Instruction: Generate impression based on findings.

Input: Clinical question: Assess disc herniation and stenosis. Signs and symptoms: LLE pain. Nonenhanced lumbar MRI:The signal intensity of the vertebral column demonstrate changes secondary to degenerative disease and unremarkable otherwise.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate minimal degenerative changes and unremarkable otherwise.L2-L3 demonstrate mild disc disease, mild bilateral ligamentum flavum hypertrophy and mild facet disease including bilateral facet effusion. No spinal stenosis and only mild neural foraminal compromise is present. A previously noted far right lateral annular fissure is no longer appreciated and presumed healed.L3-L4 demonstrate mild disc disease, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease with facet effusion. There is no central spinal stenosis however mild left and moderate right neural foraminal compromise is present. There is no significant change since prior exam.L4-L5 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy and mild to moderate bilateral facet disease and mild hypertrophy. There is resultant mild grade 1 anterolisthesis. There is no significant change since prior exam. There is however interval complete resolution of previously noted right lateral disc protrusion. No central spinal stenosis however moderate to severe right neural foraminal and right lateral recess compromise is again noted similar to prior study.L5-S1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise or any significant change since prior exam.

Output: 1.Mild to moderate degenerative changes of lumbar spine and including mild grade 1 anterolisthesis at L4-L5 without significant change since prior exam.2.Interval complete resolution of a right lateral large disc protrusion at L4-L5 since prior study.3.No central spinal stenosis at any level. Moderate to severe right neural foraminal compromise at L4-L5 secondary to degenerative changes without significant change since prior exam and mild neural foraminal compromise at other levels as detailed.4.Incidental note is made of multiple bilateral renal cysts with subtle interval increased size since prior study.


Instruction: Generate impression based on findings.

Input: Pain and radiculopathy, lumbar region Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5, which is also seen on prior radiograph from 8/6/2014. Alignment is otherwise within normal limits. Bone marrow signal is benign with T1 hyperintense foci involving the T12 and anterior superior L4 vertebral bodies compatible with hemangiomas. The conus medullaris is normal in position.There is evidence of prior right L5 laminectomy. Multilevel degenerative changes are seen with multilevel disc height loss, severe at the L5-S1 level. Vacuum disc phenomena is noted at the L3-L4 and L4-L5 levels. Additional details as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a small left paracentral disc extrusion which partially effaces the left lateral recess. There is no significant central spinal canal or neural foraminal stenosis. L3-L4: There is a disc bulge and left foraminal protrusion as well as mild facet arthropathy and ligamentum flavum thickening. There is partial effacement of the left lateral recess. There is mild to moderate left neural foraminal stenosis. No significant central spinal canal stenosis or right neural foraminal stenosis. L4-L5: There is moderate bilateral facet arthropathy with distention of the facet joints, grade 1 anterolisthesis, small disc extrusion with mild cranial extension, and ligamentum flavum thickening. There is moderate central spinal canal stenosis. There is mild narrowing of the right neural foramen. Left neural foramen is patent.L5-S1: Prior right-sided laminectomy. There is osteophyte and associated disc which efface the right lateral recess with contact of the right S1 nerve root. There is no significant central spinal canal stenosis. Minimal narrowing of the neural foramina.

Output: 1. Degenerative grade 1 anterolisthesis at the L4-L5 level which can be further assessed with dynamic radiographs if clinically warranted. There is mild to moderate central spinal canal stenosis at this level.2. No high-grade neural foraminal stenosis at any level. There is partial effacement of the lateral recesses at the left L2-L3, left L3-L4, and right L5-S1 levels as well as mild to moderate left L3-L4 neural foraminal stenosis. Please see additional details above.3. Prior right-sided laminectomy at the L5-S1 level. If patient has symptoms of right S1 radiculopathy, postcontrast sequence to assess extent of scar tissue may be helpful.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke workup. Signs and symptoms: Right hand weakness and slurred speech. Nonenhanced brain MRI:Diffusion weighted images are negative for an acute ischemic stroke.Extensive periventricular and subcortical FLAIR hyperintensity in bilateral cerebral hemispheres as well as bilateral basal ganglia and to a lesser degree bilateral thalami and pons are again identified. There is subtle interval progression of findings in the pons since prior exam. Finding consistent with chronic small vessel ischemic strokes.Multiple small foci of susceptibility in the cerebral hemisphere are consistent with chronic microhemorrhages.No detectable cortical signal abnormality and unremarkable bilateral cerebellar hemispheres and vermis.Signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, calvarium and paranasal sinuses.

Output: 1.No acute intracranial process.2.Extensive chronic findings of small vessel ischemic strokes as detailed. There is mild progression of disease in the pons since prior exam.


Instruction: Generate impression based on findings.

Input: 23 year old man with dTGA s/p arterial switch operation presents with atypical chest pain and arrhythmia. He is referred for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 219 ml (normal range 142+/-34), the LV end systolic volume index is 63 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 136 g (normal range 164+/-36). There are no regional wall motion abnormalities present; however, the LV shape is elongated. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 230 ml (normal range 142+/-31), the RV end systolic volume index is 65 ml/m2 (normal range 31+/-9), and the RVESV is 123 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 mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is severely dilated. The remainder of the thoracic aorta is normal in size. Measurements as below. No aortic dissection is noted.Sinus of Valsalva: 50x52mmST Junction: 37x39mmAscending Aorta: 30x28mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. It is located anteriorly and to the left of the aorta. The left and right pulmonary arteries straddle over the ascending aorta. The LPA is 20mm in diameter and the RPA is 16mm in diameter. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Coronary OriginsThe left anterior descending artery originates from the left sinus. The right coronary artery originates from the right sinus. The left circumflex originates anomalously from the proximal RCA and takes the retroaortic course to the left AV groove.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. D-TGA s/p arterial switch operation.2. Mild LV dilation with mildly reduced systolic function (LVEF 46%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 3. Mild RV dilation with mildly reduced systolic function (RVEF 47%).4. The pulmonary artery is located anteriorly and to the left of the aorta. The left and right pulmonary arteries straddle over the ascending aorta. 5. Severely dilated aortic root without evidence of thoracic aortic dissection. 6. Anomalous origin of the left circumflex artery with a retro-aortic course.


Instruction: Generate impression based on findings.

Input: 68 years Male (DOB:2/10/1948)Reason: Evaluate for ischemia, possibly underlying mass History: L sided neglectPROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is a T2 and FLAIR signal hyperintense lesion associated with diffusion restriction measuring 30 x 37 mm are present along the right inferior parietal lobule and extending towards the adjacent right temporal lobe involving gray and white matter. Another focus of diffusion restriction associated T2 and FLAIR signal abnormality is present along the posterior aspect of the right insular cortex measuring 20 x 6 mm axial dimensions. A few punctate foci of susceptibility effect compatible with petechial blood products are present along the cortex and there appears to be some intravascular enhancement as well as intravascular susceptibility along the involved sulci.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.Findings are compatible with late acute/early subacute infarction involving the right inferior parietal lobule, adjacent temporal lobe and posterior aspect of the insular cortex.


Instruction: Generate impression based on findings.

Input: 45 year old female with biopsy-proven cancer in the right inferior breast. She underwent a lumpectomy on 10/08/2014 with positive medial margin. She underwent re-excision for the medial margin and right mastectomy in November 2014. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. Spot compression CC and MLO views of the left breast were also obtained. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is a lobulated mass in the medial left breast, lower inner quadrant. This was seen on prior mammograms and persists on spot compression views. On comparison to prior MRI 9/23/2014, this mass is consistent with a cyst. No additional mass, suspicious microcalcifications or areas of architectural distortion in the left breast. No abnormalities in the left axilla.

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


Instruction: Generate impression based on findings.

Input: Undiagnosed seizure disorder with possible temporal lobe epilepsy, presenting with aura followed by GTC. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. In particular, the hippocampi are unremarkable and there is no evidence of heterotopia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are small retention cysts in the maxillary sinuses. The skull, orbits, and scalp soft tissues are unremarkable.

Output: No discernible candidate seizure foci.


Instruction: Generate impression based on findings.

Input: Female, 27 years old, history of cerebral cavernous malformation status post craniotomy for lesion resection. Surveillance scan. Findings are seen compatible with prior right temporal craniotomy appearing similar to prior exams.A 9 x 5 mm somewhat wedge-shaped parenchymal defect is evident within the right pons just below the cerebral peduncle. Several foci of susceptibility are evident within or around this defect. No pathologic enhancement is seen. The appearance of this abnormality has not significantly changed over multiple prior exams.Within the left subinsular white matter, just anterior to the basal ganglia, an oval 9 x 8 mm lesion is evident showing rim hemosiderin staining and mildly increased T1/T2 signal internally. This lesion has not significantly changed from prior exams. No definite associated enhancement or obvious pathologic vasculature is demonstrated.Several small foci of susceptibility are evident scattered around the cerebral hemispheres including within the right superior frontal gyrus, more inferiorly in the right centrum semiovale, within the left inferolateral thalamus and in both temporal lobes. No additional convincing signal abnormality is evident at these locations on the other MR sequences. Some but not all of these foci were visualized on prior exams though this may be related to differences in technique.A developmental venous anomaly is suspected within the left precentral gyrus. Otherwise, no pathologic enhancement is evident on this examination.No parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. The ventricles are normal in size and morphology.

Output: 1.A small parenchymal defect is evident within the right pons which may be postoperative in nature given evidence of prior craniotomy. Correlation with surgical history is suggested. In any event, this finding has not significantly changed dating back to 2008.2.A lesion within the left subinsular white matter is identified with imaging features compatible with a cavernous malformation. No definite associated DVA is seen. Again, this lesion has not substantially changed dating back to 2008.3.A developmental venous anomaly is seen within the left precentral gyrus, but no other associated abnormalities are detected.4.Scattered small foci of susceptibility within the cerebral hemispheres are nonspecific given lack of any other associated signal abnormality.


Instruction: Generate impression based on findings.

Input: Monitoring of hemangioblastoma. There is redemonstration of an enhancing lesion located in the left posterior inferior aspect of the cerebellum which measures 13 x 15 mm and is unchanged compared to the prior exam. There is a smaller adjacent enhancing lesion which has increased in size, now measuring 8 mm compared to 3 mm on the 9/30/2014 exam. However, this lesion appears similar in size when compared to the 1/24/2014 exam. There is a moderate amount of associated vasogenic edema which is increased compared to the 9/30/2014 exam. However, the amount of vasogenic edema, like the size of the enhancing lesion, also appears similar when compared to the 1/24/2014 exam. There are overlying skull changes compatible with post craniotomy status.A mild degree of periventricular and subcortical punctate hyperintense white matter lesions are again seen on the FLAIR and T2 images, unchanged.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. There is an empty sella. The midline structures and craniocervical junction are otherwise within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. There is partial opacification of the right mastoid air cells which is unchanged compared to prior. The left mastoid air cells are within normal limits. The orbits are unremarkable.The imaged portions of the cervical spine reveal disc bulge at C3-4 with mild central spinal canal stenosis, unchanged.

Output: Two nodules of enhancement in the left inferior cerebellum are compatible with residual hemangioblastoma. The larger of these lesions appears stable. However the smaller lesion appears to fluctuate in size. Although this lesion has increased when compared to the past two exams, it is similar in size compared to the January 2014 exam. Similarly, the amount of associated vasogenic edema appears increased when compared to the past two exams but is similar in extent compared to the January 2014 exam.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with syncopal episode. Brain:No evidence of restricted diffusion is seen to suggest acute ischemia. No parenchymal edema or mass effect is detected. Three or four small foci of nonspecific white matter T2 hyperintensity are evident scattered in the cerebral hemispheres. Brain parenchymal morphology is within normal limits. No evidence of intracranial hemorrhage or any other abnormal extra-axial fluid is seen. The ventricular system is normal in size and morphology.Bone marrow signal characteristics are within normal limits. Mild paranasal sinus mucosal thickening and some polypoid nasal mucosal thickening is seen. There appears to be evidence of prior endoscopic sinus surgery. Incidental note is made of a 6 mm cyst with a fluid-heme level in the right parotid gland, likely of no clinical significance.MRA brain:The intracranial vessels demonstrate normal flow related signal. No evidence of any significant vascular stenosis or vascular occlusion is seen. No aneurysms are detected within the limitations of technique. The ACOM artery is unremarkable. A large left PCOM artery is present with fetal origin of the left PCA. A moderately sized right PCOM artery is present. The left vertebral artery is dominant.MRA neck:The origins of the great vessels are not well visualized likely due to noncontrast technique. No significant vascular stenosis is detected within the carotid circulation by NASCET criteria. The left vertebral artery is well visualized throughout the neck and is dominant. The right vertebral artery demonstrates only thready flow related signal throughout its entire cervical course. Given the correspondingly small size of the foramina transversaria on the right as noted on prior CT, this is almost certainly a congenital variation.

Output: 1.No evidence of acute ischemia or other acute intracranial abnormalities which would account for the patient's symptoms.2.Unremarkable MRA evaluation of the brain and neck vasculature.


Instruction: Generate impression based on findings.

Input: 54 year old female. Cirrhosis. Bil dil on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic mass is identified. Patent hepatic vasculature. Mild central intrahepatic dilatation and diffuse marked extrahepatic ductal dilatation measuring up to 18 mm, which has increased from 2011 when it measured 10 mm. Patient will be called back for MRCP images for further evaluation of this biliary dilatation.Blooming artifact next to the ampulla due to a duodenal diverticulum, better seen on prior CT.Questionable nodular thickening near the ampulla (series 1201, image 67), unchanged from 2011 (seen on series 12, image 14), most likely benign and may represent collapsed duodenal folds. Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic mass. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild cortical scarring of the left kidney.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites or varices.

Output: 1.No suspicious hepatic mass.2.Mild central hepatic and diffuse marked extrahepatic biliary ductal dilatation which has increased from 2011. Patient will be called back for MRCP images for further evaluation and addendum will be issued at that time.


Instruction: Generate impression based on findings.

Input: cervical stenosis, pain, numbenss and weakness in right shoulder, arm and hand Normal cervical lordosis appears to be lessened. However, its clinical significance is undetermined. Mild disc dessications are seen on C45 and C67 than other discs.The cranial-cervical junction is normal. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: Mild disc dessication on C45 and C67 with minimal loss of normal cervical lordosis as described above.Otherwise unremarkable C spine MRI.


Instruction: Generate impression based on findings.

Input: Foot pain TENDONS: No significant abnormality noted. Specifically, the peroneus brevis and peroneus longus tendons are normal.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Specifically, the fifth metatarsal is normal in signal intensity.ADDITIONAL

Output: Findings suggestive of mild plantar fasciitis. The remaining structures of the foot are otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 68-year-old male with multiple myeloma and known compression fracture at L3 and posterior fixation of the L5/S1 vertebral bodies with persistent pain. Known L3 compression fracture is out of the field-of-view. There is posterior rod and screw devices affixing the L5 and S1 vertebral bodies without evidence of hardware complication. BONE MARROW: Diffuse signal abnormality on T1 sequences likely reflects red marrow replacement secondary to myeloma treatment However, no fractures or malalignment is visualized. SOFT TISSUES: Abnormal signal is visualized diffusely within the left gluteus musculature with mild fraying of the distal tendon, which may reflect partial tear. Edema also is visualized within the proximal IT band, which may represent reactive inflammatory change.JOINTS: Moderate osteoarthritis affects the bilateral hips with subchondral cysts and areas of sclerosis. The sacroiliac joints appear within normal limits.ADDITIONAL

Output: 1. Findings compatible with diffuse red marrow replacement of the marrow.2. Findings compatible with partial tear of left gluteus maximus and associated reactive inflammatory change.3. Posterior rod and screw fixation of the L5-S1 vertebral bodies without evidence of significant complication.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsClinical question: Evaluate for seizure like activity, patient is admitted to LTMSigns and Symptoms: Episode of GTC like activity in her sleep witnessed by husband. No known gaze deviation or focality noted. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of a right sphenoid sinus air cell. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is a 3mm submucosal cystic nodule present in the nasopharyngeal mucosal space which is probably benign

Output: MRI of the brain is within normal limits. There is no evidence for intracranial mass lesion and no evidence for cerebral infarction to explain the patient's tonic-clonic seizures.


Instruction: Generate impression based on findings.

Input: Crohn's disease. Persistent left knee pain. MENISCI: There is degeneration of the posterior horn of the medial meniscus without discrete linear signal to suggest tear. The lateral meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the cartilage of the medial patellar facet with underlying bone marrow reactive changes. There is minimal cartilage degeneration in the medial compartment.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.OTHER: Small joint effusion is present. No abnormal enhancement is seen to suggest infection or synovitis.

Output: Mild degenerative changes, as described above. No abnormal enhancement to suggest an infectious or inflammatory process.


Instruction: Generate impression based on findings.

Input: 23 years, Male, Reason: worsening of headaches Brain parenchyma appears within normal limits. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No diffusion abnormality. No intracranial hemorrhage. No extra-axial collections. There is no abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Trace mucosal thickening in the right ethmoid air cells. Paranasal sinuses appear otherwise clear. Mastoid air cells are clear. Calvarium is intact. There is thickening and irregularity involving the posterior parietal scalp which can be better assessed by direct examination.

Output: 1. MRI of the brain is within normal limits. No intracranial mass or evidence of mass effect.2. There is thickening and irregularity involving the posterior parietal scalp which may be posttraumatic, for example, but can be better assessed by direct examination.


Instruction: Generate impression based on findings.

Input: Male, 39 years old, with pain radiating to the shoulder. Straightening of the cervical lordosis is likely positional. Alignment is otherwise within normal limits. Vertebral body height and morphology are unremarkable. No evidence of marrow replacement or edema is seen. The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural lesions are suspected.A small central disc protrusion at C6-7 has not substantially changed. No associated spinal canal or foraminal compromise is seen. The remaining intervertebral discs are preserved and free of significant herniation. Foraminal narrowing on the right at C3-4, primarily due to uncovertebral hypertrophy, is unchanged as well.Incidental note is made of prominent bilateral palatine tonsils, a finding which was not present on the prior examination.

Output: 1.Minimal disc degeneration is seen without evidence of spinal canal stenosis, cord impingement or high-grade foraminal compromise. Mild foraminal narrowing is evident on the right at C3-4 due to uncovertebral hypertrophy.2.Incidental note is made of bilaterally prominent palatine tonsils, a new finding from the prior examination. Correlation with physical examination is recommended.


Instruction: Generate impression based on findings.

Input: There is diffusion restricted focus in the left occipitoparietal lobe. Multiple diffusion restricted foci are seen in the cingulate gyrus bilaterally, in the bilateral caudate nucleus and in both frontal lobes. Scattered punctate susceptibility foci are seen in the bilateral thalami and the left basal ganglia which are suspicious for either petechial hemorrhage or mini-calcification.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Findings are consistent with acute ischemic infarction in the left occipitoparietal lobe, bilateral caudate nucleus, and in both frontal lobes. There is no evidence of hemorrhagic conversion.2. Scattered punctate susceptibility foci are seen in the bilateral thalami and the left basal ganglia which are suspicious for either petechial hemorrhage or mini-calcification.


Instruction: Generate impression based on findings.

Input: Male, 6 years old, with intracranial abscess status post washout and mastoidectomy on the right side with antibiotic treatment. Four week follow-up exam. Multiple surgical sequelae are redemonstrated including evidence of a right squamous temporal craniotomy/craniectomy and right mastoidectomy. As on the prior examination, the mastoidectomy bed is filled with T2 hyperintense material, and the surgical region in general demonstrates diffuse enhancement.A rim-enhancing nodule is redemonstrated contiguous with the right mastoid roof and extending cranially to involve the right inferior temporal gyrus. This lesion seems to have slightly increased in size, now measuring 14 x 13 mm on axial images, previously 13 x 12 mm. More noticeable, however, is the interval progression of vasogenic edema originating from this lesion and spreading through the anterior temporal lobe and beyond, nearly reaching the basal ganglia and subinsular region.The remainder of the brain demonstrates normal morphology and signal characteristics. No additional enhancing lesions are seen. The ventricular system is normal in size and morphology.

Output: 1. Mild interval increase in the size of an enhancing lesion along the right mastoid roof with involvement of the overlying temporal lobe. In addition, there has been a notable increase in the degree of associated vasogenic edema. These findings are concerning for the presence of persistent, slightly growing intracranial abscess.2. Redemonstration of postoperative findings involving the right temporal bone structures. The mastoidectomy bed remains opacified and enhancing which is nonspecific in the context of prior surgery.


Instruction: Generate impression based on findings.

Input: Radiculopathy. Two month history of left neck/shoulder pain and tingling with preceding trauma. Please note only sagittal sequences were obtained. Patient was in pain and could not tolerate further imaging. The obtained sagittal sequences are also motion degraded.Within this limitation, vertebral body heights are normal. There is mild nonspecific heterogeneity of the bone marrow without focal destructive lesions, including areas of T1 shortening in the bone marrow possibly related to prior radioiodine ablation. No obvious cord signal abnormality. Degenerative changes are seen with mild multilevel facet arthropathy as well as disc osteophyte complexes which mildly efface the ventral thecal sac at multiple levels. There is however no evidence of significant spinal canal stenosis at any level. Neural foramina are not well evaluated without axial images, although bony foraminal stenosis is evident on recent radiographs. No gross evidence of ligamentous injury within the limitations above.

Output: Severely limited exam as described above. There are mild multilevel degenerative changes without significant spinal canal stenosis at any level. Neural foramina cannot be evaluated without axial images although multilevel foraminal stenoses are evident on recent radiographs. Repeat examination with sedation can be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: 72-year-old male with history of renal cell carcinoma with new lung lesions ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Numerous lesions in the liver are unchanged. Largest ones are cysts. Some of them are too small to accurately characterize but stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular left adrenal gland is unchanged. Nodular right adrenal gland is also unchanged.KIDNEYS, URETERS: Status post right nephrectomy. Cysts involving the left kidney are unchanged. Punctate, nonobstructing stone in the lower pole of the left kidney is unchanged.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged. For reference purposes a left para-iliac node measures 1.2 by 0.9 cm on image number 91, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland. Enhancement in the posterior peripheral zone is suspicious for prostate cancer. Correlation with PSA level and/or pelvic MRI is recommended.BLADDER: Diffuse wall thickening of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the abdomen. Enhancement within the posterior peripheral zone although prostate, suspicious for prostate cancer. Correlation with PSA values and/or biopsy results is recommended.


Instruction: Generate impression based on findings.

Input: 12-year-old male status post pinning of multiple resection with history of radiation therapy, off therapy evaluation. Findings related to left frontal craniotomy with a resection cavity in the posterior aspect of the left inferior frontal gyrus are unchanged. The associated, surrounding T2 FLAIR hyperintensity is also unchanged. There is no suspicious contrast enhancement at the resection bed. Susceptibility artifact within the surgical cavity is stable.There is no intracranial hemorrhage, new mass, or acute infarct. There is no abnormal brain parenchymal or leptomeningeal contrast enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: There has not been significant change in the treatment bed in the posterior inferior left frontal lobe. There is no MRI evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Reason: R LCL and ACL rupture, lateral meniscus tear History: R knee pain/instability MENISCI: The posterior horn of the medial meniscus appears markedly small and truncated. While the etiology is unclear and this may be related to surgery it is more likely secondary to tearing. The lateral meniscus appears grossly intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: Postsurgical changes following ACL graft reconstruction are noted. The graft fibers appear indistinct, consistent with tearing. There is impingement of the remnant fibers of the ACL graft in the intercondylar notch. There is buckling of the PCL, however it appears grossly intact. The MCL and LCL are intact.EXTENSOR MECHANISM: The patellar and quadriceps tendons appear grossly intact.ADDITIONAL

Output: 1. Truncation of the posterior horn of the medial meniscus, most likely secondary to tearing.2. Tearing of the ACL graft with impingement in the intercondylar notch of the remnant fibers.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are ultrasound images for both breasts and right axilla (6/9/15), images from ultrasound guided FNA of with axilla (6/9/15) performed at Aurora Grafton Medical Center. ULTRASOUND IMAGES FOR BOTH BREASTS AND RIGHT AXILLA (6/9/15):MR-directed ultrasound was performed for both breasts based on the outside reading of MRI study (6/3/2015). No abnormal findings are detected in either breast. In the right axilla, a small borderline lymph node with cortical thickness of 3 mm is detected.IMAGES FROM ULTRASOUND GUIDED FNA OF WITH AXILLA (6/9/15):Fine-needle aspiration was performed for the borderline right axillary lymph node with appropriate needle placement.Per outside radiology report, the cytology result was negative for malignant cells.

Output: Negative MR-directed ultrasound for both breasts. Negative FNA of the right axillary lymph node.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: CervicalgiaClinical question: neck pain, right arm and leg sensory disturbanceSigns and Symptoms: as above The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level associated with some endplate osteophytes and uncovertebral osteophytes.At C5-6 there is no significant compromise to the spinal canal. There is a disc bulge present at this level associated with some endplate osteophytes and uncovertebral osteophytes. There is some mild encroachment of the exiting nerve roots within the neural foramina bilaterally at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this levelAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.A number of lymph nodes identified within the soft tissues of the neck don't quite meet size criteria for adenopathy

Output: 1.There are multilevel degenerative changes present in the cervical spine without significant compromise to the spinal canal. There is mild encroachment of the exiting nerve roots at C5-6 due to degenerative changes.2.No spinal cord lesions are appreciated.


Instruction: Generate impression based on findings.

Input: 83 years, Female, right-sided weakness and aphasia. There are areas of restricted diffusion involving the left posterior frontal and anterior parietal lobes including the pre and post central gyri and extending laterally into the operculum. There is corresponding T2/FLAIR hyperintensity. There is a 4 mm focus of susceptibility effect involving the left lateral post central gyrus suspicious for hemorrhagic transformation. No significant edema or mass effect.Again seen are multiple chronic infarcts including the right parieto-occipital lobes and bilateral cerebellar hemispheres with evolution of the previously seen right superior cerebellar artery territory infarct on prior MRI from 2/17/2011. There is susceptibility compatible with chronic hemosiderin deposition involving the prior right cerebellar infarct.No intracranial mass or mass effect. No extra-axial collections. No hydrocephalus. Bilateral T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter is compatible with background of moderate chronic small vessel ischemic disease. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Acute infarct involving the left posterior frontal and anterior parietal lobes including the pre and post central gyri and extending laterally into the operculum. There is a 4 mm focus of susceptibility involving the left lateral post central gyrus suspicious for minor hemorrhagic transformation.2. Multiple chronic infarcts including the right parietal lobe as well as bilateral cerebellar hemispheres. There has been interval evolution of the previously seen large right superior cerebellar artery territory infarct seen on MRI dated 2/17/2011 with chronic hemosiderin deposition also present in this region. 3. Evidence of moderate chronic small vessel ischemic disease also again seen.Dr. Ali discussed findings with Dr. Del Brutto Andrade at 930 hrs on 11/15/2015.


Instruction: Generate impression based on findings.

Input: 46-year-old female with lateral left knee pain. Evaluate for lateral meniscus tear versus chondral injury. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral facet of the patella with underlying subchondral signal abnormality. There is also focal full-thickness articular cartilage degeneration along the medial facet of the patella with underlying subchondral signal abnormality. There is near full-thickness to full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea and partial-thickness articular cartilage degeneration along the medial facet of the femoral trochlea. There is tricompartmental osteophyte formation. Heterogeneous bone marrow signal abnormality may reflect residual islands of red marrow.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is a small amount of fluid within the medial collateral ligament bursa which may reflect a mild bursitis. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Degenerative changes most pronounced along the patellofemoral compartment. These findings can be seen in CPPD arthropathy.2. The medial and lateral meniscus appear intact.3. Tendinosis/interstitial tearing of the semimembranosus tendon as described above.


Instruction: Generate impression based on findings.

Input: family hx of Chiari I malformations The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils extend approximately 6 mm below the level of the foramen magnum. CSF flow is present at the foramen magnum. There is no evidence for ventriculomegaly.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: Findings are compatible with Chiari I malformation. There is no significant impediment to CSF flow appreciated and no evidence for ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with aqueduct stenosis, surveillance exam. No significant interval change is seen in the degree of marked lateral and third ventriculomegaly with modest prominence of the fourth ventricle. The cerebral aqueduct is perhaps narrowed proximally, similar to the prior exam. As before, there is a defect in the floor of the third ventricle through which a jet of CSF flow passes as seen on the phase contrast CSF flow images.No pathologic parenchymal or extra-axial enhancement is seen. Redemonstrated is extensive white matter volume loss and scattered nonspecific foci of T2 hyperintensity showing no significant interval change from prior. The inferior vermis is small and the foramina of Magendie and Luschka are wide, also stable findings. A right frontal bone burr hole is redemonstrated.

Output: 1.No significant change in the degree or pattern of ventriculomegaly.2.Findings compatible with a patent third ventriculocisternostomy.


Instruction: Generate impression based on findings.

Input: A 53 year old female with personal history of hypertension, left ventricular outflow tract obstruction and dyspnea on exertion. A recent echocardiography study showed normal systolic function with increased LVOT gradient but signal related to mitral regurgitation was not ruled out. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. There is asymmetric hypertrophy of the interventricular septum (maximum IVSd is 15mm and PWd is 8mm). There is additionally evidence of a focal contact lesion on the interventricular septum likely secondary to repetitive contact between the interventricular septum and the anterior mitral leaflet during systolic anterior motion of the anterior mitral leaflet. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 134 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 114 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying focal replacement fibrosing, infiltrative, or inflammatory process.Native myocardial T1-times were globally mildly increased (range between 1090 to 1110ms), suggesting the presence of interstitial myocardial fibrosis.No myocardial iron overload was noted.No intracavitary thrombus was noted.Left AtriumThe left atrium is mildly dilated. The LA volume is 105 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 93 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 41 ml (normal range 35+/-13).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet and opens widely. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate to severe mitral regurgitation. There is evidence of systolic anterior motion of the mitral leaflet. Additionally, the anterior leaflet is thickened and somewhat calcified. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. A "pseudo-bovine" pattern was noted (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSee lung findings on recent chest CT. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with normal systolic function (LVEF 58%) without evidence of late gadolinium enhancement but with mildly elevated native myocardial T1 times suggesting the presence of mild interstitial fibrosis.2. There is asymmetric hypertrophy of the interventricular septum associated with systolic anterior motion of the mitral valve leaflets causing a focal contact lesion on the interventricular septum, moderate flow acceleration in the left ventricular outflow tract, and moderate to severe mitral regurgitation. The maximum thickness of the interventricular septum is 15mm; where as, the posterior wall thickness is approximately 8mm. Given these findings, the diagnosis of hypertrophic cardiomyopathy should be considered. 3. Trileaflet aortic valve without evidence of aortic valve stenosis. 4. Normal RV size and systolic function (RVEF 55%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: BRAIN MRI:A small focus of questioned diffusion collection is seen in the left insular cortex with no corresponding FLAIR abnormality.There is moderate volume loss of the right parieto-occipital lobe with encephalomalacia and ex vacuo dilatation of the right lateral ventricle. There are also smaller scattered areas of encephalomalacia in the right frontal lobe.There are patchy foci of high signal in T2 and FLAIR in the periventricular white matter and in the subcortical white matter of the frontal and the parietal lobes, more on the right than the left. This represents chronic small vessel ischemic changes. Extensive patchy abnormal signal of T2 and FLAIR is seen in the pons.Linear susceptibility is seen along the lateral margin of the ex vacuo dilated right occipital horn, at least in part due to calcification seen on CT as well as chronic blood products.There is no midline shift. No evidence of bleed, mass effect, or edema. Flow void is not seen in the right ICA. The right MCA flow voids appear diminutive in caliber. The remainder of the intracranial vascular structures demonstrate normal flow voids.MRA BRAIN:There is no flow-related enhancement associated with the right internal carotid artery. The left internal carotid artery is patent.The right A1 is diminutive in caliber and incompletely assessed, possibly developmental. There is normal left A1 artery and there is a single A2 trunk.The right middle cerebral artery branches are small in caliber compared to the left side, relating to collateral flow. The left middle cerebral artery is patent and normal in caliber. Small right P-comm visualized. The left P-comm is not visualized.The right posterior cerebral artery is normal. The proximal left P2 segment is irregular. The basilar artery is patent, as are the vertebral arteries.

Output: 1. Small focus of diffusion restriction is seen in the left insular cortex with no corresponding FLAIR abnormality, which may represent a tiny early infarct or may be artifactual. Please correlate clinically.2. Chronic occlusion of the visualized right ICA. Diminutive right middle cerebral artery branches, likely supplied by collaterals. Right A1 segment is diminutive and incompletely assessed, although possibly developmental. MRA neck may be helpful for a more complete evaluation.3. Right occipital encephalomalacia with other scattered areas of encephalomalacia in the right frontal lobe. Underlying moderate chronic small vessel ischemic changes.4. Proximal left P2 segment is irregular.


Instruction: Generate impression based on findings.

Input: Neurofibroma of the larynx. Neck: The previously demonstrated exophytic lesion posterior to the right vocal cord is no longer apparent. There is no evidence of significant cervical lymphadenopathy based on size criteria. There appears to be a small left palatine tonsillar crypt. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is multilevel degenerative spondylosis. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The previously demonstrated exophytic lesion posterior to the right vocal cord is no longer apparent.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural lesion to explain encephalopathy, headache, visual changes. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.There is normal anatomical morphology of the brain parenchyma. There is normal signal intensity of brain parenchyma on all MRI sequences.The unremarkable surgical cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is normal visualization of intracranial major arterial branches. There is normal signal intensity are intracranial venous sinuses.There is no detectable abnormal parenchymal, leptomeningeal, calvarial or orbital abnormal enhancement.Minimal chronic sinus disease is identified. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Negative pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 31-year-old female with history of Crohn's disease. 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: Status post ileocecectomy. No abnormal bowel wall thickening or enhancement. No obstruction. Previously described inflammatory changes involving a long segment loop of mid small bowel is not seen today.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post ileocecectomy. No abnormal bowel wall thickening or enhancement. No obstruction. Previously described inflammatory changes involving a long segment loop of mid small bowel is not seen today.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of active or chronic disease.


Instruction: Generate impression based on findings.

Input: Knee pain and instability MENISCI: There is abnormal morphology and signal intensity of the posterior horn of the lateral meniscus suggesting a small obliquely oriented tear. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is depression of the lateral femoral condyle consistent with an impaction fracture and there is a small full-thickness defect in the overlying articular cartilage. Additional near full-thickness articular cartilage loss is seen of the lateral femoral condyle posteriorly. There is marrow edema within the underlying lateral femoral condyle as well as the lateral tibial plateau posteriorly. The articular cartilage of the patellofemoral and medial compartments is preserved.LIGAMENTS: The ACL is ruptured. The PCL is intact. The MCL is ruptured. The LCL is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Ruptured ACL.2. Ruptured MCL.3. Abnormal signal intensity and morphology of the posterior horn of the lateral meniscus concerning for small tear.4. Osteochondral impaction injury of the lateral femoral condyle with small areas of full-thickness and near full-thickness articular cartilage loss. Associated marrow contusions are noted within the lateral femoral condyle and lateral tibial plateau.5. Large joint effusion with small lipohemarthrosis.


Instruction: Generate impression based on findings.

Input: Right lower quadrant pain. Concern for appendicitis. PER EPIC NOTE: On transabdominal vaginal exam, +IUP visualized, Patient was tender in RLQ, images suggesting appendicitis. Will contact Gynecology, MRI, labs added. ABDOMEN:LIVER, BILIARY TRACT: Mild loss of signal on out of phase imaging compatible with diffuse hepatic steatosis. The liver is otherwise normal in morphology and size without a focal abnormality.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: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The endometrial cavity is distended with heterogeneous signal intensity material near the fundus compatible with proteinaceous/blood product. In the lower uterine segment/cervical canal there is a well-defined bi-lobed cystic structure which may correspond to the patient's reported IUP/gestational sac. 2.0 x 1.2 cm submucosal/intramural left fundal fibroid. Focal anterior junctional zone/inner myometrial thickening up to 1.7 cm may be related to gravid state. The adnexa are unremarkable. There is trace free fluid in the pelvic cul-de-sac. There are prominent periuterine vessels which is nonspecific and may be related to gravid state.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not definitely seen by MR.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The appendix is not definitively identified by MR.2.Dilated endometrial cavity containing heterogeneous proteinaceous/blood product and a cystic bi-lobed structure in the lower uterine segment/cervical canal which may correspond to the patient's reported IUP/gestational sac, correlate with pelvic ultrasound.


Instruction: Generate impression based on findings.

Input: Grade 2 astrocytoma, status post radiotherapy, currently on TMZ. Postoperative changes are again seen from previous left frontal approach biopsy, with T2 hyperintensity along the biopsy tract. Previously biopsied left thalamic lesion overall measures 2.3 x 3.8 cm in greatest axial dimensions, previously 2.4 x 3.8 cm without significant interval change from most recent prior exam. There is no associated enhancement. There is continued mass effect upon the third ventricle, unchanged. There is slight persistent T2 signal abnormality in the left amygdala and mesial temporal lobe, but on comparison with previous exam from 11/4/2014, improved. There may be mild curvilinear enhancement in the tail of left hippocampus, which is decreased from prior. There is interval progression of patchy T2 hyperintense/FLAIR signal mostly along the left periventricular frontal lobe, likely related to posttreatment effect.The ventricles and cortical sulci are mildly prominent, unchanged. There are a few scattered and confluent cerebral white matter T2 hyperintense foci are nonspecific and similar to prior. There may be trace midline shift to the right, unchanged. The major cerebral flow voids are intact. There is mild mucosal thickening in the maxillary sinuses.

Output: Stable left thalamic and mesial temporal lobe lesion. No significant interval change in size or signal abnormality compared to the prior exam. Mild interval progression of T2 FLAIR signal along the left periventricular frontal lobe, related to posttreatment effect.


Instruction: Generate impression based on findings.

Input: 56 year-old female with metastatic breast cancer to the bone. On chemotherapy (Xeloda) Evaluate response. Restaging. CHEST:LUNGS AND PLEURA: Bilateral decrease in diffuse pleural thickening and resolution of the right-sided minimal pleural effusion. No discrete nodules are identified. Hazy groundglass opacities in the lung bases, more prominent on the right side likely represent dependent atelectasis.MEDIASTINUM AND HILA: Esophagus is slightly dilated.CHEST WALL: Status post right mastectomy. Numerous bone metastases involving the thoracic vertebral bodies, ribs and bilateral scapula. Compression fracture of T7 vertebral body and the T8 vertebral body with metastatic lesions are stable. At the level of the T8 vertebral body there is extension into the spinal canal. This has been evaluated with MRI since the prior exam.ABDOMEN:LIVER, BILIARY TRACT: Numerous new metastatic lesions in the liver. A reference lesion in the right lobe measures 3.1 x 3 cm in image number 78, series number 3.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: A large soft tissue mass destroying the left iliac bone and extending into the left hip joint is stable. Additional numerous extensive mass metastatic lesions involving the thoracic vertebral bodies and pelvic bones are stable.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic, but otherwise unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small collection in the right gluteal region seen on the prior exam has resolved or is outside the field of view. OTHER: No significant abnormality noted.

Output: Extensive skeletal metastatic disease is stable. Stable hepatic metastases and interval no change in size of the left iliac bone metastatic lesion.Right gluteal collection is no longer seen.


Instruction: Generate impression based on findings.

Input: The last formed disk space is referred to as L5-S1, consistent with prior exam. There are immediate postoperative findings related to interval L1 -- L5 interbody fusion via lateral retroperitoneal approach with placement of disk spacer devices, paravertebral swelling and edema as well as edema in the disk spaces and the endplates of L4 vertebral body. There is edema in the interspinous spaces of L3-4 and L4-5. The osseous marrow signal is heterogeneous and benign. There is relative improvement in lumbar levoscoliosis which can be further assessed with standing radiographs. There is degeneration of essentially all lumbar disks with severe loss of disk height, with improvement status post interbody fusion. The conus terminates at L1-2.T12-L1: Disk bulge and mild right facet arthropathy which in combination with scoliosis results in moderate to severe right neural foraminal stenosis and mild effacement of the thecal sac on the right with no significant spinal canal or left neural foraminal stenosis.L1-2: Mild right facet arthropathy, posterior longitudinal ligament thickening with ligamentum flavum thickening causing moderate right neural foraminal stenosis and no significant spinal canal or left neural foraminal stenosis.L2-3: Severe right and moderate left facet arthropathy with ligamentum flavum thickening, and disk bulge causing mild spinal canal stenosis and mild right neural foraminal stenosis.L3-4: Severe bilateral facet arthropathy, ligamentum flavum thickening, and associated severe spinal canal stenosis and moderate bilateral neural foraminal stenosis.L4-5: Severe left facet arthropathy and associated ligamentum flavum thickening as well as disk bulge causing moderate spinal canal stenosis and moderate left neural foraminal stenosis. No significant right neural foraminal stenosis.L5-S1: Severe bilateral facet arthropathy causing mild right and modearate left neural foraminal stenosis and mild spinal canal stenosis.Overall, the degree of neural foraminal stenoses have perhaps mildly decreased from the prior myelogram of the postsurgical levels, although differences in imaging modalities limits more definitive evaluation.

Output: 1. Expected immediate postoperative findings related to L1-5 XLIF with interbody cages appearing well-positioned as seen on CT. No large paraspinous hematomas. 2. There is relative improvement in degenerative lumbar levoscoliosis. There is some improvement in neural foraminal stenoses, although differences in technique limit comparison with prior CT myelogram. Individual levels as above including severe L3-L4 and moderate L4-L5 spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Compression of brain [G93.5] / Headache [R51] / Cervicalgia [M54.2], Reason for Study: ^Reason: chiari malformation, new symptoms, please do with CSF flow study History: headaches, neck pain, evaluate for changes and flow No evidence of acute ischemic or hemorrhagic lesion.Chiari I malformation is again seen, unchanged since prior study.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.CSF flow studyMaintained bidirectional CSF flow through the anterior aspect of upper cervical spinal cord and brainstem.Maintained bidirectional CSF flow through the posterior aspect of cervical spinal cord as well as anterior aspect of cerebellar tonsil toward 4th ventricle.Cervical Spine MRIStraightening of cervical spine.Spinal cord signal intensity is normal.There are minimal bulging of discs at the level of C3-4 and C 45. However, there is no evidence of spinal canal stenosis or neural foraminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Chiari 1 malformation, unchanged in terms of tonsilar herniation degree.3. No evidence of syrinx on cervical spinal cord.4. Maintained bidirectional CSF flow anterior and posterior aspect of cervical spinal cord. Bidirectional CSF flow was seen anterior aspect of the cerebellar tonsil as described above.


Instruction: Generate impression based on findings.

Input: 62-year-old female with mild new proximal muscle weakness, carries diagnosis of amyopathic dermatomyositis, evaluate for muscle inflammation Right: There has been progressive atrophy of the visualized pelvic and thigh muscles. Fatty infiltration of the gluteal muscles and vastus lateralis. Small joint effusion. There is no abnormal signal within the visualized pelvis or thigh musculature to suggest an inflammatory or infectious process. The subcutaneous tissues are within normal limits. Normal bone marrow signal intensity.Left: There has been progressive atrophy of the visualized pelvic and thigh muscles. Fatty infiltration of the gluteal muscles and vastus lateralis. Small amount of joint fluid. There is no abnormal signal within the visualized pelvis or thigh musculature to suggest an inflammatory or infectious process. The subcutaneous tissues are within normal limits. Normal bone marrow signal intensity.

Output: No evidence of myositis. Progressive atrophy of the muscles of the pelvis and thigh.


Instruction: Generate impression based on findings.

Input: 18 year old with history of kawasaki's disease in childhood, presenting for cardiac evaluation after syncopal event. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 222 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 97 ml (normal range 47+/-19), the LV mass index is 78 g/m2 (normal range 85+/-15), and the LV mass is 154 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native T1 times are normal (1000 ms) also suggesting that there is no underlying myocardial fibrosis or edema. Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 138 ml/m2 (normal range 82+/-16), the RVEDV is 274 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 149 ml (normal range 54+/-17). There are no focal RV free wall aneurysms or focal wall motion abnormalities. AtriaNormal left atrial size. The right atrium is moderately dilated. No atrial septal defect identified. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The coronary arteries originate from the appropriate cusps with no clear evidence of aneurysm in the left main, proximal and mid LAD, the proximal and mid RCA, or the proximal LCx. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion with no evidence of hemodynamic compromise. Extracardiac FindingsResidual thymus gland noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 56%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Moderate right ventricular dilation with mildly reduced systolic function (RVEF 45%); however, no evidence of focal RV wall motion abnormality or aneurysm. 3. Moderate right atrial dilation. 4. Normal origin of the coronary arteries without evidence of coronary aneurysm is the proximal to mid portion of the major coronary vessels.5. No obvious intra-cardiac shunt noted.6. Small pericardial effusion.


Instruction: Generate impression based on findings.

Input: Reason: eval for HCC, evaluate cystic lesion History: chronic hepatitis B, cyst in liver with ?hemorrhage on US. ABDOMEN:LIVER, BILIARY TRACT: Segment 7 lesion demonstrates T2 hyperintense signal with nodular enhancement on delayed images. No new or suspicious lesions. Hepatic vasculature patent.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: No significant abnormality noted.

Output: Segment 7 subcentimeter lesion, in correlation with sonographic features, likely represents a hemangioma. No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Right hemifacial spasm, LUE task specific dystonia, rule out lesion, abnormality involving facial nerve. MRI: There are postoperative findings related to left parietal craniotomy with encephalomalacia in the superior portion of the left postcentral gyrus. There is also mild nonspecific scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a retention cyst in the left frontal sinus. MRA: There is vertebrobasilar dolichoectasia and a markedly tortuous right vertebral artery that displaces the right cranial nerve 7 and 8 complex superiorly just medial to the porus acusticus. There is no evidence of significant steno-occlusive lesions or saccular aneurysms.

Output: 1. Postoperative findings related to left parietal craniotomy with encephalomalacia in the superior portion of the left postcentral gyrus, but no evidence of tumor.2. Vertebrobasilar dolichoectasia and a markedly tortuous right vertebral artery that displaces the right cranial nerve 7 and 8 complex superiorly.


Instruction: Generate impression based on findings.

Input: Evaluate C5/C6 central disc bulge and C6/C7 left foraminal stenosis: pain in the left arm -- radiculopathy. There is a 4 mm thick posterior disc-osteophyte complex at the C5-6 level, which slightly indents the left aspect of the spinal cord and mildly narrows the left neural foramen at this level. There is no abnormal spinal cord signal, however. There is also an eccentric left disc-osteophyte complex that moderately narrows the left neural foramen at this level. There is no significant spinal canal or neural foramen stenosis at the other cervical spine levels. There is straightening of the vertebral column in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. A disc-osteophyte complex at the C5-6 level slightly indents the left aspect of the spinal cord and mildly narrows the left neural foramen at this level. 2. An eccentric left disc-osteophyte complex moderately narrows the left neural foramen at this level.


Instruction: Generate impression based on findings.

Input: ORBITS: There is mild right sided proptosis. The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is abnormal T2 hyperintensity involving the medial and lateral left temporal cortex and to a much more subtle extent the subcortical white matter when windowed narrowly. There may be mild gyral thickening. There is also less prominent minimal T2 hyperintensity questionably involving the left paramedian frontal cortex. There is no abnormal intracranial enhancement.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The cerebellar tonsils lie 5 mm below the foramen magnum but maintain a rounded configuration. There is mild asymmetry of the skull with the sella slightly deviated to the right and a slightly small right hemi-cranium. The skull, paranasal sinuses, and scalp soft tissues are otherwise unremarkable.

Output: 1.Signal abnormality involving the left frontal and more prominently the left temporal cortex as well as more subtly the left temporal subcortical white matter. The appearance is non-specific but differential diagnosis includes encephalitis, infectious or paraneoplastic in etiology, with neoplasm felt to be less likely. 2.Mild right proptosis that may be secondary to mild skull asymmetry. 3.Minimally low lying cerebellar tonsils. This finding was called by Dr. Michael Rozenfeld to Dr. Hassan Shah on 1/20/2015 at 12:50 PM.


Instruction: Generate impression based on findings.

Input: Increased neck pain. There is a posterior disc-osteophyte complex at C5-6 that abuts the spinal cord and moderately narrows the bilateral neural foramina at this level. There is a smaller disc-osteophyte complex at C6-7 that mildly narrows the spinal canal and bilateral neural foramina at this level. There are minimal posterior disc-osteophyte complexes at C3-4 and C4-5 without significant spinal canal or neural foraminal compromise. The C2-3 and C7-T1 levels are unremarkable. 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: A posterior disc-osteophyte complex at C5-6 abuts the spinal cord and moderately narrows the bilateral neural foramina at this level. A smaller disc-osteophyte complex at C6-7 mildly narrows the spinal canal and bilateral neural foramina at this level.


Instruction: Generate impression based on findings.

Input: Reason: Abnormal brain development? History: Global developmental delay, macrocephaly, myoclonus No diffusion abnormality. No evidence of intracranial hemorrhage. No mass mass effect or midline shift. The ventricles and sulci are normal in size. No abnormal T2/FLAIR hyperintensities. Gray-white matter differentiation is preserved. No evidence of focal heterotopia or dysplasia. Paranasal sinuses and mastoid air cells are clear. Visualized orbits are intact. Osseous structures are unremarkable. Flow voids are noted in the major intracranial vasculatures.

Output: Normal appearing brain MRI. No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 62-year-old female with history of left breast MRI guided biopsy on 8/23/2010 demonstrating atypical lobular hyperplasia, questionable distortion in the right breast on prior mammogram September 2015 without sonographic correlate. Patient presents for 1 year follow-up examination. No current breast complaints. Bilateral inverted nipples since early age. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Clip from prior MRI biopsy identified in the left breast. Previously described architectural distortion in the right breast is not seen on today's imaging. Few scattered benign calcifications seen in both breasts.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over the left axilla.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 71-year-old female. Left heel ulcer. Evaluate for osteomyelitis extent in the calcaneus. There is ulceration of the soft tissues plantar to the posterior aspect of the calcaneus. The soft tissues between the ulcer and the calcaneus are replaced with abnormal signal intensity. There is also abnormal signal intensity in the inferior aspect of the posterior calcaneal tuberosity that is T1 intermediate signal intensity and T2 high signal intensity indicating osteomyelitis. The anterior aspect and superior aspect of the calcaneal body appear spared. The remaining visualized bones appear normal. We see no fluid collection in the soft tissues to suggest an abscess. Prominent enthesophyte at the insertion of the Achilles tendon on the calcaneus. The Achilles tendon itself and the remaining tendons of the ankle are unremarkable. There is thickening of the skin along the medial and lateral aspects of the ankle with mild edema in the underlying subcutaneous fat. Osteoarthritic changes affect the hindfoot and the ankle. There is atrophy of the plantar muscles of the foot.

Output: Soft tissue ulcer and calcaneus osteomyelitis, as above.


Instruction: Generate impression based on findings.

Input: 31-year-old male with VP shunt. Headache. There has been interval removal of a right-sided shunt catheter. Overall, third and lateral ventriculomegaly is improved. Enlarged third ventricle correlates with findings on prior brain MRI. There is no evidence of intracranial hemorrhage.There is a large sellar mass with extension into the basal cistern. Extensive calcifications are again seen. No significant change in the sellar mass.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Improved ventriculomegaly of the lateral and third ventricles.


Instruction: Generate impression based on findings.

Input: 48 years Female (DOB:3/31/1968)Reason: s/p Left sup hypophyseal artery aneurysm coiling History: follow upPROVIDER/ATTENDING NAME: JACQUELINE D SMART JACQUELINE D SMART MRI of the brainNo diffusion weighted abnormalities are appreciated.There is redemonstration of a small focus of encephalomalacia along the posterior aspect of the left occipital lobeThere are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 are clear. The visualized portions of the mastoid air cells demonstrate mucous retention cysts in the maxillary sinuses which were also present on prior exams. The visualized portions of the orbits are intact.MRA brain:There is redemonstration of status post embolic coil occlusion of a left superior hypophyseal aneurysm associated with a small neck remnant measuring 1.5 mm height and 2.5 mm width. This has not changed substantially since the 4/15/2015 exam.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are identified. The right posterior communicating artery is medium-sized whereas the left posterior communicating artery is very small. The vertebral arteries are similar in size.

Output: 1.Since the prior exam the patient's previously treated left superior hypophyseal aneurysm remains stable with a small neck remnant.2.Several periventricular and subcortical punctate lesions are likely of little clinical significance given their small number in the frequency with which these are seen at these numbers at this age.. 3.A small focus of encephalomalacia is present in the left occipital lobe and is unchanged since previous exams.


Instruction: Generate impression based on findings.

Input: Iinfiltrating grade 3 astrocytoma status post radiation and chemotherapy. Evaluate for interval change. There is a mildly expansile and infiltrative T1 hypointense and T2 hyperintense lesion within the left pons, mid brain, extending into the left thalamus, with no evidence of enhancement or diffusion restriction, which is unchanged. The nonspecific trace T2 hyperintensity in the right pons appears unchanged. Likewise, other scattered areas of nonspecific cerebral white matter T2 hyperintensity appear to be unchanged. There is postoperative findings within the right cerebellum with focal tissue loss, but no discernible mass lesions. There are several nonspecific punctate foci of susceptibility scattered throughout the brain parenchyma, which are unchanged. There is no evidence of acute ischemia. The ventricles are within normal limits in size and configuration. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unchanged.

Output: 1.Unchanged appearance of the astrocytoma, with involvement of the left pons, midbrain and left thalamus and possible additional site within the right ventral pons.2.Postoperative findings within the right cerebellum without evidence of tumor progression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari decompression, shunt, pseudotumor cerebri, 6 month followup: still with weakness in legs and neck pain. Brain: There are postoperative findings related to posterior fossa decompression with tenting of the inferior cerebellum and cervicomedullary junction towards the overlying dura. There is an unchanged small area of encephalomalacia in the inferior right cerebellar hemisphere. Cerebrospinal fluid flow appears to be intact across the anterior portion of the neo-foramen magnum. Otherwise, assessment posteriorly is limited by artifact from the shunt device. There is no gross evidence of intracranial hemorrhage, mass, or acute infarct. There is mild high signal within the bilateral basal ganglia and dentate nuclei. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. There is unchanged high T2 and low T1 signal in the left petrous apex and clivus. There may be bubbly secretions in the left sphenoid sinus. The orbits are grossly unremarkable.Cervical spine: There appears to be mild high T2 signal in the upper cervical spinal cord, although assessment is limited by motion artifact. The subarachnoid shunt catheter is present in the right upper cervical thecal sac. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a posterior disc-osteophyte complex at C5-6 that abuts the spinal cord. There is also a small disc-osteophyte complex at C6-7 that does not contact the spinal cord. There is no significant neural foraminal narrowing. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to posterior fossa decompression with tenting of the inferior cerebellum and cervicomedullary junction towards the overlying dura suggests adhesion formation. 2. Apparent mild signal abnormality in the upper cervical spinal cord, although assessment is limited by motion artifact. 3. Unchanged left petrous apex and clivus lesion.4. A posterior disc-osteophyte complex at C5-6 that abuts the spinal cord.


Instruction: Generate impression based on findings.

Input: Lateral elbow pain LIGAMENTS: There is poor visualization of the lateral collateral ligament beneath the common extensor tendon which is concerning for tear. The ulnar collateral ligament is intact.TENDONS: There is abnormal signal intensity and irregularity of the common extensor origin consistent with partial tearing. There is no evidence of retraction. The common flexor origin appears normal. ARTICULAR SURFACES AND BONE: There is increased marrow signal within the radial neck although no discrete fracture line is visualized. There is no osteochondral defect.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: 1. Partial thickness tearing of the common extensor origin with probable tearing of the lateral collateral ligament.2. Increased marrow edema within the radial neck without discrete fracture line. This is of uncertain clinical significance but may reflect small contusion.


Instruction: Generate impression based on findings.

Input: Lumbago. Thoracic or lumbosacral neuritis or radiculitis, unspecified. Absent left L4 transverse process on plain film exam. Evaluate for underlying tumor The transverse processes are intact with no obvious lesions. No abnormal foci of enhancement are appreciated throughout the lumbar spine.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There is multilevel disc desiccation present and straightening of the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level associated with some facet and ligamentum flavum hypertrophy. There are perineural cysts present in the spinal canal at this level.At L4-5 there is diffuse disc bulge associated with bilateral facet and ligamentum flavum hypertrophy and effacement of the fat at the lateral recess bilaterally. There is mild anterior subluxation of L4 on L5. Overall there is a moderate degree of spinal stenosis present at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in lumbar spine with a moderate degree of spinal stenosis present at L4-5 where there is mild subluxation as well as facet hypertrophy and diffuse disc bulge.2.The left L4 transverse process is intact with no evidence for marrow replacing lesion to suggest metastatic disease


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate post op, EVD clumped. Signs and symptoms: postop CT of brain without contrast:Expected postoperative changes of left suboccipital craniectomy.There is evidence of residual low density mass along the medial aspect of the left middle cranial fossa. There is evidence of hemorrhage within the expected location of more dorsal aspect of this tumor which was noted to project over the left petroclinoid ligament into the left cerebellopontine angle. There is also a small hematoma measuring approximately 10 mm times 10-mm which projects over the left cerebral peduncle and left aspect of the pons. I cannot entirely exclude the possibility of hemorrhage within the brain parenchyma however this hemorrhage may be within the residual component of tumor in the left cerebellopontine angle. Further evaluation with an MRI is recommended. There is evidence of residual blood within the prepontine cistern. There is suggestion of edema of the left cerebral peduncle.The fourth ventricle remains patent and no cerebellar abnormalities detectedThere is evidence of blood within the dependent portion of lateral ventricles and right frontal horn. In comparison with the prior examination there is no evidence of change in the above-described findings.There is a slight dilation of the supratentorial ventricular system which also remains stable since prior study.Expected postoperative changes of air within the intracranial space in bifrontal region with minimal interval decrease.

Output: 1.No detectable interval change since prior study of areas of hemorrhage or ventricular size.2.Approximately 10 mm hematoma may be within the residual component of tumor in the right cerebellopontine angle however possibility of hemorrhage within the left cerebral peduncle and pons cannot be ruled out. Further evaluation with an MRI is recommended.3.Residual low density and nonhemorrhagic tumor along the medial aspect of the left meconium fossa.


Instruction: Generate impression based on findings.

Input: Pregnant female with sickle cell disease, evaluate placenta, looking for accreta. Gestational age of 21 weeks. PELVIS:UTERUS, ADNEXA: Gravid uterus. Please note that exam is not dedicated for fetal assessment. Placenta is low-lying, with inferior edge approximately 1.2 cm from the internal orifice of the cervix, compatible with placenta previa. There are hypointense T2 bands extending through the myometrium, compatible with placenta accreta. In addition, there is intermediate signal intensity extending through the serosal layer to the left rectus abdominis muscle, best appreciated on series 4, image 17 (sagittal) and series 3, image 27 (axial). While motion artifact limits evaluation of this finding, possibility of placenta percreta with involvement of the left rectus abdominis muscle is raised.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Gravid uterus. Exam not dedicated for fetal assessment.2.Placenta previa.3.Placenta accreta and additional findings raising possibility of percreta involving the left rectus abdominis muscle.


Instruction: Generate impression based on findings.

Input: Clinical question: 7-year-old female with altered mental status, CSF with evidence ? Bacterial meningitis, this AM less somnolent, now dominant word finding difficulty, evaluate for lesion. Signs and symptoms: Altered mental status, word finding difficulties. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates small patchy foci of flair hyperintensity only in the periventricular and subcortical white matter of bilateral cerebral hemispheres (slightly more pronounced on the left) and pons. Although the findings are nonspecific considering patient's stated age of 70 most likely representing chronic microvascular ischemic strokes. The signal intensity and overall morphology the brain is otherwise within normal for age.There is no detectable abnormal enhancement the brain parenchyma, leptomeninges or the calvarium.Unremarkable images through the orbits and including axial fat sat post contrast series.

Output: 1.Negative diffusion weighted images for acute ischemic stroke.2.Findings of chronic nonhemorrhagic small vessel ischemic strokes only in the periventricular and subcortical white matter and pons.3.Negative pre-and post-enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell carcinoma to brain, completed whole brain RT 2/2015, surveillance scan. There is interval decrease in size of the enhancing lesion in the left precuneus, which now measures up to 5 mm, previously 7 mm. Likewise, the associated confluent surrounding T2 hyperintensity has diminished. The enhancing right inferior temporal gyrus lesion has also decreased in size, now measuring up to 3 mm, previously 6 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid in the mastoid air cells and retention cyst formation in the maxillary sinuses.

Output: Interval decrease in size of the left parietal and right temporal lobe metastases and associated edema.


Instruction: Generate impression based on findings.

Input: 38-year-old female patient with right hip pain. The bone marrow signal intensity is within normal limits. We see no joint effusion or fluid-filled articular cartilage defect. There are foci of intermediate signal intensity within the superior labrum that likely correspond to calcification/ossification seen on prior radiograph and may reflect mild degeneration. However, we see no fluid-filled labral tear. The musculature of the hip is within normal limits. On the large field-of-view images the left hip and sacroiliac joints appear normal and there is a small amount of free fluid in the pelvis.

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


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with bilateral C5-6 radiculopathy and numbness of the feet. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow edema or marrow replacement is seen.The visualized spinal cord shows normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: Left greater than right facet arthropathy. No spinal canal stenosis. No foraminal narrowing. C3-4: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing. C4-5: Right greater than left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C5-6: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild foraminal narrowing. C6-7: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild right foraminal narrowing. C7-T1: Facet arthropathy. No spinal canal or foraminal stenosis.

Output: Mild degenerative findings with no areas of significant spinal canal stenosis, cord impingement or foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Blurry vision. There is an enhancing tubular lesion with low diffusivity in the superonasal aspect of the left orbit that appears that appears to envelope part of the adjacent extraocular muscles. The lesion measures up to approximately 7 mm in thickness, previously also 7 mm. The left globe and optic nerve are intact. The right orbit is unremarkable. The orbital walls are intact. There is an unchanged right parotid nodule with high T2 signal and heterogeneous enhancement that measures up to 12 mm. The imaged intracranial structures are unremarkable.

Output: 1. No significant interval change in size of the mass in the superonasal aspect of the left orbit.2. Unchanged right parotid nodule that measures up to 12 mm, which may represent a pleomorphic adenoma.