Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer. Known bilateral breast masses on prior MRI There is scattered fibroglandular tissue in both breasts. Bilateral cysts are noted. Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. The known masses at the left 6:00 position and right 3:00 position do not appear significantly changed. Note is also made of focal parenchymal enhancement at the right 12:00 position that is not significantly changed across multiple prior exam allowing for differences in technique. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Migraine with aura, intractable, without status migrainosus [G43.119], Reason for Study: ^Reason: evaluate for etiology of continued headaches, speech difficulty History: as above No evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:11/5/1966)Reason: MS, f/u progression History: ParesthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a focus of encephalomalacia in the right frontal lobe.There is redemonstration of periventricular and subcortical white matter lesions of a mild to moderate degree which were also present on the previous exam. They have not changed significantly compared to the previous exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions are present which are compatible with patient's diagnosis of demyelinating disorder. Appear stable compared to the previous exam.2.Encephalomalacia in the right frontal lobe.


Instruction: Generate impression based on findings.

Input: Male, 69 years old. Left shoulder pain ROTATOR CUFF: There is a high-grade partial-thickness articular surface tear of the supraspinatus tendon at its insertion. The tear involves the posterior fibers of the tendon, extends for 7 mm in AP dimension, and involves greater than 50% of the tendon thickness. There is no significant tendon fiber retraction. The supraspinous muscle is intact. The infraspinatus tendon is intact, and there appears to be some fatty atrophy of the infraspinatus muscle. The teres minor and subscapularis tendons and muscles are unremarkable.SUPRASPINATUS OUTLET: There is mild acromioclavicular joint osteoarthritis with capsular fluid. There is no significant fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is diffuse irregularity of the labrum, compatible with degeneration. Subcortical cysts in the humeral head near the rotator cuff insertion are likely degenerative.BICEPS TENDON: The tendon of the long head of the biceps is normal in course and morphology. ADDITIONAL

Output: 1.High-grade partial-thickness tear of the supraspinatus tendon as above.2.Findings compatible with glenohumeral joint synovitis.3.Acromioclavicular joint osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: continued swelling s/p microfracture of medial femoral condyle 4/22/14 evaluate healing of microfracture History: Left knee pain and swelling. MENISCI: Postsurgical changes in the body and posterior horn of the medial meniscus are compatible with a partial meniscectomy with degeneration and tearing seen. Anterior horn of the medial meniscus is intact. Lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Lateral femoral condyles articular cartilage is unremarkable without a full-thickness tear. There is a full thickness defect of the medial femoral condyle articular cartilage measuring approximately 3 cm x 2.3 cm with corresponding loss of articular cartilage in the medial tibial plateau. LIGAMENTS: Postsurgical ACL graft appears unremarkable. The remainder of the collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Recurrent tearing and degeneration of the medial meniscus.2.Full-thickness defect of the articular cartilage of the medial femoral condyle and medial tibial plateau.


Instruction: Generate impression based on findings.

Input: History of fever, pain, nausea/vomiting, elevated LFTs, and elevated total bilirubin. Evaluate for cholangitis, choledocholithiasis. Past surgical history of cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in signal intensity. No focal hepatic lesions are identified. The gallbladder is surgically absent. There is minimal intrahepatic biliary ductal dilatation centrally. The common hepatic duct is mildly prominent measuring up to 9 mm in diameter. No biliary strictures or definite biliary ductal stones are identified. There is a questionable filling defect within the common bile duct (series 51, image 28).SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal ankle signal intensity. No focal pancreatic lesions identified. The pancreatic duct is normal in diameter.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: An intrauterine pregnancy is partially visualized in the lower abdomen.

Output: 1.Status post cholecystectomy with minimal intrahepatic biliary ductal exertion and mild extradural hepatobiliary ductal dilatation.2.Questionable tiny stone within the common bile duct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Subtle parkinsonism and difficulty swallowing with positive OPM, vertical eye movements also impaired History: see above. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is blurring of the bilateral substantia nigrosome susceptibility. There is mild scattered cerebral white matter T2 hyperintensity bilaterally. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implantsNeck: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The upper aerodigestive tract appears to be intact. The osseous structures are unremarkable, aside from small anterior and posterior disc-osteophyte complexes at C6-7 and C7-T1.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Blurring of the bilateral substantia nigrosome susceptibility is suggestive of Parkins disease. 3. Mild scattered cerebral white matter T2 hyperintensity bilaterally is nonspecific, but may represent chronic small vessel ischemia. 4. No evidence of tumors in the neck.


Instruction: Generate impression based on findings.

Input: Per EPIC, patient with history of Crohn's disease and narcotic dependence has had 4 episodes during which he became unresponsive, though awake, for minutes (20-30?) accompanied by "staring into space." No tonic clonic movements or post-ictal symptoms. Evaluate for seizure focus. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate, confluent and curvilinear areas of T2 hyperintensity in the periventricular and subcortical white matter and left cerebellum, one of which is new at the left subinsular white matter. Focal areas of T2/FLAIR hyperintensity are also noted involving the right amygdala, left frontal subcortical white matter, and the paramedian cortex involving the right superior frontal gyrus. No associated mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening of the anterior ethmoid air cells.

Output: 1. No evidence of intracranial mass or mass effect. 2. Allowing for differences in technique, no significant interval change in scattered periventricular and subcortical white matter T2/FLAIR signal abnormalities, except for a new focus of T2 hyperintensity in the left subinsular white matter. These findings are nonspecific and may be related to prior ischemia or demyelination. There also areas of T2/FLAIR hyperintensity involving the right amygdala, left frontal subcortical white matter, and the paramedian cortex involving the right superior frontal gyrus; these are of uncertain etiology and remain grossly unchanged since 2005. These may also represent sequela of prior injury although remote possibility that these may be related to cortical dysplasia however is not entirely excluded. Given stability since 2005, neoplasm is essentially excluded.


Instruction: Generate impression based on findings.

Input: Clinical question: Hemangioma. Please place fiducial. Preop stealth brain MRI. Signs and symptoms: Preop stealth brain MRI for brain tumor. Pre- and post enhanced brain MRI:Examination is performed utilizing a Stealth protocol and is not a true diagnostic exam.Examination demonstrates an 18 x 20 mm cavernoma in the posterior left plantar median pons with subtle bulge into the fourth ventricle. There is no surrounding vasogenic edema or gliosis to suggest prior hemorrhage. It demonstrate patchy foci of internal enhancement. Unremarkable exam otherwise.

Output: Redemonstration of a pontine cavernoma as detailed.


Instruction: Generate impression based on findings.

Input: This exam is limited by motion artifact. There is no evidence of acute infarct. There is an enhancing lesion within the right cerebellar hemisphere that measures 11 x 6 mm, previously 5 x 6 mm, and contains a small unchanged focus of susceptibility effect. There is an unchanged sellar and suprasellar mass that invades the clivus and measures approximately 17 x 15 mm. It is predominantly left sided with an asymmetric thick left cavernous sinus and possible contiguity of the mass into the left cavernous sinus on coronal T2W images, although postcontrast coronal imaging is limited. There is new diffuse pial enhancement, including enhancement along the bilateral posterior intraorbital optic nerves, bilateral seventh and eighth nerves, and possibly the bilateral third and fifth cranial nerves.The internal carotid flow voids are grossly intact. There are multiple rounded foci of T2 hyperintensity throughout the supratentorial white matter that have somewhat decreased in both size and number. The ventricles are slightly increased in size. For example, lateral ventricles measure 35 mm in transverse dimension, previously 32 mm, and the third ventricle measures 8 mm in transverse dimension, previously 6 mm. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the bilateral mastoid air cells.

Output: 1.Motion limited exam. 2.New diffuse pial enhancement, including along the bilateral optic nerves, bilateral seventh and eighth nerves, and most likely along the bilateral third and fifth cranial nerves, is most likely neoplastic in etiology. 3.Grossly unchanged sellar and suprasellar mass with clival invasion that cannot be separated from the left cavernous sinus. 4.Increase in size of the right cerebellar metastasis. 5.Decrease in size and number of the supratentorial T2 hyperintense non-enhancing white matter lesions that are most likely treatment related. 6.Slight increase in ventricular size, either due to early communicating hydrocephalus secondary to the leptomeningeal disease and/or treatment related volume loss. Close follow-up is recommended. These findings were called by Dr. Michael Rozenfeld to Dr. Anjali Gera at on 3/20/2015 1:10 PM.


Instruction: Generate impression based on findings.

Input: 71-year-old female with metastatic breast cancer to the liver and bone with increased right hip pain. Please evaluate for fracture. BONE MARROW: Note is made of increased bone marrow signal abnormality within the right inferior and superior pubic rami with associated enhancement on postcontrast sequences consistent with metastatic disease. There is cortical irregularity and linear low signal abnormality traversing the right inferior and superior pubic rami suspicious for minimally displaced pathologic fractures. Additionally note is made of multiple additional foci of signal abnormality in the right iliac bone and right superior acetabulum suspicious for osseous metastatic disease. There is linear low signal abnormality traversing the superior right acetabulum suspicious for a nondisplaced pathologic fracture. There are additional foci of enhancing signal abnormality within the base of the femoral neck and intertrochanteric region consistent with osseous metastatic disease involving approximately 50% of the width of the base of the femoral neck. No acute fracture is identified, as clinically questioned. There are compression fractures affecting the vertebral bodies of the imaged lower lumbar spine, which are incompletely imaged, with associated increased signal abnormality on fluid sensitive sequences, suspicious for pathologic fractures. Please see the accompanying MRI lumbar spine report for additional details.SOFT TISSUES: Note is made of increased signal abnormality within the gluteal musculature bilaterally which is nonspecific although a subacute denervation injury cannot be excluded. The remainder of the imaged musculature is normal in appearance.JOINTS: The right hip joint alignment is anatomic. Moderate degenerative changes affect the right hip.ADDITIONAL

Output: Multifocal osseous metastatic disease with pathologic fractures involving the lower lumbar spine, right superior acetabulum, as well as the right superior and inferior pubic rami. There is osseous metastatic disease affecting the intertrochanteric region of the right femur without convincing evidence of an acute fracture, as clinically questioned. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female 68 years old Reason: Portal HTN, eval for evidence of cirrhosis or for PV thrombosis History: Portal HTN, varices with previous bleed, for possible TIPS placement ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology. It has a nodular contour and widened fissures.No focal hypervascular liver lesion. The hepatic and portal veins are patent. No intra-or extrahepatic biliary ductal dilation. Status post cholecystectomy.There is trace perihepatic ascites.SPLEEN: Spleen is enlarged in size. There are a few scattered upper abdominal mesenteric varices.PANCREAS: Mild age-related pancreatic fatty atrophy.ADRENAL GLANDS: The left adrenal gland is mildly nodular.KIDNEYS, URETERS: The right kidney has an exophytic cyst from its upper pole. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Retroperitoneal or mesenteric lymphadenopathy. There are small upper abdominal portacaval and peripancreatic lymph nodes.BOWEL, MESENTERY: Trace mesenteric ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Status post median sternotomy.

Output: 1.Cirrhotic liver without suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There are full-thickness tears both the supraspinatus and infraspinatus tendons with retraction of the tendons to the level of the glenoid. The teres minor and subscapularis tendons are intact. There is severe fatty atrophy of the supraspinatus and infraspinatus muscles.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding. There is increased signal within the anterior and superior labrum reflecting degenerative change.BICEPS TENDON: The intra-articular portion of the biceps tendon is not well seen although it is appears relatively normal within the intertubercular groove. This may be the result of severe tendinosis of partial tearing.ADDITIONAL

Output: 1. Full-thickness tears of the supraspinatus and infraspinatus tendons with associated retraction and severe muscle atrophy.2. Poor visualization of the intra-articular biceps tendon which may be the result of severe tendinosis or tearing.


Instruction: Generate impression based on findings.

Input: There is no suspicious intracranial enhancement. There is no acute infarct, mass effect or midline shift. There are scattered T2 signal abnormalities in the periventricular and subcortical white matter, nonspecific. There is no extra-axial fluid collection. The flow voids at the skull base are intact. There is mild retroflexion of the tip of the dens causing mild effacement of the ventral CSF space without significant stenosis of the lower brainstem/upper cervical cord. There is a left lens implant.

Output: No evidence of intracranial metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified abnormalities of gait and mobility. Malignant neoplasm of unspecified part of unspecified bronchus or lung Secondary malignant neoplasm of brainClinical question: Pt w/ NSCLC brain mets, s/p SRS to R cerebellar met and subsequent WBRT. Now on PD1 Ab.Signs and Symptoms: gait difficulty. Falls. Brain mets. NSCLC. The CSF spaces are appropriate for the patient's stated age with no midline shift. There are no foci of diffusion restriction appreciated within the brain parenchyma.There is a 6 x 3 mm axial dimension focus of contrast enhancement in the medial aspect of the right cerebellar hemisphere. This associated with susceptibility effect on the susceptibility weighted images.There is a punctate focus of enhancement present along the left isthmus of the cingulate gyrus which was also present on the prior exam and is unchanged since then however it is smaller than on the 6/8/2015 exam.There are other punctate foci of signal hypointensity on susceptibility imaging in the subcortical white matter which are also stable.There are patchy T2 and FLAIR signal hyperintensities in the brainstem. These were not present on the January 2015 examPreviously noted small foci of enhancement in the paracentral lobules and left fusiform gyrus are not conspicuous on the current exam. These were not present on the January 2015 examThere is a mild degree of periventricular and subcortical patchy hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses and some scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells demonstrate some scattered opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.There is a small hemorrhagic focus present in the right cerebellar hemisphere. This remains stable over time.2.Multiple enhancing lesions present in the supratentorial brain are not conspicuous on the current exam suggests regression of metastatic load.3.A punctate lesion in the left cingulate gyrus isthmus is stable compared to the prior exams but smaller than the June exam.4.There are patchy periventricular and subcortical white matter T2 and FLAIR signal hyperintensities and brainstem T2 and FLAIR signal hyperintensities which were not present at the beginning of the year and are suspected to be posttreatment related.5.There is no evidence for acute cerebral ischemic infarction.


Instruction: Generate impression based on findings.

Input: 71 year-old female with cirrhosis status post fall with altered mental status. Evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse regions of hypodensity throughout the subcortical white matter consistent with advanced small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Advanced small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 36 years Female (DOB:6/19/1980)Reason: Evl Stroke History: abovePROVIDER/ATTENDING NAME: JAMES AHN GREGG M HELLAND The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 15 mm cystic lesion present in the nasopharynx adjacent to the pharyngeal mucosal space.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the maxillary sinuses and partial opacification of ethmoid air cells and left frontal sinus these findings to some degree were present on prior exams.. Below that more on the current.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for cerebral infarction or intracranial hemorrhage.2.Findings are compatible with a large Thornwaldt cyst in the nasopharynx. Stable compared to the previous exam from January3.There is some mild mucosal thickening present in the paranasal sinuses which is likely inflammatory in nature.


Instruction: Generate impression based on findings.

Input: Follow-up on left intracranial hemorrhage due to melanoma metastasis. The CSF spaces are appropriate for the patient's stated age. There redemonstration of a large left basal ganglia hematoma currently measuring 38 x 43 millimeters which measures similar to the prior exam. It is associated with a satellite foci of hemorrhage in the left inferior frontal gyrus measuring about 10 mm x 9 mm also unchanged since prior exam . It is also Associated with a small amount of intraventricular blood in the lateral ventricles. There is mass effect present with shift of the septum pellucidum approximately 6 mm to the right of midline and the shift of the third ventricle approximately a 3 mm the right of midline. The suprasellar cistern appears intact. Since the previous exam the amount of the vasogenic edema associated with this and a focus of hemorrhage appears to have mildly increased.There is a hyperdense focus present in the left temporal lobe anterior pole measuring 10 mm in diameter on the current exam which was not visible on the previous exam. It could not be identified on an MRI of 10/27 /09 on gradient echo images on the previous exam it measured around this 6 mm in diameter compared there are a couple more hyperdense foci present one in the the right precentral gyrus measures approximately 5 mm in diameter. A couple are present along the pars marginalis bilaterally each measuring about 4 or 5 mm and several are present along the left superior frontal gyrus which are all adjacent to each other. Overall these have been identified on the gradient echo MRI. It can also be identified on prior CT scan . The one zone along the pars marginalis are more conspicuous on the current foramen appearThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the previous examination the edema associated with a large left basal ganglia hematoma has a mildly increased. The midline shift is not substantially different. There may be a difference of a millimeter or two more midline shift on the current versus the prior exam.2.There are multiple foci of hyperdensity scattered in above hemispheres of the brain most of which are identified on the prior exam a two or 3 of them are slightly more conspicuous on the current exam indicating that there may have been a small amount of hemorrhage which has occurred.


Instruction: Generate impression based on findings.

Input: Male, 23 years old, with tingling in the left finger and groin. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow edema or enhancement is seen. The visualized spinal cord demonstrates normal signal characteristics and morphology. No pathologic cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.At C3-4, uncovertebral hypertrophy is evident causing mild bilateral spinal canal narrowing. No other significant disc disease, spinal canal stenosis or foraminal narrowing is seen.

Output: 1.Minimal degenerative findings without high-grade spinal canal or foraminal stenosis.2.No abnormalities of the spinal cord.


Instruction: Generate impression based on findings.

Input: Reason: r/o RCT History: r/o RCT ROTATOR CUFF: Intermediate signal intensity within the supraspinatus tendon indicates moderate degenerative tendinosis and likely surface fraying, particularly along the bursal surface. Although we see no fluid signal intensity within the tendon to indicate a fluid-filled tear, approximately 1cm proximal to the tendinous insertion on the greater tuberosity there is a 6mm region of intermediate signal intensity extending through the full thickness of the tendon with no discrete fibers observed at this location, which could either represent focal tendinosis or a focal full thickness tear filled with granulation tissue (series 13, image 11). There is mild atrophy of the supraspinatus muscle along the myotendinous junction, but otherwise the muscle appears normal. The aforementioned tendinosis and surface fraying extends posteriorly to involve the anterior fibers of the infraspinatus tendon, with what appears to be a small (4mm) insertional undersurface tear with edema in the underlying humeral head. The infraspinatus muscle is unremarkable. There is mild tendinosis and perhaps interstitial tearing of the subscapularis tendon, but the muscle is unremarkable. There are small cysts in the underlying humeral head that are likely degenerative. The teres minor muscle appears normal.SUPRASPINATUS OUTLET: There is heterogeneous signal intensity within the subacromial/subdeltoid bursa on fluid-sensitive sequences indicating a moderate bursitis. GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a moderate glenohumeral joint effusion with heterogeneous fluid in the subscapular recess likely reflecting synovitis. There is mild increased signal intensity and irregularity of the glenoid, but no discrete tear.BICEPS TENDON: Fluid and synovitis from the glenohumeral joint extends into the biceps tendon sheath but the tendon itself is unremarkable. ADDITIONAL

Output: 1.Subacromial/subdeltoid bursitis and glenohumeral joint effusion/synovitis as above.2.Rotator cuff tendinosis and surface fraying as described above. Although we see no fluid-filled supraspinatus tendon tear, focal intermediate signal intensity within the supraspinatus tendon could either represent focal tendinosis or a small full thickness tear filled with granulation tissue. There also appears to be a small undersurface insertional tear of the infraspinatus.3.Other findings as above


Instruction: Generate impression based on findings.

Input: 45-year-old female with pain. Due to the patient's body habitus, the high-definition coil could not be utilized resulting in slightly suboptimal image quality.MENISCI: There is blunting and deformity of the posterior horn of the medial meniscus consistent with complex degenerative tearing which extends to the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle and medial tibial plateau with underlying degenerative subchondral signal abnormality. There is partial-thickness articular cartilage degeneration along the lateral tibiofemoral compartment. There is full-thickness articular cartilage degeneration affecting the patellofemoral joint most pronounced along the lateral facet of the patella with underlying subchondral signal abnormality. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Severe degenerative osteoarthritic changes of the knee most pronounced along the medial tibiofemoral compartment. Complex degenerative tearing of the medial meniscus.2. Large joint effusion and Baker's cyst with foci of low signal internal debris which may reflect a synovitis.


Instruction: Generate impression based on findings.

Input: Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: L1 vertebral bone biopsy under CT guidance. A total of 11 samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: 42 years Female (DOB:10/5/1974)Reason: Grade 2 oligoastrocytoma on TMZ. History: grade 2 oligoastrocytoma.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS The patient is status post right sided frontal craniotomy. As a surgical defect involving the right inferior frontal gyrus and right middle frontal gyrus. There is T2 and FLAIR signal hyperintensity surrounding this defect. The extent of the N T2 signal hyperintensity is similar to the 5/19/2016 exam. There is associated exit vacuo effect on the right lateral ventricle. Some punctate foci of susceptibility are present along the surgical resection site. There is no associated contrast enhancementThere are several punctate foci of signal loss and susceptibility imaging within the subcortical and periventricular white matter.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Status post right frontal lobe surgery for surgical removal of a primary neoplasm known to represent a grade 2 oligoastrocytoma. The appearance of the surgical bed is stable. There is no current evidence for recurrence.


Instruction: Generate impression based on findings.

Input: Reason: Possible meniscal tear History: Knee pain, joint line tenderness MENISCI: Normal appearing menisci bilaterally.ARTICULAR CARTILAGE AND BONE: There is focal low signal intensity within the articular cartilage of the lateral tibial plateau just anterior to the posterior horn of the lateral meniscus likely representing focal degeneration. There is also a focal near full-thickness fluid-filled defect along the articular cartilage of the lateral femoral condyle just posterior to the meniscus. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Normal appearing menisci.2. Focal cartilage defects/degeneration in the lateral tibiofemoral compartment.


Instruction: Generate impression based on findings.

Input: Concern for critical process requiring surgery: shaking of the arm and leg, vertigo. Brain MRI: There is an unchanged mildly expanded partially-empty sella. The Meckel's caves also appear prominent, which is unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild nonspecific scattered T2 hyperintense foci in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. An unchanged mildly expanded partially-empty sella can be a manifestation of pseudotumor cerebri or may be age-related, but is nonspecific. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive arterial lesions in the head and neck.


Instruction: Generate impression based on findings.

Input: Optic neuritis. Evaluate for cervical spine demyelinating lesions. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from mild reversal of cervical lordosis which may be in part positional. Bone marrow signal is benign including small focus of T1 hyperintensity involving the posterior aspect of the C5 vertebral body most consistent with a small hemangioma..The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancement.Mild degenerative changes are seen in the cervical spine with small disc osteophyte complexes at the C3-C4, C4-C5, and C5-C6 levels with partial effacement of the ventral thecal sac but overall no significant spinal canal stenosis. Additional details as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Mild narrowing of the left neural foramen related to uncovertebral hypertrophy. Otherwise no significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of demyelinating disease in the cervical spinal cord.2. Mild multilevel degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: 48-year-old female with elevated liver enzymes ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion is evident. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right breast implant is noted. Status post left mastectomy.

Output: 1.No focal liver lesion as clinically queried.


Instruction: Generate impression based on findings.

Input: Reason: assess for osteomyelitis History: Right plantar foot ulcer, fever, pain. There is ulceration of the soft tissues beneath the first MTP joint. There is abnormal signal intensity and enhancement of the underlying subcutaneous fat, reflecting inflammation. There is a track which extends from the ulcer to and around the flexor hallucis longus tendon with abnormal signal intensity and enhancement of the sesamoid bones, compatible with osteomyelitis. There is also a small amount of fluid between the first and second metatarsals heads. We cannot determine if this reflects a mild bursitis or if this communicates with the aforementioned sinus. We see no fluid tracking along the flexor hallucis longus tendon. Moderate osteoarthritis affects the first MTP joint. There is mild signal abnormality and enhancement within the marrow of the first metatarsal head as well as fluid within the first MTP joint, but it is difficult to determine if this represents infection or simply the sequela of osteoarthritis. The phalanges of the great toe appear intact. The remaining metatarsals and phalanges appear intact. Osteoarthritis affects the midfoot with subchondral cyst formation within the lateral cuneiform. There is edema of the dorsal subcutaneous fat of the forefoot and midfoot. There is also mild edema type signal within the musculature of the foot which may reflect subacute atrophy, which is not uncommonly seen in diabetic patients.

Output: Ulceration beneath the first MTP joint with inflammation of the soft tissues and findings compatible with osteomyelitis of the sesamoid bones beneath the first metatarsal head. There is signal abnormality within the first metatarsal head and a small amount of fluid within the first MTP joint, which could also reflect infection or simply the sequela of osteoarthritis.


Instruction: Generate impression based on findings.

Input: 44 years, Female, headache, facial numbness and tingling. Evaluate for jugular foramen tumor. There is a 9.5 x 5.5 mm enhancing, T2 hyperintense, T1 isointense, fairly well-demarcated lesion medial and inferior to the right carotid canal, without mass effect. The surrounding bone is unremarkable. There is no restricted diffusion. The mastoid air cells are well pneumatized. The internal auditory canal and inner ears are normal in morphology and signal intensity. There is no abnormal enhancement of the facial nerve. There is a dominant right sigmoid sinus. There is no evidence of acute infarction or hemorrhage. The ventricles are within normal limits in size and configuration. Brain parenchyma is unremarkable for age. Major flow-voids are preserved

Output: Enhancing T2 hyperintense, well-demarcated lesion within the right petrous temporal bone, medial and inferior to the right carotid canal, probable cholesterol granuloma or cholesteatoma. CT of the skull base is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: Unspecified disturbances of skin sensation [R20.9], Reason for Study: ^Reason: evaluate for stroke History: R face, arm, leg Brain MRIThere is focal restricted diffusion on the left thalamus without evidence of susceptibility artifact indicating acute/subacute ischemic stroke without hemorrhagic conversion.Underlying brain shows scattered high signal intensity on T2/FLAIR images indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 4 x 3 mm sized right MCA distal M1 segment aneurysm.There is also about 2.8mm x 3.8mm sized left pcom arterial bulge which appears to be connected with a small patent left pcom artery. This lesion could represent infundibulum. However, the size and configuration are suggesting possibility of associated pcom aneurysm.Bilateral P-comm arteries are patent.Luminal irregularities without significant luminal stenosis are seen on intracranial arterial system indicating atherosclerotic changes.There is no other intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 5 mm sized aneurysmal bulge on the right ICA distal aspect of petrous segment.Left vertebral artery ostium arises very proximal to the left subclavian artery thus difficult to evaluate on this imaging due to artifact.Otherwise bilateral common carotid arteries, bilateral carotid bifurcation as well as right vertebral artery appears to be unremarkable.

Output: 1. Acute/subacute ischemic infarction on the left thalamus without evidence of hemorrhagic conversion.2. Right MCA distal M1 aneurysm and left Pcom possible aneurysm as described above. 3. Right distal petrous segment ICA aneurysm.


Instruction: Generate impression based on findings.

Input: Female, 3 months old, twin pregnancy born at 36 weeks, with nystagmus. Assess for optic glioma, brainstem or cerebellar abnormality. The morphology and signal characteristics of the cerebrum, brainstem and cerebellum are within normal limits. No areas of significant parenchymal signal abnormality, edema or mass effect are seen. No pathologic parenchymal or extra-axial enhancement is noted. The ventricles are normal in size morphology. No abnormal fluid collections are detected.The pattern of white matter myelination is appropriate for the corrected gestational age. The region of the pituitary gland and sella are unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. Likewise the corpus callosum is fully formed and intact.On dedicated orbital imaging, the globes are round and symmetric, the extraocular muscles show normal caliber, and the optic nerves are free of pathologic thickening, signal abnormality or enhancement. On the coronal STIR sequence, mild symmetric increased signal is seen along the superior orbital soft tissues which is of uncertain but doubtful significance.

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


Instruction: Generate impression based on findings.

Input: TIA. There are several scattered cerebral white matter T2 hyperintense lesions bilaterally. Although a few of the lesions in the right centrum semioval exhibit high signal intensity of DWI, there is no convincing restricted diffusion on the ADC map. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There are scattered paranasal sinus secretions.

Output: 1. Findings suggestive of mild subacute to chronic small vessel ischemic disease without convincing evidence of acute infarction.2. Partially empty sella.


Instruction: Generate impression based on findings.

Input: 63-year-old male with prostate cancer PELVIS:PROSTATE:Prostate Size: 4.4 x 5.3 x 5.7 cmPeripheral Zone: Subcentimeter nonspecific focus of T2 hypointensity in the right mid gland peripheral zone. The previously identified left mid gland lesion is not clearly seen on the current study.Central Gland: Marked degree of benign prostatic hypertrophy.Seminal Vesicles: Atrophy of the seminal vesicles.Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disease affects bilateral femoral heads. Patulous fat-containing right inguinal canal.OTHER: Previously seen filling defects in the left femoral vein and right common iliac vein are no longer present.

Output: 1.The previously identified left mid gland lesion is not clearly seen on the current study.2.Subcentimeter nonspecific focus of T2 hypointensity in the right mid gland peripheral zone.3.Marked degree of benign prostatic hypertrophy.


Instruction: Generate impression based on findings.

Input: 3-month-old with a AT/RT status post resection, VP shunt, and chemotherapy. Increasing morning vomiting. Rule out shunt malfunction, hydrocephalus. The VP shunt catheter enters the skull through the right aspect of the occipital bone. The catheter tip terminates in the left frontal lobe. Position of the catheter is stable from previous studies. Ventricular size is stable from the prior study.In the posterior fossa there is a rounded area of hypoattenuation at the region of the patient's previous tumor resection. This is enlarged since the prior study and raises concern for a cystic lesion exerting mass effect upon the brainstem. Recommend contrast enhanced MRI for better evaluation of this finding.There is increased attenuation in the right transverse and sigmoid sinus consistent with the patient's known dural sinus thrombosis.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Enlarging, cystic lesion in posterior fossa at site of patient's previous tumor resection. Recommend contrast enhanced MRI for further evaluation. 2. Stable catheter position and ventricular size.3. Stable findings of right transverse and sigmoid sinus thrombosis.These findings were discussed with Dr. Anzoma at 5:40 p.m. 08/19/2008.


Instruction: Generate impression based on findings.

Input: History of epidermoid cyst status-post CyberKnife treatment needs surveillance scan. Redemonstrated are postoperative findings related to left temporal craniotomy. There is a lobulated non-enhancing T2 hyperintense mass that displays restricted diffusion centered within the left choroid fissure with extension into the suprasellar cistern and third ventricle, as well as a separate punctate focus in the right occipital horn. The lesion appears to be unchanged in size, the main component of which measures 41 AP x 34 RL x 29 SI mm. However, there is interval increase in the T2 hyperintensity in the adjacent brain parenchyma. Additionally, the parenchyma along the posterolateral margin of the cyst now enhances, suggestive of radiation necrosis. There is unchanged regional mass effect upon the brain parenchyma and left aspect of the optic apparatus. There is a right transoccipital ventricular shunt catheter that terminates in the right lateral ventricle, which is unchanged. There is no evidence of intracranial hemorrhage or acute territorial infarct. There is no midline shift or herniation. The skull and scalp soft tissues are unchanged.

Output: 1.Stable size of the epidermoid cyst centered in the left choroid fissure with associated presumed treatment effects in the adjacent brain parenchyma.2.The shunted ventricular system is unchanged in size, with a possible fragment of epidermoid in the right occipital horn.


Instruction: Generate impression based on findings.

Input: 17-year-old female with hypothyroidism transferring care to University of Chicago.EXAMINATION: Sonogram thyroid 12/21/2016 RIGHT LOBE MEASUREMENTS: 4.9 x 1.5 x 1.3 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.1 x 1.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Two predominantly hypoechoic lesions are visualized of which neither demonstrate calcification. The first is non-vascular and measures 0.5 x 0.4 x 0.5 and may be extrathyroid in location. The second lesion is hyperechoic centrally and demonstrates central vascularity and measures 0.9 x 0.3 x 0.7 cm. Background glandular heterogeneity and somewhat ill-defined areas of hyperechogenicity.LEFT LOBE: A round mildly hypoechoic mass is seen posteriorly with medial extension measuring 1.4 x 0.5 x 0.5 cm. There is mild peripheral vascularity. Background glandular heterogeneity and somewhat ill-defined areas of hyperechogenicity.ISTHMUS: Background glandular heterogeneity and somewhat ill-defined areas of hyper echogenicity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Predominantly hypoechoic lesion within the right lobe of the thyroid may be extrathyroidal in location. Correlation with prior outside imaging is recommended to assess for change.2. The second right thyroid lesion appears morphologically compatible with lymph node.3. Hypoechoic mass within the left thyroid is of unclear etiology, but could represent a parathyroid gland. Correlation with serum calcium and PTH levels may be obtained.


Instruction: Generate impression based on findings.

Input: 22-year-old female with neuromyelitis optica now presenting with episodic weakness and numbness below the T6 level Redemonstrated are postoperative findings related to right transfrontal biopsy which is decreased in conspicuity with FLAIR technique. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The paranasal sinuses and orbits are unremarkable. Redemonstrated is the patient's medullary and upper cervical spine cord lesion which is decreased in size with no residual enhancement. As before, there are no other cervical cord lesions. There are no thoracic cord or conus lesions. The cervical and thoracic vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1.Redemonstrated are postoperative findings related to right transfrontal biopsy which is decreased in conspicuity with FLAIR technique. 2.Redemonstrated is the patient's medullary and upper cervical spine cord lesion which is decreased in size with no residual enhancement.3.As before, there are no other cervical cord lesions. 4.There are no thoracic cord or conus lesions.


Instruction: Generate impression based on findings.

Input: 48-year-old male with history of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter hepatic cysts. The hepatic parenchyma demonstrates dark signal on the in phase series compared to the out of phase series.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ahaustral descending colon compatible with chronic changes from inflammatory bowel disease. Status post small bowel resection with neoterminal ileum formation with mild narrowing at the neoterminal ileum, not significantly changed. There is mild enhancement of the neoterminal ileum wall. No evidence of abscess or fistulization.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with predominantly chronic changes from inflammatory bowel disease with mild acute component.2.Findings as detailed consistent with iron deposition in the hepatic parenchyma.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with Chiari malformation and pseudotumor cerebri, VA and LP shunts, six month follow-up. Evidence of suboccipital craniectomy and resection of the posterior C1 arch is again seen for Chiari decompression. The shape and positioning of the cerebellar tonsils are unchanged from prior.Minimal nonspecific T2 hyperintensity along the body of the right lateral ventricle is unchanged. No other new or significant parenchymal lesions are seen. No mass effect or edema is detected. No abnormal collections are noted. The previously seen minimal cerebral convexity subdural effusions are not well visualized on today's examination. The ventricular system is stable and normal in size.

Output: 1.Demonstration of findings compatible with surgical Chiari decompression. The cerebellar tonsils are stable in shape and positioning.2.No new or acute intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for post op pain. Signs and symptoms: Status post transphenoidal microadenoma resection. CT of brain without contrast:Portable CT of brain without contrast at bedside was obtained.Examination demonstrates expected postoperative changes of transphenoidal hypophysectomy. There is fluid density within the sphenoid sinus and ethmoid sinuses as well as fatty signal intensity within the sella which is believed to represent packing material. There is no evidence of hemorrhage within the subtle or intracranial space.There is evidence of a right sided ventricular catheter entering from the right frontal bone, traversing the right frontal lobe, entering the right lateral ventricle and with the tip at the level of foramina of Monro. There is near complete collapse of lateral ventricles.Previously noted on MRI examination the slightly dilated tip of the right temporal horn is again identified. There is no evidence of parenchymal hemorrhage, edema, mass effect or midline shift.Calvarium is intact. Mastoid air cells and middle ear cavities are unremarkable.Fluid level within bilateral maxillary sinuses, opacification of bilateral ethmoids and sphenoid appear to be result of recent surgical intervention.

Output: 1.Expected postoperative changes of transphenoidal hypophysectomy.2.Extensive fluid density within paranasal sinuses are result of prior surgical approach.3.Fatty density within the sella consistent with packing.4.No evidence of intracranial abnormality and in particular no hemorrhage.5.Shunt the right lateral ventricle and complete collapse of supratentorial ventricles.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of upper lobe, bronchus or lung [162.3] / Malignant neoplasm of other parts of bronchus or lung [162.8], Reason for Study: ^Reason: Intracranial mass location History: Left arm and leg weakness The examination was performed under Stealth protocol with fiducial markers attached on scalp.The examination was limited due to patient's motion.Redemonstration of right frontal lobe intra axial mass lesion with surrounding edema and mass effects.The degree of midline shift toward left side and the extent of surrounding edema do not show any significant interval change since prior exam. No change of ventricles since prior exam.

Output: Limited examination.No change of right frontal intra axial mass lesion with surrounding edema and mass effects since prior exam.


Instruction: Generate impression based on findings.

Input: Evaluate change in dilation/stricturing or hepatic lesions. History of primary sclerosing cholangitis diagnosed by biopsy in March 2010. ABDOMEN:LIVER, BILIARY TRACT: There is minimal intra and extrahepatic biliary ductal dilatation, similar to prior. A segment 8 hepatic cyst is unchanged. Additional subcentimeter T2 hyperintense hepatic lesions, probably cysts, are unchanged. No enhancing lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. No ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable mild intra and extra hepatic biliary ductal dilatation. No evidence of cholangiocarcinoma.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with worsening blurry vision, lymphoma, pancytopenia, EBV and CMV viremias. Also with urinary incontinence. Evaluate for epidural abscess, cord compression. Brain:Motion artifact degrades image quality on several sequences. No restricted diffusion is seen. No evidence of any significant parenchymal edema or mass effect is detected. There are no enhancing parenchymal or extra-axial lesions. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is within normal limits.Lumbar spine:There are four fully lumbar type vertebral bodies and a transitional L5.A mild kyphotic angulation is seen at the L4-5 level, but elsewhere sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits.Innumerable small foci of enhancing marrow replacement are seen within the visualized marrow space of the lumbar spine and sacrum. The background marrow signal characteristics are otherwise relatively fatty in nature. Vertebral body height and morphology are within normal limits.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic intrathecal enhancement is seen. No epidural tumor or fluid collection is evident.Mild facet arthropathy develops at lower lumbar levels. This results in a significant transverse narrowing of the spinal canal at the L4-5 level. The L4-5 neural foramen and may also be mildly narrowed.Mild disc bulging and a right foraminal annular fissure are seen at L5-S1. Mild foraminal narrowing is also evident at this level but the spinal canal remains patent.Elsewhere, the intervertebral discs are preserved and there is no significant spinal canal or foraminal stenosis.

Output: 1.No significant intracranial findings are seen.2.No evidence of any epidural tumor or abscess in the lumbar spine. No abnormalities of the spinal cord or nerve roots are seen.3.Note is made of innumerable small foci of enhancing marrow replacement within the marrow space of the lumbosacral region. This is nonspecific and could represent an infectious or inflammatory process, lymphomatous involvement, or a reaction to stem cell transplantation.


Instruction: Generate impression based on findings.

Input: History of pancreas mass (pathology showed IPMN without dysplasia) status post laparoscopic distal pancreatectomy and splenectomy. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis within a normally distended gallbladder. No focal hepatic lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: Status post splenectomy.PANCREAS: Postsurgical changes from a distal pancreatectomy. The pancreatic duct is normal in caliber. There are several punctate cystic lesions within the pancreatic parenchyma compatible with multiple side branch IPMNs, the largest of which measures 7 mm (series 5 image 1).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes from a distal pancreatectomy. Several punctate cystic lesions within the pancreatic parenchyma compatible with multiple sidebranch IPMNs, the largest of which measures up to 7 mm.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate occipital cyst, metastases? Signs and symptoms: Incontinence. Pre and post enhanced brain MRI:Diffusion weighted images are severely limited due to a large metallic artifact obscuring a significant portion of images on the left. Beyond the artifact there is no evidence of acute intracranial process and negative diffusion weighted series.There is also significant metallic caused artifact obscuring portion of the left orbit and left hemisphere. Beyond the artifact the anatomical morphology and signal intensity of brain remains within normal. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and the brain myelination.There is also no detectable abnormal enhancement of brain parenchyma or the leptomeninges beyond the metallic artifact.Within the limitation of the exam there is no detectable abnormal enhancement of the calvarium or the soft tissues of the scalp.Pre and post enhanced cervical MRI:Similar to prior exam from 8-1-15 there is mild degenerative changes of cervical spine and reversal of cervical lordosis.The signal intensity and the anatomical alignment of vertebral column however remains within normal and without abnormal enhancement.There is normal signal intensity and caliber of the cervical cord and without abnormal enhancement.No spinal stenosis or neural foraminal compromise at any level.Pre and post enhanced thoracic MRI:Similar to prior recent MRI of thoracic spine from 8-1-15 examination redemonstrates diffuse scattered small foci of T2 and T2 hyperintense and T1 hypointense throughout the vertebral column and with enhancement highly suggestive of metastatic disease. There is no evidence of fracture or malalignment and no detectable extraosseous spread of lesion into the epidural space or the paravertebral soft tissues. The lesions are detected in nearly all vertebral levels. The largest lesion is in the anterior body of T11 and measures approximately at 18 x 17 mm on sagittal T2 STIR series.The signal intensity and caliber of thoracic cord remains within normal and without abnormal enhancement. There is mild degenerative changes of thoracic spine however without evidence of spinal stenosis or neural foraminal compromise at any level.Unremarkable paraspinal soft tissues.Pre and post enhanced lumbosacral MRI:Examination demonstrates extensive recent postoperative changes of posterior laminectomy for debulking of tumor at L5-S3 levels. There is interval partial bulking of tumor within the sacral canal since prior exam. There is however no significant expansion of thecal sac which is mostly secondary to presence of extensive postoperative changes and to a smaller degree of residual tumor. Extensive postoperative changes on this initial postop study precludes precise assessment for degree of residual tumor and follow-up exam is recommended.Very large presacral residual tumor anterior and to the left at S1-S3 is again noted. Extensive loculated lymph nodes in the left prevertebral space is again identified without significant change. The nodes measured maximum of 35 mm in AP axis thickness and extent from approximately L1 through L5 levels. Revisualization of multiple small foci of marrow signal replacement and enhancement throughout the lumbar spine is again identified and concerning for metastatic disease. There is no detectable extension of disease process into the spinal canal from T2 through L5 levels which is a similar observation to prior exam.Severely distended bladder is again identified.

Output: 1.Pre- and post enhanced brain MRI is limited due to a large metallic artifact overlapping the left hemisphere. Beyond the region of artifact examination is unremarkable and in particular there is no evidence of metastatic disease.2.Pre and post enhanced MRI of cervical spine demonstrate mild degenerative disease and mild reversal of cervical lordosis. No abnormal enhancement of the vertebral column or the cord/leptomeninges. No central spinal stenosis or neural foraminal compromise.3.Pre- and post enhanced thoracic MRI demonstrate a small varying size foci of marrow signal replacement and enhancement involving nearly the entire vertebral column and highly suggestive of metastatic disease. Normal signal intensity and caliber of the cord without abnormal enhancement. No detectable extraosseous spread of lesions into the spinal canal, neural foraminal or paraspinal soft tissues. No spinal stenosis or neural foraminal compromise.4.Pre and post enhanced MRI of the lumbar spine demonstrate postoperative changes of posterior approach for debulking of tumor within the sacral canal. Extensive postoperative changes surgical level obscures the thecal sac and precludes precise assessment for detection of residual tumor within the canal. Follow-up is recommended after at least partial resolution of postop changes for better assessment. Beyond the region of surgery examination again demonstrate stable large presacral enhancing mass, extensive marrow signal replacement and enhancement of the sacral spine as well as multiple foci of marrow signal replacement and enhancement of L1 through L5 suggestive of metastatic disease. Extensive loculated prevertebral lymph nodes on the left extending from L1 through L5 without significant change since prior exam.


Instruction: Generate impression based on findings.

Input: Male 62 years old Reason: evaluate pancreas division. History: glaucoma left eye. cataract left eye. retinal detached ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. There is no intra-or extrahepatic biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is dilated measuring 5 mm in the pancreatic head, raising the possibility of narrowing at the ampulla. No definite evidence of pancreas divisum. 3-mm cystic lesion in the pancreatic tail likely represents a small side branch IPMN. There is no enhancing pancreatic mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered T2 hyper intensities within the left kidney are consistent with renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Dilatation of the main pancreatic duct, raising the possibility of narrowing at the ampulla.2.Small side branch IPMN in the pancreatic tail.


Instruction: Generate impression based on findings.

Input: Tingling, numbness in third, fourth and fifth digits, symmetric with neck pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis. There is also mild anterolisthesis of C5 on C6. Bone marrow signal is benign. There is abnormal T2 signal within the cord bilaterally, but primarily on the left. There is mild enhancement, but suboptimally assessed due to motion degradation on the postgadolinium sequences. No additional levels of signal abnormality elsewhere in the cervical spine or the partially imaged upper thoracic spine are demonstrated. Degenerative changes are seen in the cervical spine including multilevel disc desiccation and mild generalized facet arthropathy. Additional details as described below:C2-3: No significant compromise to the spinal canal or right neural foramen. There is minimal left neural foraminal stenosis related to facet arthropathy.C3-4: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing.C4-5: No significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowing.C5-6: There is a central disc extrusion which effaces the ventral thecal sac. There is indentation on the ventral cord with T2 signal abnormality and mild enhancement at this level. Dorsal thecal sac at this level is relatively preserved. There is mild bilateral neural foraminal narrowing.C6-7: Small disc osteophyte complex without significant spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis. C7-T1: There is a central and left paracentral disc protrusion associated with partial effacement of the ventral thecal sac. No significant spinal canal stenosis overall at this level. There is mild left and minimal right neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There is nonspecific partial opacification of the mastoid air cells.

Output: 1. There is a central disc extrusion at the C5-C6 level with associated mild deformity of the ventral cord. There is abnormal T2 hyperintensity and mild enhancement within the cord at this level suspected to represent edema, probably related to the disc extrusion. Inflammatory myelopathy seems less likely but can be considered in the appropriate clinical setting.2. Small disc protrusion is evident at the C7-T1 level, without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: History of laryngeal carcinoma, now with progressive low back pain. There is generalized osteopenia. At the inferior endplate of L2, there is a lytic lesion, with bone erosion and concave depression of the endplate into the L2 vertebra. There is mild soft tissue thickening in the paraspinal region. There is also lucent lesion involving posterior aspect of the S1 vertebra, with subtle cortical disruption. These lesions are suspicious for metastatic bone disease. There are additional lucent lesions scattered throughout the rest of the lumbosacral spine, which can also potentially represent metastatic disease. Further correlation with MRI of the lumbar spine is recommended.There is a sclerotic focus in the left ilium, which is nonspecific, but is compatible with a bone island. Degenerative disease is seen throughout the lumbosacral spine, resulting in spinal canal and neural foraminal narrowing. Disk bulging / protrusion and degenerative changes of the posterior elements are seen at L1 -- L2 to L5 -- S1 levels. The spinal canal stenosis is worst at L3 -- L4 and L4 -- L5 levels. Neuroforaminal narrowing is visualized at all levels, worst at L4 -- L5 levels, with likely impingement of the exiting nerve on the right.There is enlargement of the prostate gland and thickening of the bladder wall. Aorto-femoral stents are noted.

Output: 1. Lytic lesions at L2 and S1 with bone erosion, suspicious for metastatic disease. Further evaluation with MRI without and with contrast is recommended.2. Degenerative disease of the lumbar spine as described above, with spinal canal and neuroforaminal stenosis. 3. Please also refer to CT pelvis for additional findings.


Instruction: Generate impression based on findings.

Input: Male, 24 years old. History of TBI, dystonic tremors, impulsive disorder, seizures, and underwent a DBS insertion on 9/16/15. The patient presented 10/9/15 with altered mental status. Again seen is evidence of the recently removed right frontal approach deep brain stimulator lead . The previously seen ovoid fluid collection in the right frontal lobe and insula is grossly stable in size, measuring 5.3 x 2.1 x 3.0 cm (series 7, image 21; series 8, image 26). The fluid collection only partially suppresses on FLAIR, indicating the presence of proteinaceous debris or diluted blood products, with a small amount of layering blood products posteriorly. There is new thin rim enhancement along this cavity, particularly as seen on late acquired postcontrast images. There is no diffusion restriction associated with this collection. Moderate surrounding vasogenic edema in the right frontal lobe is not significantly changed from prior, with persistent local mass effect and mild leftward midline shift. There is no evidence of herniation. The lateral ventricles appear unchanged in configuration. There is persistent mild enhancement along the tract of the prior deep brain stimulator, which extends through the frontal lobe, nearly reaching the basal ganglia. The previously described peripherally enhancing subgaleal fluid collection at the site of the right frontal burr hole is not as clearly evident compared to the prior study. A right cerebellopontine angle area of CSF prominence appears similar to prior possibly representing a small arachnoid cyst .The cranial-cervical junction is normal. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mild scattered paranasal sinus mucosal thickening. The mastoid air cells, and orbits are unremarkable.

Output: 1.New rim enhancement surrounding the right frontal lobe/insular fluid filled cavity is of uncertain significance but could reflect granulation, reactive inflammation or infection. The size and shape of the cavity are unchanged. Likewise, there has been no change in enhancement along the deep brain stimulator lead tract.2.No significant change in the extent of edema in the right frontal lobe and associated local mass effect.


Instruction: Generate impression based on findings.

Input: Right lumbar radiculopathy. Right leg pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from straightening and minimal retrolisthesis of L4 on L5. Bone marrow signal is benign. The conus medullaris is normal in position terminating at the inferior L1 level. There is focal fatty infiltration involving the filum terminale measuring approximately 1.6 x 2.7 mm in the AP and transverse dimensions and 1.8 cm in the craniocaudal dimensions, and extending from the L1-L2 to the mid L2 levels. The conus appears dorsally positioned as compared to the distal thoracic cord which is ventral.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is a central and right paracentral disc extrusion with minimal craniocaudal extension with effacement of the right lateral recess and possible impingement of the descending right-sided nerve roots. There is no significant stenosis involving the central canal. There is minimal narrowing of the neural foramina. Mild facet arthropathy.L5-S1: There is a central right paracentral disc protrusion which partially effaces the right lateral recess and contacts the right S1 nerve root. No significant central canal stenosis or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits. There is a cystic right adnexal lesion which is partially imaged measuring up to 2.5 x 1.6 cm and may be physiologic (ovarian follicle) in the reproductive age group.

Output: 1. Large central and right paracentral disc extrusion at the L4-L5 level which extends into the right lateral recess, where there may be impingement of the descending right L5 nerve root as well as the more posterior descending S1 nerve root. There is also a smaller right paracentral disc protrusion at L5-S1 which abuts the descending right S1 nerve root.2. Incidentally noted is a small lipoma of the filum terminale. Conus terminates at a normal position at the lower L1 level but appears dorsally displaced. This finding may be incidental but would suggest correlation for possible clinical signs of cord tethering.


Instruction: Generate impression based on findings.

Input: Low back pain radiating to left leg. There is a patchy area of bone marrow edema in the left L5 pedicle, adjacent to mild facet joint arthropathy. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved, aside from small intravertebral disc herniations at multiple levels and minimal chronic anterior wedging of the T12 vertebral body. There are mild anterior endplate degenerative signal alterations at T12 and L2. There is no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: A patchy area of bone marrow edema in the left L5 pedicle may represent inflammation related to facet degenerative disease or perhaps microfracture. Otherwise, no significant spinal canal or neural foraminal stenosis in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 25-year-old female with recurrent pancreatitis, with history of multiple pseudocysts. Transferred from outside hospital for further evaluation of pseudocysts. Now with fevers and acute renal failure. Evaluate for progression of pseudocysts. Evaluate for hydronephrosis, urinary obstruction. Fever to 42 degrees with a previous right lower lobe pneumonia. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: Small bilateral, right greater than left, pleural effusions. Subcentimeter lesion in the fat pad at the right cardiophrenic angle is a borderline enlarged lymph node. LIVER, BILIARY TRACT: Re-demonstration of the lesions in the liver as seen on MRI study. A lesion in the right hepatic dome, with central target-like enhancement is identified. Two additional hyperdense lesions are also seen. With review of MRCP study, hepatic adenoma is favored for the dome lesion and slightly atypical hemangiomas are favored for the other two lesions. No new lesions. SPLEEN: No significant abnormality notedPANCREAS: There is mild pancreatic ductal dilatation, most pronounced in the pancreatic head. Pancreatic head is enlarged with surrounding fat stranding and fluid compatible with acute pancreatitis.Superiorly there is a 3.2 x 4.8 cm cystic lesion (axial image 81/215) seen near the gastroesophageal junction, which likely represents a pancreatic pseudocyst when reviewed with current MRCP study performed here. Smaller cystic lesions in region of pancreatic head are probably smaller pseudocysts, but these are not well seen on this exam.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Multiple enlarged and borderline enlarged mesenteric and retroperitoneal lymph nodes are probably reactive to theBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Posterior surgical fusion Harrington rods with mild scoliosis are noted. The surgical appliances are in the expected position and appear intact. Metallic streak artifact from the surgical appliances limit detailed evaluation of adjacent structures.OTHER: Mild abdominal and pelvic ascites is stable.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Posterior surgical fusion rods with mild scoliosis is notedOTHER: Mild abdominal and pelvic ascites is seen.

Output: 1) Findings consistent with focal pancreatitis in pancreatic head and multiple pancreatic pseudocysts are stable. 2) Three hepatic lesions are stable, most like due to a hepatic adenoma and slightly atypical hemangiomas.3) Multiple additional findings are unchanged.


Instruction: Generate impression based on findings.

Input: No abnormal enhancement or masses are seen to suggest metastatic disease in the cervical spine. Vertebral body heights are maintained. Mild to moderate degenerative changes are seen in the cervical spine with mild loss of cervical lordosis and small disc osteophyte complexes at the C3-C4, C4-C5, and C5-C6 levels. There is mild associated spinal canal stenosis and mild neural foraminal stenosis at these levels. There is partial ankylosis across the C2-C3 disc space at the level of the right C2-C3 and C3-C4 facet joints. There is trace anterolisthesis of C3 on C4. No cord signal abnormality. Moderate facet arthropathy at the right C4-C5 level.THORACIC SPINE

Output: 1. Hypervascular right sacral mass highly suspicious for neoplasm with epidural tumor extension and effacement of the right lateral aspect of the sacral canal. No evidence of pathologic compression fractures or epidural tumor elsewhere in the cervical, thoracic, or lumbar spine.2. Small additional foci of enhancement as described above at T5, T11, T12, L2 and right iliac bones are suspicious for additional foci of metastatic disease. Bone scan may be helpful to assess burden of osseous metastatic disease.3. Multilevel degenerative changes with mild multilevel spinal canal stenosis in the cervical spine and moderate spinal canal stenosis at the L4-L5 level.


Instruction: Generate impression based on findings.

Input: Male 77 years old Reason: Bleeding liver mass s/p embolization, mass etiology unknown, follow-up History: liver mass ABDOMEN:LIVER, BILIARY TRACT: The heterogeneous, exophytic left hepatic mass measures 3.5 x 3.3 cm, stable from prior study where it also measured 3.5 x 3.3 cm. There is no washout on postcontrast sequences. There is progressive incomplete peripheral nodular enhancement. No new lesions are noted. An adjacent T2 hyperintense lesion is consistent with a simple cyst. A subcentimeter hypoenhancing lesion in the posterior right hepatic lobe (series 9, image 47) is nonspecific but unchanged compared to prior study.Layering material within the gallbladder suggestive of sludge/stones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.An exophytic left hepatic mass is unchanged in size. It is difficult to accurately characterize given the history of prior embolization but may represent a hemangioma. Again, further evaluation with percutaneous biopsy could be considered if clinically warranted.


Instruction: Generate impression based on findings.

Input: Meningioma versus dural breast cancer metastasis. There is a 6 mm wide dural-based, homogeneously enhancing mass along the left middle frontal gyrus convexity. There is no evidence of intracranial hemorrhage or acute infarct. There are minimal scattered punctate foci of high T2 signal in the cerebral white matter. There is a nonspecific punctate focus of susceptibility effect in the left parietal lobe deep white matter without associated enhancement. There is a small left cerebellar hemisphere developmental venous anomaly. 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.

Output: 1. A 6 mm wide dural-based, homogeneously enhancing mass along the left middle frontal gyrus convexity likely represents a meningioma and less likely a metastasis given the lack of aggressive feature, but there can be overlap in the imaging findings of the conditions. 2. A nonspecific punctate focus of susceptibility effect in the left parietal lobe deep white matter without associated enhancement may represent a chronic microhemorrhage rather than an atypical metastasis. Otherwise, no evidence of brain metastases.


Instruction: Generate impression based on findings.

Input: Neck pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: There is a left paracentral disc protrusion with mild effacement of the left ventral aspect of the thecal sac. No significant spinal canal stenosis overall or neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Partially empty sella incidentally noted.

Output: Minimal degenerative changes in the cervical spine including small left C6-C7 disc protrusion. No significant spinal canal stenosis or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Redemonstrated is mild dilatation of the central canal within the thoracic spinal cord spanning from approximately mid T6 through the superior aspect of T9, not significantly changed from prior exam. The tiny syrinx measures up to 2 mm in the axial dimension. The thoracic spine is in normal alignment. The vertebral body heights are well-maintained. There is mild to moderate loss of disc height throughout the thoracic spine. There are unchanged scattered T1 hyperintense foci in the thoracic spine, which likely represent focal fatty replacement and/or fat-containing hemangiomas. Small Schmorl's nodes are seen involving the inferior endplates of T9 and T10. Minimal disc bulge at T10-T11 and T11-T12 with mild degenerative changes are unchanged. There is no significant spinal canal or foraminal stenosis within the thoracic spine. The thoracic spinal cord is otherwise within normal limits.

Output: 1. Compared to 1/30/2010, no significant interval change in mild dilatation of the central canal/small syrinx within the thoracic spinal cord.2. Mild degenerative changes of the thoracic spine without significant spinal canal or foraminal stenosis at any level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [R40.4], Reason for Study: ^Reason: eval tumor s/p craniotomy pod 1 History: eval tumor s/p craniotomy pod 1 Right frontal craniotomy with right frontal meningioma post operative status.The resection cavity demonstrates mixed signal intensities indicating operation related blood products. On Gad enhanced scan, there is subtle enhancements especially on the inferior and mesial aspect of the original mass but do not show discrete enhancement. This finding is non specific since the scan was performed in early postoperative period, thus recommend follow up imaging to evaluate possible residual mass lesion. Reactive enhancements are seen on the right frontal lobe gyri which are not unusual postoperative finding.There are right superior frontal gyral ICH and parafalcine SDH which are likely related to surgical procedure.Right frontal lobe peritumoral edema and the degree of midline shift toward left side do not show any significant interval change since prior scan.Subgaleal low signal intensities overlying craniotomy site indicate operation related air density, no change since postoperative CT scan.No acute ischemic lesion on this scan.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post operative status of the right frontal meningioma as with blood products in tumor beds as described above.2. No significant interval change of right frontal peritumoral edema and the degree of midline shift toward left side since prior scan.3. Right superior frontal gyrus ICH and parafalcine SDH (left side) as described above.


Instruction: Generate impression based on findings.

Input: Female 12 years old Reason: evaluation of iron overload History: elevated ferritin Both liver and cardiac MR was performed specifically for diagnosis of iron load.Liver T2*is of 9.7 ms on average and the heart T2*is 29.3 ms in an average.

Output: 1. Iron load of the heart within normal limits.2. Increasing iron load of the liver.


Instruction: Generate impression based on findings.

Input: Right neck/back/tricep pain, weakness. There is an eccentric right posterior disc-osteophyte complex at C6-7 that indents the spinal cord, which otherwise displays normal signal. There is narrowing of the medial right C6-7 neural foramen as well. There is no significant degenerative spondylosis at the other cervical spine levels. There is no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: An eccentric right posterior disc-osteophyte complex at C6-7 that indents the spinal cord, which otherwise displays normal signal. There is narrowing of the medial right C6-7 neural foramen as well.


Instruction: Generate impression based on findings.

Input: 48-year-old man with right hip pain ACETABULAR LABRUM: There is abnormal signal of the posterior labrum compatible with a tear and/or changes related to prior repair. An additional small defect is seen within the anterior superior labrum.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits. Mild lateral acetabular osteophytes are noted. The articular cartilage is normal.SOFT TISSUES: No significant abnormality noted. Iliopsoas, abductor, gluteal and hamstring morphology is normal. There is no muscular fatty atrophy.ADDITIONAL

Output: Postoperative and degenerative changes of the labrum as detailed above.


Instruction: Generate impression based on findings.

Input: Patient with history of breast cancer. Lytic bone lesion at S1. Please provide biopsy Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: S1 left sacral ala bone biopsy under CT guidance. Samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Interpretation of outside lumbar spine MRI dated 6/7/2014 is requested. Spina bifida and tethered cord and burning sensation in her foot. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the lower L1 level.Mild degenerative changes are seen with mild disc desiccation at all levels, individual levels as described below:L1-L2: Minimal disc bulge and small Schmorl's node. Endplate marrow signal changes involving the superior endplate of L2 are on a degenerative basis. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Tiny Schmorl's node involving the anterior superior L3 endplate. No spinal canal or neural foraminal stenosis.L3-L4: Tiny dorsal annular fissure. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Small left dorsal annular fissure and minimal disc bulge eccentric to the left. No spinal canal or right neural foraminal stenosis. Minimal left neural foraminal narrowing.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine with minimal left L4-L5 neural foraminal narrowing. Otherwise no spinal canal or neural foraminal stenosis in the remainder of the lumbar spine. No findings to suggest tethered cord.


Instruction: Generate impression based on findings.

Input: 53 year old female with AML status post transplant with mental status changes, known subdural hemorrhage. Redemonstration of thin subdural blood products along the posterior falx cerebrum and tentorium appearing similar to the prior exam. No new focus of hemorrhage is identified.Additional subdural collections seen along the convexities on prior MRI of 4/7/2012 are not as well visualized on this exam.There is no evidence of mass effect, midline shift or edema. The gray-white matter differentiation is grossly preserved.Asymmetry of the lateral ventricles with the right lateral ventricle appearing significantly larger than the left, unchanged from the exam on 6/2009. The remaining cortical sulci and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Signal abnormality reported on prior MRI is not as well appreciated on this CT study due to technical limitation of CT.Mucosal thickening of the maxillary, ethmoid and right sphenoid sinuses. The mastoid air cells and middle ear cavities also appear partially opacified, unchanged from the prior exam.

Output: 1. Small subdural hematomas appear grossly unchanged as compared to the prior exam. No new focus of hemorrhage is identified. 2. Stable moderate paranasal sinus, middle ear cavity and mastoid opacification.


Instruction: Generate impression based on findings.

Input: Evaluate for spinal stenosis: pain, fall. There is some degradation of image quality due to patient body habitus. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is mild loss of disc height at T10-11. There is desiccation of the discs, with vacuum disc phenomenon at L5-S1. The vertebral bone marrow signal is unremarkable. The spinal cord displays grossly normal signal. The paravertebral soft tissues are unremarkable. At T10-T11, limited images demonstrate a disc bulge and facet hypertrophy resulting in severe central canal and neuroforaminal stenosis. At T11-T12, limited images demonstrate a right disc protrusion and facet hypertrophy resulting in mild left and moderate right foraminal stenosis. At T12-L1, there is facet hypertrophy resulting in mild bilateral neuroforaminal stenosis, but no significant spinal canal stenosis. At L1-L2, there is facet hypertrophy resulting in moderate bilateral neuroforaminal stenosis, but no significant spinal canal stenosis. At L2-L3, there is mild disc bulge and facet hypertrophy resulting in moderate bilateral neuroforaminal stenosis, but no significant spinal canal stenosis. At L3-L4, there is mild disc bulge and facet hypertrophy resulting in mild neuroforaminal stenosis, but no significant spinal canal stenosis. At L4-L5, there is a disc bulge with a superimposed focal central protrusion, as well as facet hypertrophy with effusions resulting in mild spinal canal stenosis and severe left greater and mild to moderate right foraminal stenosis. At L5-S1, there is facet hypertrophy with effusions resulting in moderate to severe neuroforaminal stenosis bilaterally, but no significant spinal canal stenosis.

Output: 1.Partially imaged severe spinal canal narrowing with spinal cord impingement and bilateral neuroforaminal stenosis at T10-T11. Further evaluation via dedicated thoracic spine MRI may be useful.2.Multilevel degenerative spondylosis of the lumbar spine with mild spinal canal stenosis at L4-5 and scattered neuroforaminal stenosis, some of which is rather severe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unspecified dementia without behavioral disturbance [F03.90], Reason for Study: ^Reason: 69 year old with short-term memory loss, likely dementia, considering Alzheimer disease and vascular etiology. Please comment on hippocampus. History: memory loss. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Bilateral amygdala and bilateral parahippocampal gyri appear to be symmetrically small in size. There is no evidence of increased signal intensity of bilateral hippocampus on FLAIR or T2 images though this is not a dedicated temporal lobe MR scan. There is no evidence of preferential fronto-parietal lobar atrophy. Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating non specific small vessel ischemic disease.The ventricular system appears to be slightly enlarged but 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 and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Bilateral symmetric atrophic changes of both amygdala and parahippocampal gyri as described above, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of previous cervical fusion with neck and left arm pain. Again seen is an anterior plate with screws directed into the C5 and C6 vertebral bodies. A spacer device is again noted between the C5 and C6 vertebra. The C4-C5 and C5-C6 disc spaces are indistinct suggesting some osseous fusion, overall increased from prior. Also again noted is lucency surrounding the C5 screws and anterior tilting of the superior aspect of the plate again concerning for loosening appearing similar to prior. Mild loss of height of the C4, C5, and C6 vertebral bodies better characterized on prior MRI appears similar to prior.There is loss of the normal cervical lordosis. There is no evidence of instability on flexion and extension views. The upper cervical neuroforamina appear grossly patent. The lower cervical neural foramina are obscured by overlying anatomy.

Output: Postoperative changes of ACDF as described above without evidence of instability.


Instruction: Generate impression based on findings.

Input: 17 years, Female, daily headaches, history of ALL status post chemotherapy. Brain parenchyma appears within normal limits. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No extra-axial collections. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is paranasal sinus disease with moderate opacification of the bilateral anterior and posterior ethmoid air cells as well as mild mucosal thickening involving the bilateral frontal, maxillary, and sphenoid sinuses. Mastoid air cells are clear. Bone marrow signal and remainder of the extracranial soft tissues are within normal limits.

Output: 1. MRI of the brain is within normal limits.2. Moderate opacification of the paranasal sinuses.