Instruction: Generate impression based on findings.

Input: Reason: Crohn's disease with colonic and peri anal involvement History: peri anal disease ABDOMEN:LIVER, BILIARY TRACT: Prominent common bile duct and mild intrahepatic biliary ductal dilatation, likely within normal limits given age and status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesions within the pancreatic neck, body and tail measuring up to 7 mm (7/17), likely represent side branch IPMNs. The main pancreatic duct is nondilated.ADRENAL GLANDS: Left adrenal nodularity, similar to prior CT.KIDNEYS, URETERS: Left renal cyst. Additional bilateral subcentimeter T2 hyperintensities, are also likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.There is circumferential bowel wall thickening and hyperenhancement involving the anal canal and distal rectum extending approximately 7 cm in length. There is edema in the surrounding soft tissues with enhancement, indicating inflammation. No focal fluid collection or sinus tract is identified. There is otherwise a moderate amount of stool throughout the colon.No abnormal enhancement or thickening throughout the remainder of colon. The terminal ileum is unremarkable.BONES, SOFT TISSUES: OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent inguinal lymph nodes.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Circumferential bowel wall thickening and enhancement involving the anal canal and distal rectum is compatible with active Crohn's disease.2.Cystic lesions within the pancreas likely represent side branch IPMNs.3.Left adrenal nodularity is unchanged from prior CT.


Instruction: Generate impression based on findings.

Input: Small effusion. Laxity on Lachman. Evaluate ACL. MENISCI: The medial meniscus appears intact. There is mucoid degeneration of the root of the anterior horn of the lateral meniscus that is new when compared with the prior study additional increased signal intensity within the peripheral fibers of the anterior horn of the lateral meniscus extending to the femoral articular surface appears more extensive on the current study on the prior study, and may represent a partial-thickness longitudinal tear in the red zone. There is also undersurface shallow undersurface fraying/tearing of the posterior horn of the lateral meniscus. The body of the body of the lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is edema within the anterior aspect of the lateral femoral condyle and the inferomedial aspect of patella likely representing a recent transient lateral patellar dislocation. There is partial thickness degeneration of the articular cartilage of the patella, particularly along the median eminence, that appears to have progressed when compared with the prior study. The articular cartilage of the femoral trochlea appears relatively intact, but the trochlear groove itself appears shallow suggesting femoral trochlear dysplasia. There is a full-thickness cleft of the articular cartilage of the weightbearing surface of the lateral tibial plateau that appears similar to that seen on the prior study accounting for technical differences. The underlying marrow edema seen on the prior study has resolved. There is additional degeneration of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus. The articular cartilage of the medial compartment appears relatively intact.LIGAMENTS: The anterior cruciate ligament is intact. The posterior cruciate ligament is intact. The medial collateral ligament is intact, as is the lateral collateral ligament complex. There is edema along the medial retinacular structures including the medial patellofemoral ligament, the femoral attachment of which is poorly defined suggesting a tear. The patellar attachment of the medial retinacular structures is also poorly defined which may reflect additional tearing. The lateral retinacular structures appear normal. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal. The tibial tuberosity to trochlear groove distances within normal limits. Insall-Salvati ratio is within normal limits.ADDITIONAL

Output: 1.Normal-appearing anterior cruciate ligament.2.Small to moderate-sized joint effusion.3.Imaging findings of recent transient patellar dislocation with injury to the medial supporting structures of the patella as described above.4.Progression of cartilage abnormalities as described above.5.Lateral meniscal degeneration/tearing as described above.


Instruction: Generate impression based on findings.

Input: Reason: rule out structrual lesions History: headache Examination is somewhat compromised based on metal artifact from the patient's dental procedures to varying degrees depending on the pulse sequence. This results in artifact distorting the appearance of the orbits, paranasal sinuses, the right frontal lobe more than left frontal lobe as well as the right anterior temporal lobe 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 a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Examination is mildly compromised due to metal artifacts which obscure is portions of the right frontal lobe and right temporal lobe and orbits and paranasal sinuses to the extent of visualization no significant abnormality is appreciated intracranially.


Instruction: Generate impression based on findings.

Input: 51-year-old male with history of fibromatosis, iron deficiency anemia. Evaluate for progression of fibromatosis. ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter enhancing segment 5 focus which does not demonstrate washout; this lesion is nonspecific and unchanged going back to 2013 examination.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are scattered T2 hyperintense foci in both kidneys without enhancement; findings consistent with cysts. Mild bilateral perinephric stranding is nonspecific.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference subtle soft tissue nodule adjacent to the transverse colon is unchanged measuring 1.1 x 1.3 cm (series 4, image 34). Additionally referenced right-sided mesenteric lymph node measures 1.0 x 1.0 cm (series 900, image 103), previously measuring 1.0 x 0.9 cm.BONES, SOFT TISSUES: There is bowel wall thickening, submucosal edema, and fluid involving the mid jejunal loops. Small bowel containing anterior abdominal wall hernia without evidence of bowel obstruction. Stable soft tissue density in the anterior abdominal wall subcutaneous tissues measuring 1.4 x 1.0 cm (series 1200, image 8).OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in the referenced soft tissue nodules.2.Inflammatory changes involving mid jejunal bowel loops. Differential considerations include focal enteritis versus early fibrosis of the adjacent mesentery.3.Nonspecific enhancing segment 5 hepatic lesion, unchanged since 2013.


Instruction: Generate impression based on findings.

Input: Male 15 years old Reason: eval for rotator cuff tear versus tendinopathy History: shoulder pain for a year with swimming ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: Changes in signal on proton density, T1 and T2 sequences close to its humeral insertion noted (image 12 on series 8, 11 and 12); since there is lack of high signal on fluid sensitive sequences and no perilesional edema, is most likely chronic tendinitis with possible partial tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Chronic tendinitis with possible partial tear of the supraspinatus tendon as described.


Instruction: Generate impression based on findings.

Input: 12 years, Male, seizure disorder. There is no evidence of cortical dysplasia, gray matter heterotopia, intracranial mass, or other lesions to suggest possible seizure focus. Bilateral hippocampi are symmetric in size and signal characteristics with preserved internal architecture. No evidence of infarct, hemorrhage, or mass effect. No hydrocephalus. No extra-axial collections. Corpus callosum is fully formed but demonstrates a relatively small splenium and absent isthmus, findings which can be a normal variant. Midline structures and posterior fossa are otherwise unremarkable. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: No findings to suggest a seizure focus are appreciated.


Instruction: Generate impression based on findings.

Input: Mental status changes, homicidal thoughts. Off Zoloft. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. There is no evidence of intracranial hemorrhage, mass, midline shift or extra axial fluid collection. The ventricles and basal cisterns appear symmetric.A fixation plate in the left periorbital region is noted which would not preclude the patient from getting an MRI. An old buckle fracture of the right zygomatic arch is again noted. There is partial opacification of the left maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable examination without acute intracranial abnormality. Small vessel ischemic disease, age indeterminate.


Instruction: Generate impression based on findings.

Input: 99-year-old female with headache. There is no evidence of intracranial hemorrhage, mass or edema. Mild, diffuse hypodensities in the periventricular and subcortical white matter distribution consistent with mild small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Cervical spine:There is upper cervical curvature. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: UnremarkableC6/7: Mild disc bulge partially effaces the anterior CSF without significant resulting central stenosis.C7/T1: UnremarkableThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There is no abnormal enhancement.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.

Output: 1.C6/7: Mild disc bulge partially effaces the anterior CSF without significant resulting central stenosis.2.Negative thoracic spine MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow brain MRI, last MRI was motion degraded, seizure protocol tube. 3T the possible. Signs and symptoms: Left temporal epilepsy, medically intractable, postsurgical workup. Nonenhanced brain MRI:No diffusion weighted abnormalities.Examination is slightly degraded due to motion artifact infarct there are axial series however diagnostic.Examination again demonstrates very subtle fullness of the left hippocampus without definite associated signal abnormality of parenchymal this site. The temporal horn of the lateral ventricle is identified and demonstrate no abnormality. The anterior tip of right temporal horn is slightly larger than left and similar to prior studies. This also is not associated with any adjacent parenchymal signal abnormalities. There is no appreciable change of these findings of questionable clinical significance. Correlate with neurological evaluation as well as EEG findings.The signal intensity and morphology of the brain otherwise demonstrate normal signal intensity on all MRI sequences and stable since prior exam.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells as calvarium and soft tissues of the scalp. A small right maxillary retention cyst however is noted.

Output: 1.No evidence of an acute or new finding since prior study.2.Stable mildly prominent left hippocampus without associated signal abnormality or interval change.3.Stable mildly larger anterior tip of the right temporal horn since prior exam.4.Stable nonspecific linear flair hyperintensity along the margin of left lateral ventricle laterally.5.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 69-year-old male with history of myelodysplastic syndrome presents with a large tender palpable mass on upper back. Diagnostic sensitivity is suboptimal secondary to patient motion. There is a T1 hypointense, T2 hyperintense mass lesion centered in the left upper back, just beneath the ipsilateral scapular tip. The mass measures 3.8 x 1.5 cm on series 6, image 23 and demonstrates some peripheral contrast enhancement. Streaky enhancement is also noted in the adjacent soft tissues. No acute findings seen in the visualized lungs or mediastinum.

Output: Peripherally enhancing mass lesion just inferior to the left scapular tip as described above. While this lesion could be a focus of extramedullary hematopoiesis, other entities such as elastofibroma may also be seen in this location and can be considered in the differential diagnosis.


Instruction: Generate impression based on findings.

Input: Personality change. Rule out ICH. Significant atherosclerotic calcifications are noted in the internal carotid arteries and vertebral arteries. Extensive low-attenuation in the right MCA distribution with significant volume loss and ex vacuo dilatation of the right lateral ventricle is consistent with a chronic right MCA infarct. If there is clinical concern for acute ischemia, an MRI with diffusion-weighted images is recommended for further evaluation. No acute intracranial hemorrhage is identified. No evidence of midline shift. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic right MCA infarct. If there is clinical concern for acute ischemia, an MRI with diffusion-weighted images is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of restricted diffusion to suggest acute ischemic infarction. There is a small focus of chronic encephalomalacia within the right cerebellar hemisphere appearing similar to 2013 CT. Punctate and confluent foci of increased T2/FLAIR signal within the supratentorial white matter are nonspecific but favored to represent mild-moderate chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration for age. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. Postcontrast images do not demonstrate any abnormal parenchymal enhancement.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. The right P-comm is not definitively visualized. The left P-comm is diminutive. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.No acute ischemic infarction.2.Chronic mild-moderate small vessel ischemic changes.3.Small chronic infarction in the right cerebellar hemisphere.4.MRA without evidence of flow-limiting stenosis or aneurysm.


Instruction: Generate impression based on findings.

Input: 9 day old male evaluate for possible surgery or repair. History of GU malformations.VIEWS: Pelvis AP and frog leg (two views) 1/15/2015 No fracture or malalignment. Perineal soft tissue mass better evaluated on the prior MRI, and not well seen on today's exam.

Output: Perineal soft tissue mass better evaluated on the prior MRI, and not well seen on today's exam.


Instruction: Generate impression based on findings.

Input: bilateral lower extremity pain, numbenss, inability to walk. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are significant degenerative change of lumbar spine including intervertebral disc degenerations on L34, L45 and L5S1 with MODIC type 2 changes.There is also grade 1 spondylolisthesis of L2 on L3 which most likely related to degenerative changes of facet joint.The conus medullaris terminates at the T12-L1 level. And the spinal cord signal intensity is normal.Paraspinal soft tissue is normal.No evidence of compression fracture.Degenerative changes are specified by the intervertebral level as follows: L1-L2: Diffuse bulging of disc with bilateral ligamentum flavum thickening creating mild spinal stenosis. L2-L3: Diffuse bulging of disc with bilateral ligamentum flavum thickening results severe spinal stenosis. Bilateral neural foraminal stenosis is also moderate to severe degree (left worse than right) L3-L4: Diffuse bulging of disc with bilateral ligamentum flavum thickening results severe spinal stenosis. Bilateral neural foraminal stenosis is also seen in moderate to severe degree. L4-L5: Diffuse bulging of disc with focal broad based disc bulging results severe right side neural foraminal stenosis as well as right lateral recess stenosis. L5-S1: Diffuse bulging of disc. Bilateral neural foraminal stenosis, severe degree.

Output: Advanced degenerative spondylosis including grade 1 spondylolisthesis of L2 on L3, spinal stenosis from L34 to L45 level and multilevel various degreed neural foraminal stenosis as described above.Spinal cord signal intensity appears to be normal.


Instruction: Generate impression based on findings.

Input: Metastatic base of tongue squamous cell carcinoma, treated with pembrolizumab, palliative RT to left orbit, and started palliative carbo/paclitaxel/cetuximab. The left cerebellar tonsil lesion is now intrinsically T1 hyperintense with associated susceptibility effect and measures up to 5 mm in diameter. There is no evidence of other infratentorial or supratentorial lesions. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is interval decrease in size of the enhancing left posterior globe lesion, measuring up to 3 mm in thickness, previously 7 mm. The left lateral retinal detachment has resolved. There is mild diffuse conjunctival and lacrimal gland enhancement, likely related to radiation therapy effects. The skull and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst. There are left mastoid air cell effusions.

Output: 1. Interval evolution of the appearance of the subcentimeter left cerebellar tonsil metastasis, likely due to treatment effects. 2. Interval decrease in size of the left ocular metastasis with improvement of the associated retinal detachment.


Instruction: Generate impression based on findings.

Input: Bilateral neck fullness/pressure. Hypercortisolism work up was negative. There is prominence of the bilateral supraclavicular fat pads. Otherwise, there is no evidence of measurable mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical flows voids are grossly intact. The osseous structures are unremarkable. There is a subcentimeter left nasopharyngeal retention cyst. The airways are patent. The imaged intracranial structures are unremarkable.

Output: Prominence of the bilateral supraclavicular fat pads. Differential considerations include a manifestation of nutritional obesity, benign symmetric lipomatosis, and less likely Cushing syndrome, given the negative work up and lack of the typical disproportionate dorsocervical fat accumulation.


Instruction: Generate impression based on findings.

Input: Headaches. Brain: There cerebellar tonsils extend up to 9 mm inferior to the foramen magnum and display pointed morphologies. The posterior fossa also appears to be slightly small. Nevertheless, there is flow of cerebrospinal fluid across the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Findings compatible with Chiari malformation, but no syringohydromyelia.


Instruction: Generate impression based on findings.

Input: HTN, preDM and new right CN 4 palsy, worsening. MRI: There are a few scattered T2 hyperintensities in the cerebral white matter bilaterally. The brainstem and cerebellum appear unremarkable. There is no evidence of intracranial hemorrhage or acute infarction. There is no midline shift or mass effect. There is mucosal thickening of the maxillary sinuses, left greater than right, with an fluid in the left maxillary sinus. The orbits, cavernous sinuses, and skull are unremarkable. MRV: The major dural venous sinuses are patent and symmetric, without evidence for dural venous sinus thrombosis.

Output: 1. No discernible cranial nerve abnormality.2. A few scattered foci of cerebral white matter T2 hyperintensity are nonspecific, but may represent chronic microvascular ischemic disease.3. No evidence of venous sinus thrombosis.4. Findings suggestive of acute left maxillary sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of brain status post resection. There are postoperative findings related to left suboccipital craniotomy with a small amount of air and blood products within the surgical bed. There has been partial resection of a T2 hyperintense mass involving the left cerebellar hemisphere. The residual mass measures up to approximately 4 cm. There is persistent associated mass effect upon the adjacent brainstem with obliteration of the cerebellomedullary and cerebellopontine angle cisterns. In addition, the cerebral aqueduct is effaced and the fourth ventricle appears slitlike, while the lateral and third ventricles are dilatated and surrounded by periventricular T2 hyperintensity. While there is restricted diffusion within and surrounding the tumor, which may be due to ischemia, there is otherwise no evidence of acute territorial infarction. There are a few scattered nonspecific punctate foci of T2 hyperintensity within the cerebral white matter. There is mild mucosal thickening in the bilateral maxillary sinuses. The orbits are unremarkable.

Output: Postoperative findings related to recent left suboccipital craniotomy and partial resection of left cerebellar mass with persistent obstructive hydrocephalus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 26 years old. Right knee pain MENISCI: There is a bucket handle involving the body, anterior and posterior horns of medial meniscus, with a flipped torn meniscal fragment in the intercondylar notch. The posterior horn of the medial meniscus and the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is minimal bone marrow edema along the medial most aspect of the medial tibial plateau and medial femoral condyle, correlating with underlying meniscal injury. Otherwise, bone marrow signal is normal. The articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal.ADDITIONAL

Output: Medial meniscal bucket handle tear with flipped meniscal fragment as above.


Instruction: Generate impression based on findings.

Input: Knee pain after ski injury There is curvilinear low signal intensity within the posterior aspect of the lateral tibial plateau with surrounding edema, indicating a fracture. The fracture extends to the articular surface beneath the posterior horn of the lateral meniscus and also extends through the overlying articular cartilage. The resultant fragment is approximately 1 cm in AP dimension, 6 mm in depth (not including the overlying articular cartilage) and 2 cm in mediolateral dimension. The fracture fragment is nondisplaced. I see no additional fractures and the remainder of the articular cartilage appears normal. The majority of the lateral meniscus appears intact; however, there is increased signal intensity traversing the posterior horn near its root attachment which, given its proximity to the aforementioned fracture, likely represents a small peripheral tear. There is poorly defined increased globular signal intensity within the posterior horn and body of the medial meniscus suggesting intrasubstance degeneration. Additionally, there is horizontally oriented linear signal abnormality within the posterior horn and body of the medial meniscus that appears to contact the femoral articular surface on a single image; statistically, this finding has an approximately 40% chance of representing a true tear. The anterior horn of the medial meniscus appears normal. The cruciate and collateral ligaments are intact. The extensor mechanism is intact. There is a moderate-sized joint effusion. There is a lobulated collection of heterogeneous signal intensity adjacent to the posterior margin of the medial aspect of the distal femoral metaphysis, with extension laterally anterior to the popliteal vessels. Overall the collection is approximately 3 x 1 cm in cross-sectional and 2 cm in craniocaudal dimension. This collection contains components that are isointense to fat on all imaging sequences. Given the aforementioned fracture, I suspect that it represents blood and marrow elements that have migrated through the fracture into the subgastrocnemius recess.

Output: Acute osteochondral fracture of the posterior aspect of the lateral tibial plateau as described above. I suspect that this is associated with a small peripheral tear through the posterior horn of the lateral meniscus near its root attachment. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Lumbago with sciatica, left side [M54.42] / Muscle weakness (generalized) [M62.81] / Pain, unspecified [R52], Reason for Study: ^Reason: eval for lumbar spine pathology History: lower back pain and bilat leg pain 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 conus medullaris terminates at the L1-L2 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: There is central to right broad based disc protrusion, unchanged since prior scan. Disc dessication is seen, unchanged. No 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: no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Unchanged central to right broad based disc protrusion with disc dessication at the level of T12-L1.2. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Clinical question: 83-year-old female with myelofibrosis with neutropenia and altered mental status and congestion. Signs and symptoms: Neutropenia Nonenhanced CT of brain: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 for patient stated age of 83. Limited view of orbits are unremarkable. Calvarium demonstrates old biparietal burr holes and is otherwise unremarkable. Limited view of paranasal sinuses are unremarkable.Nonenhanced CT of paranasal sinuses:Routine nonenhanced CT of paranasal sinuses are obtained.The paranasal sinuses are well pneumatized and with no evidence of acute or chronic sinus disease. The frontal sinuses are not developed.Images through the nasal cavity are essentially unremarkable with the exception of a small septal bony spur projecting to the left and measuring 4-mm in size. Diffuse sclerotic changes of clivus without any bony destructive changes is noted. Please correlate with history and if clinical concern persist follow-up with an MRI is recommended.

Output: 1.Negative CT of brain .2.Negative CT of paranasal sinuses. Frontal sinuses are not pneumatized which is an anatomical variation.3.Diffuse sclerotic changes of clivus with no destructive bony changes. Correlate with history and follow-up with an MRI if there is a clinical concern for malignancy.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to wide decompressive laminectomies from T8 to T11. There is interval resolution of the previously identified left dorsal epidural abscess from the T8 to T11 levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is deformity of spinal cord at the T10 level. The spinal cord otherwise displays normal signal. There is diffuse enhancement of the paraspinal soft tissue in the surgical bed with mild enhancement of the T8-T11 facets and T6 spinous process.

Output: 1. Postoperative findings related to wide decompressive laminectomies from T8 to T11 with interval resolution of the previously identified epidural abscess and no significant spinal canal stenosis. 2. Deformity of the spinal cord at the T10 level is likely attributable to the prior mass effect from the abscess that was present at this level.3. Diffusely enhancing granulation tissue at the laminectomy site with mild enhancement of the T8-T11 facets and T6 spinous process, which may be reactive, although osteomyelitis cannot be entirely excluded.  I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Juneja is a 41 year old female with biopsy proven high-grade DCIS in the right breast and biopsy proven fibroadenoma in the left breast. Multiple scattered foci of enhancement are seen in both breasts, compatible with moderate portable enhancement bilaterally.Right breast: In the right breast, 1 o'clock position, there is a 1.9 cm spiculated enhancing mass with adjacent post biopsy change. Susceptibility artifact from biopsy marker clip is present within the central aspect of this lesion. No additional abnormal enhancement is seen within the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.Left breast: In the left breast, 3 o'clock position, there are expected biopsy related changes seen. Susceptibility artifact from biopsy marker clip is present in this area, compatible with previously biopsied fibroadenoma. There is no abnormal enhancement seen in this area or within the rest of the left breast.No abnormal axillary lymph nodes are identified in the left axillary region.

Output: 1.Unifocal biopsy proven malignancy within the right breast. If breast conservation therapy is desired, this area can be localized via seed or wire localization.2.Benign biopsy proven fibroadenoma within the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 20 year-old female with edema and pain at multiple regions. Evaluate for Lisfranc injury, fifth metatarsal and lateral ligaments. There is edema within the dorsal subcutaneous fat of the forefoot and midfoot extending into the dorsal/lateral ankle where it appears to become confluent and be associated with high signal on T1 weighted images, indicating ankle hematoma. Although the ankle is not visualized in its entirety, the PTaFL appears intact. The calcaneofibular ligament appears thickened, which may represent sprain. We do not clearly visualize the ATaFL and suspect a tear. The anterior tibiofibular ligament is not well seen, possibly due to the obliquity of the acquired images. Edema within the deep fibers of the deltoid ligament may represent a sprain. There is a small tibiotalar joint effusion.There is a fracture of the base of the fifth metatarsal, extending to the tarsometatarsal joint with fragments in near anatomic alignment. Edema within the plantar aspect of the base of the fourth metatarsal and third metatarsal may represent contusions as we see no discrete fracture lines. A focus of edema within the medial base of the first metatarsal likewise may represent a contusion as we see no distinct fracture line. The Lisfranc ligament itself appears intact. The bone marrow signal of the cuneiforms and navicular is within normal limits. Edema within the anterior cuboid may represent a contusion as we see no fracture line. Edema most concentrated within the medial head of the talus may represent a contusion although we cannot exclude a nondisplaced surface fracture. The bone marrow signal of the distal metatarsals and phalanges is within normal limits. The fourth toe is absent, presumably due to amputation.

Output: 1. Although an ankle MRI exam was ordered, MRI of the forefoot and midfoot was performed, which does not include the ligaments of the ankle in their entirety. We will have the patient return for dedicated ankle MRI exam and will not charge for this forefoot/midfoot examination.2. Nondisplaced fracture of the base of the fifth metatarsal with additional foci of edema within multiple bones which may represent contusions, as described above.3. Hematoma along the lateral ankle with poor visualization of the ATaFL, which could be further evaluated if the patient returns for dedicated ankle MRI.


Instruction: Generate impression based on findings.

Input: Unspecified epilepsy without mention of intractable epilepsy [345.90], Reason for Study: ^Reason: Evaluate for seizure. Seizure protocol with 1mm thin cut and coronal flair. History: epilepsy, recurrent. Recent CT showed small focus of low attenuation There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.On contrast enhanced images, there is a developmental venous anomaly on the left frontal lobe middle frontal gyrus without evidence of susceptibility lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Normal brain MRI.2. Developmental venous anomaly on the left frontal lobe middle frontal gyrus.


Instruction: Generate impression based on findings.

Input: 51-year-old female with history of rheumatoid arthritis and status post duodenal ulcer cauterization in outside hospital presenting with abdominal pain vomiting and hematemesis ABDOMEN:LUNG BASES: Small amount of bilateral pleural effusions and dependent atelectasis.LIVER, BILIARY TRACT: Pneumobilia. Two punctate air bubbles near the common bile duct best seen on image number 47 on coronal series likely represent air in the cystic duct stump, however, possibility of free air cannot be entirely excluded. SPLEEN: Wedge-shaped nonenhancing area in the superior pole of the spleen measuring 2.6 x 2.8 cm and is consistent with an infarct. Superior pole of the spleen adjacent to the infarct demonstrates heterogeneous enhancement. The etiology is unknown but may be secondary to ischemia and much less likely an infiltrating neoplastic process. Follow-up imaging can be helpful in a month for further evaluation.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys consistent with bases on history of end-stage renal disease. 12 x 12 mm hypodense lesion in the upper pole of the left kidney contains linear enhancements. This represent a thin septations, however, a solid lesion cannot be entirely excluded. There are other numerous, small hypodense lesions in both kidneys, some which contain increased density. These are too small to fairly characterize.RETROPERITONEUM, LYMPH NODES: Right retrocrural borderline enlarged lymph node measuring 10 x 7 mm or 20, series 5.BOWEL, MESENTERY: Proximal small bowel loops are minimally dilated measuring up to 2.7-cm. In the right lower quadrant, and distal small bowel loops are decompressed. Colonic loops are distended with fluid. These findings may be secondary to mild partial small bowel obstruction.The wall of the stomach and duodenum is definitive thickened.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount ascites.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes affecting the joints. Small amount of fluid around the hip joint anteriorly demonstrating possible loculations. Further evaluation with MRI may be helpful.OTHER: Decubitus ulcer with a subcutaneous abscess in the pelvis measuring 10 x 14 mm adjacent to the decubitus ulcer.

Output: Pneumobilia. The etiology is unknown. Punctate amount of air near the common bile duct may represent air in the cystic duct stump, however, although the possibility of free air is low, this cannot be entirely excluded.Splenic infarct in the upper pole of the spleen. Follow-up imaging in one month is recommended to further evaluate the splenic tissue surrounding the infarct.Bilateral small hypodense lesions in atrophic kidneys. These are incompletely evaluated with this single phase study. Follow-up imaging in 6 Maas is recommended especially for the evaluation of the left upper pole complex lesion.Mild partial small bowel obstruction. Gastroduodenal wall thickening.Decubitus ulcer with subcutaneous abscess.Left hip joint fluid demonstrating possible loculations. Further evaluation with MRI may be helpful to exclude septic arthritis.


Instruction: Generate impression based on findings.

Input: Pain in joint, pelvic region and thigh [719.45] / Pain in joint, lower leg [719.46] / Lumbago [724.2], Reason for Study: ^Reason: Compare to mri done on 9/14/14 History: Pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is a 30.1 mm x 30.3 mm x 22.4 mm sized L4 vertebral body hemangioma, no change since prior scan. The peripheral displacement of neural roots at the level of L5S1, no change since prior scan.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 except L4 vertebral body. 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 T12-L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable. Neural foramen and spinal canal appear to be within normal range.There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. No change of L4 vertebral body hemangioma in terms of size and MR characteristics since prior scan. 2. No change of peripherally displaced neural roots at the level of L5S1 since prior scan.3. Otherwise unremarkable. Comment: Since a large hemangioma can be a cause of back pain, although there is no change in terms of size and MR characteristics since prior scan, if clinically indicated, clinic consultation to neurointerventional radiology (page: 9287) can be considered.


Instruction: Generate impression based on findings.

Input: Brain: Brain parenchyma appears unremarkable. No intracranial mass or abnormal enhancement to suggest hemangioblastoma. No evidence of infarct or hemorrhage. 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. Mild scattered paranasal sinus mucosal thickening again seen, slightly worse involving the right anterior ethmoid sinuses. No findings to suggest endolymphatic sac tumor. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.Spine: CERVICAL: Linear enhancement along the posterior medial aspect of the cord related to vascular ectasia. Nodular focus of enhancement measuring 3 mm along the dorsolateral aspect of the spinal canal at the right C7 level compatible with hemangioblastoma remains unchanged. Tiny nodular focus along the left lateral aspect of the spinal canal along intradural nerve at the C3 level also unchanged. No new or enlarging lesions.Mild degenerative changes in the cervical spine including mild left neural foraminal narrowing at the C5-C6 level is unchanged. Spinal canal is patent. Vertebral body heights and alignment are maintained. No cord signal abnormality.THORACIC: 3 to 4 mm nodular foci of enhancement at the T1 level bilaterally suspected to represent tiny hemangioblastomas along the intradural aspect of the nerve rootlets and unchanged. Additional foci along the intradural spinal nerve rootlets including at the T4 on the right, the T4-5 level on the left, the T5 level on the right, as well as numerous foci along the conus. These lesions are unchanged in size and no new lesions are appreciated. Findings compatible with vascular ectasia are also seen along the dorsal and ventral surface of the distal spinal cord and conus.Alignment is anatomic. Vertebral body heights are preserved. No concerning marrow signal change is demonstrated.Spinal cord signal intensity and morphology are normal throughout. No significant spinal canal or neuroforaminal narrowing is demonstrated. LUMBAR: Numerous intradural enhancing nodules are redemonstrated along the nerve roots of the cauda equina. The largest of these is at the L1 level and measuring up to 15 x 15 mm in the axial plane and 17 mm in the craniocaudal dimension, which is unchanged, previously 15 x 15 x 16 mm on 5/11/2015. There is gradual enlargement when compared to examination dating back to 6/21/2013 when this lesion measured 11 x 12 x 12 mm. The other nodules including a relatively more prominent 7 mm nodule at the upper L3 level are also unchanged including numerous punctate foci along the distal nerve roots. No definite evidence of any new lesions is seen.Alignment is anatomic. The vertebral body heights are preserved. No concerning marrow signal change is demonstrated.Mild degenerative changes include mild to moderate right L4-L5 neural foraminal stenosis related to a small disc protrusion which appears minimally more prominent in the interval. Disk desiccation at the L5-S1 level with small disc protrusion at the left L5-S1 level with contact of the left S1 nerve root in the lateral recess is similar to prior. Spinal canal neural foramina and lumbar spine are otherwise preserved.Enhancing retroperitoneal lesion along the lateral aspect of the left 12th rib measuring approximately 10 x 12 mm is unchanged. 11 mm lesion at the aortic bifurcation is also unchanged. Additional abdominal findings including renal cysts and evidence of bilateral adrenalectomy again seen and better assessed on prior dedicated abdominal MRI.

Output: 1. No evidence of intracranial lesions.2. Multiple hemangioblastomas in the cervical, thoracic, and lumbar spine are overall not significantly changed since MRI from 5/11/2015. The more dominant mass at the L1 level measuring 15 x 15 x 17 mm demonstrates gradual enlargement as detailed above.3. No significant change in enhancing nodules in the left retroperitoneal region as well as at the aortic bifurcation.4. Mild degenerative changes in the lumbar spine with disc protrusions at L4-L5 and L5-S1 levels as described above.


Instruction: Generate impression based on findings.

Input: Pain and weakness. Rule out rotator cuff tear. ROTATOR CUFF: The supraspinatus tendon and muscle appear normal. The infraspinatus tendon appears normal. There is very mild fatty infiltration along the myotendinous junction of the infraspinatus, but the muscle otherwise appears normal. The teres minor muscle and tendon appear normal. The subscapularis tendon and muscle appear normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint associated with minimal impression upon the superior fibers of the supraspinatus muscle. I see no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is focal loss of articular cartilage along the postero-superior aspect of the glenoid with a small focus of degenerative signal abnormality in the underlying subchondral bone. Although I see no fluid signal intensity entering the glenoid labrum, intermediate signal intensity within the substance of the superior labrum is suspicious for a SLAP tear. Poorly defined signal intensity within the superior aspect of the anterior labrum likely reflect degeneration. The inferior labrum is grossly intact given the limitations of a non-arthrogram study. I see no joint effusion. A small cyst in the posterior aspect of the humeral head is of doubtful clinical significance.BICEPS TENDON: The tendon of the long head of the biceps appears normal. 1.

Output: 2.3.No evidence of rotator cuff tear.4.Mild acromioclavicular and glenohumeral joint osteoarthritis.5.Possible superior labral tear, of questionable current clinical significance.6.Other findings as above.


Instruction: Generate impression based on findings.

Input: Redemonstrated are remote post-operative findings related to a left parieto-occipital craniotomy for tumor resection. There is unchanged T2/FLAIR hyperintensity surrounding the resection cavity as well as unchanged bilateral periventricular and subcortical T2/FLAIR hyperintensity, left greater than right. There is no suspicious enhancement. There is a thin rim of T1 shortening and susceptibility artifact along the periphery of the surgical cavity, consistent with blood degradation products and/or mineralization. There is an unchanged punctate focus of susceptibility effect within the left frontal white matter, consistent with hemosiderin deposition from chronic microhemorrhage. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, including mild ex vacuo dilatation of the left ventricular atrium. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Compared to 1/22/2015 and 7/9/2014, there are stable post-operative findings related to a remote left parieto-occipital craniotomy for tumor resection with surrounding T2/FLAIR hyperintensity consistent with posttreatment change. No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Female 76 years old Reason: H/o lymphoma and IPMN, please restage IPMN History: LUQ discomfort ABDOMEN:LIVER, BILIARY TRACT: No suspicious liver lesion. Patent hepatic vasculature. Status post cholecystectomy. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in the uncinate process is again seen. It measures 1.0 x 0.9 x 1.4 cm (series 5, image 22; series 9, image 19) and is unchanged compared to prior study. No solid enhancing component identified. Tiny additional sidebranch lesions in the pancreatic neck and body are also unchanged. No pancreatic duct dilatation.ADRENAL GLANDS: Stable left adrenal gland thickening.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Stable uncinate process cystic lesion which is most compatible with a sidebranch IPMN. Additional small pancreatic cystic lesions are also stable and these likely represent additional IPMNs.


Instruction: Generate impression based on findings.

Input: -year-old admitted with sepsis. Findings no unwitnessed fall. Assess for cervical spine injury. There is widening of intervertebral disk space at C5 -- C6 level. There is also slight retrolisthesis of C5 in respect to C6. Extensive irregularity and loss of bony density of the inferior half of C5 vertebrae and to a lesser degree of C6 vertebrae is noted. Although these findings may represent advanced degenerative disk disease with associated endplate changes possibility of an infectious process cannot be entirely ruled out. Further follow-up with an MRI examination with infusion is highly recommended. There are no old studies for comparison. The findings are not believed to be post traumatic. No distinct bony fractures identified. The bony density of the rest of the spine and the alignment remains unremarkable. Degenerative changes at other levels with hypertrophic spur formation is noted. Degenerative changes causes neural foramina compromise at C3 -- C4 on the right, C4 -- C5 bilaterally and C5 -- C6 bilaterally. Limited images of the apices of the lungs are unremarkable.

Output: 1.Findings at C5 -- C6 as detailed above. Further evaluation with an infused MRI is recommended to exclude an infectious process.2.No definitive evidence of fracture.3.Minimal retrolisthesis of C5 on C6. 4.5.


Instruction: Generate impression based on findings.

Input: Blurry vision. Suggestion of intracranial mass on head CT scan. Though the study was initially protocoled with and without intravenous contrast, the patient did refuse to complete the examination. Only precontrast images are available. Also, neck MRA was not performed.Brain MRI:There is confluent T2-hyperintense signal involving the left occipital lobe with anterior extension into the medial right temporal lobe.. The signal abnormality is limited to the white-matter but the overlying cortex is mildly T1-hyperintense. Most of the associated diffusion signal is T2-shine through. The right occipital lobe shows a less extensive signal abnormality, compared to the left. The signal abnormality is predominantly in the cortex which is swollen and T2-hyperintense and shows diffusion restriction. The occipital abnormalities caused mild mass-effect manifested by mildly closed occipital sulci.Two foci of T2-hyperintense signal, also with no diffusion restriction, are present in the left thalamus.Susceptibility-weighted imaging is notable for focus of susceptibility effect in the right thalamus with no associated edema which may represent mineralization or hemosiderin deposition. There is no hemorrhage in the occipital abnormality.Patchy frontoparietal white-matter T2-hyperintense lesions without diffusion restriction are nonspecific but likely reflect chronic microvascular ischemia. There is generalized mild brain volume loss manifested by expansion of the ventricles and the other CSF-containing spaces. There is no midline shift or brain herniation.There is mild maxillary and ethmoid mucosal thickening. There is a chronic right orbital medial blowout fracture.Head MRA:There is no flow-limiting stenosis, occlusion or aneurysm of the major intracranial arteries, including the posterior circulation.

Output: 1.The abnormality in the left occipital lobe, with temporal extension, and left thalamus are most compatible with subacute infarcts. The abnormality in the right occipital lobe is more recent given the associated cortical diffusion restriction and matching ADC hypointensity. There is no intracranial hemorrhage or herniation. Punctate susceptibility effect in the right thalamus without edema probably represent mineral deposition or hemosiderin staining. In addition, there are findings of chronic microvascular ischemia in the cerebral white-matter.2.Head MRA shows no significant stenosis, occlusion or aneurysm of the major intracranial arteries.3.Incidental findings include mild mucosal thickening in the paranasal sinuses which is nonspecific and a chronic right medial orbital blowout fracture.


Instruction: Generate impression based on findings.

Input: Reason: MS, f/u progression History: paresthesias Brain:Redemonstration of numerous T2 hyperintense lesions within the periventricular and to a lesser extent subcortical white matter, including within the corpus callosum. There is a single new lesion in the right posterior frontal lobe subcortical white matter (series 501 image 64 and series 801 image 47). This demonstrates mild enhancement compatible with an active lesion.There is no evidence of intracranial hemorrhage, or mass.The ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.Right maxillary sinus mucous retention cyst. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:Again noted are multiple poorly defined long segment foci of increased T2 signal within the cervical spine. There is no associated cord expansion. The vertebral column alignment is within normal limits. The vertebral body and disc heights are preserved. The vertebral bone marrow signal is unremarkable. No significant spinal canal or neural foraminal stenoses.

Output: 1. Numerous intracranial white matter lesions compatible with the history of multiple sclerosis. There is a single new right frontal lobe subcortical lesion which also demonstrates enhancement indicating an active lesion.2. Numerous long segment poorly defined intramedullary lesions in the cervical spine compatible with the history of MS. No significant interval change.


Instruction: Generate impression based on findings.

Input: History of pancreatic ductal dilatation on a US dated 3/5/2015. Presents for follow-up examination. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. There is no intrahepatic biliary ductal dilatation. The common bile duct measures up to 7 mm without an obstructing stone or discrete lesion. It tapers smoothly at the major ampulla. The gallbladder is normally distended without cholelithiasis. Several subcentimeter hepatic cysts are noted. The vessels are patent.SPLEEN: The spleen is normal in size and signal intensity without a discrete lesion.PANCREAS: The pancreas is normal in morphology signal intensity and enhancement. The main pancreatic duct is minimally prominent up to 3 to 4 mm, not significantly changed from the prior study. There is a short segment stricture at the pancreatic body/tail junction without a discrete mass lesion. The main pancreatic duct appears to drain at the major ampulla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Bilateral renal cysts. Intrinsically T1 weighted hyperintense lesion in the right superior pole demonstrates no enhancement on subtraction images and is compatible with a proteinaceous/hemorrhagic cyst. No suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Borderline prominent main pancreatic duct with a focal stricture at the level of the pancreatic body/tail junction without a discrete mass lesion. Follow-up MRI in 6 months to 1-year is recommended.


Instruction: Generate impression based on findings.

Input: 32 years, Male, epilepsy. Preoperative planning for depth electrodes. Examination is limited to sequences for operative planning and intraoperative navigation. Abnormal signal involving the left hippocampus is better appreciated previously. There is no intracranial mass or mass effect or abnormal enhancement in the brain. Mild global parenchymal volume loss is again evident.

Output: Examination limited to sequences for operative planning. Signal abnormality involving the left hippocampus better appreciated on prior complete brain MRI studies.


Instruction: Generate impression based on findings.

Input: Female 60 years old Reason: Evaluate for stress fracture - patient with severe pelvic and thigh pain not explained by MRI of lumbar spine. BONE MARROW: Mild osteoarthritis affects the pubic symphysis, otherwise the bone marrow signal of the pelvis is normal. No features suggestive of stress fracture.SOFT TISSUES: Musculature the pelvis appears normal. JOINTS: The SI joints are unremarkable. Hip joints appear normal for age.ADDITIONAL

Output: No stress fracture or other findings to account for patient's severe pelvic and thigh pain.


Instruction: Generate impression based on findings.

Input: Female, 32 years old, history of neuroblastoma, yearly follow-up to evaluate for meningiomas. Redemonstrated are findings secondary to bilateral frontal and left temporal craniotomy. The bilateral frontal lobes remain encephalomalacic and hemosiderin-stained similar to the prior examination.A nodular enhancing lesion along the left aspect of the posterior interhemispheric falx is unchanged in size measuring up to 8 mm in thickness. A nodular enhancing lesion along the right dorsum sella is also unchanged measuring up to 6 mm. Thin plaque-like enhancement along the right frontal convexity is unchanged as well.An enhancing lesion within the right frontal bone measures up to 20 mm in length and is slightly increased in size when compared to prior examinations where it measured 15 or 16 mm. It is more noticeably increased in size when compared to more remote examinations dating back to 2006.No new enhancing lesions are identified. No significant parenchymal edema is detected. Ex vacuo dilatation of the frontal horns is unchanged. Ventricles are otherwise unremarkable. Scattered foci of parenchymal susceptibility effect are unchanged and likely related to prior radiotherapy.

Output: 1.Redemonstration of extensive postoperative and treatment related findings. Hemosiderin stained encephalomalacia of the bilateral frontal lobes is unchanged.2.Multiple dural based enhancing lesions show no significant interval change in size.3.A lesion centered on the right frontal bone shows a mild interval increase in size, most notable when comparison is made to examinations from several years ago. The etiology and clinical significance of this finding are uncertain.


Instruction: Generate impression based on findings.

Input: Renal cancer status post nephrectomy on surveillance. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense hepatic foci, unchanged, likely cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical findings of right nephrectomy without evidence of local recurrence.No suspicious lesions in the left kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of local recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: 44-year-old male patient with history of renal cell carcinoma status post nephrectomy. Evaluate for renal recurrence or distant metastasis. 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: Status post left nephrectomy. No evidence of recurrence within the nephrectomy bed. There is a 1 cm simple cyst within the right lower pole. No suspicious renal lesion is identified within the right kidney. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post left nephrectomy without evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:1/11/1960)Reason: Patient w/ hx of CVA s/p VP shunt, w/ AMS, eval for CVA/ vascular occlusion/ hemorrhage History: As abovePROVIDER/ATTENDING NAME: MICHELLE K MARTINCHEK MICHELLE K MARTINCHEK MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. The ventriculostomy tube courses the right parietal calvarium through the right central sulcus into the right lateral ventricle with tip in the frontal horn of the right lateral ventricle.A ventriculostomy tract course of the right frontal lobe.There are a couple periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are T2 and FLAIR hyperintense patchy foci within the brainstem.There is abnormal signal along the medial aspect of the right cerebellar hemisphere similar to the prior exam. There is associated susceptibility effect within this cerebellar lesion.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 redemonstrate 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left A1 segment is larger than the right A1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.There is extracranial origin of the posterior inferior cerebellar arteries bilaterally.There is suspected meningeal thickening present which is stable since the prior exam.

Output: 1.A right cerebellar lesion might likely represent prior vascular injury associated with hemorrhage. This is stable since the prior exam.2.Ventriculostomy tube is in place.3.There is no evidence for intracranial cerebrovascular occlusive disease.4.There are bilateral ventricular shunts present without evidence for ventriculomegaly.5.There is redemonstration and no change in pachymeningeal thickening. One possibility is that it is related to the ventricular shunts.


Instruction: Generate impression based on findings.

Input: 71 year old female with history of clear cell carcinoma of the uterus, status post chemotherapy. Metastatic uterine cancer with known enlarged retroperitoneal lymph nodes, presents with 3 weeks of progressive bilateral lower extremity edema. Evaluate for IVC clot/compression. CHEST:LUNGS AND PLEURA: Multiple small micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense focus in the dome the liver is unchanged. There are no other focal lesions. Gallstones are unchanged, but the gallbladder is contracted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Double-J stent in the left kidney collecting system is unchanged. Mild left caliectasis is unchanged. On axial image 58/165 of series 3, a 1.8 x 2 cm left midpole renal cortical mass is found. In retrospect this was present on the prior examination, but the timing of contrast bolus was inadequate to delineate the mass. This mass may represent a metastasis or primary renal neoplasm.RETROPERITONEUM, LYMPH NODES: Left para-aortic mass invading the L4 lumbar vertebral body now measures 4.6 x 4.1 cm image number 83, series number 3. The mass encases the left ureter. Adjacent retroperitoneal adenopathy is also slightly smaller. Increasing distraction of the L4 vertebral segment with compression deformity. Increasing periaortic and left mesenteric adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Destruction of the L4 vertebral body is increased.OTHER: No IVC obstruction was found. The IVC is narrowed at the inferior hepatic margin, without change from the prior examination.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Increasing periaortic and mesenteric lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is increasing edema within the dependent portion of the lower extremities on this scan which extends to the proximal thighs bilaterally.OTHER: Periaortic/psoas/L4 vertebral body mass with direct invasion of the psoas and vertebral body is approximately unchanged in size. New compression deformity of the L4 vertebral segment. The spinal canal is difficult to evaluate in MRI may be helpful for further evaluation, if cord compression is a concern.

Output: 2-cm diameter left midpole renal mass may be metastasis versus renal cell cancer.Slight increase in the size of the left psoas/L4 mass and retroperitoneal adenopathy. Increased destruction of L4 vertebral body with compression deformity. No other significant change from previous CT.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.8 x 2.6 x 3.6 cmPeripheral Zone: Heterogeneous peripheral zone with small T2 hypointense foci.Central Gland: Large anterior tumor measuring at least 2.4 x 2.1 cm that abuts the anterior fibromuscular stroma and capsule. Tumor extends from the apex to the base. Anterior extracapsular extension is suspected.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Anterior extracapsular extension is suspected.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large anterior tumor with suspected extracapsular extension.


Instruction: Generate impression based on findings.

Input: Avascular necrosis ACETABULAR LABRUM: Evaluation of the acetabular labrum is limited given the lack of intra-articular contrast. Within these limits, there is no evidence of gross labral detachment although there is some slight signal irregularity within the anterior labrum for example on series 6 image 24 and series 9 images 8 through 11.ARTICULAR CARTILAGE AND BONE: There is serpentine low T1 signal intensity involving the left femoral head indicating avascular necrosis. Similar findings are also evident in the right femoral head and a tunnel from prior decompression is identified extending through the right femoral head neck junction. The articular surface of the left femoral head is maintained. Alignment is normal. There is a trace amount of fluid within the joint but no joint effusion.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Avascular necrosis of the left hip without evidence of articular collapse.2. Slight signal irregularity of the anterior labrum.


Instruction: Generate impression based on findings.

Input: History of right upper extremity pain and weakness. Nonenhanced MRI of the right humerus demonstrates a normal appearance of the bones and soft tissues. We see no findings to account for the patient's right upper extremity pain and weakness. Please note that this study is not protocoled for evaluation of the rotator cuff.Nonenhanced MRI of the right hand demonstrates a normal appearance of the bones and soft tissues. We see no findings to account for the patient's pain and weakness. Please note that this study is not protocoled for detailed evaluation of the intrinsic ligaments of the wrist.

Output: Normal-appearing right arm and hand without specific findings to account for the patient's pain and weakness.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsions Liver transplant statusClinical question: evaluate for PRESS, vasculitis, intracranial mass, PTLDSigns and Symptoms: seizure MRI of the brainNo diffusion weighted abnormalities are appreciated.There is T2 and FLAIR signal hyperintensity involving the subcortical white matter of the occipital, parietal and frontal lobes in a watershed type distribution. There is no associated hemorrhage diffusion restriction or 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 demonstrate mucosal thickening. The visualized portions of the mastoid air cells are partly opacified. The visualized portions of the orbits are intact. The eyes are mildly elongated in the AP dimension.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The right transverse sinus is smaller than the right transverse sinus.

Output: 1.Findings are compatible with posterior reversible encephalopathy syndrome (PRES).2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.4.MR venogram of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Reason: r/o hcc History: History of long-term primary sclerosing cholangitis and ulcerative colitis, liver cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. No arterially enhancing lesion with washout is present to suggest HCC. Peripheral cystic foci in the left lobe of the liver. One of them is more tubular shaped and measures 20 x 11 mm (series 9 image 309) and more lobular lesion measures 21 x 12 mm (series 9 image 301). These may represent focal intrahepatic dilatation, but cannot exclude abscess.No obvious choledocholithiasis or stricture of the bile duct is noted.SPLEEN: Liver measures 18.8 cm and is enlarged. Splenule noted near the splenic hilum.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Periportal adenopathy is likely due to primary sclerosing cholangitis.BOWEL, MESENTERY: Loss of haustra and mild mucosal enhancement of the colon compatible with ulcerative colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Peripheral cystic foci in the left lobe of the liver may represent focal intrahepatic dilatation, but cannot exclude abscess.2.No specific evidence of HCC.3.Findings of liver cirrhosis and splenomegaly.4.For future follow-up, recommend MRCP exam.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: MS, f/u progression History: paresthesias Multifocal bihemispheric FLAIR white matter high signal intensity lesions are again seen.In particular, left left periventricular and centrum semiovale lesion shows relatively homogeneous signal intensity comparing to prior which showed slightly inhomogenous pattern. In addition, bilateral internal capsule lesions are not as conspicuous as they were on prior scan. These changes may reflect changes of disease activity.However, considering images were obtained from different MR machine (previously 3 T but this one was performed in 1.5T), these findings may not represent actual interval change.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Right maxillary sinus shows retention cyst which appears to be slightly bigger than before.There is another small retention cyst on the left side.

Output: No significant interval change of multiple various size bihemispheric white matter lesions considering different magnet strength since prior scan.


Instruction: Generate impression based on findings.

Input: For the purposes of labeling, the last rib-bearing vertebra is designated T12. The L5 vertebra appears sacralized. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained without evidence of compression fracture. There is disc desiccation with moderate loss of disc height at L3-L4. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the T12-L1 level.T10-T11 (sagittal images only): Small right perineural cyst. No significant disc bulge, spinal canal stenosis. T11-T12: Bilateral perineural cysts. No significant disc bulge or spinal canal stenosis. T12-L1: Bilateral perineural cysts. No significant disc bulge or spinal canal stenosis. L1-L2: No significant disc bulge, spinal canal or foraminal stenosis. L2-L3: Bilateral perineural cysts, mild disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum. No significant spinal canal or foraminal stenosis. L3-L4: Disc bulge with superimposed left paracentral disc extrusion and superior migration of 13 mm, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild left foraminal stenosis. No significant spinal canal or right foraminal stenosis. L4-L5: Mild disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum. No significant spinal canal or foraminal stenosis. L5-S1: No significant disc bulge, spinal canal or foraminal stenosis.

Output: 1. No compression fractures. Mild degenerative changes of the lumbar spine as detailed above. There is a left paracentral disc extrusion at L3-L4 with superior migration of 13 mm. There is mild left L3-4 foraminal stenosis. Spinal canal and neural foramina in the lumbar spine are otherwise patent. 2. Multiple small perineural cysts are incidentally noted and of doubtful clinical significance.3. Transitional lumbosacral anatomy as detailed above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right shoulder impingement ROTATOR CUFF: There is articular surface fraying of the supraspinatus tendon with superimposed tendinosis but there is no evidence of full-thickness tear. The remaining rotator cuff tendons are intact. There is mild fatty atrophy of the infraspinatus muscle but the remaining rotator cuff musculature is intact.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. No significant fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is severe osteoarthritis of glenohumeral joint with subchondral cystic change along both the glenoid and humeral head with a large humeral head osteophyte. There is deformity of the superior labrum suggesting tearing. Additionally, there is flattening of the posterolateral aspect of the humeral head which may represent a Hill-Sachs deformity from prior dislocation.BICEPS TENDON: Evaluation of the biceps tendon is limited given the internal rotation of the patient. Within these limits, the intra-articular portion of the biceps tendon is poorly visualized which may suggest tearing.ADDITIONAL

Output: 1. Severe osteoarthritis of the glenohumeral joint with moderate changes of the acromioclavicular joint.2. Fraying and tendinosis of the supraspinatus tendon without evidence of full-thickness rotator cuff tear.3. Poor visualization of the biceps tendon which may in part be positional in nature but is also concerning for at least partial tearing.


Instruction: Generate impression based on findings.

Input: Cervical spine:There has been prior anterior cervical fusion at C5, C6, and C7 better visualized on previous cervical spine CT.Redemonstrated is congenital narrowing of the spinal canal.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Previously demonstrated minimal anterolisthesis is again noted. Mild disc bulge as well as facet and uncovertebral proliferative change is present resulting in moderate left neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, uncinate hypertrophy, and facet hypertrophy. There is mild/moderate central and moderate bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex asymmetric to the right, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. The cord is flattened both anteriorly and posteriorly, worse on the right anteriorly, demonstrating intrinsic cord T2 hyperintensity of myelomalacia. There is moderate central and moderate bilateral neural foraminal stenosis.C5/6: Right uncinate hypertrophy causes mild-to-moderate right neural foraminal stenosis.C6/7: Bilateral uncinate hypertrophy (right greater than left) and causes mild left and mild-to-moderate right neural foraminal stenosis.C7/T1: Mild bilateral facet are particular without stenosis.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. A benign hemangioma is present within the T11 vertebral body. T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates a shallow right paracentral disc protrusion causing minimal anterior right hemicord flattening without intrinsic cord signal abnormality or stenosis.T3/4 demonstrates a minimal right shallow paracentral disc protrusion without cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates a shallow central disc protrusion without cord encroachment. T8/9 demonstrates a shallow right paracentral disc protrusion without cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates a shallow right paracentral disc protrusion without cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:As been prior L5 laminectomy with a disc spacer at L5/S1, better demonstrated on previous CT.There are no acute fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Redemonstrated is grade 1 anterolisthesis L5 on S1, grade 1, minimal retrolisthesis of L2 on L3, minimal retrolisthesis L3 on L4, and grade 1 anterolisthesis L4 on L5. These findings are unchanged.L1/2: Mild bilateral facet hypertrophy without stenosis.L2/3: Mild disc bulge and mild bilateral facet hypertrophy without stenosis.L3/4: Mild disc bulge and mild-to-moderate bilateral facet hypertrophy without stenosis.L4/5: Diffuse annular disc bulge, severe facet hypertrophy associated with what appears to be bilateral bone graft material. Residual facets demonstrate bilateral effusions. There is associated reactive marrow edema that extends into the right L4 and L5 pedicles. There is no central stenosis however there is moderate bilateral neural foraminal stenosis.L5/S1:Disc and covering with facet hypertrophy and what appears to be bone graft material. There is no central stenosis however there is mild bilateral neural foraminal stenosis.

Output: 1.Postoperative changes of the cervical lumbar spines as described above.2.C2/3: Moderate left neural foraminal stenosis.3.C3/4: Mild/moderate central and moderate bilateral neural foraminal stenosis.4.C4/5:The cord is flattened both anteriorly and posteriorly, worse on the right anteriorly, demonstrating intrinsic cord T2 hyperintensity of myelomalacia. There is moderate central and moderate bilateral neural foraminal stenosis.5.C5/6: Mild right neural foraminal stenosis.6.C6/7: Mild left and mild-to-moderate right neural foraminal stenosis.7.T2/3 demonstrates a shallow right paracentral disc protrusion causing minimal anterior right hemicord flattening without intrinsic cord signal abnormality or stenosis.8.T3/4 demonstrates a minimal right shallow paracentral disc protrusion without cord encroachment. 9.T7/8 demonstrates a shallow central disc protrusion without cord encroachment. 10.T8/9 demonstrates a shallow right paracentral disc protrusion without cord encroachment. 11.T11/12 demonstrates a shallow right paracentral disc protrusion without cord encroachment. 12.L4/5: Bilateral effusions and reactive marrow edema that extends into the right L4 and L5 pedicles. There is no central stenosis however there is moderate bilateral neural foraminal stenosis.13.L5/S1:Mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 42-year-old male with altered mental status and lethargy There is no evidence of intracranial hemorrhage, mass or edema. Encephalomalacia involving bilateral frontal lobes and bilateral temporal lobes are again noted and not significantly changed from comparison MRI accounting for technical differences. Otherwise symmetric prominence of a ventricular system is in proportion to the diffuse sulcal prominence compatible with generalized brain atrophy. Slight hyperdense lesion extending from the left basal ganglia into the left cerebral peduncle that corresponds to high T1 signal lesion on prior MR is of uncertain clinical etiology and significance.Basal ganglia and right insula calcifications have increased in size, but were likely present on prior MRI. There are atherosclerotic calcifications of the basilar artery as well as bilateral internal carotid arteries and middle cerebral arteries.Hyperostosis frontalis is noted. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Accounting for technical differences, there is no significant change compared to prior MRI as described above. Due to multiple abnormalities correlation with MRI should be considered for more definitive comparison.


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer and history of benign right breast biopsy in 2013. Tyrer Cusick model shows her lifetime risk to be 31%. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are multiple bilateral enhancing foci in the breasts, none of which are uniquely enhancing.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: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 70-year-old with fat malabsorption. Concern for obstructing lesion in the pancreatic head. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. There is diffusely decreased parenchymal signal and signal dropout on the in phase images compatible with iron deposition. No focal mass lesion.There are multiple dependent stones within the gallbladder. No intrahepatic or extrahepatic biliary ductal dilatation. Common bile duct is normal in size and contour.SPLEEN: The splenic parenchyma has diffusely decreased signal compatible with iron deposition.PANCREAS: The pancreas is mildly atrophic, but maintains normal signal. No obstructing lesion is identified within the limits of a noncontrast exam. There is pancreatic divisum with the main duct draining into the minor papilla (series 501 image 22). The main pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple cysts in the kidneys bilaterally. One cyst in the superior pole of the left kidney is minimally complex containing a few thin septations. No mass lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes from Roux-en-Y gastric bypass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreatic divisum without associated dilatation of the main pancreatic duct. No obstructing mass lesion is identified within the pancreatic head.2.Cholelithiasis without evidence of choledocholithiasis. No biliary ductal dilatation.3.Findings of hemosiderosis with increased iron content in the liver and spleen.


Instruction: Generate impression based on findings.

Input: ORBITS: The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no restricted diffusion to suggest acute ischemic infarction. There is no evidence of intracranial hemorrhage. There are no areas of abnormal parenchymal signal or 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. The midline structures and craniocervical junction are within normal limits. Incidental note is made of a small cystic structure within the posterior nasopharynx compatible with a normal variant Tornwaldt cyst.

Output: 1.No evidence of acute ischemic infarction.2.Orbits and optic nerves unremarkable and without specific findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: Diagnosis: Facial weaknessClinical question: Eval R frontal lesionSigns and Symptoms: R ptosis, abnormality on MRI woComments: MRI Brain W/ per Olayinka Kamson (1769), Non-infused brain done 9-24-15 | MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: MRI of the brain and orbits is within normal limits. No frontal lobe lesion is appreciated.. There is no lesion identified which could explain the patient's ptosis on the current exam.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with ataxia and lower extremity hyperreflexia. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. There is no evidence of marrow edema or pathologic marrow enhancement.The visualized spinal cord demonstrates normal signal intensity and morphology. No areas of focal signal abnormality, edema or volume loss are seen. No pathologic spinal cord enhancement is detected, within the limitations of artifact degradation on the axial postcontrast images. There are no epidural lesions suspected.The intervertebral discs are preserved with no evidence of significant bulge or herniation. The spinal canal and neural foramina remain patent.

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


Instruction: Generate impression based on findings.

Input: Reason: evaluate for ischemia, stroke History: left leg weakness, lethargy MRI of the brainThe 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 is stableThere is phase encoding artifact present anteriorly which partially obscures visualization at the anterior skull base.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 are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no convincing evidence for intracranial aneurysm or cerebrovascular occlusion, however, artifacts at the level of the carotid siphons and the proximal ACAs may obscure a subtle lesion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. The left A1 segment is hypoplastic. There is fenestration of the basilar artery .Along the right in the right and left carotid siphon there is artifact present which may obscure a lesion.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No lesions explaining patient's left-sided leg weakness can be identified.2.Please note that the patient's MR angiogram of the brain is somewhat compromised by artifact especially along the carotid siphon and the A1 and anterior communicating regions. If there is concern for aneurysms, vascular leisons or vascular occlusive lesions in these locations a CT angiogram is suggested or alternatively a 3 Tesla MR angiogram of the brain.


Instruction: Generate impression based on findings.

Input: 23 years Male (DOB:5/23/1993)Reason: Seizure foci History: SEIZURE DOPROVIDER/ATTENDING NAME: NAOUM ISSA DAVID G. BEISER 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.There are a couple left sided periventricular punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.A couple left-sided periventricular white matter lesions are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.No intracranial mass lesion is identified


Instruction: Generate impression based on findings.

Input: Female 14 years old Reason: Stress Fracture, Osteomyelitis History: lupus on immunosuppression and high dose of steroids TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No low T1 signal to suggest osteomyelitis. ADDITIONAL

Output: Normal examination. No evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Chronic progressive headaches started after an motor vehicle accident, please evaluate for reasons. Multiple sequences are motion degraded. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Postgadolinium sequences are severely motion degraded, but there is no obvious abnormal enhancement noted intracranially. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Examination is moderately motion degraded. No intracranial hemorrhage, mass, or mass effect is appreciated.


Instruction: Generate impression based on findings.

Input: 70-year-old female with history of IPMN. Now with unintentional weight loss. ABDOMEN:LIVER, BILIARY TRACT: No hepatic. No intra or extrahepatic ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Multiple small cystic foci of the pancreas that demonstrate connection with the pancreatic duct on the MRCP sequence show no significant interval change and are consistent with IPMNs. The largest of these cystic lesions measure 1.1 x 1 cm and is located in the pancreatic tail (axial series 401 image 16), unchanged. Pancreatic atrophy is again noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval weight loss is notable. Osseous hemangioma of the L2 vertebral body, unchanged.OTHER: Susceptibility artifact in the right lower quadrant anterior abdominal wall of unknown etiology.

Output: 1.Stable cystic foci of the pancreas compatible with IPMNs. 2.Inconclusive etiology of interval weight loss. No anatomic abdominal abnormality identified.