Instruction: Generate impression based on findings.

Input: Diagnosis: Unilateral primary osteoarthritis, left knee Lumbago with sciatica, right side Lumbago with sciatica, left sideClinical question: DDD of lumbar spineSigns and Symptoms: back and leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate osteophytes at this level. There is mild facet and ligamentum flavum hypertrophy present at this level. There is a left far lateral disc protrusion present which abuts the left-sided exiting nerve root after it exits the neural foramen.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation, endplate reactive changes and diffuse disc bulge at this level associated with mild facet hypertrophy and moderate ligamentum flavum hypertrophy. There is a left far lateral disc protrusion present which abuts the left-sided exiting nerve root after it exits the neural foramen.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height and a disc bulge at this level associated disc desiccation. There is mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height and a disc bulge at this level associated disc desiccation. There is mild ligamentum flavum hypertrophy at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.The uterus is large and contains a multiple large calcific lesions probably representing fibroids.There are large retroperitoneal lymph nodes present. A lymph node in the right periaortic region at the level of the C2-3 disc space currently measures 31 x 15 mm axial dimensions. Additional lymph nodes are identified elsewhere in the retroperitoneal space.

Output: 1.There are multilevel degenerative changes present in the lumbar spine without significant compromise to spinal canal or neural foramina. There are left-sided far lateral disc protrusions at L4-5 and L5-S1 which affects the left-sided exiting nerve roots at these levels.2.Multiple uterine fibroids.3.Findings suggest retroperitoneal lymphadenopathy. This was also present on the prior CT of the abdomen. A better assessment would be made using abdomen CT if clinically appropriate.


Instruction: Generate impression based on findings.

Input: There is a lesion in the left frontal lobe measuring approximately 12 x 17 mm in transaxial dimension and 19 mm in cc dimension. The lesion is primarily hypointense on T1, hyperintense on T2, demonstrating signal nulling with FLAIR technique. Internally there are small punctate to linear foci of differing signal characteristics, specifically demonstrating T2 hypointensity, T1 hyperintensity, without susceptibility abnormality. There is no associated contrast enhancement or restricted diffusion. The lesion extends to adjacent subcortical white matter, however without involving overlying cortices. Additionally, there is no associated mass effect.Ventricular sizes are normal. There is no midline shift. There are no diffusion abnormalities elsewhere to suggest the presence of acute ischemia. Myelination appears normal for a term infant. Expected vascular flow voids are demonstrated. The mastoid air cells and middle ear cavities are clear.

Output: Complex, unusual appearing, nonenhancing lesion of the left frontal lobe as described in detail above. The constellation of features are most suggestive of a tumefactive perivascular space. However, the internal punctate to linear foci are unusual for this diagnosis. Thus, the differential diagnosis also includes dysembryoplastic neuroepithelial tumor (DNET). Recommendations are made to obtain follow-up imaging in 3 months with contrast, or sooner if patient symptoms related to the CNS change.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, with type 1 diabetes, 23 weeks pregnant, with persistent headache, worse when supine. MRI:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.MRA:The intracranial arterial vasculature demonstrates normal morphology and caliber. No significant stenosis or occlusion is seen. No aneurysms are detected within the limitations of technique.MRV:The dural venous sinuses and major deep intracranial veins demonstrate flow related signal compatible with patency.

Output: 1.Unremarkable MRI evaluation of the brain with no specific findings to account for the patient's headaches.2.No abnormalities are detected on either the MRA or MRV.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression. Degenerative changes are noted of the cervical spine at C5/6 and of the lower lumbar spine. Posterior surgical changes from T10 through T12 are consistent with the provided history of plasmacytoma, presumably status post resection.

Output: No acute cord compression.


Instruction: Generate impression based on findings.

Input: 32-year-old female patient with knee pain, effusion, clinical instability. Assess for ACL tear and MCL sprain. MENISCI: There is a complex, branching tear of the posterior horn of the lateral meniscus with truncation of the free edge indicating a radial tear as well as a large horizontal component that transects the meniscus from the periphery to the truncated free edge. The tear appears to extend to the root of the meniscus. The body and anterior horn of the lateral meniscus appear intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There are contusions within the posterior aspect of the lateral tibial plateau and more anteriorly within the lateral femoral condyle. Additional contusion is noted of the posterior aspect of the medial tibial plateau. A cortically based intermediate signal intensity focus along the posterior aspect of the proximal tibial metaphysis may represent a healed nonossifying fibroma.There is focal increased signal intensity of the articular cartilage of the medial facet of the patella representing degeneration. Otherwise, the articular cartilage of the medial and lateral femoral compartments appears intact.LIGAMENTS: There is complete rupture of the anterior cruciate ligament. The posterior cruciate ligament is intact. There is also complete tear of the medial collateral ligament at the femoral attachment with surrounding edema. Edema extends distally along the medial retinacular structures. We do not confidently see the medial patellofemoral ligament or posterior oblique ligament and cannot confirm their integrity. Furthermore although the meniscotibial coronary ligament is visualized, the meniscofemoral coronary ligament is not seen and may be torn. There is mild increased signal intensity adjacent to and within the fibers of the lateral collateral ligament proper suggesting a sprain, but the distal fibers are intact and insert normally with the conjoined fascia of the biceps femoris. Mild edema is noted within the soft tissues medial to the fibular head but we see no discrete structural abnormality.EXTENSOR MECHANISM: Mild edema is noted within the subcutaneous tissues anterior to the tibial tuberosity, but the extensor mechanism is intact.ADDITIONAL

Output: 1. Tears of the anterior cruciate ligament and medial collateral ligament as described above.2. Complex tear of the lateral meniscus.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: cystic brain mets (breast primary) s/p drain placementSigns and Symptoms: eval for extent of disease; for study protocol (please see comments)Comments: Prior surgery: Rickham catheter placement into the L frontoparietal and R temporal lesions on 10/15/15 A ring-enhancing fluid collection present in the left frontal lobe measures 32 x 47 mm axial dimensions and 36 x 36 mm coronal dimensions. On the prior exam it measured 36 x 36 mm coronal dimensions and 35 x 45 mm axial dimensions. The right frontal lobe ring-enhancing lesion measures 8 mm x 9 mm and previously measured 8 mm x 9 mm. A right posterior temporal lobe lesion which is irregularly shaped currently measures 39 x 28 mm axial dimensions and previously measured 45 x 30 mm axial dimensions. This temporal lobe ring-enhancing lesion measures 29 x 14 mm coronal dimensions on the current exam and 39 23-mm coronal dimensions on the prior exam.There is no associated diffusion restriction within these fluid collections. Fluid collections have high signal on T2 and FLAIR imaging within them. There is surrounding halo of edema with each of these ring-enhancing lesions.The patient is status post catheter placement in the left frontal lobe cystic lesion as well as the right temporal lobe lesion through adjacent burr holes.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since prior exam a right temporal lobe ring-enhancing lesion has decreased in size. The left frontal lobe lesion in the right frontal lobe lesion remains stable in overall dimensions.2.The patient is status post catheter placement in the left frontal lobe cystic lesion as well as the right temporal lobe lesion through adjacent burr holes.


Instruction: Generate impression based on findings.

Input: 89 years Female (DOB:5/12/1927)Reason: Assess for location of stroke History: R hemianopsia, gait imbalancePROVIDER/ATTENDING NAME: IRA J BLUMEN KOUROSH L REZANIA MRI of the brainThere are patchy foci of diffusion restriction present along the left inferior parietal lobule. This can also be identified on FLAIR and T2 imaging. On susceptibility imaging there are prominent signal voids along the left angular artery and even to some degree the right angular artery relative to the previous exam. Comparing to the MRA exam the signal voids are disproportionately larger. The other appears to be flow in the right angular artery there is not appear to be flow in the left angular arterySince the prior exam the patient has developed susceptibility effect along the deep gray nuclei of the right cerebellar hemisphere which is associated with volume loss and T2 and FLAIR signal hyperintensity suggesting interval infarction since 2012..There is redemonstration of a encephalomalacia along the left superior and middle temporal gyri anteriorly which was also present on the previous exam. There is redemonstration of some encephalomalacia along the right temporal lobe anteriorly. There is associated exact effect on the right lateral ventricle more than the left lateral ventricle.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are patchy signal hyperintensities along the brainstem on T2 and FLAIR imaging.There appears to be stenosis in the upper cervical spine at C3-4.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is asymmetry in of the superior and inferior division branches demonstrate flow along their proximal most portions it appears that there is diminished flow distal to that along the inferior division.There is a high-grade stenosis present along the left A3 segment and milder narrowing of the right A3 segment. There is also attenuation of the right angular artery.There is a 60% stenosis present at the left internal carotid artery at the distal cavernous segment.There is redemonstration of a an aneurysm along the left internal carotid artery adjacent to the anterior clinoid which measures 5 x 4 mm. It does not appear to have changed substantially when compared to the previous exam. It is directed laterally is located in the clinoidal segment.The anterior communicating artery is identified and is medium size. The left A1 segment is hypoplastic. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Findings suggest the partial occlusion of the left middle cerebral artery territory along the M2 portion of the inferior division and occlusion or near complete occlusion of the left angular artery.2.There is patchy appearing subacute infarction along the left inferior parietal lobule.3.There is distal intracranial cerebrovascular occlusive disease. There are distal arterial stenoses present along the anterior cerebral arteries bilaterally but more the left A3 segment when compared to the right as well as in attenuation of distal branches such of the right angular artery. The posterior cerebral arteries are not imaged significantly distal to the P2-3 junction.4.There is 60% stenosis at the distal left internal carotid artery.5.Encephalomalacia along the right cerebellum related to an infarction which was documented on 6/19/20126.Encephalomalacia along the anterior lateral aspects of the temporal lobes bilaterally.7.Periventricular and subcortical white matter lesions of a moderate degree and patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 82-year-old female patient with cervical mass and cervical bleeding. Preoperative evaluation. PELVIS:UTERUS, ADNEXA: There is a heterogeneously enhancing, intermediate T2 signal mass within the lower cervix measuring approximately 3.5 x 3.3 x 2.8 cm (image 32, series 5 and image 50, series 12). This lesion appears to involve the upper one third of the vagina. The mass abuts the posterior wall of the bladder and anterior wall of the rectum, however, there is no specific evidence of invasion. There is no apparent invasion of the pelvic sidewall. Based on post-contrasting imaging and T2 weighted sequences, there is no definite parametrial invasion.A tubular foreign body within the vagina, likely a component of the gel applicator (per technologist removed prior to patient leaving hospital).BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Cervical mass compatible with tumor involving the upper third of the vagina without definite parametrial invasion. 2. No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Vertigo. Brain: There are multiple scattered cerebral white-matter lesions that are most pronounced in the frontoparietal lobes. None of the lesions shows abnormal contrast enhancement. Compared to the previous examinations, there is no new or growing lesion. The lesions are more visually more conspicuous on today's examination but this may relate to technical factors.There continues to be no corpus callosal lesion. The corpus callosal volume is preserved. A small right dorsal pontine lesion is present. There is no significant involvement of the posterior fossa, otherwise.The small medial left middle cranial fossa arachnoid cyst is unchanged. Mild expansion of the ventricles and to lesser extend the sulci has not changed since the previous examination and probably reflects loss.The mastoid cells and the paranasal sinuses are clear. There is no gross orbital abnormality.Internal Carotid Canal:Internal artery canals are symmetric and normal. There is no abnormal signal or enhancement along the cisternal and canalicular segments of the seventh/eighth cranial nerve complexes. The inner ear structures are symmetric and show no abnormal contrast enhancement. The mastoid air cells are clear as well as the middle ear cavities. There is no destructive petrous lesion.Cervical Spine:Alignment is anatomic. The vertebral bodies are preserved in height and marrow signal. The intervertebral discs are also unremarkable. There is no central spinal canal or foraminal stenosis.The cervical spinal cord shows normal morphology and signal. There is no abnormal spinal cord or leptomeningeal contrast enhancement.There is a partially imaged 2 cm left thyroid lobe nodule. This was present on the previous neck ultrasound examination of January 21, 2013. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Brain: Numerous cerebral white-matter lesions without contrast enhancement are not significantly changed since the August 2015 MRI. The lesions do not show typical or specific features of multiple sclerosis, but an atypical demyelinating process may still be considered. Other etiologies including postinfectious and inflammatory phenomena would also be in the differential.2.IAC-CPA: No significant abnormality along the seventh/eighth cranial nerves or in the inner ear structures. There is a punctate T2-hyperintensity in the dorsal pons which has not changed since the previous examination. Otherwise, the brainstem is normal.3.Cervical spine: Normal. A left thyroid nodule is only partly visualized.


Instruction: Generate impression based on findings.

Input: Reason: right knee pain History: pain There is a small (4 to 5 mm) subchondral lucency within the anterior aspect of the medial femoral condyle likely corresponding to a subchondral focus of signal abnormality seen on the prior MRI examination from last year representing either a degenerative cyst or a small posttraumatic osteochondral lesion. The knee otherwise appears normal. We see no joint effusion.

Output: Small subchondral lucency within the anterior aspect of the medial femoral condyle may represent a degenerative cyst or a small posttraumatic osteochondral lesion.


Instruction: Generate impression based on findings.

Input: 32-year-old female patient with history of Crohn's disease with small bowel stricturing. Please assess disease extent and any complications. 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: Right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is fibrofatty proliferation within the right lower quadrant. There is short segment wall thickening and stricturing of the terminal ileum over a length of approximately 4 cm which demonstrate progressive enhancement compatible with active disease. There is a 3.7 cm stricture of the mid transverse colon which corresponds to a region of stricturing identified on the prior CT.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal intra-abdominal fluid collection is identified.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free fluid in the pelvis is likely physiologic in a premenopausal female.

Output: 1.Active inflammation of the terminal ileum with chronic stricturing compatible with acute on chronic disease.2.Chronic appearing stricture of the mid-transverse colon.


Instruction: Generate impression based on findings.

Input: Spinal stenosis, lumbar region, with neurogenic claudication [724.03] / Thoracic or lumbosacral neuritis or radiculitis, unspecified [724.4], Reason for Study: ^Reason: New HNP? Pt has known lumbar stenosis. History: New onset severe low back pain. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Again demonstrated grade 1 spondylolisthesis of L3 on L4 and L4 on L5, no change since prior study scan.There is normal lumbar lordosis. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. Right upper pole renal cyst, no change since prior scan.Degenerative changes are specified by the intervertebral level as follows: T12-L1: No evidence of neural foraminal narrowing or spinal stenosis.. L1-L2: Diffuse bulging of disc with disc desiccation abuts thecal sac. Minimal spinal canal stenosis, no change since prior scan. L2-L3: Diffuse bulging of disc with bilateral ligamentum flavum thickening causing minimal to mild spinal canal stenosis, disc desiccation, no change since prior scan. L3-L4: Diffuse bulging of disc with bilateral ligamentum flavum thickening causing mild to moderate spinal canal stenosis. In addition, there is a focal bulging toward the left neural foramen and somewhat far laterally which indents left side nerve root. However, all above findings do not show any interval change since prior scan. L4-L5: Diffuse bulging of disc with bilateral ligamentum flavum thickening causing mild to moderate spinal canal stenosis. There is right far lateral broad-based disc protrusion which compresses right side nerve root. No change since prior scan. L5-S1: Diffuse bulging of disc with disc dessication. There focal central disc bulging with broad based disc bulging toward left lateral recess and neural foramen which narrows left side neural foramen, again, no change since prior scan.

Output: 1. Diffuse degenerative spondylosis with multifocal disc protrusions and bulging including L34 (left side foraminal and far laterally), L45 (right far lateral) and L5S1 (central and left lateral recess), no change since prior exam.2. Grade 1 spondylolisthesis of L34 on L45 and L45 on L5S1, no change since prior scan.3. No change of right renal cyst.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: 58-year-old male with leg and back pain. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. Mild disc height loss and Schmorl's nodes are again visible from T11 through L1. There is also mild loss of disc height involving the L5-S1 level. There is no focal worrisome marrow signal abnormality. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is multi-level facet arthropathy which has progressed slightly at the L5-S1 level compared to the prior exam. There is also a mild disc bulge and small superimposed right paracentral disc protrusion involving the L5-S1 level which is new since 2008 and which may be causing impingement on the traversing right S1 nerve root. There is at most mild narrowing involving the bilateral L5-S1 neuroforamina. The paravertebral soft tissues are unremarkable.

Output: Multilevel spondylotic changes most prominent at the L5-S1 level where slight progression of the facet arthropathy, a mild disc bulge and small superimposed right paracentral disc protrusion may be causing impingement on the traversing right S1 nerve root. Correlate for a possible S1 radiculopathy.


Instruction: Generate impression based on findings.

Input: VESSELS:The distance from the level of the aortic valve to the innominate artery is approximately 6.9 cmSINUS OF VALSALVA: 2.4 X 2.3 x 2.4 cmSINOTUBULAR JUNCTION: 2.3 X 2.2 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 2.6 X 2.6 cmASCENDING THORACIC AORTA IMMEDIATELY PROXIMAL TO THE INNOMINATE ARTERY: 2.2 X 2.3 cmPROXIMAL DESCENDING THORACIC AORTA IMMEDIATELY DISTAL TO THE LEFT SUBCLAVIAN ARTERY: 1.8 X 1.8 cmDESCENDING THORACIC AORTA AT LEVEL OF HIATUS: 1.7 X 2.0 cmINFRARENAL ABDOMINAL AORTA: 10.2 X 10.7 cmRIGHT COMMON ILIAC ARTERY: 6.9 X 7.6 mmRIGHT EXTERNAL ILIAC ARTERY: 5.0 X 5.9 mmRIGHT COMMON FEMORAL ARTERY: 6.5 X 7.4 mmLEFT COMMON ILIAC ARTERY: 6.5 X 7.2 mmLEFT EXTERNAL ILIAC ARTERY: 5.9 X 6.7 mmLEFT COMMON FEMORAL ARTERY: 5.6 X 7.1 mmCHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: There is believe right ventricular and atrial chamber dilatation. There is a large ASD, secundum type which measures approximately 1.8 in AP dimension (11/41) from the axial images.No mediastinal or hilar lymphadenopathy.The pulmonic valve is thickened with redundancy of the leaflets. Retrospective imaging was not performed; therefore, the motion of the pulmonic valve with potential prolapse cannot be assessed.CHEST WALL: No significant abnormality noted.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat filled umbilical hernia.PELVIS:UTERUS, ADNEXA: Nodularity of the uterus raises a question of leiomyoma.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1.Cardiomegaly with ASD at the location of the valve of the fossa ovalis measuring 1.8 in AP dimension using axial images. Right sided chamber enlargement.2. Access vasculature measurements above.


Instruction: Generate impression based on findings.

Input: 57 years, Female, 2 month postoperative evaluation of meningioma resection. Since prior MRI from 11/10/2015 there has been resection of previously seen meningioma involving the right high frontal convexity. There are postsurgical changes related to tumor resection including right frontoparietal craniotomy and enhancement of the dura deep to the craniotomy flap. There are minimal areas of dural based thickening which may represent postsurgical change. No definite evidence of residual or recurrent tumor. There is T2/FLAIR hyperintensity involving the posterior aspect of the right superior frontal gyrus and medial aspect of the right precentral gyrus compatible with gliosis. There are minimal foci of T2/FLAIR hyperintensity including the left pons which may be related to chronic small vessel ischemia but unchanged. Remainder of the brain is otherwise unremarkable. No evidence of recent infarct or hemorrhage. No new mass or mass effect. No extra-axial collections. Trace mucosal thickening is seen in the paranasal sinuses, which are otherwise clear. Mastoid air cells are clear. Major flow-voids are preserved. Aside from postsurgical changes, calvarium and extracranial soft tissues are unremarkable.

Output: Postoperative changes of right frontal meningioma resection without evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Parkinson's, preoperative planning for DBS placement. Examination is obtained for operative planning. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Slightly prominent perivascular spaces are incidentally noted at the level of the midbrain. There is global parenchymal volume loss, commensurate with age. There is mild fullness and heterogeneous enhancement involving the sella without discrete mass, but is not well evaluated on the limited sequences. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Examination for operative planning per DBS protocol. No intracranial mass or vascular abnormalities along the expected trajectories of the DBS leads.


Instruction: Generate impression based on findings.

Input: 76 year-old and status-post fall Multiple small parenchymal hematomas in the right frontal lobe in the mid to high convexity are noted. The largest hematoma measures 8.8-mm x 14.6-mm measured on axial image 17. Minimal surrounding vasogenic edema is noted. Minimal amount of blood in the subarachnoid space in the right and left frontal region is also noted.Hematoma within the medial aspect of left temporal lobe at the level of the edge of the tentorium measures 30-mm times 18-mm in transaxial dimension on axial image 12. There is evidence of extension of blood into the trigone of left lateral ventricle. Minimal amount of blood within the perimesencephalic cistern is also noted. A small area of contusion with surrounding vasogenic edema within the inferior aspect of the right frontal lobe at the level of the floor of the right anterior cranial fossa is also present.Extensive patchy areas of low attenuation in the periventricular white matter of both cerebral hemispheres is consistent with small vessel disease.Large area of CSF collection in the right middle cranial fossa is contiguous with trigone of the right lateral ventricle and is believed to represent ex vacuo dilation of the right temporal horn. This area can be better evaluated with an MRI exam. No hydrocephalus or midline shift.No evidence of abnormality of the paranasal sinuses or mastoid air cells. Calvarium remains essentially unremarkable. Soft tissue density containing multiple foci of increased density within the high convexity right frontal scalp is noted. This lesion measures 15.5-mm x 18 0.2-mm. there is no evidence of associated bony changes with this finding and soft tissues of the scalp adjacent to these lesion demonstrate no evidence of edematous changes. The exact etiology of this finding is not clear however the finding less likely to represent a hematoma and possibly could represent a sebaceous cyst or a soft tissue mass of the scalp.

Output: 1.Multiple areas of hemorrhagic contusion of the brain in both cerebral hemispheres as detailed.2.Extension of blood from the left middle temporal lobe hematoma into the trigone of left lateral ventricle.3.Significant ex vacuo dilation of right temporal horn of uncertain etiology. This finding can be further monitored with a dedicated MRI.4.Small vessel disease of indeterminate age.5.Notice of fracture.6.Well pneumatized mastoid air cells and paranasal sinuses.


Instruction: Generate impression based on findings.

Input: Delirium, personality changes, evaluate for stroke versus dementia. The examination is limited by motion artifact. There has been interval development of bilateral subdural hematomas involving the cerebral convexities since prior CT, which demonstrated mild nonspecific prominence of the bifrontal extra-axial spaces without clear subdural collection. The collections are mixed signal, however predominantly T1 hyperintense suggesting that they are subacute. The collection on the right measures up to 13 mm while the collection on the left measures up to 8 mm in width. There is right greater than left mass effect and 5 mm leftward midline shift. The right frontoparietal lobe sulci are particularly effaced. The basal cisterns are patent with no evidence for uncal herniation. Foci of susceptibility in the right frontal and temporal lobes relate to dystrophic appearing calcifications seen on prior CT. There is no evidence for acute ischemia or acute intraparenchymal hemorrhage. No hydrocephalus. A retrocerebellar cystic space likely relates to mega cisterna magna or small arachnoid cyst without mass effect. Mild scattered paranasal sinus mucosal thickening is seen.

Output: Subacute subdural hematomas along the bilateral cerebral convexities, larger on the right than the left. There is associated mass effect including adjacent sulcal effacement and 5 mm leftward midline shift.Findings were reported to D. Dismukes on 10/26/2016 at 4:00 PM and the patient was subsequently transferred to the emergency department.


Instruction: Generate impression based on findings.

Input: Dysphagia, unspecified(787.20) [787.20], Reason for Study: ^Reason: subacute stroke History: drooling, dysphagia, decreased grip strength Motion artifacts degraded image quality.There is focal enhancing lesion (about 4mm) on the midline to slightly right side of the tectum on T1 Gad enhanced images (series 1201, image 16/32). The lesion shows low signal intensity on T1 non contrast images and slightly high signal intensity on T2 weighted images. On FLAIR images, the lesion area shows CSF signal intensity. There is no evidence of mass effects of this lesion toward adjacent anatomical structure. There is no evidence of susceptibility artifacts on this lesion.Therefore, this lesion could be a partial volume averaging artifacts with tectum area CSF, possibly small pineal cyst and adjacent internal cerebral vein. However, possibility of small tectal glioma or capillary telangiectasia cannot be completely excluded. Repeat MRI scan with thinner section of the lesion with and without contrast enhancement may be considered for further imaging evaluation. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is focal encephalomalacia on the left posterior inferior temporal lobe without evidence of susceptibility artifacts indicating chronic ischemic infarction.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Focal enhancing lesions on the tectum as described above, possibilities include partial volume artifacts, tectal glioma, capillary telangiectasia. Repeat exam with thin section around the tectum may be considered for further imaging evaluation.3. Focal encephalomalacia on the left inferior posterior temporal lobe likely represent chronic ischemic infarction, as described above.


Instruction: Generate impression based on findings.

Input: Female 49 years old Reason: Evaluate loose fragment/cyst at scaphoid History: Pain after fall 2 days ago BONES: There is a comminuted, essentially nondisplaced, intra-articular fracture of the distal radius consisting predominantly of a transverse fracture plane with longitudinal extension to the articular surface proximal to the lunate. The ulnar styloid appears intact. A subcentimeter triangular focus of low signal intensity is situated dorsal to the distal pole of the scaphoid and proximal to the trapezoid bone corresponding to a small mineralized fragment seen on outside radiographs perhaps reflecting sequela of old trauma. We see no acute fracture of the scaphoid or of the other carpal bones.Mild osteoarthritis affects the basilar joint. A small focus of signal abnormality in the proximal lunate may represent a cyst or bone contusion.LIGAMENTS: Evaluation the scapholunate and lunotriquetral ligaments is limited due to lack of intra-articular contrast but we see no findings to suggest a tear.TRIANGULAR FIBROCARTILAGE COMPLEX: There is mild heterogeneity of signal intensity of the lamina and adjacent articular disc of the triangular fibrocartilage which may reflect degeneration but we see no fluid traversing the articular disc to indicate an acute tear.TENDONS: There is a bifid abductor pollicis longus which may be a normal variant. There is a small amount of fluid surrounding the extensor pollicis longus tendon as it crosses the second dorsal compartment tendons, this has been described in association with distal radius fractures.ADDITIONAL

Output: Nondisplaced, comminuted, intra-articular fracture of the distal radius and other findings as described above.Findings were discussed by phone with Dr. Birnie at 09:31 on 6/1/2016.


Instruction: Generate impression based on findings.

Input: 54-year-old male. Please evaluate thyroid cancer. Pathology results of recent thyroid biopsy consistent with papillary thyroid carcinoma. BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. No abnormal postcontrast enhancement no evidence of parenchymal or leptomeningeal metastases within limited intracranial images.Re-demonstration of the postoperative changes of a bilateral antrostomy, middle turbinectomy, partial ethmoidectomy and osteotomy of the sphenoidal sinus wall.There is unilateral mucosal thickening of the left maxillary sinus, the ethmoidal air cells the left frontal sinus, and the left sphenoidal sinus, with inspissated and bubbly secretions, consistent with sinus disease.NECK SOFT TISSUES:The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid and submandibular glands are unremarkable. Thyroid gland is normal in size and with a focal regions of hypoattenuation within the superior poles of the right and left thyroid glands. The soft tissues/cartilage surrounding thyroid glands are unremarkable. There are multiple, non-pathologically sized lymph nodes in the neck.The cervical and visualized upper thoracic spine demonstrates a hypoattenuating focus within the T1 vertebral body is nonspecific and may represent a hemangioma, metastasis less likely but cannot be excluded, further evaluation with MRI may be considered as clinically indicated.Bilateral neck vasculature is patent. Mild cervical spine degenerative change, most prominent at C5-6 level with no evidence of canal stenosis.LUNG APICES:Lung apices are clear bilaterally.

Output: 1. Abnormal thyroid with focal hypo-attenuating lesions as described above without adjacent soft tissue/cartilage abnormality.2. Scattered small lymph nodes in the neck soft tissue. They are not considered pathological based on size criteria. 3. Small focal hypoattenuating lesion within the T1 vertebral body, most likely represents a hemangioma, metastasis is less likely but cannot be excluded, further evaluation with MRI may be considered as clinically indicated.4. Stable postsurgical changes of sinus surgery with residual sinus disease as described above.


Instruction: Generate impression based on findings.

Input: Altered mental status at church. Rule out stroke, acute process. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation. Calcifications are noted within the basal ganglia bilaterally which is probably dystrophic.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there clinical concern for an acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 57-year-old male with well-differentiated neuroendocrine tumor in the liver. ABDOMEN:LIVER, BILIARY TRACT: There is a circumscribed, enhancing mass in hepatic segment four measuring 7.6 x 7.6 cm. Tumor replaces the right and left portal veins, main portal vein extending into the confluence of the SMV and splenic vein. There is cavernous transformation of the portal vein with numerous porta hepatis varices, gastric varices and splenic varices.The gallbladder is normal in appearance. The cystic duct is normal in caliber. There is mild intrahepatic and proximal extrahepatic ductal dilatation with compression on the common bile duct by tumor thrombus from the portal vein.SPLEEN: Splenomegaly measuring 17 cm.PANCREAS: The main pancreatic duct is normal in caliber. There are small T2 hyperintense foci in the uncinate process and body of the pancreas. The focus in the body of the pancreas demonstrates clear communication with the main pancreatic duct compatible with a side branch IPMN. The largest T2 hyperintense lesion measures 8 mm in the distal body of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged porta hepatis lymph node measuring 2.8 x 2.1 cm (series 201, image 26).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Circumscribed, avidly enhancing hepatic segment 4 lesion as described above, consistent with patient's biopsy-proven metastatic neuroendocrine tumor. Tumor thrombus also replaces the right and left portal veins, main portal vein, and extends into the confluence of the SMV and splenic vein. Cavernous transformation of the portal vein and numerous varices are present. Metastatic adenopathy present.2.Evaluation of pancreas is somewhat limited due to mass effect from aforementioned extensive tumor thrombus and due to paucity of intra-abdominal fat. Within these limitations, no suspicious pancreatic masslesion evident. No pancreatic ductal dilatation.3.Cystic lesions within the uncinate process and body of the pancreas are felt to represent side-branch type IPMNs.


Instruction: Generate impression based on findings.

Input: Rt facial numbness x 4-5 days The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 10mmx18mm axial dimension gyriform focus of diffusion restriction along the left occipital lobe which partially involves primary visual cortex and partially higher level cortex.There is a subtle punctate focus of DWI signal hyperintensity in the lateral aspect of the left thalamus which is not identified on ADC maps.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a small subacute infarction along the left occipital lobe as described above.2.There is a punctate lesion in the left thalamus along its lateral aspect. It is possible that this also represents a punctate subacute cerebral infarct.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine, unspecified, intractable, without status migrainosusClinical question: worsening headaches, eval for structural cause 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.Incidental note is made of a developmental venous anomaly in the right inferior parietal lobule.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for intracranial mass lesion or other intracranial lesion to account for the patient's headaches.2.There are some mild mucosal thickening in some of the paranasal sinuses. This is most likely inflammatory in nature


Instruction: Generate impression based on findings.

Input: Altered mental status and acute onset of slurred speech, right facial droop, confusion and bilateral lower extremity weakness. Rule out stroke. The study is moderately limited by patient motion.Brain MRI:There is an area of diffusion restriction involving the right cerebellar hemisphere. In addition, there are numerous foci of diffusion restriction involving both cerebellar hemispheres and, to a lesser extent, both cerebral hemispheres. While many of the lesions are located within the white matter, some of them involve the overlying cortex. There is a tiny focus of susceptibility effect in the left occipital lobe which probably reflects the presence of blood products. Otherwise, there is no gross intracranial hemorrhage within the limitation of this motion-degraded examination. There is confluent periventricular cerebral white matter T2 hyperintensity without diffusion restriction, probably reflecting chronic microvascular ischemia. Given the small size of the diffusion restricted lesions, they are not associated with significant mass effect. There is no midline shift or herniation. The ventricles and other CSF-containing spaces are normal in size. The orbits are unremarkable. There is fluid in the mastoid air cells and there is mild anterior ethmoid mucosal thickening. The other included paranasal sinuses are clear. Head MRA:There is no large vessel significant stenosis or occlusion. There might be mild narrowing of the left internal carotid artery as it enters and within the cavernous sinus but this study lacks the quality needed for assessing for mild stenosis. There is no severe narrowing in the internal carotid arteries or the paired middle and anterior cerebral arteries. Of note, the left A1 segment is very small which is probably congenital given the large right A1 segment and anterior communicating artery. The flow in the more downstream anterior cerebral arteries is fairly symmetric. Similarly, the flow in the posterior cerebral arteries is preserved and symmetric. The basilar artery is also without significant narrowing. Visualization of most of the intracranial vertebral arteries is severely affected by motion.

Output: 1.The examination is moderately limited by patient motion.2.Right cerebellar and numerous other smaller foci of diffusion restriction throughout the brain are compatible with acute/subacute infarcts. Tiny focus of susceptibility effect in the left occipital lobe is probably related to microscopic blood products, likely chronic. Otherwise, there is no gross intracranial hemorrhage, within the limitation of the examination.3.Mild background chronic microvascular ischemia of the white matter.4.Within the limitation of the examination, there is no significant intracranial vessel narrowing or occlusion. Dr. Monther Qandeel discussed the above results with Dr. Matthew Burns over the phone on September 19, 2015 at 1730 hours.


Instruction: Generate impression based on findings.

Input: There is a right transfrontal ventricular catheter that terminates in the region of the right foramen of Monro. There is unchanged mild high T2 signal surrounding the catheter. There is also unchanged mild nonspecific T2 hyperintensity in the left corona radiata. The third and lateral ventricles appear to be slightly smaller. Patency of the third ventriculostomy cannot be ascertained based on the available sequences. There is no midline shift or herniation. There is no evidence of acute infarction, hemorrhage, or mass. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: Slight interval decease in size of the shunted ventricular system.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:3/9/1946)Reason: Eval for acute infarct in R internal capsule vs pons History: L face/arm/Leg weaknessPROVIDER/ATTENDING NAME: ROBERT A MULLIKEN CHRISTOPHER M GOMEZ There is a new focus of diffusion restriction present in the right pons.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Small foci of T2 hyperintensity are present in the right internal capsule, right basal ganglia and thalami bilaterally. These were also present on the prior exam. There are patchy foci of T2 and FLAIR signal hyperintensity in the brainstem. The right cerebral peduncle is low but smaller than the left cerebral peduncle. There is signal hyperintensity within the right cerebral peduncle on T2 and FLAIR MR imaging.Susceptibility imaging is degraded by motion artifact as are many of the pulse sequences. There are punctate signal hypointensity is redemonstrated in the left middle cerebellar peduncle. In isolation these are of unknown clinical significance.No abnormal mass lesions are appreciated intracranially.Normal vascular flow voids are present in the distal left 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 right internal carotid artery flow-void is not readily visualized. This is a finding also present on the prior exam.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 demonstrate elongation the AP dimension of the right eye. The lens of the left eye is thin.

Output: 1.Findings are compatible with an acute right pontine lacunar infarct.2.Findings are compatible with old lacunar infarcts in the right basal ganglia, thalami and brainstem.3.Findings are suggestive of occlusion of the right internal carotid artery.4.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 5.Right eye staphyloma.6.The examination is degraded by patient motion which can obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis complex and subependymal giant cell astrocytoma treated with Afinitor. There is an avidly enhancing mass in the region of the right foramen of Monro, which measures up to 32 mm. There is no significant change in the numerous bilateral lateral ventricular subependymal nodules and appearance of the ventricular system. Likewise, the numerous scattered cortical and subcortical tubers appear unchanged. There is no evidence of acute infarction or hemorrhage. The cerebral flow voids are grossly unremarkable. There are bilateral mastoid effusions. The skull and orbits appear unchanged.

Output: No significant interval change in the subependymal giant cell astrocytoma and other intracranial stigmata of tuberous sclerosis complex.


Instruction: Generate impression based on findings.

Input: Reason: r/o 3rd met stress fx History: pain There is mild increased signal abnormality within the base of the second metatarsal indicating a mild stress reaction (image 11; series 4). No discrete fracture line is identified. The alignment is maintained. There is minimal subcutaneous and soft tissue signal abnormality in the surrounding area (image 30; series 12). Fluid signal abnormality in the surrounding area interposed between the second and third metatarsals may represent a mild bursitis. The flexor and extensor tendons appear intact. No additional bone marrow signal abnormality is identified. The remainder of the imaged soft tissues structures are normal in appearance. There is a lobulated focus of fluid signal abnormality along the posterior aspect of the flexor tendons at the level of the posterior aspect of the talus likely representing ganglion formation.

Output: Findings indicating mild stress reaction of the base of the second metatarsal. We see no discrete fracture line at this time. No stress fracture of the third metatarsal is seen, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Dorsalgia, unspecified [M54.9], Reason for Study: ^Reason: 45 yof with S epi bacteremia, previous hardware in lumbar spine, spinal tenderness throughout, evaluate for epidural abscess History: Bactermia Postoperative status of the lower lumbar spine, screws and plate with external fixation from L4 to S1.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The conus medullaris terminates at the level of L1.Bilateral pleural and adjacent lung tissue enhancements are seen indicating pleural effusions with possible subsegmental atelectasis. If clinically indicated, dedicated lung CT scan can be considered.There are enhancements around the instrumentations and adjacent soft tissues indicating postoperative changes. However there is no evidence of postoperative unusual enhancements on lumbar spine.There is mild diffuse bulging of disc at the level of C56 which abuts thecal sac. Otherwise cervical spine intervertebral discs appear to be normal.Thoracic vertebral intervertebral discs are within normal limits.There is diffuse bulging of disc and disc height reduction at the level of L34. Associated with bilateral ligamentum flavum thickening, there is moderate to severe spinal canal stenosis at this level.Disc dessication is seen at the level of L5S1 with minimal anterolisthesis of L5 on S1. There is spinal canal widening from L4 to S1 level which is postoperative changes.

Output: 1. Postoperative no unusual finding.2. Diffuse disc bulging at the level of C56.3. Moderate to severe spinal canal stenosis at the level of L34 as described above.4. No abnormal enhancement except bilateral pleural enhancement as described above.


Instruction: Generate impression based on findings.

Input: Male, 12 years old. Reason: Evaluate lesion in right temporal lobe, evaluate stability and characterization History: Right temporal lobe lesion, seizure Motion somewhat degrades evaluation. The previously seen focus of susceptibility artifact in the right corona radiata (series 1002, image 109) appears unchanged. The previously described subcentimeter T2 hyperintense subcortical focus in the inferior right temporal lobe is unchanged from the prior study dated 06/12/2015. The lesion does not appear to suppress readily on FLAIR, although this in part could relate to slice selection. Evaluation for enhancement is markedly limited by local pulsation and motion artifacts. There is no mass effect or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses, mastoid air cells, and orbits are unremarkable.

Output: 1.A subcentimeter right temporal lobe T2 hyperintense focus is grossly stable although does not definitely appear to suppress on FLAIR. Differential is unchanged, although additional follow-up imaging at 3T, to include 3-D T1 postcontrast and 3-D FLAIR sequences provided the small size of the lesion, is recommended to confirm FLAIR characteristics and to more completely assess for associated enhancement.2.A stable nonspecific focus of susceptibility in the right corona radiata may represent sequelae of prior microhemorrhage or may represent a small cavernoma.


Instruction: Generate impression based on findings.

Input: Cholangiocarcinoma status post Whipple now with jaundice. ABDOMEN:LIVER, BILIARY TRACT: There are postsurgical changes from a Whipple procedure including a hepaticojejunostomy. There is marked intrahepatic biliary ductal dilatation to the point of Klatskin where there is abrupt narrowing of the biliary tree. There is very subtle mild T2 hyperintensity and restricted diffusion at the site measuring approximately 2.7 x 2.2 cm (series 8/33). There is thickening and enhancement of the common hepatic duct (series 1404/83). Additionally, there is poorly defined delayed enhancement in the region of biliary duct amputation. These findings are suspicious for infiltrative cholangiocarcinoma recurrence.No additional suspicious intrahepatic lesion. The hepatic artery and hepatic veins appear patent. There is narrowing of the portal vein at the porta hepatis at the level of the ill-defined infiltrative lesion and biliary ductal narrowing with reconstitution distally.Several foci of transient hepatic intensity differences without underlying discrete abnormality are noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is moderately atrophic. There is a multiloculated cystic lesion in the pancreatic tail measuring 2.7 x 1.4 cm (series 8/23), not significantly increased from the CT dated 7/28/2014 using similar measurement technique. The lesion appears to communicate with the pancreatic duct which is irregularly dilated up to 5 mm.The pancreatic parenchyma is decreased in intrinsic T1 signal intensity and enhancement compatible with pancreatic dysfunction. It enhances homogeneously.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the abdominal aorta with mild infrarenal ectasia.BOWEL, MESENTERY: Postsurgical changes from a gastrojejunostomy. Large volume ascites.There are numerous dilated small bowel loops measuring up to 3.2 cm. There are collapsed distal small bowel loops and the colon is decompressed. These findings raise the possibility of a small bowel obstruction versus partial ileus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small pleural effusions. Postsurgical changes from sternotomy.

Output: 1.Marked intrahepatic biliary ductal dilatation to the level of Klatskin point where the bile ducts are abruptly narrowed and there is an ill-defined lesion suspected suspicious for recurrent cholangiocarcinoma at Klatskin point. Thickening and enhancement of the common hepatic duct likely periductal spread. The portal vein is significantly narrowed at this point as well with distal reconstitution.2.Large volume ascites.3.Stable pancreatic tail cystic neoplasm, likely a side-branch IPMN. 4.Findings of pancreatic dysfunction without specific evidence of acute pancreatitis.5.Small bowel dilatation is partially evaluated raising the possibility of a low-grade small bowel obstruction versus partial ileus. Clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: 59-year-old male. Pain in right shoulder with overhead activity. Evaluate for possible right RTC tear. Images are severely degraded by motion artifact, limiting evaluation.ROTATOR CUFF: There is a full-thickness chronic rotator cuff tear of the supraspinatus tendon with a high riding humeral head and joint fluid extending into the subdeltoid bursa as well as AC joint. The subscapularis tendon is not well-visualized, possibly also torn though this may in part be due to motion artifact.SUPRASPINATUS OUTLET: Mild osteoarthritis of the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: No gross abnormality of the labrum on this motion limited exam.BICEPS TENDON: The extra-articular biceps tendon is seen within the bicipital groove; intra-articular portion is not well-visualized due to severe motion artifact.ADDITIONAL

Output: Very motion limited exam. Chronic full thickness tear of the supraspinatus tendon and possibly also subscapularis.


Instruction: Generate impression based on findings.

Input: 62 year old man with systolic heart failure and worsening fatigue who presents for Cardiac MRI to evaluate for possible ischemic etiologyMEDICATIONS: Norvasc, Aspirin, Lipitor, Lasix, Lisinopril, Toprol XL First Pass PerfusionDuring hyperemia, there are reversible perfusion defects noted in the entire apex and mid anterior, anteroseptal, and inferoseptal segments. The overall ischemia score is 7 out of 32 and 22% of the myocardium is ischemic.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and mildly reduced in systolic function. The overall LV ejection fraction is 43 %, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 204 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 116 ml (normal range 47+/-19), the LV mass index is 53 g/m2, and the LV mass is 119 g. There is global hypokinesis. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 141 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 67 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a mild but large burden of ischemia in the usual territory of the left anterior descending artery. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with mildly reduced systolic function (LVEF 43%). No underlying myocardial fibrosis, inflammation, or infiltration is noted.4. Normal RV size and systolic function (RVEF 53%).


Instruction: Generate impression based on findings.

Input: NF 1, pain to percussion and upper and lower thoracic spine. Thoracic: Examination is mildly motion degraded. Vertebral body heights and alignment in the thoracic spine are normal. Lack of contrast and mild motion degradation limiting evaluation for small lesions. However no discrete mass within the thoracic spinal canal or neural foramina is appreciated. Thoracic cord appears normal in signal. There is no significant spinal canal or neural foraminal stenosis at any level. Bone marrow signal is within normal limits. There are multiple T2 hyperintense lesions involving the subcutaneous soft tissues compatible with patient's history of neurofibromatosis. There is a 14 x 34 mm T2 hyperintense lesion involving the musculature at the right upper posterior chest wall which is incompletely evaluated without T1-weighted sequence but may represent a neurofibroma given patient's history.There are trace bilateral pleural effusions.Lumbar: Vertebral body heights in the lumbar spine are normal. Alignment is normal. Within the limitations of noncontrast sequences, no discrete mass within the spinal canal or neural foramina is appreciated. Conus is in normal position. Bone marrow signal is benign. There is no significant spinal canal or neural foraminal stenosis at any level.There is an area of T1, T2, and STIR hyperintensity involving the right lower lumbar and pelvic paraspinous musculature measuring approximately 4.3 x 3.4 cm, axial oblique T2 image 25, with scalloping of the adjacent sacrum and iliac bones. Signal features suggest question of fat within this lesion but not well evaluated. More superficially, in the deep subcutaneous tissues of the right lower back posteriorly there is an area of T1 hypointensity and STIR hyperintensity measuring approximately 1.2 cm x 7.0 cm without mass effect, and suspected to represent an infiltrating neurofibroma.

Output: 1. Lack of contrast limits evaluation for small lesions. There is however no discrete mass involving the thoracic or lumbar spinal canal or neural foramina.2. Stigmata of neurofibromatosis 1 with multiple lesions involving the visualized subcutaneous tissues. Relatively larger soft tissue lesions are seen involving the right upper chest wall posteriorly as well as in the right lumbosacral paraspinous region as described above. These may represent neurofibromas given history but would suggest comparison with prior studies to assess stability.


Instruction: Generate impression based on findings.

Input: New diagnosed rectal cancer seen on colonoscopy. PELVIS:UTERUS, ADNEXA: The enhancing tumor invades the uterine body.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an annular mass lesion resulting in a focal stricture of the rectum with heaped up shouldering margins of the mid to upper rectum extending approximately 8 cm in length as delineated by the diffusion-weighted images (series 1005 image 360 through 252). Proximally the lesion likely extends into the distal sigmoid. The lesion measures up to 3.9 x 2.4 cm in maximal cross section (series 1000 5/276). The lesion demonstrates peripheral enhancement. The most distal aspect of the mass lesion is approximately 7 to 8 cm from the anal verge (series 701/25).Dorsally the lesion does not abut the presacral space. Ventrally the enhancing lesion invades the uterine body (series 701/25).At the level of the stricture there are strands of low T2-weighted signal intensity extending into the mesorectal fat (series 901/45). There are scattered small lymph nodes within the mesorectal fat (series 1101/44) at the 5:00 position and (series 1101/49) at the 10:00 position. Additionally there is a prominent lymph node in the ischiorectal space (series 1101/44) at the 9:00 position measuring 6 x 5 mm.Limited evaluation of the more proximal sigmoid colon demonstrates diverticulosis with moderate wall thickening which may be secondary to obstruction or chronic diverticular disease/muscular hypertrophy.In the region of the left adnexa there are small cystic components which may represent adnexal cysts versus a focal fluid collection related to a contained perforation. BONES, SOFT TISSUES: Patchy red marrow throughout the visualized osseous structures.OTHER: No significant abnormality noted.

Output: Annular mass extending from the mid rectum to the most distal sigmoid colon with invasion of the uterus. Suspicious mesorectal and pelvic lymphadenopathy. Proximally the colon is not distended but demonstrates diffuse wall thickening which may be secondary to chronic obstruction versus muscular hypertrophy from chronic diverticular disease. Left adnexal fluid collection may represent adnexal cysts versus a focal fluid collection related to a contained perforation.


Instruction: Generate impression based on findings.

Input: 15-year-old male patient with history of right axillary abscess/edema status post I&D with drain placement. Evaluate for possible lymphatic malformation or soft tissue lesion. There are multiple prominent lymph nodes in the right axilla that are favored to be reactive. Small focus of T2 signal hyperintensity in the right axilla measures 1.6 x 1.2 cm (series 8 image 17) and may represent a small focus of residual collection versus a lymph node, as there is minimal adjacent edema and enhancement. There is no underlying soft tissue lesion or evidence of a vascular or lymphatic malformation.Small scattered left axillary lymph nodes noted.Incidental note is made of the renal cyst in the inferior pole of the left kidney.

Output: 1.Reactive right axillary lymph nodes and small focus of T2 signal hyperintensity in the right axilla may represent residual fluid collection versus a reactive lymph node.2.Left renal cyst.


Instruction: Generate impression based on findings.

Input: 85-year-old male with history of prostate cancer treated with brachytherapy 10 years ago now with pelvic pain and dysuria. PELVIS:PROSTATE/SEMINAL VESICLES: Multiple small signal voids are present within the prostate likely representing brachytherapy seeds. There is a single small signal void located within the left periprostatic fat, but this is equivocal. BPH.BLADDER: Mildly trabeculated bladder wall likely the result of chronic outlet obstruction.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right groin skin scarring.

Output: Mild findings of chronic outlet obstruction likely from BPH. Majority of brachytherapy seeds appear to be within the prostate gland, although there is suggestion that one seed may be located within the left periprostatic fat, however this is equivocal given susceptibility of MRI to artifact. Please note that CT is more sensitive to evaluate more exact location of brachytherapy seeds.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with history of amyotrophic lateral sclerosis and bilateral upper extremity weakness with EMG showing denervation in the cervical and thoracic myotomes. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of concerning marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed below.At T5-6, there is a central disc protrusion with mild flattening of the ventral cord but no significant cord signal abnormality. The neural foramina are patent.At T6-7, there is a central/left paracentral disc protrusion with mild flattening of the ventral cord but no cord signal abnormality. The neural foramina are patent.At T7-8, there is a central/right paracentral disc protrusion with mild flattening of the ventral cord but no cord signal abnormality. The neural foramina are patent.At T11-12, there is moderately severe facet hypertrophy and a mild disc bulge but without significant spinal canal or foraminal stenosis.Mild disc degeneration is evident in the partially visualized lower cervical region.

Output: 1.No significant abnormalities of the spinal cord are identified.2.Relatively mild degenerative findings are seen with small disc protrusions at T5-6 through T7-8, as well as a disc bulge and facet hypertrophy at T11-12. 3.No high-grade spinal canal or foraminal stenosis is observed.


Instruction: Generate impression based on findings.

Input: 26-year-old male with acute mental status change over past 9 days The density and morphology brain parenchyma remains entirely within normal limits for patient's stated age of 26. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium, paranasal sinuses and mastoid air cells are also unremarkable. Further follow-up with an MRI examination is recommended.

Output: Normal CT of brain without the infusion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Sickle-cell disease without crisisClinical question: sickle cell dsSigns and Symptoms: eval Moya Moya or stenosis MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacity left maxillary sinus which are unchanged. The visualized portions of the mastoid air cells demonstrate partial opacification of the right mastoid air cells. This finding was present on the prior exam and has not changed. The visualized portions of the orbits are intact.There is diffuse calvarial thickening present and diffuse marrow replacement.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is extracranial origin of the posterior inferior cerebellar artery bilaterally.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating arteries are identified and are large.. The vertebral arteries are similar in size.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease. There is no evidence for moyamoya. Compared to the prior exam there is no interval change. Previously noted mild narrowing of the left middle cerebral artery can be accounted for on the basis of time-of-flight artifact.2.Diffuse calvarial thickening and marrow replacement can be accounted for on the basis of the patient's sickle cell disease


Instruction: Generate impression based on findings.

Input: 75-year-old female with PSC, increased bilirubin. Evaluate for dominant stricture. ABDOMEN:LIVER, BILIARY TRACT: There is an irregular appearance of the distal common bile duct and a stricture of the proximal common bile duct at the level of Klatskin's point. Hazy increased enhancement at Klatskin's point is noted on the delayed phase imaging (series 11 image 324). Multiple intrahepatic biliary strictures are also noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is dilated to the level of the ampulla and mildly irregular appearance. There are small sidebranch IPMNs at the level of the pancreatic body (series 5 image 79).ADRENAL GLANDS: Small left adrenal nodule demonstrating loss of signal on the in and out of phase sequences compatible with a benign adenoma (series 1001 image 49, series 1002 image 49).KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Within the infrarenal abdominal aorta, there is an intraluminal linear focus, which raises the question of a focal dissection (series 11 image 78). Asymmetric loss of signal of the right proximal common iliac artery is concerning for severe stenosis versus occlusion (series 5 image 384).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.A stricture at the proximal common bile duct at the level of Klatskin's point with hazy increased enhancement of the adjacent parenchyma on the delayed phase imaging. While this could represent inflammation, an underlying mass cannot be excluded. Correlate with ERCP and brushings as clinically indicated.2.Dilatation of the pancreatic duct to the level of the ampulla. Small sidebranch IPMNs also noted. 3.Intraluminal linear focus of the infrarenal abdominal aorta raises the question for a focal dissection. Loss of signal intensity of the right proximal common iliac artery concerning for severe stenosis versus occlusion. No prior imaging is available for comparison.


Instruction: Generate impression based on findings.

Input: Headache. Visual field defect. There is restricted diffusion lesions on bilateral occipital lobes indicating acute ischemic infarct.. There is no evidence of hemorrhagic conversion.There is a linear focal encephalomalacia seen on the right side of upper pons suggesting chronic infarct.Multiple scattered bilateral centrum semiovale and periventricular white matter high signal intensities on FLAIR images indicate nonspecific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate subtle irregularities of bilateral MCA M1 segments. However, there is no significant (more than 50%) luminal stenosis or intracranial arterial aneurysm. Vertebrobasilar system shows focal signal loss on the right PCA proximal P3 segment. This could represent a embolus but could also be an artifactual finding.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non visualization of the left vertebral artery proximal segment from its ostium. This can represent segmental occlusion of the left vertebral artery.The right vertebral artery ostium shows signal loss indicate focal luminal stenosis. However, this is more likely due to tortuosity related artifacts. Bilateral common carotid arteries and internal carotid arteries appear to be normal.

Output: 1. Acute ischemic infarctions on bilateral occipital lobes (PCA territories) without hemorrhagic transformation.2. Non visualization of the left vertebral artery from its ostium to the level of C4, likely represent occlusion.3. Atherosclerotic changes of intracranial arteries.


Instruction: Generate impression based on findings.

Input: History of microadenoma, dementia. The pituitary gland has not significantly changed in size, measuring up to 8 mm in height. However, assessment for tumor is limited due to the lack of intravenous contrast. There is no mass-effect upon the optic apparatus or cavernous sinuses. There is partially-imaged nonspecific cerebral white matter T2 hyperintensity.

Output: The pituitary gland as not significantly changed in size. However, assessment for tumor is limited due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Unspecified epilepsy with intractable epilepsy The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.MRI of the brain is within normal limits2.This is a limited exam which was obtained for surgical guidance for depth electrode placement.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with radiculopathy, assess for lumbar stenosis. Trace retrolisthesis of L2 relative to L3 and L3 relative to L4 is seen. A mild anterior compression of the T12 vertebral body is noted with no more than 10% loss of vertebral body height and mild associated STIR signal abnormality which may represent edema. No other areas of significant marrow edema are seen. Fatty degenerative endplate signal abnormality is noted from L3 through S1. The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected. A right renal cyst is suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Loss of disc height and disc bulging. Moderate generalized spinal canal stenosis with crowding of the cauda equina. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Loss of disc height and disc bulging. Moderate generalized spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. L4-5: Advanced facet hypertrophy and ligamentum flavum thickening. Loss of disc height and disc bulging. Severe generalized spinal canal stenosis particularly affecting the left aspect of the spinal canal. Severe left and mild right foraminal narrowing. L5-S1: Facet hypertrophy. Loss of disc height and disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Disc and posterior element degeneration contribute to moderate spinal canal stenosis at L2-3 and L3-4, and severe stenosis at L4-5. A severe stenosis of the left neural foramen is also evident at L4-5.2.Very mild anterior wedging of the T12 vertebral body which may be subacute to chronic.


Instruction: Generate impression based on findings.

Input: History of cervical cancer presenting for planning prior to radiation treatment. PELVIS:UTERUS, ADNEXA: The fiducial marker extends through the lower uterine segment into the peritoneum. There is a poorly enhancing tumor along the right aspect of the cervix measuring approximately 1.1 x 1.1 cm (series 1103, image 289), decreased from the prior study where the tumor measured 2.3 x 1.1 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The fiducial marker extends through the lower uterine segment into the peritoneum.2.Interval decrease in cervical lesion size as described.


Instruction: Generate impression based on findings.

Input: Low back pain for years on and off with bilateral sciatica. There are small central disc protrusions with annular fissuring at L4-5 and L5-S1, without significant spinal canal stenosis or neural foraminal stenosis. The other lumbar spine levels are unremarkable. There is no evidence lumbar spine mas lesions. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Small central disc protrusions with annular fissuring at L4-5 and L5-S1, without significant spinal canal stenosis or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 21-year-old female with with HIV now with headache and persistent fevers. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma is unremarkable. The pituitary gland is small but otherwise unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 64-year-old male with cranial nerve III palsy. There is no evidence of intracranial hemorrhage, mass, or edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. There is no diffusion abnormality to suggest acute ischemia. There is an unchanged punctate focus of susceptibility effect. There is a new small focus of susceptibility artifact just above the left cerebellar peduncle and 2 punctate foci in the left parietal lobe. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses and mastoid air cells are unremarkable. There are bilateral lens replacements. The orbits are otherwise unremarkable. There is a subcentimeter nodule in the right occipital scalp, which may represent an inclusion cyst. There is a posterior disc-osteophyte complex at C3-4, which slightly indents the spinal cord.

Output: 1. No evidence of acute ischemia.2. A right pons lesion with susceptibility effect is compatible with a capillary telangectasia, as demonstrated on the prior MRI with contrast. Otherwise, several punctate foci of susceptibility effect elsewhere may represent chronic microhemorrhages.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49 year old with history of left lumpectomy for breast cancer in 2007, and radiation and chemotherapy. Family history of breast carcinoma in her mother at age 64, and maternal cousin at age 36. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Surgical scar is seen in the left 11 - 12:00 position.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with right arm pain, paresthesias and weakness. Mild reversal of the cervical lordosis is again seen, unchanged. Grade 1 retrolisthesis of C4 relative to C5, and C5 relative to C6, are also unchanged.Vertebral body morphology is otherwise unremarkable. No concerning marrow signal abnormality is detected.Spinal cord signal intensity and morphology are within normal limits.Mild/moderate facet hypertrophy is evident at every level, unchanged. Scattered perineural root sleeve cysts are seen, not significantly changed. Level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. No interval changes.C3-4: Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. No interval changes.C4-5: Posterior disk osteophyte formation. No significant spinal canal stenosis. Severe bilateral foraminal narrowing. No interval changes.C5-6: Posterior disk osteophyte formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. C6-7: Posterior disk osteophyte formation. No significant spinal canal stenosis. Mild left neuroforaminal narrowing. No significant interval changes. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. T1-2: As assessed on sagittal images only, disk osteophyte formation is evident but without significant spinal canal compromise. The right neural foramen may be narrowed.

Output: 1. No significant change in degenerative disk disease which causes no significant spinal canal stenosis.2. No significant interval change in scattered foraminal narrowing which ranges from mild to severe as above.3. No new findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 2 years old, with transient left sided facial drooping and slurred speech. Evaluate for ADEM, mass, dissection. MRI brain:No evidence of focal signal abnormality, edema or mass effect is seen. No restricted diffusion is demonstrated. There is no pathologic intracranial enhancement. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection are seen. The ventricles are normal in size and morphology. The brain development and pattern of white matter myelination are appropriate for age. The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed.MRA head:No evidence of significant vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is detected. The ACOM artery is moderately sized and unremarkable. Moderately sized bilateral PCOM arteries are present. MRA neck:No significant vascular stenosis or occlusion is seen in the neck. No evidence of intramural hematoma or other findings to suggest dissection are seen.

Output: Unremarkable MRI and MRA evaluations. No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Status post tumor resection. Interval postsurgical changes of left parietal craniectomy for resection of metastatic calvarial lesion is seen. Cranioplasty with titanium mesh is noted. There is small focus of T1 hyperintensity and enhancement at the medial margin of the craniectomy defect which was present on prior from 4/6/2015 and nonspecific. No residual tumor within this location is definitively appreciated. Small extra-axial collection is noted at the surgical site with minimal if any mass effect on the adjacent parenchyma. Brain parenchyma demonstrates no evidence of infarct, hemorrhage, mass, or abnormal enhancement to suggest intraparenchymal metastatic disease. There is dural thickening and enhancement along the left parietal convexity which is again seen and may be reactive. Ventricles are within normal limits without evidence of hydrocephalus. Major flow-voids are preserved. Unchanged punctate focus of enhancement in the left frontal calvarium, axial post gadolinium series 15 image 175 of 272.

Output: 1. Expected postsurgical changes of left parietal craniectomy and cranioplasty relating to resection of left parietal calvarial mass. No residual tumor within this location is definitively demonstrated. There is small focus of T1 hyperintensity and enhancement adjacent to the medial margin of the craniectomy defect which is nonspecific and can be assessed on follow-up studies.2. Punctate additional focus of enhancement in the left frontal calvarium again seen, which may represent an additional lesion.3. No intraparenchymal metastases is appreciated. Left parietal dural thickening and enhancement is again seen and may be reactive.


Instruction: Generate impression based on findings.

Input: 68-year-old female with known small mass in the uncinate process of the pancreas. It needs surveillance MRCP to evaluate for change. ABDOMEN:LIVER, BILIARY TRACT: Normal variant of the biliary tree consisting of a separate right posterior bile duct (series 10 image 75). The left bile duct normally joins the anterior right bile duct to form the common hepatic duct. The cystic duct opens into the right posterior duct. Just distal to this, the cystic duct and right posterior duct join the common hepatic duct to form the common bile duct.SPLEEN: No significant abnormality noted.PANCREAS: The cystic lesion of the pancreatic uncinate process has decreased in size currently measuring 6 x 5.5 mm (prior 10.7 x 14 mm) (series 6 image 36). No contrast enhancement. No perihepatic ductal dilatation.Additional subcentimeter T2 hyperintense foci of the pancreatic body and tail are unchanged (series 6 images 29, 35).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter cyst of the right lower renal pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small intramuscular lipoma of the right posterior-lateral abdominal wall, unchanged (series 7 image 38).OTHER: No significant abnormality noted.

Output: 1.Interval decreased size of the uncinate process cystic lesion measuring 6 x 5.5 mm (prior 10.7 x 14 mm).


Instruction: Generate impression based on findings.

Input: Female 70 years old Reason: L great toe infection, r/o osteomyelitis History: As above TENDONS: Flexor and extensor tendons are intact.LIGAMENTS: The Lisfranc ligament is intact.ARTICULAR SURFACES AND BONE: There is cortical destruction and marrow replacement involving the tuft of the great toe. This involves the anterior 50% of the tuft. The cortical defect is along its medial and inferior aspects. Edema type signal extends through the remainder of the tuft and the nailbed.Osteoarthritis affects the bones of the midfoot and the tarsometatarsal joints.There is a moderate hallux valgus deformity with associated osteoarthritic changes at the first MTP joint. There is subluxation of the sesamoid bones laterally.Degenerative arthritic changes are present at the midfoot. No joint effusion. ADDITIONAL

Output: Findings of acute osteomyelitis involving the tuft of the first digit


Instruction: Generate impression based on findings.

Input: There is no acute intracranial hemorrhage or acute infarction. There is diffuse cerebral volume loss with prominent sulci and third and lateral the ventricles. There are jets of cerebrospinal fluid flow into the third and lateral ventricles. There is deep bilateral cerebellar hemisphere mineralization. There is no midline shift or mass effect. There is a chronic deformity of the left lateral wall of the maxillary sinus. The osseous structures are otherwise intact. The imaged contents of the paranasal sinuses and mastoid air cells are grossly unremarkable. There is deformity of the left zygomatic arch and posterior wall of the maxillary sinus.

Output: 1. No acute intracranial hemorrhage or acute infarction. 2. Diffuse cerebral volume loss. Superimposed normal pressure hydrocephalus is a potential consideration, nevertheless.3. Sequela of remote left zygomaticomaxillary complex fracture.


Instruction: Generate impression based on findings.

Input: 3 months, Male, bradycardia with apnea. Brain parenchyma appears within normal limits for age. Sulcation and myelination appear age-appropriate. Midline structures including the corpus callosum and posterior fossa structures appear within normal limits. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved with apparent low signal surrounding the basilar artery on the T2 weighted and susceptibility weighted sequences probably artifactual.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Apparent low signal surrounding the basilar artery on the T2-weighted and susceptibility weighted sequences favored to be artifactual.