Instruction: Generate impression based on findings.

Input: Diagnosis: Tuberous sclerosisClinical question: Please re-eval for tubers, SEGAs, other abnormalities with tuberous sclerosisSigns and Symptoms: tuberous sclerosis, childhood epilepsy The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal craniotomy. There is a CSF tract extending through the left frontal lobe into the left frontal horn surrounded by T2/FLAIR signal hyperintensity and local volume loss. A focus of punctate susceptibility is present at the left frontal horn adjacent ot the foramen of Monro.Foci of cortical signal hyperintensity of FLAIR MRI are present in the left frontal lobe at the left middle and inferior frontal gyri, left post central gyrus, right frontal lobe including superior frontal gyrus, right inferior parietal lobule, right middle temporal gyrus, left middle temporal gyrusNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple cortical tubers.2.Status post left frontal horn and frontal lobe surgery. Please correlate with clinical history.3.Left ventricular ependymal lesion may represent a small subendymal nodule versus post surgical effect.


Instruction: Generate impression based on findings.

Input: Male 28 years old Reason: right knee pain History: right knee pain Bone mineralization is normal. Alignment is anatomic. There is a small joint effusion. There is a subtle cortical depression involving the lateral femoral condyle compatible with a contusion injury.Contralateral left knee is unremarkable.

Output: Small joint effusion, other findings detailed above.


Instruction: Generate impression based on findings.

Input: 63-year-old female with ankle pain, chronic posterior tibial insufficiency. TENDONS: There is increased linear fluid signal abnormality within the peroneus longus tendon consistent with a interstitial/longitudinal split tear. There is increased linear signal abnormality within the distal Achilles tendon consistent with an interstitial/longitudinal split tear. The flexor and extensor tendons appear intact.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized portions of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is narrowing of the subtalar joint with subchondral cyst formation within the calcaneus, likely degenerative in etiology. Otherwise no bone marrow signal abnormality is identified.ADDITIONAL

Output: 1. Interstitial tearing of the Achilles tendon.2. Interstitial tearing of the peroneus longus tendon.3. Degenerative changes and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: R proximal tibia mass present for 1 yr, not expanding but now painful, evaluate for malignancy History: R knee painful mass A mass is located in the soft tissues anterolateral to the proximal tibia, with nonspecific MRI features including high T2 signal and low T1 signal, as well as thick walls with inhomogeneous peripheral enhancement. No calcification is seen within the surrounding soft tissues. The mass does not cause cortical destruction or local invasion of the bone. There is marked increase in red marrow signal likely related to patient's known sickle cell disease.While this study was not protocoled for routine knee, the ligaments and tendons appear grossly normal.

Output: 1.Soft tissue mass anterolateral to the tibia with nonspecific MRI features, which may represent an irregular ganglion cyst, although thickened walls and inhomogeneous enhancement make this less likely. No aggressive features are identified. Tissue sampling is recommended.2.Diffuse increase in red marrow signal related to patient's known sickle cell disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: low back pain and bilateral leg pain Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal. There is a broad based posterior right paramedian disk extrusion present with extruded disk material which extend behind the adjacent endplates. It mildly encroaches on the right exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine: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.At L4-5 the patient is status post right hemilaminectomy. There is loss of disk space height and disk dessication at this level associated with a broad based right paramedian dis protrusion which extends across the midline and encroaches the nerve roots at the lateral recesses bilaterally - right more than left.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Status post L4-5 right hemilaminectomy where there is a right paramedian disk protrusion affecting the nerve roots at the right lateral recess and to a lesser the gree the left lateral recess.2.There is a right paramedian disk extrusion at C5-6 without significant compromise to the spinal canal. It mildly encroaches on the right exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a focus of relative hypoenhancement centered within the right pituitary gland measuring 8 mm transverse x 6 mm craniocaudal x 12 mm AP dimensions (previously 16 mm transverse by 13 mm craniocaudal by 14 mm AP dimensions), best demonstrated with dynamic coronal imaging. Previously demonstrated entry into the right cavernous sinus is no longer apparent. As before, it displaces the pituitary stalk to the left. It continues to demonstrate significant decrease in size, and does not approach the optic apparatus. Limited evaluation of the intracranial contents remains unremarkable.

Output: Continued decrease in size of a right pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: Female, 86 years old, altered mental status after right hip surgery, concern for ischemia. MRI:Two punctate foci of high signal on diffusion weighted images are seen within the right corona radiata. These show corresponding FLAIR hyperintensity, but no definite ADC correlation.Otherwise, no restricted diffusion is seen. Scattered small foci of T2 hyperintensity are seen within the periventricular white matter. No parenchymal edema or mass effect is detected. No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are within normal limits for size and morphology.On postcontrast images, a 2-mm focus of enhancement is seen along the cortex of the lower left parietal lobe (image 3 series 19). No other pathologic parenchymal or extra-axial enhancement is detected.MRA:Aortic branching is conventional. The origins of the great vessels are patent. No significant stenosis is seen within the carotid vasculature of the neck (by NASCET criteria). Likewise, no significant stenosis is seen within the vertebral vasculature of the neck.Intracranially, no evidence of high-grade vascular stenosis or occlusion is seen. No aneurysms are detected within the limitations of technique.

Output: 1. No definite acute ischemia. Two punctate foci of hyperintense diffusion signal within the right corona radiata could represent small resolving ischemic lesions or T2 shine through artifact.2. Relatively mild chronic microvascular ischemic disease.3. A single 2-mm focus of enhancement is seen within the lower left parietal cortex, a finding which is of uncertain etiology and significance. However, given the history of multiple prior cancers, a follow up examination should be performed to assess for the possibility of metastatic disease.


Instruction: Generate impression based on findings.

Input: 41-year-old female with paresthesias and previous abnormal brain MRI, evaluate for progression The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images, unchanged over the interval. There are no new lesions, and there are no posterior fossa lesions.The patient is status post suboccipital craniotomy for Chiari I, unchanged in appearanceMild gyral asymmetry between the parietal lobes is stable and may simply represent a developmental asymmetry.There is a redemonstration of a small focus of susceptibility effect in the right centrum semi-ovale associated with central T2 and flair signal hyperintensity, unchanged in appearance, and consistent with a developmental venous anomaly which may be associated with a small cavernous malformationNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Stable periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They are not specific and could be vascular related, related to demyelination, trauma, vasculitis, or sarcoid. However, they have not changed significantly when compared to the previous exam.2.Stable postsurgical changes from prior suboccipital craniotomy for Chiari decompression.


Instruction: Generate impression based on findings.

Input: Abdominal painEXAMINATION: MR enterography without and with IV contrast 5/5/2016 ABDOMEN:LIVER, BILIARY TRACT: Mildly distended gallbladder without stones or sludge. No focal lesions are identified in the liver. There is no biliary ductal dilatation.SPLEEN: The spleen is normal in size and signal intensity.PANCREAS: Normal pancreatic parenchyma. No peripancreatic fluid.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: kidneys and uretersRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:There is no evidence of abnormally thickened or enhancing loops of bowel. There is no evidence of bowel obstruction. Adequate peristalsis is noted on the CTA views. There are no strictures or fistulas.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple cystic lesions in the left and right adnexa likely represent benign ovarian follicles.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The large and small bowel are normal in caliber. No focal lesions are identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Normal MR enterography.


Instruction: Generate impression based on findings.

Input: 33-year-old female with metastases. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no evidence of obstruction. There is abnormal enhancement and corresponding restricted diffusion involving a medium length segment of colon which is persistently decompressed. The terminal ileum is aperistaltic and dilated with fecalization present. There is no discrete narrowing or abnormal enhancement of the ileocecal valve. Underlying incompetence is not excluded.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Abnormal enhancement and corresponding restricted diffusion of a persistently decompressed sigmoid and descending colon may reflect acute on chronic inflammation.2.Aperistaltic and dilated terminal ileum with fecalization present. There is no discrete narrowing or abnormal enhancement of the ileocecal valve. Underlying incompetence is not excluded.3.Gastric distention with debris is present without obvious active disease to explain this finding.


Instruction: Generate impression based on findings.

Input: 35-year-old male with pituitary tumor, evaluate for changes, growth. Yearly surveillance. Unchanged 7 mm x 8 mm x 9 mm heterogeneously hypoenhancing mass in the anterior pituitary gland extending into the optic chiasm without significant mass effect. The pituitary stalk remains deviated to the right. There is symmetric enhancement of the cavernous sinus with no evidence of tumor involvement.

Output: Unchanged pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: There are foci of T2 hyperintensity throughout the white matter as well as within the pons and the right cerebellar hemisphere without mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Note is made of a hypoplastic right vertebral artery. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 53 year old female status post left lumpectomy in 2010 for left breast ALH and LCIS. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. An X-shaped biopsy clip is present in the left upper outer quadrant, and a bar-shaped biopsy clip is present in the left lower inner quadrant at the site of a prior MRI biopsy. Amorphous clusters of calcifications are identified bilaterally and unchanged from prior studies dating back to 2010.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.

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


Instruction: Generate impression based on findings.

Input: 65 year old man with history of HTN, new LV dysfunction and rectal cancer referred for stress MR as part of ischemic evaluation.MEDICATIONS: carvedilol, lisinopril, aspirin, spironolactone First Pass PerfusionDuring hyperemia, there were no perfusion defects observed.Viability/ Myocardial ScarThere was a prominent mid-wall stripe pattern of late gadolinium enhancement which is atypical for previous myocardial infarction, seen in the basal to mid septum, and inferior wall. This has been described in dilated cardiomyopathy. No evidence for previous myocardial infarction.Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 147 ml/m2 (normal range: 74+/-15), the LVEDV is 238 ml (normal range 142+/-34), the LV end systolic volume index is 93 ml/m2 (normal range 25+/-9), the LVESV is 150 ml (normal range 47+/-19), the LV mass index is 72 g/m2, and the LV mass is 116 g. There is borderline LVH (wall thickness of 10-11mm). There is global hypokinesis with regional variation, but notable abnormalities in the regions associated with late gadolinium enhancement as above.Left AtriumThe left atrium is moderate-severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 117 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely, is trileaflet, and there is qualitatively moderate aortic regurgitation.Mitral ValveThe mitral valve leaflets are tethered with thickening of the leaflet tips. There is mild mitral regurgitationPulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects with stress.2. No prior myocardial infarction, however there is a prominent pattern of mid-wall late gadolinium enhancement throughout the basal-mid septum and basal-mid inferior wall with associated significant wall motion abnormalities. While this has been described in dilated cardiomyopathy, this could also suggest infiltrative, inflammatory or fibrotic disease. 3. Severely dilated LV size with moderate-severely reduced systolic function (LVEF 37%).4. Normal RV size and mildly reduced systolic function (RVEF 46%).5. At least moderate aortic regurgitation with a trileaflet aortic valve.6. Mitral valve tethering with mild mitral regurgitation.7. Biatrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Low back painClinical question: Vertebro-basilar insufficiency. Occipital neuralgia. Spinal stenosis in the cervical spine. MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. Signal hyperintensity is present along the right anterior aspect of the medulla best identified on T2 imaging. This was also present on the previous exam.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid 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 left vertebral artery flow-void is present. The right vertebral artery is slightly smaller than the left vertebral artery but there is no flow void appreciated.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the right posterior cerebral artery. The right P1 segment is medium-sized. The left posterior communicating artery is very small..No intracranial flow is identified in the right vertebral artery. There are tandem stenoses present along the basilar artery. One is located between the level of the anterior inferior cerebellar arteries and the superior cerebellar arteries and has approximately 80% stenosis which has not changed since the prior exam; it is located closer to the anterior inferior cerebellar arteries than the superior cerebellar arteries. On the 10/23/2012 exam this stenosis was not present. Another between the vertebrobasilar junction and the anterior inferior cerebellar arteries has 70% stenosis which has not changed significantly since the prior exam, however, it appears more stenotic than the 2012 exam.. No flow is identified in the distal intracranial right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and left vertebral artery. 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 left vertebral artery. The right ascending cervical artery is fairly prominent. The right vertebral artery is occluded at its origin.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is ossification of the posterior longitudinal ligament present extending from the C2-3 level down to the C4-5 level associated with spinal stenosis. Spinal stenosis appears to be progressing gradually over time. When compared to the 2011 exam the spinal canal appears smaller on the current exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is narrowing of the right neural foramen. There is some narrowing of the AP dimension of the spinal canal due to ossification of the posterior longitudinal ligament at this level. These findings are stable compared to the prior exam.At C3-4 there is a ossification of posterior longitudinal ligament present this level associated with the effacement of spinal fluid ventral and posterior the spinal cord at this level and some mild flattening of the spinal cord. Effacement of the spinal fluid ventral and posterior to the spinal cord extends from the mid C3 vertebral level to the mid C4 vertebral level. There is encroachment of the exiting nerve roots bilaterally within the neural foramina at this level. These findings are stable compared to the prior exam.At C4-5 there is ossification of the posterior longitudinal ligament associated with a disc bulge and ligamentum flavum hypertrophy associated with effacement of spinal fluid ventral and posterior to the spinal cord. There is mild flattening of the spinal cord. Overall there is moderate spinal stenosis at this level. There is encroachment of the exiting nerve roots within the neural foramina. These findings are stable compared to the prior exam.At C5-6 there is no significant compromise to the spinal canal. There are some uncovertebral osteophytes present on the right-sided this level associated with disc material and mild narrowing of the right neural foramen. These findings are stable compared to the prior exam.At C6-7 there is no significant compromise to the spinal canal. There is narrowing of the neural foramina bilaterally at this level due to uncovertebral osteophytes and disc bulge. These findings are stable compared to the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The left vertebral artery flow void is appreciated. The right vertebral artery has hyperintense signal within it on T2 imaging.

Output: 1.Tandem high-grade stenoses along the basilar artery. These are stable compared to the prior exam of 12/8/2014. Although not significantly different compared to last year's exam, compared to the 2012 exam, there appears to be progression of basilar artery stenoses.2.Occlusion of the right vertebral artery at its origin. No flow is appreciated in the right vertebral artery intracranially. 3.There is moderate spinal stenosis present in the upper cervical spine worse at the C3-4 and C4-5 levels related to ossification of the posterior longitudinal ligament and degenerative change. This is gradually progressed over the years. It is not significantly different than the 2014 exam, however, it appears to have progressed since 2011.4.There is encroachment of exiting nerve roots within the neural foramina of the cervical spine at C3-4 , C4-5 and C6-7.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 6.There is no evidence for acute cerebral infarction.7.Old lacunar infarction along the anterolateral aspect of the right medulla.


Instruction: Generate impression based on findings.

Input: Please note this examination is technically degraded, particularly the axial T2 fat-sat sequences. Coronal STIR images demonstrate grossly symmetric T2 hyperintensity involving the nerve roots of the brachial plexus proximally. There is suggestion of asymmetrically increased T2 hyperintensity involving the left C6 and C7 nerve roots and to a lesser degree C8 nerve roots more distally; findings seen on axial series 6 images 18 and 19; coronal STIR series 4 image 17. In retrospect, there appears to be subtle increased T2 signal involving the left C6 to left C8 nerve roots in the same region on prior brachial plexus MRI studies.No lymphadenopathy or extrinsic masses within the neck are appreciated. There is volume loss involving the left sternocleidomastoid muscle which was present on prior CT. Degenerative changes in the cervical spine are partially imaged.

Output: Examination is suboptimal in quality and if clinically indicated repeat examination may be considered. There is however suggestion of subtle increased signal involving the distal aspects of the left C6 to C8 nerve roots which in retrospect also appears to be present on prior MRI from 1/13/2011 and 8/4/2009 studies. Findings may represent sequela of prior radiation. No obvious lymphadenopathy or masses to suggest extrinsic compression are appreciated. MRI with gadolinium may be helpful to identify the areas of scarring if surgery is contemplated.


Instruction: Generate impression based on findings.

Input: 32-year-old female with fatigue and memory loss with a T10 sensory level on the left. Evaluate for interval change. Note differences in technique limit comparison with the current study performed with high-resolution. Redemonstrated are multiple supratentorial periventricular and subcortical white matter lesions with morphology and distribution compatible with patient's known history of multiple sclerosis. Many of these lesions have become more conspicuous compared to the previous exam which is favored to be related to technique differences. No new, relatively large lesion to definitively suggest progression. There is mild burden of T1 hypointense lesions. No significant parenchymal volume loss.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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple T2/FLAIR hyperintense lesions with morphology and distribution consistent with known demyelinating disease. Allowing for slight differences in technique, there is no clear evidence of progression compared to 1/31/2016.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 35 years old Reason: cause for abdominal pain: acute on chronic pancreatitis Vs active Crohn's disease? History: abdominal pain, increased CRP. The patient was unable to tolerate the full dose of enteric contrast. Patient also had difficulty following breathing instructions which somewhat limits image quality. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: Findings suggestive of chronic pancreatitis with unilocular cysts identified in the pancreatic head, stable in appearance compared to prior study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is marked gastric dilatation which may in part relate to contrast ingestion as per CT enterography protocol or may relate to chronic narcotic use. There is above average stool burden and marked dilatation of the entire colon which again may relate to chronic narcotic use. There is abnormal dilatation of the small bowel measuring up to 3.8 cm. Long segment of mural thickening and luminal involving the distal ileum with intervening skip lesions. There is asymmetric abnormality of the mesenteric wall and pseudo-sacculations. The appearance is suggestive of acute or chronic inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Intrauterine device within the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Long segment of distal ileum abnormality suggestive of acute on chronic inflammation with intervening skip lesions. The proximal small bowel is dilated suggesting a partial bowel obstruction.2. Gastric and colonic distention which is likely related to chronic narcotic use. 3. Chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: Evaluate for new stroke History: Multiple episodes of lightheadedness w behavioral change, loss of bowels. History of stroke and TIA There is a small focus of diffusion restriction in the left peritrigonal white matter. There is prominence of the cortical sulci in proportion to cerebral ventricles consistent with global volume loss. There are numerous foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter. Several scattered lacunar infarcts are demonstrated in the bilateral centrum semiovale. There is a punctate focus of gradient susceptibility in the left thalamus likely relating to mineralization or chronic hemosiderin deposition. No midline shift or mass effect is appreciated. No intracranial fluid collections are visualized.

Output: 1. There is a punctate area of acute ischemia in the left peritrigonal white matter.2. Global volume loss and white matter changes consistent with advanced small vessel ischemic disease, progressed since 3/7/2010.


Instruction: Generate impression based on findings.

Input: Chronic lymphocytic thyroiditis. Rule-out nodules RIGHT LOBE MEASUREMENTS: 6.6 by 1.9 x 2.5 cmLEFT LOBE MEASUREMENTS: 6.1 x 1.7 x 1.7 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous with scattered nodules. The largest is slightly complex but mostly hypoechoic, located posteriorly at the lower pole and measures 1.4 x 0.9 x 1.6 cm.LEFT LOBE: Diffusely heterogeneous with scattered nodules. The largest measures 6 mm and is located at the equator.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Subcentimeter lymph nodes bilaterally.OTHER: No significant abnormality noted.

Output: Diffuse heterogeneous thyroid with scattered nodules as described above.


Instruction: Generate impression based on findings.

Input: 49 old woman with transient left-sided weakness since morning an ongoing left weakness. There is no evidence of intracranial hemorrhage, mass or edema. No CT findings of acute stroke. However if acute stroke is of clinical concern, recommend MRI.The ventricles and basal cisterns are normal in size and configuration. A partially empty sella, a nonpathologic finding, is noted.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT findings of acute intracranial abnormality. If stroke is a clinical concern recommend MRI.


Instruction: Generate impression based on findings.

Input: Right facial numbness. There is apparent punctate focus of enhancement along the cisternal segment of the right trigeminal nerve, without discernible mass lesions otherwise. There are small vascular flow voids adjacent to the right trigeminal nerve, without apparent impingement upon the nerve. The bilateral Meckel caves and cavernous sinuses are unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: An apparent punctate focus of enhancement along the cisternal segment of the right trigeminal nerve may represent a normal vascular structure, without discernible impingement upon the nerve. Nevertheless, a follow MRI of this region may be useful for further assessment, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Cervical spine:The cervical spine is in normal alignment with normal cervical lordosis. The vertebral body and disc heights are well-maintained. There is no worrisome focal neural signal abnormality appreciated. No evidence of spinal stenosis.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The thyroid gland is heterogeneous and markedly enlarged.Lumbar spine: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 loss of disc space height disc desiccation and a disc bulge with no significant narrowing of the neural foramina. There are some endplate reactive changes present at this level which have high signal on T2 and intermediate signal on T1 suggesting subacute reaction.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.2.There are minor degenerative changes present in the cervical spine which is stable compared to the previous exam.3.Markedly enlarged thyroid gland.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 60-year-old woman history of left mastectomy for invasive ductal carcinoma in 2011, no chemotherapy, presents with status post excisional biopsy with pathology showing invasive ductal carcinoma grade 2 involving the dermis and underlying adipose tissue. The patient submitted outside study for review. Submitted for review are breast MRI (7/15/2015) performed at North Shore Hospital. For comparison,standard mammogram (7/8/2014) and ultrasound (6/25/2015) are available. MRI

Output: Known recurrence of malignancy in the left reconstructed breast. Postsurgical changes of left mastectomy and reconstruction with implant intact. Two enhancing foci in the left reconstructed breast correlating with ultrasound findings- an 8 mm mass at the 11:00 position and a 4 mm mass in the 4:00 position.A 6 mm enhancing mass in the right breast 9:00 position is likely an intramammary lymph node. An ultrasound can be performed to further evaluate this finding.Normal axilla bilaterally.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: 58 yo F with metastatic NSCLC to brain, eval for number of mets The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate enhancing lesion present in the right cerebellar hemisphere in the inferior semilunar lobule. A similar sized lesion is present in the left inferior semilunar lobule of the left cerebellar hemisphere. Another punctate lesion is present along the posterior aspect of the right pons which was also present on the prior exam.A couple lesions along the right inferior parietal lobule are not readily identified on the current exam.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 are several punctate lesions present in the cerebellar hemispheres and pons which are suspicious for metastatic disease. Lesions previously identifiable in the right inferior parietal lobule are not readily identified on the current exam. Please note that the visualized lesions are less conspicuous on the current exam versus the prior exam.2.Please note that this examination is somewhat limited and specifically acquired for the purpose of stereotactic guidance during treatment.


Instruction: Generate impression based on findings.

Input: 65-year-old on with history of cyst in the neck of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal hepatic lesions are identified.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal.PANCREAS: Within the neck of the pancreas (6/26) there is a 21 x 17 mm T2 hyperintense lesion with thick wall and minimal internal septation. Although there is no nodular enhancement within this lesion, there is minimal complexity and internal enhancement. Additionally, this lesion appears to have a small taillike extension which connects to the pancreatic duct (700/27).The patient has pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesion in the neck of the pancreas with thick wall, internal septations, and mild enhancement. This could represent a sidebranch IPMN or a mucinous lesion.2.Pancreas divisum.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with history of stroke and residual deficits (expressive aphasia, left-sided weakness), now with worsening mental status, unable to respond to questions or simple commands. Concern for new stroke. Image quality is degraded by significant motion artifact. Within this limitation, the following observations are made.Large areas of encephalomalacia are redemonstrated involving the left parietal, occipital and temporal lobes, and the right middle frontal gyrus. These lesions appear similar to the prior MRI. Encephalomalacia in the right occipital lobe is new from the prior MRI but unchanged relative to a CT from 2012. Numerous small, chronic cerebellar infarcts are also unchanged. No evidence of restricted diffusion is seen to suggest acute ischemia.Ill-defined periventricular T2 hyperintensity has progressed from the prior examination. Ventricles and sulci are prominent compatible with volume loss. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: 1.Evidence of extensive bilateral chronic ischemia is seen, largely within the MCA distributions, showing no significant change from prior exams.2.Findings compatible with moderate chronic microvascular ischemic disease have progressed from prior.3.No evidence of acute ischemia or any other definite acute intracranial abnormality. No new findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses.

Output: Negative noncontrast cervical spine MRI. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female 64 years old Reason: is there a portosystemic shunt? We are especially concerned for left gastric artery shunt History: Acute worsening Hepatic encephalopathy in patient with cirrhosis on adequate treatment. The study is significantly limited by artifact related to motion and intra-abdominal ascites. Consideration could be given to the fluid tap prior to additional MR imaging.ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates cirrhotic morphology. The gallbladder is nondistended and there is gallbladder wall thickening, likely secondary to diffuse ascites. Questionable tiny gallstones, difficult to evaluate given the wall thickening and underdistention. No suspicious liver lesion. Apparent low signal focus within the left hepatic lobe is felt to represent pulsation artifact from the abdominal aorta. The liver demonstrates diffusely T2 hypointense signal and loses signal on in phase images consistent with iron deposition.Due to suboptimal timing of the contrast bolus the celiac and superior mesenteric artery branches are poorly visualized. The intrahepatic IVC is compressed and the hepatic veins are poorly visualized.SPLEEN: Splenomegaly measuring 14.2 cm, slightly reduced compared to prior study. The spleen loses signal on in phase images consistent with iron deposition.PANCREAS: The pancreas loses signal on in phase images consistent with iron deposition.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent upper abdominal and retroperitoneal lymph nodes which can be seen in the setting of cirrhosis.BOWEL, MESENTERY: Diffuse bowel wall thickening, likely secondary to diffuse ascites.BONES, SOFT TISSUES: No significant abnormality noted.Other: Stable moderate to large abdominal ascites. Again seen is left, right and main portal vein dilatation, recanalized umbilical vein and paraesophageal, gastroesophageal, ventral abdominal and splenic varices.

Output: 1.Cirrhotic liver morphology. No suspicious liver lesion.2.Signal loss within the liver, spleen and pancreas on in phase images consistent with iron deposition.3.Stable moderate to large abdominal ascites with multiple collateral vessels as detailed above.4.Visualization of the arteries is poor due to the limitations described above, in particular suboptimal timing of the contrast bolus and the left gastric artery (for which there was clinical concern) is not well seen.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dorsalgia, unspecified Other chronic painClinical question: abscess, osteoSigns and Symptoms: pain, imaging suggestive of osteo The cervical vertebral bodies are appropriate in overall alignment and height. There is thickening of the posterior longitudinal ligament present. There is cord signal hyperintensity centrally at the C5 and C6 vertebral body levels. There is straightening of the normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level. There is mild narrowing of the left neural foramen.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level associated with mild ligamentum flavum hypertrophy. There is cord signal hyperintensity present this level.At C5-6 there is a broad-based central disc protrusion present associated with the effacement of spinal fluid ventral to the spinal cord. There is cord signal hyperintensity and loss of volume at this level. Comparison to an MRI from 8/30/2015 suggests that these findings are long-standing.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based central disc protrusion present at this level. Some disc material extends into the right neural foramen and mildly encroaches on the right-sided exiting nerve root. At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There are T2 hyperintense lesions present in the pons. Incidental note is made of empty sella.

Output: 1.There is a mild to moderate degree of spinal stenosis present at C5-6 related to disc protrusion and uncovertebral and endplate osteophytes. Associated cord signal change and atrophy suggest this could be related to spondylitic myelopathy. Straightening of the normal cervical curvature could give the impression that the stenosis is not is severe as it would be in the extended position. Comparison to an MRI from 8/30/2015 suggests that these findings are long-standing.


Instruction: Generate impression based on findings.

Input: Male, 41 years old, with history of squamous cell carcinoma of the sinonasal region, now with pain at the nasal ridge. Extensive surgical findings are again seen compatible with left orbital exenteration, along with left maxillary and ethmoid resection, resection of the left nasal cavity structures, and partial left rhinectomy.Soft tissue within the left orbital resection bed is stable and demonstrates a pattern of enhancement and signal most compatible with a soft tissue flap construct.No definite evidence of any tumor-like process is seen within or adjacent to the surgical bed. In particular, no new lesions are evident along the nasal ridge.The left frontal sinus and frontoethmoidal recess contain trapped fluid similar to prior exams. The left sphenoid sinus is opacified with mild rim mucosal thickening, new from the prior MRI but similar to the recent prior CT.

Output: 1.Redemonstration of extensive postoperative findings compatible with left orbital exenteration and left sinonasal resection. No evidence of recurrent tumor is seen within the resection bed or along the nasal ridge.2.Stable fluid entrapment within the left frontal sinus and frontoethmoidal recess. Mucosal inflammation and secretions within the left sphenoid sinus are new from prior MRI but similar to recent prior CT.


Instruction: Generate impression based on findings.

Input: Status post orthotopic liver transplant for PSC. Evaluate for recurrent biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement. Compared to the 9/26/2014 study, there is a focal stricture of the right hepatic duct just proximal to Klatskin's point and worsening right and left intrahepatic biliary ductal dilatation. The common hepatic/bile duct is normal in caliber with focal narrowing distally just proximal to the hepaticojejunostomy. The portal vein is moderately narrowed at its anastomosis approximately 50%, improved from the prior. The hepatic veins are patent. The hepatic artery is suboptimally evaluated at the porta hepatis.No focal hepatic lesion. Cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant focal abdominal wall hernia containing small bowel seen on the coronal series 2 image 36 is incompletely evaluated. On coronal series 2 image 22 there is a partially imaged fluid containing structure in the left lower quadrant, likely a bowel loop.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild basilar atelectasis. Left lung base nodular focus is incompletely characterized. ASD occluder device noted.

Output: 1.Focal stricture of the right hepatic duct, increased from prior, and distal common bile duct stricture just proximal to the hepaticojejunostomy, similar to prior. Worsening intrahepatic biliary ductal dilatation. No significant common bile duct dilatation.2.50% narrowing of the portal vein at its anastomosis. Inadequately evaluated hepatic artery. 3. No focal liver lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disturbance of skin sensation. Malignant neoplasm of spinal cordClinical question: assess thoracolumbar tumor/syrinx progressionSigns and Symptoms: progressing RLE numbness > LLE, back pain, imbalance MRI thoracic spine:There is a large complex syrinx which involves the spinal cord from the T5-6 disk space level to the conus medullaris. There appears to be a 61mmx11mm septated cystic lesion from the superior aspect of T6 down to T8-T9. On the 10/23/14 exam this cystic lesion measured 11x48mm and extended from T6-T7 to T8-9 and was not clearly present on the 2/13/2008 exam. Below and adjacent to this cystic lesion there are smaller laterally located spinal cord cystic lesions which were also present in 10/23/2014 but not on 2/13/2008. Below and adjacent those septated cystic lesions there is a larger peripherally enhancing septated cystic lesion extending from the T11-T12 level to the L1 level, measuring 51x14mm sagittal dimensions and on 3/2015 measuring 52x14mm sagittal dimensions. There is rim enhancement associate with this lesion which is thicker on the prior exam relative to the current exam. There is a soft tissue enhancing component along the inferior and right sided aspect of this lesion measuring 10x8x 14mm and previously measuring 11x15x 16mm.The patient is status post T12 and L1 laminectomies. There is a levocurvature to the lumbar spine and a dextrocurvature to the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is a levocurvature to the lumbar spine. The patient is status post T12 and L1 laminectomies. There is a septated cystic lesion extending from the T11-T12 level to the L1 level, measuring 51x14mm sagittal dimensions and on 3/2015 measuring 52x14mm sagittal dimensions. There is rim enhancement associate with this lesion which is thicker on the prior exam relative to the current exam. There is a soft tissue enhancing component along the inferior and right sided aspect of this lesion measuring 10x8x 14mm and previously measuring 11x15x 16mm.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are contiguous complex cystic lesions present within the spinal cord as a complex syrinx and an inferiorly located enhancing lesion as detailed above. The most inferior cystic lesion has peripheral enhancement and is known to represent a thoracic intradural cyst, whose soft tissue component is slightly (but measurably) smaller on the current exam when compared to the March exam. The superior most cystic lesion is larger on the current exam when compared to the October 2014 exam as described above and was not clearly present in the February 2008 exam. There are abutting laterally centered cystic lesions between the above described lesions also present on 10/23/14 but not on 2/13/08.


Instruction: Generate impression based on findings.

Input: History of uterine fibroids. Considering uterine fibroid embolization. PELVIS:UTERUS, ADNEXA: Anteverted uterus.The uterus measures 14.8 x 9.7 cm in the sagittal plane.The endometrium measures 4 mm in thickness, within normal limits.The endometrial and inner myometrial/junctional zone interface is unremarkable.There are 2 well-defined masses compatible with leiomyomata. The largest is a 6.0 x 5.5 cm intramural fibroid in the left posterior fundus demonstrating very low T2-weighted signal intensity and intermediate T1-weighted signal hyperintensity. It demonstrates no postcontrast enhancement.Additional 4.3 x 3.9 cm intramural fibroid in the right posterior fundus is noted. It is isointense to the myometrium on T1 and T2-weighted images. This lesion demonstrates avid postcontrast enhancement.The cervical stroma is normal in signal intensity with a small nabothian cyst at the cervico-vaginal junction. The left ovary measures 2.9 x 1.8 cm containing several physiologic follicles.The right ovary measures approximately 2.9 x 3.8 cm containing several physiologic follicles.Several parauterine vessels are not remarkably dilated.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: Two uterine fibroids with the largest measuring 6.0 cm with imaging characteristics compatible with a nonenhancing hemorrhagic fibroid. Additional 4.3 cm intramural enhancing fibroid.


Instruction: Generate impression based on findings.

Input: Right eye blurred vision. There is diffuse T2 hyperintensity involving the right optic nerve orbital segment, without associated abnormal enhancement. The rest of the optic nerves and bilateral orbital contents are otherwise unremarkable. There is no evidence of orbital mass lesions. The imaged portions of the intracranial structures and sinonasal cavities are unremarkable.

Output: Sequela of right optic neuritis, without evidence of new lesions.


Instruction: Generate impression based on findings.

Input: Reason: stenosis History: RUE paresthesias. MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered subcortical T2 hyperintensities within the parietal lobes bilaterally. 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.MRI cervical spine:There is straightening of the cervical spine, otherwise alignment is anatomic. Multilevel disc desiccation with mild disc space loss at C4-C5, C5-C6 and C6-C7. No abnormal marrow signal. There is increased signal within the posterior cord at C5-C6 extending approximately one vertebral level. Diffuse mild increased signal at C4-C5 adjacent to a disc osteophyte complex more likely likely represents myelomalacia or artifact. C2-C3: No significant spinal or neuroforaminal stenosis. C3-C4: No significant spinal or neuroforaminal stenosis. C4-C5: Mild posterior disc osteophyte complex, asymmetric to the left. No significant central canal stenosis. Minimal left neural foraminal stenosis. No right neural foraminal stenosis C5-C6: Minimal posterior disc osteophyte complex. No significant spinal or neuroforaminal stenosis. C6-C7: No significant spinal or neuroforaminal stenosis. C7-T1: No significant spinal or neuroforaminal stenosis.

Output: 1.Increased nonenhancing solitary focus of increased T2 signal within the posterior spinal cord at C5-C6 is nonspecific. Differential considerations include demyelinating disease and inflammatory etiologies with neoplasm considered unlikely.2.A few subcortical T2 hyperintensities are nonspecific and may represent mild chronic small vessel ischemic disease. Given lesional location and morphology, demyelination is less likely.


Instruction: Generate impression based on findings.

Input: 52-year-old male with history of prostate cancer. Right apex 3+4, right mid 3+4, right base 3+4. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.4 cm.Peripheral Zone: There is a T2 hypointense lesion extending from the right apex to the mid gland into the base with associated restricted diffusion compatible with patient's known adenocarcinoma. Maximal axial dimensions are 1.4 x 0.7 cm (image 7 of series 901).Increased bilateral T1 signal abnormality compatible with hemorrhage, likely from recent biopsy.Central Gland: Mild BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: The aforementioned right peripheral gland lesion seems to extend outside the capsule at the posterolateral margin near the apex.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right peripheral apex/mid gland lesion as above compatible with patient's known adenocarcinoma with probable extracapsular extension at the posterolateral apex.


Instruction: Generate impression based on findings.

Input: Diagnosis: Spina bifida with hydrocephalus, unspecified region. Dizziness and giddiness Syncope and collapse Presence of cerebrospinal fluid drainage deviceClinical question: h/o vp shunt, Chiari malformation with falls and dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post suboccipital craniectomy. The cerebellar tonsils are low lying and pointed. The tips of the tonsils extend to the C1 vertebral level.There is biphasic flow at the level of the foramen magnum on the CSF flow study.A ventriculostomy tube courses through the right frontal lobe into the left lateral ventricle and has its tip in the left basal ganglia. The lateral ventricles are not dilated.There is redemonstration of a T2 hyperintense focus which is low signal on FLAIR and T1-weighted imaging following CSF space on all pulse sequences located in the left thalamus which is stable compared to prior exams.The sella is enlarged and a partially empty. There is a nonenhancing focus present along the left half of the sella against the left cavernous sinus which is unchanged since the prior exam this appearance has been unchanged since the prior exam of 3/21/14 and has been present since exams dating back to 2009 when it was thinner.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The lateral ventricles are stable in size compared to prior exams. The patient is status post suboccipital craniotomy and has Chiari I malformation. There is no change in appearance compared to the prior exam. The patient's ventriculostomy shunt catheter is in stable position.2.There is a nonenhancing lesion in the pituitary fossa, eccentric towards the left side significance is uncertain. It has been stable since the prior exam but was thinner in 2009. The possibility this represents some atelectatic pituitary adenoma cannot be excluded. Please correlate with clinical symptoms. Continued follow-up would be appropriate.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with chronic pain syndrome. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of parenchymal and extra-axial enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Short TE single voxel spectroscopy was performed on regions of predominantly gray matter, predominantly white matter and thalamus. The ratios of the major metabolic peaks are all within normal limits for their respective tissues. No abnormal peaks are identified.

Output: 1.No specific abnormalities are seen on conventional imaging of the brain to account for the patient's symptoms.2.MR spectroscopy of representative regions of the brain (gray matter, white matter and deep gray tissue) is within normal limits. No findings are seen to suggest neuronal injury or metabolic derangement.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out abnormality in patient with upper motor neuron signs (and lower motor). Signs and symptoms: Suspect ALS. Nonenhanced brain MRI:No diffusion-weighted abnormalities.There is no detectable acute intracranial process.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is stated age.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Reason: MS, f/u progression History: paresthesias The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular white matter lesions which are stable when compared to the prior exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. A mild degree of white matter lesions are stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 62-year-old female with a history of osteoarthritis presents with left knee pain. Please note the study is somewhat suboptimal due to patient's morbid obesity.MENISCI: The posterior horn of the medial meniscus is abnormally small which may be secondary to degenerative changes and/or tearing. The anterior horn of the medial meniscus is also abnormally small. The lateral meniscus is intact and unremarkable.ARTICULAR CARTILAGE AND BONE: There is marked loss of articular cartilage, particularly of the medial tibiofemoral compartment. The cartilage of the lateral tibiofemoral compartment is unremarkable. No focal defects are identified in the patellofemoral compartment.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Severe osteoarthritis of the left knee with almost complete loss of hyaline cartilage medially.


Instruction: Generate impression based on findings.

Input: 49 year-old female, evaluate for chondral injury versus meniscal tear MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There are no fluid-filled articular cartilage defects. The articular cartilage appears normal particularly considering the patient's age.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. Round and ovoid foci of low signal intensity within the joint as described above which morphologically appear to represent multiple loose bodies, although no calcified loose bodies are seen on recent radiographs. While PVNS is another consideration, the appearance would be atypical. If further imaging evaluation is clinically warranted, contrast-enhanced MRI may be considered.2. Thickening of the medial patella plica.3. Intact menisci and articular cartilage.


Instruction: Generate impression based on findings.

Input: Sturge Weber syndrome with intractable epilepsy status post radiofrequency ablation for right frontal disconnection. There are postoperative findings related to recent radiofrequency ablation for right frontal disconnection, with foci of high T2 signal adjacent ot the right frontal horn and overlying scalp swelling. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is otherwise unchanged right frontal, right temporo-parieto-occipital, left parietal, left occipital and left temporal atrophy and subcortical calcifications, diffuse leptomeningeal enhancement associated with anomalous venous drainage. 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. Expected postoperative findings related to radiofrequency ablation for right frontal disconnection.2. Other stigmata of Sturge Weber syndrome are unchanged.


Instruction: Generate impression based on findings.

Input: 13-month-old male with DiGeorge syndrome and traumatic brain injury. Per the electronic medical record, the patient was born prematurely and subject to abuse with prior subdural hematoma. There are subdural hematomas along the bilateral cerebral convexities without significant mass effect. The collections are predominantly T1 isointense and T2 hyperintense with the right slightly larger than the left. The right subdural collection also contains a small amount of T1 hyperintense signal, which suggests a recent component. There is marked cystic encephalomalacia in the parietal, occipital, and temporal lobes bilaterally. Milder encephalomalacia changes are present in the right superior frontal lobe. There is severely diminished supratentorial white matter. The lateral and third ventricles are markedly enlarged. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. Major flow-voids are preserved.Bilateral cleft lip with a cleft defect in the maxilla is noted. However, the maxillofacial structures are incompletely evaluated.

Output: 1. Extensive cystic encephalomalacia involving the bilateral cerebral hemispheres which may be related to prior diffuse anoxic brain injury. 2. Marked dilatation of the lateral and third ventricles, likely primarily due to ex vacuo dilatation. However, a component of hydrocephalus cannot be completely excluded. Comparison with prior examinations would be beneficial if available.3. Bilateral, right greater than left, cerebral convexity subdural hematomas with a small areas of T1 hyperintensity indicating a subacute component. No significant associated mass effect.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other visual disturbances Anesthesia of skin Multiple sclerosisClinical question: MS evolution, suspect acute relapse, R arm numbness, R eye pain blurrinessSigns and Symptoms: ms evolution, suspect acute relapse, R arm numbness, R eye pain blurriness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of T2 and FLAIR signal hyperintensity present along the gray-white interface at the medial and superior aspect of the right cingulate gyrus along its more posterior aspect. There is no associated enhancement following gadolinium administration. There is no associated diffusion restriction. It is subtly hypointense on T1.There is a T2 and FLAIR signal hyperintense lesion present adjacent to the temporal horn of the left lateral ventricle and lateral to it. There is no associated enhancement following gadolinium administration. It is hypointense on T1-weighted imaging.A couple punctate foci of signal loss and susceptibility weighted imaging are present one in the left temporal lobe and one in the left frontal periventricular white matter.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is a signal hyperintense focus present along the posterior aspect of the spinal cord at the C1-2 level. This is not associated with enhancement following contrast administration. There is some mild multilevel disc desiccation present.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a cervical spinal cord lesion along its posterior aspect at C1-2 which is suspicious for a focus of demyelination.2.There is no MR evidence to support an assessment of optic neuritis.3.There is a right cingulate gyrus lesion present and a left temporal lobe lesion which are nonspecific in isolation. It is quite possible that these are related to demyelination given the patient's clinical history.4.A couple microhemorrhages are present in the left hemisphere which in isolation are nonspecific.5.There are mild degenerative changes present in the cervical spine worse at C3-4 related to disc bulge.6.Exam is somewhat compromised due to patient motion especially in the postcontrast sequences which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Right throat pain: evaluate for mass in nasopharynx. Neck: The nasopharynx appears unremarkable, without evidence of mass lesions. Likewise, the rest of the pharyngeal mucosal space and oral cavity contents appear to be intact. There is no evidence of cervical lymphadenopathy. The salivary glands and thyroid appear to be unremarkable. There is mild multilevel degenerative spondylosis and kyphotic alignment of the cervical spine. There is an air-filled cavity in the right tracheoesophageal groove that measures approximately 3 cm in width.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. No evidence of nasopharyngeal or other pharyngeal mucosal space mass lesions.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Right tracheal diverticulum


Instruction: Generate impression based on findings.

Input: Chiari malformation, 6 months post decompression, new neck pain and headache. There are postsurgical changes of Chiari 1 decompression with suboccipital craniectomy and removal of the posterior arch of C1. There is a CSF signal intensity fluid collection in the surgical bed consistent with a pseudomeningocele and has decreased in size since 7/24/2015, currently measuring approximately 16 x 35 mm (sagittal plane), previously 33 x 57 mm. The cerebellar tonsils abut the dorsal aspect of the dura which may be related to scarring, with diminished CSF flow dorsally at the foramen magnum. There remains good biphasic CSF flow ventrally at the foramen magnum. CSF flow sequence also demonstrates flow extending into the pseudomeningocele. The cervical spinal cord has normal signal characteristics and overall morphology. No evidence of syrinx.Vertebral body heights and alignment in the cervical spine are normal. Bone marrow signal is within normal limits. Trace disc bulges are present. There is however no spinal canal or neural foraminal stenosis at any level.

Output: 1. Postoperative changes of Chiari decompression. There remains diminished CSF flow dorsally at the foramen magnum. The cerebellar tonsils abut the dorsal dural margin, possibly related to scarring.2. Decrease in size of pseudomeningocele compared to 7/24/2015.


Instruction: Generate impression based on findings.

Input: 33 years Male (DOB:2/4/1982)Reason: Malignant tumor of soft tissue of upper limb, left History: Pain in bilateral lower back, "pea sized" lump noted to left lower backReferring Attending: REX C. HAYDON 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. No abnormal enhancing lesions are appreciated in the lumbar spine. There is a formed disc present at S1-S2At L5-S1 there is loss of disc space height, disc desiccation and a broad-based left lateral recess disc protrusion which impresses on the nerve root at the left lateral recess and displaces it. There is no significant enhancement associated with this.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There is a left lateral recess disc protrusion present at L5-S1 which impresses on and displaces the nerve root of the left lateral recess.


Instruction: Generate impression based on findings.

Input: 17 year old man with dilated cardiomyopathy with LGE on previous CMR referred for evaluation of interval change. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 109 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 95 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is epicardial late gadolinium enhancement involving the basal to mid anterior, anterolateral, inferolateral, and inferior walls. The finding is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).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 are normal in size and drain normally into the right atrium.PericardiumThere is a small circumferential 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. Normal LV size with moderately reduced systolic function (LVEF 38%) with extensive late gadolinium enhancement as described above. There is no late gadolinium enhancement on the apical half of the interventricular septum, reducing the diagnostic yield of right ventricular endomyocardial biopsy.2. Normal RV size with mildly reduced systolic function (RVEF 47%).3. When compared to prior cardiac MRI, the LVEF is a little better but there is no significant change in the burden of late gadolinium enhancement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Optic gliomas status post chemotherapy: off therapy evaluation. There is near interval resolution of enhancement and T2 hyperintensity in the left globus pallidus. Otherwise, there has been interval increase in size of multiple enhancing foci along the expected course of the bilateral optic pathways. For example, an enhancing component in the left lateral thalamic region measures up to 15 mm, previously 12 mm and a left postchiasmatic optic nerve focus of enhancement measures up to 7 mm, previously 5 mm. There is no significant interval change in the optic chiasm and intraorbital component of the optic nerve gliomas, right larger than left, with persistent mild enhancement of the orbital segment of the right optic nerve and marked dilatation of the right optic nerve sheath. There is persistent faint intrinsic T1 hyperintensity of the bilateral basal ganglia and cerebellar nuclei. There is no evidence of acute infarct. The ventricles are mildly prominent, which is unchanged. There is no midline shift. There is a nonspecific focus of enhancement of the skin and subcutaneous tissues of left cheek, which may be inflammatory in nature.

Output: Near interval resolution of the enhancing lesion in the left globus pallidus, but interval increase in size of multiple enhancing lesions along the expected course of the bilateral optic pathways. Otherwise, no significant interval change in the optic chiasm and intraorbital components of the optic nerve gliomas, right larger than left


Instruction: Generate impression based on findings.

Input: 50 year-old female with seizures. There are transtemporal depth electrodes positioned in the various portions of the right temporal lobe region. There is no evidence of any substantial intracranial hemorrhage. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. Cerebellar tonsillar ectopia is again noted.

Output: 1.There are transtemporal depth electrodes positioned in the various portions of the right temporal lobe region. 2.Cerebellar tonsillar ectopia is again noted.


Instruction: Generate impression based on findings.

Input: Locked in syndrome secondary to embolic stroke involving the vertebrobasilar system, status post embolectomy. There is extensive T2 hyperintensity and restricted diffusion within the bilateral cerebellar hemispheres, particularly, the superior portions. There is also T2 hyperintensity and restricted diffusion within the pons and to a lesser extent the midbrain and medulla. In addition, there are scattered punctate foci of T2 hyperintensity and restricted diffusion within the bilateral occipital lobes and hippocampi. There is patchy T2 hyperintensity and restricted diffusion within the bilateral thalami, right greater than left. There is effacement of the fourth ventricle and cerebral aqueduct, with interval enlargement of the third and lateral ventricles with associated diffuse periventricular white matter T2 hyperintensity, which likely represents transependymal cerebrospinal fluid flow. There is also mild inferior cerebellar tonsillar herniation and effacement of the foramen magnum cerebrospinal fluid spaces and compression of the medulla. There is no evidence of intracranial hemorrhage. There is no midline shift. The vertebrobasilar flow voids are slightly heterogeneous, which may be related to flow or residual thrombus. There is extensive sinonasal fluid and mucosal thickening, as well as a small amount of fluid within the right mastoid air cells, which may be related to intubation. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Extensive recent infarcts involving the posterior circulation territories, including the cerebellum, brainstem, thalami, occipital lobes, and hippocampi, without hemorrhagic conversion. However, the ensuing edema has resulted in obstructive hydrocephalus and mild inferior herniation of the cerebellar tonsils. Discussed with Dr. Ardelt at 8:55 AM on 2/17/16.


Instruction: Generate impression based on findings.

Input: Female, 62 years old.Order specific questions:RFO trigger: Organ transplantSuspected RFO location: AbdomenName of suspected RFO: UnknownAttending surgeon: Dr. Millis, pager 8217Body mass index: 20.4 Surgical drain projects over the right abdomen. 2 hepatic hypodense foci are seen, as described on recent CT scan and MRI. Nonobstructive bowel gas pattern. No pneumoperitoneum. No unexpected radiopaque foreign body is seen.

Output: No unexpected radiopaque foreign body seen. This finding was communicated by the resident radiologist to Dr. Millis on 11/18/2015 at 1300.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of multiple myeloma. Concern for cord compression. There is straightening of the cervical spine, likely positional. Again seen are multilevel spondylotic changes of the cervical spine. Specifically, there is mild disc bulge with central disc protrusion at C4-5 with associated mild central spinal canal stenosis and mild indentation of the spinal cord (without intrinsic cord signal abnormality). There is also mild right neuroforaminal stenosis at this level. There is mild disc bulge with mild bilateral neuroforaminal narrowing at C5-6. There is mild disc bulge without stenosis at C6-7. These findings are not significantly changed compared to the prior exam. Vertebral body and disc space heights are well-preserved. There is no evidence of signal abnormality involving the bone marrow or spinal cord. The paravertebral soft tissues are within normal limits.

Output: Spondylotic changes of the cervical spine, most pronounced at C4-5, without evidence of acute cord compression. These findings are unchanged in appearance.


Instruction: Generate impression based on findings.

Input: 47-year-old female with hip pain ACETABULAR LABRUM: There is increased linear signal abnormality within the superior acetabular labrum situated at the 12 o'clock position, consistent with degeneration/tearing, within the limitations of a non arthrogram study.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. No articular cartilage defects are seen. Mild degenerative changes affect the hips bilaterally.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance. ADDITIONAL

Output: Mild osteoarthritic changes of the left hip with associated acetabular labral tear, as described above.


Instruction: Generate impression based on findings.

Input: Reason: Staph aureus bacteremia and prior imaging with concern for cervical epidural abscess, monitor status on antibiotics History: bacteremia, septic thrombophlebitis, ? mastoiditis, ? epidural abscess Images are degraded by motion artifact. Given this limitation, the following findings are noted.An epidural collection seen on the prior study at the C1/2 level has resolved. There is persistent adjacent paraspinal soft tissue edema. No additional fluid collection is identified. Again seen is left jugular thrombus with loss of flow-void.Bilateral mastoid air cell opacification, left greater than right. Cervical medullary junction is unremarkable. Cerebral tonsils are in normal position. Spinal cord has a smooth contour without focal atrophy or edema. No intraspinal hematoma or mass.There is multilevel degenerative disease of the cervical spine. There is grade 1 retrolisthesis of C5 over C6. There is linear increased STIR/T2 signal in the posterior T1 vertebral body which may represent a somewhat atypical hemangioma. Vertebral body heights are maintained. There is diffuse disc desiccation.C1/C2: No significant spinal canal stenosis or foraminal narrowing. C2/C3: No significant spinal canal stenosis or foraminal narrowing. C3/C4: No significant spinal canal stenosis. Mild facet arthropathy with mild bilateral foraminal narrowing. C4/C5: Posterior disc osteophyte complex with focal left paracentral, foraminal component. Mild spinal canal stenosis. Moderate left foraminal narrowing.C5/C6: Grade 1 retrolisthesis of C5 over C6 with mild spinal canal stenosis and bilateral moderate to severe foraminal narrowing. Loss of disc height.C6/C7: Posterior disc osteophyte complex with mild spinal canal stenosis. Moderate left and mild right foraminal narrowing.C7/T1: No significant spinal canal stenosis. Mild facet arthropathy with mild left foraminal narrowing.T1/T2: Posterior disc osteophyte complex partially evaluated on lateral view.T2/T3: Posterior disc osteophyte complex partially evaluated on lateral view with apparent spinal canal stenosis.

Output: 1.The epidural collection seen on the previous study has resolved with persistent paraspinal soft tissue edema.2.Degenerative changes of the spine as above.


Instruction: Generate impression based on findings.

Input: 65-year-old female with abdominal pain, weight loss status post a US showing 4 cm solid/cystic mass in the pancreatic head ABDOMEN:LUNG BASES: Scarring and traction bronchiectasis in the para mediastinal right lung base compatible with post radiation changes. Trace right pleural effusion.LIVER, BILIARY TRACT: Trace subhepatic free fluid. Findings compatible with iron deposition.SPLEEN: Scattered calcified granulomas in the spleen. Small amount of perisplenic fluid.PANCREAS: Mixed solid and cystic masslike enlargement of the pancreatic head measuring 3.9 x 3.2 cm (series 1403, image 283). The lesion demonstrates enhancement with a nonenhancing central focus. Peripancreatic interstitial edema surrounding the head and uncinate process and second portion of the duodenum. Mild atrophy of the proximal body of the pancreas. Minimal scattered peripancreatic subcentimeter lymph nodes, the largest measuring 1.5 x 0.6 cm (series 1404, image 439). The main arteries and veins are patent. There is decreased compliance of the main pancreatic duct with administration of secretin. There is a focal short segment stricture of the main pancreatic duct at the head of the pancreas. No significant upstream dilation of the main duct.ADRENAL GLANDS: Nodularity of the left adrenal gland.KIDNEYS, URETERS: Scattered T2 hyperintense cysts in bilateral kidneys. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: An IVC filter is noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mixed solid and cystic masslike enlargement at the pancreatic head as described above. While underlying malignancy cannot be entirely excluded, findings are more supportive of focal pancreatitis. A follow-up MRI/MRCP with and without contrast is recommended in six weeks for confirmation.2.Findings of iron deposition in the liver and spleen.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoClinical question: eval for spondylolysisSigns and Symptoms: lbp for months 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 a broad based right lateral recess disk protrusion at this level. There is fat surrounding the nerve roots at the lateral recess bilaterally at this level. There is disk dessication at this level. At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are Schmorl's nodes in the visualized lower thoracic spine.

Output: 1.There is a right paramedian disk protrusion at L5-S1 without significant compromise to the nerve roots at this level.2.No compromise to lumbar spinal canal or neural foramina.3.Schmorl's nodes in the visualized lower thoracic spine.


Instruction: Generate impression based on findings.

Input: On neoadjuvant chemotherapy, ISPY MRI #2. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Interval decrease in enhancement within the right breast. The index mass currently measures 1.5 x 1.6 x 1.4 cm, previously up to 2.0 cm, and is somewhat less enhancing. Satellite mass immediately anterolateral to the index mass is not distinctly visualized. Additional small enhancing masses medial to the index mass are also decreased in enhancement--there is now only residual focal and non-mass enhancement along the pectoralis muscle at the site of those masses. Areas of chest wall enhancement are similar to the previous research protocol study. The nonmass enhancement felt to be related to biopsy that became apparent only on the research MRI (after research biopsy), is significantly decreased as well, compatible with resolving post biopsy change.No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.Scattered high T2 liver lesions are not significantly changed, likely representing cysts or hemangiomas.

Output: Some interval decrease in degree of enhancement and size of the right breast index lesion. Additional masses in the right breast are also decreased in size.  BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch)Clinical question: h/o pituitary adenoma; pre surgical planningSigns and Symptoms: pre op planning The CSF spaces are appropriate for the patient's stated age with no midline shift. There is asymmetric enhancement in the pituitary fossa with a 12 x 9 mm axial dimension lesion centered in the left half of the pituitary fossa extending towards the left cavernous sinus. It has some suprasellar extension.A cystic lesion is present adjacent to the left temporomandibular joint.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is a mass present centered in the left pituitary gland extending towards the left cavernous sinus and across the midline which most likely represents a pituitary adenoma. It has some suprasellar extension.2.Examination is limited for the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Lung cancer, eval Increased uptake of the lumbar spine L2 end plate, which may be due to osteomyelitis or tumor per PET scan H For the purposes of numbering and to be consistent with prior PET report, the most inferior well-defined disc space is labeled L5-S1. Small hypoplastic ribs are evident however at L1, as numbered.There is mild compression fracture involving the right superior endplate of L2 with edema and enhancement involving the L2 vertebral body. No adjacent soft tissue mass or discrete metastatic lesion is appreciated. Bone marrow signal elsewhere in the lumbar spine is benign including marrow signal changes involving the anterior aspect of the L5 and S1 vertebrae which are on a degenerative basis. No epidural tumor, leptomeningeal disease, or paraspinous mass in the lumbar spine.Aside from L2, remainder of the vertebral body heights are preserved. Alignment is grossly maintained aside from minimal L5-S1 retrolisthesis. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease aside from minimal bulge. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.L4-L5: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. No significant spinal canal stenosis. Mild right neural foraminal narrowing. Left neural foramen is patent.L5-S1: Disc height loss, disc bulge with small central protrusion, and facet arthropathy. There is moderate bilateral neural foraminal stenosis. There is partial effacement of the left lateral recess. There is no significant central canal stenosis.

Output: 1. Mild compression fracture involving the right superior L2 endplate with vertebral body edema and enhancement which is likely reflective of recent injury. There is no evidence of underlying tumor but would suggest follow-up to exclude this possibility. No evidence of discitis-osteomyelitis.2. Degenerative changes in the lumbar spine, relatively worse at the L5-S1 level where there is up to moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis at any level.3. Please note comment about numbering scheme above.


Instruction: Generate impression based on findings.

Input: MRSA right wound stump. Rule out osteomyelitis. Exam is limited by motion artifact on coronal T1 sequence as well as by patient positioning in deep flexion.Patient is status post below knee amputation.MENISCI: Evaluation is limited, as above.ARTICULAR CARTILAGE AND BONE: The distal aspect of the remaining tibia demonstrates increased T2 marrow signal spanning approximately 5 cm, with associated T1 hypointensity, compatible with osteomyelitis in the appropriate clinical setting. No loculated fluid collection is present.LIGAMENTS: Evaluation is limited, as above. EXTENSOR MECHANISM: Evaluation is limited, as above.ADDITIONAL

Output: 1.Limited exam due to motion artifact and positioning.2.Findings compatible with osteomyelitis complicating stump wound infection in the appropriate clinical setting.