Instruction: Generate impression based on findings.

Input: Tethered cord with worsening symptoms , 3 -4 month MRI follow up MRI thoracic spine:The patient status post laminectomies from T8 through T11.There is redemonstration of a multicystic syrinx associated with distortion of the thoracic spinal cord extending from T9 inferiorly. The inferior tip of the conus medullaris is at the L1 vertebral body level. In general this appearance remains stable when compared to a prior exam from 1/8/2015 and 9/15/2014.There is a fluid collection behind the thecal sac which measures 50 mm superior-inferior dimension and approximately 2 7-mm AP dimension. There was also present on the prior exam and has not changed substantially. It extends from the T9 vertebral body level to the T11 vertebral body level. It does not appear to compress the spinal cord.Comparison sagittal prone to supine MRI appears that the spinal cord appears to the posterior aspect of the thecal sac at the T12 vertebral body level in the possibly adheres to be anterior aspect of the thecal sac at the T10 vertebral body level. This raises the question of some associated arachnoiditis. The cauda equina moves anteriorly.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is a multicystic syrinx present in the lower spinal cord.Comparison sagittal prone to supine MRI appears that the spinal cord appears to the posterior aspect of the thecal sac at the T12 vertebral body level in the possibly adheres to be anterior aspect of the thecal sac at the T10 vertebral body level. This raises the question of some associated arachnoiditis. The cauda equina moves anteriorly.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.A multicystic syrinx in the lower spinal cord appears to be associated with findings suggestive of arachnoiditis. The extent and appearance of the syrinx remains stable when compared to the previous exam.2.The patient is status post multilevel laminectomies in the lower thoracic spine. A small fluid collection behind the thecal sac remains stable when compared to the previous exams


Instruction: Generate impression based on findings.

Input: 42-year-old female with elevated alkaline phosphatase. ABDOMEN:LUNG BASES: Trace pleural effusions.LIVER, BILIARY TRACT: No significant abnormality noted. No focal hepatic lesions. No cholelithiasis, choledocholithiasis, or biliary ductal dilation. No biliary strictures or irregularity to suggest primary sclerosing cholangitis.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: A subcentimeter focal fluid intensity collection in the upper abdomen is nonspecific and may represent fluid within a duodenal diverticulum (series 6, image 24) . Otherwise, no significant abnormality noted.BONES, SOFT TISSUES: Incompletely evaluated 1.5 cm T2 hyperintense focus in the inferior lateral right breast (series 6, image 3); correlation with any prior or future dedicated breast imaging is recommended.OTHER: No ascites.

Output: No specific findings to account for the patient's elevated alkaline phosphatase.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: 51-year-old male with right mouth droop. Clinical question: Right mouth through Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Fairly acute strokes can be missed on nonenhanced head CT. Recommend follow with an MRI considering patient's presenting symptoms.Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. The gray -- white matter differentiation remains normal.There is extensive opacification of left ethmoid air cells and significant rightward nasal septum deviation this limited view of paranasal sinuses.

Output: Negative nonenhanced head CT. Considering provided clinical data recommend follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: 12 year old man who is s/p Tetralogy of Fallot repair with a transannular patch and monocuspid pulmonic valve. He is referred to assess for severity of pulmonic regurgitation and RV volumes and function. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 75 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 29 ml (normal range 47+/-19), the LV mass index is 32 g/m2 (normal range 85+/-15), and the LV mass is 39 g (normal range 164+/-36). There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size. A small superiorly located secundum-type atrial septal defect is noted (11x7mm).Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve is thickened and calcified. There is moderate to severe pulmonic regurgitation. The regurgitant fraction is 45%. Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is an over-riding aorta. The aortic root is mildly dilated (sinus of Valsalva 34x32x32mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (19mm). The left pulmonary artery branch has an acute angled take off and is significantly narrowed (minimal diameter 5mm) with evidence of flow acceleration through the stenosis suggesting the narrowing is hemodynamically significant. The right pulmonary artery is normal in size (10mm). LPA flow 29ml (28% relative contribution) and RPA flow 75ml (72% relative contribution).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge thymus tissue noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 61%).2 Mild RV dilation (RVEDVi 117ml/m2) with normal systolic function (RVEF 51%). 3. Mild right atrial dilation.4. Small secundum-type atrial septal defect noted.5. Pulmonic valve is thickened and calcified with severe pulmonic valve regurgitation.6. Mild to moderate tricuspid regurgitation.7. Over-riding aorta with aortic root dilation.8. Left pulmonary artery stenosis resulting in only 28% of pulmonary flow.9. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Patient with recuring back pain, after kyphoplasty at T8 and T9. There are findings related to kyphoplasty at the T8 and T9 levels, where there is marked loss of vertebral height with exaggeration of the kyphosis. There is no evidence of cement extrusion. There is also endplate deformity at L1 with approximately 40 % loss of height centrally, but no evidence of new compression fractures in the thoracic spine. There is a small disc-osteophyte complex that slightly effaces the intrathecal cerebrospinal fluid space. There is no significant spinal canal stenosis at the other levels. The spinal cord signal is unremarkable.

Output: 1. No evidence of complications related to kyphoplasty at the T8 and T9 levels, where there is marked loss of vertebral height with exaggeration of the kyphosis. 2. Unchanged chronic L1 vertebral compression fracture.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Altered mental status. Non-enhanced CT of brain:Heavy vascular calcification of vertebral and cavernous carotid arteries are again identified.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Findings consistent with small vessel disease are again identified and made no gross interval change since prior exam.Calvarium is intact. Mastoid air cells, middle ear cavities and limited view of paranasal sinuses are well pneumatized.A very small calcific dural based lesion is believed to represent a very small meningioma which was also noted on prior MRI examination from 2 -- 26 -- 2010. On coronal postinfusion image 14 of prior MRI exam this lesion measures approximately 5 mm in transaxial dimensions.

Output: 1.No evidence of acute intracranial findings.2.Small vessel disease of indeterminate age with no gross interval change since prior exam.3.A tiny 5-mm left frontal calcific meningioma with no change since prior exam.


Instruction: Generate impression based on findings.

Input: Unspecified abnormalities of gait and mobility [R26.9] / Unspecified fall, subsequent encounter [W19.XXXD], Reason for Study: ^Reason: r/o structural lesion or stroke History: gait imbalance, falls No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.About 5 mm downward displacement of cerebellar tonsil.

Output: 1. 5mm downward displacement of cerebellar tonsils are seen.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 61-year-old male with left hip pain and thigh pain. Since the prior exam, there is increased signal intensity within the imaged semimembranosus tendon and new increased signal intensity within the muscle belly. There is now a complete full-thickness tear of the semimembranosus with at least 4 cm retraction of the muscle tendon. There is significantly increased fluid signal intensity/edema surrounding the semimembranosus, posterior compartment, and surrounding subcutaneous tissue. Interfascial edema is also noted between the quadratus femoris and proximal adductor magnus muscle. The conjoined tendon shows increased signal intensity. It is difficult to follow the tendon to its origin on the inferomedial facet of the ischial tuberosity. The marrow signal intensity of the ischium is normal. There is thickening of the distal tendon of the rectus femoris due to an old injury. Marrow edema of the patella.

Output: 1.Complete, full-thickness tear of the semimembranosus with increased edema/fluid as described above. 2.Signal abnormality within the conjoined tendon with difficulty following the tendon to its origin.


Instruction: Generate impression based on findings.

Input: 47-year-old female with known right breast cancer presents for bracketed ultrasound-guided needle localization of index right upper outer quadrant mass and satellite lesion. On review of the prior studies, again seen is the index mass in the upper outer quadrant of the right breast at posterior depth at the 10:00 position corresponding to the patient's known history of malignancy. Additionally, note is made of a 5 x 6 mm oval mass in the upper outer quadrant of the right breast, approximately 1.4 cm inferior to the index mass, corresponding to the findings of a satellite lesion seen on prior MRI and ultrasound examination. Target well defined mass and satellite lesion are located in the right breast in the upper outer quadrant region located posteriorly at the 10 o’clock. The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast mass and satellite lesion were targeted using lateral to medial approach. The skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using ultrasound guidance, a 7 cm Kopans needle was placed adjacent to the superior margin of the right breast index mass. Using ultrasound guidance, a second 7 cm Kopans needle was placed adjacent to the inferior margin of the right breast satellite lesion. On sonography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Two view orthogonal mammograms reveal the spring wires to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Sanchez and Schacht performed the procedure. Dr. Schacht was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the mass, clip, and 2 spring wires to be within the specimen. The satellite lesion was not well seen on prior mammograms and that is true also for these images.

Output: Successful ultrasound-guided bracketed needle localization of the right breast mass and right breast satellite lesion.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 23-year-old female with history of juvenile idiopathic osteoarthritis now with hip pain and stiffness, evaluate for progression of ischemic or sclerotic changes ACETABULAR LABRUM: Examination is not optimized for evaluation of labrum.ARTICULAR CARTILAGE AND BONE: Degenerative changes affect the hip joint including mild joint space narrowing and osteophyte formation better assessed on 7/5/2012 radiograph but appearing grossly similar to prior. Bone marrow signal is grossly unremarkable without definite evidence of avascular necrosis. The SI joints appear unremarkable.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Degenerative changes of the bilateral hip joints better assessed on 7/5/2012 radiograph but appearing grossly unchanged. No definite evidence of avascular necrosis.


Instruction: Generate impression based on findings.

Input: Follow up for progression of glomus tumor left skull base. Neck: There is no significant interval change in size of the well-defined enhancing mass containing flow voids in the left post-styloid parapharyngeal space with slight extension into the left posterior fossa through a widened jugular foramen, as well as into the middle ear cavity. The tumor abuts the left cerebellar hemisphere. Overall, the mass measures up to approximately 4.5 cm. There appears to be associated compression of the left sigmoid sinus and upper internal jugular vein. The left internal carotid artery is deviated anteromedially. There is no significant lymphadenopathy in the imaged portions of the neck. The salivary glands are unremarkable. There are secretions in the left posterior ethmoid sinus. There is partly imaged nonspecific patchy posterior cerebral white matter T2 hyperintensity.Brain: There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse patchy cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a persistent left trigeminal artery. The orbits are grossly unremarkable.

Output: 1. No significant change in size of the left jugulotympanicum paraganglioma, measuring up to approximately 4.5 cm.2. Persistent left trigeminal artery.


Instruction: Generate impression based on findings.

Input: Clinical question: Ptosis, double vision,? Horner's. Signs and symptoms: Is a bulge. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a dural based extra-axial well-demarcated and uniformly enhancing mass along the left side of falx in left anterior parietal consistent with a meningioma. The lesion measures approximately 18 x 14.5-mm in transaxial and 17-mm in (cc ) dimensions. This finding demonstrates very subtle indentation on the adjacent brain parenchyma without detectable signal abnormality.There is also an additional smaller meningioma in the right posterior frontal along the inner table of the skull. This finding measures approximately 9 times 10-mm in transaxial dimensions and results in very subtle indentation of adjacent parenchyma without signal abnormality.There is mild uniformly prominent cerebral cortical sulci which could be within normal range for patient stated age of 72.Ventricular system are within normal and maintained midline.The myelination of brain is also within normal. The signal void of major intracranial arterial branches are identified. There is no detectable abnormal parenchymal or leptomeningeal enhancement other than above detailed small meningiomas.The signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.Calvarium and soft tissues of the scalp are unremarkable. Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized.

Output: 1.No acute intracranial process.2.Left parietal falcine meningioma measuring at 18 x 14 x 17-mm in size. No significant mass effect or associated adjacent brain parenchymal signal abnormality.3.Right posterior frontal meningioma along the inner table of the skull measuring at 9 x 10-mm and the subtle indentation of adjacent parenchyma.4.Slight generalized prominence of cortical sulci which could be within normal for patient's stated age of 72 and unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disorder of brain, unspecifiedClinical question: eval brain mass noted on CT head -- infection vs malignancySigns and Symptoms: newly diagnosed brain mass and lung mass There is a ring-enhancing lesion measuring 11 mm in diameter present along the right centrum semiovale associated with adjacent T2 and FLAIR signal hyperintensity suggestive of vasogenic edema. The lesion is adjacent to the right lateral ventricle and distorts the parenchymal lining of the right lateral ventricle. Centrally within the fluid collection there is diffusion restriction. The margins of the ring enhancing lesion are smooth. On T2 imaging the ring is low signal.There is a ring-enhancing lesion present along the right cerebellar hemisphere measuring 11 mm in diameter with similar characteristics as the right centrum semiovale ring-enhancing lesion. There is associated vasogenic edema.There is a 4 mm focus of ring enhancement along the left occipital pole subcortical white matter which also present diffusion restriction and vasogenic edema.There is diffusion restriction present within the right lateral ventricle associated with the FLAIR signal hyperintensity along the subependymal lining of the right lateral ventricle. There is some patches of abnormal enhancement present along the right lateral ventricle.A small focus of diffusion restriction is present in the fourth ventricle. This associated with intermediate signal on FLAIR imaging but no significant contrast enhancement.There is a punctate focus of diffusion restriction along the posterior aspect of the left occipital horn of the left lateral ventricle.A small amount of diffusion restriction is also present within the inferior aspect of the third ventricle.Some punctate foci of diffusion restriction are present adjacent to the cerebellar hemispheres and vermis.A T2 and FLAIR hyperintense punctate subcortical white matter lesion is present adjacent to the left frontal lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells demonstrate minor opacities.. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with multiple abscesses (most likely pyogenic) located adjacent to the right lateral ventricle subependymal region and centrum semiovale, right cerebellar hemisphere and left occipital lobe. There is associated ventricular involvement predominantly involving the right lateral ventricle but with extension into all ventricles. There is right lateral ependymitis. Additionally, there is some indication of posterior fossa cisternal involvement.2.Findings were discussed with Michael Cui of the referring clinical service including the ventricular involvement.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (2/26/16, 7/19/16), ultrasound images of right breast (7/19/16), breast MRI (8/3/16), MRI guided biopsy of right breast and post-procedural mammogram (8/11/16) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (2/26/16, 7/19/16):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). A marker clip from prior biopsy is present at posterior upper outer quadrant in the right breast.A focal asymmetry with possible architectural distortions is seen at upper outer quadrant in the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (7/19/16):A few irregularly shaped hypoechoic lesions are detected within the upper outer quadrant in the right breast.BREAST MRI (8/3/16):The study was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an enhancing mass measuring 7 x 8 x 10 mm (AP x LR x CC) at 12:00 position in the right breast.Segmental non-mass enhancement, measuring 27 x 41 x 50 mm is present in the right upper outer quadrant, surrounding the mass.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.MRI GUIDED BIOPSY OF RIGHT BREAST AND POST-PROCEDURAL MAMMOGRAM (8/11/16):MRI guided biopsy was performed for 2 sites; the enhancing mass at 12:00 position (site #1), and non-mass enhancement at 10:00 position (site #2). A needle placement appears appropriate. A hematoma is present at 12:00 position after biopsy. Postprocedural mammogram demonstrates a coil clip at posterior 12:00 position, and a Hydromark clip at anterior 10:00 position.Per pathology report, the result of site #1 was malignant; invasive ductal carcinoma grade 1 with lobular features, ductal carcinoma in situ low-grade, and the result of site #2 was benign.

Output: 1. Biopsy proven carcinoma at posterior 12:00 position in the right breast.2. MR guided biopsy for non-mass enhancement in the right breast at upper outer quadrant was benign but discordant.If breast conservation surgery is planned, a needle localization for site #1 for lumpectomy, and site #2 for excisional biopsy is recommended.3. No mammographic or MR evidence of malignancy in the left breast.4. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: r/o meniscus tear History: pain MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness articular cartilage defects are identified. Foci of decreased signal abnormality within the lateral femoral condyle likely represent benign bone islands. Otherwise no bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is minimal increased signal abnormality and fluid sensitive sequences within the distal quadriceps tendon which may reflect a very mild tendinosis.ADDITIONAL

Output: Minimal quadriceps tendon tendinosis. Otherwise normal-appearing right knee without evidence of a meniscal tear. Other findings as described above.


Instruction: Generate impression based on findings.

Input: There is multifocal low T1 and T2 signal in the dorsal epidural space from the T4-T9 levels, which may represent ossification along the ligamentum flavum. There is associated severe spinal canal stenosis from the T4-T5 to T6-T7 levels with flattening of the cord and suggestion of high T2 signal within the spinal cord. There is no high-grade spinal canal stenosis in the cervical or lumbar spine.There is prominence of the lumbar dorsal and ventral epidural fat from the L3-S1 levels, along with narrowing of the distal spinal canal, which may be suggestive of epidural lipomatosis and possible developmental narrowing of the spinal canal. Additional note is made of prominent facet arthropathy, particularly at the L4-5 and L5-S1 levels.The vertebral bodies are appropriate in overall alignment and height.

Output: 1. This is a limited exam specific for the exclusion of cord compression only. There is multifocal decreased T1 and T2 signal in the dorsal epidural space from the T4-T9 levels, which may represent ossification along the ligamentum flavum. There is consequent severe spinal canal stenosis, flattening of the cord and suggestion of high signal within the spinal cord at these levels. Recommend dedicated MR of the thoracic spine; CT of the thoracic spine would also be useful.2. Findings suggestive of developmental narrowing of the lower lumbar spinal canal with epidural lipomatosis.


Instruction: Generate impression based on findings.

Input: Thoracic spine: There is a low T1 signal, enhancing lesion involving the posterior elements of T6 with mild expansion of the left lamina and pedicle. There is no discernible compromise to spinal canal or neural foramen. The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. There is overall heterogeneity of the bone marrow signal with multiple T1 and T2 hyperintense lesions, compatible with focal fatty marrow and/or intraosseous hemangiomas and what may represent radiation effects in the upper thoracic vertebrae. The spinal cord is of normal caliber and signal. There is no pathological enhancement of the spinal cord. There are minimal disc bulges at T10-11 and T11-12. There is no other significant disc bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. There is an enhancing lesion with low T1 signal in the posterior aspect of the left eighth rib. The left adrenal gland is enlarged, nodular and enhancing measuring up to 2.4 cm. There are partly imaged and incompletely characterized abnormalities in the right lung. Lumbar spine: The lumbar spine is in normal alignment. There is diffusely heterogeneous bone marrow signal multiple foci of T1 and T2 signal which may relate to intraosseous hemangiomas or focal fatty marrow. There is degenerative endplate marrow signal change at L4-5. There is no definite pathological enhancement. Interspinous process enhancement and edema at the L2-3 level is also likely degenerative in nature. The distal spinal cord and conus are within normal limits. There are mild disc bulges with central disc protrusions at L3-4 and L4-5, which along with bilateral facet arthropathy and ligamentum flavum thickening results in mild spinal canal and right neural foraminal stenoses. Mild disc bulges and bilateral facet arthropathy are present at the remaining levels without significant spinal canal or neural foraminal stenosis.

Output: 1. Metastatic lesions involving the posterior elements of T6, left posterior eighth rib, and left adrenal gland. 2. No significant spinal canal stenosis, neural foraminal narrowing or abnormal thoracic spinal cord signal.3. Lumbar degenerative changes predominantly at L3-4 and L4-5 with mild spinal canal and right neural foraminal stenoses at these levels.4. Partly imaged and incompletely characterized abnormalities in the right lung. Please refer to the prior chest CT report for details.


Instruction: Generate impression based on findings.

Input: History of multifocal prostate cancer. Patient presents for focal laser ablation of the 3+4 disease in the left mid gland and apex peripheral zone disease. Patient used prophylactic antibiotics before and after the procedure asprescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500 mg bidstarting the night before the procedure. He took 2 tablets of Ciprofloxacin 500 mg beforethe procedure and will take two tablets after the procedure. Following the discussion ofthe risks, benefits, and alternatives of the procedure, informed consent was obtained forthe research study. The procedure was performed under moderate conscious sedation.MRI focus in the left mid-gland and apical peripheral zone suspicious for patient's known cancer waslocalized with T2 weighted MR images. Following sterile preparation, Visualase laserablation template was placed in the perineum on the patient and localized on MR images andregistered to the MR images where prostate lesion could be visualized.Following local anesthesia with lidocaine, 14-gauge MR- compatible needles were insertedinto the left side of the prostate to stabilize the prostate. Upon confirmation of thetip of the needle on the left side close to the known lesion, a total of 6 laser ablationswith 30-W, 90 % power was performed within the left mid-gland and apical peripheral zone of theprostate zone. The patient tolerated the procedure well without any immediate complications.Pre-and postcontrast axial MR images are obtained before and after administration of 20 ccMultiHance, upon completion of the procedure. On MR images of ablation defect was notedwithin and around the ablated region. COMPLICATIONS: No immediate complications.BLOOD LOSS: < 3 ml

Output: MR guided laser ablation of the left mid-gland and apical peripheral zone of theprostate.PLAN: Patient was sent to the post-procedural area for observation to ensure voiding versus Foley catheter placement. Will follow-up with urology.


Instruction: Generate impression based on findings.

Input: 44-year-old male with a history of multiple myeloma on clinical trial with right-sided sciatic nerve pain. BONE MARROW: The previously described small linear foci of abnormal signal intensity within the medial aspect of the left ilium, thought to represent sites of prior marrow aspiration and biopsy, are less distinct on today's examination. There is slight heterogeneity of the bone marrow of the pelvis, lower lumbar spine, and proximal femurs which may represent residual red marrow. There is no focal signal abnormality or abnormal enhancement to suggest myelomatous deposits.SOFT TISSUES: No significant abnormality noted. JOINTS: The hip joints, pubic symphysis, and sacroiliac joints appear normal.

Output: No discrete myelomatous deposits are identified. No findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 8-year-old female with history of left knee injury. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No bone contusions are evident. The articular cartilage is intact.There is a 1.5 cm cortically based T2 hyperintense lesion with sclerotic borders located about the posterior aspect of the distal femoral metaphysis.LIGAMENTS: The ACL is not well visualized at its femoral insertion. Nonspecific low signal intensity band resting along the top of the tibial plateau likely represents residual ACL fibers. The PCL, LCL, and MCL are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complete ACL rupture at its femoral insertion. Given lack of bone contusions and significant joint effusion, this likely represents a chronic tear. The menisci are intact.2. Probable benign NOF along the posterior aspect of the distal femoral metaphysis.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of hydrocephalus. Evaluate hydrocephalus. There is no evidence of intracranial hemorrhage, mass, or extra-axial fluid collection.There is moderate hydrocephalus involving the third ventricle and lateral ventricles bilaterally. There is no evidence of intracranial mass or other obstructive lesion. The cerebral aqueduct of Sylvius is patent. The fourth ventricle within normal limits. There is minimal effacement of the sulci in the parietal occipital lobes bilaterally. There is no midline shift. There are bilateral areas of low attenuation noted in the subcortical white matter of the posterior frontal lobes which are not consistent with transependymal exiting of CSF. These findings are nonspecific and clinical correlation with the patient's history and comparison with the prior CT examination is recommended. If no prior examinations are available, further evaluation with MRI could be considered.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. There is extensive opacification of the left ethmoid air cells associated with minimal bony remodeling.

Output: 1.Moderate hydrocephalus involving the third ventricle and the lateral ventricles bilaterally without a definitive obstructing lesion or mass.2.Bilateral areas of low attenuation in the subcortical white matter of the posterior frontal lobes. These findings are nonspecific and clinical correlation with the patient's history and comparison with the prior CT examination is recommended. If no prior examinations are available, further evaluation with MRI could be considered.3.Opacification of the left ethmoid air cells associated with minimal bony remodeling. Clinical correlation is indicated and further evaluation with a dedicated CT sinus examination is recommended.


Instruction: Generate impression based on findings.

Input: New gait abnormality and history of lymphoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mucosal thickening in the right sphenoid sinus.

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


Instruction: Generate impression based on findings.

Input: 57-year-old female with known CCM disease including bleeding in July 2015, and prior history of resection in 2007. There are innumerable areas of low signal intensity on susceptibility-weighted sequences of varying sizes within the bilateral cerebral hemispheres as well as brainstem and cerebellum consistent with cavernous malformations. There is a large lesion within the left posterior frontal lobe abutting the frontal horn of the left lateral ventricle measuring 3.2 cm x 3.1 cm (series 701, image 19) which demonstrates internal T1 hyperintensity which may be related to recent hemorrhage. An additional lesion within the medial right temporal lobe measures 2.3 cm x 2.0 cm (series 701, image 11) demonstrates similar signal intensity pattern. There is no surrounding edema associated with these lesions. There is also hemosiderin staining involving the left pre- and postcentral gyri likely related to prior rupture of a cavernous malformation. There is evidence of prior resection within the right parietal lobe. There is no evidence of infarct. No midline shift or herniation. No hydrocephalus.Partial opacification of the right maxillary sinus, anterior ethmoid air cells and sphenoid sinuses. The orbits are unremarkable.

Output: 1. Numerous cavernous malformations throughout the brain. The largest lesions involving the left posterior frontal periventricular region and the right medial temporal lobe demonstrate T1 hyperintensity which may be related to more recent hemorrhage. There is also hemosiderin staining involving the left pre and postcentral gyri likely related to prior ruptured cavernous malformation. No edema is associated with the lesions. No prior studies are available for comparison, and if made available, an addendum can be issued.2. Postsurgical changes in the right parietal lobe presumably related to prior cavernous malformation resection.


Instruction: Generate impression based on findings.

Input: Reason: multiple cystic lesion to thighs bilaterally and varicosities to lower legs History: mass In the subcutaneous soft tissues of the right thigh are multiple encapsulated ovoid structures which follow fat signal on multiple sequences, consistent with subcutaneous lipomas. The largest of which measures 34 x 17 mm (series 16, image 2). A 12 x 9 mm ovoid density which does not follow fat signal likely represents a subcutaneous sebaceous cyst (series 12, image 34).Bone marrow signal is within normal limits. The visualized muscles and tendons are within normal limits.

Output: Multiple subcutaneous lipomas.


Instruction: Generate impression based on findings.

Input: Seizure, multifocal spikes, and speech delay. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No potential seizure foci are identified.


Instruction: Generate impression based on findings.

Input: New since the prior MRI of 03/17/16, postop changes are seen related to vascular malformation resection in the area of the left basal ganglia, including restricted diffusion around the resection margin. There are layering blood products in the occipital horn of the right lateral ventricle, also likely postprocedural in etiology.The known cyst within the fourth ventricle is similar in size and appearance to the previous study, displacing the quadrigeminal plate, superiorly. There is questionable increase in the degree of edema in the midbrain adjacent to the cyst. Similarly, there is increased edema adjacent to the occipital horn of the right lateral ventricle. The temporal horns are mildly increased in size when compared to the prior study, by approximately 1 to 2 mm, bilaterally.The CSF is diffusely nonsuppressing on FLAIR, which may relate to debris and/or blood products diluted within the CSF spaces. The septated bilateral subdural fluid collections are similar in size, measuring up to 2 cm adjacent to the left frontal lobe. Stable appearance of bilateral frontal porencephaly. Diffuse superficial siderosis is unchanged.There is new/increased diffuse enhancement of the ventricular walls and ependyma, which may relate to ventriculitis. The dura and subdural septations also diffusely enhance, but this is stable from the previous study. There is expected postoperative enhancement in and around the resection cavity.There is fluid in the left maxillary sinus, similar to previous. The mastoid air cells are clear. Visualized portions of the orbits are intact, although the right globe remains significantly larger than the left.

Output: 1.Evidence of resection in the region of the left basal ganglia, with expected local postoperative findings.2.New and/or progressive ependymal enhancement throughout the ventricular system, with slight increase in size of the temporal horns. While this may represent reactive ventriculitis secondary to blood products or debris, the possibility of infection should also be considered.3.Slight increase in the degree of edema in the midbrain adjacent to the known fourth ventricular cyst, as well as around the right occipital horn.4.Stable appearance of other chronic intracranial deformities.


Instruction: Generate impression based on findings.

Input: 24-year-old male patient with history of ileocolonic Crohn's, colonoscopy performed and unable to bypass transverse colon. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. No suspicious enhancing hepatic lesions.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: Again seen is loss of plical markings in the distal and terminal ileum, similar compared to prior examination. The descending colon distal to the splenic flexure and proximal to the sigmoid colon is now featureless, new compared to prior examination. There is no abnormal enhancement to suggest active inflammation. No evidence of stricturing or obstruction. No fistula or fluid collection seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Featureless distal and terminal ileum as well as descending colon are compatible with sequelae of Crohn's disease. No evidence of acute inflammation or stricture.


Instruction: Generate impression based on findings.

Input: 99 year old male with history of fall striking head; rule out bleed. Low attenuation lesions identified in the left posterior parietal region and right posterior parietal region with surrounding edema; given recent MRI, these likely represent metastases with surrounding edema. The appearance is unchanged from previous.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Unchanged appearance of brain metastases without acute bleed.


Instruction: Generate impression based on findings.

Input: Right lower extremity weakness, Multifocal scattered various sized high signal intensity lesions on FLAIR imaging are seen on bilateral frontal lobes, parietal lobes and corpus callosum. Especially on sagittal FLAIR scan, those high signal intensity lesions appear to be arranged as per periventricular to ventricle. On gadolinium enhancement, there is a focal enhancing nodule on the right precuneus which may indicate active lesion.Above findings suggest possibility of demyelinating disease such as multiple sclerosis.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C spine MRI:Again, there are multifocal patch high signal intensity lesions on the spinal cord, especially at the level of C2-C3 and T1-T2 junction level with minimal cord expansion indicating possible edema. On gadolinium enhancement, C3-C4 level as well as T1-2 junction region show patch or periportal enhancement indicating active lesion. Considering multifocal white matter lesions on brain MRI, the spine MRI findings are consistent with spinal cord involvement of demyelinating disease such as multiple myeloma.The cranial-cervical junction is normal. There is straightening of spica spine losing normal lordotic angle. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.From C2-C3 to T1-2 level, there is no evidence of neural foraminal or spinal canal stenosis.

Output: Multifocal patchy high signal intensity lesions on bilateral hemispheres as well as spinal cord (cervical spine) as described above. There are some enhancing lesions on gadolinium enhancement mostly on cervical spinal cord. These findings suggest possibility of multiple sclerosis with active plaques. Clinical and laboratory [CSF study] correlation are recommended.


Instruction: Generate impression based on findings.

Input: There is no convincing evidence of diffusion abnormality in the hippocampi or elsewhere in the brain. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. There are scattered foci of susceptibility compatible with chronic microhemorrhages including peripherally in the left temporal and right occipital lobe, in the left parietal periventricular white matter, as well as small foci in the posterior fossa. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for patient's advanced age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRA HEAD

Output: 1. No diffusion abnormality in the brain to suggest acute ischemia.2. Mild chronic small vessel ischemic disease. 3. Few scattered foci of chronic microhemorrhage which are in a nonspecific distribution and may be related to amyloid angiopathy and/or hypertension.


Instruction: Generate impression based on findings.

Input: History of cT1N2a squamous cell of the left tonsil in 1994 status post definitive radiation, now with a second primary cT4aNx malignancy of the left base of tongue. There are post-treatment findings in the left oropharyngeal region. There is an enhancing ulcerative mass involving the left tongue base and oral tongue with extension across the midline and left glossotonsillar sulcus. Overall, the mass measures up to approximately 45 mm. There is also abnormal signal in the medial left masticator space and left mandibular body and ramus. Although not significantly enlarged by size criteria, left level 1 and level 3 lymph nodes display signal characteristics that appear to be different from the other lymph nodes in the neck. There is high diffuse T2 signal in the hypopharynx and portions of the larynx, without associated discrete mass lesions. There is a posterior disc-osteophyte complex at C5-6 with mild spinal canal stenosis. The imaged portions of the orbits, intracranial structures, and thorax are grossly unremarkable.

Output: 1. A mass involving the left tongue base and oral tongue with extension across the midline and left glossotonsillar sulcus is compatible with the clinically reported squamous cell carcinoma. 2. Although not significantly enlarged by size criteria, left level 1 and level 3 lymph nodes display signal characteristics that appear to be different from the other lymph nodes in the neck. This is nevertheless nonspecific and may represent metastatic disease versus an inflammatory or reactive process.3. Abnormal signal in the hypopharynx and portions of the larynx, as well as in the left masticator space without associated discrete mass lesions likely represents treatment effects or inflammation.


Instruction: Generate impression based on findings.

Input: Claudication and radicular symptoms. There is multilevel degenerative spondylosis of the lumbar spine with diffuse loss of disc space height and fluid signal. At T12-L1, there is mild right facet joint hypertrophy with mild right neural foramen stenosis, but no significant spinal canal stenosis. At L1-L2, there is a slight disc bulge, but no significant spinal canal or neural foraminal stenosis. At L2-L3, there is bilateral facet hypertrophy with mild left and minimal right neural foraminal narrowing, but no significant spinal canal stenosis. At L3-L4, disc bulging, ligamentum flavum thickening, and bilateral facet hypertrophy result in mild right and moderate left bilateral neural foramen stenosis. At L4-5, there is trace disc bulging, mild ligamentum flavum thickening, and bilateral facet hypertrophy with mild right and mild-to-moderate left neural foraminal stenosis, but no significant spinal canal stenosis. At L5-S1, there is a no significant spinal canal or neural foraminal stenosis. There is partial sacralization of L5. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is diffuse paraspinal muscle atrophy.

Output: Multilevel degenerative spondylosis of the lumbar spine, as described in the findings section.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other symptoms and signs involving the musculoskeletal systemClinical question: eval for tethered core, h/o of spinal bifidaSigns and Symptoms: inability to ambulate, BLE weakness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The spinal cord is tethered and there is a spina bifida defect present in the upper sacrum. There is a sinus tract which extends through the spina bifida defect to the skin surface. The distal spinal cord is attached to the sinus tract. There is a small fluid collection present at the sinus tract measuring 24 x 5 mm sagittal dimensions and 14 x 5 mm axial dimensions. This fluid collection is eccentric towards the left side as is the sinus tract. These findings are stable compared to the previous examAt L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.The spinal cord is tethered and is associated with a sinus tract as detailed above. The patient is status post myelomeningocele repair. These findings appear stable compared to the previous exam from 1/2014.


Instruction: Generate impression based on findings.

Input: Congenital sensorineural hearing loss, in which the right ear appears to be decreasing in hearing sensitivity and the left ear is fluctuating. Right Interval Auditory Canal: There is mild enlargement of the endolymphatic duct. There also appears to be slight deficiency of the modiolus and septation of the cochlea. The semicircular canals and vestibule appear to be intact. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions.Left Interval Auditory Canal: There is enlargement of the endolymphatic duct and sac. There also appears to be slight deficiency of the modiolus and septation of the cochlea. The semicircular canals and vestibule appear to be intact. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Bilateral enlarged vestibular aqueduct syndrome, left more pronounced than right, with features suggestive of mild cochlear involvement associated with incomplete partition type 2.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Patellar instability MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The posterior cruciate ligament is intact. The anterior ligament appears to be torn and discontinuous at its most cephalad componentMedial collateral ligament is intact. The lateral collateral complex is intactEXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Anterior cruciate ligament tear.


Instruction: Generate impression based on findings.

Input: Ms. Zentner is a 69-year-old female with a personal history of left breast lumpectomy in 2005 for DCIS followed by radiation and Arimidex therapy. Family history of breast cancer in her paternal cousin and ovarian cancer in her mother. She has no current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the left retroareolar region, at site of prior lumpectomy. Stable enhancing focus identified in the left lower outer breast. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: There is mild anterolisthesis of L4 on L5 and mild retrolisthesis of L5 on S1. There is disc desiccation throughout the lumbar spine with moderate to severe loss of disc height at L3-L4, L4-L5 and L5-S1, which is progressed from prior study. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. The cauda equina nerve roots are thickened and redundant.T12-L1: Bilateral facet degeneration, but no significant spinal canal or neural foraminal stenosis.L1-L2: Bilateral facet degeneration, but no significant spinal canal or neural foraminal stenosis.L2-L3: Unchanged disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild to moderate bilateral foraminal stenosis.L3-L4: Unchanged disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. There is effacement of the lateral recesses.L4-L5: Unchanged mild anterolisthesis of L4 on L5 with pseudo disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate bilateral foraminal stenosis. There is effacement of the lateral recesses.L5-S1: Mild retrolisthesis of L5 on S1 with pseudo disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild spinal canal narrowing and moderate bilateral foraminal stenosis. There is effacement of the lateral recesses.

Output: 1. Interval progression of multilevel loss of disc height of the lower lumbar spine. Otherwise, no significant interval change in the advanced degenerative changes of the lumber spine, most prominent at L3-L4 and L4-L5 levels, resulting in moderate to severe spinal canal stenosis, moderate bilateral foraminal and bilateral lateral recess compromise. 2. Unchanged mild spinal canal narrowing at L2-L3 and L5-S1 with up to moderate bilateral foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for altered mental status in patient with metastatic lung adenocarcinoma. Signs and symptoms: 76-year-old male with newly diagnosed stage IV lung cancer. Enhanced head CT:60 cc of Omnipaque 350 is administered for this study.There is a focus of subtle increased density in the inferior aspect of the vermis measuring approximately 14 times 10-mm in size (axial image 7). There is no distinct mass effect or any detectable surrounding vasogenic edema. Possibility of artifact cannot be entirely ruled out considering patient's history. Recommend further follow-up with enhanced brain MRI. The fourth ventricle is normal in size. Images through the supratentorial space demonstrate no findings to suggest metastatic lesion. There are however subtle subcortical and periventricular low-attenuation of white matter in bilateral cerebral hemisphere concerning for moderate degree of small vessel ischemic stroke of indeterminate age. The cortical sulci, ventricular system and all CSF cisterns remain within normal.Limited images through the orbits are unremarkable.Calvarium is intact.

Output: 1.One subtle focus of increased density/enhancement in inferior aspect of vermis with no associated surrounding vasogenic edema or any detectable mass effect. To exclude possibility of metastatic lesion recommend follow-up with an MRI exam.2.Small vessel ischemic strokes of indeterminate age.3.Calvarium is intact.


Instruction: Generate impression based on findings.

Input: Evaluate for pancreatic head mass. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Gallbladder wall edema is nonspecific.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of pancreatic lesion in the area of interest seen on prior CT within the limitations of a noncontrast exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Abnormal increased signal in the collecting system may reflect patient's known nephropathy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There are large bilateral pleural effusions.

Output: No evidence of pancreatic lesion within limitations of a noncontrast exam in the region of interest seen on prior CT.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with left upper extremity and left lower extremity pain. Cervical:Alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are within normal limits.Visualized spinal cord shows normal signal characteristics and morphology. No epidural abnormalities are suspected.C2-3: Left facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Left facet hypertrophy. Right paracentral and foraminal disc osteophyte formation, similar to prior. Effacement of the ventral thecal sac with mild spinal canal narrowing. Severe right and moderate left foraminal narrowing, not significant changed.C6-7: Left facet hypertrophy. Right uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. No significant interval changes.C7-T1: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. Thoracic:The thoracic kyphosis is mildly exaggerated. Spinal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or edema is seen.Visualized spinal cord demonstrates normal signal intensity and morphology throughout. No epidural abnormalities are suspected.Facet hypertrophy and ligamentum flavum thickening is seen particularly on the right at T10-11. No significant disc bulging or disc herniation is seen. No spinal canal or foraminal stenosis is detected.Lumbar:There is a mild dextrocurvature to the lumbar spine. Sagittal alignment is unremarkable. Vertebral body morphology and signal characteristics are within normal limits.The visualized distal spinal cord, conus and cauda equina are within normal limits. No epidural abnormalities are seen.L1-2: Mild loss of disc T2 signal. No spinal canal or foraminal stenosis. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: No significant spinal canal stenosis or neuroforaminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Loss of disc T2 signal and height with mild disc bulging and a left foraminal annular fissure. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Loss of disc T2 signal, mild disc bulging and a left paracentral annular fissure. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.In the cervical spine, degenerative disease is most notable at C5-6 where there is a mild spinal canal stenosis, severe right and moderate left foraminal narrowing; and at C6-7 where there is moderate to severe bilateral foraminal narrowing.2.No significant spinal canal stenosis or foraminal narrowing is seen in the thoracic spine.3.In the lumbar region, disc degeneration and posterior element hypertrophy is most notable at L4-5 where there is moderate right foraminal narrowing.


Instruction: Generate impression based on findings.

Input: The vertebral body and disc heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits for configuration with the conus terminating at the mid-L3 level. The lumbar spine demonstrated normal alignment, with a normal lumbar lordosis. There is T1 hyperintense linear focus at the filum terminale that measures up to 2 mm in width and 20 mm in length. There is no significant disc bulge, herniation, or spinal canal or neural foramen stenosis within the lumbar spine. On prone imaging, there is no significant anterior translation of the conus. There is left hydronephrosis and marked bladder distension.

Output: 1. Low-lying conus medullaris associated with a fibrofatty filum terminale and suggestion of tethered cord.2. Left hydronephrosis and marked bladder distension.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 16-year-old female with pituitary microadenoma, annual evaluation. Redemonstrated is mild prominence of the pituitary gland measuring 11 x 9 mm in the transverse by craniocaudal dimensions, which is unchanged. There is a symmetric convex superior margin of the gland. There is uniform enhancement of the pituitary gland without signal abnormality to suggest a discrete mass. Redemonstrated is minimal leftward deviation of the pituitary stalk, but it is otherwise normal in caliber, signal intensity, and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable.

Output: No significant interval change in mild pituitary prominence. No discrete pituitary mass is identified.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. Incidental note is made of partial vertebral body fusion at T1/T2. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: There is a tiny midline disc protrusion without cord deformation or resulting stenosis.C5/6: Minimal disc bulge without significant mass effect or resulting stenosis.C6/7: UnremarkableC7/T1: Unremarkable

Output: 1.Incidental note is made of partial vertebral body fusion at T1/T2.2.C4/5: There is a tiny midline disc protrusion without cord deformation or resulting stenosis.3.C5/6: Minimal disc bulge without significant mass effect or resulting stenosis.


Instruction: Generate impression based on findings.

Input: Prostate cancer with bone metastasis. Evaluate for disease progression.. The patient could not tolerate doing the thoracolumbar examination and only the thoracic spine was scanned. There is anterior and posterior fusion of C3-C4. T1-hypointense signal in the C5-C6 vertebral bodies and pedicles is incompletely assessed. In addition, the lesion with a central compression fracture involving the L1 vertebral body is not fully characterized, but there is apparently increased retropulsion. There is a rightward convex curvature that is mild and broad-based. The T1 and T2 hyperintense lesions involving the C7, T5, T7, T8, and T10 vertebral bodies are unchanged, most compatible with hemangiomas. Focal T1-hypointense, T2 hyperintense, contrast-enhancing marrow abnormality just subjacent to the focally deficient inferior endplate of T8 vertebral body is most likely a Schmorl node. A smaller similar one is present at T9 also along the inferior endplate. There is subtle increase in T2 signal and decrease in T1 signal along the anterior aspect of T11 and T12 vertebral bodies with associated mild contrast enhancement. This was present previously and may be degenerative in nature. The vertebral body heights are preserved. The minimal T2-T3 disc-osteophyte complex indenting the thecal sac but no causing significant spinal canal or foraminal narrowing has not changed. Otherwise, the disc space heights are preserved. There are prominent midthoracic anterior spinal osteophytes, which are predominately right-sided and may reflect diffuse idiopathic skeletal hyperostosis. The spinal cord displays normal signal and morphology. There is interval increase in size of a left retroperitoneal nodule, which may represent a lymph node metastases, although this is incompletely characterized.

Output: 1.The patient was unable to complete the examination and only the thoracic spine was imaged.2.Minimal, focal contrast enhancement along the inferior aspect of T8 and T9 vertebral bodies is probably related to Schmorl nodes. Multilevel hemangiomas are unchanged. There is no suspicious thoracic spine lesion, otherwise.3.The pathologic compression fracture involving the L1 vertebral body is not diagnostically imaged, but there is increased retropulsion.4.Interval increase in size of a left retroperitoneal nodule, which may represent a lymph node metastases, although this is incompletely characterized.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of HCV cirrhosis and hepatocellular carcinoma status post resection, now with right upper quadrant pain. Evaluate for recurrence or for fluid collection. ABDOMEN:LIVER, BILIARY TRACT: Redemonstration of nodular contour of the liver with widened fissures consistent with cirrhosis.Postoperative change of segment 5 partial hepatectomy with evidence of a T2 heterogeneous postoperative fluid collection which measures 3.7 x 2.5 cm. Trace perihepatic fluid.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral scattered subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: Redemonstration of occlusion of the proximal celiac trunk with collateralization.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Heterogeneous postoperative fluid collection measuring up to 3.7 cm in segment 5 at the location of the previous excision.2.No enhancing lesions to suggest hepatocellular carcinoma recurrence.3.Redemonstration of occlusion of the proximal celiac trunk with collateralization.


Instruction: Generate impression based on findings.

Input: History of chronic suppurative otitis media now with dizziness and headaches in the setting of possible chronic Lyme disease. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right temporal lobe developmental venous anomaly. 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, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Internal Auditory Canals: There is mild high T2 signal in the right mastoid air cells region. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable.

Output: 1. Mild scattered foci of T2 hyperintensity in the right mastoid air cells, which may represent a sequela of prior infection. However, assessment of the middle ear is limited on MRI and a temporal bone CT may be useful for further evaluation.2. Right temporal lobe developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dorsalgia, unspecifiedSigns and Symptoms: Back pain Five lumbar type vertebral bodies are presumed to be present. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and diffuse disc bulge present at this level. There is mild narrowing of the neural foramina at this level. Some acute endplate reactive changes are present at this levelAt L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate facet hypertrophy at this level. There is loss of disc space height, Schmorl's nodes and diffuse disc bulge at this level associated with mild anterior subluxation of L4 on L5. There is narrowing of the neural foramina bilaterally at this level with partial effacement of the fat surrounding the right-sided exiting nerve roots. The exiting nerve roots within the left neural foramen are surrounded by fat. There is effacement of the fat at the right lateral recess more than the left lateral recess at this level. Overall there is a mild degree of spinal stenosis at this level. A CT of the abdomen from 4/13/2010 indicates that some of these findings were present at that time.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height, disc desiccation and diffuse disc bulge at this level . There are Schmorl's nodes present at this level as well as some acute endplate reactive change associated with the Schmorl's nodes.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the lower lumbar spine which appear to be worse at L4-5 where there is mild subluxation and a mild degree of spinal stenosis with some encroachment of the nerve roots of the right lateral recess and mild encroachment of the nerve roots at the right neural foramen.


Instruction: Generate impression based on findings.

Input: 68 years, Male, anaplastic thyroid cancer. Brain lesions or PET scan. There are at least 8 foci of abnormal enhancement scattered within the brain parenchyma consistent with intracranial metastases. Punctate lesions are evident in the left posterior frontal lobe, right parietal lobe, bilateral temporal lobes, right occipital lobe, as well as in the right cerebellum. A relatively larger left temporal enhancing lesion abutting the dura measures up to 18 x 14 mm. The right cerebellar lesion measures up to 7 mm. Some of these lesions demonstrate punctate susceptibility effect indicating small hemorrhage, such as a right cerebellar lesion. There is loss of sulcal CSF suppression on the FLAIR sequence in the left occipital lobe with corresponding susceptibility effect most compatible with a small subarachnoid hemorrhage. There are also punctate parenchymal foci of susceptibility in the left occipital lobe without associated enhancement compatible with nonspecific microhemorrhage. There is a wedge-shaped focus of diffusion restriction involving the left posterior cerebellar hemisphere with associated T2/FLAIR hyperintensity and no significant enhancement which likely represents a subacute left cerebellar infarct. Additional foci of diffusion hyperintensity correspond to the small foci of hemorrhage above. A punctate focus of diffusion hyperintensity in the left postcentral gyrus may be artifactual.There are scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. There is mild edema associated with some of the lesions. No significant intracranial mass effect, midline shift, or herniation is evident. No hydrocephalus. Minimal scattered paranasal sinus opacification. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Multiple foci of abnormal parenchymal enhancement in the brain are compatible with intracranial metastases. The multiple intraparenchymal lesions are subcentimeter. A relatively larger left temporal lesion measures up to 18 x 14 mm and abuts the dura, and favored to represent a dural based metastasis (a meningioma as an alternative explanation for the solitary dural based lesion seems less likely). There is mild associated edema without significant intracranial mass effect, midline shift, or herniation.2. Suspected acute to subacute small infarct in the left cerebellar hemisphere.3. Likely small left occipital subarachnoid hemorrhage.Dr. Ali discussed findings with Dr. Sarne on 8/27/2016 at 925 hrs.


Instruction: Generate impression based on findings.

Input: 55 year old female with non-obstructive CAD, DM< HTN, OSA, chest pain, NSTEMI. LVEF 60% with unexplained apical hypokinesis. Referred for cardiac MRI to rule out myocarditis. Left VentricleThe left ventricle is mildly dilated with normal systolic function. There is a small focal area of apical inferior wall hypokinesis. The overall LV ejection fraction is 66%. The LVEDV is 178 ml (normal range 109+/-23), LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), LVESV is 61 ml (normal range 31+/-10), and LV end systolic volume index is 25 ml/m2 (normal range 18+/-5). The LV mass is 134 g (normal range 114+/-24) and the LV mass index is 54 g/m2 (normal range 67+/-11). There is a small, focal, subendocardial, non-transmural, late gadolinium enhancement in the apical inferior wall. The pattern is suggestive of a very small myocardial infarction. The native T1 myocardial relaxation time is elevated at 1150-1160 ms, suggestive of underlying diffuse fibrosis.There is no myocardial iron overload.Left AtriumThe left atrium is mildly dilated .Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 64%, the RVEDV is 200 ml (normal range 110+/-24), the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVESV is 72 ml (normal range 35+/-13), and the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is mildly dilated . Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery (45 mm) is severely dilated. Right and left branch pulmonary arteries are dilated (RPA 22 mm, LPA 23 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is mildly dilated with normal systolic function. LVEF 66%. 2.There is a small apical inferior wall motion abnormality caused by a small non-transmural myocardial infarction.3.There is mild left ventricular hypertrophy with mildly increased native myocardial T1-relaxation times suggestive of mild, diffuse, interstitial fibrosis.4.The right ventricle is mildly dilated with normal systolic function. RVEF 64%.5.Severe dilation of the main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 51 years old Reason: laparotomy, hysterectomy, oophorectomy 6 months ago for endometriosis with persistent abdominal and pelvic pain. History: chronic abdominal and pelvic pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. At least 3 right hepatic lobe lesions and one left hepatic lobe lesion. The lesion in segment 6 of the liver measures 11 x 11 mm on image 150/series 2201; if imaging features are nonspecific of either a cyst or hemangioma.The lesion in segment 7 of the liver is slightly hypervascular compared to background liver and is located between the right hepatic vein and IVC measuring 4.1 x 3.0 cm. The lesion shows some arterial enhancement but no washout. The lesion in segment 7 located peripherally also has similar features.A segment 3 lesion shows arterial enhancement and no washout measures 2.5 x 1.8 cm on image 203. The lesion is lobular and has a subtle central scar.No intra or extra hepatic biliary ductal dilatation. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. The previously noted leiomyomata and endometriomata have been resected. No residual lesions in the surgical bed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the pelvis. There is a small amount of fluid in the left inguinal area.OTHER: Enteric ascites.

Output: 1.Status post hysterectomy without residual disease in the pelvis.2.At least 4 hepatic lesions. The lesion in segment 3 of the liver has imaging features of focal nodular hyperplasia. 3. The segment 7 lesions may represent either focal nodular hyperplasia or hepatic adenomas. But their imaging features are considered indeterminate. They can be followed with a 12 month MRI to ensure stability.4.The smaller segment 6 lesion has nonspecific imaging features and can also be followed with a 12 month MRI of the liver


Instruction: Generate impression based on findings.

Input: 43-year-old female. Crohn's disease, status post complete colectomy with ileostomy. Report from outside hospital shows a 3 x 3 cm mass containing gas adjacent to ileostomy compatible with probable abscess. Evaluate for abscess versus bowel wall thickening due to Crohn's flare. CHEST: LUNGS AND PLEURA: Minimal bibasilar atelectasis. No pulmonary nodules. No pleural effusions or focal airspace consolidation. MEDIASTINUM AND HILA: No mediastinal or hilar adenopathy. The heart size is normal. No left ventricular hypertrophy. No pericardial effusion. CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: No significant abnormalities seen within the liver or gallbladder. SPLEEN: No significant abnormality noted. KIDNEYS, URETERS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted. PANCREAS: No significant abnormality noted. RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes. Small mesenteric nodes identified as well. BOWEL, MESENTERY: There is a 3.9 x 4 cm rim enhancing loculated fluid collection with internal gas at axial image 98/157 extending from the rectal sheath into the subcutaneous fat at the site of the ileostomy. This is compatible with a uniloculated abscess.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted. PELVIS: UTERUS, ADNEXAE: Patient is status post hysterectomy. There is a 4.8 x 3 cm mass in the right adnexa (image 120/157 series number 3). This is this was present on the prior examination it appears slightly smaller. If indicated the mass may be further evaluated with transvaginal ultrasound or MRI. The left adnexa is unremarkable. BLADDER:Unremarkable LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: Right lower quadrant ileostomy is present compatible with patient's known Crohn's disease and total colectomy. Cyst present in the subcutaneous tissues just lateral to the ostomy site. See both. In addition, multiple loops of small bowel have wall thickening in the pelvis which is new since the prior CT examination of 1/6/08. The wall thickening is best seen at axial image 121/157 of series 3 and is compatible with a Crohn's flare. No intraperitoneal abscess and no bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No other significant abnormality was found.

Output: 1. Status post colectomy with right lower quadrant ileostomy. New abscess lateral to ostomy site. Crohn's flare involving pelvic small bowel loops. See above.2. Large right adnexal mass which is not completely evaluated on this examination. The mass appears slightly smaller since 1/6/07. If indicated, transvaginal ultrasound or MRI would be helpful in further evaluating this lesion.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils lie 8-9 mm below the level of the foramen magnum and demonstrate a pointed morphology, consistent with Chiari I malformation.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and visualized upper thoracic cord are normal in signal without evidence of syrinx. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Minimal posterior osteophyte disc complex without stenosisC4/5: UnremarkableC5/6: Mild posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild right neural foraminal and moderate to severe left neural foraminal stenosis.C6/7: UnremarkableC7/T1: Unremarkable. Note is made of partial fusion of the vertebral bodies posteriorly.

Output: 1.The cerebellar tonsils lie 8-9 mm below the level of the foramen magnum and demonstrate a pointed morphology, consistent with Chiari I malformation.2.C5/6: Mild right neural foraminal and moderate to severe left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 63-year-old female with worsening left hip pain, radiograph with evidence of osteonecrosis, history of steroid use ACETABULAR LABRUM: The acetabular labrum appears within normal limits for nonarthrographic technique.ARTICULAR CARTILAGE AND BONE: Mixed T2 signal in the superior aspect of the left femoral head with marked decreased T1 signal in a serpentine pattern compatible with avascular necrosis. No collapse of the cortex or articular cartilage. The geographic territory of the affected area appears similar to the sclerotic region seen on prior radiograph.Susceptibility artifact from metallic right total hip arthroplasty device is noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Avascular necrosis of the left femoral head without evidence of advanced collapse as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of cerebral meningesClinical question: recurrent meningioma status post resection; please evaluate for progressionSigns and Symptoms: recurrent meningioma The patient is status post craniotomy involving both parietal bones and the superior sagittal sinus. There is an extra-axial collection at the craniotomy site measuring up to 13 mm in thickness which was also present on the prior exam. Since the prior exam and this appears to be low more organized. There is associated diffusion restriction within this extra-axial collection. There is adjacent dural thickening which was also present on the prior exam. The dural thickening is more evident on the left versus the right side of the falx. A nodular thickening along the posterior falx currently measures 9 mm x 12 mm and previously measured 9 mm x 12 mm and on sagittal imaging measures 16 x 9 mm on the current exam than on the prior exam measured 12 x 10 mm.Within the brain parenchyma adjacent to the craniotomy site there is signal change within the subcortical white matter in a contiguous fashion which has not changed substantially since the prior exam and has not changed since the preoperative exam.Incidental note is made of partial empty sella.There is mild anterior subluxation of C1 on C2.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 demonstrate opacification of the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Status post parietal craniotomy and superior sagittal sinus surgery for removal of a meningioma. Some residual dural thickening at the surgical site could represent postsurgical change or residual meningioma especially at the junction of the falx and superior sagittal sinus where a nodule appears to be increased in size.2.A fluid collection is present at the surgical site. The possibility this is infected cannot be excluded. Please correlate with patient's clinical symptoms.3.Opacification of the right mastoid air cells and middle ear persists4.There is mild anterior subluxation of C1 on C2 which appears unchanged since prior exam


Instruction: Generate impression based on findings.

Input: 31-year-old male. Clinical question to be answered: Intracranial hemorrhage. Signs and symptoms: Acute cysts left ear. Changes consistent with patient's history of pituitary adenoma with enlarged sella are again identified with no interval change since prior exam. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. This examination remains a stable since prior study. Exclude residual pituitary tumor an MRI examination with infusion is the appropriate study.Mastoid air cells and middle ear cavities are unremarkable. Limited view of paranasal sinuses are unremarkable.

Output: No areas of interval change since prior examination from 6 -- 28 -- 2009.


Instruction: Generate impression based on findings.

Input: 62-year-old male with continued shoulder pain despite injections. ROTATOR CUFF: There is a small full-thickness tear of the supraspinatus measuring approximately 5 mm in the AP dimension with approximately 1.5 cm of retraction of the proximal tendon fragment. The supraspinatus muscle appears intact. There is thickening and intermediate signal intensity within the infraspinatus tendon indicating moderate tendinosis. There is partial thickness undersurface tearing of the anterior fibers of the infraspinatus at the level of its insertion on the greater tuberosity without significant retraction. The subscapularis muscle and tendon appear intact. The teres minor muscle appears intact. There is mild interstitial tearing of the teres minor tendon which otherwise appears intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint with inferior osteophyte formation resulting in slight impression upon the superior fibers of the supraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Within the limitations of a non arthrogram study, the glenoid labrum appears intact.BICEPS TENDON: The long head of the biceps tendon appears intact. ADDITIONAL

Output: Full-thickness tear of the supraspinatus tendon with retraction as described above.


Instruction: Generate impression based on findings.

Input: 36 year old man with history of hypertrophic cardiomyopathy and associated gene mutation, referred for cardiac MRI to evaluate function and obtain cardiac dimensions as part of a research trial. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 60 ml/m2 (normal range: 74+/-15), the LVEDV is 121 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 44 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 120 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is mild asymmetric hypertrophy of the septum (maximum thickness 13-14mm). Technical issues with administration of gadolinium preclude evaluation for late gadolinium enhancement; the patient will be brought back for repeat imaging.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 121 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 63 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal sized LV with normal systolic function (EF=63%). Mild asymmetric septal hypertrophy consistent with the patient's diagnosis of hypertrophic cardiomyopathy.2. Normal sized RV with normal systolic function (EF=49%).3. Mild LA dilation and moderate RA dilation.4. Unable to assess for late gadolinium enhancement on this series of images due to inadequate administration of contrast.


Instruction: Generate impression based on findings.

Input: Comparing to prior scan, coupled angulation of cervical spine has not been changed.Vertebral heights are preserved.Spinal cord signal intensity appears to be normal.Cervical level specific findings : C2-3: No evidence of spinal canal stenosis. No neural foraminal stenosis.C3-4: No spinal canal stenosis. No neural foraminal stenosis.C4-5: No spinal canal stenosis. No neuroforaminal stenosis.C5-6: There is a broad-based disc protrusion central to right which abuts thecal sac and spinal cord. Comparing to prior scan, the degree of protrusion appears to be slightly progressed especially on sagittal scan.C6-7: There is broad-based disc protrusion which abuts thecal sac central to left. Comparing to prior scan, the degree of protrusion also appears to be slightly progressed.C7-T1: No significant abnormality noted.

Output: 1. Interval progression of disc protrusion at the level of C5-6 and C6-7. However, there is no MR evidence of spinal cord signal abnormality.2. Unchanged Kyphotic angulation of cervical spine.


Instruction: Generate impression based on findings.

Input: 50-year-old male with history of pancreatitis complicated by numerous pseudocyst formation status post EUS guided drainage and stent placement. Evaluate pancreatic pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: Again noted is small focus of T2 hyperintensity in the right hepatic lobe, likely benign. Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Residual splenic tissue is unchanged compared to the previous examination. No perisplenic fluid collection. The splenic vein is narrowed but patent with evidence of perigastric varices.PANCREAS: Mild peripancreatic inflammatory changes. The pancreatic duct is dilated with evidence of irregularity and side branches involving the body and tail of the pancreatic duct; findings likely secondary to chronic pancreatitis. No evidence of a pancreatic pseudocyst. There is a blunted response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are present.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings consistent with chronic pancreatitis without evidence of pseudocyst. 2.Blunted response to secretin.


Instruction: Generate impression based on findings.

Input: Female 25 years old Reason: Left hip pain x 4 months, no improvement with physical therapy, evaluate for labral tear History: Left hip pain. ACETABULAR LABRUM: There is linear increased signal intensity traversing the anterior superior labrum from the one to 3 o'clock position indicating a tear.ARTICULAR CARTILAGE AND BONE: There is minimal prominence of the lateral aspect of the proximal femoral epiphysis best seen on coronal image 10 of series 801, we see no classic cam deformity. The articular cartilage appears normal. There is minimal edema type signal within the superior pubic rami bilaterally which could conceivably represent mild stress reaction, but we see no stress fracture.SOFT TISSUES: There is mild fatty atrophy of the quadratus femoris muscles bilaterally that could represent chronic ischiofemoral impingement, but the clinical significance in this patient is uncertain. ADDITIONAL

Output: Anterior superior labral tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with low back pain. Image quality is degraded by motion artifact. Within this limitation, the following observations are made.Spinal alignment is anatomic. Vertebral body heights are preserved. Mild endplate edema is seen anteriorly at L2-3. No other significant or concerning marrow signal abnormality is seen.The visualized spinal cord and conus are unremarkable. Details of the cauda equina will be discussed by level as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Disc bulge asymmetric to the left foraminal and far lateral regions. Mild generalized spinal canal stenosis. Moderate left foraminal narrowing. L3-4: Moderate facet hypertrophy. Ligamentum flavum thickening. Bulging disc with mild to moderate generalized spinal canal stenosis. Moderate left foraminal narrowing. L4-5: Severe facet hypertrophy. Ligamentum flavum thickening. Bulging disc. Severe generalized spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. L5-S1: Severe facet hypertrophy. Ligamentum flavum thickening. Mild generalized spinal canal stenosis. Moderate to severe right and mild left foraminal narrowing. Ill-defined STIR hyperintense signal is seen along the left prevertebral and periaortic soft tissues of uncertain significance. This is visualized only on sagittal STIR images and not well seen on the axial sequences.

Output: 1. Multilevel degenerative findings, most severely affecting the L3-4 level where there is a mild to moderate spinal canal stenosis, and at the L4-5 level where there is a severe spinal canal stenosis.2. Ill-defined abnormal signal is seen within the prevertebral and periaortic tissues on the left as visualized on sagittal STIR images. The significance of this finding is uncertain and it could even be technical in nature. If clinical concern warrants, dedicated abdominal imaging can be considered.


Instruction: Generate impression based on findings.

Input: There is redemonstration of a syrinx the extends from about T5 down to T10 which has a maximum diameter of approximately 2 mm and is unchanged when compared to the prior exam. There is no evidence of mass lesions in the thoracic spine. The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: No appreciable interval change in thoracic spinal cord syrinx.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.