Instruction: Generate impression based on findings.

Input: New onset of dizziness and postural vertigo, more on the left. Looking for vascular or structural pathology. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unremarkable. There is scattered paranasal sinus mucosal thickening and suggestion of fluid within the left maxillary sinus.MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms, within the limits of MRA.

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


Instruction: Generate impression based on findings.

Input: 50-year-old woman with history of fat malabsorption and diarrhea on pancreatic enzymes. ABDOMEN:LIVER, BILIARY TRACT: In segment 8 of the liver (6/14) there is a mildly T2 hyperintense, 13 mm round lesion with enhancement but no washout. Otherwise, the liver is normal in signal and morphology.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct appears normal without dilation. No focal pancreatic parenchymal lesion identified. The parenchyma is slightly atrophied, however within normal limits for age.On post-secretin images, there is only mild exocrine response and filling of the duodenum. No abnormal dilation of the pancreatic duct.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: 1.Suboptimal pancreatic exocrine response to secretin stimulation but normal-appearing ductal anatomy and parenchyma.2.Liver lesion which could represent a small FNH or hemangioma but is favored to be benign.


Instruction: Generate impression based on findings.

Input: Left lower extremity sciatica, worsening incontinence. There is a disc bulge at L4-5 with eccentric left annular fissure and apparently extruded or sequestered disc material measuring up to 8 mm in width in the left lateral recesses with impingement upon the nerve roots. In conjunction with bilateral facet hypotrophy and ligamentum flavum thickening at L4-5, there is also mild right and moderate left neural foraminal stenosis. There is also a disc bulge as well as facet hypertrophy and ligamentum flavum thickening at L5-S1 that collectively results in moderate spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis. There is no significant spinal canal stenosis at the other lumbar spine levels. The imaged portions of the spinal cord are unremarkable. The vertebral body heights are preserved. The paravertebral soft tissues are unremarkable.

Output: 1. A disc bulge at L4-5 with eccentric left annular fissure and apparently extruded or sequestered disc material in the left lateral recesses impinges upon the nerve roots.2. A disc bulge as well as facet hypertrophy and ligamentum flavum thickening at L5-S1 that collectively results in moderate spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: There is straightening of the normal cervical lordosis. The vertebral body heights are preserved. There is mild multilevel loss of disc height at C3-4, C4-5, C5-6, and C6-7. The vertebral bone marrow signal is unremarkable. There is a congenitally slender cervical spinal canal from C3 to C7, but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Posterior disc material and osteophytes with superimposed small central disc protrusion, contributing to mild bilateral foraminal narrowing. No significant spinal canal stenosis.C4-C5: Posterior disc material and osteophytes, contributing to moderate right and mild left foraminal stenosis. No significant spinal canal stenosis.C5-C6: Posterior disc material and osteophytes, contributing to mild right greater than left foraminal stenosis. No significant spinal canal stenosis.C6-C7: Posterior disc material and osteophytes, contributing to mild right and moderate left foraminal stenosis. No significant spinal canal stenosis.C7-T1: No significant disc bulge, spinal canal or foraminal stenosis.

Output: 1.There are multilevel degenerative changes present mainly in the form of small lateral recess disk protrusions and associated small uncovertebral osteophytes contributing to neural foramen encroachment at several levels as described above. 2.Congenitally small cervical spinal canal without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with funicular pain bilaterally. Alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. The visualized distal spinal cord, conus and cauda equina are unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild laterally bulging disc. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild disc bulge and loss of disc T2 signal. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. Incidental note is made of two left renal cystic lesions.

Output: 1. Mild degenerative findings without evidence of significant spinal canal stenosis.2. Posterior element hypertrophy does result in a moderate right foraminal narrowing at L4-5.


Instruction: Generate impression based on findings.

Input: 68 year old female with sarcoidosis, mild atherosclerosis, mild pulmonary hypertension, possible PFO on bubble study. Referred for cardiac MRI to rule out cardiac sarcoid. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 76%. The LVEDV is 91 ml (normal range 109+/-23), LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), LVESV is 22 ml (normal range 31+/-10), and LV end systolic volume index is 14 ml/m2 (normal range 18+/-5). The LV mass is 44 g (normal range 114+/-24) and the LV mass index is 28 g/m2 (normal range 67+/-11). 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. T1 relaxation time elevated at 1070-1090 msec. This may be consistent with diffuse myocardial fibrosis versus a nonspecific finding.Left AtriumThe left atrium is normal in size. Possible patent foramen ovale with left to right shunt.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 67%, the RVEDV is 92 ml (normal range 110+/-24), the RV end diastolic volume index is 59 ml/m2 (normal range 69+/-14), the RVESV is 31 ml (normal range 35+/-13), and the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMediastinal adenopathy. 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 sized left ventricle with hyperdynamic systolic function (LVEF 76%)2.Normal sized right ventricle with normal systolic function (RVEF 67%)3.Mildly dilated main pulmonary artery.4.No late gadolinium enhancement. Slightly elevated T1 relaxation time (1070-90 ms) which could signify diffuse myocardial fibrosis versus a non-specific finding. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 35-year-old female with focal nodular myositis and worsening weakness in the right leg. Artifactual signal is visualized within the anterior and medial soft tissues of the right thigh on most sequences, limiting evaluation. However within this limitation the signal intensity of the musculature of the right thigh is within normal limits. Specifically there is no evidence of abnormal enhancement or atrophy. No MR abnormalities with the remaining soft tissues are within normal limits. Osseous structures and specifically the bone marrow signal are normal.

Output: No significant abnormality is visualized within the limitations described.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:9/16/1955)Reason: stroke History: altered mental statusPROVIDER/ATTENDING NAME: R BOOTH HALL R BOOTH HALL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Punctate focus of signal loss of signal in the right periventricular white matter is present on susceptibility weighted imaging.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is marrow replacement present in the visualized upper cervical spine and clivus

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Marrow replacement within the visualized cervical spine and clivus is a nonspecific finding. Differential considerations may include chronic disease, myeloproliferative disorder, lymphoproliferative disorder is nonspecific


Instruction: Generate impression based on findings.

Input: Contrast rapidly opacified the radiocarpal joint and its recesses. After approximately one minute of slow continuous injection, contrast was eventually noted along the medial margin of the body of the hamate, although the scapholunate and lunotriquetral intervals were obscured by overlying contrast in the radiocarpal recesses at this point. Contrast continued to opacify the midcarpal joint. The needle was removed. The wrist was manipulated in radial and ulnar deviation which showed that contrast appeared to communicate between the radiocarpal and midcarpal joints via both the scapholunate and lunotriquetral intervals. No contrast entered the distal radioulnar joint to confirm a full-thickness fibrocartilage tear, although there is irregularity along the distal surface of the articular disk suggesting partial thickness tearing. Please refer to the subsequent MRI report for further information.Exposure time: Two minutes and 51 seconds

Output: Scapholunate and lunotriquetral ligament perforations and partial-thickness tearing of the triangular fibrocartilage. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of meninges, unspecifiedClinical question: hx meningioma eval for changeSigns and Symptoms: none- surveillance imaging There is redemonstration of an extra-axial mass measuring 29 x 23 mm sagittal dimensions and 23 x 23 and millimeters axial dimensions on the current exam and similar dimensions on the prior exam located at the left cerebellopontine angle cistern and extending upwards to the left perimesencephalic cistern which displaces the pons medially and the cerebral peduncle superiorly. There is some extension of this mass into the left internal auditory canal along its anterior aspect. There is redemonstration and no change and T2 and FLAIR signal hyperintensity within the left middle cerebellar peduncle as well as the left superior cerebellar peduncle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Incidental note is made of partial empty sellaNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate partial opacification of the the left mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.There is an extra-axial mass present in the posterior fossa on the left side which most likely represents a meningioma. It is stable compared to the prior exam. It affects the left internal auditory canal and displace and compress the brainstem.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: 30 years Female (DOB:11/27/1985)Reason: eval s/p posterior fossa decompression and placement of 4th ventricular stent History: eval s/p posterior fossa decompression and placement of 4th ventricular stentPROVIDER/ATTENDING NAME: DAVID M FRIM DAVID M FRIM MRI brain:Since prior exam patient is undergone suboccipital craniotomy and fourth ventricle stent placement. There are T2 and FLAIR hyperintense foci now present along the cerebellar tonsils bilaterally. There are postsurgical changes present in the soft tissues behind the surgical site.A T2 and FLAIR hyperintense focus is present in the right periventricular white matter and frontal lobe which represents a prior ventriculostomy tract.CSF flow study demonstrates biphasic flow anterior to the brainstem and spinal cord at the level of foramen magnum and through the stent.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Since prior exam the patient is undergone decompressive suboccipital craniectomy and fourth ventricular stent placement. There are associated post surgical changes along the cerebellar tonsils and soft tissues of the upper neck and occipital calvarium.2.There is no evidence for syrinx or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: altered mental status, atrial fibrillation. There are multiple restricted diffusion lesions on bilateral hemispheres including right parietal lobe, right temporal lobe, right insular, left frontal lobe, left caudate head, left cingulate gyrus, left parietal lobe and left temporal lobe.There are also susceptibility artifacts on the left frontal, right parietal and right temporal lobe indicating hemorrhagic conversion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate minimal visualization of the left ICA cervical segment to the level of intracranial ICA bifurcation. The left MCA inferior division is reconstituted via left Pcom artery. The right side ICA is patent. Vertebrobasilar system is patent.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left extracranial ICA appears to be significantly narrowed from the level of left CCA bifurcation but still remained forward flow. This finding indicate long standing distal stenosis or occlusion. There is about 50% luminal stenosis on the right vertebral artery origin but that of the left vertebral artery appears to be normal.

Output: 1. Multifocal bihemispheric acute ischemic infarctions with evidence of hemorrhagic conversions as described above.2. Significantly narrowed the left ICA from the level of left CCA bifurcation indicating distal stenosis or occlusion.3. The left MCA inferior division is reconstituted mainly through the left Pcom artery but the superior division of the left MCA was not demonstrated. Comment: The Brain MRA WO was not performed with sufficient quality due to motion artifacts as well as low-spatial resolution (352x224) which should be at least 400 x 400 or above or 512 x 512. The neck MRA's FOV was not correct since the area coverage did not include anterior aspect of bilateral ICA thus failed to visualize bilateral cavernous sinus segments of ICAs. Therefore, both MRAs should be repeated without additional charge and under radiologists supervision.


Instruction: Generate impression based on findings.

Input: Ms.Gloria Jackson, 71 years old, submitted outside study for review. She initially presented to outside hospital for evaluation of a palpable lump in the right upper outer breast on 5/20/2016. Diagnostic ultrasound of the right breast demonstrated a 1.6 x 1.4 cm mass corresponding to the palpable abnormality. Additional 1.1 x 0.8 cm hypoechoic lesion was also identified slightly medial and superior to the palpable lump. Ultrasound-guided biopsy of the 10:00 position, posterior palpable mass revealed invasive ductal carcinoma on 5/25/2016. MRI breast on 6/2/2016 demonstrated 2 enhancing masses and 1 additional nonmass enhancement in the right upper outer breast as well as a 1.5 cm right axillary lymph node with irregular cortical thickening.Images performed at Ingalls Memorial Hospital (Harvey, IL) submitted for review: Mammogram 2/11/2016Ultrasound 5/20/2016Ultrasound-guided biopsy 5/25/2016Postprocedure mammogram 5/25/2016MRI breast the 6/2/2016Images submitted for comparison:Mammogram 1/5/2015 and 12/23/2013 MAMMOGRAM 2/11/2016: 2 standard views of both breasts with repeat MLO view were obtained. The breast parenchyma is asymmetric, heterogeneously on the right and scattered on the left, grossly unchanged from the prior. A biopsy clip is identified in the upper outer right breast. Stable benign calcifications are present in both breasts. Linear metastatic marker overlies the scar over the left anterior breast. No new dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. RIGHT BREAST ULTRASOUND 5/20/2016 : Static ultrasound images are submitted for interpretation.In the right breast, 10:00 position, 4 cm from the nipple, labeled as the palpable lump, there is an irregular, hypoechoic mass measuring 1.6 x 1.4 cm.In addition, along the same radian in the right breast, approximately 2 cm apart from the above palpable mass, there is a another smaller hypoechoic lesion measuring 1.1 x 0.8 cm. Both are suspicious for malignancy.ULTRASOUND-GUIDED BIOPSY 5/25/2016 : The right breast mass at 10:00 was targeted accurately and a clip was placed. POST PROCEDURE MAMMOGRAM 5/25/2016: A lock shaped clip is placed in the right breast 9:00 position, close to the previous biopsy clip.MRI BREAST 6/2/2016:Multisequence MRI breast imaging with and without intravenous contrast was performed as per outside MRI breast protocol. The breasts are composed of asymmetric fibroglandular tissue, heterogeneous on the right and scattered on the left. There is mild background parenchymal enhancement bilaterally. Kinetic analysis of these images was not possible. RIGHT BREAST:There is susceptibility artifact from the biopsy clip in the the right breast, 10:00 position, 3.5 cm from the nipple. There is an enhancing mass surrounding the biopsy clip measuring 1.9 x 2.2 x 2 cm (LR X AP x SI), which is consistent with the biopsy proven malignancy.In addition, in the right breast, 10:00 position, approximately 1.5 cm anterior to the index mass, is another enhancing mass with irregular margins, which measures 1.2 x 0.9 x 1.1 cm (LR X AP x SI) and correlates with the satellite lesion found on the ultrasound.There is a linear enhancement extending from the index mass anteriorly to the skin and close to the satellite mass, which could represent the biopsy track or possibly additional malignant enhancement.LEFT BREAST: There is an enhancing area with high T2 signal intensity in the slightly inferior aspect of the left central breast, posterior depth, which measures 0.7 x 1.1 x 1.2 cm (LR X AP x SI). There is no suspicious kinetic behavior associated with this non mass enhancement.AXILLAE:A nonspecific lymph node is identified in the right axilla. No suspicious lymph nodes in the left axilla.PER OUTSIDE PATHOLOGY:A. right upper outer breast breast, 10:00, posterior lesion; ultrasound guided core needle biopsy:- Invasive ductal carcinoma, grade 2- This result is concordant with the imaging findings.

Output: RIGHT BREAST: 1. 2.2 cm biopsy-proven malignancy in the right posterior breast 10:00 position.2. 1.2 cm suspicious satellite mass in the right breast 1.5 cm anterior to the index cancer. Ultrasound-guided biopsy is recommended.3. Linear enhancement extending from the index mass to the skin may represent post biopsy enhancement, though if the skin entry site from biopsy is not located towards the nipple compared to the target, malignancy would be more likely. Suggest correlation with physical exam. 4. Nonspecific right axillary lymph node for which ultrasound can be considered if clinically indicated.LEFT BREAST:1. 1.2 cm enhancing area in the posterior left breast, likely a benign process, for which 6 month MRI follow-up is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: The previously seen subcortical high T2 signal in the right parietal lobe has resolved. However, a punctate focus of susceptibility effect remains in this location. There is a new ill-defined area of T2 hyperintensity involving the left posterior cingulate gyrus and possibly part of the splenium of the corpus callosum. There is no mass-effect, restricted diffusion, or susceptibility associated with this new lesion. A smaller focus of high T2 signal in the right superior frontal gyrus as well as other small periventricular foci of high T2 signal are unchanged. There is no evidence of restricted diffusion. Encephalomalacia involving the right cerebellar hemisphere is unchanged. There is no midline shift or herniation. There is mild maxillary sinus mucosal thickening. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Interval resolution of T2 signal abnormality in the right precentral gyrus seen on the prior study, with a persistent small focus of susceptibility in this location. Scattered smaller foci of periventricular high T2 signal remain, and there is a new area of T2 signal abnormality involving the left posterior cingulate gyrus and possibly part of the splenium of the corpus callosum without mass-effect, restricted diffusion, or susceptibility in this new lesion. The apparent interval resolution of a previously seen lesion, in the absence of any medical or pharmacologic intervention, would argue against metastatic disease. The differential diagnosis therefore remains quite broad and includes inflammatory, infectious, autoimmune, and vascular etiologies along with medication effect.


Instruction: Generate impression based on findings.

Input: 69-year-old female with a history of right basal ganglia stroke now with lethargy and confusion. Evaluate for hemorrhagic conversion. There is no evidence of intracranial hemorrhage, extra-axial fluid collection or mass. There is no mass effect or midline shift. There is a focal area of hypoattenuation in the right MCA perforator distribution in the right basal ganglia and right anterior limb of the internal capsule which appears more well defined and correlates to a subacute infarction previously demonstrated on MRI. There is no significant associated vasogenic edema.Redemonstration of nonspecific moderate periventricular and deep white matter hypoattenuation. These findings are most consistent with age indeterminate small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized mastoid air cells are within normal limits. Again seen is a moderate mucosal thickening of the maxillary sinuses which appears unchanged when compared to the previous study.

Output: 1. Focal area of hypoattenuation in the right MCA perforator distribution in the right basal ganglia and right anterior limb of the internal capsule which correlates to a subacute infarction previously demonstrated on MRI. There is no evidence of hemorrhagic conversion.2. Nonspecific moderate periventricular and deep white matter hypoattenuation. These findings are most consistent with age indeterminate small vessel ischemic disease.3. Mild mucosal thickening of the maxillary sinuses bilaterally, unchanged.


Instruction: Generate impression based on findings.

Input: 62-year-old male with fall after biking. Outside hospital CT showed right temporal petechial hemorrhage There is no evidence of intracranial hemorrhage, mass, or acute infarct. A few scattered punctate foci of susceptibility are present throughout the right cerebral hemisphere including only one in the right anterior temporal pole and these are considered nonspecific. 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 and skull are unremarkable. Small right choroid plexus cyst. Edema and induration of the right supraorbital soft tissues is likely secondary to trauma. There is a focal T1 and T2 hypointesnse oval lesion in the premaxillary subcutaneous tissues of the right cheek immediately inferior to the right zygomatic arch with soft tissue swelling, which may represent an hematoma. Complete opacification of the right maxillary sinus.

Output: 1.No acute intracranial abnormality. Scattered nonspecific foci of susceptibility which may represent mineralization or trace hemosiderin deposition. No specific pattern to suggest traumatic axonal injury.2.Edema in the right supraorbital subcutaneous tissues and right premaxillary soft tissues, with subcutaneous oval area of abnormal signal in the right cheek which may represent a hematoma.3.Complete opacification of the right maxillary sinus.


Instruction: Generate impression based on findings.

Input: History of rectal cancer status post chemoradiation therapy. Evaluate extent of disease. PELVIS:UTERUS, ADNEXA: The uterus is normal in size. It appears to be partially septated with a muscular septum. The endometrium is normal in thickness.Redemonstrated 6.1 x 4.6 cm left adnexal cyst with a thin septation but no abnormal enhancing components. The right adnexa is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The previously seen low rectal circumferential wall thickening is significantly decreased in size measuring approximately 7 mm in maximal thickness compared to 11 mm previously at the 1:00 position. The longitudinal of the lesion is difficult to accurately measure. There is no definite post-contrast enhancement or significant restricted diffusion. The inferior margin of the tumor is approximately 2 to 3 cm the anal verge. There are very small mesorectal lymph nodes, the largest measuring 3 mm in short axis (series 1001/28) at the 5:00 position. One very small lymph node appears to abut the mesorectal fascia (series 1001/29) at the 4:00 position, decreased in size.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in circumferential wall thickening of the distal rectum. There are small mesorectal lymph nodes as described above one of which appears to abut the mesorectal fascia.6.1 cm left adnexal cystic lesion without suspicious mural nodularity or enhancement.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with severe back pain which limits ambulation. The L4 and L5 vertebral bodies are diffusely edematous and enhancing. The intervening disc space, while not enhancing, does show marked abnormal T2 signal. The adjacent endplates have become very irregular indicating likely erosion.Thickened enhancing soft tissue fills the ventral epidural space at L4 and L5. The dorsal epidural space is affected to a lesser degree, but the dura is diffusely enhancing beginning at the L3 level and continuing down into the sacrum. No obvious epidural fluid collections are seen at this time. However, the epidural soft tissue thickening does result in a severe narrowing of the thecal sac at L4 with crowding and possible compression of the cauda equina nerve roots. The L4-5 neural foramina are also significantly encroached upon by this soft tissue process.The anterior and posterior paraspinal soft tissues at L4 and L5 are edematous and hyperenhancing with involvement of the psoas muscles. No discrete fluid collection is seen, however. A 4 mm focus of enhancement is evident along the right posterior surface of the conus at T12-L1. An additional very small focus of enhancement is seen within the thecal sac at the S1-2 level. Spinal alignment is anatomic. Vertebral body heights are preserved. Except as discussed above, marrow signal characteristics are unremarkable.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Facet arthropathy and ligamentum flavum thickening. Disc desiccation and mild disc bulging. Progressive prominence of the dorsal epidural soft tissues. Progressive encroachment upon the thecal sac but no frank nerve root compression. Moderate bilateral foraminal narrowing, unchanged. L4-5: Facet arthropathy and ligamentum flavum thickening, slightly progressed from prior. Disc bulging with a superimposed central annular fissure. Extensive inflammatory findings as above. Significant generalized spinal canal stenosis and significant bilateral foraminal narrowing, progressed from prior. L5-S1: Facet arthropathy. Bulging disc asymmetric to the left. No significant generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing.

Output: Findings at L4 and L5 compatible with osteomyelitis discitis. The epidural tissues at these levels are thickened with solidly enhancing soft tissue which contributes to a significant narrowing of the thecal sac at L4 and significant L4-5 foraminal encroachment. No definite abscess is identified at this time.The dura of the lower sac is diffusely enhancing compatible with reactive inflammation. However, note is made of two intrathecal foci of enhancement, one at T12-L1, and one at S1-2, which are nonspecific but could potentially represent areas of intrathecal infection.Findings were discussed with the hospitalist service at pager 5866 on 2/26/16 at 1:20 PM.


Instruction: Generate impression based on findings.

Input: Pain. Chondromalacia? Due to the patient's body habitus, the high-resolution knee coil could not be used. An alternative coil was used instead which results in slightly suboptimal image quality.MENISCI: The posterior horn and body of the medial meniscus are abnormally small. I do not know if this is a result of chronic attritional tearing or prior partial meniscectomy. There is intermediate signal intensity within the posterior horn and body of the medial meniscus that extends to the tibial articular surface. While this is compatible with an undersurface tear, it may simply represent residual degenerative signal within the meniscus following partial meniscectomy. I see no fluid signal intensity entering the meniscus; however, there are small para meniscal cysts along the posterior and medial margins of the meniscus. There is slight medial extrusion of the body of the medial meniscus. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There are small tricompartmental osteophytes. Subjectively the articular cartilage of the tibiofemoral compartments appears slightly thinned, suggesting mild diffuse degeneration. There also appears to be focal full-thickness cartilage loss along the femoral trochlea centrally and along the medial facet with a small underlying subchondral cyst. This is new when compared with the prior study. The articular cartilage of the patella appears relatively intact. There is residual red marrow in the distal femur and proximal tibia, but otherwise bone marrow signal intensity is normal.LIGAMENTS: There is thickening of the anterior cruciate ligament likely representing mucoid degeneration. The posterior cruciate ligament appears intact. The medial collateral ligament and collateral collateral ligament complex appear intact. EXTENSOR MECHANISM: The extensor mechanism is intact. The femoral trochlea appears slightly shallow, perhaps represent a mild dysplasia, with slight lateral translation of the patella. The tibial tubercle to trochlear groove distance measures just over 2 cm.ADDITIONAL

Output: 1.Cartilage degeneration particularly affecting the femoral trochlea as described above.2.Medial meniscal abnormalities as described above may either reflect chronic attritional tearing, sequela of prior partial meniscectomy, or combination of both.3.Edema along tracking inferiorly along the medial head of gastrocnemius muscle suggests recent Baker's cyst rupture.4.Other findings as above.


Instruction: Generate impression based on findings.

Input: Hip pain. History of lumbar spine spondylosis. ACETABULAR LABRUM: The acetabular labrum is grossly normal. If the suspicion for labral injury remains high, MR arthrogram would be the study of choice.ARTICULAR CARTILAGE AND BONE: Small humeral head osteophytes indicate mild osteoarthritis. No fracture or malalignment is present.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Mild right hip osteoarthritis, without significant abnormality otherwise evident.


Instruction: Generate impression based on findings.

Input: 75-year-old man with history of seizures. There is diffuse confluent T2 hyperintensity in the bilateral subcortical and periventricular white matter. Additionally, there is moderate diffuse cerebral volume loss. There are also prominent perivascular spaces and/or chronic lacunar infarcts in the bilateral basal ganglia and left pons. In addition, there are scattered punctate foci of susceptibility effect in the brainstem and cerebellum, as well as a larger area in the left corona radiata. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. 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.Findings of chronic small vessel disease and probable chronic lacunar infarcts, chronic microhemorrhages, and diffuse cerebral volume loss.2.No acute ischemia, hemorrhage, or mass.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 41 year-old female with abdominal pain. Status post colonoscopy. ABDOMEN:LIVER, BILIARY TRACT: No focal mass lesions are identified. 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: There is mesenteric lymphadenopathy in the right lower quadrant, likely reactive.BOWEL, MESENTERY: There is a long segment of distal ileum, icluding the terminal ileum which demonstrates increased T2 signal abnormality, wall thickening, and enhancement, consistent with active inflammation. There is extensive inflammatory reaction in the surrounding area as well as a fistulous network, with increased linear signal abnormality suggestive of a enterocolonic fistula extending from the terminal ileum to involve the cecum. The small bowel proximal to this area appears dilated, appearing similar to the prior study, which may reflect a partial small bowel obstruction.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: There is a long segment of distal ileum, icluding the terminal ileum which demonstrates increased T2 signal abnormality, wall thickening, and enhancement, consistent with active inflammation. There is extensive inflammatory reaction in the surrounding area as well as a fistulous network, with increased linear signal abnormality suggestive of a enterocolonic fistula extending from the terminal ileum to involve the cecum. The small bowel proximal to this area appears dilated, appearing similar to the prior study, which may reflect a partial small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings consistent with acute and chronic inflammatory bowel disease involving the terminal ileum with associated fistulous network, involving the terminal ileum and cecum. Dilated small bowel proximally may reflect a partial small bowel obstruction related to the aforementioned fibrostenotic disease.


Instruction: Generate impression based on findings.

Input: Examination is motion degraded. The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine although motion degradation slightly limits evaluation. No abnormal enhancement. No evidence of epidural tumor. THORACIC SPINE

Output: 1. Examination is somewhat motion degraded. No suspicious osseous lesions however are appreciated to suggest metastatic disease in the spine. No compression fractures. No evidence of epidural tumor. 2. Degenerative changes in the lumbar spine without high grade spinal canal or neural foraminal stenosis at any level. There is mild right L4-5 neural foraminal narrowing questionably contributing to right leg pain; correlate with signs of right L4 radiculopathy. There is facet arthropathy in the lower lumbar spine which may be contributing to low back pain.3. Extraspinal findings include left lower lobe mass and atelectasis,16x23 mm right thyroid lobe nodule, and left adrenal mass, better assessed on prior CT.


Instruction: Generate impression based on findings.

Input: Other alteration of consciousness [780.09], Reason for Study: ^Reason: r/o stroke History: right-sided weakness There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Bihemispheric scattered several high signal intensities on FLAIR imaging indicate nonspecific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No change of nonspecific small vessel ischemic disease since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: 36-year-old female with right lower quadrant pain. Evaluate for appendicitis. PELVIS:UTERUS, ADNEXA: Gravid uterus. There is a T2 hyperintense focus in the left adnexa measuring up to 2 cm, most compatible with cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Appendix is normal in caliber without evidence of periappendiceal fluid or inflammatory changes to suggest appendicitis. Trace free pelvic fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Normal appendix.2.Gravid uterus. Intrauterine pregnancy is not evaluated.


Instruction: Generate impression based on findings.

Input: 74-year-old male patient with cirrhosis. Screening examination for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Interstitial T2 hyperintensity is compatible with hepatic fibrosis. There is an arterially enhancing lesion in the inferior aspect of the right hepatic lobe measuring 1.6 x 1.6 cm (image 71, series 10), previously 1.6 x 1.5 cm. There is no definite washout of this lesion, which bulges the capsule. There is an arterially enhancing lesion within the right hepatic dome which has increased in size measuring 1.5 x 1.2 cm, previously 0.9 x 0.7 cm (image 30, series 10). There is washout of this lesion on delayed imaging. A segment 8 focus of arterial enhancement without definite washout appears smaller in size (image 45, series 10). There is no intra- or extrahepatic biliary ductal dilatation. The hepatic vasculature is patent.Trace perihepatic ascites, slightly increased from the prior study. Recannulated periumbilical vein. SPLEEN: Wedge-shaped signal abnormality in the dorsal aspect of the spleen may reflect a small chronic infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral T2-weighted hyperintense foci some of which are too small to characterize, likely simple cysts. Mild right renal cortical scarring/thinning.RETROPERITONEUM, LYMPH NODES: Aneurysmal dilatation of the proximal abdominal aorta measuring up to 3.3 cm in diameter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral gynecomastia. Compression deformity of a midthoracic vertebral body is incompletely evaluated and only seen on the coronal images.OTHER: Extensive susceptibility artifact is noted in the mid-abdomen.

Output: 1.Enlarging right hepatic dome lesion with imaging characteristics compatible with hepatocellular carcinoma.2.Additional arterial enhancing foci without washout are again noted; attention to these lesions on follow up imaging is recommended.


Instruction: Generate impression based on findings.

Input: Knee pain. Assess for ligament/meniscus tear. MENISCI: There is a complex tear of the posterior horn of the lateral meniscus. There is a complex tear of the posterior horn of the medial meniscus with fragmentation. The bodies of the lateral and medial menisci appear extruded on the coronal images.ARTICULAR CARTILAGE AND BONE: There is near full thickness to full thickness loss of articular cartilage of the weight-bearing portion of the lateral femoral condyle and lateral tibial plateau. There is significant thinning of the articular cartilage of the weight-bearing portion of the medial femoral condyle with a 6 mm full thickness defect. There is a partial thickness fissure of the lateral facet of the patellar articular cartilage.Edema is noted within the lateral aspect of the lateral femoral condyle and lateral tibial plateau. Edema is also seen within the anterior aspect of the medial tibial plateau. Medial and lateral compartment osteophytes are noted.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complex tears of the medial and lateral menisci as described above.2. Severe degenerative changes and chondromalacia as described above.


Instruction: Generate impression based on findings.

Input: 77-year-old male with left lower extremity weakness x 3 days. Rule out CVA. Examination demonstrates no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The images through the supratentorial brain parenchyma are essentially within normal limits for patient of stated age of 77.Images through posterior fossa demonstrates normal morphology and density of the cerebellar hemispheres. Within the lower pons at the level of the pontomedullary junction a focal area of low-attenuation (axial image 6) in the right paramedian location is noted. This finding may represent a lacunar infarct however the possibility of volume averaging of CSF is considered and the cannot be entirely ruled out. Please correlate with clinical findings and if further evaluation is needed an MRI is recommended.

Output: 1.Unremarkable CT of brain in supratentorial brain parenchyma.2.Focal low density in the right aspect of the pons may present in a clean or an area of volume averaging with CSF as detailed.3.4.


Instruction: Generate impression based on findings.

Input: Unspecified abnormalities of gait and mobility [R26.9], Reason for Study: ^Reason: Eval for new stroke History: worsening right sided weakness There is no evidence of acute ischemic or hemorrhagic lesion on the scan.On FLAIR imaging, there are multifocal scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease, no change since prior scan.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 and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No change of nonspecific small vessel ischemic disease since prior scan.


Instruction: Generate impression based on findings.

Input: Reason: neuroendocrine tumor with liver mets History: neuroendocrine tumor with liver mets ABDOMEN:LIVER, BILIARY TRACT: Innumerable hepatic metastases have increased in size and number. A segment 4A lesion measures 3.6 x 2.6 cm (12/97), previously 2.4 x 2.7 cm. 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: Enlarged portacaval node measuring 1.5 x 1.2 cm (12/60).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 1 cm right lower lobe nodule.

Output: 1.Progression of innumerable hepatic metastases.2.New right lower lobe lung nodule. This can be better evaluated on CT.3.Enlarged portacaval lymph nodes.


Instruction: Generate impression based on findings.

Input: 50-year-old with history of benign right breast biopsy and family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Biopsy clip in the right upper outer breast with associated microcalcifications, not significantly changed. Other bilateral benign calcifications and asymmetries are also unchanged. Underlying benign morphology masses are also similar to prior studies, compatible with cysts as has been seen on prior MRIs.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Tomosynthesis for her screening exam is recommended. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 54 year old female status post bike accident on 8/2014 with dyspareunia, evaluate known T12 compression fracture THORACIC SPINE:There is a moderate anterior compression deformity at T12 which demonstrates slightly increased loss of vertebral body height compared to the prior radiograph (now 10 mm, compared to prior 13-14 mm). There is linear T1 hypointense signal through the posterior T12 vertebral body on the left side with associated mild STIR hyperintense edema and enhancement. The endplates appear intact. There is trace retropulsion of fracture fragments along the superior endplate with mild flattening of the ventral thecal sac. There is mild central canal narrowing at the upper T12 level. Signal within the cord is normal. There is mild facet arthropathy at T11-12, however no neuroforaminal stenosis is evident.Mild disk desiccation and narrowing is noted at T10-T11. The remaining disks appear normal. Alignment and marrow signal throughout the remainder of the thoracic spine is normal without neuroforaminal or central canal stenosis.LUMBAR SPINE:Compression deformity at T12 as previously described. Otherwise, marrow signal within the lumbar spine is normal. Alignment of the lumbar spine is anatomic. No acute fractures are evident within the lumbar spine. Vertebral body heights are preserved and disk spaces maintained. No abnormal enhancement within the lumbar spine. Signal within the distal cord and conus is normal, ending low normal at L2-L3.T12-L1: Broad-based disk bulge. Mild facet arthropathy. No central canal or neural frontal stenosis.L1-L2: No central canal or neuroforaminal stenosis.L2-L3: No central canal or neuroforaminal stenosis.L3-L4: No central canal or neuroforaminal stenosis.L4-L5: No central canal or neuroforaminal stenosis.L5-S1: No central canal or neuroforaminal stenosis.

Output: Moderate compression deformity at T12 is slightly progressed when compared to the prior radiograph. Associated enhancement and edema is noted at this level, in a somewhat linear fashion extending posteriorly, which may represent a superimposed subacute injury, for which clinical correlation is recommended. Trace retropulsion of fracture fragments, with mild central spinal canal stenosis at T11-12. No significant foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Hb-SS disease with crisis, unspecified [D57.00], Reason for Study: ^Reason: SCD History: eval for Moya Moya/stenosis Brain MRINo evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings are seen on bilateral maxillary sinuses. The left sphenoid bony lesion is again seen, unchanged since prior scan.Considering the patient clinical circumstances of moyamoya disease with acute crisis, post gadolinium enhanced the scan could be indicated to evaluate perivascular inflammatory changes. Therefore, if clinically indicated brain MRI with and without contrast enhancement can be considered.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Unchanged left sphenoid benign looking bony lesion.3. No evidence of intracranial arterial stenosis or occlusion. Rec: With clinical circumstances of sickle cell disease with crisis, Gad enhanced MRI can be considered to evaluate vascular enhancement.


Instruction: Generate impression based on findings.

Input: Right lower quadrant pain. Assess for appendicitis. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right mid/upper pole demonstrating wedge-shaped/striated appearance of increased T2 signal intensity (axial series 905 images 96, 136, 176) with surrounding perinephric stranding. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal-appearing appendix (axial series 2001 image 43; sagittal series 2101 image 42) without surrounding inflammatory fat stranding or fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Gravid uterus containing a gestational sac, and the right ovary also demonstrates findings compatible with a corpus luteum cyst (coronal series 1701 image 23). Trace physiologic free fluid in the pelvis also noted.

Output: 1.MRI findings compatible with right mid/upper pole pyelonephritis. The evaluation is limited due to the lack of intravenous contrast however there are normal-appearing flow voids relating to the right renal artery and vein.2.Gravid uterus containing a gestational sac. Please note the imaging parameters are not diagnostic for a gestational pelvic exam.


Instruction: Generate impression based on findings.

Input: Follow-up dysplastic nodules. Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous signal throughout the liver compatible with fibrosis, similar to prior. Innumerable subcentimeter T2 hyperintense nodules compatible with regenerative nodular cirrhosis. No focal arterially-enhancing lesion or suspicious hepatic lesion otherwise is seen. Mildly increased hepatic parenchymal signal on out of phase images suggests iron deposition. The hepatic veins, main portal vein, and main hepatic artery are patent. SPLEEN: Splenomegaly.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: Trace ascites. Upper abdominal varices.

Output: Regenerative nodular cirrhosis without suspicious hepatic lesion identified.


Instruction: Generate impression based on findings.

Input: Clinical question : 39-year-old female with history of left basal ganglia mass/calcification. Three evaluate for progression. Signs and symptoms: seizure Nonenhanced head CT:Large area of speckled calcification in the left basal ganglia with extension into the thalamus on the left is again identified. There is no evidence of any associated edema or mass effect with this finding. There is also no evidence of any interval change in the extent or size of this lesion. A small calcification is also noted in the right cerebral peduncle similar to prior exam. The exact etiology of this finding is not clear. Finding could represent dystrophic calcification. Possibility of a hemangioma cannot be ruled out. There is linear and punctate appearance of this lesion which may indicate vascular calcification. Correlate with history since this appearance may be result of prior embolization. The common further follow with an MRI examination.This examination is otherwise unremarkable and stable since prior study.

Output: Stable examination since prior study and in particular no evidence of change in the size or distribution of the left basal ganglia -- thalamic calcification. Please see above comments.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis and bladder urgency. There is interval increase in the extent of T2 hyperintense lesions in the cervical spine, including at the C3 and C4-5 levels. There is no associated abnormal enhancement, however. The thoracic spinal cord displays normal signal and morphology. However, there appear to be subcentimeter foci of T2 hyperintensity within the brainstem and right middle cerebellar peduncle. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is unchanged mild degenerative spondylosis at multiple levels of the cervical spine without significant spinal canal stenosis. There is a Schmorl node in the superior endplate of T11 and a subcentimeter area of focal fat or hemangioma in the T12 vertebral body. The vertebral bone marrow signal is otherwise unremarkable. The paravertebral soft tissues are unremarkable.

Output: Apparent interval progression of demyelinating disease in the cervical spine without evidence of associated active inflammation. The thoracic spinal cord appears unremarkable. However, there may be new infratentorial demyelinating lesions, which are otherwise incompletely characterized.


Instruction: Generate impression based on findings.

Input: Female 51 years old with left adrenal nodule. Please assess for changes. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 19 cm in length and has a smooth contour. There is no focal hepatic lesion, biliary ductal dilatation or ascites. SPLEEN: A subcentimeter, nonenhancing cystic splenic lesion is unchanged.PANCREAS: The pancreas enhances homogeneously. No pancreatic ductal dilatation.ADRENAL GLANDS: The left adrenal gland nodule measures 1.7 x 1.3 cm (series 10/19) with loss of signal on out of phase imaging consistent with an adenoma. The right adrenal gland is normal in appearance.KIDNEYS, URETERS: Subcentimeter left upper pole renal cyst is unchanged.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: Stable left adrenal nodule consistent with benign adrenal adenoma.


Instruction: Generate impression based on findings.

Input: 74-year-old female with a L2 radiculopathy. Evaluate for stenosis. Better seen on the recent lumbar CT are postsurgical changes of a spinal fusion at the L4-5 levels with bilateral pedicle screw fixation and paraspinous rods.The vertebral body heights are maintained. There is grade 1 retrolisthesis of L2 on L3. There is multilevel disc desiccation and disc height loss with multilevel endplate degenerative changes and Schmorl's nodes. The distal spinal cord and conus demonstrate normal signal in morphology. The paravertebral soft tissues are unremarkable.Degenerative changes are visualized in the lower thoracic spine with Schmorl's nodes and mild endplate degenerative changes at the T11-12 level.Degenerative changes are seen in the cervical spine as described below:T12-L1: Tiny disc bulge without spinal canal or neuroforaminal stenosis.L1-L2: Small disc bulge and mild facet arthropathy without spinal canal or neuroforaminal stenosis. L2-L3: Grade 1 retrolisthesis of L2 on L3 and facet arthropathy. Moderate to severe bilateral neural foraminal stenosis and mild to moderate spinal canal stenosis. There is soft tissue material effacing the right L2-3 foramen and the right L2-3 lateral recess. This material is adjacent to both the disc and the facet/ligamentum flavum.L3-L4, L4-5: Posterior spinal fusion hardware artifact precludes evaluation at this level.L5-S1: Full evaluation is limited by presence of hardware artifact. There does not appear to be significant spinal canal stenosis.

Output: 1.Postsurgical changes of a posterior spinal fusion at the L4-5 level. Note that hardware artifact limits evaluation from L3 through L5.2.Grade 1 retrolisthesis of L2 on L3 contributes to moderate to severe bilateral neural foraminal stenosis and mild to moderate spinal canal stenosis.3.Soft tissue material effaces the right L2-3 foramen and the right L2-3 lateral recess. This material may originate from the disc or the adjacent facet/ligament complex. This could represent a disc extrusion or sequestered disc, epidural scarring or an atypical synovial cyst.


Instruction: Generate impression based on findings.

Input: Evaluate for accumulation of MS lesions. There are numerous cerebral white matter lesions bilaterally, mainly in a periventricular distribution, but also in the right paracentral lobule subcortical white matter, as well as in the right cerebellar hemisphere. Some of the lesions demonstrate low signal on T1 weighted sequences, but there is no evidence of associated enhancement. There is no evidence of intracranial hemorrhage, mass, 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No appreciable change in the burden of demyelinating lesions related to multiple sclerosis and no evidence of acutely inflamed lesions.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: Follow up MRI for white matter changes in last MRI. MS protocol History: one seizure, numbness and tingling of legs No evidence of acute ischemic or hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement.Previously seen multifocal periventricular and subcortical white matter FLAIR/T2 high signal intensity lesions are again seen, unchanged since prior scan. These lesions are non specific. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst was seen in the left maxillary sinus, unchanged since prior scan.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Multifocal subcortical and periventricular white matter FLAIR/T2 high signal intensity lesions are again seen, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Reason: osteo History: osteo There is thickening and enhancement of the skin along the anteromedial aspect of the distal tibial diaphysis likely representing the site of ulceration and adjacent inflammation/scarring. The signal abnormality and enhancement extends to the anteromedial cortex of the distal tibial diaphysis, but we see no frank cortical penetration nor do we see findings to suggest osteomyelitis of the underlying medullary bone. There is diffuse low to intermediate signal intensity within the medullary space of the tibial diaphysis likely representing residual red marrow related to the patient's known history of sickle cell disease. Additionally, there are multiple areas of bone infarction including one adjacent to the aforementioned site of ulceration, which is new when compared to the prior study. We see no fluid collection within the soft tissues to indicate abscess formation. There is mild fatty atrophy of the musculature of the calf.

Output: Superficial soft tissue inflammation and other findings as described above, but no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell carcinoma follow up after treatment. There is interval decrease in size of the enhancing lesion in the left precuneus, which now measures up to 5 mm, previously 5 mm. Likewise, the associated mild confluent surrounding T2 hyperintensity is not significantly changed. The enhancing right inferior temporal gyrus lesion has also decreased in size, now measuring up to 3 mm, previously 3 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: No significant interval change in size of the left parietal and right temporal lobe metastases.


Instruction: Generate impression based on findings.

Input: 69-year-old male with a history of subtalar joint osteoarthritis presents with left ankle pain, evaluate for peroneal tendon pathology. Again seen is presumed posttraumatic deformity of the calcaneus as well as severe osteoarthritis of the subtalar joint and less severe osteoarthritic changes elsewhere in the ankle and foot, as described in the prior CT report. There is a small rounded focus of abnormal signal intensity within the distal fibula posteriorly that may represent a small cyst. Adjacent small focus of abnormal signal intensity in the soft tissues may represent extension of this cyst. The superior peroneal retinaculum is identified attaching to the fibula. Note is made of a prominent peroneal tubercle measuring just over 5 mm in depth.The peroneal tendons are appropriately situated posterior to the distal fibula. The peroneus longus tendon appears slightly enlarged suggesting mild tendinosis. There is also mild increased signal intensity within the peroneus brevis tendon as it courses beneath the fibular tip indicating mild tendinosis. There is perhaps trace fluid within the peroneal tendon sheath, which is not necessarily abnormal. However, there does appear to be surrounding tenosynovial thickening as the tendons course beneath the fibular tip suggesting a chronic tenosynovitis. The medial tendons appear intact. There is mild spurring of the attachment of the Achilles to the calcaneus, but the tendon appears normal. The anterior tendons are intact.The anterior talofibular and calcaneofibular ligaments appear normal. The posterior talofibular ligament appears thickened and heterogeneous which may reflect prior injury. The distal tibiofibular syndesmotic complex is intact. Loss of striations of the posterior deep tibiotalar ligament may reflect prior sprain. The sinus tarsus is predominantly fatty, which is normal. Diffuse subcutaneous edema about the ankle which extends along the dorsum of the foot

Output: 1. Posttraumatic deformity of the calcaneus with subtalar joint osteoarthritis comparable to that seen on the recent CT scan.2. Mild degenerative peroneal tendinosis and chronic appearing tenosynovial thickening without definite tear.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for pseudomeningiocele. CINE flow studies History: s/p chiari decompression with low pressure headache There is no evidence for ventriculomegaly.CSF flow appears to be disrupted at the level of the foramen magnum. The CSF at the foramen magnum is partially obliterated.The patient is status post chiari decompression with suboccipital craniectomy and posterior arch of C1 removal. There are postoperative changes present with local soft tissue swelling and minor patchy signal changes in the cerebellar tonsils.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 minor opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Chiari one malformation status post recent decompression. The CSF flow is diminished at the level of the foramen magnum.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mild mucosal thickening of the ethmoid sinuses. Small retention cysts are visualized in the right maxillary sinus.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The anterior cerebral arteries are unremarkable. There is subtle loss of signal involving the right inferior division of the middle cerebral artery and to a lesser degree the left middle cerebral artery, thought to be related to artifact as this is not a dedicated on MRA views. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.

Output: 1. MRI of the brain without contrast is negative for evidence of acute ischemia.2. MRA of the head without and MRA of the neck with contrast are negative for evidence of steno-occlusive disease.


Instruction: Generate impression based on findings.

Input: Clinical question: 70 year-old female with history of lumbosacral radicular pain. Signs and symptoms: Low-back pain radiating down to the left foot. Nonenhanced lumbar MRI:T11 -- T12 is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate left and mild right ligamentum flavum hypertrophy and minimal facet disease. No spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate mild to moderate disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy, mild bilateral widening of facet spaces with fluid signal intensity without significant hypertrophic changes and mild grade 1 anterolisthesis. Constellation of findings results in central spinal stenosis and lateral recess compromise bilaterally (left greater than right). No neural foraminal compromise. Examination also demonstrates a tiny synovial cyst on the left at this level (axial T2 series 7 image 19) projecting anterior to the left articulating facet and abutting the left ligamentum flavum. Tiny additional synovial cysts are also noted posterior to the dictating facets at this level (left greater than right).L5 -- S1 demonstrate mild degenerative disk disease, mild bilateral ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.Unremarkable paraspinal soft tissues.

Output: 1.Degenerative changes at L4 -- L5 and including mild grade 1 anterolisthesis results in central spinal stenosis and lateral recess compromise bilaterally (left greater than right). Bilateral facet effusion and multiple small synovial cysts as detailed above.2.Unremarkable nonenhanced MRI of the lumber spine otherwise.


Instruction: Generate impression based on findings.

Input: 51 year old female with weakness and cramps. Evaluate for myositis. RIGHT FEMUR:ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified.SOFT TISSUES: There is diffuse fatty infiltration/atrophy of the musculature of the entire imaged portions of the right thigh.ADDITIONAL

Output: There is diffuse fatty infiltration/atrophy of the musculature of the imaged portions of the thighs bilaterally. There are no findings to suggest acute inflammation/myositis.


Instruction: Generate impression based on findings.

Input: Reason: r/o foot path History: pain and swelling in right foot and right ankle since 6/15 following her hip surgery Right ankle:The tendons of the ankle appear intact. The ligaments of the ankle appear intact. Mild osteoarthritis affects the tibiotalar joint. There are rounded foci of signal abnormality within the distal fibula which may represent degenerative cysts or intraosseous ganglia. We see no large ankle joint effusion. Mild osteoarthritis affects the subtalar joint. There is mild edema type signal within the talus and calcaneus along the subtalar joint which may also be degenerative in etiology. Mild osteoarthritis also affects the midfoot with a subchondral cyst within the navicular bone. There is diffuse subcutaneous edema affecting the ankle.Right foot:There is edema of the subcutaneous fat along the dorsum of the foot. Mild osteoarthritis affects the Lisfranc joint, particularly affecting the first tarsometatarsal joint with a subchondral cyst within the base of the first metatarsal. Mild osteoarthritis affects the first MTP joint. The visualized tendons appear normal as does the musculature of the foot.

Output: 1. Superficial soft tissue swelling of the ankle and foot is nonspecific.2. Osteoarthritis of the ankle and foot as described above.


Instruction: Generate impression based on findings.

Input: Bilateral upper extremity weakness. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific T2 hyperintensity in the bilateral putamina and trace periventricular T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. There is mild diffuse cerebral volume loss. 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.Brachial Plexus: There are disc-osteophyte complexes at C3 through C7, with indentation upon the spinal cord at C3 though C6, but no evidence of abnormal spinal cord signal. The brachial plexus appears unremarkable bilaterally, without evidence of tumors. There is mild dextrosclerosis of centered in the upper thoracic spine. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable, aside from a mid thoracic hemangioma or focal fat. The paravertebral soft tissues are unremarkable. The thyroid gland appears to be mildly enlarged and heterogeneous.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Disc-osteophyte complexes at C3 through C7, with indentation upon the spinal cord at C3 though C6, but no evidence of abnormal spinal cord signal. Please refer to the recent cervical spine MRI report for additional details.3. The brachial plexus appears unremarkable bilaterally.4. The thyroid gland appears to be mildly enlarged and heterogeneous, which is nonspecific.


Instruction: Generate impression based on findings.

Input: 47-year-old presents with pain of the distal quadriceps tendon. MENISCI: We see no meniscal tear.ARTICULAR CARTILAGE AND BONE: There is mild to moderate predominantly superficial degeneration of the articular cartilage of the patella along both the medial and lateral facets.There is thinning of the articular cartilage of the weightbearing surface of the medial femoral condyle anterior to the posterior horn of the medial meniscus with focal delamination of the cartilage just above the free edge of the meniscus.There is also superficial degeneration of the articular cartilage of the weightbearing portion of the medial tibial plateau.Increased signal intensity of the articular cartilage of the lateral tibial plateau beneath the free edge of posterior horn of the lateral meniscus indicates focal degeneration.Bone marrow signal intensity is within normal limits. Note is made of small osteophytes.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is an incomplete tear of the quadriceps tendon that appears to predominantly involve the deep fibers (vastus intermedius). There is thickening and increased signal intensity in these distal deep fibers of the quadriceps tendon likely representing a combination of tendinosis and full-thickness insertional tearing with up to 2 cm of retraction.There is also a small tear of the medial component of the quadriceps tendon (consisting of the vastus medialis and vastus lateralis fibers) centrally with approximately 2 cm of retraction, although the majority of the vastus medialis and vastus lateralis tendons can be traced to their patellar insertions.There is a small focus of intermediate signal intensity in the distal fibers of the anterior component of the tendon (rectus femoris) which may represent focal tendinosis or tearing. Otherwise, however, the rectus femoris tendon appears intact.The patellar tendon appears intact.ADDITIONAL

Output: 1. Incomplete tear of the distal quadriceps tendon as described above, predominately involving the vastus intermedius.2. Osteoarthritis with tricompartmental cartilage degeneration.3. Small to moderate joint effusion.


Instruction: Generate impression based on findings.

Input: 61 year-old female with biopsy proven invasive lobular carcinoma in the right breast, presents for staging MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, there is an enhancing mass measuring 9 x 5 x 8 mm at posterior 9 o'clock position, consistent with a biopsy proven ILC. A marker clip is identified at lateral aspect of this mass.In the left breast at retroareolar region, benign appearing enhancing focus is present.No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal cancer in the right breast.2. Benign appearing enhancing focus in the left breast, for which follow up MRI in 6 months is recommended.3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Confusion, expressive aphasia. There is relatively symmetric cortically based mild restricted diffusion involving the bilateral parietal and occipital lobes and to a lesser degree frontal, and possibly temporal lobes with corresponding subtle T2/FLAIR signal hyperintensity. There is no evidence of restricted diffusion within the basal ganglia. There is additional patchy and confluent increased T2/FLAIR signal within the periventricular and subcortical white matter which is nonspecific but compatible with mild chronic small vessel ischemic changes. Susceptibility weighted images reveal several punctate foci of susceptibility artifact for example in the left frontal subcortical white matter, right paramedian right frontal lobe, and right parietal subcortical white matter in a nonspecific distribution and compatible with prior microhemorrhages.There is a punctate focus of enhancement involving the left precentral gyrus along the cortex. No additional pathological enhancement is identified. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Areas of bilateral cortical restricted diffusion, primarily in the parietal and occipital lobes. Differential considerations include infectious encephalitis, postictal state, metabolic encephalopathy, prion disease (although the overall distribution is somewhat atypical for CJD), and subacute cortical ischemia.2.Punctate focus of nonspecific enhancement involving the left precentral gyrus. Given cortical restricted diffusion, this may reflect component of subacute injury. Comparison with prior MRI would be helpful if available.3.Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Reason: Demyelinating disease; f/u progression History: paresthesias. MRI brain:Scattered supratentorial T2 hyperintensities are redemonstrated, with significantly decreased size of prominent right parietal and left temporal lesions. Enhancement of the right parietal lesion has resolved. There remains scattered gyriform and subcortical T2 hyperintensities in the bilateral frontal high convexities, right frontal centrum semiovale and right parietal lobe which are unchanged. Mildly prominent ventricles are unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. 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.MRI cervical spine:The vertebral column alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. Vertebral body heights are intact. Multilevel disc desiccation. No abnormal marrow signal. Mild posterior disc osteophyte complex at C6-C7, however no significant spinal canal or neural foraminal stenosis. No abnormal signal within the spinal cord. No abnormal enhancement.MRI thoracic spine:The vertebral column alignment is within normal limits. Vertebral body heights are intact. Disc spaces are preserved. No abnormal marrow signal. No significant spinal canal or neural foraminal stenosis. No abnormal signal within the spinal cord. No abnormal enhancement.

Output: 1.Significant decrease in size of right parietal and left temporal lobe demyelinating lesions seen on the prior exam with resolution of enhancement. Multiple persistent lesions are present without evidence of new lesions.2.Normal cervical and thoracic spine MRI.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, with lumbosacral radiculopathy at L5. Alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. The visualized distal spinal cord, conus and cauda equina are unremarkable.L1-2: Mild facet arthropathy with small facet joint cyst on the left. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. No interval changes. L4-5: Facet arthropathy and ligamentum flavum thickening. Mild loss of disc height and T2 signal. A right-sided subarticular disc protrusion is seen which effaces the right lateral recess and very likely impinges upon the descending right L5 nerve root. No significant interval change is seen in the size of this lesion. A mild generalized spinal canal narrowing is noted. The right neural foramen is moderately narrowed while the left remains patent. L5-S1: Facet arthropathy. Loss of disc height and T2 signal with mild disc bulging and a small central protrusion. No significant spinal canal or foraminal stenosis. No interval changes.

Output: 1.A right sided subarticular disc protrusion at L4-5 is unchanged relative to the prior examination. This lesion very likely impinges upon the descending right L5 nerve root.2.Relatively mild degenerative findings at other levels show no significant interval change.


Instruction: Generate impression based on findings.

Input: There has been interval appearance of at least three small enhancing nodular lesions along the right anterior temporal lobe and a single small enhancing lesion along the left anterior temporal lobe with surrounding FLAIR signal abnormality indicating vasogenic edema. The largest lesion in the tip of the right anterior lobe measures 8 x 9 mm (series 5, image 46). These findings are suspicious for metastatic lesions.There is unchanged underlying scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes. A left frontal developmental venous anomaly is again incidentally noted. There is no diffusion abnormality. No extra-axial fluid collection is identified. The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Again seen is a left maxillary sinus mucosal retention cyst.

Output: Interval appearance of multiple small enhancing masslike lesions in the right greater than left anterior temporal lobes with surrounding FLAIR signal abnormality indicating vasogenic edema. Differential considerations include radiation necrosis and metastases.


Instruction: Generate impression based on findings.

Input: 46-year-old with paresthesias. Evaluate for demyelinating disease. There is a single punctate focus of increased T2 signal in the right temporal lobe subcortical white matter. The remaining brain parenchyma is unremarkable.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Single punctate focus of increased T2/FLAIR signal in the right temporal lobe. This is nonspecific given the small size and singularity of the lesion.2. No evidence of acute ischemic or hemorrhagic lesion


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for prior strokes. Signs and symptoms: Dementia. Non-enhanced head CT:There is no detectable hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci, ventricular system and CSF cisterns remain all within normal patient stated age of 86. Very minute amount of periventricular low attenuation could represent minimal small vessel disease of indeterminate age. Entirely exclude a small vessel ischemic stroke as the cause for dementia recommend an MRI examination.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: Very minimal small vessel ischemic disease of indeterminate age is suspected. Examination is otherwise unremarkable for patient stated age of 86. MRI examination would significantly better assess the extent of small vessel disease.


Instruction: Generate impression based on findings.

Input: Low back pain. Patient with carcinosarcoma of the ovary status post secondary debulking with large retroperitoneal adenopathy extending from bifurcation to renal arteries, rule out invasion of spine. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L1 on L2 and L2 on L3. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. No abnormal enhancement within the spinal canal or neural foramina. No evidence of epidural or leptomeningeal tumor.Multilevel degenerative changes are seen with disc desiccation and height loss at multiple levels, including in the partially imaged lower thoracic spine. Individual levels in the lumbar spine as below:L1-L2: Mild disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with small central extrusion with suspected subligamentous inferior extension along the posterior aspect of the L3 vertebral body (sag T2 image 9). There is however no significant associated spinal canal or neural foraminal stenosis. L3-L4: Small central disc protrusion. No significant spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. There is moderate bilateral facet arthropathy.L5-S1: Disc desiccation with mild height loss; otherwise no significant disc disease. No spinal canal or neural foraminal stenosis. There is advanced bilateral facet arthropathy with partial ankylosis.Small disc calcifications and small posterior endplate osteophytes are better appreciated on prior CT. Retroperitoneal lymphadenopathy in the left periaortic region is noted and better assessed on prior CT study. Degenerative changes involving the bilateral sacroiliac joints are also noted.

Output: 1. There is left retroperitoneal para-aortic lymphadenopathy which is better assessed on prior CT study. There is no evidence of invasion into the lumbar spine.2. Multilevel degenerative changes in the lumbar spine as detailed above without significant spinal canal or neural foraminal stenosis at any level. There is a small disc extrusion which is suspected to originate from L2-L3 and extends inferiorly along the dorsal aspect of the L3 vertebral body. There is also facet arthropathy at L4-L5 and L5-S1 which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Neoplasm of uncertain behavior of cerebral meninges [D42.0], Reason for Study: ^Reason: L frontal atypical meningioma s/p resection and adjuvant radiation History: assess for extent of disease Redemonstration of the left frontal craniotomy with localized extra axial fluid collections, unchanged since prior scan.There is nodular and slightly linear enhancement at the surface of the left frontal lobe under the surgical resection site (series 1001, image 24/34) which likely represent postoperative changes or scar tissue, unchanged since prior scan.Scattered T2/FLAIR high signal intensity lesions on periventricular white matter indicating minimal non specific small vessel ischemic disease, unchanged.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on paranasal sinuses and retention cysts on bilateral maxillary sinuses are seen, slightly worse than prior.

Output: 1. No evidence of recurrence of previously resected tumor.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 9 year old with seizure. There is no evidence of intracranial hemorrhage or acute infarct. There is an unchanged patchy focus of T2 hyperintensity within the posterior limb of the left internal capsule that extends superiorly into the corona radiata, which measures up to 15 mm. The cerebellar tonsils extend approximately 3 mm inferior to the foramen magnum. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Unchanged lesion within the posterior limb of the left internal capsule that extends into the corona radiata.


Instruction: Generate impression based on findings.

Input: 53yo F w/ complicated rheum history, CKD, recurrent UTI and multiple hospitalizations with several months of AMS. Septic despite broad spectrum antibiotics. ?Tumor, autoimmune.Signs and Symptoms: AMS: confusion, word recall, weakness, emotional labilityComments: No contrast for this patient. | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is relatively low signal present within the visualized marrow elements of the cervical spine and calvarium and skull base.Exam is degraded due to motion artifact.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a minor opacity in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Examination is somewhat compromised due to patient motion. This may obscure subtle abnormalities.2.There is no evidence for acute ischemic cerebral infarction.3.The marrow signal is diffusely low. There is a nonspecific finding. This can be explained on the basis of anemia, lymphoproliferative disorder, chronic disease or renal osteodystrophy.


Instruction: Generate impression based on findings.

Input: Meningioma resection: surveillance. There are postoperative findings related to right frontal craniotomy with confluent high T2 signal in the white matter surrounding the resection cavity, but no evidence of gross tumor. There are unchanged nonspecific foci of high T2 signal in the bilateral globi pallidi. There is no evidence of acute infarct. There is a small developmental venous anomaly in the right superior frontal gyrus. 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 unchanged.

Output: Postoperative findings related to resection of a right frontal convexity meningioma, without evidence of gross residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Reason: h/o 12mm pancreatic cyst on OSH CT scan. Assess for stability History: h/o 12mm pancreatic cyst on OSH CT scan. Assess for stability ABDOMEN:LIVER, BILIARY TRACT: Nonenhancing subcentimeter T2 hyperintensities, likely cysts.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion within the pancreatic body measures 1.2 x 1.1 cm and communicates with a nondilated main pancreatic duct. No abnormal enhancement.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: Cystic lesion within the pancreatic body measuring up to 1.2 cm likely represents a sidebranch IPMN.