-old man with history of recurrent glioblastoma on Avastin therapy. There are multiple areas of abnormal signal and enhancement, overall increased in extent from the prior examination. There is a large area of heterogeneous, increased T2 signal involving the right thalamus, cerebral peduncle, posterior limb of the internal capsule, putamen, insular cortex, and temporal and parietal white matter with a surrounding, faint T1 hyperintense rim suggestive of blood products or hemorrhage. This area also contains small areas of T2 hyperintense cystic degeneration. This area measures 50 x 49 mm (10/24), previously 40 x 46 mm. Within this area, there is restricted diffusion and decreased cerebral blood volume (image 2).The area of signal abnormality in the right precuneus, post central gyrus, and splenium of the corpus callosum (12/28) appears larger than the prior examination, measuring 39 x 20 mm, previously 35 x 18 mm. This area has changed in enhancement characteristics, now enhancing only peripherally, previously more homogenously. Additionally, there are spiculated areas of internal susceptibility suggestive of vascularization (8/118) and increased cerebral blood volume (image1).An area of signal abnormality in the left periatrial white matter (12/18) has increased in size measuring approximately 13 x 10 mm, previously 10 x 8 mm. This area also has change in enhancement characteristics, now enhancing peripherally, whereas it previously was more homogenous enhancement. Spiculated areas of internal susceptibility are also noted in this region (8/92) and there is increased cerebral blood volume (image 3).There is overall increase in the extent of FLAIR hyperintensity which, in addition to the right frontal, parietal, temporal lobes, and basal ganglia, now includes the left periatrial white matter (3/22). Additionally, there is new T2 and FLAIR hyperintensity in the subcortical white matter of the left parietal lobe (3/20). There is subtle enhancement of the lateral ependymal lining of the right temporal horn (12/14) which extends along the lateral wall of the ventricle. Although there is associated mass effect with compression of the trigone of the right lateral ventricle, the lateral ventricles are mildly enlarged. There is no frank midline shift, or herniation. There is a right transtemporal catheter with surrounding susceptibility artifact indicating chronic blood products. There is no restricted diffusion to suggest acute ischemia. There is no large intracranial hemorrhage. The major flow voids are preserved. The orbits, paranasal sinuses, and calvarium are grossly unremarkable.

Output: 1.Extensive tumor centered in the right cerebral hemisphere, overall increased in extent. Tumor involving the right thalamus, cerebral peduncle, internal capsule, putamen, insular cortex, and parietal white matter appears similar to the prior examination with decreased blood volume and diffusion restrictions suggestive of treated tumor.2.Increase in size but change in enhancement pattern of adjacent right precuneus, post central gyrus, and corpus callosum tumor. Increased cerebral blood volume in this region suggests viable tumor.3.Increase in size of satellite left periatrial white matter tumor with change in enhancement pattern. Again, increased cerebral blood volume suggests viable tumor in this location.4.Enhancement along the temporal horn of the right lateral ventricle along with ventriculomegaly is suggestive of ependymal spread.


Instruction: Generate impression based on findings.

Input: Patellar dislocation and instability Note that the exam is limited by motion artifact.MENISCI: There is mild intrasubstance signal within the anterior horn of the lateral meniscus and mild attenuation of the posterior horn of the medial meniscus but there is no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited by motion. There appears to be mild diffuse thinning of the articular cartilage of the patella superiorly but no focal fluid-filled tear is identified. There is mild subjective thinning of the articular cartilage of the lateral tibial plateau but again no fluid-filled defect is appreciated. There is poorly defined signal abnormality within the intercondylar eminence of the tibia which is likely degenerative in nature. Patchy foci of residual red marrow are seen in the distal femur.LIGAMENTS: The cruciate and collateral ligaments are intact. There is thickening and irregularity of the MPFL particularly at its attachment on the patella suggesting chronic tearing.EXTENSOR MECHANISM: There is increased signal intensity of the quadriceps tendon indicating tendinosis. The patellar tendon is intact. There is approximately 2 cm of lateral subluxation of the patella relative to the center of the femoral trochlea. There is no femoral trochlear dysplasia or patella alta. The TT to TG distance is elevated measuring 2.6 cm.ADDITIONAL

Output: Lateral subluxation of the patella with increased TT to TG distance and chronic MPFL tearing. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Lung squamous cell carcinomas brain and spinal metastasis. Altered mental status. The study is limited by patient motion.The multiple cortical and subcortical foci of contrast enhancement in both cerebral hemispheres show no significant overall change since the previous examination from March 2016. For example, cortical enhancement along the right central sulcus, which also shows diffusion restriction, is mildly improved with improved associated edema. Most of the other lesions are similar to prior. A few appear to be very slightly more prominent than on the prior examination, including one in the right pars opercularis, which shows slightly increased enhancement and slightly increased edema. Many of the lesions show associated susceptibility effect reflecting the presence of microscopic blood products or mineralization. There is no definite new focus of contrast enhancement. There is no significant mass-effect, midline shift or brain herniation. While the cortical contrast enhancement may involve the adjacent leptomeninges, there is no diffuse pachymeningeal or leptomeningeal contrast enhancement. No enhancement of the cranial nerves is seen.Bifrontal encephalomalacia with surrounding T2 hyperintensity, left side more so than right, is unchanged compared to the April 2016 examination. Mild ex vacuo enlargement of the frontal horns of the lateral ventricles is also unchanged. This may reflect posttreatment change. The major intracranial vascular flow voids are preserved.There is minimal fluid signal intensity in the mastoid air cells, which is unchanged. The orbits are grossly unremarkable. There is no destructive skull lesion.

Output: 1.The examination is at least moderately limited by patient motion.2.Compared to March 2016 examination, there has been no significant overall change involving the numerous small cortical/subcortical enhancing lesions. Mild interval changes as described above, with some lesions appearing slightly smaller and others slightly larger, could be accounted for by differences in the technique between the two examinations.


Instruction: Generate impression based on findings.

Input: Olfactory groove meningioma status post subtotal resection on 2/17/15. Re-evaluation after stage II resection of olfactory groove meningioma on 2/25/15. The patient also experiences diplopia. There are postoperative findings related to recent bifrontal craniotomy with areas of susceptibility along the margins of the resection cavity and diffuse scalp and face swelling. There is nodular enhancement in the posterior aspect of the resection cavity, adjacent to the anterior cerebral arteries, that measures up to 20 mm and is compatible with represent residual tumor. There also appears to be nodular enhancement along the left planum sphenoidale that measures up to 10 mm and may represent residual tumor. Otherwise, there is diffuse linear enhancement along the margins of the resection cavity, which likely represent granulation tissue, as well as diffuse regional reactive dural enhancement. The left optic nerve abuts this dural enhancement proximal to the optic strut. The optic apparatus and orbits otherwise appear intact. There is extensive residual edema in the deformed bilateral frontal lobes. The ventricles are unchanged in size and configuration. There is no evidence of territorial infarction.

Output: Postoperative findings related to olfactory groove meningioma resection with evidence of residual tumor in the posterior aspect of the resection cavity and perhaps along the left planum sphenoidale and extensive residual edema in the bilateral frontal lobes.


Instruction: Generate impression based on findings.

Input: eval AVN talus L History: pain TENDONS: The imaged tendons of the foot and ankle are intact. The Achilles tendon is normal in caliber and signal.LIGAMENTS: The ligaments of the ankle and midfoot are intact.ARTICULAR SURFACES AND BONE: The articular cartilage demonstrates normal signal and morphology. Vertically oriented linear high signal within the mid calcaneus is consistent with a prominent vascular remnant. ADDITIONAL

Output: Normal examination. No osseous signal abnormality to suggest avascular necrosis as suggested clinically.


Instruction: Generate impression based on findings.

Input: Female 2 years old Reason: Extent of LPA stenosis History: LPA stenosis and hypoplasia by echo Examination is somehow limited due to motion artifact.Left VentricleNormal left ventricle with no evidence of hypertrophy or septal defects.Left AtriumThe left atrium is normal. Right VentricleNormal right ventricle with no evidence of ventricular dilatation, hypertrophy or septal defect. Right AtriumThe right atrium is normal. Aortic ValveDedicated through plane imaging was not performed.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation visualized. Dedicated through plane imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. The main pulmonary artery is 12.6 mm in diameter. The right pulmonary artery is 7.1 mm in diameter. The left pulmonary artery is 7.1 mm in diameter as well with no definite evidence of stenosis. Qualitative flow distribution through both lungs is symmetric.Right pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 8Forward flow volume in ml: 8.2Backward flow volume in ml: 0.2Regurgitant factor in %: 1.9Left pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 5.3Forward flow volume in ml: 5.3Backward flow volume in ml: 0Regurgitant factor in %: 0LPA flow velocity is 26.1 cm/s. RPA flow velocity is 26.5 cm/s.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.

Output: 1. Within the limitations described above, no definitive findings to confirm the suspicion of left pulmonary artery stenosis.2. No significant difference in the flow volume in between right and left pulmonary arteries.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: 13 mo with SCID, now Day +95 BMT, not engrafted, frequent falls/gait instability. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis or mass lesions. The spinal cord displays normal signal and morphology. The conus medullaris is situated at the L1-2 level and the cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Normal cerebral myelination for age and no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of spine anomalies.


Instruction: Generate impression based on findings.

Input: 62-year-old male with known AVN, neutropenic fever, bacteremia. Rule out osteomyelitis There is marked deformity of the left femoral head with collapse and fragmentation consistent with underlying avascular necrosis as well mottled bone marrow signal intensity consistent with marrow replacement. There are no MRI findings to suggest superimposed osteomyelitis however. The remaining visualized femur is unremarkable. There is mild inflammatory changes within the overlying soft tissues with no fluid collection or abscess or sinus tract extending to the adjacent bones. On the lateral most images there is mottled signal intensity within the vastus lateralis muscle which is incompletely imaged and is nonspecific. Profound metal artifact related to right total hip arthroplasty obscures the right hip. No significant abnormality is noted within the pelvis or remaining soft tissues.

Output: 1. Underlying avascular necrosis of the proximal femur with no findings to suggest superimposed osteomyelitis.2. Nonspecific mottled signal intensity within an incompletely visualized vastus lateralis muscle. Consider dedicated imaging if clinically warranted.


Instruction: Generate impression based on findings.

Input: 65-year-old male with history of renal cell cancer and brain metastases. Evaluate for progression. Three enhancing brain metastases are redemonstrated. The bilateral frontal lobe lesions have decreased in size and there is resolution of associated surrounding vasogenic edema. The largest lesion in the right frontal lobe in the superior frontal gyrus measures 8 mm, previously 10 mm. A second lesion in the left middle frontal gyrus measures 4 mm, previously 6 mm. However, there has been slight interval growth of the lesion located in the right occipital lobe, now measuring 7 mm, previously 5 mm, along with increased associated vasogenic edema. No new enhancing lesions are identified. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift. There is no evidence of acute ischemia. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Bilateral frontal lobe metastases have decreased in size with resolution of associated edema.2.A right occipital lobe metastasis has increased in size along with the associated vasogenic edema.


Instruction: Generate impression based on findings.

Input: Female, 46 years old. Reason: L shoulder MR arthrogram to evaluate for SLAP tear History: above ROTATOR CUFF: The rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is unremarkable. There is extravasation of contrast from the glenohumeral joint into the subscapularis, compatible with a small volume joint as is seen in adhesive capsulitis.No contrast is seen within the subdeltoid/subacromion bursa.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Findings compatible with adhesive capsulitis. Otherwise negative examination.


Instruction: Generate impression based on findings.

Input: Back pain, previous MRI with disc protrusion and annular tear Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild retrolisthesis of L5 on S1 which was present on prior study. Alignment is otherwise maintained. Bone marrow signal is benign. There is edema involving the L5-S1 disc as well as the L5 and S1 vertebral bodies which is new since prior. There is moderate loss of disc height at this level, slightly worse in the interval. There is questionable mild surrounding edema. No discrete paraspinous or epidural collections. There is a small disc protrusion at this level which is not significantly changed since prior. Disc desiccation at the L4-L5 level is also noted and was also present previously. The conus medullaris is normal in position.Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation with minimal disc bulge with dorsal annular fissure as before. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: Central disc protrusion as before. There has been worsening of disc height loss and increased signal abnormality in the disc and endplates as described above. Mild fluid in the facet joints as before. There is mild right worse than left neural foraminal stenosis which has progressed.

Output: Compared to 9/6/2011, there has been progression of degenerative changes at the L5-S1 level with worsening of disc height loss. There is particular increase in edema involving the disc and adjacent endplates which may be on a progressive degenerative basis. Early discitis-osteomyelitis however cannot be excluded and if there is clinical suspicion for infection, short-term follow-up MRI with post gadolinium and diffusion-weighted sequences should be considered.


Instruction: Generate impression based on findings.

Input: Reason: prostate cancer History: see above PELVIS:PROSTATE:Prostate Size: 5.2 x 4.1 x 4.5 cmPeripheral Zone: Wedge-shaped region of low T2/ADC and the right mid gland peripheral zone without early enhancement measures 0.8 x 0.6 cm (501/64).Central Gland: BPH nodules.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Small indeterminate lesion in the right mid gland peripheral zone.2.Enlarged prostate with BPH.


Instruction: Generate impression based on findings.

Input: Glioblastoma. Evaluate progression. There are postoperative findings of right parietal craniotomy for biopsy of a right temporal lobe mass. Compared to the prior study, there is been continued progression of multiple sites of enhancing tumor. The reference of satellite lesion anterolateral to the dominant mass measures 15 x 12 mm, previously 12 x 8 mm. Multiple additional satellite lesions has also increased in size. The dominant component of the solid and cystic mass measures 4.3 x 4.1 x 4.6 cm, previously 4.1 x 3.9 x 4.4 cm and extends into the midbrain. Intrinsic T1 signal within the dominant mass has decreased from the prior study, compatible with evolving postoperative changes. There is progressive thickening and T2 hyperintensity of the right splenium of the corpus callosum. There is also markedly increased T2 hyperintensity in the posterior left lateral periventricular white matter region. Otherwise, the extent of associated T2 hyperintensity appears similar to the prior study. There is persistent local mass effect on the midbrain and right lateral and third ventricles, with increase dilatation of the left lateral ventricle. There is diffuse local sulcal effacement and approximately 7 mm of leftward midline shift. There is no or evidence of acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Evidence of tumor progression, with increased size of the dominant right temporal lobe mass and increased size and number of multiple satellite lesions and slightly increased obstructive hydrocephalus.2.Continued evolution of postoperative findings related to tumor biopsy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right upper extremity weakness, hyperreflexia, and multiple falls. There are scattered foci of cortical and subcortical high T2 signal with restricted diffusion as well as punctate enhancement in the left frontal and parietal lobes in a distribution that coincides with the ACA-MCA watered territory. There is no evidence of intracranial hemorrhage, mass, or midline shift. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive mucosal thickening and secretions within the left maxillary and sphenoid sinuses. There is fluid and enhancement within the left mastoid air cells.

Output: 1. Subacute infracts in the left ACA-MCA watered territory, without midline shift or hemorrhagic transformation.2. Findings suggestive of acute sinusitis and mastoiditis.


Instruction: Generate impression based on findings.

Input: Dysphagia, unspecified for 2 years, recurrent episodes of left-sided numbness of face, arm, leg. Rule out ischemic lesion of right side of cerebrum or brainstem. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensities, which are nonspecific and unchanged. There is also a fine linear area of T2 hyperintensity in the medial left cerebellar hemisphere. The brainstem appears to be unremarkable. There is a partially empty sella. There is diffuse cerebral volume loss, which appears to be slightly more pronounced than in 2013. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute ischemia or acute intracranial hemorrhage.2. Scattered punctate and periventricular white matter T2 hyperintensities are nonspecific, but may relate to chronic small vessel ischemic disease.3. A fine linear area of T2 hyperintensity in the medial left cerebellar hemisphere may represent a chronic lacunar infarct. 4. Diffuse cerebral volume loss, which appears to have progressed since 2013.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Severe prolonged hypoglycemia day prior. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are patchy areas of relatively high T2 signal in the bilateral periventricular white matter of the parietal lobes, which likely represent terminal zones of myelination. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is posterior plagiocephaly.

Output: No discernible stigmata of hypoglycemia.


Instruction: Generate impression based on findings.

Input: Pain and cellulitis. Check for loose body. Past surgeryPOST-PROCEDURAL DIAGNOSIS : Lateral elbow painPHYSICIANS AND ASSISTANTS: Drs. Straus. Florence and Stacy. The attending physician, Dr. Stacy and Straus,was present for the critical portions of the procedure. The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural "time-out" form was completed.The patient was placed supine on the fluoroscopy table. The left elbow was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 22 gauge needle was advanced into the joint using a posterior approach. Attempted aspiration yielded no fluid. Access to the joint was difficult to obtain and the initial injection demonstrated contrast pooling om the posterior tissues with a small amount in the joint. Three repositionings were attempted and then the approach was switched to the radio capitellum approach which took two attempts, first additionally pooled. Once positioning was confirmed 7 mL of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient's skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 46 seconds.

Output: Successful fluoroscopic-guided injection of dilute gadolinium into the left elbow for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: Patient with acute ischemic stroke symptoms . NIH stroke scale score was 11. Patient received IV TPA and NIHSSS were went down to 8. 46-year-old female presents with dysarthria bilateral low lower extremity weakness and left upper extremity weakness. Please evaluate for potential for embolectomy.Technique:A total of a 130 mL of Omnipaque 350 was used. 65 for the CTA and is 65 mL for the perfusion study. A CT of the head was performed followed by a perfusion study of the brain and within the CTA of the head in neck using the University of Chicago protocols for each of these exams. 3-D reconstructions for the CTA of the head and CT of the neck were performed on an independent workstation. Cerebral blood volume maps, stroke blood flow maps, mean transit time maps were performed on an independent workstation. Individual measures of upper fusion made from the areas in question. CT head: 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.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.Perfusion CT: There is hypoperfusion to right anterior cerebral artery territory anteriorly. Based on the patient's outside MRI exam which included diffusion weighted imaging as well as the cerebral blood volume maps on the current exam much of the involve territory has already infarcted. Embolectomy would not to be of a significant benefit in this case. Along the interrogated region mean transit time was 33 versus 5.5 and the normal side with a screw blood volume in the worst component of flow 1.25 forces 4.4 normal side. Along the more anterior aspect of the hypoperfused territory and appears there is somewhat better perfusionCTA brain:CTA brain demonstrates occlusion of the right anterior cerebral artery at the distal A2 segments. There appears to be a small sliver of contrast spanning a 2-cm length along this vessel and the vessel is reconstituted at distal to this at the A3 segment. No other intracranial occlusions are appreciated.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior, middle and posterior cerebral arteries. No aneurysms are appreciated.CTA neck: A couple to ablate the defects present along the distal internal carotid artery bilaterally. This is raises the question of fibromuscular dysplasia. these weblike defect can be identified at the C2-3 level on the right and at C1-2 level on the left. Best seen on coronal images 95 and 99.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Occlusion of the right anterior cerebral artery and the A2 segment as described above. The associated that perfusion defect indicates that the tissue amenable to salvage is a less than 50% of the hypoperfused territory.3.Weblike defects along the distal cervical internal carotid arteries. The possibility of fibromuscular dysplasia is raised. No significant stenosis as described above.4.Findings were discussed with clinical service at the time of the exam.


Instruction: Generate impression based on findings.

Input: Vision loss L>R, concern for giant cell arteritis. Brain MRI: There appears to be a punctate focus of cortical restricted diffusion in the right parietal lobe with high T2 signal. There are otherwise several scattered foci of high T2 signal in the cerebral hemisphere white matter bilaterally. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: The anterior branch of the left superficial temporal artery and left ophthalmic artery appear relatively diminutive. There is no evidence of significant cerebral steno-occlusive lesions or aneurysms.Orbits MRI: There are bilateral lens implants. The lacrimal glands, optic nerve, orbital fat, and extraocular muscles otherwise appear unremarkable bilaterally. There is no evidence of intraorbital tumors.

Output: 1. Apparent punctate acute infarct in the cortex of the right parietal lobe superimposed upon a background of probable chronic small vessel ischemic white matter disease.2. The anterior branch of the left superficial temporal artery and left ophthalmic artery appear relatively diminutive, which may represent manifestations of giant cell temporal arteritis. Doppler ultrasound may be useful for further interrogation.


Instruction: Generate impression based on findings.

Input: Knee pain after fall MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Marrow edema is present predominantly within the medial femoral condyle and lateral tibial plateau but also affecting the lateral femoral condyle and medial tibial plateau. The articular cartilage of the medial and femoral compartments appears subjectively thinned otherwise intact. There is mild degenerative heterogeneity of the articular cartilage of the lateral patellar facet but otherwise the patellofemoral articular cartilage is preserved as well. LIGAMENTS: The anterior cruciate ligament is ruptured. The posterior cruciate ligament and collateral ligaments are intact.EXTENSOR MECHANISM: There is mildly increased signal intensity and thickening of the patellar tendon both at its insertion on the patella and on the tibial tubercle.ADDITIONAL

Output: 1. Ruptured ACL.2. Bone contusions predominantly affecting the medial femoral condyle and lateral tibial plateau.3. Mild patellar tendinosis.4. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Female 58 years old Reason: assess liver lesion History: HCC ABDOMEN:LIVER, BILIARY TRACT: Nodular hepatic contour with widening of the fissures consistent with hepatic cirrhosis.Reference ablation defect in the right hepatic lobe measures 1.6 x 1.1 cm, unchanged (series 13/31). There is increased peripheral arterial enhancement but without washout. Again the lesion demonstrates mild intrinsic T1 hyperintensity and subtle T2 hyperintensity.Reference subcapsular ablation defect in the right hepatic lobe has decreased in size and is no longer discretely measurable.There is additional geographic increased arterial enhancement in the right hepatic lobe, most compatible with transient hepatic arterial differences (THAD).Patent hepatic vasculature.SPLEEN: Marked splenomegaly Stable T2 hyperintense lesion within the posterior spleen which may represent a small hemangioma.PANCREAS: 1.0 x 0.7 cm T2 hyperintense lesion within the pancreatic body, compatible with IPMN and not significantly changed compared to prior (series 7/24).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable 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.Posttreatment changes relating to prior TACE/RFA. Though there is increased peripheral arterial enhancement of the largest reference lesion in the right hepatic lobe, this finding is likely related to transient hepatic arterial differences. The findings do not meet the criteria for HCC. However, attention to this area at follow-up is recommended. 2.Stable pancreatic body IPMN.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with left-sided numbness and pain. Left hemibody sensory deficits to light touch and pain, sudden onset. Brain MRI:A band of T2 hyperintensity is seen traversing the pons. There is some associated diffusion hyperintensity but no ADC correlate to verify acute ischemia/cytotoxic edema. A few additional scattered small foci of T2 hyperintensity are seen through the cerebral hemispheres. No lesions of the thalami are seen. No edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. Ventricular size and morphology are within normal limits.Brain MRA:No evidence of significant vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is suspected. The left intracranial vertebral artery is diminutive, but this can be a normal variant. The extracranial vertebral artery is better assessed on subsequent neck MRA. C-spine MRI:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement is seen. There may be mild endplate edema at C7. The visualized spinal cord shows normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Posterior disc-osteophyte complex formation with slight effacement of the ventral thecal sac. No significant spinal canal stenosis. Mild right foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C7-T1: Posterior disc-osteophyte complex formation. Slight effacement of ventral thecal sac. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing.

Output: 1.No definite acute intracranial abnormality is seen. Signal abnormality in the pons is favored to be chronic and may reflect the sequelae of microvascular ischemia.2.Unremarkable MRA evaluation of the brain.3.Mild degenerative disease is seen in the cervical spine. No significant cord or nerve root impingement is seen. No abnormalities of the spinal cord are detected.


Instruction: Generate impression based on findings.

Input: 51-year-old female with severe headache status post fall. Rule out intracranial bleed cervical spine fracture and dislocation. There is no evidence of intracranial hemorrhage, mass or edema. Stable areas of bilateral posterior parietal encephalomalacia. Multiple diffuse areas of periventricular white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. No new cortical stroke is seen. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE: Cervical spine demonstrates normal alignment. Vertebral bodies and intervertebral disk spaces are within normal limits. No evidence of fracture or malalignment. Prevertebral soft tissues and airways within normal limits. Mild multilevel degenerative disease throughout the cervical spine.C3-4 demonstrates mild left neuroforaminal narrowing. No evidence of central spinal stenosis.C4-5 and C5-6 are within normal limits. C6-7 demonstrates osteophytes and diffuse disk bulge without evidence of central spinal stenosis.C7/T1 within normal limits.

Output: 1. Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.2. Mild multilevel degenerative changes without evidence of fracture or malalignment.


Instruction: Generate impression based on findings.

Input: Reason: right knee acl tear History: right knee instability MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is mild bone marrow edema of the distal lateral femoral condyle. The remainder of the bone marrow is within normal limits.LIGAMENTS: There is separation of the medial collateral ligament and medial meniscus with abnormal fluid signal within, suggestive of meniscocapsular separation.The anterior collateral ligament and posterior collateral ligament are unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Findings suggestive of medial meniscocapsular separation. No evidence of anterior collateral ligament injury as clinically queried.


Instruction: Generate impression based on findings.

Input: Left facial droop and dysarthria, clumsy left hand, and unsteady gait. MRI: There are patchy areas of restricted diffusion and high T2 signal in the right basal ganglia, corona radiata, insula, and anterior temporal lobe. There are a few scattered foci of T2 hyperintensity in the cerebral white matter without associated restricted diffusion, which may be related to chronic small vessel ischemic disease. There is diffuse prominence of the pial vasculature in the affected right middle cerebral artery territory. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA: There is significant steno-occlusive disease involving the proximal right middle cerebral artery with paucity of flow related enhancement in the distal branches. The right vertebral artery appears to be hypoplastic. The other components of the circle or Willis appear to be intact, including bilateral fetal-type posterior cerebral arteries. There is no evidence of cerebral aneurysms.

Output: Acute right middle cerebral artery territory infarct associated with significant steno-occlusive disease involving the proximal right middle cerebral artery with paucity of distal collateral vessels, but no evidence of hemorrhagic transformation or midline shift. Discussed with Dr. BERNARD at 4:30 PM on 1/16/15.


Instruction: Generate impression based on findings.

Input: Clinical question: Left unilateral hearing loss. Signs and symptoms: Hearing loss, incontinence, tinnitus. Pre and post enhanced MRI of IACs:Examination demonstrates normal signal intensity and morphology of pons, bilateral cerebellopontine angle cisterns, bilateral neurovascular bundles, bilateral internal auditory canals, bilateral mastoid air cells and middle ear cavities and grossly unremarkable signal intensity and morphology of the inner ear structures. There is no detectable abnormality at the level of the skull base. There is no detectable abnormal enhancement of the pons, bilateral neurovascular bundles, internal auditory canals or within the petrous bones. No detectable abnormal enhancement of skull base. There is no detectable abnormality of cranial nerves and no detectable abnormal enhancement.

Output: Negative pre and post enhanced MRI of the IACs.


Instruction: Generate impression based on findings.

Input: Male, 34 years old, with recurrent glioblastoma, eight week follow-up post-trial. Again seen is evidence of left frontal lobe resection for recurrent glioblastoma. The resection cavity contains fluid which is still FLAIR hyperintense but less T1 hyperintense suggesting resolving proteinaceous or hemorrhagic products. The cavity is not significantly changed in size and morphology.The geographic extent of T2 signal abnormality surrounding the resection cavity has increased mildly from the prior examination. However, a thick and somewhat nodular rim of enhancement particularly along the inferior resection cavity margin is redemonstrated appearing thicker and more conspicuous than on the prior examinations. rCBV mapping is equivocal as it shows areas of increased and of decreased blood volume within this enhancing tissue. No entirely new areas of pathologic enhancement or signal abnormality are seen. Bilateral periventricular T2 hyperintensity is unchanged and may be related to prior therapy. No significant generalized mass effect is detected. The ventricular system is stable in size and morphology.

Output: Since the prior examination, enhancing tissue along the inferior margin of the left frontal resection cavity has increased in thickness and conspicuity. The differential would include progressive disease as well as a treatment-related effect. rCBV mapping in this case does not provide any reliable guidance. No other concerning changes are seen elsewhere in the brain.


Instruction: Generate impression based on findings.

Input: 62-year-old male with neck pain and shoulder pain and weakness/numbness. Suspect C6 radiculopathy. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis. There is mild retrolisthesis of C5 on C6. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Multilevel degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or left neural foramina. Uncovertebral hypertrophy on the right results in minimal right neural foraminal narrowing.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or left neural foramen. Mild to moderate right neural foraminal narrowing related to uncovertebral hypertrophy.C5-6: Disc osteophyte complex and prominent uncovertebral hypertrophy on the right result in moderate to severe right neural foraminal stenosis. Minimal left neural foraminal narrowing.C6-7: Small disc osteophyte complex and mild uncovertebral hypertrophy. No significant spinal canal or neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine as detailed above. There is moderate to severe right C5-C6 neural foraminal stenosis which may be impinging on the right C6 nerve root. There is also mild to moderate right C4-C5 neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: shoulder pain Note that the exam is limited by significant motion artifact.ROTATOR CUFF: Focus of fluid signal is noted near the footprint of the supraspinatus tendon reflecting at least partial tear. Further evaluation is limited given the motion artifact. Additionally, there is tearing and retraction of the subscapularis tendon to the level of the glenoid. Additionally, there is medial subluxation of the biceps tendon and its results.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the glenoid labrum is significantly limited by motion artifact. There is suggestion of anterior degenerative change without obvious full-thicknessBICEPS TENDON: The biceps tendon appears subluxed medially but appears intact. ADDITIONAL

Output: 1. Limited examination secondary to motion artifact.2. Tearing and retraction of the subscapularis tendon with associated medial subluxation of the biceps tendon which otherwise appears intact.3. At least partial-thickness tearing of the supraspinatus tendon with associated atrophy of the subscapularis musculature.


Instruction: Generate impression based on findings.

Input: 56 years, Male, Reason: evaluate posterior anal margin related to lesion, lipoma? Please do fistula protocol. Pt is kidney transplant patient. History: 1 cm painless mass posterior anal margin. PELVIS: MalePROSTATE, SEMINAL VESICLES:The seminal vesicles are dilated bilaterally, likely representing seminal vesicle cysts. There is a small amount of T1 shortening within the right cyst, likely representing hemorrhagic/pernicious contents.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES:A nonenhancing cystic lesion within the subcutaneous tissues immediately deep to the skin, posterior to the anal verge measures 2.2 x 1.0 cm (5/19). No fat is evident within the lesion. This lesion is unchanged from the recent CT of 1/23/2015 but was not present on the CT of 7/15/2011.OTHER: A right iliac fossa transplant is partially visualized.

Output: 1.Unilocular subcutaneous cyst posterior to the anal verge has nonspecific features. A developmental cyst, such as a tailgut cyst, or an epidermal inclusion cyst may be considered. An abscess is considered unlikely given lack of surrounding inflammatory changes. 2.Bilateral seminal vesical cysts.


Instruction: Generate impression based on findings.

Input: Reason: to r/o vp shunt malfunctioning History: pineal tumor, progressing, vp shunt in situ Suboccipital midline craniectomy is redemonstrated. Extensive bilateral cerebellar and left occipital cortical calcification is again identified and with no interval change. Finding are secondary to post therapy changes.There is filling of the subarachnoid space in the posterior fossa with high attenuation material which extends into the basal cistern. This is noted in the subarachnoid space at the level of foramen magnum, ambient cistern, prepontine cistern, and cerebellar pontine angles. These findings are believed to represent worsening of previously noted extensive pachymeningitis and possible carcinomatosis. There is suggestion of mass effect on the medulla secondary to above findings. Further follow-up with a dedicated MRI examination will significantly better characterize the above findings.Unchanged course and position of right lateral ventricular catheter. The shunt appears to partially traverse the right lateral ventricle. No change in the normal size of ventricular system since prior study. Diffuse low attenuation of the bilateral hemispheric white matter is stable since prior exam. This finding is believed to represent post therapy changes and surgical intervention for placement of multiple prior ventricular catheter placement.There is no hemorrhage, edema, mass effect or midline shift. The calvarium and soft tissues of the scalp are within normal limits. Air-fluid levels within the maxillary sinuses bilaterally. The mastoid air cells are clear.

Output: 1.High attenuation content within the subarachnoid space in the posterior cranial fossa with extension into the suprasellar cistern. Findings are believed to represent interval worsening of patient's known extensive pachymeningitis and possible carcinomatosis.2.Further evaluation with an infused MRI examination is recommended.3.Stable size of shunted supratentorial ventricular system.4.Stable extensive bihemispheric white matter low-attenuation believed to represent post therapy changes.5.Therapy related calcification within the cerebellum bilaterally and left occipital cortex with minimal interval worsening.


Instruction: Generate impression based on findings.

Input: 20-year-old male with history of ulcerative colitis and perianal fistulas status post seton placement for ischiorectal abscesses with incision and drainage. Evaluate. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of proctocolectomy with ileal pouch-anal anastomosis, which appears intact. The inflammatory changes noted at the pouch previously have improved.BONES, SOFT TISSUES: There are 2 complex transsphincteric fistulas with setons in both fistulas. The right sided fistula tracks from 9:00 position, extends transphincterically, and branches into a tract extending anteriorly and posteriorly. The posterior tract extends inferiorly and exits at the right gluteal cleft. The anterior tract extends into the ischiorectal fossa and terminates at that location. There is evidence of a drain in the right ischiorectal fossa.The left-sided fistula tracks from approximately 2:00 position, extends transsphincterically, and branches into a tract extending anteriorly and posteriorly. The posterior tract extends inferiorly and exits at the left gluteal cleft. The anterior tract extends into the ischiorectal fossa without measurable fluid collection.There is additionally increased T2 signal with evidence of enhancement within the perineal region bilaterally consistent with granulation tissue.No pelvic abscess is identified.OTHER: No significant abnormality noted.

Output: 1.Complex bilateral transsphincteric fistulas as described above with evidence of extensive perineal granulation tissue.2.Postoperative changes of proctocolectomy with intact ileal pouch-anal anastomosis.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of prostate cancer and rising PSA level ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific evidence in the liver on image number 22 measuring less than a centimeter, too small to characterize but most likely a cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular left adrenal gland. 10-mm left adrenal nodule, which cannot be further characterized on this single phase CT but most likely benign. If further evaluation of this lesion is clinically indicated MRI of the adrenal gland may be helpful.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. No CT evidence of recurrent disease.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Punctate sclerotic focus in the left iliac bone adjacent to SI joint on image number 100, series number 3.OTHER: No significant abnormality noted

Output: No definite CT evidence of recurrence. Punctate sclerotic focus in the left iliac bone. A small left adrenal nodule which cannot be further characterized on this noncontrast CT but more likely to be a benign adenoma. MRI of the adrenal glands may be helpful if further evaluation of this lesion is clinically indicated.


Instruction: Generate impression based on findings.

Input: Multiple myeloma, paraplegia, possible bowel incontinence. Suspected acute cord compression. Please note patient could not tolerate the complete study. Thoracic imaging is limited to sagittal sequences and no post gadolinium imaging was performed.Cervical spine:Lack of contrast slightly limits evaluation. There are small foci of low T1 signal scattered throughout the cervical spine consistent with metastatic disease. Relatively larger focus involving the C2 vertebra measures approximately 13 mm in diameter. No prior cervical MRI is available for comparison, aside from cord compression study from 11/18/2015. Vertebral body heights in the cervical spine are normal. Alignment is grossly maintained. Multilevel degenerative changes are seen including a right paracentral disc protrusion at the C3-C4 level which indents the ventral cord. There is overall moderate spinal canal stenosis at this level without cord signal abnormality. Degenerative changes also include uncovertebral hypertrophy at the C5-C6 level where there is moderate right and mild left neural foraminal stenosis. Aside from the aforementioned C3-C4 level, there is no significant spinal canal stenosis in the cervical spine. No obvious epidural mass is evident within the limitations of noncontrast study.Thoracic spine:Evaluation of the thoracic spine limited to noncontrast sagittal sequences. Again seen is diffuse osseous metastatic disease which appears progressed compared to 6/8/2015, with multiple new lesions throughout the thoracic spine. The largest new lesion is seen involving the anterior T6 vertebral body and measures 16 x 14 mm in the AP and craniocaudal dimensions. Relatively larger lesions involving the T3 vertebral body is again seen. There is suggestion of decrease in epidural tumor at this level although suboptimally evaluated without contrast. Extensive tumor infiltration involving the T9 posterior elements with dorsal epidural tumor at the T9 level again seen which is associated with compression of the thoracic cord. Mild increase in craniocaudal extent of epidural tumor. There is edema within the cord from approximately T8-T10 which appears mildly worse compared to 6/8/2015. There also appears to be increased tumor infiltration involving the T9-T10 11 posterior elements and paraspinous soft tissues on the sagittal images.Again seen is a severe compression fracture involving the T8 vertebral body which mild interval worsening of height loss. There appears to be decrease in epidural tumor at this level. No new compression fractures are evident.Lumbar spine:Evaluation of the lumbar spine limited to sagittal STIR sequence again demonstrate multiple small metastatic lesions in the lumbar spine and sacrum without evidence of new large lesions. Compression fracture with moderate loss of height involving the L1 vertebral body similar to prior. Mild associated retropulsion and minimal spinal canal narrowing similar to prior. Otherwise no significant spinal canal stenosis is evident in the lumbar spine. No new pathologic compression fractures.

Output: 1. Please note patient could not tolerate the complete study. Thoracic and lumbar imaging is limited to sagittal sequences and no post gadolinium imaging of the spine was obtained.2. Multiple new metastatic lesions are seen throughout the thoracic spine compared to 6/8/2015. Multiple small lesions are present throughout the cervical spine, with no prior cervical spine MRI available for comparison. Multiple small metastatic lesions in the lumbar spine and visualized pelvis are also seen without evidence of a new large lesion.3. There is suggestion of decrease in epidural tumor at the T3 and T8 levels with decrease in associated mass effect on the cord at this level but suboptimally evaluated without contrast and absence of axial images. 4. Mild increase in craniocaudal extent of epidural tumor at the T9 level which appears to be compressing the cord and is associated with worsening of cord signal abnormality at this level.5. Severe pathologic fracture at the T8 level which demonstrates mild worsening of height loss at this level. Compression fracture involving the L1 vertebral body with mild associated osseous retropulsion and minimal spinal canal narrowing are similar to prior. No new pathologic compression fractures are evident. No obvious epidural mass in the cervical or lumbar spine within the limits of noncontrast study.6. Degenerative changes at the C3-C4 level with up to moderate spinal canal stenosis at this level, without cord signal abnormality.


Instruction: Generate impression based on findings.

Input: T1N0 acinic cell carcinoma of the left posterior alveolus status post WLE on 4/29/2015 with primary closure. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy, including a left level 2A lymph node that measures up to 10 mm in short axis. There is unchanged mild diffuse prominence of the palatine tonsils, which is nonspecific. The tongue and rest of the upper aerodigestive tract appear to be intact. The thyroid and major salivary glands are unremarkable. The major cervical vessels flow voids are intact. The osseous structures are unchanged. The airways are patent. The imaged intracranial structures are unremarkable. There is residual thymic tissue in the anterior superior mediastinum.

Output: No evidence of measurable mass lesions or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female 25 years old Reason: Ulnar abutment, positive ulnar variance, evaluate ulnar side of wrist and TFCC LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: Following radiocarpal injection of gadolinium, no contrast material is evident within the midcarpal space indicating an intact triangle fibrocartilage complex.TENDONS: The imaged portions of the flexor and extensor tendons appear intact. BONES: Minimal cystic changes are noted along the proximal margin of the lunate consistent with ulnar abutment syndrome.ADDITIONAL

Output: Cystic changes along the proximal margin of the lunate are consistent with ulnar abutment syndrome, but with findings consistent with an intact triangular fibrocartilage complex.


Instruction: Generate impression based on findings.

Input: Reason: peroneal tendonitis tenosynovitis History: pain and swelling and popping TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Normal bone marrow signal.ADDITIONAL

Output: No significant abnormality noted.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of stomach, unspecified [C16.9], Reason for Study: ^Reason: severe back pain, gastric CA. Bony mets? pt ESRD History: severe low back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Multifocal various sized bone marrow replacing vertebral body lesions involving T11, T12, L1, L2, L3, L5, S1 and bilateral iliac bones indicating metastatic lesions. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc with bilateral ligamentum flavum thickening result mild to moderate spinal stenosis. L3-L4: Diffuse bulging of disc with bilateral ligamentum flavum thickening result moderate to severe spinal stenosis. L4-L5: Slightly eccentric central to left disc broad based disc protrusion with bilateral ligamentum flavum thickening result severe spinal stenosis and left side neuroforaminal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multifocal metastatic lesions involving thoracolumbosacral vertebral bodies and bilateral ilium.2. Degenerative changes of lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: 50 years Male (DOB:2/14/1966)Reason: assess for MS plaques History: urinary incontinencePROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. Mild reversal of normal cervical curvature could be positional .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.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.MRI thoracic spine:At the T11 vertebral body level there is suspected signal abnormality along the anterior and medial aspect of the spinal cord.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. There are degenerative changes present in the thoracic spine with Schmorl's nodes at the T7 and T8 superior endplates and the superior and inferior endplates of T11 as well as inferior endplate of T10 and the superior endplate of T12.

Output: 1.A thoracic spinal cord lesion present along the anterior aspect of the spinal cord at the T11 level. This could represent demyelinating focus.2.There are mild degenerative changes present in the thoracic spine.3.There is no convincing evidence for demyelinating focus in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Reason: Assess for rectus abdominus tear at pelvic insertion, sports hernia History: Pain at lower abdomen/groin. There is mild intermediate signal intensity within the prepubic aponeurotic complex, to the left of midline, which may reflect degeneration, but we see no tear of the rectus abdominis or the adductor tendons. The adductor musculature of the hip appears normal. Mild osteoarthritis affects both hips and the sacroiliac joints. Severe degenerative disc disease affects the lower lumbar spine. There is focal atrophy of the right gluteus maximus muscle, posteriorly, with vascularity perhaps representing a venous malformation. There are foci of low signal intensity within the overlying soft tissues which may represent an injection granuloma.

Output: 1. No findings to suggest a tear of the rectus abdominis or other specific findings of a sports hernia. 2. Severe degenerative disc disease of the lumbar spine and other findings as described above.


Instruction: Generate impression based on findings.

Input: Motor vehicle accident. Possible re-tear of rotator cuff ROTATOR CUFF: There appears to be a partial articular sided tear of the supraspinatus near its insertion.. No evidence of retraction. No evidence of communication with the subdeltoid or subacromial bursa. The infraspinatus is normal. The subscapularis is normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: There is been a surgical tenodesis of the long head of the biceps tendon.

Output: Small articular sided partial tear of the supraspinatus.


Instruction: Generate impression based on findings.

Input: Nasolacrimal duct cyst versus epidermal cyst: 1cm nodule on left nasal side wall. There is a well-defined ovoid T2 hyperintense and T1 hypointense non-enhancing lesion in the subcutaneous tissues of the left nasolabial fold that measures up to 9 mm. The lesion does not involve the nasolacrimal duct and the underlying bone is intact. There is a right tympanomastoid effusion. There is a small retention cyst in the left maxillary sinus. There appears to be a small right temporomandibular joint effusion and mild anterior subluxation of the mandibular condyle. The salivary glands are unremarkable. The orbits and imaged intracranial structures are also unremarkable.

Output: 1. A well-defined cystic lesion in the subcutaneous tissues of the left nasolabial fold that measures up to 9 mm likely represents an epidermal inclusion cyst. 2. Right tympanomastoid effusion.3. Small right temporomandibular joint effusion and mild anterior subluxation of the mandibular condyle, which may indicate temporomandibular joint dysfunction.


Instruction: Generate impression based on findings.

Input: Change in mental status. Rule out bleed Extensive a small vessel disease of undetermined age is detected.Bilateral chronic appearing subdurals are identified in the frontal and parietal region.No evidence of hemorrhage, mass effect, midline shift or hydrocephalus is detected. Further evaluation with an MRI is recommended for evaluation of subdurals and possible new acute small vessel strokes. Calvarium is unremarkable.

Output: 1.Extensive small vessel disease of undetermined age. Further follow-up with MRI is recommended.2.Bilateral chronic subdural CSF collections.3.No evidence of mass effect, hemorrhage, midline shift or hydrocephalus.4.5.


Instruction: Generate impression based on findings.

Input: Clinical question: Headaches, history of GBM, post radiation. Signs and symptoms: As above Non-enhanced head CT:The examination demonstrates new area of low attenuation in the right basal ganglia measuring 13.9 x 14.5-mm on axial image 10. This finding could represent a lacunar infarct however possibility of tumor cannot be excluded. A smaller second similar lesion more posteriorly with extension into the thalamus is also present. Follow-up with an MRI is recommended. There is also a large area of CSF density well-demarcated collection measuring 33.5 x 33.6-mm in transaxial dimension and approximately 44 mm in cranial -- cephalad access. This is suspected for a cyst formation at the surgical site and or cystic tumor.The combination of above findings results in effacement of adjacent cortical sulci and subtle mass effect on the third ventricle and right lateral ventricle which appears a slightly smaller than before. There is also midline shift of approximately 4.6 mm to the left at the level of septum pellucidum.There is a small extra-axial collection likely subdural in the right frontal region anterior to the anterior edge of right frontal craniotomy flap which measures approximately 36 mm in length and 8.3 -mm in thickness which is measured on axial image 13.New since prior exam there is also a cortical based low attenuation of the left anterior frontal lobe that is suspected for a small cortical stroke. This finding is appreciated on axial images 13 to 15.A punctate size calcification at the anterior aspect of third ventricle is this could represent a small colloid cyst which was also noted before and report change.

Output: 1.Suspect a small left frontal cortical stroke, local nor stroke of right basal ganglia as detailed above.2.Large cyst formation at the surgical site in the right temporal lobe measuring approximately 32.5 x 33 x 44-mm concerning for a cyst or a cystic tumor.3.Well-demarcated a small low-attenuation lesions in the right basal ganglia concerning for strokes and or tumor.4.A small CSF density subdural in the right frontal region measuring 36-mm in length and 8.3-mm in thickness.5.Combination of above findings results in further subtle increase in mass effect on the right lateral ventricle and midline shift of approximately 4.6 mm.6.Constellation of all these new findings require further evaluation with a dedicated MRI examination.


Instruction: Generate impression based on findings.

Input: Reason: Restaging metastatic breast cancer to CNS History: Restaging The patient is status post left-sided frontal craniotomy. There is redemonstration of encephalomalacia in the left frontal lobe without evidence for local recurrence. There are punctate foci of susceptibility present in the tumor bed.Several punctate foci of susceptibility are present in the right periventricular white matter and right superior and parietal lobuleThere is a 5 x 7 mm enhancing nodule in the medial left frontal lobe at the anterior aspect of the superior frontal gyrus just anterior to the cingulate sulcus which previously measured 5 x 4 mm.  Another nodule measuring 5 x 3 mm is present along the left inferior frontal gyrus along the pars triangularis.A previously described enhancing nodule at the lateral aspect of the left precentral gyrus is not readily seen on the current exam.A previously described enhancing nodule in the left superior temporal gyrus is not readily identified on the current exam.A punctate questionably enhancing focus is present at the medial aspect of the right superior frontal gyrus anteriorly which is of uncertain significance.A previously described punctate lesion in the left basal ganglia is not readily identified on the current examThere is redemonstration of a microhemorrhage surface of the left thalamus superiorlyNormal 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 demonstrate minor opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam nodules in the left basal ganglia left superior temporal gyrus and the left precentral gyrus are not readily identified on the current exam.2.Since the prior exam nodules in the left inferior frontal gyrus and left superior frontal gyrus are slightly larger3.status post left frontal craniotomy for removal of a left frontal lobe mass


Instruction: Generate impression based on findings.

Input: Mesothelioma. Increased confusion. The exam is limited by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There are also unchanged nonspecific areas of high T2 signal within the bilateral basal ganglia, which may also represent chronic ischemic lesions. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small left maxillary sinus rentention cyst. There is a punctate enhancing lesion in the left temporal scalp.

Output: 1. No definite evidence of intracranial metastases, although the exam is limited by patient motion. 2. A punctate enhancing lesion in the left temporal scalp is nonspecific and may represent an inflammatory process or neoplasm, including metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with back pain, persistent after nonoperative treatment. Spinal alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is within normal limits. The visualized spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology. No epidural abnormalities are seen.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Unremarkable. L4-5: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L5-S1: Moderate facet arthropathy. Loss of disc T2 signal. Small central disc protrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Degenerative findings are seen at L5-S1 with facet arthropathy, a small central disc protrusion and mild left foraminal stenosis.2.Elsewhere, no significant abnormalities are detected.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB:7/9/1965)Reason: Rule out fracture, disc herniation History: painPROVIDER/ATTENDING NAME: GABRIELLA L BORRELLI THOMAS J KELLY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a disc bulge present at this level with some mild narrowing of the right neural foramen. There are small uncovertebral osteophytes present this level contributing to neural foramina narrowing.At C4-5 there is no significant compromise to the spinal canal. There is a broad-based right lateral recess disc protrusion associated with some uncovertebral osteophytes and narrowing of the right neural foramen. There are some encroachment of the right-sided exiting nerve roots. This was also present on the prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine worse at C3-4 and C4-5 where there is mild encroachment of the right-sided exiting nerve roots at C3-4 and moderate encroachment of the right-sided exiting nerve roots at C4-5.


Instruction: Generate impression based on findings.

Input: 29-year-old woman with history of Chiari malformation and headache. The cerebellar tonsils are low lying with peglike morphology, with caudal descent approximately 6mm inferior to the foramen magnum. There is crowding of the cervicomedullary junction. Normal, biphasic CSF flow is seen ventrally. Diminished, biphasic flow is seen posteriorly. There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is no hydrocephalus. The major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is a small amount of fluid and frothy secretion in bilateral maxillary sinuses, sphenoid sinus, and ethmoid air cells. There is also a right maxillary mucosal retention cyst. Bone marrow signal and extracranial soft tissues are within normal limits. CERVICAL SPINE

Output: 1.Chiari 1 malformation with diminished biphasic CSF flow posteriorly at the cervicomedullary junction.2.No evidence of syrinx in the cervical cord.3.Bilateral paranasal sinus air-fluid levels and frothy secretions which may represent acute sinusitis in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with end-stage renal disease and vague spinal pain. Evaluate for occult infection. Most sequences are degraded by motion artifact which limits the sensitivity of the examination. Given this caveat, the following observations are made.The articulation between the left lateral masses of C1 and C2 is severely degenerated with edema or fluid in the joint space and edema in the surrounding marrow. There is no evidence of significant pannus formation around the dens, and none of the other spinal articulations are affected similarly.Straightening of the cervical lordosis may be positional. Sagittal alignment is otherwise unremarkable. The remaining spinal elements are free of significant edema or marrow replacement. Image quality does not allow for accurate assessment of the spinal cord or epidural space. Minimal cervical disc degeneration is seen without significant spinal canal stenosis. The neural foramina are not well assessed, though no high-grade stenoses are suspected.

Output: This examination is significantly limited by motion artifact. Nevertheless, severe bony degeneration and inflammation are seen centered on the articulation between the C1 and C2 lateral masses on the left. This joint appears to be involved in isolation. These findings may reflect accelerated degeneration related to a prior traumatic injury of this joint, or potentially a chronic infectious process. An inflammatory arthropathy would be less likely given the unilateral involvement of a single joint, though this is not completely excluded. Findings were discussed with Dr. Spiegel at 9:30 AM on 12/2/16.


Instruction: Generate impression based on findings.

Input: 55-year-old male with left-sided weakness There is no evidence of acute intracranial hemorrhage or midline shift. There has been continued evolution of the previously seen subacute stroke in the distribution of the right MCA with more prominent encephalomalacia (involving the right frontal, parietal and temporal lobes) and associated ex vacuo dilatation of the right lateral ventricle. A second previously noted focus of encephalomalacia in the right occipital lobe is also again seen appearing similar to the prior MRI of the brain from 3/2011. Additional patchy areas of hypodensity are seen in the periventricular and subcortical white matter likely represent small vessel ischemic disease of indeterminant age. A hyperdense proximal right MCA is again noted which may represent intraluminal clot, grossly unchanged.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. A left ethmoid sinus benign osteoma is again noted.

Output: 1. No acute intracranial hemorrhage. CT is insensitive for the early diagnosis of acute nonhemorrhagic CVA.2. Continued evolution of an old right MCA CVA.


Instruction: Generate impression based on findings.

Input: 67 year old female with a history of PSC, evaluate for cholangiocarcinoma ABDOMEN:LIVER, BILIARY TRACT: Status post left hepatectomy and cholecystectomy. Dilation of the right intrahepatic biliary ducts is again seen, stable to slightly increased when compared to the prior studies. Common bile duct normal in size. No evidence of pancreas divisum.Magnetic susceptibility artifact is seen in the porta hepatis from a metal clip which is better seen on the prior CT. No discrete liver lesion is seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: Subcentimeter gastrohepatic lymph nodes, unchanged.BOWEL, MESENTERY: The cecum is distended, containing material of heterogeneous signal intensity, which may represent fecal material, which is poorly assessed on this nondedicated study. BONES, SOFT TISSUES: No significant abnormality noted.

Output: Postoperative changes of prior left hepatectomy and cholecystectomy. Stable to slight interval increase in mild to moderate right intrahepatic biliary duct dilation. No discrete liver lesion identified.


Instruction: Generate impression based on findings.

Input: 19-year-old male with Crohn's disease and previously described active TI disease. Evaluate for progression of Crohn's involvement since the last exam. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Persistent wall thickening of the terminal ileum with early and persistent mural enhancement extending for approximately 9 cm. On the T2 series, there is mild submucosal edema. Mild restricted diffusion of the terminal ileum is also noted. The length of involvement has decreased compared to the prior exam. There is a short segment focal narrowing of the distal terminal ileum (axial series 7 image 16). No obvious fistulization. No drainable fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Persistent thickening and enhancement of the terminal ileum suggestive of acute on chronic Crohn's disease. The length of involvement has decreased compared to the 5/12/2014 MRI exam.


Instruction: Generate impression based on findings.

Input: Male, 30 years old, with profound bilateral lower extremity weakness and decreased sensation, mid back pain. Assess for cord compression. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No worrisome marrow signal abnormality is seen.No evidence of cord compression is detected. However, a fairly prominent tract of T2 hyperintensity is seen within the central cord in the cervical region, and again to a lesser degree in the upper thoracic region. The nerve roots of the cauda equina are not well visualized on the sagittal STIR sequence which may indicate thickening or abnormal signal. Incidental note is also made of probable abnormal signal within the pons.

Output: 1.No evidence of cord compression.2.Findings are seen concerning for abnormal central cord signal within the cervical and upper thoracic region. In addition, the nerve roots of the cauda equina are not distinctly visualized which may indicate thickening or abnormal signal.3.Findings are also seen suspicious for abnormal signal within the pons.4.The above findings should be verified and further assessed with dedicated postcontrast MR imaging of the brain and spine.


Instruction: Generate impression based on findings.

Input: Neck pain, evaluate for structural lesion Craniovertebral junction appears within normal limits. There is mild reversal of cervical lordosis with apex at the C4 level as seen before. There is mild desiccation of the C2-C6 intervertebral discs as before. The cervical vertebral bodies are otherwise appropriate in overall alignment and height. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels in the cervical spine as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild nonspecific reversal of cervical lordosis which is unchanged since 11/20/2014. Examination of the cervical spine is otherwise unremarkable. No disc herniation, cord signal abnormality, or spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 16-year-old female. Evaluate for intra-partum seizure. 16-year-old with seizure during labor. Status post C-section. The density of the brain parenchyma and subarachnoid space remains within normal limits. No evidence of parenchymal hemorrhage or subarachnoid hemorrhage is detected. Focal area of increased density at the level of the sella on axial image 7 is noted. Although this finding could represent volume averaging of bone I cannot entirely exclude possibility of hemorrhage within the pituitary gland. MRI examination is recommended for exclusion for further evaluation. This examination is essentially otherwise within normal limits.

Output: 1.Increased density within the sella as described above which would be concerning for pituitary hemorrhage and an MRI is recommended.2.Unremarkable CT of brain otherwise.


Instruction: Generate impression based on findings.

Input: Male; 20 years old. Reason: 20 year old male with history of acute idiopathic pancreatitis, presumably autoimmune History: Pancreatitis ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. No intra-or extrahepatic biliary ductal dilation. No cholelithiasis or gallbladder wall thickening.SPLEEN: No significant abnormality noted.PANCREAS: The previously described enlargement of the pancreas is not seen on today's examination. There is mild loss of the expected T1 signal in the pancreatic tail and uncinate process. No pancreatic ductal dilation. No focal pancreatic lesions. No significant peripancreatic fluid. No pancreatic pseudocyst. No evidence of intra-or extrahepatic biliary dilatation.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: Interval resolution of the previously described enlargement of the pancreas. There is, however, abnormal signal within the tail and uncinate process of the pancreas which may reflect changes related to prior episodes of pancreatitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer with history of treated brain metastases. Please reassess disease. Signs and symptoms: Same. Enhanced head CT:No additional contrast is given for this exam. This examination was performed immediately post enhanced CT of chest abdomen and pelvis.There is no evidence of metastatic disease of brain parenchyma, leptomeninges or the calvarium. Aexamination demonstrates a developmental venous anomaly of the left anterior temporal lobe as was noted on prior enhanced brain MRI examination.The cortical sulci, ventricular system and CSF cisterns remain operating normal. Very subtle subcortical and periventricular low attenuation of white matter as was noted on prior brain MRI history to represent small vessel ischemic disease of indeterminate age.

Output: 1.No evidence of metastatic disease.2.Minimal small vessel ischemic strokes of indeterminate age.3.Revisualization of the left anterior temporal lobe development of venous anomaly.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from mild L5 on S1 retrolisthesis. Bone marrow signal is benign. There is a T1 hyperintense lesion involving the left aspect of the L3 vertebral body extending into the posterior elements on the left likely representing a hemangioma. There is apparent iso to T1 hyperintense signal involving the ventral aspect of the thecal sac without corresponding T2 signal abnormality and not seen on the sagittal T1-weighted sequence and most likely artifact. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge and facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge and facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge and facet arthropathy. No spinal canal or neural foraminal stenosis.L4-L5: There is prominent bilateral facet arthropathy, worse on the right and mild distention of the facet joint on the left. There is also a disc bulge with partial effacement of the right subarticular zone. There is mild bilateral neural foraminal stenosis. There is also mild central spinal canal stenosis.L5-S1: Severe loss of disc height with associated fatty endplate marrow signal changes. There is also a prominent posterior osteophyte involving the right ventral aspect of the spinal canal but without significant central spinal canal stenosis. Moderate bilateral facet arthropathy. There is moderate bilateral neural foraminal stenoses.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine relatively worse at the L4-L5 and L5-S1 levels. There is up to mild spinal canal stenosis at the L4-L5 level. There is up to moderate bilateral neural foraminal stenoses at the L5-S1 level.2. Advanced facet arthropathy at the L4-L5 level and to a lesser degree at the L5-S1 level which may also be contributing to patient's low back pain.3. Left L3 vertebral body hemangioma extending into the posterior elements. No suspicious osseous lesions.


Instruction: Generate impression based on findings.

Input: 30-year-old female with lateral knee pain. Evaluate for ligamentous injury. MENISCI: There is increased linear signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial and femoral articular surfaces, consistent with a vertical tear, involving the insertion of the Wrisberg ligament suggesting a "Wrisberg rip". The anterior horn of the lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema type signal abnormality within the medial femoral condyle and medial tibial plateau. There is a focal articular cartilage defect and delamination along the medial aspect of the medial facet of the femoral trochlea. There is a subcentimeter focus of decreased signal abnormality just anterior to the medial facet of the femoral trochlea which likely represents an articular cartilage fragment within the joint space. There is underlying subchondral marrow signal abnormality suggesting bone contusion or subchondral fracture.LIGAMENTS: There is irregularity and increased signal abnormality about the midsubstance and distal fibers of the ACL consistent with at least a partial tear of the ACL. The PCL appears intact. The lateral collateral ligament proper and the distal biceps femoris tendon are indistinct suspicious for LCL rupture. There is no significant retraction of the biceps femoris. The MCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: 1. Tearing of the ACL and components of the LCL as described above.2. Vertical tear of the posterior horn of the lateral meniscus extending from the insertion site of the Wrisberg ligament, consistent with a "Wrisberg rip".3. Articular cartilage defect and delamination along the medial facet of the femoral trochlea. 4. Small joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Hereditary hemorrhagic telangiectasia. Congenital anomaly of cerebrovascular system MRI of the brainThe 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.On T1-weighted imaging there is signal hyperintensity present within the basal ganglia.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm, AVM, or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.T1 signal hyperintensity in the basal ganglia raise the question of liver dysfunction or parenteral nutrition. Please correlate with clinical exam findings.2.There is no convincing evidence for arteriovenous malformation or other vascular malformation within the brain parenchyma.


Instruction: Generate impression based on findings.

Input: Reason: sports injury knee pain History: pain MENISCI: There is linear increased signal abnormality within the peripheral fibers of the posterior horn of the medial meniscus which extends to the femoral articular surface indicating a longitudinal tear. There is linear signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial and femoral articular surfaces which may represent superficial fraying or tiny longitudinal tears. ARTICULAR CARTILAGE AND BONE: There is increased bone marrow signal abnormality within the lateral femoral condyle and posterior lateral tibial plateau likely representing bone contusions. There is depression along the weightbearing surface of the lateral femoral condyle indicating an impaction fracture "lateral notch sign". There is an associated full-thickness articular cartilage fissure along the posterior aspect of the aforementioned impaction fracture.LIGAMENTS: There is complete disruption of the ACL involving its proximal and midsubstance fibers. The PCL appears intact. The superficial band of the MCL appears intact. There is increased signal abnormality along the medial aspect of the medial femoral condyle indicating disruption of the meniscofemoral coronary ligament. The LCL appears intact. There is increased signal abnormality in the expected location of the oblique popliteal ligament which may indicate a sprain or disruption, however, this is equivocal. The posterior oblique ligament appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Disruption of the ACL through its proximal and midsubstance fibers.2. Longitudinal tear through the posterior horn of the medial meniscus. Probable superficial fraying or tiny longitudinal tearing of the posterior horn of the lateral meniscus as well.3. Disruption of the meniscofemoral coronary ligament of the deep component of the MCL.4. Bone contusions along the lateral femoral condyle and lateral tibial plateau including a lateral notch sign and full-thickness articular cartilage fissure in the adjacent area, as described above.5. Large joint effusion with fluid fluid levels likely representing a hemarthrosis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of biopsy proven ileocolonic Crohn's with bloating. Evaluate for active disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal morphology, size, signal intensity and enhancement without a focal lesion or biliary ductal dilatation. Normally distended gallbladder.SPLEEN: Spleen is normal in size and signal intensity without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.The bowel is normal in caliber and wall thickness. There is no abnormal postcontrast enhancement restricted diffusion or fibrofatty proliferation to suggest acute inflammation. No persistent luminal narrowing or prestenotic/upstream dilatation to suggest a stricture. No significant mesenteric lymphadenopathy. No significant free fluid or loculated fluid collection. No evidence of sinus tract or fistula formation.The cecum is up-turned.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.The bowel is normal in caliber and wall thickness. There is no abnormal postcontrast enhancement restricted diffusion or fibrofatty proliferation to suggest acute inflammation. No persistent luminal narrowing or prestenotic/upstream dilatation to suggest a stricture. No significant mesenteric lymphadenopathy. No significant free fluid or loculated fluid collection. No evidence of sinus tract or fistula formation.The cecum is up turned.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific evidence of active small bowel inflammation or flow limiting stricture.


Instruction: Generate impression based on findings.

Input: Female 79 years old; Reason: evaluate for osteomyelitis History: R foot pain, persistent infection There is increased soft tissue edema throughout the ankle and dorsal aspect of the midfoot compared to prior, without marrow changes to indicate osteomyelitis. No loculated fluid collection to suggest abscess is seen. The lateral and medial collateral ligaments are intact. The Achilles tendon is intact. Scattered degenerative changes are similar to prior, most prominent at the carpometacarpal joints.

Output: Increased soft tissue edema, without evidence of abscess or osteomyelitis.