Instruction: Generate impression based on findings.

Input: Premature and developmentally delayed: no walking or sitting up on own. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris lies at the L2 vertebral body level. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial anomalies.2. No evidence of cervical or thoracic spine anomalies.


Instruction: Generate impression based on findings.

Input: 70 year old man with history of sarcoid (pulmonary and ocular involvement), diabetes, hyperlipidemia, with exertional dyspnea and significant hypertrophy on echocardiogram. He was referred for cardiac MR stress testing to evaluate for coronary disease and/or infiltrative cardiomyopathies. MEDICATIONS: aspirin, enalapril, lovastatin, metformin First Pass PerfusionDuring hyperemia, there is a circumferential perfusion defect involving the basal, mid, and apical slices of the left ventricle.Viability/ Myocardial ScarThere is extensive late gadolinium enhancement involving the entirety of the left ventricular subendocardium, in a pattern which is atypical for previous myocardial infarction. In addition, the inversion time for the myocardium and the LV cavity are within 80ms of each other, which is also suggestive of amyloidosis. Left VentricleThe left ventricle is severely hypertrophied (IVSd=16mm) but with normal systolic function.Left AtriumThe left atrium is moderately enlarged. The left atrial wall is thickened.Right VentricleThe right ventricle is normal size and systolic functionRight AtriumThe right atrium is moderately enlarged. The interatrial septum is thickened. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a "pseudo-bovine" brachiocephalic branching pattern. Mild thoracic and descending aorta atherosclerosis.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion. Extracardiac FindingsBilateral upper pulmonary infiltrates noted. Trivial right effusion. Large para-aortic and subcarinal lymph nodes noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Although during hyperemia, there is significant circumferential perfusion defect involving the entire left ventricle, it is unclear if this finding is secondary to presumed cardiac amyloidosis or due to coronary artery disease.2. There is no evidence of prior myocardial infarction. 3. Severe left ventricular hypertrophy with normal systolic function. There is extensive late gadolinium enhancement in a pattern that is strongly suggestive of the diagnosis of cardiac amyloidosis rather than cardiac sarcoidosis.4. Normal RV size and systolic function.5. Moderate biatrial dilation. 6. See extra-cardiac findings. 7. Quantification of LV/RV volumes and myocardial T1 times to follow as an addendum. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: At C5-6, there is a small posterior disc-osteophyte complex with mild spinal canal stenosis. Likewise, at C6-7, there is a posterior disk osteophyte complex with mild disc space narrowing and mild effacement of the ventral thecal sac and slight bilateral neural foramen narrowing. There is also a prominent anterior disc-osteophyte complex at this level. There is no evidence of neural foramen or paraspinal soft tissue mass lesions. The vertebral column alignment is anatomic and the vertebral body heights are preserved. There is a T2 and T1 hyperintense nonenhancing focus in the C6 vertebral body, which is compatible with fat deposition or hemangioma. There is a partially imaged arachnoid cyst in the sella with flattening of the anterior hypophysis.

Output: 1.Mild degenerative spondylosis at C5-6 and C6-7, but no evidence of neural foramen or paraspinal soft tissue mass lesions. 2.Partially imaged arachnoid cyst in the sella with flattening of the anterior hypophysis. A dedicated pituitary MRI may be useful for further evaluation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis, evaluate for progression. Signs and symptoms: Weakness. Nonenhanced brain MRI:Negative diffusion-weighted images.There is technique difference between the current exam (routine multiple sclerosis brain MRI with 4 mm slices) compared to prior Dr Javed's dedicated protocol with 2 mm slices. This examination is also performed without intravenous contrast as is requested by clinical service compared to prior post enhanced exam. The difference in technique precludes precise evaluation for detection of smaller lesions.Within this limitation however there is no convincing evidence of new demyelinating plaque or progression of demyelinating disease since prior study. Mild findings of demyelinating disease in the supratentorial brain parenchyma, midbrain, posterior pontine and bilateral cerebellum are again identified.Unremarkable cerebral cortex and cortical sulci and with normal size of the ventricular system with maintained midline. There is revisualization of cavum septum pellucidum and vergae.

Output: Findings consistent with patient's known demyelinating disease without convincing evidence of interval progression. Please see above comments.


Instruction: Generate impression based on findings.

Input: 22-year-old female with a history of a of Tetralogy of Fallot for which she underwent a complete repair with preservation of the pulmonary valve annulus and subsequent pulmonary valve replacement. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 102 ml/m2 (normal range: 65+/-11), the LVEDV is 180 ml (normal range 109+/-23), the LV end systolic volume index is 45 ml/m2 (normal range 18+/-5), the LVESV is 79 ml (normal range 31+/-10), the LV mass index is 56 g/m2 (normal range 67+/-11), and the LV mass is 98 g (normal range 114+/-24). There is a septal bounce consistent with right ventricular volume overload and previous sternotomy, otherwise normal LV wall motion. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No intracavitary thrombus present. There is evidence of membranous VSD patch without evidence of shunt. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated mildly reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 139 ml/m2 (normal range 69+/-14), the RVEDV is 244 ml (normal range 110+/-24), the RV end systolic volume index is 83 ml/m2 (normal range 22+/-8), and the RVESV is 146 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately to severely enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is thickened without significant mitral regurgitation.Pulmonic ValveThere is a bioprosthetic pulmonic valve in place. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is an eccentric jet of tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is persistent pectus excavatum deformity with a retrosternal to anterior vertebralmeasurement of 5 cm. There is evidence of sternotomy wires consistent with previous cardiac surgery. Th

Output: 1. The left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 56%2. The right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 40%Compared to prior study of 3/22/2013, the right and left ventricular volumes and function are similar.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for progression of disease, history of SCC of lung with metastases to brain. Signs and symptoms: Altered mental status. Pre-and post-enhanced brain MRI:Negative diffusion weighted images for acute ischemic stroke.Previously noted two metastatic foci in the vermis demonstrates subtle interval increased size. The larger midline lesion measuring at 13-mm compared to prior study measurement of 11. There is a tiny metastatic lesion in the right lateral aspect of the pons with interval increased size since prior exam and measuring at approximately 2.8 mm in size. No surrounding edema or mass effect.Images through supratentorial space demonstrate multiple parenchymal metastatic lesions which demonstrate interval increase size since prior study. A superficially located left posterior temporal lobe because the lesion measuring at 13.5-mm has increased since prior exam measurement of 9. A right parietal cingulate gyrus metastases lesion measuring at 14.5-mm compared to prior study measurement of 10.5mm.A left posterior parietal metastatic lesion measuring 18.8 x 14.4-mm has increased since prior exam measurement of 11.7 times 12-mm.there is extensive flair hyperintensity of bilateral hemispheric white matter with disproportionately less mass effect is due to represent a combination of peritumoral edema and post treatment/radiation change. Ventricular system remains within normal size and maintained midline.There is no evidence of calvarial or soft tissues of the scalp metastatic lesions. Unremarkable images through the orbits and including axial fat sat post enhanced series.

Output: 1.Interval progression of metastatic disease demonstrating increased size of all supratentorial and infratentorial metastatic lesions as detailed/measured above.2.Fairly extensive flair hyperintensity of bilateral hemispheric white matter is believed to represent a combination of peritumoral edema and post treatment/radiation change. This appearance remains fairly similar to prior exam.3.Stable normal size of ventricular system and without evidence of midline shift.4.No detectable calvarial, soft tissues of the scalp or orbital metastatic lesions.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left frontal lobe resection of recurrent glioblastoma. The cavity is slightly decreased in size since the previous study but continues to contain heterogeneous FLAIR hyperintense and T1 hypointense material compatible with blood product. This vasogenic edema along the cavity margins is stable to at most minimally increased. Nonspecific linear enhancement surrounding the resection cavity and the resection cavity is not significantly changed. Below the resection cavity, there are two regions of new enhancement; one in the left orbital gyrus and one in the left gyrus rectus. The lesion in the left gyrus rectus is associated with increased relative cerebral blood volume, but the lesion in the orbital gyrus is not. There are few punctate susceptibility signal is in the left basal ganglia and in the right parietal lobe, suggestive of old blood products. The ventricles and the basilar cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is no acute infarction.

Output: 1. There is decrease in size of the resection cavity which continues to contain blood products. There is no change in the nonspecific peripheral enhancement of the margins of the resection cavity.2. There are two new foci of parenchymal enhancement below the resection cavity, one of which, in the left gyrus rectus, is associated with increased relative cerebral blood volume. The differential diagnosis would include progression of tumor versus subacute parenchymal injury from recent surgery, though progression of tumor is slightly favored.


Instruction: Generate impression based on findings.

Input: Right facial droop, admission for seizure disorder. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size. Mild parenchymal loss is seen, relatively greater involving the cerebellum noted. There is focal outpouching involving the right frontal horn laterally which may be related to remote ischemic injury of the adjacent white matter. Brain parenchyma appears otherwise within normal limits. Bilateral hippocampi appear symmetric without findings to suggest mesial temporal sclerosis.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Mild mucosal thickening in the paranasal sinuses and small left maxillary mucus retention cyst. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct, hemorrhage, mass, or mass effect. No findings to suggest seizure focus.2. Disproportional volume loss involving the cerebellum which is nonspecific but can be seen with antiepileptic medications.3. Focal outpouching involving the right frontal horn which may relate to remote ischemic injury involving the adjacent white matter.4. No abnormal enhancement or lesions are seen along the course of the facial nerves. Examination was obtained per seizure protocol limiting evaluation for subtle lesions; if clinically indicated, MRI per dedicated facial nerve protocol/IAC study may be helpful.


Instruction: Generate impression based on findings.

Input: Clinical question: Brain lesion that causes seizure. Signs and symptoms: Staring spells x 5 minute period past medical history of IVH and possible PVL. Unenhanced brain MRI: No diffusion weighted abnormalities.Examination demonstrates extensive bilateral hemispheric periventricular cystic encephalomalacia highly suggestive of PVL. The ventricular system remain within normal size and with maintained midline. There is a slight prominence of cerebral cortical sulci for patient's stated age of 12 and concerning for possible underlying proximal volume loss.There is no detectable signal abnormality of cerebral cortex. There is no detectable congenital anatomical malformation.CSF spaces are unremarkable.There is no evidence of a mass or mass effect. Susceptibility MRI images are negative for any chronic hemorrhagic changes.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are beginning normal.Calvarium is intact.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Findings consistent with extensive PVL.3.Slight generalized prominence of cortical sulci for age.4.No evidence of a mass or congenital anatomical anomaly of brain to explain patient's seizures.


Instruction: Generate impression based on findings.

Input: 52-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.4 x 4.9 x 4.8 cm.Peripheral Zone: No focus suspicious for prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No focus suspicious for prostate cancer.


Instruction: Generate impression based on findings.

Input: A polypoid lesion is present, but incompletely evaluated, at the right sphenoid sinus abutting the clivus, which is suspicious for a myelomatous lesion.There is enhancing lesion within the anterior vertebral body body of C5. The cervical spine is in normal alignment. The vertebral body heights are well-maintained. No abnormal cord signal is evident.Multilevel degenerative disease is present, as on prior examination with small disc osteophyte complexes, facet arthropathy, and ligamentum flavum hypertrophy with mild resultant spinal canal and neural foraminal narrowing at C4-C5, C5-C6, and C6-C7. There is mild flattening of the ventral spinal cord at C5-C6. No significant interval change since 7/2/2012.THORACIC SPINE

Output: 1. New enhancing lesions in the C5 vertebral body and L1 vertebral body consistent with myelomatous disease progression. No epidural extension or enhancing mass in the lumbar spinal canal.2. Incomplete evaluation of a small polypoid lesion at the clivus/right sphenoid sinus, which may represent a myelomatous lesion rather than just sinus mucosal disease. Dedicated imaging can be considered to better assess if clinically indicated.3. There are postoperative changes of partial corpectomy and T6-T9 fusion. Stable mild chronic compression fractures at T7 and T8 with stable associated moderate spinal canal stenosis. Small focal cord signal abnormality at this level may represent myelomalacia relate to prior compression. 4. Multilevel degenerative changes throughout the cervical, thoracic and lumbar spine, as detailed above. No significant interval change since 7/3/2012. Unchanged up to moderate spinal canal stenosis at C5-C6. Stable severe right neural foraminal stenosis at L3-4 related to disc protrusion.


Instruction: Generate impression based on findings.

Input: 16 year old woman with history of suspected myocarditis with previous LV dysfunction and PVCs, now referred for repeat cardiac MRI to evaluate function and for evidence of inflammation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 108 ml/m2 (normal range: 65+/-11), the LVEDV is 172 ml (normal range 109+/-23), the LV end systolic volume index is 44 ml/m2 (normal range 18+/-5), the LVESV is 71 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 94 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a persistent small focus of late gadolinium enhancement in the mid chamber of the left ventricle at the inferior insertion point the right ventricle which could suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is in the same location as was seen on the previous cardiac MRI. There is no myocardial edema. Left AtriumThe left atrium is normal size. Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 125 ml/m2 (normal range 69+/-14), the RVEDV is 199 ml (normal range 110+/-24), the RV end systolic volume index is 67 ml/m2 (normal range 22+/-8), and the RVESV is 108 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion, thickening or edema present.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with normal systolic function (EF 59%), which is improved from the prior MRI exam. 2. Small focus of late gadolinium enhancement in the mid chamber of the left ventricle at the inferior RV insertion point; this is stable compared to the prior exam. 3. Moderately dilated right ventricle with mildly reduced systolic function (EF 46%). While the function has improved, the RV remains dilated. Given the patient's history of ventricular ectopy, consider further dedicated RV imaging for ARVC if clinically indicated.4. Right atrium mildly dilated.


Instruction: Generate impression based on findings.

Input: 17 years old male tennis player. Right radial sided wrist pain - eval for scaphoid injury vs soft tissue injury. There is bone marrow edema of the distal and volar aspect of the scaphoid, involving less than 50% of the bone volume, compatible with La Hei grade 2 scaphoid contusion. No fracture is identified. Bone marrow signal elsewhere is normal. No significant joint effusion. The ligaments and other imaged soft tissues appear normal.

Output: Scaphoid contusion, without fracture.


Instruction: Generate impression based on findings.

Input: Encephalopathy, known brain metastasis. Some of the sequences are degraded by patient motion. There is an enhancing lesion centered in the sphenoid triangle with epidural extension into the left middle cranial fossa that measures up to 5 mm in thickness, with mild mass effect upon the anterior pole of the temporal lobe and associated vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. There is minimal periventricular white matter T2 hyperintensity, which is nonspecific. There is mild diffuse cerebral volume loss. There is mild coaptation of the right frontal horn of the lateral ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening in the maxillary sinuses. There is a partially-imaged cystic lesion in deep lobe of the parotid gland that projects into the right parapharyngeal space that measures at least 15 mm. There are also multiple subcentimeter cystic foci in the superficial right parotid gland. There appear to be small scalp lipomas in the occipital region.

Output: 1. Unchanged metastatic lesion centered in the left sphenoid triangle with epidural extension into the left middle cranial fossa and associated mild vasogenic edema in the anterior temporal lobe.2. No evidence of acute intracranial hemorrhage or cerebral infarct.3. Multiple cystic lesions in the right parotid gland, which may be sequela of an inflammatory or autoimmune process versus a neoplastic condition such as Warthin tumors. Follow up with dedicated parotid imaging may be useful if clinically warranted.


Instruction: Generate impression based on findings.

Input: 54-year-old female with right hip pain and decreased range of motion. ACETABULAR LABRUM: There is heterogeneity and increased signal abnormality within the anterior acetabular labrum indicating degeneration/degenerative tearing within the limitations of a non arthrogram study. There is heterogeneity and increased signal abnormality within the posterior acetabular labrum indicating degeneration/tearing within the limitations of a non arthrogram study.ARTICULAR CARTILAGE AND BONE: There is no evidence of avascular necrosis as clinically questioned. There is a punctate focus of increased signal intensity within the right femoral head which likely represents subchondral cyst formation. Mild to moderate osteoarthritis affects the right hip.SOFT TISSUES: The imaged musculature of the right hip is normal in appearance. ADDITIONAL

Output: Osteoarthritis of the right hip and degeneration/tearing of the acetabular labrum. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 76-year-old female with intermittent abdominal pain and rising white cell count ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodense lesions in the left lobe, too small to characterize but are most likely cysts.SPLEEN: No significant abnormality notedPANCREAS: 14 x 7 mm cystic lesion in the pancreatic body likely representing a benign branch type I PMN. Follow-up imaging with MRI in one year is recommended.ADRENAL GLANDS: Diffuse left adrenal thickening.KIDNEYS, URETERS: Striated nephrogram involving the left kidney consistent with acute pyelonephritis. Mild wall thickening of the right uroepithelium, most prominent in the pelvis is also suspicious for pyelonephritis. Fat stranding along both ureters also suggest pyelonephritis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral pyelonephritis. No evidence of abscess.Small pancreatic cyst likely representing a branch type I PMN. Follow-up with MRI in one year is recommended.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:9/1/1954)Reason: eval lumbar spine and foramen History: lower back pain with sciatica, worsening over past 6 yrs and prev failed LESI's and physical therapyPROVIDER/ATTENDING NAME: TARIQ MUSLIM MALIK TARIQ MUSLIM MALIK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with narrowing of the neural foramina bilaterally and partial effacement of the fat surrounding the exiting nerve roots. There is effacement of the fat at the left lateral recess at this level with some encroachment of the nerve root at the left lateral recess. There is also partial effacement of the fat at the right lateral recess at this level. There is mild facet and ligamentum flavum hypertrophy at this level.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral facet and ligamentum flavum hypertrophy as well as translation thecal sac with effacement of the spinal fluid within the thecal sac at the nerve roots. There is moderate to severe spinal stenosis present at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge at this level associated with some mild disc desiccation and ligamentum flavum hypertrophy.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lumbar spine worse at L4-5 and L5-S1 where there is moderate to severe spinal stenosis at L4-5 and encroachment of the nerve roots at the left lateral recess at L5-S1.


Instruction: Generate impression based on findings.

Input: Reason: seizure focus? History: first time seizure 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 is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are more in the left hemisphere compared to the rightThe hippocampi are similar in size and signal characteristics.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 and demonstrates mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute cerebral infarction.2.No evidence for intracranial mass lesion or intracranial hemorrhage.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific but preferentially involve the left hemisphere. They are likely of little clinical significance but are nonspecific and their origin cannot be ascertained on this exam.4.No evidence for mesial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Evaluate for possible MR ultrasound fusion biopsy. 2/1/2014 biopsy showed 3+3 right base medial, right mid medial and left base lateral disease involving up to 20% of the submitted tissue. PELVIS:PROSTATE:Prostate Size: 4.0 x 5.7 x 5.6 cmPeripheral Zone: Demonstrated again in the paramedial right mid gland is a 1.5 x 0.6 cm T2 weighted hypointense lesion with associated restricted diffusion (series 801/17 and series 704/304), suspicious for prostatic adenocarcinoma. The lesion extends towards the base. It is not significantly changed from the prior. This lesion is associated with faint arterial enhancement. Additional punctate 3 mm focus in the lateral right peripheral zone of the mid gland is noted (series 801/15), unchanged.Punctate 3 mm focus in the lateral left peripheral zone of the base is noted (series 801/20), unchanged. Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right peripheral zone paramedial lesion abuts the capsule without specific evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stable right mid-gland to base peripheral zone lesion with imaging characteristics suspicious for prostatic carcinoma. No specific evidence of extraprostatic extension or pelvic lymphadenopathy. 2. Additional punctate foci of abnormal signal in the right and left lateral peripheral zone are unchanged.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with worsening memory and transient altered mental status. No evidence of restricted diffusion is seen. Brain parenchymal morphology is within normal limits. A few scattered small foci of T2 hyperintensity are seen in the periventricular and subcortical white matter. No evidence of mass effect or parenchymal edema is seen. No pathologic parenchymal or extra-axial enhancement is observed. The ventricular system is normal in size and morphology. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection are seen.

Output: 1.Minimal scattered white matter lesions which likely reflect chronic microvascular ischemic disease.2.No acute intracranial abnormality and no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 47 year old woman with history of left axillary lymphadenopathy positive for carcinoma, suspected breast primary. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a large conglomerate of necrotic lymph nodes extending from the left axilla to the left supraclavicular space measuring 5.8 x 7.4 x 7.1 cm (AP x LR x CC). This is associated with edema in the left breast and pectoral muscle along with skin thickening over the left breast. There is an additional abnormal lymph node with absent hilum, measuring 12 mm, in the left axilla. Diffuse parenchymal enhancement is seen without suspicious enhancing lesion in either breast. A few cysts are noted in the right breast. No abnormal lymph node in right axilla.Right medial chest wall port is noted.

Output: 1. Necrotic lymph nodes in the left axillary - supraclavicular space.2. No MR evidence of malignancy in either breast.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 52-year-old female with a highly suspicious mass in the right breast. Status post right breast skin biopsy at periareolar region. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.In the right breast, there is a highly suspicious, lobulated, rim-enhancing mass measuring 24 x 22 x 25 mm at 7 o'clock position.There is a mild skin enhancement for 13 mm at lateral periareolar region in the right breast, consistent with skin biopsy changes.In the right axilla, there is one lymph node (14 mm in diameter) with borderline cortical thickening.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in left axillary region.

Output: 1. Highly suspicious mass in the right breast. Ultrasound guided biopsy of this mass was performed later today.2. Borderline suspicious right axillary lymph node. Ultrasound guided biopsy of this lymph node was performed later today.3. No MR evidence of malignancy in left breast or in left axillary region.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with encephalopathy. Image quality is degraded by motion artifact. Within this limitation, the following observations are made.Prominence of the ventricular system is again seen, out of proportion to the caliber of the sulci. A thin rim of T2 hyperintensity is seen along the ventricular margins.There may be a few additional scattered small foci of T2 hyperintensity. No evidence of restricted diffusion or significant parenchymal edema is seen. No abnormal extra-axial fluid collection or acute intracranial hemorrhage is detected.The left mastoid air cells are opacified.

Output: 1.Prominence of the ventricles out of proportion to the caliber of the sulci is again seen. This could reflect a communicating hydrocephalus versus an atypical central pattern of parenchymal volume loss.2.No other significant or acute intracranial findings are seen.


Instruction: Generate impression based on findings.

Input: Patient with acute ischemic stroke symptoms . NIH stroke scale score was 11. Patient received IV TPA and NIHSSS were went down to 8. 46-year-old female presents with dysarthria bilateral low lower extremity weakness and left upper extremity weakness. Please evaluate for potential for embolectomy.Technique:A total of a 130 mL of Omnipaque 350 was used. 65 for the CTA and is 65 mL for the perfusion study. A CT of the head was performed followed by a perfusion study of the brain and within the CTA of the head in neck using the University of Chicago protocols for each of these exams. 3-D reconstructions for the CTA of the head and CT of the neck were performed on an independent workstation. Cerebral blood volume maps, stroke blood flow maps, mean transit time maps were performed on an independent workstation. Individual measures of upper fusion made from the areas in question. CT head: 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.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.Perfusion CT: There is hypoperfusion to right anterior cerebral artery territory anteriorly. Based on the patient's outside MRI exam which included diffusion weighted imaging as well as the cerebral blood volume maps on the current exam much of the involve territory has already infarcted. Embolectomy would not to be of a significant benefit in this case. Along the interrogated region mean transit time was 33 versus 5.5 and the normal side with a screw blood volume in the worst component of flow 1.25 forces 4.4 normal side. Along the more anterior aspect of the hypoperfused territory and appears there is somewhat better perfusionCTA brain:CTA brain demonstrates occlusion of the right anterior cerebral artery at the distal A2 segments. There appears to be a small sliver of contrast spanning a 2-cm length along this vessel and the vessel is reconstituted at distal to this at the A3 segment. No other intracranial occlusions are appreciated.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior, middle and posterior cerebral arteries. No aneurysms are appreciated.CTA neck: A couple to ablate the defects present along the distal internal carotid artery bilaterally. This is raises the question of fibromuscular dysplasia. these weblike defect can be identified at the C2-3 level on the right and at C1-2 level on the left. Best seen on coronal images 95 and 99.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 evidence for acute intracranial hemorrhage mass effect or edema.2.Occlusion of the right anterior cerebral artery and the A2 segment as described above. The associated that perfusion defect indicates that the tissue amenable to salvage is a less than 50% of the hypoperfused territory.3.Weblike defects along the distal cervical internal carotid arteries. The possibility of fibromuscular dysplasia is raised. No significant stenosis as described above.4.Findings were discussed with clinical service at the time of the exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Pain in right hipClinical question: back and (R) radicular hip painSigns and Symptoms: as above Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a broad-based central disc protrusion present at this level associated with disc desiccation and loss of disc space height. The fat at the lateral recess is not effaced on either left or right side. This appears to be approximately the same compared to the prior exam.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some mild ligamentum flavum hypertrophy. The fat at the lateral recesses is effaced. Overall there is a mild to moderate degree of spinal stenosis at this level. The fat surrounding the exiting nerve roots within the neural foramina is preserved at this level. This has not changed significantly when compared to the prior exam from 5/1/2015At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are some degenerative changes present in the lower lumbar spine worse at L4-5 where there is a mild to moderate degree of spinal stenosis present. This has not changed significantly when compared to the prior exam from 5/1/2015.2.A central disc protrusion at L5-S1 is also stable when compared to the prior exam


Instruction: Generate impression based on findings.

Input: Right-sided visual neglect, intermittent weakness, left side Motion artifact degrades image quality.The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement. Minimal enhancement of the anterior right ethmoid sinus as well as part of the right frontal sinus indicating possible inflammatory changes

Output: Normal orbit MRI.


Instruction: Generate impression based on findings.

Input: 59-year-old male with aphasia and post transplant lymphoproliferative disorder, concern for CVA, mass or lymphoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific foci of increased T2 signal in the subcortical white matter, cerebellum and brainstem, as well as confluent areas of increased T2 signal in the periventricular white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an approximately 21 x 28 x 53 mm mass just medial to the right carotid artery, which displaces the carotid artery laterally and was present on the prior CT neck examination, although it appears slightly increased in size. There is partially imaged upper cervical lymphadenopathy. Otherwise, the orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Mass just medial to the right carotid artery, which appears increased in size from the prior CT examination, which may relate to the patient's post transplant lymphoproliferative disorder, although infection is a differential consideration.2.No evidence of acute intracranial hemorrhage, mass, or acute infarct.3.Nonspecific foci of increased T2 signal in the subcortical and white matter, as well as the cerebellum, and brainstem, suggestive of small vessel chronic ischemic disease.4.Partially imaged upper cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 43 year old with history of two left breast benign biopsies, with biopsy results including FEA. Marked parenchymal enhancement is noted bilaterally. An extensive amount of fibroglandular tissue is present. Multiple bilateral high T2 signal cysts are present in each breast, with the largest cysts present in the right lower outer breast. No abnormal enhancement is seen in either breast. One of the two biopsy clips is well seen in the mid depth of the left upper outer breast. The other less well seen, likely in the far lateral posterior depth of the upper outer left breast. The degree of enhancement near the clips is similar to the level of background. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Marked background enhancement but no uniquely suspicious area of enhancement identified.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 39-year-old male with right hip pain. Evaluate for right hip ACETABULAR LABRUM: The acetabular labrum appears small secondary to the underlying osteoarthritic changes described below.ARTICULAR CARTILAGE AND BONE: Moderate degenerative changes affect the right hip joint with near bone-on-bone apposition, osteophyte formation and subchondral cyst formation. There is mild redundancy and inflammation within the joint which may be related to the intra-articular injection procedure. There is hyperintense signal intensity on the T2-weighted images within the bone marrow of the femoral head raising the possibility of mild avascular necrosis. There is mild bony prominence along the anterolateral femoral head neck junction with the possibility of a small CAM deformity not excluded. Alpha angle measures 65 degrees.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Possible small CAM deformity along the anterolateral femoral head as described above. 2. Moderate degenerative changes affect the right hip with hyperintense T2 signal within the bone marrow of the femoral head raising the possibility of mild avascular necrosis.3. Mild redundancy and inflammation within the joint which may be related to the intra-articular injection procedure.


Instruction: Generate impression based on findings.

Input: 69-year-old female with history of sinus pressure and pain and gait problems. CT head: There is asymmetric atrophy of the left temporal lobe appearing similar to prior. There is mild periventricular and subcortical white matter hypoattenuation. No evidence of acute intracranial hemorrhage. Mildly advanced volume loss for age. No abnormal mass or mass effect. The ventricles and sulci are symmetric. The basal cisterns are intact. The paranasal sinuses will be discussed below.CT Sinus: There is extensive mucosal thickening within the right maxillary sinus, right ethmoid air cells, and nasal passage with a large amorphous density of unclear etiology. There is relatively mild mucosal thickening of the left ethmoid air cells and right frontal sinus. There is a large nasal septal defect which seems to be filled with amorphous soft tissue material of uncertain etiology. Right cheek lesion is no longer visualized. The lamina papyracea are intact. The sphenoid sinuses communicate widely with the nasal cavity which may be congential or postsurgical in etiology. The right maxillary infundibula and frontoethmoidal recesses are opacified. The left ostiomeatal complex and frontoethmoidal are unremarkable. The mastoid air cells are clear.

Output: 1. No acute intracranial hemorrhage, mass or mass effect.2. Stable chronic small vessel ischemic disease and left temporal lobe atrophy.3. Severe sinus disease as above predominantly affecting the right paranasal sinuses.4. Large nasal septal defect with amorphous soft tissue density which may represent secretions or iatrogenic material. Correlation with clinical exam is recommended.


Instruction: Generate impression based on findings.

Input: There are scattered patchy foci of T2 hyperintensity within the supratentorial white matter, including within the corpus callosum and pericallosal regions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Multiple white matter lesions compatible with provided history of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 43-year-old female with history of right scapholunate repair, presenting with new right wrist pain. Limited examination secondary to susceptibility artifact from a scapholunate fixation screw and non arthrographic technique.LIGAMENTS: No significant abnormalities noted within the limitations of the examination.TRIANGULAR FIBROCARTILAGE COMPLEX: Evaluation of the TFCC is limited due to adjacent susceptibility artifact and non arthrographic technique. Allowing for these limitations, we see no distinct tear of the TFCC, nor do we see abnormal fluid accumulation in the distal radioulnar joint.TENDONS: No significant abnormality noted. BONES: Limited examination secondary to susceptibility artifact from scapholunate fixation screw. Mild degenerative changes affect the basilar joint. Marrow signal of the distal ulna appears within normal limits.ADDITIONAL

Output: Limited study as described above without specific evidence of TFCC tear.


Instruction: Generate impression based on findings.

Input: History of cervical cancer. Presents for surveillance. History of s/p abdominal trachelectomy and abdominal cerclage. PELVIS:UTERUS, ADNEXA: 4.0 cm minimally complex left but likely physiologic (dominant follicle) and 2.5 cm right adnexal cyst with additional multiple follicles. Subcentimeter right hemorrhagic cyst.Postsurgical changes from a trachelectomy with no focal enhancing mass.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small volume pelvic fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No enhancing mass or pelvic lymphadenopathy to suggest recurrence.


Instruction: Generate impression based on findings.

Input: Reason: meniscus tear History: pain MENISCI: Note is made of a full-thickness radial tear involving the body of the lateral meniscus. There is also linear branching signal abnormality within the peripheral fibers of the posterior horn of the medial meniscus which appears to extend to the femoral articular surface, indicating a complex horizontal tear with a longitudinal component (image 6; series 5). The majority of tear involves the peripheral fibers and extends to posterior peripheral surface of the meniscus.There are lobulated subcentimeter foci of fluid signal intensity along the posterior aspect of the posterior horn of the meniscus indicating parameniscal cyst formation (image 7; series 9), which also also support the presence of a tear in the posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is minimal superficial fraying/blistering of the articular cartilage along the median eminence of the patella. Otherwise no full-thickness or near full-thickness articular cartilage defects are identified. There is increased signal abnormality within the tibial tubercle at the insertion of the patellar tendon which may represent an enthesitis. Otherwise no bone marrow signal abnormality is seen.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is minimal increased signal abnormality within the proximal fibers of the patellar tendon which may reflect a mild patellar tendinosis. ADDITIONAL

Output: 1. Radial tear of the lateral meniscus. Complex tear of the posterior horn of the medial meniscus with parameniscal cyst formation.2. Findings indicating a mild patellar tendinosis and enthesitis at its insertion on the tibial tuberosity.3. Fluid signal intensity tracking along the semimembranosus may reflect a ruptured/leaking Baker's cyst or perhaps a mild strain injury in the correct clinical context. Other findings as described.


Instruction: Generate impression based on findings.

Input: 63 years, Male, Prostate cancer PELVIS:PROSTATE:Prostate Size: 4.4 x 3.7 x 3.4 cmPeripheral Zone: There is a lesion in the left peripheral zone extending from the mid gland to apex which also extends slightly right of midline and is low signal on T2/ADC with early enhancement, suspicious for prostatic adenocarcinoma. This lesion measures 1.9 x 0.7 cm (801/13). There is a small amount of extracapsular extension along the posterior aspect of the capsule.There is a separate lesion in the anterior left mid gland (604/204) with low signal on T2/ADC and early enhancement which is also suspicious for prostatic adenocarcinoma.Central Gland: Heterogeneous signal likely represents benign prostatic hypertrophy.Seminal Vesicles: No involvement.Extracapsular Extension: Small amount along the posterior aspect of the capsule.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the left peripheral zone, extending from the mid gland to apex with extracapsular extension, suspicious for prostatic adenocarcinoma.2.Additional lesion in the anterior mid gland is also suspicious for prostatic adenocarcinoma.3.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Chiari decompression with syrinx, follow up in February 2015. There are postoperative findings related to Chiari decompression surgery. There appears to be intact CSF flow across the neo-foramen magnum. The discontinuous syrinx that extends from C4-C5 through L1-L2 is stable to perhaps slightly smaller in caliber, measuring up to 6 mm at the midthoracic level. The vertebral column alignment is unchanged. 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 unchanged.

Output: 1. Stable to slightly decreased caliber of the extensive syringohydromyelia.2. Unremarkable findings related to Chiari decompression surgery with a patent neo-foramen magnum.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of left adrenal gland [C74.92], Reason for Study: ^Reason: Recurrent stage 4 neuroblastoma to posterior fossa; post surgery, radiation, and chemotherapy. Assess for progression of disease History: Neuroblastoma Significant metallic artifacts degraded image quality especially on the right temporo-parieto-occipital areas. There is no evidence of abnormal finding on visualized brain parenchyme, however, this exam is essentially non diagnostic.

Output: There is no evidence of abnormal signal intensity nor abnormal enhancement on visualized area of brain. However, due to significant metallic artifacts from the right parieto-occipital area, this MRI exam is essentially non-diagnostic.


Instruction: Generate impression based on findings.

Input: Aphasia and right hemianopsia. The images are degraded by patient motion. There is patchy, predominantly gyriform, high T2 signal and restricted diffusion in the left medial posterior temporal lobe and medial left occipital lobe. There are a few scattered foci of high T2 signal in the cerebral white matter without restricted diffusion. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Acute infarct in the left posterior cerebral artery territory.


Instruction: Generate impression based on findings.

Input: Change in pituitary lesion? Pituitary microadenoma. The previously demonstrated punctate pituitary lesion is much less conspicuous. The pituitary gland is not enlarged. The infundibulum is intact. There is no compromise of the optic apparatus or cavernous sinuses.

Output: The previously demonstrated punctate pituitary lesion is much less conspicuous.


Instruction: Generate impression based on findings.

Input: 23-year-old female with cavernous confirmations. Redemonstrated are lesions with susceptibility effect in the left basal ganglia, right anterior temporal lobe, right precentral gyrus, posterior right medulla, left superior cerebellar hemisphere, and at the junction of the left pons and midbrain. The nidus of the left basal ganglia lesion has increased in size (as measured on axial T2 technique), now measuring 8 mm in transverse dimension (previously 5 mm), although there is no associated perilesional edema. The remaining lesions are stable. There are no new lesions and there are no associated developmental venous anomalies. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple supratentorial and infratentorial subcentimeter lesions are compatible with cavernous malformations. The nidus of the left basal ganglia lesion has increased in size, although there is no associated perilesional edema, thus suggesting interval internal microhemorrhage yet not within an acute time frame. The remaining lesions are stable in appearance and there are no new lesions.


Instruction: Generate impression based on findings.

Input: Seizures and pituitary lesion. Per EPIC: supratherapeutic dilantin, hyperammonia from VPA; Possible toxic-metabolic component: pending workup; Paraneoplastic panel negative; LP negative for infection. Pituitary: There is an intrinsically T1 hyperintense lesion in the pituitary gland that measures up to 9 mm. The infundibulum is intact. There is no mass effect upon the optic apparatus or cavernous sinuses.Brain: There is diffuse T2 hyperintensity of the hippocampi. The rest of the brain parenchyma appears unremarkable. There is no evidence of intracranial heterotopia, hemorrhage, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small probable retention cyst in the adenoids. There is a small hemangioma in the left parietal calvarium.

Output: 1. An intrinsically T1 hyperintense lesion in the pituitary gland that measures up to 9 mm likely represents a Rathke cleft cyst. 2. Diffuse T2 hyperintensity of the hippocampi likely represents vasogenic edema, which can be a result of a toxic-metabolic process, such as hyperammonemia, for example.


Instruction: Generate impression based on findings.

Input: Postcontrast images are limited by patient motion. There is minimal grade 1 retrolisthesis of C4 on C5 and C5 on C6 measuring 1-2 mm, degenerative in etiology. The cervical spine is otherwise in normal alignment, with straightening of the normal cervical lordosis. There is moderate disc narrowing at C5-C6 and C6-C7 with mild disc narrowing at C4-C5. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.At C2-C3, there is left-sided ligamentum flavum thickening.At C3-C4, there is mild right greater than left uncovertebral hypertrophy. There is minimal left-sided ligamentum flavum thickening. There is minimal right foraminal narrowing.At C4-C5, there is uncovering of the disc with a diffuse posterior osteophyte disk complex with superimposed right paramedian central disc protrusion. There is moderate bilateral foraminal narrowing and overall moderate central spinal canal stenosis. There is an indentation of the right ventral cord. There is trace left ligamentum flavum thickening.At C5-C6, there is a mild posterior osteophyte disk complex superimposed central/right paracentral disc protrusion as well as uncovering of the disc. There is mild right uncovertebral hypertrophy and moderate right foraminal narrowing and mild-moderate central spinal canal stenosis. There is deformity of the right ventral cord. There is trace left ligamentum flavum thickening.At C6-C7, there is a mild disc bulge with bilateral uncovertebral hypertrophy. There is mild-moderate central spinal stenosis.At C7-T1, there is no significant disk pathology or stenosis.THORACIC SPINE

Output: 1. No MR evidence of demyelinating disease within the spinal cord.2. Mild scattered spondylotic changes including minimal degenerative subluxations as detailed above. Mild deformity of the ventral cord at C4-C5 and C5-C6.3. Mild chronic anterior wedging of the T12 vertebral body with associated Schmorl's node.


Instruction: Generate impression based on findings.

Input: Reason: eval for fx vs. Ligament rupture History: pain at base of 2nd metacarpal and distal row, dorsally TENDONS: The flexor and extensor tendons appear intact. BONES: There is increased bone marrow signal abnormality on fluid sensitive sequences within the capitate as well as within the bases of the second, third and fourth metacarpals. No discrete fracture line is identified at this time. There is also bone marrow signal abnormality within the head of the third metacarpal.ADDITIONAL

Output: Bone marrow signal abnormality within the capitate as well as within the second through fourth metacarpals may represent bone contusions versus occult nondisplaced fractures. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: 52 y.o. with h/o Crohn's with ostomy. MRE in 1/2015 showed left paracolic gutter abscesses and sinus tracts with fistulous communication with the rectal stump. Please eval if worsened or improved. History: abd pain, fistula/abscess as above. ABDOMEN:LIVER, BILIARY TRACT: Segment 6 liver cysts, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild to moderate left hydroureteronephrosis with thickening of the distal left ureteral wall. Left nephroureteral stent. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of small bowel, sigmoid colon, and ileocecal resection with a right lower quadrant ileostomy. No evidence of bowel wall thickening or inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of small bowel, sigmoid colon, and ileocecal resection with a right lower quadrant ileostomy. No evidence of bowel wall thickening or inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval resolution of left pelvic abscess.

Output: 1.Postsurgical changes without definite evidence of active inflammatory bowel disease.2.Interval resolution of left pelvic abscess. 3.Left hydroureteronephrosis with stent. Distal ureteral wall thickening, nonspecific.


Instruction: Generate impression based on findings.

Input: Male 59 years old Reason: Assess for recurrence of HCC History: + HCC/ s/p TACE RFA ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology with fibrotic changes. Segment 6 ablation cavity measures 3.4 x 3.0 cm previously, 3.5 x 3.4 cm. There is hemorrhage within the cavity. However, no suspicious enhancement to indicate residual disease.No new suspicious hepatic lesions. Hepatic and portal veins are patent. Gallbladder contains multiple small stones. No biliary ductal dilatation.SPLEEN: Spleen is mildly enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small bowel is normal in caliber. Linear enhancement along the left peritoneal cavity is unchanged and is of unclear etiology.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable appearance of the segment 6 ablation cavity without specific evidence for recurrent or residual disease.2.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Multiple cell carcinoma, staging Within the posteromedial subcutaneous tissues of the lower extremity are multiple small enhancing foci reflective of the patient's known Merkel cell carcinoma. Index lesions are as follows (transaxial x craniocaudal dimensions as seen on post contrast axial sequence series 14):1. Image 25, 18 x 6 x 8 mm2. Image 12, 11 x 6 x 7 mm3. Image 11, 8 x 5 x 25 mmAdditional areas of slightly nodular enhancement are seen on image 8, 18 and 19. More proximally, there are no areas of abnormal subcutaneous enhancement. The signal intensity of the bone marrow and leg musculature is normal although there is mild diffuse fatty atrophy of the calf musculature. There is also mild nonspecific subcutaneous edema of the lower extremities beginning at the level of the mid diaphysis.

Output: Small enhancing subcutaneous nodules within the right lower extremity consistent with known Merkel cell carcinoma.


Instruction: Generate impression based on findings.

Input: Carotid-cavernous fistula, possibly related to the apparent small cavernous ICA aneurysm. Headaches. MRI BRAIN: There are a few scattered foci of T2 hyperintensity in the periventricular and subcortical white matter bilaterally. There is no evidence of acute ischemia or acute intracranial hemorrhage. There is no midline shift or mass effect. There is mild diffuse cerebral volume loss. There is an approximately 6 mm thick lipoma in the right parietal scalp. There is mild scattered paranasal sinus mucosal thickening. There are small retention or Thornwaldt cysts in the nasopharynx. The orbits are unremarkable. The skull appears to be intact. MRA BRAIN: There is a wide-based outpouching involving the lateral wall of the left cavernous internal carotid artery with neck that measures up to approximately 3 mm. The cavernous sinuses do not appear distended and there are no grossly abnormal flow voids or arterialized flow within the sinus. The right internal carotid artery appears unremarkable. The anterior and middle cerebral arteries are intact. The posterior cerebral arteries, vertebral arteries, and basilar artery are unremarkable. Indeed, there is no evidence of significant steno-occlusive cerebrovascular lesions.

Output: 1. A laterally oriented left cavernous internal carotid artery aneurysm measures up to approximately 3 mm.2. No specific findings to suggest a carotid-cavernous fistula. However, a dynamic cerebrovascular imaging examination may be more sensitive for detecting that condition.3. A few scattered foci of T2 hyperintensity in the subcortical and periventricular white matter are nonspecific, but may represent chronic small vessel ischemic disease. Otherwise, no evidence of acute infarction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 62 years old. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.6 x 3.4 x 3.7 cmPeripheral Zone: 9 x 7 mm lesion in the left apex is hypointense on T2 and ADC and demonstrates contrast enhancement concerning for prostate adenocarcinoma. This lesion extends beyond the margin of the prostate.Central Gland: Mild benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The left apical lesion extends beyond the margin of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 10 x 7 mm left apical lesion extends beyond the margin of the prostate and is concerning for prostate adenocarcinoma. PIRADS 4.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdfI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Assess for right lower extremity radiculopathy. Right buttock pain. Patient slipped on ice and fell. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from dextrocurvature which was also evident on prior radiographs. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation with minimal disc bulge with dorsal annular fissure. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation with minimal disc bulge with dorsal annular fissure. No spinal canal or neural foraminal stenosis.L5-S1: Disc desiccation and mild disc bulge, slightly larger than above. There is minimal contact with the exiting right L5 nerve root. There is otherwise no significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine as described above. L5-S1 disc bulge contacts the exiting right L5 nerve root without clear evidence of impingement. There is no significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: History of tethered cord release with history of syringomyelia. Evaluate syrinx. There is dilatation of the central spinal canal that extends from the level of T4-T5 to the conus medullaris, which terminates at the level of L1-L2. The central canal with the cord is again dilated, and measures up to 10 x 9 mm at the level of T7-T8, previously 10 x 9 mm, and 5 x 5 mm at the level of T12, previously 5 x 5 mm. There is no significant change in the extent or size of the syrinx. There is appropriate ventral motion of the cord with prone positioning. There is no evidence of filar T1 hyperintensity or filar thickening. The vertebral column alignment is within normal limits. The vertebral body and disk space heights are preserved. There is no worrisome bone marrow signal. There is no significant spinal canal stenosis, disc herniation, or neural foraminal narrowing.

Output: 1. Stable size of the thoracolumbar syrinx. 2. No MR evidence of cord tethering.


Instruction: Generate impression based on findings.

Input: Reason: CERVICAL stenosis? radiculopathy? History: headache, neck pain, hyperreflexia The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.There is a T2 and T1 hyperintense lesion which supresses on the T2 STIR images located within the T1 vertebral body measuring 14 mm diameter. It most likely represents a vertebral body hemangioma.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small focal right paramedian disk protrusion at this level which minimally effaces CSF ventral to the spinal cord. At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small broad based right paramedian disk protrusion at this level which minimally effaces CSF ventral to the spinal cord. At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: MRI cervical spine is within normal limits.


Instruction: Generate impression based on findings.

Input: Reason: R shoulder mass, superficial History: shoulder mass There is a 3.0 x 1.1 cm mass superficial to the posterior aspect of the deltoid and acromion which extends slightly superior to the acromion and is predominantly fat signal intensity compatible with a lipoma. There is no enhancement on postcontrast sequences. There is intermediate signal intensity within the supraspinatus tendon at its insertion on the greater tuberosity likely representing a combination of tendinosis and insertional tearing that involves the majority of the thickness of the tendon and may focally disrupt the bursal surface fibers at their greater tuberosity attachment. This signal abnormality measures less than 1 cm in the AP dimension. There are small cysts within the underlying humeral head. There is linear increased signal intensity which also extends proximally into the supraspinatus tendon likely representing additional tendinosis and perhaps early delamination. There is perhaps mild tendinosis of the anterior fibers of the infraspinatus, but we see no discrete infraspinatus tendon tear. The subscapularis and teres minor muscles and tendons appear intact. Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa suggesting a mild bursitis. Mild osteoarthritis affects the glenohumeral joint. The anterior superior labrum is at least partially separated from the glenoid labrum which may represent a SLAP tear or a normal variant. There is no glenohumeral joint effusion or enhancement on postcontrast sequences to suggest a synovitis. The tendon of the long head of the biceps appears intact.

Output: 1. Subcutaneous lipoma as described above.2. Osteoarthritis of the glenohumeral and acromioclavicular joints.3. Separation of the anterior superior glenoid labrum from the underlying glenoid may represent a normal variant or a SLAP tear.4. Insertional tendinosis/tearing of the supraspinatus as described above.5. Mild subacromial/subdeltoid bursitis.


Instruction: Generate impression based on findings.

Input: There are numerous areas of serpiginous T2 hyperintense and T1 hypointense signal with enhancement on postcontrast imaging. The most prominent abnormal area is in the proximal right tibial metadiaphysis that extends proximally into the mid epiphysis and measures 10.5 cm in craniocaudal dimension. Along the anteromedial aspect of the proximal metaphysis there is a probable subperiosteal abscess with a tract that appears to drain to the skin surface (series 11 image 10). Linear area of abnormal signal with less pronounced postcontrast enhancement within the cortex of the right tibial mid diaphysis that measures proximally 5.1 cm in craniocaudal dimension.In the distal right tibial metadiaphysis there is abnormal signal with mild enhancement that measures 7.6 cm in craniocaudal dimension. There is no definitive evidence of spread of abnormal signal to the distal epiphysis. There is a focal cortical defect in the posteromedial distal metaphysis (series 4 image 65). There is mild subcutaneous inflammation along the medial distal metaphysis without evidence of a subperiosteal abscess.

Output: Findings compatible with osteomyelitis in the proximal right tibia with spread to the proximal epiphysis. Probable osteomyelitis in the mid diaphysis and the distal metadiaphysis.


Instruction: Generate impression based on findings.

Input: Metastatic colon cancer to liver, being considered for resection ABDOMEN:LIVER, BILIARY TRACT: Multiple poorly enhancing hepatic lesions involving segments 4A, 6, and 7 measuring up to 1.5 x 1.3 cm in segment 7 (series 9, image 24), previously 2.1 x 2.0 cm. One of these lesions is located more centrally posterior to the right hepatic vein abutting the anterior margin of the right portal vein (series 9, image 36). These lesions have decreased in size compared to the prior exam. The hepatic and portal veins are patent. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Although this study is not protocoled for the evaluation of the pancreatic duct, there is suggestion of a pancreatic ductal anomaly on the thick slice coronal T2 sequence.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonspecific low signal focus in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Multiple hepatic metastases as described above with slight interval decrease in size compared to the prior exam.2.No new lesions.


Instruction: Generate impression based on findings.

Input: Left-sided trigeminal neuralgia s/p radiofrequency thermocoagulation x2, now with recurrent symptoms, who is referred to discuss radiosurgery. There is a venous structure that loops along the inferior aspect of the root entry zone of the left trigeminal nerve. The right trigeminal nerve appears to be unremarkable. There is no evidence of intracranial hemorrhage or mass. The ventricles and sulci and mildly prominent diffusely, suggestive of cerebral volume loss. There is no midline shift or herniation. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There is partially-imaged prominent probable torus mandibularis on the right.

Output: Findings suggestive of left trigeminal nerve venous vascular loop syndrome.


Instruction: Generate impression based on findings.

Input: Clinical question: Please perform Dr.Javed's dedicated multiple sclerosis protocol on 3T. Pre-and post-enhanced brain MRI:Examination is performed utilizing Dr.Javed's dedicated multiple sclerosis protocol.Examination demonstrates numerous small varying sized foci of flair hyperintensity throughout the cerebral and cerebellar hemispheres without convincing evidence of any significant change since prior study. Multiple the very large number of lesions makes precise comparison difficult. Findings consistent with patient's known demyelinating disease. There is no detectable abnormal enhancement of any of the lesions on post enhanced series. There is ex vacuo dilatation of the supratentorial ventricles without change since prior exam and with maintained midline. There is also slight prominence of cortical sulci with the patient's stated age similar to prior exam. Findings are suggestive of underlying parenchymal volume loss.

Output: 1.Extensive findings of chronic demyelinating disease involving supra-and infratentorial brain parenchyma without convincing evidence of interval change. There is no detectable abnormal enhancing plaque.2.Ex vacuo dilatation of supratentorial ventricles and cerebral cortical sulci similar to prior exam.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, approximately 31 weeks gestational age, with multiple fetal anomalies detected on ultrasound, further evaluation with MRI requested. The cerebral hemispheres appear normally formed and demonstrate a degree of gyration commensurate with the gestational age. The ventricles are not dilated. The corpus callosum is intact. The cerebellum is small but still falls within the spectrum of normal variation and is otherwise normally formed. The brainstem is unremarkable. No abnormal extra-axial collections are detected. The globes and orbits are small. Fetal motion precludes accurate assessment for the possibility of tethered cord, but no large spinal anomalies are identified.

Output: 1.Normal cerebral morphology.2.No ventriculomegaly.3.Small but otherwise unremarkable cerebellum.4.Small globes and orbits bilaterally.


Instruction: Generate impression based on findings.

Input: History of neuroblastoma with right temporal signal abnormality on prior MRI, follow-up. There is a solitary, ovoid 4 x 5 mm focus of high T2 signal within the mid right temporal lobe, which has slightly decreased in size and intensity compared to the prior examination and which lacks associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The brain parenchyma otherwise appears unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A nonspecific subcentimeter lesion within mid right temporal lobe appears less prominent than on the 11/9/2015 exam. Otherwise, no evidence of neuroblastoma metastases to the head.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Back pain There is anterior plate and screw fixation of C6-C7 with associated placement of interbody disc spacer. There is minimal levocurvature of the thoracolumbar spine with the apex noted at T8. The vertebral body heights and disc spaces are otherwise relatively well preserved.There is a positive sagittal balance of approximately 3.1 cm. There is no significant coronal imbalance.

Output: Orthopedic fixation of the cervical spine with additional findings described above.


Instruction: Generate impression based on findings.

Input: Medulloblastoma. Status post resection, chemotherapy and radiotherapy. Off treatment. Brain:The treatment bed in the posterior fossa to the right of midline (involving the posterior medial aspect of the right cerebellar hemisphere) has not changed. It is not associated with suspicious contrast enhancement. The minimal extent of surrounding parenchymal T2/T2 FLAIR hyperintensity has not changed. Otherwise, there is no contrast-enhancing brain lesion. Accounting for mild ex vacuo enlargement in the posterior fossa, the ventricular system is nondilated. Normal flow-voids are present within the major intracranial vascular structures.Moderate mucosal thickening in the maxillary and to a lesser extent the posterior ethmoid and sphenoid sinuses improved since the previous examination.Spine:Spinal alignment is anatomic. The marrow is more fatty than expected for age which probably reflects previous treatment. There is no suspicious marrow lesion. The spinal canal is preserved.The spinal cord shows normal morphology and signal. The tip of the conus medullaris is at the lower L1 level. There is no abnormal spinal or leptomeningeal contrast enhancement.The left renal pelvis and ureter are slightly prominent but not frankly hydronephrotic.

Output: 1. Unchanged posttreatment findings without evidence of tumor recurrence within the brain or spine.2. Nonspecific moderate paranasal sinus mucosal thickening is mildly improved since the prior exam.


Instruction: Generate impression based on findings.

Input: 74-year-old female with altered mental status. Evaluate for stroke. Large focal left hypodensity within the extra-axial space with septations and mass effect. This finding could represent a chronic subdural hematoma. Further imaging evaluation with MRI may be considered, if clinically warranted. Mild microangiopathic changes of indeterminate age.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: Large focal hypodensity may be due to chronic subdural hematoma but would be better evaluated with MRI, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Reason: Patient with likely neurogenic claudication History: bilateral leg pain Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.There appears to be thickening of the posterior longitudinal ligament from C2-3 to see 56At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with a disk bulge and with only some mild narrowing of the neural foramina.At C4-5 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level with only some mild narrowing of the neural foramina.At C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with a disk bulge and with only some mild narrowing of the neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. At T8-9 there is loss of disk space height associated with a diffuse disk bulge posterior ligamentous hypertrophy and T2 signal hyperintensity within the T8 and T9 vertebral bodies. There is a resultant effacement of spinal fluid surrounding the spinal cord at this level and flattening of the spinal cord. Overall there is a severe degree of spinal stenosis present. The spinal cord signal is abnormal at this level. There is also bilateral neural foramen encroachment at this level with encroachment of the exiting nerve roots.At T7-T8 there is a disk bulge present without significant compromise of spinal canal or neural foraminaLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is some accumulation of fat within the distal lumbar spinal canal suggestive of an element of epidural lipomatosis.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge present at this level. There is mild facet hypertrophy at this level. There is mild disk desiccation at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge present at this level. There is mild to moderate facet hypertrophy at this level. There is mild disk desiccation at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge present at this level. There is mild disk desiccation at this level. At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a cystic lesion present along the right posterolateral aspect of the spinal canal at this level associated with the ligamentum flavum but protruding into the spinal canal. It does not appear to cause significant compromise to the spinal canal.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Severe spinal stenosis at T8-9 associated with cord signal abnormality. There is associated encroachment of exiting nerve roots. Etiology appears to be degenerative in nature.2.Findings suggest some ossification of the posterior longitudinal ligament and degenerative changes in the cervical spine without significant compromise of spinal canal or neural foramina.3.There are degenerative changes present in the lumbar spine is also mild distal lumbar spinal canal epidural lipomatosis. There is no significant compromise to the lumbar spinal canal exiting nerve roots as a result of the degenerative changes. The effect of the epidural lipomatosis is best assessed clinically.4.Findings were discussed with Dr Pac at 9:45 am5.There is a cystic lesion protruding into the spinal canal at the L2-3 level which could represent either a ligamentum flavum cyst or synovial cyst.


Instruction: Generate impression based on findings.

Input: Meningioma follow up. There is no significant interval change in the extra-axial enhancing mass along the planum sphenoidale and olfactory groove that measures 25 AP x 26 RL x 19 SI mm. There is unchanged mild confluent T2 hyperintensity along the adjacent inferior right frontal lobe, which likely represents edema. There is mild pneumosinus dilatans and hyperostosis. There are a few scattered foci of cerebral white matter T2 hyperintensity, which have progressed. There is no evidence of intracranial hemorrhage or acute infarct. There is an unchanged defect in the left cerebellar hemisphere and a new punctate defect in the right cerebellar hemisphere. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a 5 mm wide right frontal bone outer table osteoma.

Output: 1. No significant change in the meningiomas along the planum sphenoidale and olfactory groove.2. Mild chronic small vessel ischemic changes with chronic cerebellar infarcts that have progressed, but no acute infarct.


Instruction: Generate impression based on findings.

Input: 16-year-old female patient with chronic abdominal pain. Evaluate for small bowel disease.EXAMINATION: MR enterography without and with IV contrast 11/06/2015 ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no bowel wall thickening, abnormal enhancement, stricture, fistula, or obstruction. Moderate stool burden the colon with mild distention of the descending colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis may be physiologic.

Output: 1.No specific evidence of inflammatory changes in the bowel.2.Moderate stool burden in the colon.


Instruction: Generate impression based on findings.

Input: 39-year-old female with a family history of breast cancer in her mother, maternal aunt, and maternal grandmother. Personal history of benign left breast MR biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Cysts are present in both breasts.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: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dizziness and giddinessClinical question: Evaluate for etiology of vertigo and nystagmusSigns and Symptoms: Vertigo and nystagmus 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 is a 5 x 4 mm T1 hyperintense focus present within the left half of the pituitary gland posteriorly which does not enhance following gadolinium administration.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: A small lesion within the pituitary gland is suspected to represent a Rathke's cleft cyst, however, given its slightly atypical location correlation with the patient's clinical history with attention to intracranial logic the radiation and a follow-up exam would be helpful. Please note that this does not explain the patient's symptoms of nystagmus and vertigo.


Instruction: Generate impression based on findings.

Input: 52-year-old female. Pain. Evaluate for ulnar styloid impaction. LIGAMENTS: The scapholunate and lunotriquetral ligaments are grossly intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Grossly intact.TENDONS: The extensor carpi ulnaris tendon is perched along the medial edge of the ulnar groove suggesting extensor carpi ulnaris subsheath injury. There is trace fluid around the tendon suggestive of tenosynovitis. Mild increased signal intensity within the tendon consistent with tendinosis.BONES: There is bone marrow edema in the distal ulna, likely reactive to the aforementioned ECU tendinosis. Foci of fluid signal abnormality within the carpal bones, including the radial aspect of the lunate, likely represent small degenerative cysts. Mild edema in the medial edge of the scaphoid, likely degenerative in etiology.ADDITIONAL

Output: 1. Extensor carpi ulnaris tendinosis and subsheath injury.2. Subcentimeter ganglion cyst volar to the triquetrum.


Instruction: Generate impression based on findings.

Input: Advanced degenerative disk disease with sclerotic changes of the vertebral body endplates throughout the lumbar spine. Multilevel retrolisthesis and anterolisthesis, as described below. Lumbar spine level specific findings T12-L1: Advanced degenerative disk disease with vacuum disk phenomena. Dorsal to the T12 vertebral body is a cluster of calcification in the midline with associated soft tissue density. This likely represents an old herniated disk. No narrowing of the neural foramina or central spinal stenosis. L1-2: Advanced degenerative disk disease with vacuum disk phenomena. Grade 1 retrolisthesis of L1 on L2. No narrowing of the neural foramina or central spinal stenosis. L2-3: Advanced degenerative disk disease with vacuum disk phenomena.Grade 1 retrolisthesis of L2 on L3. No narrowing of the neural foramina or central spinal stenosis. L3-4: Mild degenerative disk disease . No narrowing of the neural foramina or central spinal stenosis. L4-5: Advanced degenerative disk disease . No narrowing of the neural foramina or central spinal stenosis. L5-S1: Grade 2 anterolisthesis of L5 on S1 with bilateral defects of the pars interarticularis compatible with spondylolysis. Hypertrophic changes of the posterior elements. No narrowing of the neural foramina or central spinal stenosis.

Output: Spondylolysis at L5-S1 with multilevel retrolisthesis and advanced degenerative disk disease, as described above


Instruction: Generate impression based on findings.

Input: Clinical question: History of right parietal hemorrhagic stroke. Signs and symptoms: Left-sided weakness. Nonenhanced head CT:Subacute old right parietal and posterior stroke is again identified. There is only subtle mass effect of the adjacent cortical sulci in portions of the stroke. No evidence of hemorrhage. The cortical sulci, ventricular system and CSF cisterns are otherwise unremarkable. There is a small focus of increased density measuring 5.8 times 4-mm in size in the AP lateral to the right head of caudate nucleus. Review of prior limited MRI examination (only diffusion weighted images were obtained) reveals no abnormality. This finding may represent a small nonspecific calcification. Possibility of small hemorrhage cannot be ruled out however this is not associated with any edema of adjacent brain parenchyma.

Output: 1.Right posterior frontal -- parietal stroke with no evidence of hemorrhage.2.5.8 times 4-mm focus of high density adjacent to the right caudate nucleus as described.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Left-sided weakness. The vertebral body and intervertebral disc heights are maintained. There is slight loss of signal in multiple intervertebral discs most severe at C4-5 indicating early desiccation. The alignment is anatomic. No bone marrow signal abnormalities. The spinal cord has normal signal and morphology. Level by level findings are as follows:C2-C3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.C3-C4: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.C4-C5: Very trace disc bulge with slightly asymmetric prominence in the right paracentral region. No significant spinal canal stenosis or neuroforaminal narrowing.C5-C6: Trace diffuse disc bulge. No spinal canal stenosis. Minimal right neuroforaminal narrowing.C6-C7: Trace diffuse disc bulge with asymmetric prominence of the right. Minimal right neural foraminal narrowing. No spinal canal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.

Output: Minimal degenerative disease in the cervical spine with minimal right-sided neural foraminal narrowing as described. No findings to account for the patient's left-sided weakness.


Instruction: Generate impression based on findings.

Input: Progressive headaches. Dental brace artifact degrades the image quality of many sequences. Within this limitation, there is no gross 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.

Output: No gross evidence of Chiari malformation of intracranial tumor, although the exam is limited by dental brace artifact.