Instruction: Generate impression based on findings.

Input: History of glioblastoma. Follow-up exam. Stable postoperative findings from right temporal and frontal craniotomy related to prior subtotal resection of tumor. Redemonstration of a centrally necrotic residual tumor mass in the right temporal lobe measuring 5.3 x 4.3 cm, previously 4.8 x 4.0 cm. Overall there is slight interval increase in associated edema particularly within the anterior aspect of the temporal lobe. There is associated local mass effect with local sulcal effacement.Additional centrally necrotic tumor in the right frontal lobe is not significantly changed measuring 2.9 x 1.8 cm, previously 3.0 x 1.8 cm. 2 adjacent cavities with high T1 and T2 signal and peripheral rims of susceptibility compatible with intraparenchymal hemorrhage appear similar to prior. The degree of vasogenic edema surrounding this tumor is not significantly changed from prior.There is stable 5 mm leftward midline shift and partial effacement of the left ambient cistern.Perfusion imaging again shows increased relative cerebral blood volume along the anteromedial aspect of the frontal lobe lesion and surrounding the temporal lobe lesion suggestive of viable tumor within the enlarging mass.Scattered foci of periventricular and subcortical white matter T2 hyperintensity appear similar to prior and may reflect a combination of small vessel ischemic changes and possibly postradiation effect. The ventricles are stable in size. The basal cisterns are preserved. The expected intracranial vascular flow voids are present. The paranasal sinuses and mastoid air cells are clear. Effacement of the left ambient cistern

Output: 1.Slight interval increase in size and adjacent vasogenic edema associated with the right temporal lobe tumor.2.No significant interval change in size or edema associated with the right frontal lobe tumor.3.No significant interval change in 2 intraparenchymal hemorrhagic collections adjacent to the right frontal lobe tumor.4.Perfusion imaging again shows increased relative cerebral blood volume along the anteromedial aspect of the frontal lobe lesion and surrounding the temporal lobe lesion suggestive of viable tumor within the enlarging mass.


Instruction: Generate impression based on findings.

Input: 70 year old man with NICM, referred for further evaluation of underlying etiology. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. There is severe concentric left ventricular hypertrophy (IVSd=20ms). The overall LV ejection fraction is 28%, the LV end diastolic volume index is 123 ml/m2 (normal range: 74+/-15), the LVEDV is 254 ml (normal range 142+/-34), the LV end systolic volume index is 88 ml/m2 (normal range 25+/-9), the LVESV is 182 ml (normal range 47+/-19), the LV mass index is 122 g/m2 (normal range 85+/-15), and the LV mass is 251 g (normal range 164+/-36). LV dysfunction is global. The native myocardial T1 time is severely elevated (1202ms), indicative of an underlying infiltrative process. There is diffuse, circumferential, endocardial late gadolinium enhancement which is worst along the base and mid myocardium and a little less at the apex. The TI scout shows nearly simultaneous myocardial and LV cavity nulling. These findings are diagnostic of cardiac amyloidosis. Left AtriumThe left atrium is severely dilated. The atrial wall and interatrial septum are thickened.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 101 ml/m2 (normal range 82+/-16), the RVEDV is 208 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 131 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate 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.PericardiumA small pericardial effusion is noted. Extracardiac FindingsSmall right pleural effusion is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated and severely hypertrophied with severely reduced systolic function (LVEF 28%). There is diffuse, circumferential, endocardial late gadolinium enhancement which is worst along the base and mid myocardium and a little less at the apex. The TI scout shows nearly simultaneous myocardial and LV cavity nulling. The native myocardial T1 relaxation time is severely elevated. Together, these findings are diagnostic of cardiac amyloidosis. 2. Normal RV size with moderately reduced systolic function (RVEF 37%).3. Severe biatrial dilation.4. Mild to moderate mitral regurgitation.5. Mild aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI brain: There is a subtle punctate focus of restricted diffusion within the floor of the fourth ventricle which may relate to acute ischemia. There is a punctate focus of susceptibility effect in the left parietal lobe which likely corresponds to the hyperdense focus seen on CT and is consistent with blood product. There is another focus of susceptibility in the left posterior frontal lobe. In addition, there is patchy susceptibility in the right frontal lobe sulci suggesting trace subarachnoid blood product. Small foci of susceptibility at the pontomedullary junction may also represent minimal hemosiderin staining. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is partially empty sella, incidentally noted. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is also in the midline Thornwaldt cyst in the posterior nasopharynx.  MRA brain: The intracranial internal carotid arteries show some evidence of atherosclerotic irregularity but probably no high-grade stenosis. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery and the posterior cerebral artery are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA neck: The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: 1. Trace subarachnoid blood products in the right frontal lobe.2. Corresponding to the hyperdense focus in the left postcentral gyrus on CT, there is susceptibility compatible with blood products. A few other scattered foci of susceptibility may represent hemosiderin of uncertain age.3. Moderate chronic small vessel ischemic disease.4. Small focus of acute ischemia along the floor of the fourth ventricle.5. Unremarkable MRA brain and MRA neck.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, founded nursing home acutely slumped over bleeding technician, history of stroke with residual weakness of legs, wheelchair-bound. No evidence of restricted diffusion is seen. Patchy periventricular T2 hyperintensity is evident, a nonspecific finding which likely represents chronic small vessel ischemic disease. No intracranial hemorrhage or abnormal extra-axial fluid collections are seen. There is no evidence of parenchymal edema or mass effect. The ventricular system is normal in size and morphology. No pathologic parenchymal or extra-axial enhancement is seen.

Output: 1. No evidence of acute ischemia or other definite acute intracranial abnormality.2. Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Hydrocephalus, yearly follow-up. Compared to CT dated 11/15/2012, there is no significant change in ventriculomegaly involving the lateral, third, and fourth ventricles. There is diminished supratentorial white matter volume particularly the left parieto-occipital and frontal lobes. There is thinning of the corpus callosum. No evidence of recent infarct or hemorrhage. Small chronic blood products involving the dependent portion of the left lateral ventricle are decreased in conspicuity compared to prior MRI. Sulcation appears within normal limits. There is normal myelination pattern. No new mass or mass-effect. No extra-axial collections. Major flow-voids are preserved. Partially empty sella. There is mild nonspecific opacification of the paranasal sinuses. There is a cystic lesion involving the right parietal scalp which may represent a scalp lesion such as sebaceous cyst for example.

Output: 1. No significant change in ventriculomegaly involving the lateral, third, and fourth ventricles compared to CT 11/15/2012 compatible with communicating hydrocephalus. 2. Diminished supratentorial white volume and thinning of the corpus callosum.3. Slight decrease in conspicuity of chronic intraventricular blood products.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of Marcaine, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time 60 seconds

Output: Successful right hip arthrogram.


Instruction: Generate impression based on findings.

Input: Right lower extremity radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disk bulge. No significant spinal canal or neural foraminal stenosis.L2-L3: Minimal disk bulge with component of left foraminal disk protrusion. There is mild left neural foraminal stenosis. No spinal canal or right neural foraminal stenosis.L3-L4: Mild disk bulge and facet arthropathy with mild left and minimal right foraminal narrowing. No significant spinal canal stenosis.L4-L5: Mild disc bulge with left far lateral protrusion. There is minimal bilateral neural foraminal narrowing. There is contact of the left L4 nerve root with the disc extraforaminally. No significant spinal canal stenosis. Mild facet arthropathy.L5-S1: Mild disc bulge with right foraminal protrusion. There is mild to moderate right foraminal narrowing and possible impingement of the right L5 nerve root. There is mild left foraminal narrowing. No significant spinal canal stenosis. Bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine. There is a disc bulge at L5-S1 with right foraminal disc protrusion. There is resulting mild to moderate right L5-S1 neural foraminal stenosis and possible impingement of the exiting right L5 nerve root. Additional levels as detailed above.No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: No diffusion-weighted abnormalities are identified. No evidence of intracranial hemorrhage. There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size. There are no extraaxial fluid collections. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are unremarkable. The orbits are intact. There is no abnormal enhancement within the brain. Focal left occipital calvarial T1 and T2 hyperintensity that is nonenhancing, likely representing focal fat deposit.

Output: No evidence of intracranial metastasis.


Instruction: Generate impression based on findings.

Input: Sciatica, right side [M54.31] / Sciatica, left side [M54.32], Reason for Study: ^Reason: eval for sctructal cause of recalcitrant sciatica lasting >6 weeks History: LBP and bilateral sciatic pain radiating to feet For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis. L5-S1: Slightly prominent bilateral ligamentum flavum as well as facet joints which result minimal narrowing of bilateral lateral recess. Otherwise no remarkable finding.

Output: Minimal narrowing of bilateral lateral recesses at the level of L5S1, otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Cervical cancer with possible brain mets on CT head. There are two enhancing lesions within the inferior left cerebellar hemisphere that measure up to 8 mm and 4 mm each. There is mild surrounding vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. . The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Subcentimeter lesions within the left cerebellar hemisphere likely represent metastases.


Instruction: Generate impression based on findings.

Input: 49 year old with a history of BRCA2 mutation. She plans to undergo a prophylactic mastectomy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 10-year-old female with wrist pain. LIGAMENTS: No abnormally increased T2/STIR signal around the major ligaments to indicate acute inflammation. The scapholunate, lunotriquetral, and radioulnar ligaments are within normal limits.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC demonstrates normal signal and morphology without acute abnormality.TENDONS: No abnormally increased T2/STIR signal within the tendons to indicate tendinosis/tendinopathy. No evidence of tendon rupture or edema within the tendon sheaths. BONES: No acute fracture or dislocation. Normal marrow signal without bone marrow edema.ADDITIONAL

Output: Normal examination without specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: High-resolution images of the sella demonstrate the pituitary gland to be normal in size measuring 8 mm in height. There is no discrete mass to confirm the presence of a pituitary microadenoma. There is no macroadenoma. The pituitary infundibulum inserts on the midline of the gland. There are no sellar, suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally.

Output: Negative MRI of the brain and sella including gadolinium enhancement. There is no discrete mass to confirm the presence of a pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosusClinical question: Evaluate for cause of headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is an isolated punctate subcortical white matter lesion on the medial aspect of the left temporal lobe. In isolation this is probably of little clinical significance and not unusual at this age.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.Findings suggest a disc protrusion at C4-5 with findings which are suspicious for spinal stenosis but cannot be confirmed on this exam.

Output: 1.MRI of the brain is within normal limits.2.Findings raise the question of disc extrusion in the cervical spine with possible spinal stenosis


Instruction: Generate impression based on findings.

Input: 56-year-old male with history AV malformation, seizure disorder who presents with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. Vascular calcifications are noted. The region of encephalomalacia within the posterior temporal occipital region with high density clip/coils presumably from the prior AVM repair. No evidence of hemorrhage. Multiple patchy low low attenuation is nonspecific and likely represents small vessel disease, age determinate. If there is clinical concern for acute ischemia an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic changes as described above. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Epilepsy since 2009 and new onset headache. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions or aneurysms.


Instruction: Generate impression based on findings.

Input: 45-year-old woman status post repair of type B aortic dissection now with increased ICP and headache. The quality of the study is suboptimal. Since the previous study, diffuse effacement of the cortical sulci has developed. There is interval decrease in size ventricular system and partial effacement of the basal cisterns. These findings are consistent with diffuse cerebral edema. There is hypoattenuation in the right MCA territory suggestive of cortical edema. Recommend MRI to assess for acute stroke.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Incidental note is made of an accessory suture in the frontal bone.A nasogastric tube is present in the right naris.

Output: 1. Interval development of diffuse cerebral edema.2. Cortical hypoattenuation in right MCA territory. Recommend MRI to evaluate for acute stroke.


Instruction: Generate impression based on findings.

Input: 27-year-old with history of fibrocystic disease and body nipple discharge. Family history of breast cancer in her mother. A targeted bilateral ultrasound was performed for the areas of palpable concerning and the areas measured on the prior ultrasound. In the right breast 10:00 location, approximately 8 cm from the nipple the macrolobulated hypoechoic mass containing a clip measures 1.7 x 0.7 x 1.4 cm, previously 1.6 x 0.7 x 1.3 cm. There is minimal associated vascularity.In the right breast 12:00 location, approximately 3 cm from the nipple, there are two macrolobulated hypoechoic masses with minimal associated vascularity and similar characteristics to the biopsy-proven fibroadenomas. The more superficial mass measures 1.5 x 0.6 x 1.4 cm, the deeper mass measures 0.9 x 0.6 x 1.0 cm. Possible correlates are seen in retrospect on the recent breast MRI.In the left breast 11:00 location, approximately 2 cm from the nipple a macrolobulated hypoechoic mass measures 0.8 x 0.5 x 0.7 cm, previously 0.7 x 0.5 x 0.8 cm. There is minimal associated vascularity. This is a biopsy proved fibroadenoma.The clustered cysts seen on the prior ultrasound were redemonstrated, many additional similar cysts were seen bilaterally.

Output: 1.The bilateral biopsy-proven fibroadenomas are unchanged in size and sonographic appearance. 2.Two additional not previously documented masses in the right breast at the 12:00 position have possible correlates on MRI. These could represent fibroadenomas, six-month follow-up ultrasound of both breasts is recommended to ensure stability.Findings and recommendations were discussed with the patient and with Dr. Jaskowiak.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Female, 30 years old, status post spinal cord injury at T7 with back pain. Bilateral posterior instrumented fusion is seen with stabilization rods affixed to bilateral pedicle screws at T4, T5, T6, T9 and T10.There is an exaggeration of the normal thoracic kyphosis. The T7 and T8 vertebral bodies are fused with obliteration of the intervening disc space. Elsewhere vertebral body morphology is relatively normal and there is no evidence of any concerning marrow replacement or marrow edema. No pathologic enhancement is seen.Beginning in the cervical region, severe septated syringohydromyelia is seen continuing inferiorly to the T9 level. The spinal cord parenchyma through this region is maximally thinned and the syrinx cavity fills the entire spinal canal. Below T9, the spinal cord demonstrates a normal appearance.Minimal degenerative disc disease is seen at T2-3 and T3-4. No significant spinal canal stenosis is seen. The T7-8 neural foramina are narrowed due to vertebral body fusion at this level. Otherwise, the neural foramina are within normal limits.

Output: 1.Evidence of instrumented posterior spinal fusion from T4 through T10.2.Fusion of the T7-8 vertebral bodies may reflect prior trauma or a congenital anomaly.3.Severe septated syringohydromyelia affects the spinal cord from the cervical region down to the T9 level. Below T9, the spinal cord shows a relatively normal morphology.


Instruction: Generate impression based on findings.

Input: Altered mental status, agitation and psychosis. Evaluate for meningitis or other process. The cutaneous/subcutaneous extensive nodularity, compatible with neurofibromatosis type I, has not significantly changed (or minimally increased) since April 2014.There is no significant brain abnormality. There is no abnormal brain diffusion restriction, susceptibility effect or contrast enhancement. There is also no abnormal leptomeningeal contrast enhancement. The major intracranial vessels are patent.The orbits are normal. There is no gross mass along the optic pathway but this is not optimal for orbit/optic pathway lesions. The mastoid air cells and paranasal sinuses are clear.

Output: 1.There is no brain abnormality.2.There is extensive subcutaneous and subcutaneous nodularity, compatible with neurofibromatosis type I.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:2/14/1972)Reason: eval for ischemia; also eval for changes in white matter lesions from previous MRI in Jan '16 History: L face numbnessPROVIDER/ATTENDING NAME: MAHESH PADMANABAN Since the previous examination the patient is developed a new enhancing lesion in the left trigeminal root inlet within the pons on the left side.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. This has not changed significantly compared to the previous exam.A punctate focus of susceptibility effect is redemonstrated in the left temporal lobe at the inferior temporal gyrus subcortical white matter which is stable compared to prior exam and not readily appreciated in other pulse sequencesNormal 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.Since prior examination patient developed a new lesion in the left pons in the expected location of the left trigeminal root inlet. Associated contrast enhancement suggests that this is acute or subacute2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Pathologic fracture Examination is limited by motion artifact. Multiple repeat sequences were attempted.A large destructive lesion of the right iliac wing is seen consistent with known history of pathologic fracture. Abnormal marrow signal involves the majority of the right iliac wing as well as the SI joint and inferior acetabulum.Evaluation of the sciatic nerve is markedly limited by motion artifact and by the abnormal signal intensity detailed above. The proximal portion of the sciatic nerve is seen however the course of the nerve is obscured at the level of the sacroiliac joints and near the area of pathologic fracture. What is thought to represent the sciatic nerve appears slightly increased in signal intensity although this may be reactive in nature. The distal portion of the sciatic nerve at the level of the femoral head/neck appears intact.There is diffuse soft tissue edema and enhancement, likely reactive in nature. Abnormal marrow signal within the right femoral head suspected to represent avascular necrosis.

Output: 1. Large destructive lesion of the right iliac wing consistent with known history of metastatic disease and pathologic fracture.2. Abnormal marrow signal throughout the right hemipelvis likely reflects a combination of metastatic disease and postradiation change.3. Limited evaluation of the sciatic nerve at the level of the pathologic lesion secondary to extensive motion artifact and abnormal surrounding signal intensity although the distal portion of the nerve appears intact.4. Avascular necrosis of the right femoral head.


Instruction: Generate impression based on findings.

Input: Status post SRS for left cerebral vascular malformation in May 2015: surveillance. MRI: There is interval appearance of an irregularly rim-enhancing lesion measuring up to approximately 20 mm surrounding the site of the treated left temporo-occipital region arteriovenous malformation. There is increase in the extent of surrounding vasogenic edema. However, the anomalous vessels are less conspicuous. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no discernible arterialized flow within the nidus of the arteriovenous malformation. There is no evidence of significant steno-occlusive lesions in the regular cerebral arteries. There is no evidence of aneurysms.

Output: Interval development of radiation necrosis at the site of the treated left temporo-occipital region arteriovenous malformation, with associated surrounding vasogenic edema. The nidus of the arteriovenous malformation appears to have thrombosed.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unchanged. 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: No evidence of acute intracranial metastases, although the assessment is limited by the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: 56 year old female with a history of left shoulder pain. Evaluate for rotator cuff tear. Evaluation of the shoulder is limited due to the patient's body habitus and patient motion artifact.ROTATOR CUFF: There is metallic susceptibility artifact indicating suture anchors with tunnels extending into the anterior and superior aspect of the humeral head. There is marked thinning of the supraspinatus tendon, likely reflecting chronic attritional tearing. Furthermore, there appears to be delamination of the tendon with retraction of the undersurface fibers to the level of the top of the humeral head. However, some fibers of the supraspinatus can be traced from the myotendinous junction to their insertion on the greater tuberosity. There is also suggestion of a small focal full-thickness defect of the tendon just above the vertex of the humeral head. Additionally, there is intermediate signal intensity within the posterior fibers of the supraspinatus tendon at their insertion likely representing insertional tendinosis. Cuff material is seen along the greater tuberosity superficial to the surgical tunnels, with what appears to be superficial partial-thickness tearing of the bursal surface fibers. There is mild atrophy of the supraspinatus muscle. There is moderate degenerative tendinosis of the infraspinatus tendon with foci of high signal intensity at its insertion likely representing concealed insertional tears and perhaps mild interstitial tearing along the myotendinous junction. There is moderate atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear intact. There is mild increased signal intensity within the distal subscapularis tendon suggesting tendinosis. We see no discrete tear and the muscle of the subscapularis appears intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. Fluid within the acromioclavicular joint may reflect prior surgery. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is slightly high riding. Evaluation of the glenoid labrum is limited due to the aforementioned technical factors and lack of intra-articular contrast. Portions of the labrum appear blunted likely representing degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps is situated within the bicipital groove as seen on the axial images. On sagittal oblique sequences the tendon appears enlarged with associated increased signal intensity likely reflecting tendinosis.

Output: 1. Limited study as described above. Postoperative changes of prior rotator cuff repair. There is marked thinning of the supraspinatus tendon likely reflecting chronic attritional tearing and retraction of delaminated undersurface fibers. There is also suggestion of a small focal full-thickness defect at the vertex of the humeral head. Other rotator cuff abnormalities as described above.2. Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB: 2/18/1971)Reason: please evaluate progression of disease and compare to imaging brought in from. History: progressive LE weakness with T4 sensory level. MRI spine shows T-spine T2 non-enhancing lesionsPROVIDER NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.On susceptibility weighted imaging there is a hypointense focus present in the left inferior parietal lobule subcortical white matter. This is not readily identified on any of the other pulse sequences. There is no associated contrast enhancement.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 cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified 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.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.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is a T2 hyperintense lesion present in the right hemicord at the T2 vertebral body level C1 vertebral body level length. Another T2 hyperintense lesion is present in the left hemicord at the T2 and T3 vertebral body levels. Additional T2 hyperintense lesions are present at T3-4 on the left side extending one vertebral body length and at the T5-6 level in the left hemicord staining under 1 vertebral body level length. There is no associated contrast enhancement with these lesions.There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.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. No abnormal enhancing lesions are identified in the lumbar spine. There is a transitional vertebra present with sacralization of L5.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present 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.There are cystic lesions present in the pelvis. A multicystic lesion in the right hemipelvis is suspected to represent an ovary. There is a larger cyst associated with this measuring 34 x 20 mm axial dimensions

Output: 1.There are multiple lesions present in the upper thoracic spinal cord. Etiology is uncertain. They appear to involve gray matter. Demyelinating disorder could have this appearance. Alternatively, myelitis may have a similar appearance.2.A microhemorrhage in the left inferior parietal lobule in isolation is of unknown clinical significance.3.There is a cystic lesion present in the pelvis which is not completely imaged on this exam. One possibility this represents an ovarian cyst. If clinically appropriate additional imaging of the pelvis may be of further benefit.4.An alphanumeric page and email were sent to Dr Kamson.


Instruction: Generate impression based on findings.

Input: Headache. MRI: 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.MRA: There is no evidence of significant steno-occlusive arterial lesions. There is also no evidence of saccular aneurysms.MRV: There is no evidence of venous thrombosis.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive arterial lesions.3. No evidence of venous thrombosis.


Instruction: Generate impression based on findings.

Input: Female, 38 years old. Knee pain MENISCI: There is intrasubstance degeneration within the posterior horn and body of the medial meniscus with mild focal increased signal intensity within the undersurface fibers of the meniscus suggesting mild fraying, but we see no fluid-filled or otherwise unstable meniscal tear.ARTICULAR CARTILAGE AND BONE: We see no fluid-filled cortical defects. Bone marrow signal intensity is normal.LIGAMENTS: There is thickening and increased signal intensity within the proximal fibers of the anterior cruciate ligament suggesting mucoid degeneration. The posterior cruciate ligament and collateral ligaments appear normal. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal.ADDITIONAL

Output: 1.Mild degeneration and undersurface fraying of the medial meniscus but no findings to suggest an unstable meniscal tear.2.No articular cartilage defects are evident.3.Mucoid degeneration of the anterior cruciate ligament.4.Nonspecific edema within the deep soft tissues adjacent to the posterior margin of the distal femoral metaphysis.5.Thickening of the inferior patella plica of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: History of pancreatitis 9/2013 and pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement. No focal suspicious lesion. No biliary ductal dilatation or vascular abnormality.Normally distended gallbladder. Focal cystic thickening of the gallbladder wall compatible with adenomyomatosis. Small amount of pericholecystic fluid is nonspecific. No additional secondary findings to suggest acute cholecystitis.SPLEEN: 1.0 x 1.0 cm pancreatic head unilocular cystic lesion without mural nodularity or abnormal enhancement. It communicates with the main pancreatic duct and is compatible with a sidebranch IPMN, unchanged. Additional, subcentimeter T2-hyperintense lesions located more distally in the pancreas are also unchanged, and likely represent side-branch IPMNs.No pancreatic ductal dilatation.The pancreas is mildly decreased in signal intensity likely reflecting sequela of prior pancreatitis. No specific evidence of acute pancreatitis currently with normal enhancement and without peripancreatic fluid collections, arterial or venous complication.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter renal cysts. No hydronephrosis or suspicious focal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in the pancreatic head side branch IPMN. Additional stable subcentimeter cystic lesions likely reflect side-branch IPMNs.2.Sequela of prior pancreatitis. No evidence of acute pancreatitis or complication thereof.3.Nonspecific small amount of pericholecystic fluid without additional findings of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: 57-year-old with history of cerebral cavernous malformations and prior hemorrhage. Redemonstrated are numerous foci of susceptibility effect within the supratentorial and infratentorial brain. As before, the largest lesion measures up to 10 mm in the right inferior frontal gyrus. No lesions demonstrate perilesional edema. There is no extra-axial hemorrhage or acute infarction. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The expected intracranial vascular flow voids are present, without evidence of associated developmental venous anomalies. The skull and extracranial soft tissues are unremarkable. There is no abnormal enhancement.

Output: Stable multiple supratentorial and infratentorial cerebral cavernous malformations without evidence of interval associated acute hemorrhage or developmental venous anomalies.


Instruction: Generate impression based on findings.

Input: 41-year-old female with shoulder pain. ROTATOR CUFF: There is intermediate signal intensity within the distal supraspinatus tendon consistent with mild tendinosis. The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears intact. The glenohumeral joint alignment is anatomic. No articular cartilage defects are identified.BICEPS TENDON: The tendon of the long head of the biceps is normal in appearance.ADDITIONAL

Output: Rotator cuff tendinosis without evidence of full-thickness rotator cuff tear or labral tear.


Instruction: Generate impression based on findings.

Input: Re-evaluate for progression of prior abnormalities, and assess for new insult of the right centroparietal on the basis of EEG change in this area: CJD remains at top of differential. There are more conspicuous areas of high DWI signal in the right caudate, posterior right cingulate gyrus, right medial parietal lobe cortex, and left thalamus and posterior cingulate gyrus. There is no associated abnormal enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged mild scattered periventricular and subcortical white matter T2 hyperintense lesions, which are nonspecific. There is cavum septum pellucidum and vergae. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening and secretions in the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Mild nonspecific cerebral white matter lesions may represent chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct. More conspicuous areas of asymmetric signal abnormality in the right caudate, posterior right cingulate gyrus, right medial parietal lobe cortex, and left thalamus and posterior cingulate gyrus may once again represent a form of Creutzfeld Jacob disease.


Instruction: Generate impression based on findings.

Input: Ms. Childers is a 43 year old female with BRCA2 mutation and known left breast fibroadenoma. Family history of breast cancer in mother and paternal grandmother. Family history of ovarian cancer maternal aunt. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Few scattered foci of enhancement are re-visualized in the left breast, all of which appear similar in distribution and appearance when compared to multiple prior MRI's. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Pituitary microadenoma: galactorrhea. There is no significant interval in size of the hypoenhancing lesion in the anterior pituitary gland, which measures up to 7 mm in width and 3 mm in height. The infundibulum is intact and situated in the midline. There is no disruption of the optic apparatus. The cavernous sinuses and intracranial internal carotid arteries are intact.

Output: No significant interval change in size of the pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: Floor of mouth cancer. There is an ill-defined lesion in the anterior floor of mouth that measures up to approximately 15 mm. There is a cluster of small posterior level 2B lymph node, which appear to be somewhat prominent in terms of signal characteristics. There is otherwise no evidence of significant cervical lymphadenopathy based on size criteria. The major salivary glands are unremarkable, although there is herniation of the left sublingual gland through a mylohyoid defect. There is a punctate cystic nodule in the left thyroid lobe. There is multilevel degenerative cervical spondylosis. The imaged intracranial structures are unremarkable. There are bilateral lens implants.

Output: An ill-defined lesion in the anterior floor of mouth that measures up to approximately 15 mm is compatible with the known cancer. A cluster of small posterior level 2B lymph node, which appear to be somewhat prominent in terms of signal characteristics may be reactive or neoplastic in nature. Otherwise, no evidence of significant cervical lymphadenopathy based on size criteria.


Instruction: Generate impression based on findings.

Input: Near drowning, on April 29, 2016. Seizure activity. Assess for ischemic brain injury. There is no acute brain infarct or intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. Myelination is appropriate for age. The major intracranial vascular flow voids are preserved. The ventricles and the other CSF-containing spaces are normal in size.There is no gross skull or scalp abnormality. The orbits are unremarkable.

Output: Noncontrast brain MRI is within normal limits.


Instruction: Generate impression based on findings.

Input: Female, 7 months old, with infantile spasms. A routine exam prior to initiating ACTH therapy workup. Brain parenchymal morphology and the pattern of gyral development are within normal limits. No pathologic parenchymal signal abnormality, edema or mass effect is observed. There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricular system is normal in size and morphology.The pattern of white matter myelination is appropriate for age. The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are within normal limits.

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


Instruction: Generate impression based on findings.

Input: Female, 56 years old. Reason: Evaluate for R ischial tuberosity bony abnormality vs hamstring origin tendonitis History: R ischial tuberosity pain associated with some R heel numbness. Otherwise healthy. BONE MARROW: The visualized bones have normal signal.SOFT TISSUES: The visualized musculature appears normal. JOINTS: The imaged joints appear normal.ADDITIONAL

Output: Evidence of mild tendinitis at the bilateral hamstrings tendon insertions, right slightly greater than left. No other acute abnormality. The bones and muscles appear normal.


Instruction: Generate impression based on findings.

Input: Pain and paresthesia. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Mild developmental spinal canal narrowing is noted with superimposed degenerative changes in the cervical spine as described below:C2-3: There is left-sided facet arthropathy and uncovertebral hypertrophy which contributes to mild left foraminal stenosis. No significant spinal canal or right neural foraminal narrowing.C3-4: Small disc osteophyte complex which effaces the ventral thecal sac and contacts the ventral cord. There is at most mild spinal canal stenosis at this level. Neural foramina are patent. C4-5: Minimal central disc osteophyte complex. No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.Postcontrast sequences are motion degraded. There is however no abnormal enhancement within the spinal canal. There is enhancement involving the disc and endplates at the C2-C3 level which is likely on a degenerative basis. The vertebral artery flow voids appear to be intact. There is a partially imaged T2 hyperintense structure in the left upper paratracheal region which measures at least 2.9 x 3.7 cm in the axial plane and up to 4.5 cm in the craniocaudal dimension cm, possibly a large thyroid nodule but incompletely assessed.Lumbar spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Edematous marrow signal changes are noted at the L3-L4 level including the disc and adjacent endplates. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.L3-L4: There is mild disc bulge and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate left and mild right neural foraminal narrowing. No significant spinal canal narrowing.L4-L5: There is mild disc bulge and bilateral facet arthropathy, greater on the right. There is no significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. There are mild multilevel degenerative changes in the cervical spine as described above without significant spinal canal stenosis or cord signal abnormality. No abnormal enhancement.2. Mild degenerative changes in the lumbar spine. There is no significant spinal canal stenosis at any level. There is neural foraminal narrowing at the L3-L4 and L4-L5 levels as described above. 3. Edema and enhancement involving the C2-C3 and L3-L4 endplates which is likely on a degenerative basis.4. Partially imaged structure measuring approximately 2.9 x 3.7 x 4.5 cm in the left upper paratracheal region, possibly a large thyroid nodule but inadequately assessed. Consider ultrasound for further visualization.


Instruction: Generate impression based on findings.

Input: 21 years Male (DOB:11/11/1994)Reason: eval for aneurysm; History: ha with lifting and vision and hearing loss for 2-3 years.PROVIDER/ATTENDING NAME: HOLLY JOAN BENJAMIN HOLLY JOAN BENJAMIN The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst 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.There is no evidence for intracranial mass lesion2.Please note that CT angiogram and MR angiogram or more sensitive in detecting aneurysms than MRI of the brain with and without contrast.


Instruction: Generate impression based on findings.

Input: Pituitary tumor: surveillance. Pituitary: There is a pituitary mass with suprasellar extension that measures up to 28 mm in craniocaudal dimension, which is not significantly changed. There is associated mass effect upon the optic chiasm and extension of tumor into the bilateral cavernous sinuses, without significant narrowing of the internal carotid artery flow voids. The tumor also has mass effect upon the infundibulum, hypothalamus, anterior commissure, and left medial temporal lobe.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia and gliosis in the right inferior frontal gyrus with a small amount of susceptibility effect. There are scattered foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Unchanged probable pituitary macroadenoma with mass effect upon the optic chiasm.2. Chronic right inferior frontal lobe infarct.


Instruction: Generate impression based on findings.

Input: Pain, back and left hip Pelvis and hip: Moderate osteoarthritic changes of both hips are observed, specifically no additional superimposed acute left hip abnormality. Overall preserved femoral head shape. SI joints unremarkable.L-spine: Severe degenerative changes of L5-S1 with vacuum phenomenon, narrowing and osteophytes with sclerosis. Mild wedge deformity of L3 with a bulky anterior osteophyte, nonacute given appearance is similar to a 2012 MRI.

Output: L3 and L5-S1 changes as described and grossly similar to prior more remote MR imaging.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB: 6/19/1943)Reason: 72 year old with AML, concern for AML in spinal fluid and brain vs stroke, please eval History: neurologic deficits; right sided weaknessPROVIDER NAME: ANDRZEJ J JAKUBOWIAK MICHAEL J THIRMAN MRI brain: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.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate partial opacification of the right mastoid air cells. The visualized portions of the orbits are intact.There is a diffuse marrow replacement throughout the visualized calvarial and skull base structures.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is diffuse marrow replacement throughout the visualized spine. There is multilevel disc desiccation presentThere are enlarged lymph nodes present within the jugular chains superior and supraclavicular regions.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. There is a disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. There is diffuse marrow replacement throughout the thoracic vertebrae.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is partial lumbarization of the S1 segment.. S1 represents a transitional vertebra The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine. There is multilevel disc desiccation present. There is diffuse marrow replacement throughout the lumbar vertebrae.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild anterior subluxation of L5 on S1 associated with a diffuse disc bulge and mild facet hypertrophy.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild disc bulge at this level associated with ligamentum flavum hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild disc bulge at this level associated with ligamentum flavum hypertrophy.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild disc bulge at this level associated with ligamentum flavum hypertrophy.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is diffuse marrow replacement throughout the calvarium, skull base and spine which is compatible patient's diagnosis of multiple myeloma.2.There is neck lymphadenopathy present.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.There are some mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or neural foramina.5.There are mild degenerative changes present in the cervical spine.


Instruction: Generate impression based on findings.

Input: Male, 14 years old, status post third ventriculocisternostomy, yearly follow-up examination. The left frontal approach ventricular shunt tube is in stable position terminating within the left frontal horn. The right occipital approach ventricular shunt tube is also in stable position terminating within the temporal horn.The lateral ventricles remain chronically dilated, left side more than right. Since the prior examination, the degree of ventricular dilatation has increased. For example, the left temporal horn now measures 18 mm across, previously 11 mm. The osseous cranial diameter has not significantly changed. As on the prior examination, a discrete cisternostomy defect is not appreciated within the floor of the third ventricle and there is no evidence of biphasic CSF flow spanning the third ventricle and basal cisterns. Focal narrowing or occlusion of the anterior aspect of the aqueduct of Sylvius is again seen, similar to prior.No new areas of parenchymal signal abnormality are appreciated. Mild abnormal signal and encephalomalacia affecting the left superior parietal lobule, just above the lateral ventricle, is less conspicuous than on the prior examination. No intracranial hemorrhage or any new abnormal extra axial fluid collection is seen.

Output: 1.Persistent chronic lateral ventricular dilatation, left side more than right, with moderate interval progression in the degree of dilatation.2.As on the prior examination, no evidence of any discrete ventriculocisternostomy defect is seen within the floor of the third ventricle, and biphasic CSF flow is not evident spanning the third ventricle and basal cisterns.3.Stable positioning of the bilateral ventricular shunt tubes. No additional new intracranial abnormalities..


Instruction: Generate impression based on findings.

Input: 60 year old female with biopsy proven IDC in the right breast There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a unifocal enhancing mass in the right anterior 11:00 position, measuring 11 x 12 x 15 mm (AP x LR x CC), which is a proven cancer.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal cancer in the right breast.2. No MR evidence for malignancy in the left breast3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer abnormality on the right skull on bone scan. Needs further evaluation. Signs and symptoms: Right skull abnormality. Pre-and post infused head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal.There is no evidence of any abnormal enhancement or brain parenchymal or the leptomeninges.Visualized paranasal sinuses and mastoid air cells are unremarkable.Evaluation of the skull reveals a very faintly identified area all low density of calvarium in the right frontal bone on extreme windowing of images. This finding is best appreciated on axial images 10 through 18 and on coronal images 6 through 15. There is suggestion of multiple linear defects within the lesion in the diploic space which may represent vascular channels. This lesion is not associated with any destructive changes of bone, inner or outer tables of the skull. There is also no detectable associated epidural or subgaleal abnormal soft tissue densities or enhancement. The finding is unlikely to represent a metastatic disease. I believe the lesion represents a hemangioma. Recommend an MRI examination for better assessment of the lesion. This lesion measures approximately 24 x 4 in its trans-axial dimensions and 34-mm in cranial -- cephalad axis. A

Output: 1.This pre-and post infused CT examination of brain demonstrates no evidence of intracranial abnormality.2.Very faintly identified low attenuation of the marrow space of the right frontal bone containing multiple serpiginous defects to represent vascular channels. There is no evidence of any erosive changes of diploic space, outer or inner table of the skull. There is also no evidence of any associated subgaleal or epidural soft tissue component. This finding is not consistent with a metastatic disease and likely represent benign lesion like a hemangioma. Recommend follow-up with an MRI examination.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber with hypoplasia of the intracranial left vertebral artery. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.Unremarkable brain MRI. 2.No evidence of intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: C6-7 fracture. Weakness to right tricep and sensory loss to 2nd digit right hand. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. There is edema involving the C6 and C7 vertebral bodies and C6-7 disc space which may be related to trama given history or degenerative disease. Right C6 lamina fracture extending into the right C6-7 facet joint better assessed by CT. Ligaments are intact. Diffuse congenital narrowing of the cervical spinal canal is noted.There is abnormal T2 hyperintensity in the cervical cord at C6-7 involving the central cord bilaterally.The cervical spinal cord has otherwise normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge and right uncovertebral hypertrophy result in mild right neural foraminal narrowing. No significant compromise to the spinal canal or left neural foramen.C4-5: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: There is loss of disc height and small disc osteophyte complex. Minimal narrowing of the spinal canal. Mild bilateral neural foraminal narrowing, right worse than left related to uncovertebral hypertophy.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Congenital narrowing of the spinal canal with mild superimposed degenerative changes, relatively worse at C6-7, as detailed above. There is mild right C3-4 and mild bilateral C6-7 neural foraminal stenosis. No high grade spinal canal or neural foraminal stenosis. 2. Abnormal T2 hyperintensity involving the central cord at C6-7 bilaterally which may represent sequela of prior trauma given history. Please note right C6-7 fractures are better seen on prior CT. No findings to suggest nerve root avulsion. Edema involving the C6 and C7 vertebral bodies and intervening disc space compatible with prior trauma.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post re-do untethering. Signs and symptoms: As above. Nonenhanced lumbar MRI:Examination demonstrates evidence of tethered cord without convincing evidence of interval change since prior exam. There is no detectable anterior movement of the cord on sagittal T2-weighted images when compared with supine series. This is a similar observation is prior exam. Similar to prior exam there is termination of the cord at S2 level. Visible central canal is again identified in the lower cord without interval change in size or extent. Signal intensity and alignment of vertebral column is within normal without evidence of spinal canal or neural foraminal compromise. Postoperative changes of recent surgery evidenced by postoperative fluid accumulation in the soft tissues over the lower back extending from mid L3-L5-S1 disc level. There is no evidence of mass effect on the spinal canal secondary to this expected postoperative finding. The fluid accumulation measures approximately at 40 x 30 mm in transaxial dimensions.

Output: 1.Postoperative changes of redo untethering of the cord evident by posterior lower spine soft tissue fluid accumulation extending from L3 to L5/S1 disc level without mass effect on the thecal sac.2.No convincing evidence of anterior movement of the cord on prone sagittal T2 weighted images compared to supine.3.Revisualization of termination of the cord at S2 level and central canal without change.


Instruction: Generate impression based on findings.

Input: Effusion. Question of intra-articular injury. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is extensive multifocal chondromalacia, similar in distribution as the prior examination. There is redemonstration of a focal fissure in the weight-bearing portion of the lateral femoral condyle, appearing similar to prior study (image 21, series 601). Additionally, there is a 2-mm full-thickness chondral defect of the posterior lateral femoral condyle, (image 21, series 601). More anteriorly along the lateral femoral condyle there is cartilage thinning with multiple associated small subchondral cysts and focal marrow edema that is similar to the prior exam.There is a new full-thickness chondral defect measuring approximate 20 x 20 mm of the weight-bearing portion of the medial femoral condyle (image 10, series 601 and image 19, series 801).There is redemonstration of complete cartilage loss of the lateral patella articular surface with denuding of the lateral 50% of the lateral femoral trochlea articular surface. Additionally there is mild thinning and fraying of the medial patellar articular surface inferiorly.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Multifocal chondromalacia with new large full-thickness chondral defect of the medial femoral condyle.2. Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Right buttock and perineal numbness and tingling Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal anterolisthesis of L4 and L5 as seen before as well as minimal L1 on L2 retrolisthesis also as before. Alignment is otherwise maintained with preserved lordosis. Bone marrow signal is benign. The conus medullaris is normal in position. There is mild clumping of the cauda nerve roots from the L4 to L4-5 levels which also appears to be present previously and compatible with arachnoiditis.Again seen are postoperative changes of surgical fusion from L4 to L5 with bilateral paraspinous rods, pedicle screws, as well as interbody spacer at L4-L5 similar to prior. Since the prior MRI from 3/11/2016 interval decompressive laminectomy at L4-L5 has been performed with this level surgically well decompressed. Multilevel degenerative changes are seen as described below:At T11-T12, sagittal images demonstrate a mild disc bulge without significant spinal canal or neural foraminal stenosis. At T12-L1, there is a disc bulge eccentric to the right. There is mild right-sided facet arthropathy and ligamentum flavum thickening. There is mild right-sided neural foraminal stenosis and mild spinal canal stenosis.At L1-L2, there is mild disc bulge. There is mild facet arthropathy and ligamentum flavum thickening, contributing to overall mild central spinal canal stenosis, as well as mild to moderate right and minimal left foraminal narrowing. At L2-L3, is a stable trace disc bulge with rightward predominance and mild bilateral facet arthropathy as well as ligamentum flavum thickening. There is mild central spinal canal stenosis as well as mild mild bilateral neural foraminal stenosis.At L3-L4, there is a disc bulge eccentric to the left with effacement of the left lateral recess as well as moderate left-sided neural foraminal stenosis. Right neural foramen is patent. There is moderate bilateral facet arthropathy and ligamentum flavum thickening contributing to overall mild to moderate central spinal canal stenosis. At L4-L5, there is interval laminectomy with spinal canal now well decompressed. There is facet hypertrophy and disc uncovering with mild bulge. Neural foramina are suboptimally evaluated due to hardware however are grossly patent.At L5-S1, there is dorsal osteophyte formation without significant spinal canal stenosis. There is minimal narrowing of the neural foramina.

Output: 1. Since prior MRI from 3/11/2016, decompressive laminectomy at L4-L5 has been performed. This level is now well decompressed. There are multilevel degenerative changes throughout the lumbar spine which are not significantly changed in the interval with up to moderate left L3-L4 neural foraminal and left lateral recess stenosis, and no high-grade central spinal canal stenosis at any level. Additional details as above.2. There is mild clumping of the cauda equina nerve roots at the L4 level suggestive of arachnoiditis and grossly similar to prior.


Instruction: Generate impression based on findings.

Input: Intractable migraine, without status migrainosus. Right-sided persistent headache and diplopia, concern for mass, abscess. MRI BRAIN: Technically degraded exam due to artifacts related to patient's dental hardware, particularly affecting the diffusion-weighted sequences and the susceptibility sequences. Within these limitations, there is no evidence of intracranial mass or acute infection. The brain parenchyma and pituitary gland appear unremarkable. There is a developmental venous anomaly along the midline pons. Otherwise, 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 right nasal turbinates and mucosa are oedematous.MRI ORBIT: No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Degraded exam due to artifacts related to patient's dental hardware. Within these limitations, no gross evidence of intracranial abscess or mass.2. Unremarkable MRI orbits.


Instruction: Generate impression based on findings.

Input: Note only sagittal T1 and T2-weighted sequences of the cervical spine were obtained, which are also motion degraded. Note thoracic and lumbar spine images were not obtained.Motion degraded images of the cervical spine demonstrate straightening of the cervical spine curvature. Vertebral body heights and alignment are otherwise maintained. There is developmental narrowing of the cervical spinal canal. There are degenerative changes with disc osteophyte complex at the C3-C4 with up to moderate degree of spinal canal stenosis suspected at this level on a degenerative basis. No large destructive osseous lesion the cervical spine is evident.

Output: Patient was claustrophobic and could not tolerate the study despite medications. Examination is limited to sagittal sequences of cervical spine, which are significantly motion degraded. No pathologic fracture in the cervical spine or large destructive osseous lesion is evident. There are degenerative changes with suspected up to moderate spinal canal stenosis at the C3-C4 level related to disc osteophyte complex. Examination under anesthesia can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with pain in the right leg. Findings are seen compatible with posterior instrumented fusion from L2 through L5. The L4 and L5 vertebral bodies demonstrate osseous fusion across the disc space while the other vertebral body levels remain distinct.The normal lumbar lordosis is straightened. A grade 1 retrolisthesis of L5 relative to S1 is seen. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. Where metallic artifact does not obscure, the bone marrow signal is unremarkable.Laminectomy has been performed from approximately L2 through L4 with expansion of the spinal canal through this region. No significant spinal canal stenosis is demonstrated at any level. Mild disc bulging is seen at L1-2. At L5-S1, disc uncovering and disc bulging is seen.The neural foramina are not perfectly visualized due to metallic artifact. However, it does appear that the foramina from L1-2 through L4-5 are reasonably patent. At L5-S1, there appears to be severe foraminal narrowing on the right and moderate to severe narrowing on the left .Incidental note is made of multiple renal cysts.

Output: 1.Findings compatible with posterior instrumented fusion from L2 through L5. The vertebral bodies of L4 and L5 demonstrate osseous fusion across the disc space.2.The spinal canal remains patent throughout with no areas of high-grade spinal canal stenosis.3.Severe foraminal narrowing is evident on the right at L5-S1 with moderate to severe narrowing on the left.


Instruction: Generate impression based on findings.

Input: Ms. Hoffmann is a 72-year-old female enrolled in a research breast cancer screening study for high risk individuals. She has a family history of breast cancer in her mother, two sisters, and her daughter. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Scattered foci of enhancement are seen in both breasts, appearing stable when compared back to multiple prior examinations. In particular, there is a stable enhancing focus identified in the left breast 5:00 position. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No interval change or MRI evidence for malignancy. Follow-up should be as per the research protocol.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Female, 3 years old, with arachnoid cyst. A cystic lesion is redemonstrated which seems to originate in the right aspect of the quadrigeminal plate cistern and which follows CSF on all sequences. The lesion measures no more than 21 x 16 mm in the axial plane showing no increase in size from the prior examination. The lesion causes mild mass effect upon the adjacent right thalamus, and causes leftward displacement of the pineal gland and internal cerebral veins.Brain parenchymal morphology is otherwise within normal limits. No areas of pathologic signal abnormality are seen. No parenchymal edema is detected. There are no findings to suggest intracranial hemorrhage. The ventricular system is otherwise normal in size. A normal variant cavum vergae is noted.

Output: Stable appearance of a cystic lesion centered on the right quadrigeminal plate cistern which is favored to represent an arachnoid cyst.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left elbow was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 22 gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 8 mL of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 41 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the left elbow for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: History of lung cancer metastatic to the brain, the, weakness, ataxia. Rule out cord compression. Examination is obtained per screening cord compression protocol. No significant stenosis in the cervical, thoracic, or lumbar spine is seen. There is no evidence of cord compression. Sagittal STIR sequence demonstrates abnormal T2 hyperintensity at the C6-C7 level and the T2-T3 level.The vertebral bodies are appropriate in the overall alignment and height. Mild degenerative changes are seen with small disk bulge at the C3-C4 and C4-C5 levels as well as at the L5-S1 level without significant stenosis.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and details are not as evident as dedicated protocols of the spine. No cord compression is identified.2. Abnormal T2 hyperintense lesions in the spinal cord at C6-7 and T2-3 levels, which given history and brain MRI findings, are suspicious for intramedullary metastases. Recommend dedicated cervical and thoracic MRI study with gadolinium.Dr. Ali discussed findings with Dr. Wang at 10 am on 3/13/2015.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status, unspecified Cerebellar stroke syndromeClinical question: r/o acute infarcts or enhancementSigns and Symptoms: altered mental status MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia involving the posterior aspect of the right cerebellar hemisphere which was in the subacute phase and 2013. There is associated asymmetric dilation of the fourth ventricle. A smaller focus of encephalomalacia is present in the left temporal lobe anteriorly. Another small focus of encephalomalacia is present along the left cerebellar hemisphere.Redemonstration of a T2 and FLAIR hyperintense focus centered in the left thalamus.Periventricular and subcortical white matter T2 and FLAIR hyperintense punctate foci of a mild degree are present. The lateral ventricles are fairly large but unchanged compared to a recent head CT.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The pituitary gland measures 10 mm in height but is unchanged since prior exam 9/20/2013.MRA brain:Exam is somewhat degraded due to patient motion which would obscure more subtle abnormalities.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The A2 segment is azygos.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute cerebral infarction.4.There is redemonstration of moderate-sized focus of encephalomalacia involving the right cerebellar hemisphere and smaller foci of encephalomalacia in the left cerebellar hemisphere and anterior portion of the left temporal lobe which were present on the recent CT head exam from 11/30/15 and have not changed. These are likely vascular related.5.There is redemonstration of an old lacunar infarct in left thalamus.6.The lateral ventricles appear large. Although this could be a result of brain atrophy possibility of normal pressure hydrocephalus cannot be excluded. Please correlate with patient's clinical symptoms.7.Enlargement of the pituitary gland is relatively stable compared to prior exams. Possibility of a pituitary abnormality cannot be excluded. Please correlate with patient's clinical history, signs and laboratory tests8.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Trigeminal neuralgia, facial pain. The clearest delineation of the facial sensorimotor cortex was achieved with the lip puckering and tongue movement paradigms. Sensorimotor cortical activation of the face maps as expected along the lateral aspects of the pre- and post-central gyri.

Output: Successful functional MRI for evaluation of facial sensorimotor cortical activation.


Instruction: Generate impression based on findings.

Input: Again seen is a right frontal approach deep brain stimulator, which courses in the right frontal lobe and basal ganglia and terminates at the right medial temporal lobe. There is a branching pattern of enhancement with susceptibility effect and punctate T2 hyperintensity in the right thalamus and cerebral peduncle, which is unchanged. Associated calcification is better demonstrated on CT. There is no associated mass effect. There is no evidence of a large acute intracranial hemorrhage or acute infarct. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Unchanged vascular lesion involving the right thalamus and cerebral peduncle which is most compatible with a developmental venous anomaly or capillary telangiectasia. 2. Right frontal approach deep brain stimulator.


Instruction: Generate impression based on findings.

Input: 34-year-old male with chronic abdominal pain and history of ileal Crohn's disease and gastric ulcer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild narrowing of the terminal ileum over a segment measuring approximately 9 cm, suggestive of quiescent inflammatory bowel disease. No significantly increased enhancement to suggest active inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings suggestive of terminal ileum quiescent inflammatory bowel disease. No evidence of active inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: history of NSCLC with multiple brain mets; completed whole brain RT; please evaluate post treatment History: brain metastases There are two lesions showing high signal intensity on FLAIR/T2 images without demonstrating significant differences in enhancing pattern located on 1) right superior frontal gyrus and 2) around the right pars marginalis. These findings are suggestive of developing vasogenic edema after radiation treatment.Other multiple nodular enhancing parenchymal lesions on bilateral hemispheres and left cerebellar hemisphere do not show any significant interval change in terms of the size of each lesion, number, configuration and enhancement pattern.Gyriform enhancing lesions at the right temporal lobe do not show any interval change since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval development of vasogenic edema on the right frontal lobe superior frontal gyrus and adjacent to right pars marginalis which is likely to be related to radiation therapy.2. No change of other metastatic lesions in terms of size, number and MR characteristics since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for radiculopathy. Signs and symptoms: Left arm weakness. Pre-and post enhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate a small centrally located disk protrusion with slight flattening and posterior displacement of the cord and no central spinal stenosis. There is mild kyphotic deformity of the cervical spine at this level. No neural foraminal compromise.C4 -- C5 is unremarkable.C5 -- C6 demonstrate mild disk disease and loss of disk height, shallow broad base disk protrusion in the midline with some effacement of ventral subarachnoid space however without the spinal stenosis. There is also a right lateral small disk protrusion and tiny bony spur which results in mild right neural foraminal compromise.C6 -- C7 demonstrate mild degenerative changes with resultant mild right neural foraminal compromise and unremarkable otherwise. C7 -- T1 demonstrate mild degenerative disk disease, minimal grade 1 anterolisthesis and mild facet hypertrophic changes. There is however moderate bilateral neural foraminal compromise.Uppermost visualized thoracic spine and the entire cervical and uppermost visualized thoracic cord demonstrate normal signal intensity.

Output: 1.Degenerative changes at C3 -- C4 and including a centrally located disk protrusion results in subtle flattening and posterior displacement of the cord. No spinal stenosis or neural foraminal compromise.2.Degenerative changes at C5 -- C6 results in mild right neural foraminal compromise. A small central disk protrusion with subtle effacement of subarachnoid space is also present.3.Mild degenerative disease, minimal anterolisthesis and bilateral neural foraminal compromise at C7 -- T1 as detailed.4.Normal signal intensity and caliber of the cervical and uppermost visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: 56-year-old female with metastatic colon CA with lesion in T11. Urinary incontinence, RLE pain/weakness. Please evaluate for cord compression. Limited imaging of the cervical, thoracic, and lumbar spine shows preserved vertebral body heights, alignment, and disc spaces. There is no evidence of severe central canal stenosis or spinal cord signal abnormality. Schmorl's node deformity is seen at the inferior endplate of T11. The T11 vertebral body marrow is otherwise unremarkable. Fatty changes along the superior endplate of T12 are additionally noted.

Output: Limited imaging of the cervical, thoracic, and lumbar spine shows no evidence of acute spinal cord compression.


Instruction: Generate impression based on findings.

Input: Male, 69 years old. Bilateral knee pain, instability. ARTICULAR CARTILAGE AND BONE: There are large osteophytes at the medial, lateral, and patellofemoral compartments. There is marked tricompartmental joint space narrowing with complete loss of the articular cartilage in the medial and lateral compartments and severe patellar cartilage thinning. There is bone marrow edema within the lateral tibial plateau.MENISCI: There are irregular blunted small remnants of the posterior horn of the lateral meniscus and posterior horn of the medial meniscus. The anterior horns appear absent.LIGAMENTS: The ACL is not visualized, compatible with chronic tear. The PCL and collateral ligaments are unremarkable.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Severe osteoarthritis with associated cartilage loss, bone marrow reactive changes, and significant meniscal degeneration as described above.2.Chronically torn ACL.


Instruction: Generate impression based on findings.

Input: HgbSS (on hypertransfusion protocol at La Rabida) and poorly controlled epilepsy (refractory to multiple AEDs) secondary to left MCA stroke in 2007 (with residual right sided weakness), who presents with worsening generalized weakness and gait changes over the past 4 weeks. The study is limited by patient motion.MRI: There is unchanged extensive encephalomalacia in the left frontal, left parietal, and to lesser extent left temporal lobes, with Wallerian degeneration of the left brainstem. However, there is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with ex vacuo dilatation of the left lateral ventricle. The orbits are grossly unremarkable. There is diffuse low T1 and T2 signal in the bone marrow and findings related to Dyke Davidoff Masson on the left side. EEG leads are in place on the scalp. MRA: There is unchanged severe steno-occlusive disease of the left supraclinoid internal carotid artery. The proximal left anterior and middle cerebral arteries appear to be diffusely narrowed as well. There is a paucity of cortical vessels overlying the areas of left cerebral hemisphere encephalomalacia. There also appears to be narrowing of the supraclinoid right internal carotid artery, which is more pronounced than previously, and minimal collateral vessel formation in the region. The vertebral, basilar, and posterior cerebral arteries are intact. There is no evidence of cerebral aneurysms.

Output: 1. Chronic extensive left middle cerebral artery territory infarction related to sickle cell disease, without evidence of acute infarction.2. Severe steno-occlusive disease of the left supraclinoid internal carotid artery, proximal left anterior and middle cerebral arteries stenoses are also unchanged, with associated moyamoya. Stenosis involving the right supraclinoid internal carotid artery is more pronounced, although this might be artifactual. 3. The appearance of the skull is likely related to sickle cell disease.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of bronchus and lung, unspecified site. Secondary malignant neoplasm of brain and spinal cordClinical question: hx of lung CA, eval mets, please compare to previous and measure The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. A submillimeter subtle focus of apparent enhancement in the left medial temporal lobe (image 29 series 1101) is felt to represent artifact. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is redemonstration of confluent T2 and FLAIR hyperintense lesions along the periventricular and external capsules which is unchanged since the prior 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 is no convincing evidence for recurrent metastasis. A submillimeter focus of apparent enhancement in the left temporal lobe is felt to represent artifact. Continued close interval follow-up is suggested.2.There is periventricular and external capsule signal change which is likely treatment related.