Instruction: Generate impression based on findings.

Input: 38 years Female (DOB:11/27/1977)Reason: assess for structural lesions History: word-finding difficultiesPROVIDER/ATTENDING NAME: WILLARD W SHARP BETTY C SOLIVEN MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is larger than the right A1 segment. There is fetal origin of the right posterior cerebral artery with a medium sized right P1 segment. The left posterior communicating artery is not readily appreciated. The right vertebral artery is larger than the left vertebral artery. The right superficial temporal artery is asymmetrically larger than the left superficial temporal artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: 56-year-old woman with history of pancreatic mass. Additional history as per chart: 3/2016 CT abdomen with 4.4 mm hypodense lesion at the junction of the neck and body of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. A few subcentimeter hepatic cyst identified, otherwise no focal hepatic lesions seen.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is normal in size. The pancreatic parenchyma is normal without focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter bilateral renal cysts noted. Kidneys otherwise appear normal and enhance symmetrically. There is no hydronephrosis.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: No significant abnormality noted, specifically no pancreatic mass.


Instruction: Generate impression based on findings.

Input: History of Li Fraumeni Syndrome with liver lesions on PET. History of breast cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. There is loss of signal on the out of phase images consistent with fatty infiltration.There are several hepatic lesions. The largest in segment 6/7 measures 2.7 x 2.3 cm (series 11/20) and the inferior right hepatic lobe measuring 1.8 x 1.6 cm (series 11 image 32) with similar imaging characteristics, specifically homogeneous macroscopic fat content without enhancing components compatible with lipomas or angiomyolipomas.There are several additional arterial homogeneously enhancing foci most of which are subcentimeter. The largest in the inferior right hepatic lobe measures 1.5 x 1.6 cm (series 13/72), which is mildly hyperintense on T2-weighted sequences. This larger lesion demonstrates mild restricted diffusion. There is no washout on portal venous or delayed imaging, restricted diffusion of the remaining lesions, rim enhancement or other suspicious imaging characteristics.There is a right hepatic lobe segment 7 peripheral/subcapsular wedge-shaped region of post-contrast enhancement, compatible with a THID (Transient Hepatic Intensity Difference).No vascular abnormality. Status post cholecystectomy.SPLEEN: Normal splenic morphology and size without a focal lesion.PANCREAS: Normal pancreatic morphology and signal intensity without a discrete lesion. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. Left ovarian physiologic cysts.BLADDER: No significant abnormality noted.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. Several arterial homogeneously enhancing foci most of which are subcentimeter, including an indeterminant 1.6 cm right inferior hepatic lobe lesion demonstrating mild T2-weighted hyperintensity, enhancement and restricted diffusion. The remaining lesions demonstrates no apparent washout, restricted diffusion, rim enhancement or other suspicious imaging characteristics. We recommend that the patient returns for a 45 minute to 2 hour delayed imaging sequence following hepatobiliary agent administration to evaluate whether this lesion is an FNH or possible metastatic lesion. The patient will be called back by the radiology department at no cost to the patient for this additional imaging.2. 2.7 and 1.8 cm hepatic lipomas. 3. Steatosis.


Instruction: Generate impression based on findings.

Input: 25 year-old woman with bilateral basal ganglia hypodensity. Evaluate question of increased swelling. Portable head CT. Examination of the brain stem and posterior fossa structures is limited due to artifact.The basal ganglia, surrounding subcortical white matter, and internal capsule exhibit marked hypoattenuation bilaterally consistent with edema. Accounting for differences in technique, these findings appear to be stable from the MRI dated 8/14/2008. On the current study, there are two focal areas of hyperattenuation in the region of the right internal capsule which are consistent with punctate hemorrhage. On the prior MRI, there are no corresponding findings in this region, suggesting interval change.There is effacement of the cortical sulci suggestive of cerebral edema. Gray-white differentiation is preserved. The right basal ganglia exert mass effect upon the right lateral ventricle causing partial effacement. There are no findings of obstructive hydrocephalus.The calvaria and skull base are radiographically normal. Mucosal thickening is present in the sphenoid sinus and ethmoid air cells. There is partial opacification of the mastoid air cells bilaterally.An endotracheal tube is present. A nasogastric tube enters through the left naris.

Output: 1. Bilateral hypoattenuation of the basal ganglia and surrounding white matter consistent with edema. Accounting for differences in technique, this finding appears roughly stable from the prior MRI.2. Focal areas of hyperattenuation in region of right internal capsule consistent with punctate hemorrhage.3. Effacement of cortical sulci consistent with cerebral edema.4. Limited evaluation of brainstem and posterior fossa.


Instruction: Generate impression based on findings.

Input: BRAIN: There is interval decrease in size of the infiltrative enhancing mass centered within the nasopharynx and skull base. The tumor is ill-defined and measures approximately 4 cm, previously approximately 7 cm. There is also nonspecific confluent enhancement extending laterally into the bilateral masticator spaces and pterygopalatine fossae. In addition, there is diffuse enhancement within the clivus and sinonasal walls. There is persistent, but decreased involvement of the cavernous sinuses with encasement of the carotid arteries. The abnormal enhancement along the planum sphenoidale and within the sella is also markedly reduced and perhaps resolved. There is no evidence of brain parenchymal involvement. There has been interval decrease in size of the left level 2A and bilateral retropharyngeal lymph nodes. There is mild mucosal thickening throughout the paranasal sinuses and fluid within the bilateral mastoid air cells. There are unchanged nonspecific patchy foci of T2 hyperintensity throughout the supratentorial white matter and pons that may represent chronic small vessel disease or post-treatment effects. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. ORBITS: Intraorbital extension of the tumor has subsided bilaterally.

Output: Post-treatment findings with interval decrease in size of the infiltrative nasopharyngeal carcinoma and associated lymphadenopathy. Please refer to the concurrent neck CT for additional details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, with history of MS and paresthesias. Multiple, approximately 15, T2 hyperintense lesions are redemonstrated scattered through the cerebral hemispheres and the brainstem. There has been no significant interval change in the size or number of these lesions. The lesions in most cases correlate with moderate to marked T1 hypointensity which has also not significantly changed.Hyperintensity on the 3-D FLAIR sequences along the floor of the anterior cranial fossa is artifactual as it was not duplicated on a conventional 2-D FLAIR sequence. Susceptibility imaging demonstrates marked artifact in this region probably arising from air in the paranasal sinuses. A 4 x 4 millimeter focus of dural thickening is seen along the left petrous apex projecting into the CP cistern, without significant interval change. No parenchymal edema or mass effect is detected. The ventricles are normal in size and morphology.

Output: 1.Stable size and number of lesions compatible with multiple sclerosis.2.Small area of nodular dural thickening along the left petrous apex may represent an incidental meningioma and in any event is unchanged.


Instruction: Generate impression based on findings.

Input: Reason: low back pain History: low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation present at this level as well is a mild diffuse disk bulge and loss of disk space height.At L4-5 there is loss of disk space height, disk desiccation and diffuse disk bulge at this level associated with ligamentum flavum hypertrophy and triangulation of the thecal sac. Overall there is a mild degree of spinal stenosis present this level. The fact that the lateral recesses is not effaced. The surrounding the exiting nerve roots within the neural foramina is not effaced.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Multilevel degenerative changes present in the lumbar spine without significant compromise to spinal canal or neural foramina . There is mild spinal stenosis present at L4-5 due to degenerative changes.


Instruction: Generate impression based on findings.

Input: 41 year old female status post right partial mastectomy and sentinel lymph node biopsy needs MRI due to dense breasts for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Thin rimmed enhancing seroma cavity measuring 19 x 12 x 15 mm (AP X ML X CC) is identified in the right breast 12:00 position. No abnormal enhancement is seen in right breast. Oval progressively enhancing mass with smooth margins is noted in the left breast 4:00 position, mid depth that measures 8 x 5 x 6 mm (AP X ML X CC) which is most likely benign but not easily identified on the mammogram in retrospect. No abnormal axillary lymph nodes are identified in either axillary region. Post surgical changes in the right axillary region. Small high T2 signal lesion in right lobe of liver is most likely a cyst of a hemangioma.

Output: Post surgical changes in right breast and axillary region. Incidentally noted 8 mm oval enhancing mass is seen in the left breast 4:00 position for which MRI directed ultrasound is recommended. If ultrasound is negative, 6 month follow up MRI is recommended to confirm stability of this most likely benign lesion. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Brain MRI:Redemonstrated is marked dilatation of the lateral ventricles with absence of septum pellucidum. The ventricular sizes are unchanged. The cerebral aqueduct is not visualized, unchanged in appearance. The floor of the third ventricle is thin in some areas, but no clear evidence of a gap or perforation is seen, similar to prior. As before, there is no detectable CSF flow across the floor of the third ventricle. Fluid is again noted in bilateral middle ear cavities and mastoid air cells.Complete spine MRI:There is unchanged cervicothoracic scoliosis and postoperative findings related to lipomeningocele surgery in the lumbar spine. There has been interval near complete resolution of the previously demonstrated long segment syrinx, no longer measurable. The conus medullaris terminates at the L3-4 level, unchanged in position or morphology. There is an unchanged fatty signal intensity of the filum terminalis and fat within the spinal canal extending from L5 inferiorly. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. Upon prone maneuvering, there is no significant interval change in the position of the cauda equina or conus, which may be related to the patient's scoliosis.

Output: 1.Unchanged ventricular sizes.2.No CSF flow detected across of the floor of the third ventricle, as demonstrated previously.3.Unchanged cervicothoracic scoliosis.4.There has been interval near complete resolution of the previously demonstrated long segment syrinx, no longer measurable.5.Unchanged conus position and morphology.6.Unchanged fibrofatty filum terminalis and fat within the spinal canal that extends from L5 inferiorly.7.Upon prone maneuvering, there is no significant interval change in the position of the cauda equina or conus, which may be related to the patient's scoliosis.


Instruction: Generate impression based on findings.

Input: 53-year-old female with right upper quadrant pain and epigastric pain x3 days ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense lesions throughout the liver compatible with cysts. Redemonstrated is mild to moderate intrahepatic biliary ductal dilatation. The common hepatic duct is dilated measuring 9 mm, not significantly changed when compared to the prior exam dated 11/3/2007. There is anomalous pancreaticobiliary junction with insertion of the pancreatic duct proximal to the ampulla. There is a smooth tapered appearance of the distal common bile duct with beading and narrowing involving the distal common bile duct, pancreaticobiliary junction, and duct distal to the junction leading to the ampulla.Abnormal appearance of the ampulla with a port catheter in the duodenum which raises the possibility of prior procedure such as a sphincterotomy. There is no evidence of fistula to the bowel. No inflammatory changes to suggest infection.Pneumobilia is again noted, not significantly changed since recent CT. SPLEEN: No significant abnormality noted.PANCREAS: Main pancreatic duct measures up to 4 mm.ADRENAL GLANDS: No significant abnormality noted.PneuKIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ostomy is again noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Beaded stricturing involving the distal common bile duct, pancreatic or biliary junction, and duct distal to the junction. Provided an anomalous pancreaticobiliary junction with insertion of the main pancreatic duct proximal to the ampulla, this stricturing explains the prominence of both the CBD and main pancreatic duct. There has been no significant change in CBD caliber since 2007 examination. Pneumobilia is new since 2007, not significantly changed since recent CT.2.Prominence of the pancreatic head with decreased enhancement without mass effect on the main pancreatic duct.3.Outward tethering of the duodenum and abnormal appearance of the ampulla raises the possibility of prior procedure such as a sphincterotomy. Correlation with past procedure/surgical history is necessary.4.The above-mentioned findings are favored to reflect an inflammatory process, such as post-procedural stricture or HIV cholangiopathy, that involves the bile ducts as opposed to pancreatic head mass. ERCP with biopsy may be considered.Findings discussed with Dr. Murray at 1016 on 10/31/16.


Instruction: Generate impression based on findings.

Input: 42-year-old female with no significant past medical history presenting with headache (left-sided frontal) and nausea. Please evaluate for sinus inflammation. There is no evidence of acute findings including intracranial hemorrhage, edema or midline shift. A left frontal hypodense mass lesion appears extra-axial and is associated with adjacent bony remodeling. There is no evidence of mass effect on the adjacent cerebral cortex. It is of unclear etiology and an MRI is recommended for further evaluation. Prominence of the sulci and ventricles indicates diffuse parenchymal volume loss especially considering the patient's age.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Left frontal extra axial hypodense mass is of unclear etiology and an MRI is recommended for further evaluation. 2. No evidence of paranasal sinus inflammatory disease.3. Diffuse parenchymal volume loss considering the patient's age.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with aphasia, concern for acute stroke. No restricted diffusion is seen. Minimal scattered foci of white matter T2 hyperintensity are seen, predominantly in the periventricular regions, the right basal ganglia and right internal capsule, which are nonspecific. No evidence of edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology. Partial opacification of the right mastoid air cells is seen.

Output: No acute intracranial abnormality is seen. In particular, there are no findings of acute ischemia or any other specific abnormality which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Recent right-sided craniotomy for resection of a metastasis. Headache. There are postoperative findings related to a right-sided craniotomy for resection of a cystic appearing mass. There is fluid, air and a small amount of blood products within the resection cavity, as well as pneumocephalus along the bilateral frontal convexities, as well as scalp swelling overlying the craniotomy. There is circumferential enhancement along the margins of the resection cavity, particularly posteriorly, which measures up to 5 mm in thickness. There are curvilinear hyperdensities in the right sylvian fissure and right posterior frontal lobe sulci. There is a small amount of fluid subjacent to the craniotomy that measures up to 4 mm in thickness. There is extensive confluent high T2 signal surrounding the resection cavity and persistent effacement of the third and lateral ventricles, as well as persistent right to left midline shift of 4 mm. There are scattered foci of high T2 signal elsewhere in the cerebral white matter, but no evidence of acute territorial infarction. There is mild mucosal thickening in the maxillary sinuses.

Output: Postoperative findings related to a right-sided craniotomy for resection of a cystic appearing mass with findings suggestive of residual tumor along the margins of the resection cavity and surrounding edema.


Instruction: Generate impression based on findings.

Input: Transverse myelitis There is signal abnormality on the STIR sequence extending throughout the cervical cord which is less apparent than on remote study from 6/19/2010, when it also demonstrated enhancement. There is also suspected abnormal T2 hyperintensity involving the thoracic cord at the T9-T10 level, without prior thoracic spine MRI available for comparison. Degenerative changes are evident at the L4-L5 level with disc height loss, bulge, and mild bilateral neural foraminal narrowing. Vertebral body heights and alignment are grossly maintained. There is mild diffuse narrowing of the cervical spinal canal. There is no evidence of cord compression or significant spinal canal stenosis in the cervical, thoracic, or lumbar spine.

Output: 1. Please note this examination is limited to sequences per cord compression protocol. There is no evidence of cord compression or high-grade stenosis in the cervical, thoracic, or lumbar spine.2. Extensive signal abnormality throughout the cervical cord appears less prominent than prior cervical spine MRI from 2010, when it also demonstrate enhancement. Abnormal signal in the lower thoracic cord is also suspected. If there is suspicion for recurrence of transverse myelitis, suggest dedicated cervical and thoracic spine MRI with gadolinium.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, pain, visual blurring. There are greater than 20 T2/flair hyperintense lesions involving the bilateral periventricular and subcortical white matter. Most of these lesions demonstrate a morphology and distribution characteristic of known demyelinating disease. More confluent FLAIR signal abnormality is noted in the bilateral periatrial regions and along the temporal horns. Small infratentorial lesions including the right superior and middle cerebellar peduncle are also seen. Several lesions with low T1 signal also noted. There is mild global parenchymal volume loss including the cerebellum as well as hypoplasia involving the inferior cerebellar vermis which is incidentally noted. No intracranial mass or mass-effect. No hydrocephalus or extra-axial collections. Major flow-voids are preserved.Dedicated sequences were not obtained however orbits and sella are grossly unremarkable. There is possible T2/FLAIR hyperintensity at the level of the chiasm and optic tracts which can be confirmed with coronal T2 sequences. Paranasal sinuses and mastoid cells are clear. Calvarium is intact. Extracranial soft tissues are within normal limits.

Output: 1. Numerous T2/FLAIR hyperintense lesions consistent with known demyelinating disease. Possible FLAIR hyperintensity at the level of the chiasm and bilateral optic tracts which may be artifactual but can be confirmed with coronal T2 sequences. Please note prior MRI is not available for comparison and an addendum can be issued if it is made available to the radiology department.2. Please note only MRI brain without contrast was obtained. Patient could not tolerate further imaging and postcontrast brain sequences as well as cervical spine study was not performed.


Instruction: Generate impression based on findings.

Input: 37-year-old female has peri-umbilical bulge. Rule out ventral hernia. History of uterine fibroids. ABDOMEN:LUNG BASES: Mild bibasilar dependent atelectatic changes. No acute infiltrates or effusions.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a bowel-containing supraumbilical right sided paramedian ventral hernia with neck measuring approximately 3.9 cm diameter.PELVIS:UTERUS, ADNEXAE: Two masses within the uterus were found on the prior MRI exam, one consistent with fibroid, and one which represents either fibroid or focal adenomyoma. Scarring in the uterus and anterior abdominal wall with suggestion of adhesion. Nabothian cysts. Right lower quadrant cyst, likely paraovarian cyst or duplication cyst has a thickened wall and measures approximately 3 cm in diameter at axial image 104/148 of series 4.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bowel-containing nonobstructing supraumbilical right sided ventral hernia. Left adnexal cyst.


Instruction: Generate impression based on findings.

Input: History of low grade osteosarcoma of left mandible status post mandibulectomy with recurrence from outside hospital biopsy. There are postoperative findings related to left inferior rim mandibulectomy. There is a subcentimeter focus of enhancement in the left mandibular alveolus. There is no evidence of cervical lymphadenopathy. There thyroid and salivary glands are unremarkable. There is a left maxillary sinus retention cyst. The orbits and imaged intracranial structures are unremarkable.

Output: Postoperative findings related to left partial mandibulectomy. A subcentimeter focus of enhancement in the left mandibular alveolus may correspond to the site of known tumor recurrence and/or biopsy effects.


Instruction: Generate impression based on findings.

Input: Female 69 years old Reason: elevated alk phos, ultrasound with chronic pancreatitis in 2002 History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Status post cholecystectomy. There is mild dilatation of the common bile duct measuring up to 11 mm. No discrete calculi is identified.SPLEEN: Spleen is normal in sizePANCREAS: Pancreas is normal in morphology. Pancreatic duct is normal in caliber. No peripancreatic fluid. No fluid collections.] Enhance homogeneously.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys are normal in morphology. Hypoattenuating subcentimeter right renal lesion measures 8 mm. The lesion does not meet the criteria for simple cyst and has possible subtle internal enhancement.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.No evidence of acute or chronic pancreatitis. Pancreatic duct is normal in morphology.2.Mildly dilated common bile duct following cholecystectomy without intrahepatic biliary ductal dilatation.3.No suspicious hepatic lesions.4.8 mm indeterminate right renal lesion for which a 12 month follow-up is suggested.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of head and neck cancer status post chemoradiation therapy with liver lesion noted on recent chest CT. ABDOMEN:LIVER, BILIARY TRACT: Within the limitation of motion artifact and limited sequences, no definite hepatic lesion is identified. Mild intra and extrahepatic biliary ductal dilatation, likely secondary to cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal T2 hyperintense focus is incompletely characterized but statistically likely cyst.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: Limited examination as detailed without a discrete liver lesion. Patient to return to complete the examination.


Instruction: Generate impression based on findings.

Input: Clinical question: Left lumbar radicular pain for 6 months. Signs and symptoms: As above. Nonenhanced lumbar MRI:The signal intensity of the vertebral column is unremarkable.The anatomical alignment of vertebral column is preserved.Lower most visualized thoracic spine and cord is unremarkable.T12-L1, L1-L2, L2-L3 levels are unremarkable.L3-L4 demonstrate mild disease and mild bilateral facet and ligamentum flavum hypertrophy without neural foraminal compromise or convincing evidence of central spinal stenosis.L4-L5 demonstrate mild to moderate left and mild right facet and ligamentum flavum hypertrophy and mild facet disease. There is a shallow right lateral disc protrusion with slight extension into the right lateral recess (axial T2 series 5 image 18 and sagittal T2 and T2 STIR images 6 through 8). This finding results in mass effect on the right lateral recess and right L5 nerve root. No spinal stenosis or significant neural foraminal compromise. No spinal stenosis and mild left neural foraminal compromise.L5-S1 demonstrate mild to moderate disc disease and loss of disc height, mild to moderate bilateral facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is a broad-based central disc protrusion at this level which is in contact and slightly displaces the left S1 nerve root in the left lateral recess. No spinal stenosis or neural foraminal compromise.Unremarkable perispinal soft tissues.

Output: 1.Mild to moderate degenerative changes at L5-S1 and a central broad-based disc protrusion with subtle mass effect on the left lateral recess and left S1 nerve root.2.Shallow small right lateral disc protrusion at L4-L5 with resultant mass effect on the right lateral recess and right L5 nerve root.3.No central spinal stenosis or significant neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other malformations of cerebral vessels Hemangioma of intracranial structures MyoclonusClinical question: Venous anomaly with telangiectasia, 6 month follow up; 3T Scanner, CCM ProtocolSigns and Symptoms: tremor, off balance, difficulty speaking The CSF spaces are appropriate for the patient's stated age with no midline shift. There is leptomeningeal enhancement along the surface of the right cerebellar hemisphere. There is a large developmental venous anomaly present extending into the right cerebellar hemisphere, midbrain and pons. There is a a 33mm x 57mm axial dimension patchy focus of the susceptibility effect and patchy contrast enhancement involving the pons, midbrain, right middle cerebellar peduncle and the right cerebellar hemisphere. There are multiple foci of punctate more profound signal loss within this area.No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a large brainstem and right cerebellar lesion associated with a developmental venous anomaly which is suspected to represent capillary telangiectasia. There are multiple foci of suspected microhemorrhage within this.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There are diffusion restriction with T2/FLAIR hyperintensities in the left aspect of the pons, in the right basal ganglia, and in the right temporal lobe, suggestive of acute infarcts. There are a few T2/FLAIR hyperintensities in the subcortical and periventricular white matter suggestive of chronic small vessel ischemic changes. There is minimal compression of the anterior horn of the right lateral ventricle, due to the acute infarct in the right basal ganglia. There is no midline shift. No evidence of acute hemorrhage.MRA BRAIN:The MRA is degraded by severe motion artifacts.MRA demonstrates occlusion of the distal left M1 segment. There are atherosclerotic irregularities of the right middle cerebral artery with no significant stenosis. The right A1 segment is hypoplastic. There are luminal irregularities of the anterior cerebral arteries.There are arteriosclerotic irregularities of the posterior cerebral arteries with small and narrowed right posterior cerebral artery, more than the left. The basilar artery is patent. The right vertebral artery is hypoplastic.

Output: 1. Acute ischemic infarcts in the right basal ganglia, right frontal lobe, and the left side of the pons.2. The MRA is severely degraded by motion artifacts. There is occlusion of the distal segment of the left M1. Hypoplastic right A1. The right vertebral artery is hypoplastic. Remainder of the cerebral arteries demonstrates severe atherosclerotic changes.


Instruction: Generate impression based on findings.

Input: Fever status post liver transplant ABDOMEN:LIVER, BILIARY TRACT: Status post hepatic transplant. Status post cholecystectomy. New from prior MRI is portal venous stent, not well assessed like other vascular structures without IV contrast. Patent cholecystojejunostomy. Unchanged prior study is mild intrahepatic biliary duct prominence, more pronounced on left lobe and right, with mild central ductal irregularity again seen, image 15 series 401. No measurable perihepatic hematoma seen currently.SPLEEN: Splenomegaly, spleen measures 18.2 cm in longitudinal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right midpole subcentimeter hemorrhagic/proteinaceous cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small ascites. Bowel wall thickening nonspecific in setting of ascites. Mildly dilated small bowel, measuring up to 4.9 cm in right abdomen, similar to earlier CT study from July 6, 2015, collapsed distal ileal loops suggested, fluid seen distally in colon. Overall appearance again suspicious for partial SBO or ileus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Decreased size of now small right pleural effusion, interval resolution of previously visualized trace left pleural effusion. Continued decrease in size of perigastric and perisplenic hematomas, former now a subcentimeter focus measuring 0.5 x 0.3 cm while latter measures up to 1.2 cm, previously 1.6 x 1 cm. Interval decrease in size of right ventral subcutaneous fluid collection, measuring 4.1 x 1.5 cm, previously measured 7.8 x 1.7 cm.

Output: 1. Small ascites. Bowel wall thickening nonspecific in setting of ascites. Mildly dilated small bowel, measuring up to 4.9 cm in right abdomen, similar to earlier CT study from July 6, 2015, collapsed distal ileal loops suggested, fluid seen distally in colon. Overall appearance again suspicious for partial SBO or ileus.2. Unchanged mild prominence of biliary tree with patent choledochoduodenostomy. New from prior MRI portal venous stent.3. Decreased size of ventral abdominal fluid collection and intra-abdominal hematomas as above.4. Decreased pleural fluid.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are a few scattered patchy foci of T2 hyperintensity within the supratentorial white matter that are most compatible with mild chronic small vessel ischemic disease. There is a single punctate focus of susceptibility effect within the left frontal white matter likely representing chronic microhemorrhage. 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. There is minimal paranasal sinus mucosal thickening.MRA HEAD: There is mild narrowing of the right cavernous carotid artery. The intracranial internal carotid arteries are otherwise normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.No evidence of acute infarct.2.Mild chronic small vessel ischemic disease.3.No significant steno-occlusive lesion within the head.


Instruction: Generate impression based on findings.

Input: 41-year-old woman with history of menorrhagia status post UFE on 6/30/2016. PELVIS:UTERUS, ADNEXA: Uterus is still enlarged with multiple fibroids. The intramural anterior fundal fibroid (6/13) no longer enhances and measures 24 x 22 mm, previously 40 x 39 mm. A crescent-shaped portion of the submucosal fibroid in the right fundus (6/15) still partially enhances (10012/238) but is decreased in size measuring 29 x 20 mm, previously 46 x 37 mm. Additional, smaller fibroids appear subjectively smaller and do not enhance.The endometrial canal is somewhat distorted by fibroids, but otherwise normal. Previously seen hemorrhage in the cervical canal is not visualized.Nabothian cysts and ovarian follicular cysts are again noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Very small amount of free pelvic fluid noted.

Output: 1.Multiple fibroids which have decreased in size compared to the prior examination and demonstrate no enhancement.2.Submucosal right fundal fibroid also decreasing in size but with residual partial enhancement.


Instruction: Generate impression based on findings.

Input: 32-year-old woman with a newly diagnosed right breast cancer metastatic to a right axilla lymph node presents for staging. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right Breast: In the lower outer quadrant, there are multiple homogeneously enhancing irregular masses and foci centered in the 8-9 o'clock position with associated architectural distortion. Clip artifact is seen within one of the two largest masses which measures 2.0 x 1.8 x 1.8 cm (AP x TV x CC). Another adjacent contiguous mass seen immediately anterior and medial to this mass which measures 2.1 x 2.0 x 1.5 cm (AP x TV x CC). The entire extent of the masses, including the largest mass, spans 5.3 x 4.9 x 3.7 cm (AP x TV x CC).Left Breast: No abnormal enhancement is seen.Axilla: There are mildly enlarged right axillary lymph nodes, asymmetric when compared to left axilla. Clip artifact is seen along the anterior aspect of the disease positive lymph node which measures up to 2.0 cm (CC). No abnormal lymph nodes are identified in the left axillary region.

Output: (1) Multiple enhancing irregular masses centered in the right lower outer quadrant , the largest of which represents the known biopsy-proven malignancy. The entire extent of abnormal enhancement measures 5.3 x 4.9 x 3.7 cm (AP x TV x CC).(2) Asymmetrically enlarged right axillary lymph nodes as described with the biopsy-proven metastatic lymph node measuring up to 2.0 cm.(3) No MRI evidence for malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: A 37 year old female with breast cancer and bones metastasis after chemotherapy presenting with heart failure symptoms while the echocardiography showed severely decreased left ventricular function. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 247 ml (normal range 109+/-23), the LV end systolic volume index is 103 ml/m2 (normal range 18+/-5), the LVESV is 207 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 129 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is no late gadolinium enhancement.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderate to severe systolic dysfunction. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 154 ml (normal range 110+/-24), the RV end systolic volume index is 55 ml/m2 (normal range 22+/-8), and the RVESV is 110 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mitral regurgitation, visually estimated to be mild. Dedicated imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is visually estimated trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsDiffuse osseous metastases are better characterized on the recent CT thorax. A right port catheter is present with the tip located at the superior caval atrial junction. Small hiatal hernia. While this is not specifically designed for evaluation of the hepatic parenchyma, there are foci of high signal scattered throughout the liver. For example on series 301 images 4 and 7, there are high signal foci raising the question of metastases. This can be better characterized with contrast-enhanced MRI, if clinically appropriate.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function, the LVEF is 16%. There is global hypokinesis with regional variation. 2. Foci of high signal in liver raise the question of metastases. This can be better characterized with contrast-enhanced MRI, if clinically appropriate3. The right ventricle is normal in size with moderate to severe systolic dysfunction, the RVEF is 28%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Images are limited by patient motion. SWI images are nondiagnosticProminent areas of diffusion restriction are seen in the area of the right trigone in similar configuration to the most recent outside MRI. There is a likely partially embolized AVM in this location, and may represent residual blood products and/or evolving ischemia. There is minimal extension in the right posterior body of the corpus callosum. Surrounding more extensive T2/FLAIR hyperintensity overall has progressed since the prior exam. In the posterior right temporal and occipital lobes, there was previously a vasogenic pattern of edema, which has improved with only minimal residual vasogenic edema remaining in the lateral posterior right temporal lobe. There is persistent transcortical involvement of the anteromedial right occipital lobe by FLAIR abnormality.There has been progression of other more anterior areas of FLAIR abnormality. For example, there were a few subtle foci of FLAIR hyperintensity in the periventricular white matter along the right temporal horn, which is now effaced by confluent signal abnormality. There are also now globular areas of FLAIR abnormality in the mesial right temporal lobe, including involvement of the right hippocampus with gyral expansion. There is greater medial and cranial extension of abnormal signal, along the medial right thalamus and right corona radiata. Additional areas of diffusion restriction with T2/FLAIR hyperintensity are seen along the right lateral margin of the anterior third ventricle just adjacent to the right foramen of Monro. There is resultant focal mass effect with narrowing of the third ventricle, not present on the outside exams. There is more subtle diffusion hyperintensity along the periventricular white matter of midbody of the lateral ventricles along the corona radiata in areas of somewhat oval appearing T2/FLAIR abnormality without convincing ADC hypointensity, likely relating to evolving prior subacute infarcts.There is a slightly more conspicuous area in the right superior vermis, and there is now discontiguous involvement of the more inferior vermis, as well as the right lateral periventricular white matter along the fourth ventricle. The inferior vermian involvement results in mass effect on the fourth ventricle, which is now partially effaced. Retrospectively, there may have been a small early focus of FLAIR hyperintensity along the inferior vermis on the most recent outside MR images.Compared to recent CTs, there is stable localized mass effect including upon the posterior right lateral ventricle. However, mass effect is progressed since the prior outside exams. Midline shift to the left is similar at 5-6 mm, but again slightly progressed since outside exams. There are stable tubular areas of intrinsic T1 hyperintensity in the medial aspect of the right parietal lobe in the area of the AVM which may relate to embolization material or blood products. Right temporal horn was noted to be patent on the most recent outside CT, but is now completely effaced. There is additional confluent periventricular signal consistent with transependymal CSF flow. Although there is likely underlying moderate age-related volume loss, there is increased lateral ventricular size since outside exams, consistent with mild-moderate hydrocephalus.The basal cisterns remain patent. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which appear somewhat increased in number since the prior exams and may represent interval non-acute small vessel ischemic changes. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is incidental empty sella. The remainder of the midline structures and craniocervical junction are within normal limits. There is a large left maxillary sinus mucosal retention cyst.The intracranial internal carotid arteries are normal in course and caliber. There is a hypoplastic right A1 segment. The middle and anterior cerebral arteries are otherwise unremarkable. There is a mildly hypoplastic left P1 segment. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.The area of the right parietal AVM appears to be fed from branches of the right posterior cerebral artery. There may be small veins draining the area of the AVM towards the atrium of the right lateral ventricle in the vicinity of the choroid plexus glomus.

Output: 1. Limited exam secondary to patient motion and lack of contrast. Areas of diffusion restriction centrally in the region of the right parietal AVM, which may represent chronic blood products. Although decreased vasogenic pattern of edema along especially posterolateral margins of AVM, there has been progression of more anterior and medial extension of abnormal signal involving the right temporal lobe, with now complete effacement of the right temporal horn. Given outside imaging appearance, this most likely represent areas of evolving cytotoxic edema from infarct, with possible venous as well as small arterial components.2. Other scattered areas of probable evolving possibly embolic infarct, including the right superior vermis, inferior vermis, corona radiata bilaterally, and along right lateral margin of anterior third ventricle.3. Midline shift and localized mass effect appears similar to that of the recent CTs, but are progressed from outside imaging including increased effacement of the posterior right lateral ventricle and complete effacement of right temporal horn. Increased mass effect on the anterior third ventricle and now partially effaced fourth ventricle by new and evolving areas of probable infarct. Increased lateral ventricular caliber with transependymal edema. Close continued follow-up of ventricular size is recommended.4. MRA demonstrates possible arterial feeders from the right PCA to the right parietal AVM. There is questioned subtle venous drainage towards the right atrial choroid plexus.


Instruction: Generate impression based on findings.

Input: Right foot pain Tendons and ligaments: The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. The Lisfranc ligament is intact. Osseous structures: There is irregular hyperintense T2 signal and markedly decreased T1 signal involving the lateral half of the navicular bone consistent with avascular necrosis. There is secondary moderate osteoarthritic changes of the talonavicular articulation with additional areas of increased signal abnormality within the anterior talus, cuboid, and peroneal tubercle. There is no joint effusion. There are no osteochondral lesions identified. There is normal alignment of the metatarsals. Muscles: The plantar musculature is unremarkable.Bone Marrow: The bone marrow signal is normal. There is no fracture or contusion. There is no marrow replacing lesions.

Output: 1. Avascular necrosis of the navicular. Additional areas of signal abnormality are noted within the foot which may represent reactive edema or early infarct.2. Moderate osteoarthritis of the midfoot particularly at the talonavicular articulation.


Instruction: Generate impression based on findings.

Input: 86-year-old male with history of MI with profound short-term memory loss. Expansile mass is present within the sella, which was better characterized on prior brain MRI study, as a pituitary macroadenoma. There is no evidence of intracranial hemorrhage, mass or edema. 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: No acute abnormality or interval change.


Instruction: Generate impression based on findings.

Input: MRI brain:Please note some of the sequences are highly motion degraded. There is restricted diffusion in the left middle frontal gyrus consistent with acute to early subacute infarction. There is T2/FLAIR hyperintensity and encephalomalacia involving the right frontal lobe with mild ex vacuo dilatation of the frontal horn of the right lateral ventricle consistent with chronic infarction. There is a wedge-shaped area of encephalomalacia in the right cerebellum related to chronic infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is mild global parenchymal volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.There is suspicion of a lobulated isointense T1 and iso to slightly hyperintense T2 weighted mass in the sella/suprasellar region which is incompletely imaged. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mucosal thickening in the left maxillary sinus. MRA head : This is a motion degraded exam. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There are bilateral small P-comm arteries. The vertebral arteries, basilar artery and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. Small areas of restricted diffusion in the left frontal lobe compatible with acute to subacute ischemia.2. Chronic infarct in the right frontal lobe. Chronic infarct in the right cerebellar hemisphere.3. Mild degree of chronic small vessel ischemic disease. 4. A suprasellar/sellar mass is incompletely imaged. Further evaluation with dedicated contrast enhanced pituitary MRI is recommended.5. Motion degraded MRA exam. Within the limitation, no gross evidence of cerebrovascular occlusion or aneurysm.Findings were discussed with Dr Xial at 10:40 hrs on 12/23/2015.


Instruction: Generate impression based on findings.

Input: Neurofibroma of the larynx. Neck: The previously demonstrated exophytic lesion posterior to the right vocal cord is no longer apparent. There is no evidence of significant cervical lymphadenopathy based on size criteria. There appears to be a small left palatine tonsillar crypt. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is multilevel degenerative spondylosis. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The previously demonstrated exophytic lesion posterior to the right vocal cord is no longer apparent.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: h/o multiple myeloma; worsening R knee pain, >4 months at this point, mild OA noted on x-ray. Please evaluate. History: h/o multiple myeloma; worsening R knee pain, >4 months at this point, mild OA noted on x-ray. Please evaluate. There is a small joint effusion with posterior extension into a Baker’s cyst. There is mild synovial enhancement consistent with synovitis.

Output: Degeneration as well as tearing of the medial meniscus as described above. Tricompartmental articular cartilage thinning.


Instruction: Generate impression based on findings.

Input: 76-year-old female with severe lower back pain. Evaluate for spinal stenosis, disc herniations. Five lumbar type vertebral bodies are presumed to be present which are appropriate in in height. Moderate levoscoliosis is present with apex at the L4-5 level. There is mild right lateral subluxation of L2 on L3 and left lateral subluxation of L4 on L5. Mild grade 1 anterolisthesis of L4 on L5 is also noted. Edematous marrow changes of T12 and L1 are likely degenerative in etiology. The conus medullaris on sagittal imaging is grossly intact. Fatty atrophy of the paraspinous musculature is additionally presentAt T11-T12 there is moderate disk bulge, ligamentum flavum hypertrophy and facet hypertrophy. There is no significant central canal stenosis, and there is mild left neuroforaminal compromise.At L1-2 there is mild disk bulge, ligamentum flavum hypertrophy and facet arthropathy. There is no significant central canal stenosis and mild left neuroforaminal compromise.At L2-3 there is mild disk bulge, ligamentum flavum hypertrophy, and facet hypertrophy. There is mild central canal stenosis, as well as mild bilateral neuroforaminal stenosis.At L3-4 there is mild disk bulge, ligamentum flavum hypertrophy, and severe facet hypertrophy. There is moderate central canal stenosis and mild bilateral neuroforaminal compromise.At L4-5 there is moderate disk bulge, ligamentum flavum hypertrophy and severe facet hypertrophy. There is moderate to severe central canal stenosis and moderate to severe right and mild to moderate left neuroforaminal compromise. There is also a tiny extraforaminal cyst on the left, which may represent a synovial cyst.At L5-S1 there is mild disk bulge, ligamentum flavum hypertrophy, and facet hypertrophy. There is no significant central canal stenosis. There is mild to moderate left neuroforaminal compromise.Right renal pelvic ectopia located again noted incidentally.

Output: 1.Multilevel degenerative changes of the lumbar spine, with moderate to severe central canal stenosis at L4-5 and to a lesser degree at other levels as detailed above.2.Moderate to severe right neuroforaminal compromise at L4-5, and mild to moderate on the left at L4-5 and L5-S1. 3.Moderate lumbar levoscoliosis as describe above.4.Facet arthropathy throughout the lumbar spine, relatively worse at L4-5 and L5-S1.


Instruction: Generate impression based on findings.

Input: Elevated LFTs. Evaluate for obstruction. ABDOMEN:LUNG BASES: Cardiomegaly. Right mid lung atelectasis. Trace left pleural effusion.LIVER, BILIARY TRACT: Normal liver morphology and size. No intrahepatic or extrahepatic biliary ductal dilatation. Partially contracted gallbladder without gallstones or wall thickening or pericholecystic fluid.Right hepatic dome subcentimeter nonenhancing T2 weighted hyperintensity, likely a benign cyst. No focal suspicious lesion.SPLEEN: No significant abnormality noted.PANCREAS: Normal pancreatic parenchymal enhancement. Punctate 4 mm nonenhancing cystic lesion adjacent to the pancreatic duct at the pancreatic head, likely a side branch IPMN. No pancreatic ductal dilatation.ADRENAL GLANDS: Bilateral homogeneously enlargement of the adrenal glands measuring up to 4.4 x 2.4 cm on the left (series 14 102/357) and 3.9 cm x 2.0 cm on the right (image 352) demonstrating signal dropout on out of phase imaging and maintaining their morphology, compatible with adenomatous adrenal hypertrophy. KIDNEYS, URETERS: Symmetric perinephric fluid/stranding. Right renal interpolar 1.2 cm simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Marked left greater than right lateral body wall subcutaneous edema.OTHER: No significant abnormality noted.

Output: 1.No biliary ductal dilatation as clinically questioned.2.Adenomatous adrenal hypertrophy.3.4 mm pancreatic head IPMN.


Instruction: Generate impression based on findings.

Input: 53-year-old female with lumbago and neck pain and tingling down arms CERVICAL SPINE:There is straightening of the cervical spine. Vertebral body heights are maintained. The cervical spinal cord signal intensity and morphology are normal throughout. The craniocervical junction is normal.C2-3: No central spinal stenosis or significant neuroforaminal narrowing. C3-4: Mild degenerative disk disease and mild bilateral left greater than right neuroforaminal narrowing. No central spinal stenosis.C4-5: No central spinal stenosis or significant neuroforaminal narrowing. C5-6: Left uncovertebral and facet joint hypertrophy. Moderate left neuroforaminal narrowing. No spinal stenosis.C6-7: Severe degenerative disk disease and ventral osteophyte causing flattening of the anterior thecal sac. Mild central spinal stenosis. Moderate left and mild right neuroforaminal narrowing.C7-T1: No central spinal stenosis or significant neuroforaminal narrowing.T1-T2: Small central disk protrusion (image two series 701) without significant neuroforaminal narrowing or spinal stenosis.LUMBAR SPINE:Vertebral body heights are maintained. There is grade 2 anterolisthesis of L5 on S1. Alignment is otherwise within normal limits. The signal and morphology of the visualized lower cord and nerve roots appears normal.T12-L1: No central spinal stenosis or significant neuroforaminal narrowing. L1-L2: No central spinal stenosis or significant neuroforaminal narrowing. L2-L3: No central spinal stenosis or significant neuroforaminal narrowing. L3-L4: Mild degenerative disk disease. No central spinal stenosis or significant neuroforaminal narrowing. L4-L5: Moderate degenerative disk disease. No central spinal stenosis or significant neuroforaminal narrowing. L5-S1: Severe degenerative disk disease and vertebral body endplate changes. Moderate to severe right greater and mild left neuroforaminal narrowing. No significant central canal stenosis. There is likely spondylolysis at least on the right.

Output: 1. Grade 2 anterolisthesis of L5 on S1 with severe degenerative disk disease and moderate to severe right neuroforaminal narrowing. There is likely a pars defect at least on the right although this could be confirmed by CT imaging if clinically warranted.2. Moderate cervical degenerative changes worst at C6/7 with moderate neuroforaminal narrowing and mild central spinal stenosis.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of long bones of lower limb [170.7], Reason for Study: ^Reason: 30 yo F with Ewing sarcoma of R femur with met to retroperitoneum p/w fever, neutropenia, and headache, s/p Vincristine, doxorubicin, and cyclophosphamide chemo. No evidence of acute ischemic or hemorrhagic lesion on this scan.There is no abnormal enhancement.There is about 4.7mm cerebellar tonsilar herniation through the foramen magnum.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement. No intracranial mass.3. About 4.7mm cerebellar tonsilar herniation through foramen magnum as described above.


Instruction: Generate impression based on findings.

Input: Relapsed neuroblastoma, pre-NANT 11-01. Orbits: There has been near resolution of the anterior and central skull base tumor with mild residual enhancement along the left lesser wing of the sphenoid and sphenoid roof, without appreciable mass effect upon surrounding structures. There is persistent focal T2 hyperintensity in the canalicular and posterior orbital portions of the left optic nerve. The right orbit is unremarkable. 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. The major cerebral flow voids are intact. The previously described right occipital bone region finding is unchanged and may be related to the lambdoid suture. There is a small amount of residual scattered paranasal sinus mucosal thickening.

Output: 1. Near resolution of the anterior and central skull base tumor with mild residual enhancement along the left lesser wing of the sphenoid and sphenoid roof, without appreciable mass effect upon surrounding structures.2. Persistent focal T2 hyperintensity in the canalicular and posterior orbital portions of the left optic nerve may be related to prior compressive neuropathy. 3. Decreased pansinus mucosal inflammation.


Instruction: Generate impression based on findings.

Input: 51-year-old female. Evaluate for demyelinating disease, myelitis. Left-sided weakness and normal brain MRI Cervical Spine: There are postoperative findings related to anterior fusion at C6 and C7. There is loss of the usual cervical lordosis, but no spondylolisthesis. There are small posterior disc-osteophyte complexes at C4 through C6 with effacement of the anterior thecal sac cerebrospinal fluid, but no spinal cord compression. In addition, uncovertebral hypertrophy results in mild right C3-4 and C5-6 neural foraminal narrowing. The vertebral body heights are preserved. Thoracic Spine: There is a small posterior disc-osteophyte complex at T5-6 with slight indentation of the spinal cord. The spinal cord signal is otherwise unremarkable. Smaller posterior disc-osteophytes at T6 though T9 do not results in significant spinal canal stenosis at the other levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are scattered foci of focal fat and/or hemangioma in the vertebrae. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to anterior fusion at C6 and C7 and multilevel degenerative spondylosis of cervical spine, including small posterior disc-osteophyte complexes at C4 through C6 with effacement of the anterior thecal sac cerebrospinal fluid, but no spinal cord compression, as well as uncovertebral hypertrophy that results in mild right C3-4 and C5-6 neural foraminal narrowing.2. A small posterior disc-osteophyte complex at T5-6 slightly indents the spinal cord.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for mid bicep pain with questionable mass present within musculature History: mid bicep pain with elbow flexion We see no mass. The biceps muscle appears normal as does the distal tendon. The remaining musculature of the arm likewise appears normal. There is a small amount of fluid within the glenohumeral joint as well as mild synovial enhancement indicating a mild synovitis that extends into the tendon sheath of the long head of the biceps. We see no erosions. There is patchy intermediate signal intensity within the proximal humerus likely representing residual islands of red marrow.

Output: Mild synovitis of the glenohumeral joint, but we see no mass or other findings to account for the patient's biceps pain.


Instruction: Generate impression based on findings.

Input: Right lateral knee pain MENISCI: There is horizontal tearing of the posterior horn of the lateral meniscus with extension into the body. Linear and globular degeneration of the anterior horn of the lateral meniscus is also noted near its root. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage degeneration along the lateral tibial plateau posteriorly with additional degeneration of the articular cartilage along the weightbearing portion of the lateral femoral condyle. There are degenerative subchondral cysts in the underlying bone. The articular cartilage of the medial compartment is intact.There is moderate thinning of the articular cartilage of the patella inferiorly with underlying subchondral cysts. Subjectively, the femoral trochlea appears slightly shallow which may reflect mild dysplasia. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Degeneration of the articular cartilage of the lateral and patellofemoral compartments with horizontal tearing of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: Recurrent, disseminated glenohumeral tumor. Treated with chemotherapy and radiation treatment. Last MRI showed new contrast enhancement. Brain: There are postoperative findings related to left temporal craniotomy and tumor resection. The enhancing T2 hyperintense mass within the left middle cranial fossa surgical bed has not significantly changed. Likewise, there is unchanged is encephalomalacia surrounding the treatment bed. There is extensive enhancement within supratentorial and infratentorial sulci and basal cisterns, which has is overall similar in extent. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is a right maxillary sinus retention cyst.Spine: The images are limited by patient motion. There is diffuse linear and nodular leptomeningeal enhancement in the spinal canal. There is also an unchanged volume of enhancing tumor within the sacral spinal canal, although the enhancement is more intense, which may be technical in nature. The spinal cord signal otherwise appears normal. A left paracentral disc protrusion at L5-S1 and a mild disc bulge at C3-4 are also unchanged. The spinal column alignment is unchanged. The vertebral body morphology and signal characteristics are unremarkable.

Output: 1. Unchanged residual tumor in the left middle cranial fossa and extensive leptomeningeal tumor dissemination.2. Unchanged drop metastases in the spinal canal.


Instruction: Generate impression based on findings.

Input: 66-year-old female patient with history of pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intrahepatic biliary ductal dilatation. Common bile duct measures up to 12 mm maximal diameter, mildly dilated.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is mildly atrophic. There is a 2.5 cm segment of mild pancreatic duct dilatation, measuring up to 6 mm in maximal dimension, in the body of the pancreas. T2 hyperintense lesion in the pancreatic tail measures 1.9 cm (series 7 image 36), previously 2.5 cm. This lesion does not enhance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace intra-abdominal ascites.BONES, SOFT TISSUES: There is a small amount of retained fluid within an umbilical hernia. Again seen is a cystic lesion in the left posterior abdominal wall at the level of the kidneys.OTHER: No significant abnormality noted.

Output: 1.Segment of pancreatic ductal dilatation compatible with a pancreatic stricture in the midbody of the pancreas.2.Decreasing pancreatic pseudocyst in the pancreatic tail.3.Mild extrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: 65-year-old woman with history of alcoholic cirrhosis and liver lesion seen on 2015 MRI. ABDOMEN:LIVER, BILIARY TRACT: Liver appears cirrhotic in signal and morphology. In segment 4A (20/371), there is a 9 x 8 mm area of washout which appears similar in size to prior examination, previously 9 x 7 mm. This area does not demonstrate early arterial enhancement, abnormal T2 signal, or abnormal diffusion signal. This region does contain fat as evidenced by signal dropout on opposed phase imaging.Additionally, there is a new geographic focus of arterial enhancement in segment 4A (20/166). This area does not washout on delayed phase imaging and is isointense to liver on T2 without restricted diffusion.The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal cysts noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable nonspecific segment 4A lesion.2.New arterially enhancing segment 4A lesion which is also nonspecific but not characteristic of HCC and can be followed on subsequent imaging.


Instruction: Generate impression based on findings.

Input: 65 year old with loss of consciousness rule out bleed The examination is somewhat compromised by patient motion. In several areas there is poor differentiation of gray white junction with the suggestion of subcortical hypodensity. In addition the sulci and basilar cisterns are small and I cannot rule a possibly of some increased intracranial pressure.I recommend obtaining an MRI with diffusion weighted imaging to evaluate.There is no evidence of intracranial hemorrhage as clinically questioned.Bone windows reveal no osseous abnormality.

Output: Somewhat compromised examination by patient motion does demonstrate poor definition of the gray white junction as well as suggestion of subcortical hypodensities. Cerebral sulci and basilar cisterns are somewhat small for the patient's stated age and the possibility of diffuse edema cannot be excluded. MRI of the brain is recommended to fully evaluate.


Instruction: Generate impression based on findings.

Input: Left lower extremity radiculopathy, left S1 root compression suspected Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L5 on S1. Alignment is otherwise grossly maintained. There is severe loss of disc height at the L4-L5 and L5-S1 levels. Bone marrow signal is benign with mild edema involving the L4 and L5 endplates on a degenerative basis.. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge eccentric to the left with small left sided annular fissure. Mild facet arthropathy. There is mild to moderate left neural foraminal stenosis. No significant spinal canal or right neural foraminal narrowing.L3-L4: Mild disc bulge and and mild facet arthropathy. There is no significant spinal canal stenosis. There is mild right and mild to moderate left neural foraminal stenosis.L4-L5: There is disc bulge with ligamentum flavum thickening, mild facet arthropathy, and slight prominence of the epidural fat resulting in mild to moderate spinal canal stenosis at this level. There is effacement of the lateral recesses. There is moderate left and mild to moderate right neural foraminal stenosis.L5-S1: Disc bulge with small left paracentral protrusion which effaces the left lateral recess. There is contact and possible impingement of the descending left S1 nerve root at this level. There is ligamentum flavum thickening and mild facet arthropathy. No significant central spinal canal stenosis. Minimal bilateral foraminal narrowing. There is a 3.7 x 4.6 cm lobulated lesion with homogeneous T1 and T2 hyperintensity involving the right piriformis muscle which likely represents lipoma. Paraspinous soft tissues are otherwise within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine as detailed above. There is effacement of the left lateral recess related to disc protrusion at the L5-S1 level which may be impinging on the descending left S1 nerve root. Additional levels of foraminal stenosis as detailed above. There is mild to moderate spinal canal stenosis at L4-L5.2. Incidentally noted is a T1 and T2 hyperintense lesion involving the right piriformis muscle which likely represents a lipoma.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: cva History: left sided sensory changes. Brain MRIThere is no restricted diffusion on diffusion weighted image indicating no evidence of acute ischemic infarct.T2-weighted axial scan as well as T1 weighted sagittal scan of brain shows no evidence of abnormal finding.In particular, the ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection on this scan. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate wide neck vascular bulge on the top of basilar artery. The size of vascular bulge is measured about 1.6mm x 3.3mm suggesting possible top of basilar artery aneurysm. However, the spatial resolution of this brain MRA is low thus cannot be confirmatory for this small size lesion. Therefore, if clinically indicated, CT angiography can be considered for further imaging evaluation.Otherwise, bilateral ICAs, MCAs and ACAs appear to be normal.

Output: 1. Limited study. No evidence of acute ischemic lesion on this scan. No evidence of mass or fluid collection. Ventricular system appears to be normal.2. Possible wide neck top of Basilar artery aneurysm (1.6mm x 3.3mm). Otherwise unremarkable. CT angiography can be considered for further imaging evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: 69-year-old male with syncope. There is no evidence of intracranial hemorrhage, mass or edema. Lacunar changes within the left basal ganglia and diffuse hypodensity within a periventricular and subcortical white matter distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: Reason: patient with retroperitoneal fibrosis around aorta. Has had CT abdomen before. Evaluate for any progression/ improvement. ABDOMEN:LIVER, BILIARY TRACT: Punctate T2 hyperintense lesion in segment II is suggestive of a benign cyst. No additional focal hepatic lesion is identified. There is no abnormal enhancement. The gallbladder is normal. There is no intra or extra hepatic biliary ductal dilatation.SPLEEN: A small splenule is noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney again appears atrophic with small renal cysts. Additional punctate T2 hyperintense lesions in the left kidney also are compatible with benign cysts. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: Again seen is infrarenal periaortic and aortocaval soft tissue density, which extends inferiorly, to the level of the aortic bifurcation, which appears minimally improved when compared to the prior study accounting for differences in technique.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Retroperitoneal fibrosis encasing the infrarenal aorta/IVC and inferior mesenteric artery appears minimally improved.


Instruction: Generate impression based on findings.

Input: Seven year old male evaluate for facial fracture/ICH CT of brain.No evidence of calvarial fracture is identified. Mastoid air cells and paranasal sinuses are unremarkable. No evidence of intracranial post traumatic finding. No evidence of edema, mass effect, hemorrhage, midline shift is detected. There is however a slight prominence of the lateral ventricles which although may be within normal limits possibility of hydrocephalus cannot be entirely ruled out an MRI examination is recommended.CT of the maxillofacial region.The paranasal sinuses are well pneumatized. The regional maxillofacial demonstrate no evidence of fracture. No definitive evidence of any soft tissue abnormality is detected.

Output: 1.No evidence of maxillofacial fracture.2.No evidence of post traumatic findings on CT of brain.3.Slight prominence of lateral ventricles as detailed.


Instruction: Generate impression based on findings.

Input: Right neck/arm pain: evaluate for stenosis, herniation. There is an eccentric right disc extrusion with 8 mm of superior migration at C6-7 that results in effacement of the right lateral recess with flattening of the right hemicord and moderate medial right neural foramen stenosis. Otherwise, there is no spinal cord signal abnormality and no significant disc bulges or herniations at the other levels of the cervical spine. There is loss of the usual cervical lordosis in the sagittal plane. The vertebral body heights are preserved, however. The vertebral bone marrow signal is unremarkable. The paraspinal soft tissues and imaged intracranial structures are unremarkable.

Output: An eccentric right disc extrusion with superior migration at C6-7 exerts mass effect upon the right aspect of the spinal cord and moderately narrows the medial aspect of the right neural foramen.


Instruction: Generate impression based on findings.

Input: Tender lesion fourth digit Examination of the right hand reveals a soft tissue mass along the volar lateral aspect of the fourth proximal phalanx. The lesion measures approximately 11 x 23 mm and extends from just distal to the proximal inner phalangeal joint to just distal to the distal interphalangeal joint. The lesion is homogeneously of increased signal on the T2-weighted images and isointense with muscle on the T1-weighted images. With intra-articular gadolinium there is peripheral enhancement with a central area of nonenhancement. The walls of this lesion are somewhat thickened.

Output: Most likely a synovial cyst of the fourth digit. Somewhat unusual in that it has a thickened wall. The diagnosis could be confirmed with aspiration.


Instruction: Generate impression based on findings.

Input: 49-year-old female with history of knee pain. MENISCI: There is mild intrasubstance signal abnormality within the medial meniscus likely representing degeneration, but we see no discrete meniscal tear. There is obliquely oriented linear signal intensity within the periphery of the posterior horn of the lateral meniscus extending to the far peripheral aspect of the undersurface. While this may represent the interface of the meniscus with the meniscofemoral ligament of Wrisberg, its relatively lateral location within the posterior horn is more suggestive of a tear. Please note that this may represent an acute tear or a chronic healed tear given its position in the meniscus, and is of questionable current clinical significance. There is also poorly defined globular signal abnormality within the anterior horn of the lateral meniscus indicating degeneration with probable undersurface fraying.ARTICULAR CARTILAGE AND BONE: There is edema-type signal within the posterior aspect of the lateral tibial plateau subjacent to the aforementioned lateral meniscal tear. There is mild superficial fraying of the articular cartilage of the lateral tibia plateau more anteriorly and medially. There is mild degeneration of the posterior articular cartilage of the lateral femoral condyle. There is focal degeneration of the articular cartilage along the posterior aspect of the medial femoral condyle compatible with degeneration. There is moderate degeneration of the articular cartilage of the patella as well as focal degeneration of the articular cartilage of the trochlea inferiorly and centrally. There are small tricompartmental osteophytes.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The quadriceps fat pad appears edematous which is of questionable clinical significance. The extensor mechanism is otherwise intact.ADDITIONAL

Output: 1.Findings suggestive of a tear of the peripheral fibers of the posterior horn of the lateral meniscus.2.Osteoarthritic changes as described above.


Instruction: Generate impression based on findings.

Input: 9-year-old female with history of relapsed neuroblastoma presenting with right lower extremity numbness and tingling. Brain:The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement within the brain. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is heterogeneous bone marrow signal throughout the skull with a few areas of focal signal abnormality such as in the left frontal bone where there is enhancement suspicious for metastases. No large lesions or evidence of epidural tumor.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.  Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a mottled appearance to the marrow of the cervical spine associated with some foci of signal loss and some vertebrae. Small focus of contrast enhancement is present along the posterior and right aspect of the odontoid of the C2 vertebra. There is an enhancing lesion present between the spinous processes of C7 and T1 measuring 12 x 8 mm on sagittal images, eccentric to the left side.The cervical spinal cord has normal signal characteristics and overall morphology.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment. There is mild loss of vertebral body height at T6 and T10, compatible with pathologic fracture. There is a heterogeneous signal present within the upper thoracic vertebrae. There is T1 signal hyperintensity throughout the vertebrae most prominent at T1, T5, T10, T11 and T12. There is contrast enhancement within T6, T8, and T10 centrally.There are multiple enhancing paravertebral lesions present along the thoracic spine. One located to the left of the T2 vertebral body measures 18 x 9 mm on axial images and one to the right of the T2 vertebral body measures 8 x 13 mm axial images (series 55 image 6). There is a 30 x 13 mm lesion to the left of the T4 vertebral body, which enters the left T4-5 neural foramen and mildly effaces the posterior left epidural space (series 55 image 12). There is also evidence of mild epidural tumor at the T8 level. The thoracic spinal cord has normal signal characteristics and overall morphology. There are 2 lesions in either side of the T3 spinous process present measuring 18 x 11 mm on the right and 13 x 22 mm on the left in axial dimensions. Multiple additional smaller lesions are present between spinous processes of other levels throughout the thoracic spine.There is no significant disk bulge or herniation throughout the thoracic spine.Lumbar spine:The lumbar vertebral bodies are normal in overall alignment and height. The conus medullaris and distal spinal cord are normal. There are contrast enhancing foci present at L4. There is T1 signal hyperintensity throughout the L1 and L2 vertebrae. This is suspected represent radiation effect. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. There are marrow replacing lesions present within the iliac bones and sacrum. An enhancing lesion is present in the left half of the sacral spinal canal, which is incomplete visualized on today's examination. The tumor involvement along the left sacral nerve roots was better appreciated on the previous examination. The left presacral lesion is partially visualized.

Output: 1. Extensive paraspinal and osseous spinal metastases, similar to the prior examination. Metastatic lesions at T4-5 and T8 levels again demonstrate mild epidural extension. Neural foraminal tumor is most conspicuous at the left T4-T5 level. No evidence of significant cord compression, abnormal cord signal, or metastatic spinal cord lesion.2. No evidence of intracranial metastatic disease. Nonspecific heterogeneous bone marrow signal and enhancement in the calvarium, which could relate to metastatic involvement, particularly of the left frontal bone.3. Partially visualized small left-sided epidural lesion within the left sacral spinal canal with evidence of involvement of the left sacral nerve roots better evaluated on prior examination. Lumbar spinal canal and lumbar neural foramina are patent.


Instruction: Generate impression based on findings.

Input: 63 year old woman with GBM. Rule out bleed. There is no evidence of acute intracranial hemorrhage.Patient is status post left temporal craniotomy and left temporoparietal tumor resection. A resection cavity is present in the left temporoparietal region. The temporal horn of the left lateral ventricle is dilated, reflecting volume loss. Left-sided periventricular hypoattenuation and mild dilation of the body of the left lateral ventricle are present -- these findings likely reflect treatment-related gliosis/edema and volume loss. Meningeal thickening is present along the left greater wing of the sphenoid and the left temporal bone -- this is likely postoperative in nature. The study is inadequate to assess for the presence of residual or recurrent tumor -- recommend contrast enhanced MRI for this purpose.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT evidence of acute intracranial hemorrhage.2. Postoperative findings of left temporoparietal tumor resection as detailed above.


Instruction: Generate impression based on findings.

Input: A 41 year old female with fatigue, a mild systolic left ventricular dysfunction, left bundle branch block and a strong family history of cardiomyopathy. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 122 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), the LVESV is 64 ml (normal range 31+/-10), the LV mass index is 35 g/m2 (normal range 67+/-11), and the LV mass is 62 g (normal range 114+/-24). There is septal bounce compatible with left bundle branch block. Normal wall thickness. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Normal native myocardial T1-times suggesting no intersitial fibrosis.No enhancement in T2-weighted images suggesting no active inflammation/edema.No intracavitary thrombus was noted.No myocardial iron overload was noted.Left AtriumThe left atrium is normal in size (60ml).Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 61 ml/m2 (normal range 69+/-14), the RVEDV is 109 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 48%. There is septal bounce compatible with left bundle branch block. Normal wall thickness. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Normal native myocardial T1-times suggesting no intersitial fibrosis. No enhancement in T2-weighted images suggesting no active inflammation/edema.3. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 49%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with arm numbness and tingling. Assess for myelopathy. Mild reversal of the expected cervical lordosis is seen, likely positional and/or related to degenerative disease. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is observed.The visualized spinal cord demonstrates normal signal intensity and morphology. No evidence of myelopathy is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing.C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis.

Output: 1.Relatively mild degenerative findings with no significant spinal canal or foraminal stenosis.2.Normal appearance of the spinal cord with no findings to suggest myelopathy.


Instruction: Generate impression based on findings.

Input: Chronic daily headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small retention cyst in the left maxillary sinus.

Output: No evidence of intracranial mass or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with cervical myelopathy, left forearm is small, abnormal EMGs, abnormal cervical spine plain films. Slight retrolisthesis of C6 relative to C7 is seen. Sagittal alignment is unremarkable. Mild degenerative loss of vertebral body height is seen at C5 and C6. Vertebral body morphology is otherwise unremarkable. No pathologic marrow replacement is identified.The visualized spinal cord demonstrate normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Disc osteophyte formation with a central superiorly directed disc extrusion. Mild impingement of the ventral cord without cord signal abnormality. Mild right foraminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C5-6: Posterior disc-osteophyte complex formation resulting in effacement of the ventral thecal sac but no significant cord impingement or generalized spinal canal stenosis. Severe bilateral foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. The right mastoid air cells are opacified. The partially visualized thyroid gland appears to be enlarged.

Output: 1.Disc osteophyte formation and a central disc extrusion at C3-4 results in mild spinal cord impingement.2.Disc osteophyte formation at C5-6 and C6-7 causes effacement of the ventral thecal sac and significant bilateral foraminal stenosis.