Instruction: Generate impression based on findings.

Input: Male 71 years old; Reason: evaluate for osteomyelitis. Pt with severe redness and purulence of leg. Images are slightly degraded by motion artifact.There is diffuse soft tissue swelling about the ankle and midfoot, most prominent at the dorsal and medial aspects. No osseous changes are seen to suggest osteomyelitis. No drainable fluid collection is evident. No discrete soft tissue ulcer is seen. This soft tissue edema extends cranially beyond the field of view of this exam. The soft tissue ulceration seen on the prior radiographs is not included in the field of view.Degenerative changes are noted in the midfoot. There is a pes planovalgus deformity of the mid and hindfoot, which is better evaluated by the prior radiographs. The tendons and ligaments of the ankle are unremarkable.

Output: 1. Diffuse soft tissue edema, without evidence of osteomyelitis or abscess formation.2. The soft tissue edema extends cranially beyond the field of view of this exam. The soft tissue ulceration seen on the prior radiographs is not included in the field of view, and re-attempt at tibia/fibula imaging is recommended when clinically feasible.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:6/14/1962)Reason: brain mets with cystic lesions s/p drain placement and whole brain rt History: eval for extent of diseasePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA A ring-enhancing fluid collection present in the right temporal lobe lobe measures currently measures 25 x 21 mm axial dimensions and 18 x 23 mm coronal dimensions. It previously measured 21.3 mm x 25 mm axial dimensions 25 x 20 mm coronal dimensions. This lesion abuts the right lateral ventricle. There is a drainage tube which courses through the right temporal lobe into the lateral aspect of this lesion adjacent to the lateral ventricle.A lesion centered in the left postcentral gyrus currently measures 17 x 10 mm axial dimensions and previously measured 47 x 33 mm axial dimensions. A drainage tube courses to the left parietal lobe into this lesion and subsequently into the adjacent white matter of the centrum semiovale.A right frontal lobe ring-enhancing lesion measures 5 mm on the current exam and previously measured 8 mm x 9 mm. On the 10/15/2015 exam it measured 8 mm x 9 mm. There is no associated diffusion restriction within these fluid collections. Fluid collections have high signal on T2 and FLAIR imaging within them. There is surrounding halo of edema with each of these ring-enhancing lesions.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 opacified. The visualized portions of the orbits are intact.

Output: 1.Since prior exam a right temporal lobe ring-enhancing lesion has mildly decreased in size. 2.The left parietal lobe lesion has dramatically decreased in size. 3.A the right frontal lobe lesion remains stable in overall dimensions.4.The patient is status post catheter placement in the left frontal lobe cystic lesion as well as the right temporal lobe lesion through adjacent burr holes.


Instruction: Generate impression based on findings.

Input: 68-year-old female with cirrhosis. Assess for ascites. Must be done at bedside. OTHER: Small right pleural effusion. No ascites identified in the 4 quadrants of the abdomen.

Output: 1. Small right pleural effusion.2. No ascites identified.


Instruction: Generate impression based on findings.

Input: 50 year old woman with left-sided paresthesias since this morning. Evaluate for bleed / CVA. There is no evidence of intracranial hemorrhage, mass or edema. If stroke is a clinical concern, recommend MRI. 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: Normal brain CT. If stroke is of clinical concern, recommend MRI.


Instruction: Generate impression based on findings.

Input: 4-year-old female patient with cyclic vomiting and precocious puberty. Evaluate pituitary. Pituitary: The pituitary enhances homogeneously and is normal is size. There is no evidence of pituitary tumors. The posterior pituitary bright spot and infundibulum are intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellum appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No gross evidence of pituitary or brainstem lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 77 years Male (DOB:10/13/1939)Reason: evaluation of brain lesion History: Altered mental statusPROVIDER/ATTENDING NAME: SEJAL PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hemorrhagic mass present in the right parietal lobe measuring 27 x 26 mm axial dimensions. There is associated vasogenic pattern of edema. There are some patchy enhancement associated with this.There is leptomeningeal enhancement present along the right hemisphere. On susceptibility imaging there are punctate foci of signal loss in the right frontal lobe subcortical white matter. There is some vasogenic edema present within the right frontal lobe.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.There is a hemorrhagic mass present in the right parietal lobe which is concerning for a neoplasm. This patient is reported to have a primary tumor in the esophagus. As a result it is suspicious for metastatic disease.2.There is leptomeningeal disease involving the right hemisphere. Differential considerations include leptomeningeal carcinomatosis and infection with meningitis. Please correlate with patient's clinical history.3.There are multiple microhemorrhages present in the right frontal lobe. These are nonspecific. In the current clinical context they could represent punctate foci of metastatic disease though they could also be a result of leptomeningeal carcinomatosis or meningitis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Transient cerebral ischemic attack, unspecifiedClinical question: Right facial numbnessSigns and Symptoms: as above MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are several punctate T2 and FLAIR hyperintense lesions present in the pons and thalami.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.A 12 x 10 mm axial dimension mass is present in the deep right parotid gland which is very bright on T2 ,bright on FLAIR and low signal on T1. It is homogeneous and well circumscribed.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right A1 segment is larger than the left A1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The left vertebral artery is larger than the right vertebral artery.

Output: 1.No evidence for intracranial cerebrovascular occlusive disease.2.No evidence for acute ischemic cerebral infarction.3.Periventricular and subcortical white matter lesions of a mild to moderate degree and several punctate lesions in the pons and thalami are nonspecific. At this age they are most likely vascular related. 4.A small right deep parotid gland mass is present. Statistically it most likely represents pleomorphic adenoma though malignancy cannot be excluded. A follow-up exam would help further evaluate it.


Instruction: Generate impression based on findings.

Input: Patellofemoral pain, knee popping/subluxation. Question of chondral injury, plica. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signal is within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: There is subtle edema in the superolateral aspect of Hoffa's fat pad which may suggest patellofemoral instability.ADDITIONAL

Output: 1. Intact articular cartilage, ligaments, and menisci. 2. Subtle edema in superolateral Hoffa's fat pad may suggest patellofemoral instability.


Instruction: Generate impression based on findings.

Input: Male, 4 months old, with caudal regression, imperforate anus, evaluate for tethered cord. Five normally formed lumbar vertebral bodies are demonstrated. Five sacral vertebral bodies are also seen. The posterior elements of the lower sacral segments are not well visualized. No coccygeal segments are identified.Spinal alignment is anatomic. Vertebral body height and morphology are otherwise unremarkable. No evidence of marrow signal abnormality is seen. No significant compromise of the spinal canal or neural foramen is identified.The conus may be slightly more rounded than what is typically seen, but it terminates at the L1 level which is within normal limits. The nerve roots of the cauda equina are unremarkable. No evidence of fatty filum terminale or any intraspinal mass lesion is seen. Clear anterior translation of the conus and cauda equina is demonstrated on prone imaging.

Output: 1.Although the conus appears slightly more rounded than what is typically seen, it terminates at a normal spinal level. There is no evidence of tethered cord on this examination.2.Poor visualization of the sacral posterior elements does not necessarily indicate a segmentation anomaly and may simply reflect thin or incompletely ossified bones.3.Lack of visualization of the coccygeal segments could reflect a very mild form of caudal regression.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out expansion of existing ischemia. Signs and symptoms: MCA stroke. Nonenhanced brain MRI:Diffusion weighted series demonstrate multiple new additional small foci of restriction in the left cerebellar and medulla consistent with new acute foci of ischemic strokes. Additionally there are new foci of cortical restricted diffusion extensively in the right frontal lobe and right insular cortex and basal ganglia.The new finding in the right frontal lobe results in thickening of the cerebral cortex and mild effacement of adjacent cortical sulci.Examination also demonstrates interval increased extent of a large left MCA territory subacute ischemic infarct to include left basal ganglion. There is interval significant increase in edema of the left hemisphere in the distribution of left MCA stroke with resultant significant effacement of the cortical sulci and mild rightward deviation of midline of approximately 4 mm. There is extensive susceptibility signal changes throughout the left MCA territory subacute stroke since prior exam and consistent with diffuse petechial hemorrhage. There is mild interval decreased size of ventricular system secondary to increased intracranial pressure. There is crowding of the basal cistern and mild bilateral (L>R) transtentorial inferior herniation of temporal lobes (coronal T2 weighted series 7 images 15 through 19). Postoperative changes of a wide left-sided craniectomy for decompression of a stroke is again identified and significant bulge of the left hemisphere through the craniectomy defect remains grossly similar to prior exam.

Output: 1.New additional foci of restricted diffusion in the left cerebellum, medulla, right frontal and right basal ganglion.2.Interval increased extend of subacute left MCA stroke with extensive new petechial hemorrhage and significant increased edema as detailed.3.Mass effect with effacement of basal cistern and (L>R) transtentorial herniation.4.Stable mild rightward deviation of midline and small size of the ventricles.


Instruction: Generate impression based on findings.

Input: Other malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: 3 t scanner ccm protocol, qsm/permiability History: s/p resection from 7/21 Evidence of left frontotemporal craniotomy with susceptibility lesions on the left mesial temporal lobe indicate postoperative status.There is underlying dural enhancement and thickening at the level of craniotomy which is again postoperative changes.There is no evidence of acute hemorrhagic or ischemic lesion on the scan.The ventricles, sulci and cisterns are unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Left mesial temporal lobe cavernous malformation resection status, no unusual finding.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 28-year-old female with nausea and abdominal pain with new diagnosis of Crohn's disease. Reevaluate phlegmon seen on CT scan from February. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild narrowing of the terminal ileum over approximately a 5 cm length with mild wall thickening and increased enhancement, most compatible with active inflammatory bowel disease. Minimal inflammatory changes within the mesenteric fat in the right lower quadrant, significantly decreased since prior exam. No evidence of abscess or fistula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Subcentimeter ovoid T2 hyperintense lesion in the left perineal region is most likely due to a Bartholin gland cyst (series 7/38).OTHER: No significant abnormality noted.

Output: 1. Mild active inflammatory bowel disease affecting the terminal ileum.2. Inflammatory changes in the right lower quadrant have significantly decreased since prior exam. No evidence of abscess or fistula.


Instruction: Generate impression based on findings.

Input: Male, 39 years old, with history of ALL and new bilateral testicular lesions concerning for leukemic involvement. Patient with worsening sciatica for one week, left more than right. Thoracic:No pathologic medullary or leptomeningeal enhancement is seen. No intraspinal masses are detected. Cord signal characteristics and morphology are normal.Spinal alignment is anatomic. Vertebral body morphology is normal. Marrow signal characteristics are slightly heterogeneous but without concerning marrow replacement or pathologic enhancement.A very small central disk protrusion is seen at T10-11. No significant spinal canal stenosis or neuroforaminal narrowing is detected at any level. Scattered small Schmorl's nodes are seen at lower thoracic levels.Lumbar:The distal spinal cord, conus and nerve roots of the cauda equina show normal morphology and signal characteristics. No pathologic enhancement is suspected. No intraspinal masses are seen.Spinal alignment is anatomic. Vertebral body morphology is unremarkable allowing for scattered small Schmorl's nodes. Again, marrow signal is slightly heterogeneous but without concerning areas of marrow replacement or pathologic marrow enhancement.T12-L1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.L1-2: Mild facet hypertrophy. Mild loss of disk height and T2 signal. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet hypertrophy. Loss of disk T2 signal. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L4-5: Moderate facet hypertrophy. No significant spinal canal stenosis. Minimal bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy. Large left subarticular/foraminal disk protrusion with impingement of the transiting left S1 nerve root. Mild effacement of the left ventral spinal canal. Moderate left foraminal narrowing. Mild right foraminal narrowing.

Output: 1. Large left-sided disk protrusion at L5-S1 with impingement of the transiting left S1 nerve root2. Very mild degenerative findings at additional levels.3. No evidence to suggest neoplastic involvement in the spinal canal or bony elements.


Instruction: Generate impression based on findings.

Input: 31 years Female (DOB:6/5/1984)Reason: Demyelinating disease; eval for 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 are predominantly subcortical white matter lesions scattered within the brain parenchyma concentrated more along the right parietal lobe and medial aspects of the temporal lobes but scattered elsewhere within the supratentorial brain. There is a lesion the subcortical white matter of the right precentral gyrus at the hand motor area. This is stable since the prior exam. These were also present on the prior exam and do not appear to have changedNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is generalized volume loss of brain present.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: They're predominantly subcortical white matter lesions present especially along the right hemisphere and in particular the right parietal lobe. These appear stable and compared to the previous exam from 11/18/2015. These are nonspecific but compatible with demyelinating disease.


Instruction: Generate impression based on findings.

Input: Right-sided weakness, slurred speech, and behavioral changes. There is restricted diffusion involving the left cerebral peduncle, as well as a punctate focus more posteriorly in the left midbrain compatible with acute infarction. The FLAIR images are limited by patient motion. There may also be a punctate focus of high T2 signal in the left frontal lobe white matter, without restricted diffusion. The ventricles are normal in size.

Output: Limited examination with evidence of acute infarction involving the left cerebral peduncle and left midbrain. Findings were text paged to the Neurology resident on call covering pager x4174 at 9:20 am on 1/13/2016.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Reason for for ventricular obstruction and herniation, evaluate for CSF leak. Pre- and post enhanced brain MRI:Diffusion weighted images are negative.Images through the supratentorial space demonstrate paucity of cortical sulci, small size of supratentorial ventricular system however with maintained midline, crowding and effacement of the basal cistern as well as evidence of minimal transtentorial herniation of left temporal lobe (coronal T2 series 1/1/2001 image 20). There is no detectable signal abnormality of supratentorial brain parenchyma.Images through posterior fossa demonstrate interval resolution of extensive previously seen edema of the inferior cerebellar hemispheres since prior MRI exam from 7-2-15 and with evolution of bilateral small foci of encephalomalacia of the cerebellum (R>L). Similar to prior exam the 14th ventricle is a small however in midline. There is postoperative changes of Chiari decompression with prolapse of the cerebellum into the expanded space and near complete absence of subarachnoid space in the posterior fossa and at the level of the compression. This appearance is similar to prior exam.Post enhanced images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges. Mild dural enhancement at the surgical site is within expected postoperative finding. There is no evidence of CSF from the fundus exam as is questioned clinically.Pre- and post enhanced cervical spine MRI:Examination demonstrates post operative changes of Chiari decompression. There is inferior prolapse of the cerebellum inferiorly with resultant near complete effacement of CSF space at the level of Chiari decompression. Small foci of encephalomalacia (R>L) in inferior bilateral cerebellum at the site of previously noted acute strokes are identified. The signal intensity and caliber of cervical cord is within normal.Post contrast images demonstrate no detectable abnormal enhancement of the cord or the pia-meninges. The expected epidural enhancement of the cervical region appears more pronounced and could represent engorgement/increased pressure.There is no evidence of CSF leak on this study.Pre and post enhanced MRV:Examination demonstrates normal appearing are intracranial venous sinuses and without evidence of abnormality. There is also normal visualization of bilateral internal cerebral veins, vein of Galen and straight sinus. Inferior sagittal sinus is also identified and unremarkable. Bilateral cavernous sinuses and bilateral inferior petrosal veins are detected. There is increased size and enhancement of the visualized upper cervical epidural venous plexus which could represent increased pressure. There is no detectable abnormality of cerebral cortical venous structures

Output: 1.Nonenhanced brain MRI demonstrate no evidence of restricted diffusion. There is a significant paucity of cortical sulci, slitlike ventricular system, effacement of basal cisterns and minimal transtentorial herniation of the left cerebellum. Prolapse of cerebellum into the expanded subarachnoid space at the level of Chiari decompression with resultant complete effacement of the CSF space and with small size of fourth ventricle. Findings are believed to be secondary to decreased intracranial pressure. This appearance is not significantly different than prior head CT examination from 9-8-15. Interval evolution of regions of bilateral inferior cerebellar acute strokes to small foci of encephalomalacia as detailed. No detectable abnormal enhancement.2.Pre and post enhanced MRI of cervical spine demonstrate prolapse of the cerebellum into the subarachnoid space at the level of Chiari decompression and with resultant complete effacement of subarachnoid space. Normal signal intensity and caliber of the cord. No detectable abnormal enhancement. The epidural venous plexus is prominent.3.MRV of intracranial circulation demonstrates normal appearing all intracranial venous sinuses, deep venous structures and the cerebral cortical veins. There is robust visualization of prominent visualized upper cervical epidural venous plexus which conceivably could represent increased venous pressure.


Instruction: Generate impression based on findings.

Input: 2 day old female with left lower extremity hemangioma, evaluate for extent of involvement Multiple conglomerate foci of T2 signal abnormality extend from the retroperitoneum inferior to the left kidney to the pelvis with encasement of the rectum and extension into the peritoneum. There is encasement of the left buttock with less extensive involvement of the right buttock as well as encasement of the proximal left thigh along its lateral, posterior, and medial aspects. Foci of signal abnormality extend along the femur to the level of the knee with involvement of the popliteal fossa and distally along the posterior and medial leg the level of the ankle. The majority of the enhancement is seen on the delayed phases rather than on early arterial phases. No large flow-voids are visualized.The bladder is moderately distended with fluid. High T1 signal within the bowel likely represents meconium.

Output: Vascular malformation involving the abdomen, pelvis, and left lower extremity as described above which may represent a hemangioma or mixed veno/lymphatic lesion. The findings would be atypical for an AVM.


Instruction: Generate impression based on findings.

Input: 69-year-old female with a nonhealing deep ulceration of the plantar left heel. Metallic susceptibility artifact from the patient's fibular plate and screw device limits evaluation of the lateral aspect of the ankle.There is soft tissue irregularity along the plantar aspect of the calcaneus consistent with the stated history of ulceration. There is subcutaneous edema in the surrounding area. The ulceration extends to the level of the plantar aspect of the calcaneus. No focal fluid collection is identified to suggest abscess formation. There is diffuse nonspecific subcutaneous edema about the ankle and dorsal aspect of the foot which may represent a cellulitis.There is increased signal abnormality and fluid sensitive sequences within the calcaneus. There is associated decreased signal abnormality within the tuberosity of the calcaneus corresponding to the aforementioned increased signal abnormality on fluid sensitive sequences, consistent with osteomyelitis.

Output: Findings consistent with osteomyelitis of the calcaneus as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:11/1/1970)Reason: Evaluate for follow up neuroimaging as part of stroke workup - L M1 stenosis noted on CTA History: R hemiplegia, global aphasiaPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainThere are patchy foci of diffusion restriction in the left middle cerebral artery territory particularly in the watershed zones involved areas include the left caudate nucleus left middle frontal gyrus, left pre and postcentral gyri and portions of the left superior parietal lobule and portions of the left inferior parietal lobule. These are associated with FLAIR signal hyperintensity. There is intravascular enhancement and some leptomeningeal enhancement along the left middle cerebral artery territory suggestive of early subacute phase infarction.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense patchy lesions are present in the brainstem.There are multiple punctate foci of signal hypointensity present in the brainstem, thalami and basal ganglia as well as the right insular cortex and right frontal lobe. There are foci of signal loss within the patchy areas in the inferior infarction in the left frontal and parietal lobes.The CSF spaces are appropriate for the patient's stated age with no midline shift. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is a high-grade 90% stenosis present proximal left middle cerebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is a high-grade stenosis present at the proximal left middle cerebral artery M1 segment. It is not clear whether this is related to acute thrombus or stenosis due to other cause.2.There are patchy foci of subacute infarction the left middle cerebral artery territory some of which display some petechial blood.3.There are multiple microhemorrhages predominantly in the distribution suggestive of hypertension.4.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific, however, given the patient's other findings most likely they are vascular related.5.Patchy lesions in the brainstem are likely vascular related as well.


Instruction: Generate impression based on findings.

Input: Ms. Cynthia Novak is a 49 year old female with a personal history of right breast cancer status post lumpectomy in 2012 followed by radiation and chemotherapy. MAMMOGRAM: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. A linear marker is placed on the scar overlying the right breast. There are stable post-lumpectomy changes present in the right breast and right axilla, including architectural distortion, increased density, and surgical clips.Stable benign morphology mass, characterized as fibroadenolipoma on prior MRI, in the left upper outer left breast.There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in either breast.

Output: No mammographic evidence of malignancy. Postsurgical change in the right breast. Stable benign mass in the left breast. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: 35-year-old G2 P1 at 31 weeks with history of tethered spinal cord status post release, evaluate lumbar spine prior to epidural placement for C-section. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:Examination demonstrates normal anatomical alignment of vertebral column.There is revisualization of postoperative changes of prior cord untethering evident by posterior laminectomy at L4 and L5 without change.Compared to prior exam there is a slight prominence of the ventral epidural space demonstrating T2 hypointensity which is believed to represent engorged epidural venous plexus secondary to patient's pregnancy. This finding is best appreciated on sagittal T2 weighted images.There is termination of the cord at L2-L3 disc level similar to prior exam. The signal intensity of the lower most visualized thoracic cord, conus and cauda equina is within normal and there is no evidence of spinal canal compromise or stenosis at any level. There is no detectable fatty signal intensity of the filum.No significant degenerative changes of the spine and no evidence of neural foraminal or lateral recess compromise at any level.Unremarkable perispinal soft tissues other than chronic stable postoperative changes of prior cord untethering.

Output: 1.Compared to prior study there is mild prominence of the ventral epidural space with T2 hypointensity suggestive of engorged epidural venous plexus secondary to patient's pregnancy.2.Stable post operative changes of cord untethering as detailed.3.There is termination of the cord at L2-L3 disc level and with normal signal intensity of the lower thoracic cord, conus and the cauda equina.4.No spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side [I69.351], Reason for Study: ^Reason: ? stroke History: AMS No evidence of acute ischemic or hemorrhagic lesion.There are multifocal susceptibility lesions especially involving bilateral thalami and basal ganglia indicating possible petechial chronic hemorrhage. In addition, there are multifocal lacunar infarcts involving bilateral basal ganglia as well as left periventricular white matter, left frontal lobe and the left side pons.Relatively smaller left side cerebral peduncle indicate possible Wallerian degeneration.Scattered T2/FLAIR high signal intensities on bilateral periventricular white matter and centrum semiovale indicate associated 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, 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. Multifocal bilateral lacunar infarctions with petechial hemorrhages involving bilateral thalami and basal ganglia.2. Suggestive findings of left side Wallerian degeneration.3. Associated small vessel ischemic disease.4. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Status post craniotomy for epidural abscess evacuation, view for residual epidural abscess or subdural abscess Metallic artifact from the patient's braces limits the anterior and inferior aspect of the diffusion-weighted and susceptibility weighted images.Status post frontal craniotomy. New rim-enhancing, diffusion restricting fluid collections along the right posterior falx and superolateral to the right frontal lobe are compatible with subdural abscesses. The largest collection adjacent to the posterior falx just anterior and superior to the torcula measures 1.7 cm in thickness (image 14, series 1301). The extra-axial collection overlying the right frontal lobe measures 1.1 cm in thickness (image 11, series 1401). These collections causes local mass effect on the adjacent brain parenchyma and increased T2/FLAIR signal within the right superior frontal and right occipital white matter, compatible with edema/cerebritis. There is no ventricular extension of these collections and the ventricles are normal in size.Minimal enhancement anterior to the right frontal lobe is likely postsurgical and no residual abscess is seen in this area. Enhancing material within the frontal sinuses likely represents granulation tissue.No intraparenchymal mass lesion is seen. No intraparenchymal areas of diffusion restriction are seen to suggest acute infarction. Major intracranial artery and dural venous sinus flow voids are present without evidence of thrombosis.

Output: New subdural abscesses along the right posterior falx cerebri and overlying the right frontal lobe.


Instruction: Generate impression based on findings.

Input: 52-year-old male patient with prostate cancer, nerve sparing. PELVIS:PROSTATE:Prostate Size: 4.9 x 3.4 x 3.7 cmPeripheral Zone: There is a lesion within the left base extending to the left mid gland demonstrating T2 hypointensity, ADC hypointensity, and early enhancement compatible with carcinoma. The largest tumor is in the left base measuring 7 x 8 mm. Central Gland: No significant abnormality.Seminal Vesicles: No definite involvement.Extracapsular Extension: There is slight extraprostatic extension of tumor in the left base. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Tumor in the left base extending to the left midgland with slight extraprostatic extension.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild dextrocurvature at the thoracolumbar junction and mild levocurvature of the lower lumbar spine. Trace retrolisthesis is present at L2-L3 and L3 on L4. Bone marrow signal is heterogeneous which is nonspecific but without discrete destructive osseous lesions evident. There are also bone marrow signal changes involving the endplates, particularly type I Modic changes at the L2-L3 level, related to degenerative disease. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge and mild facet arthropathy without spinal canal or neural foraminal stenosis. L2-L3: Degenerative edematous endplate changes and vacuum phenomena evident at the disc space. There is a disc bulge and facet arthropathy contributing to mild central spinal canal stenosis. There is moderate left and minimal right neural foraminal stenosis.L3-L4:. Mild disc bulge and facet arthropathy contribute to mild spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosisL4-L5: Mild disc bulge, ligamentum flavum thickening and facet arthropathy with mild to moderate spinal canal stenosis. There is mild to moderate right neural foraminal stenosis. Minimal left neural foraminal narrowing.L5-S1: Mild disc bulge and moderate bilateral facet arthropathy. There is no significant spinal canal stenosis. Neural foramina are also patent.

Output: Moderate degenerative changes throughout the lumbar spine. Mild to moderate spinal canal stenosis is present at L4-L5. There is multilevel facet arthropathy, relatively worse at the L5-S1 level, which may also be contributing to patient's low back pain.Additional details as above.


Instruction: Generate impression based on findings.

Input: Memory loss: stuttering/word-finding difficulty. There is mild scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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 skull is grossly unremarkable. There is a right lens implant. There is a right sphenoid sinus retention cyst.

Output: Mild scattered cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Subdural hemorrhage MRI of the brainThere are bilateral subdural effusions present adjacent to both hemispheres. The right one is larger than the left lung. The one on the right measures approximately 17 mm in thickness along the left measures approximately 17 mm in thickness. The subdural collections are hyperintense on T2 and FLAIR sequences and somewhat homogeneous. There is no evidence for any significant restriction of diffusion. There is associated diffuse pachymeningeal enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No diffusion weighted abnormalities are appreciated.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.The patient is status post a drainage tube placement which courses through the left cerebellar hemisphere into the lateral aspect of the fourth ventricle and left foramen of Luschka. It appears be in stable position compared to prior CT exam. There is a focus of enhancing tissue at the anterior tip of the ventriculostomy tube adjacent to the 4th ventricle - along its left posterior inferior aspect - and adjacent to the left foramen of Luschka within the cerebellum. There is associated T2/FLAIR signal hyperintensity which is unchanged since the prior exam but larger than on 8/28/14. On August it measured 8mm whereas now it measures 12mm.MRA brain:Antegrade flow is present in the distal left internal carotid artery, the distal vertebral arteries, the basilar artery and the proximal left middle and bilateral posterior cerebral arteries. Artifact from aneurysm clips in the right middle cerebral artery region obscures visualization of the distal right internal carotid artery and the right middle cerebral artery as well as the right anterior cerebral artery and the anterior communicating artery region.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is obscured by artifact. There is fetal origin of the left posterior cerebral artery. The right posterior communicating artery is obscured by artifact. The vertebral arteries are similar in size.

Output: 1.There are bilateral subdural collections present which also been identified in the recent CT of the head and are associated with mass effect and compression of the underlying brain.2.There is a small lesion present at the tip of the ventriculostomy tube adjacent to the 4th ventricle and left foramen of Luschka in the left cerebellar hemisphere. This is not obviously changed since the prior exam from 12/30/14 (a non contrast exam) but larger than on the August exam. The possibility of progression cannot be excluded. DDX includes metastasis and radiation change/necrosis.3.There is diffuse pachymeningeal enhancement present which is non-specific. Possibilities include that this could be a reaction to prior surgery or the subdural hematomas. 4.Artifact from aneurysm clip significantly diminishes visualization of intracranial vasculature. No obvious aneurysms in the visualized vasculature are appreciated.5.Findings were discussed with Dr Awad.


Instruction: Generate impression based on findings.

Input: Assess for right L5 radiculopathy. Pain in the right lower extremity Five lumbar type vertebral bodies are presumed to be present. Again seen are postsurgical changes of posterior spinal fusion with hardware extending from the L2 to the S1 levels bilaterally. Paraspinous rods and pedicle screws as well as interconnecting rod at the L3 level are better assessed on prior CT and plain films. Right sacroiliac fusion hardware is also partially visualized.Vertebral body heights are within normal limits. Anterolisthesis of L4 on L5 is again seen as well as minimal anterolisthesis of L3 on L4. Bone marrow signal is benign. The conus medullaris is normal in position.Susceptibility artifact limits evaluation however no high-grade spinal canal or neural foraminal stenosis is appreciated at any level. Nerve roots of the cauda equina appear grossly unremarkable without imaging findings to suggest arachnoiditis.Atrophy of the right psoas muscles again noted.

Output: Postoperative changes of L2-S1 posterior spinal fusion as well as right sacroiliac fusion. Associated susceptibility artifact limits evaluation, however, no high-grade spinal canal or neural foraminal stenosis is appreciated at any level in the lumbar spine. Specifically, no appreciable neural foraminal narrowing at the right L5-S1 level is appreciated. Hardware integrity and position can be better assessed with CT or radiographs.


Instruction: Generate impression based on findings.

Input: Epilepsy status post ablation. Surveillance of ablated area. There has been expected interval evolution of laser ablation effects in the right parietal lobe with mild patchy T2 hyperintensity, enhancement, and susceptibility effect in the ablation zone. There are also postoperative findings related to partial right temporal lobe lobectomy with confluent T2 hyperintensity along the surgical margins. There is no evidence of intracranial hemorrhage or acute territorial cerebral infarction. The ventricles and basal cisterns are normal in size and configuration. There are subcentimeter left choroid plexus xanthogranulomas. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. Expected interval evolution of laser ablation effects in the right parietal lobe.2. Stable postoperative findings related to partial right temporal lobe lobectomy with probable gliosis along the surgical margins.


Instruction: Generate impression based on findings.

Input: Multiple myeloma and soft tissue involvement of the neck status post radiation therapy to the neck, now with recurrent neck pain and systemic relapse Redemonstrated is exaggerated kyphotic angulation of cervical spine as well as diffuse heterogeneous marrow signal intensity. As before, there is stable mild compression of the C5 vertebral body containing marrow edema and enhancement, although the degree of marrow edema has decreased compared to prior consistent with increasing sclerosis identified on previous x-ray. There are no new compression deformities of the cervical spine. Compression deformity of T5, T6, and T7 are again noted, unchanged in appearance, with evidence of previous vertebroplasty involving T7, stable. There is no new evident epidural soft tissue component. Moderate central and bilateral neural foraminal stenosis at C4/5 and C5/6 is again noted. The cord remains normal in signal.

Output: 1.Stable mild compression of the C5 vertebral body containing marrow edema and enhancement, although the degree of marrow edema has decreased compared to prior consistent with increasing sclerosis identified on previous x-ray. 2.There are no new compression deformities. 3.Compression deformities of the upper thoracic spine are stable in appearance.4.There is no new evident epidural soft tissue component.


Instruction: Generate impression based on findings.

Input: Numbness in right shin/knee and top of foot. History of spondylolysis. Five lumbar type vertebral bodies are present. Chronic pars defect at left L4 again noted, better seen on prior CT. 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 lower L1 level.There appears to be mild congenital narrowing of the mid to lower lumbar spine. Superimposed degenerative changes are seen, as described below:L1-L2: No significant disc disease. No significant spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No significant spinal canal or neural foraminal stenosis.L3-L4: There is disc dessication with dorsal annular fissure, and disc protrusion. There is moderate spinal canal stenosis including effacement of the bilateral lateral recesses. Minimal bilateral neural foraminal stenosis. Findings are new since 11/9/2007.L4-L5: Disc dessication and bulge, which are new since 11/9/2007. Mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Disk protrusion at L3-4 with associated moderate spinal canal stenosis including effacement of the bilateral lateral recesses. Finding is new since prior MRI.2. Mild foramina narrowing at L3-L4 and L4-L5 as described above. No high grade neural foraminal stenosis.3. Chronic left L4 pars defect as seen on prior CT. No spondylolisthesis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate lumbar stenosis or lumbar disc disease. Signs and symptoms: RLE radiculopathy and hip pain. Nonenhanced lumbar MRI:Lower most visualized thoracic spine from T10 inferiorly demonstrate no spinal stenosis and with normal signal intensity of the cord.T12-L1 demonstrate mild degenerative changes and unremarkable otherwise. No significant change since prior exam.L1-L2 demonstrate moderate disc disease, subtle loss of disc height, shallow broad-based bulging disc and mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise. No significant change since prior exam.L2-L3 demonstrate mild degenerative changes and unremarkable otherwise and no significant change since prior study.L3-L4 demonstrate moderate disc disease and loss of disc height, significant bilateral ligamentum flavum hypertrophy and moderate bilateral facet hypertrophic changes (left greater than right). There is also mild grade 1 anterolisthesis at this level. Findings results in central spinal stenosis. The AP diameter of thecal sac at this level measures 8 mm compared to prior study measurement of 8.2 mm. There is moderate to severe left and mild to moderate right neural foraminal compromise. There is no significant change since prior exam.L4-L5 demonstrate moderate disc disease and loss of disc height, significant bilateral facet and left ligamentum flavum hypertrophy changes are present. There is evidence of a prior right-sided laminectomy at this level. There is resultant interval alleviation of central spinal stenosis at this level. There is a right lateral and far lateral broad-based disc protrusion with resultant significant right neural foraminal and right lateral recess compromise which is new since prior exam. Left neural foramina remains patent.L5-S1 demonstrate advanced disc disease and loss of disc height with interval progression since prior exam. Moderate bilateral facet hypertrophic changes and mild ligamentum flavum hypertrophy. No central spinal stenosis however moderate-to-severe right and mild to moderate left neural foraminal compromise is noted.

Output: 1.Interval right-sided laminectomy at L4-L5 and resolution of previously noted central spinal stenosis. Right lateral and far lateral disc protrusion with resultant significant right neural foraminal and right lateral recess compromise is a new finding since prior exam.2.Degenerative changes at L3-L4 and including mild grade 1 anterolisthesis results in central spinal stenosis without significant change since prior exam.3.Please review above detailed report per level.


Instruction: Generate impression based on findings.

Input: 45-year-old woman with chronic left shoulder pain following an injury in January 2010. She has undergone numerous orthopedic surgeries at outside hospitals. Multiple foci of signal void within the shoulder represent metallic susceptibility artifact related to prior orthopedic surgery. Tubular foci of intermediate to low signal intensity in the humeral head presumably represent suture anchor tracks. ROTATOR CUFF: Evaluation of the rotator cuff is limited due to the lack of fat-suppressed fluid-sensitive sequences. There is moderate to severe fatty atrophy of the supraspinatus muscle. We see no fluid signal intensity traversing the supraspinatus tendon to confirm a full thickness tear. However, there is intermediate signal intensity within the distal 2 cm of the tendon, which could either represent tendinosis or granulation tissue. There is moderate to severe fatty atrophy of the infraspinatus. We see no fluid signal intensity traversing the infraspinatus tendon to confirm a full thickness tear. There is intermediate signal intensity within the distal fibers of the tendon which could represent tendinosis or granulation tissue. The teres minor muscle and tendon appear intact. There is moderate fatty atrophy of the superior portion of the subscapularis muscle with mild thickening and increased signal of the tendon distally suggesting tendinosis but we see no discrete tear. SUPRASPINATUS OUTLET: Mild deformity of the acromion process presumably represents previous surgery. There is mild hypertrophy of the capsular structures of the acromioclavicular joint. We see no frank fluid in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. We see no joint effusion. The inferior joint capsule subjectively appears slightly thickened. Increased signal within the superior labrum suggests degeneration/degenerative tearing. BICEPS TENDON: The extraarticular portion of the tendon of the long head of the biceps appears intact. The intraarticular portion is not well visualized due to lack of fat-suppressed sequences.  ADDITIONAL

Output: 1.Limited evaluation of the right shoulder as described above. The patient was contacted on the day of the examination and was asked to return, but was unable to do so. She will reschedule for a repeat study at a later date. 2.Surgical changes as described above.3.Rotator cuff muscle atrophy as described above. Although we see no fluid-filled rotator cuff tear, intermediate signal intensity within the cuff suggests tendinosis and/or granulation tissue. 4.Osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: 46 years, Female, dull right-sided headaches for the past several months There are two right-sided ventriculostomy catheters, one of which terminates near the foramen of Monro on the left and the other which courses through the lateral ventricles and terminates near the left thalamus. The bilateral lateral ventricles are dilated as is the third ventricle. There is mild nonspecific FLAIR hyperintensity surrounding the ventricles. Note no prior studies are available for comparison.No intracranial mass or mass effect. There is susceptibility artifact related to the ventricular shunts which limits evaluation of the parenchyma. There is however no obvious evidence of ischemia or intraparenchymal hemorrhage. There is gliosis along the course of the ventriculostomy catheters. There is an extra axial collection along the posterior left cerebral convexity deep to craniotomy at this level. No significant associated mass effect. There is severe diffuse thinning involving the corpus callosum. No findings to suggest intracranial mass, midline shift, or herniation.Paranasal sinuses and mastoid air cells are clear. Orbits are grossly unremarkable. Extracranial soft tissues are grossly unremarkable.

Output: 1. There is dilatation involving the bilateral lateral ventricles and third ventricles with two right-sided ventriculostomy catheters as described above. Would suggest obtaining prior studies for comparison. No evidence of infarct, hemorrhage, or intracranial mass. 2. Diffuse thinning of the corpus callosum which may be secondary to chronic hydrocephalus.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:6/5/1961)Reason: Re-evaluate disease status following completion of immunotherapy, compare to last scans, per RECIST 1.1 History: Metastatic MelanomaPROVIDER/ATTENDING NAME: JASON J LUKE JASON J LUKE The patient status post right parietal craniotomy.There are numerous foci of the susceptibility effect scattered in both hemispheres of the brain and in the cerebellum without any significant contrast enhancement. Compared to the previous exam these do not appear to have changed one in the left parietal lobe currently measures 5 mm and previously measured the same.The patient is status post right-sided parietal craniotomy. There is encephalomalacia present along the right inferior parietal lobule extending to the right temporal lobe associated with susceptibility effect.There is redemonstration of diffuse periventricular and subcortical white matter confluent signal changes which were also present on the previous exams to a similar extent.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.There are multiple hemorrhagic type lesions scattered throughout the brain which appear relatively stable compared to the exam from August. The patient is known to have metastatic melanoma to the brain.2.Extensive and diffuse white matter signal changes have been present on prior exams and are most likely treatment related.


Instruction: Generate impression based on findings.

Input: 30-year-old female patient with medial joint line tenderness and mechanical symptoms. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There are no focal cartilage defects.LIGAMENTS: The anterior cruciate ligament, posterior cruciate alignment, medial collateral ligament, lateral collateral abdomen complex, and patellar retinacula are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: No significant abnormalities or findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: 21-year-old female with pain status post new injury, history of ACL graft MENISCI: There is branching signal abnormality within the posterior horn of the medial meniscus extending to the body indicating a complex tear, consisting predominantly of a long complete longitudinal tear seen on multiple sequential images. The anterior horn of the medial meniscus is intact. There are also thin linear foci of intermediate signal intensity within the posterior horn of the lateral meniscus at its root suggesting additional longitudinal tears which were not clearly evident on the prior exam. The anterior horn and body of the lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild edema within the posterior aspect of the lateral tibial plateau as well as the anterior lateral femoral condyle indicating bone contusions. No fluid-filled defects are present in the articular cartilage.LIGAMENTS: Since the prior exam, there has been interval ACL reconstruction. However, the intra-articular graft is indistinct, indicating disruption. There is buckling of the PCL which otherwise appears intact. The MCL is intact. There is mild edema along the distal IT band and lateral collateral ligament, however the lateral collateral ligament complex is intact. A small amount of edema extends inferiorly along the fascia superior to the anterior compartment musculature.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Postoperative changes of ACL reconstruction with rupture of the ACL graft.2.Complex, predominantly longitudinal tear of the posterior horn of the medial meniscal body.3.Possible smaller longitudinal tears of the lateral meniscus posterior horn near its root.


Instruction: Generate impression based on findings.

Input: Reason: choledocholithiasis History: RUQ pain ABDOMEN:LUNG BASES: Trace left and minimal right pleural effusions are present.LIVER, BILIARY TRACT: Cirrhotic liver morphology. There is marked extrahepatic and mild intrahepatic biliary ductal dilatation, with common duct measuring up to 1.6 cm. Round filling defect in the distal common bile duct measures 1.8 x 1.0 cm suggests choledocholithiasis (best seen on series 701, image 19). Findings of adenomyomatosis in the gallbladder are redemonstrated.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. Otherwise no suspicious focal renal lesion on limited imaging.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Choledocholithiasis. Common duct stone measures up to 1.8 cm. 2.Intra- and extrahepatic biliary ductal dilatation, as above.3.Cirrhotic liver morphology.


Instruction: Generate impression based on findings.

Input: Memory problems over 5 years. The hippocampi appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity, which is nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: The hippocampi appear unremarkable.


Instruction: Generate impression based on findings.

Input: Clinical question: History of cervical thoracic syrinx. Evaluate resolution post shunting. Signs and symptoms: Spasticity, LE weakness. Nonenhanced several MRI:Examination redemonstrates syrinx the cervical cord extending from C1 through the entire cervical cord and into the thoracic cord. Compared to prior exam there is interval decreased caliber of syrinx without change in its extent.The syrinx measures 6.7 x 3.2-mm in transaxial dimensions at C3 -- C4 disk level compared to prior study measurements of 7.4 x 4.2-mm.At T7 the syrinx measures approximately 9.9 x 3.2-mm compared to prior study measurements of 12 x 4-mm.Moderate degenerative changes of disk mild hypertrophic changes of the posterior elements demonstrate no significant change. There is no evidence of central spinal stenosis at any level.Nonenhanced thoracic MRI:Similar to MRI of cervical spine there is interval decreased size of syrinx of thoracic cord however without change in its extent.The syrinx extends inferiorly to approximately T11 similar to prior study. It measures 8mm in transverse axis at T4 level compared to prior study measurement of 9mm.Suboptimal quality of the axial images makes precise measurement inferiorly more difficult.There is no evidence of spinal stenosis at any level. The alignment of the vertebral column remains within normal and there is no evidence of central spinal stenosis.Nonenhanced lumbar MRI:Examination demonstrates normal anatomical alignment of vertebral column. There is however mild exaggeration of lumbar lordosis.There is no evidence of spinal stenosis at any level. There is termination of the cord at L1 level. The signal intensity and caliber of conus or is within normal. There is no detectable signal abnormality of the cauda equina however axial T1-weighted images were not acquired this study. There are also no prior MRI at lumbar spine for comparison.T12 -- L1 demonstrate moderate disk disease and loss of disk height without spinal stenosis or neural foramina compromise.L1 -- L2 demonstrate mild disk disease and mild bilateral facet and ligamenta flava hypertrophy. No spinal stenosis or neural foramina compromiseL2 -- L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk desiccation and mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophy. No spinal stenosis or neural foraminal compromise.L5 -- S1 demonstrate moderate disk disease and loss of disk height, moderate bilateral facet hypertrophic changes and mild to moderate ligamentum flavum hypertrophy. There is shallow diffuse disk bulge present at this level with resultant subtle indentation of the thecal sac.No central spinal stenosis however moderate to severe bilateral neural foraminal compromise is present at this level.

Output: 1.Nonenhanced MRI of the cervical spine demonstrate interval decreased size of syrinx of cervical cord as detailed/measured above.2.Nonenhanced MRI of the thoracic spine also demonstrate mild interval decreased size of syrinx.3.There is no change in the length of syrinx which extends from C1 to approximate the T11 level.4.There is no evidence of spinal stenosis in the cervical or thoracic spine.5.MRI of lumber spine demonstrate no detectable cauda equina abnormality, no spinal stenosis, moderate to severe bilateral neural foraminal compromise at L5 -- S1 and patent at all other levels.


Instruction: Generate impression based on findings.

Input: Absent sensation below nipple, rule out cord compression The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal canal in the cervical, thoracic, or lumbar spine. No epidural collections are not demonstrated.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No spinal canal stenosis or cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out bleed. Signs and symptoms: Fall. Unenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter that initiation is well preserved.There is higher density of left supraclinoid internal carotid artery compared to the right lower compared to any of the other visualized intracranial large vessels. Recommend follow-up with an MRI to entirely exclude possibility of thrombus. The calvarium is intact. There is no detectable abnormality of the soft tissues of the scalp. Limited real paranasal sinuses and mastoid air cells are unremarkable.Above findings were discussed with the physician in the emergency room at the time of interpretation on the phone number 45968.

Output: Negative head CT.


Instruction: Generate impression based on findings.

Input: Increased left-sided DTRs. CT of brain without enhancement:No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system and all CSF cisterns remain within normal limits for patient's stated age of 77. The gray -- white matter differentiation is well preserved.Calvarium is intact.MRI is recommended if concern for stroke persists.Near complete opacification of right maxillary sinus consistent with chronic sinusitis. The rest of visualized paranasal sinuses are unremarkable.

Output: 1.Negative CT examination of brain. 2.Extensive chronic right maxillary sinus disease.


Instruction: Generate impression based on findings.

Input: Cervicalgia, numbness in C5 region, nerve impingement? Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is reversal of cervical lordosis centered at the C5-C6 level. There is mild anterolisthesis at C5-C6. Bone marrow signal is benign without suspicious osseous lesions evident. There is mild to moderate degree of multilevel facet arthropathy, relatively worse at the left C3-C4 and C4-C5 levels.There is mild deformity of the cervical cord contour related to above-mentioned alignment and prominent disc osteophyte complex at C5-C6. No cord signal abnormality. Additional details about degenerative changes as described below although note neural foraminal stenosis is difficult to accurately assess: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or right neural foramen. There is mild to moderate degree of left-sided neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy.C4-5: There appears to be moderate left-sided and to a slightly lesser degree right neural foraminal stenosis. There is effacement of the ventral thecal sac without significant spinal canal stenosis overall at this level.C5-6: There is a disc osteophyte complex with moderate associated spinal canal stenosis without cord signal abnormality. There appears to be moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy. C6-7: Small disc osteophyte complex and ligamentum flavum thickening with mild spinal canal stenosis. There also appears to be moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy.C7-T1: Mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy. No significant spinal canal stenosis.Paraspinous soft tissue structures appear grossly within normal limits.

Output: Multilevel degenerative changes in the cervical spine with up to moderate spinal canal stenosis at the C5-C6 level. No cord signal abnormality. There is multilevel neural foraminal stenoses with suspected impingement of the exiting nerve roots but not accurately assessed due to the motion degradation. Patient had difficulty tolerating the study as described in the technique section.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. There is an enhancing extra-axial parasagittal right frontal convexity lesion that measures 6 x 8 mm in cross-section, without mass effect upon the underlying brain. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A small extra-axial right frontal convexity lesion likely represents a meningioma versus less likely a metastasis. Otherwise, there is no evidence of intraparenchymal metastases.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with left-sided sciatica. Spinal alignment is grossly anatomic. Marrow signal intensity is heterogeneous but without suspicious marrow replacement. Mild edema of the L1-2 disc and endplates is seen, likely degenerative in nature. Elsewhere, no significant marrow edema is detected.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormality is suspected.With the exception of the L2-3 intervertebral discs, all of the lumbar discs demonstrate loss of height. T1 and T2 hyperintense signal within the L3-4 and L4-5 disc spaces is likely related to disc degeneration or disc mineralization. Additional level specific findings are as follows:L1-2: Moderate facet arthropathy and ligamentum flavum thickening. Mild disc bulging. Mild generalized spinal canal narrowing without obvious nerve root impingement. The neural foramina are mildly narrowed. L2-3: Moderate facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L3-4: Moderate facet hypertrophy. No significant spinal canal or foraminal stenosis. L4-5: Advanced facet arthropathy which is particularly bulky on the left causing effacement of the left lateral recess and a moderately severe left foraminal narrowing. The right neural foramen is mildly narrowed. The spinal canal itself is mildly narrowed. L5-S1: Advanced facet arthropathy. Minimal disc bulging with a central annular fissure. The neural foramina are mildly narrowed. No significant spinal canal narrowing is seen.

Output: 1.Multilevel disc degeneration but without evidence of any high-grade spinal canal stenosis.2.Facet arthropathy which becomes progressively worse at lower lumbar levels. At L4-5 on the left, this results in a significant narrowing of the neural foramen.


Instruction: Generate impression based on findings.

Input: Ms. Mills is a 55-year-old woman, part of the Alan Penn research protocol, presenting for an MR-directed ultrasound of the right breast. Upon physical exam at the MR directed area of concern, no discrete abnormality is palpated.A targeted right ultrasound was performed at the area of concern detected on the MRI in the lower outer quadrant. In the right breast 8:00 position, approximately 7 cm from nipple, there is a 0.7 x 0.7 x 0.8 cm reniform shaped mass with hilar vascular flow, consistent with a lymph node. This correlates with the finding on MRI. No abnormal sonographic findings are seen.

Output: Benign intramammary lymph node correlating with the MRI-detected mass in the right breast. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 17 years, Male, boy with NF1 and very frequent headaches and neck pain. Kyphosis and low back pain. History of renal artery stenosis, evidence of moyamoya? MRI BRAIN: There is a nonspecific focus of T2/FLAIR hyperintensity involving the left dorsal medulla. Additional foci of T2/FLAIR hyperintensity are seen involving the bilateral cerebellar hemispheres and the right thalamus. Prior outside study from 5/21/2013 is motion degraded however the right thalamic, the right cerebellar, and left dorsal medullary foci were present previously. Apparent foci of T2/FLAIR hyperintensity involving the brainstem including the cerebral peduncles and left periaqueductal region are less conspicuous compared to prior study and at least in part artifactual. No discrete intracranial mass or mass effect is evident. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No midline shift or herniation. The ventricles are within normal limits in size and configuration. Dedicated orbital sequences were not obtained however there is mild diffuse enlargement of the left optic nerve and similar to prior. Paranasal sinuses and mastoid air cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable.MRA BRAIN: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. No findings to suggest moyamoya.CERVICAL SPINE: Lack of contrast limits evaluation for small lesions. Vertebral body heights in the cervical spine are normal. There is scalloping involving the left dorsal aspect of the C7 vertebral body related to dural ectasia. There is loss of cervical lordosis and levoscoliosis of the cervical spine centered at the C6-C7 level, which may be in part positional. Bone marrow signal is benign.There is mild congenital narrowing of the cervical spinal canal. No evidence of cord signal abnormality or intramedullary mass. No discrete mass or enlargement of the cervical neural foramina is appreciated. There is no spinal canal or neural foraminal stenosis.THORACIC SPINE: There is dorsal scalloping involving multiple upper thoracic vertebrae related to dural ectasia. There is mildly exaggerated thoracic kyphosis. Alignment of the thoracic spine is otherwise maintained. Vertebral body heights are normal with small multilevel Schmorl's nodes noted. Bone marrow signal is benign.No abnormal signal is seen involving the thoracic cord or evidence of intramedullary mass. There is outpouching involving multiple left upper thoracic neural foramina with CSF attenuation compatible with lateral thoracic meningoceles and measuring up to 2 cm in diameter. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.Left kidney is noted to be atrophic with suggestion of compensatory enlargement of the right kidney. There is a trace right pleural effusion.

Output: 1. MRI brain demonstrates scattered supra- and infratentorial foci of T2/FLAIR hyperintensity compatible with foci of abnormal signal intensity related to known NF1; many of these are also evident on prior brain MRI with slight differences in technique limiting comparison. No discrete mass or intracranial mass effect is appreciated.2. Dedicated orbital sequences were not obtained however there is suggestion of mild, diffuse enlargement of the left optic nerve, grossly similar to prior, but suspicious for an optic nerve glioma. Consider dedicated orbital MRI for better assessment.3. MRA head demonstrates no significant stenosis in the intracranial vasculature. No evidence of moyamoya.4. MRI of the cervical and thoracic spine demonstrate stigmata of NF 1 including dural ectasia, particularly in the upper thoracic spine, and multiple left upper thoracic lateral meningoceles measuring up to 2 cm in diameter. No discrete intraspinal, neural foraminal, or paraspinous mass is evident within the limits of noncontrast study. 5. There is suggestion of cervical levoscoliosis with apex at the C6-C7 level which can be correlated with upright radiographs. There is slightly exaggerated thoracic kyphosis which is also evident on prior radiographs from 2014.


Instruction: Generate impression based on findings.

Input: Neck pain and headaches. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is intact cerebrospinal fluid flow across the foramen magnum. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the maxillary and ethmoid sinuses.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of Chiari malformation or cervical syringohydromyelia.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Four month-old female presents with infantile spasms. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There may mild thinning of the posterior corpus callosum, measuring 2 mm in thickness, but otherwise the degree of myelination appears to be appropriate. The brain parenchyma and pituitary gland appear unremarkable. There are prominent subarachnoid spaces in the bilateral anterior cerebral convexities. The ventricles and basal cisterns are normal in size and configuration. However, there is a persistent cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of hypoxic ischemic encephalopathy. 2. Prominent subarachnoid spaces in the bilateral anterior cerebral convexities.3. Perhaps mild thinning of the posterior corpus callosum, but otherwise the degree of myelination appears to be appropriate.


Instruction: Generate impression based on findings.

Input: Female; 65 years old. Reason: ovarian ca re-staging History: edema ABDOMEN:LUNG BASES: Trace right pleural effusion with mild underlying right basilar atelectasis, similar to prior exam.LIVER, BILIARY TRACT: Paradoxical loss of signal diffusely of the liver on in-and-out of phase images, suggestive of iron deposition. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal simple cyst.RETROPERITONEUM, LYMPH NODES: Index left common iliac lymph node is unchanged and measures 6 mm in diameter (series 16/4).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Body wall anasarca, similar to prior exam.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Index right external iliac lymph node is unchanged and measures 4 mm in diameter (series 16/22).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Body wall anasarca, similar to prior exam.OTHER: No significant abnormality noted.

Output: No significant change from prior study. Stable index lesions with no new sites of disease.


Instruction: Generate impression based on findings.

Input: Ms. Toporski is a 59-year-old female with biopsy-proven malignancy of the left breast. She presents today for MR imaging for further evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left lower outer breast, there is an enhancing spiculated mass identified measuring 0.8 x 0.8 x 0.6 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is located immediately inferior to this mass, compatible with biopsy-proven malignancy. There is no additional abnormal enhancement identified in the left breast.Few scattered enhancing foci are identified in the right breast, one of which contains internal fat, and likely represents a benign intramammary lymph node. Although none of the additional foci are particularly suspicious in appearance, they are asymmetric in quantity when compared to the left side (right > left). No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Unifocal malignancy of the left breast. Biopsy marker clip is located immediately inferior to this mass, and can be used for preoperative surgical guidance if breast conservation therapy is desired.(2) Scattered foci of enhancement seen in the right breast, for which a short term 6 month follow-up MRI is recommended in order to confirm stability of these findings.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 40 year old female with personal history of BRCA2 mutation and strong family history of breast cancer including her mother (diagnosed at the age of 44) and maternal grandmother (diagnosed at the age of 63). No contrast is seen in the dynamic series.

Output: Non-diagnostic study. Repeat MRI should be performed.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views.


Instruction: Generate impression based on findings.

Input: There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Partially imaged is the patient's known large goiter with rightward deviation of the trachea (please see previous neck CT for complete characterization). The remaining visualized paraspinal contents are unremarkable.Disc desiccation with significant disc height loss is present throughout. Primarily Modic type I discogenic reactive endplate change is evident at C4/5.C1/2: Severe facet degeneration (right much greater than left) narrows bilateral neural foramina, moderate on the left and severe on the right.C2/3: Mild posterior osteophyte disc complex as well as mild right facet hypertrophy. There are no significant stenoses.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and mild bilateral facet hypertrophy. There is mild to moderate bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is moderate central and severe bilateral neural foraminal stenosis.C5/6: There is partial vertebral body fusion as well as left facet fusion. Left uncinate hypertrophy and mild left facet hypertrophy cause mild left neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, ligamentum flavum thickening, and left uncinate hypertrophy. There is mild central and mild left neural foraminal stenosis.C7/T1: Trace anterolisthesis C7 on T1, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild left neural foraminal stenosis.Facet disease at T1/2 and T2/3 encroach the neural foramina.

Output: 1.C1/2: Severe facet degeneration (right much greater than left) narrows bilateral neural foramina, moderate on the left and severe on the right.2.C3/4: Mild to moderate bilateral neural foraminal stenosis.3.C4/5: Moderate central and severe bilateral neural foraminal stenosis.4.C5/6: Mild left neural foraminal stenosis.5.C6/7: Mild central and mild left neural foraminal stenosis.6.C7/T1: Mild left neural foraminal stenosis.7.Facet disease at T1/2 and T2/3 encroach the neural foramina. If the patient has symptoms referable to the thoracic spine, a thoracic spine MRI could be acquired if deemed clinically beneficial.


Instruction: Generate impression based on findings.

Input: 50 years, Female, slurred speech. Examination is mildly motion degraded. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but may represent mild chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Minimal scattered paranasal sinus opacification. Diffuse calvarial thickening is noted which may relate to chronic renal disease.

Output: 1. No evidence of acute infarct, hemorrhage, or mass effect.2. Scattered nonspecific foci of white matter signal abnormality which may relate to mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Headaches, nausea and vomiting Subtle periventricular and subcortical foci of increased signal intensity in bilateral cerebral hemispheres are noted. These findings are no noticeable than prior CT from 6 -- 30 -- 2007. This discrepancy may be due to technique. Similar findings were noted on prior MRI examinations and were believed to represent press. Cortical sulci, ventricular system and all CSF cisterns are otherwise within normal limits and stable since prior study. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus.

Output: Subtle subcortical areas of low-attenuation as detailed above which may represent sequela of prior press.


Instruction: Generate impression based on findings.

Input: 53-year-old male with left shoulder pain and limited abduction for 12 to 18 months. ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. No full-thickness rotator cuff tear is evident. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant fluid is identified within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity of the superior labrum indicating degeneration. No fluid-filled tear is evident within the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is intermediate signal intensity within the intra-articular portion of the long head of the biceps tendon indicating a very mild tendinosis. Circumferential fluid within the tendon sheath of the long head of the biceps may represent fluid extension from the joint. ADDITIONAL

Output: Rotator cuff tendinosis without evidence of full-thickness rotator cuff tear. Osteoarthritis of the left shoulder and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 19 years old, with spina bifida, status post spinal cord untethering, with syrinx, presenting with urinary changes and back pain. Redemonstrated is evidence of spinal cord untethering. The lower thecal sac remains ectatic. As before, the distal spinal cord abuts and may be adherent to the posterior thecal sac. The location of the conus tip is difficult to assess but probably occurs at the lumbosacral junction. No evidence of spinal cord ventral motion is seen on prone imaging. The previously demonstrated spinal cord syrinx shows no significant interval change. As before, it begins at T12 or L1 and continues down to the L4 level. The maximum caliber of the syrinx remains 4 x 3 mm.The typical lordotic curvature of the lumbar spine is straightened but alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No marrow signal abnormalities are detected. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen.

Output: 1.Evidence of prior spinal cord untethering is seen. The cord remains closely apposed and possibly adherent to the posterior thecal sac. No evidence of cord motion is seen on prone imaging.2.The previously demonstrated distal spinal cord syrinx has not significantly changed in maximum caliber or craniocaudal extent.3.No other significant spinal abnormality is seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Knee pain following fall, multiple prior knee surgeries. MENISCI: The lateral meniscus is intact. There is blunting and abnormal morphology of the posterior horn of the lateral meniscus however there is no discrete extension of signal to the articular surfaces to suggest an acute tear. These changes may relate to prior meniscectomy however in the absence of priors meniscal repair, these findings may represent a small tear.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the lateral, medial, and patellofemoral compartments is intact.LIGAMENTS: There is prior ACL reconstruction. The ACL graft is intact. The remaining cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Prior ACL reconstruction with intact ACL graft.2. Abnormal morphology of the posterior horn of the lateral meniscus concerning for tear however correlation with prior surgical history and imaging is recommended.


Instruction: Generate impression based on findings.

Input: There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Mild left facet hypertrophy without stenosis, unchanged.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and mild left facet hypertrophy. There is moderate left neural foraminal and mild right neural foraminal stenosis. These findings are unchanged.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, slight ligamentum flavum thickening, and mild right facet hypertrophy. There is mild central and mild bilateral neural foraminal stenosis. These findings are unchanged.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and slight ligamentum flavum thickening. There is mild central and moderate bilateral neural foraminal stenosis. These findings are unchanged.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate bilateral neural foraminal stenosis. These findings are unchanged.C7/T1: Unremarkable and unchanged

Output: 1.C3/4: Moderate left neural foraminal and mild right neural foraminal stenosis, unchanged.2.C4/5: Mild central and mild bilateral neural foraminal stenosis, unchanged.3.C5/6: Mild central and moderate bilateral neural foraminal stenosis, unchanged.4.C6/7: Moderate bilateral neural foraminal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: Severe neck pain. Examination is motion degraded as patient had difficulty tolerating the study. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild levocurvature of the cervical spine which may be positional. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.There is no significant disc disease, spinal canal, or neural foraminal stenosis at any level.There is a predominantly retropharyngeal and mild right prevertebral effusion. Amorphous calcifications inferior to the anterior arch of C1 are better seen on CT.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Retropharyngeal effusion with amorphous calcifications inferior to the anterior to the arch of C1, which are better seen on recent CTA. Findings are most consistent with acute calcific tendinitis of the longus colli muscle.2. No significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Left upper extremity weakness/triceps, finger extension. Suspect C6 -- C7 foramina stenosis. CT of the cervical spine without the infusion:3-mm axial images of the entire cervical spine were obtained. Sagittal and coronal reformatted images were obtained.Reformatted images demonstrate straightening of cervical lordosis. This finding may be positional. Mild degenerative disk disease and shallow ventral hypertrophic spurs are noted.Foramina magnum.Examination of this level is unremarkable.C2 -- C3.No central spinal stenosis or neural foramina compromise. C3 -- C4.Minimal degenerative changes which appears to be more pronounced on the left. There is minimal sclerotic changes of the left uncovertebral and articulating facet on the left (axial image 37). The left neural foramina appears slightly smaller than the right and is believed to be partially compromised.C4 -- C5.No central spinal stenosis or neural foramina compromise. Very minimal hypertrophic and sclerotic changes of the left uncovertebral on axial image 42. The left neural foramina appears minimally smaller than the right. This finding was also noted on prior MRI examination on axial T2 weighted image 15.C4 -- C5.Minimal degenerative changes. The left neural foramina appears minimally smaller than the right secondary to hypertrophic changes.C5 -- C6.Degenerative disk disease and hypertrophic changes of the posterior elements are noted. There is evidence of hypertrophic changes of bilateral uncovertebral with resultant compromise of bilateral neural foramina. This finding was also appreciated on axial T2-weighted image 23 of prior MRI of cervical spine. Large anteriorly located hypertrophic spurs at this level projects into the soft tissues of the prevertebral space. Reformatted images demonstrate a shallow ventral hypertrophic spur with minimal bulge of disk material. Review of prior MRI examination demonstrates no central spinal stenosis at this level.C6 -- C7.Mild degenerative disk disease and minimal hypertrophic changes of posterior elements. There is compromise of bilateral neural foramina secondary to above changes. This finding may be slightly more pronounced on the left. These findings were noted also on prior MRI examination cervical spine on axial T2-weighted image 27. No central spinal stenosis.C7 -- T1.Minimal asymmetrical hypertrophy changes on the left is suspected on axial image 57. This includes hypertrophied and minimally calcified ligamentum flavum on the left. Minimal compromise of the left neural foramina is suspected.

Output: 1.Degenerative changes of cervical spine with multilevel neural foramina compromise as detailed above.2.Prior MRI examination of cervical spine is also reviewed which shows similar findings as described above.


Instruction: Generate impression based on findings.

Input: 65-year-old male patient with possible right lower extremity radiculopathy. Evaluate for degenerative changes/lumbar stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are grossly preserved. Alignment is anatomic except for a grade I anterolisthesis of L4 on L5. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes, including multilevel disc dessication, are seen, as described below:L1-L2: No significant disc disease. There is mild bilateral neural foraminal stenosis. No spinal canal stenosis.L2-L3: Minimal disc bulge and ligamentum flavum hypertrophy. There is moderate left and mild to moderate right neural foraminal stenosis and mild facet hypertrophy. No spinal canal stenosis.L3-L4: There is a disc bulge, ligamentum flavum, and facet hypertrophy causing moderate to severe right and moderate left neural foraminal stenosis. No spinal canal stenosis.L4-L5: There is grade 1 anterolisthesis of L4 on L5 and disc uncovering. There is ligamentum flavum hypertrophy and advanced facet hypertrophy. There is moderate spinal canal stenosis. There is severe left and moderate to severe right neural foraminal stenosis. L5-S1: There is mild disc bulge without canal stenosis. There is bilateral ligamentum flavum and facet hypertrophy with mild right and moderate left neural foraminal stenosis. No spinal canal stenosis. A subcentimeter cystic structure posterior to the right L5/S1 facet joint likely represents a small synovial cyst.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes of the lumbar spine, worst at the L4/L5 level with moderate spinal canal stenosis. There is also moderate to severe multilevel neural foraminal narrowing as detailed above.2. Advanced facet arthropathy at L4-L5. There is grade 1 anterolisthesis of L4 on L5 which is likely on a degenerative basis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Occlusion and stenosis of basilar arteryClinical question: strokeSigns and Symptoms: stroke There is diffusion restriction present along the pons and lower midbrain neural predominantly the right lower midbrain. Small focus of diffusion restriction is present in the left cerebellar hemisphere inferiorly.The basilar artery flow-void is not readily identified.There is T2 and FLAIR signal hyperintensity present in the medulla.The visualized portions of the paranasal sinuses demonstrate mucosal thickening and air-fluid level status post intubation.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with acute cerebral infarction involving the pons and lower midbrain with a couple punctate foci of an following reduction in the left cerebellar hemisphere inferiorly. There is no evidence for acute intracranial hemorrhage.2.Please refer to yesterday's CT angiogram for status of cerebral vasculature.