Instruction: Generate impression based on findings.

Input: Nasal mass, turbinate hypertrophy. There is a cystic lesion in the right nasolabial junction that measures 14 mm in diameter. There is narrowing of the inferior portion of the piriform sinus aperture. The nasal turbinates are intact. The paranasal sinuses and nasopharynx are unremarkable. There is a partially empty sella. The orbits are unremarkable.

Output: 1. Findings compatible with a right nasolabial cyst that measures 14 mm in diameter. 2. Nonspecific partially empty sella.


Instruction: Generate impression based on findings.

Input: Female, 80 years old, with chronic low back pain and sciatica. Grade 1 anterolisthesis is seen of L3 relative to L4, L4 relative to L5, and L5 relative to S1. Vertebral body heights are preserved. Degenerative endplate edema is seen at L4-5. Otherwise, no concerning marrow replacement or marrow edema is demonstrated.The visualized distal spinal cord and conus are within normal limits. The cauda equina nerve roots are discussed below.T12-L1: Facet arthropathy. Disc bulging. Mild spinal canal stenosis. Moderate bilateral foraminal narrowing.L1-2: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Marked facet arthropathy with facet effusion on the right. Ligamentum flavum thickening. Disc bulging. Mild spinal canal stenosis. Moderate bilateral foraminal narrowing. L3-4: Marked facet arthropathy. Ligamentum flavum thickening. Disc bulging with vacuum phenomena and a superimposed central superiorly directed extrusion. Severe spinal canal stenosis with effacement of CSF and crowding/impingement of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Marked facet arthropathy with bilateral effusions. Ligamentum flavum thickening. Disc bulging. Moderate spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. L5-S1: Marked facet arthropathy. Disc bulging and annular fissuring. Moderate spinal canal stenosis. Mild bilateral foraminal narrowing. Multiple bilateral renal cystic lesions are seen including a large cystic lesion in the right upper pole.

Output: Significant disc and posterior element degeneration is seen, particularly affecting L3-4 and L4-5 where there is significant spinal canal stenosis. Scattered mild-to-moderate foraminal narrowing is also demonstrated.


Instruction: Generate impression based on findings.

Input: History of poorly differentiated sinonasal carcinoma SNUC treated with CRT. There are postoperative findings related to sinonasal tumor excisional biopsy with resection of the left ostiomeatal complex and left middle and superior turbinates. There is no evidence of measurable sinonasal region tumor. There is persistent mucosal thickening and secretions that occupy the left sphenoid sinus. There is also persistent moderate mucosal thickening in the left maxillary sinus and mild mucosal thickening within the right maxillary, right sphenoid, left frontal, and right ethmoid sinuses. The parotid glands are unremarkable. There is encephalomalacia in the inferior right cerebellar hemisphere. There are also scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There are bilateral lens implants.

Output: 1. Post-treatment findings in the sinonasal region with persistent diffuse mucosal inflammatory changes, but no evidence of measurable tumor recurrence. 2. Chronic right inferior cerebellar infarct.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of brain, unspecifiedClinical question: Preop planning for meningioma resectionSigns and Symptoms: headaches There is an extra-axial mass adjacent to the right frontal lobe measuring 48 x 32 axial dimensions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is an extra-axial mass adjacent to the right frontal lobe. Most likely this represents a meningioma.2.This examination was performed for the purposes of stereotactic guidance for surgery. It is a limited exam


Instruction: Generate impression based on findings.

Input: Diffuse metastatic breast cancer, subacute left lower extremity weakness, diarrhea, but good rectal tone. There is evidence of diffuse osseous metastatic disease with signal abnormality involving multiple cervical, thoracic, and lumbar vertebrae. There is also mild involvement of the posterior elements at multiple levels. There is a compression fracture involving the T12 vertebral body with approximately 80% loss of height and no significant osseous retropulsion. Remainder of the vertebral body heights are maintained. There is no high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine to suggest cord compression or cauda equina compression. No significant neural foraminal stenosis in the lumbar spine is appreciated at any level. No obvious cord signal abnormality. There is mild spinal canal stenosis at the C3-C4 level on degenerative basis related to disc osteophyte complex and ligamentum flavum thickening.

Output: 1. Diffuse osseous metastatic disease with severe compression fracture involving the T12 vertebral body.2. No high-grade stenosis in the cervical, thoracic, or lumbar spine to suggest cord compression or cauda equina compression. 3. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 53-year-old female with left foot injury and pain for many years. Metallic susceptibility artifact related to the patient's orthopedic fixation of the first metatarsal limits evaluation. There are foci of signal void within the dorsal soft tissues about the first MTP joint likely postsurgical in etiology.TENDONS: The peroneal tendons appear intact. The flexor and extensor tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is subchondral cyst formation within the first metatarsal head and increased bone marrow signal abnormality about the first MTP joint, likely degenerative in etiology. Otherwise, no bone marrow signal abnormalities are identified. ADDITIONAL

Output: 1. Osteoarthritis of the foot as described above. 2. Subcentimeter focus of fluid signal intensity along the dorsal aspect of the base of the fifth metatarsal likely represents ganglion formation. 3. Postsurgical changes affecting the first metatarsal.


Instruction: Generate impression based on findings.

Input: 37 years Female (DOB:11/9/1978)Reason: eval for cervical spine disease History: cervical radiculopathy RUEPROVIDER/ATTENDING NAME: SACHIN DILIP SHAH SACHIN DILIP SHAH 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. There is a small focal central disc protrusion present at this level which effaces spinal fluid ventral to the spinal cord but not posterior the spinal cord.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor broad-based disc protrusion at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are some mild degenerative changes present in the cervical spine without significant compromise of the spinal canal and neural foramina are multiple central disc protrusions present cervical spine.


Instruction: Generate impression based on findings.

Input: Reason: Intact endometrial cancer. MRI for brachytherapy planning History: Vaginal bleeding PELVIS:UTERUS, ADNEXA: There is an arcuate uterus. The endometrium is mildly thickened, however no discrete lesion is identified. No parametrial or vaginal extension is identified.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mildly thickened endometrium without a discrete lesion identified. Please note that postcontrast images were not obtained due to low GFR.2.No pelvic lymphadenopathy.3.Arcuate uterus.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: s/p tumor resection History: s/p crani Post left frontal parietal craniotomy status with the resection of the left post central gyrus intra axial mass lesion.There are tissue defects on the left postcentral gyrus with surrounding minimal edema indicating post-resection status.There are multifocal scattered white matter T2/FLAIR high signal intensity lesions indicating non specific small vessel disease.There is no evidence of acute ischemic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post resection status of the left post central gyrus intra axial mass lesion, postoperative no unusual finding.2. No evidence of acute ischemic lesion on the scan.


Instruction: Generate impression based on findings.

Input: Male, 19 months old, with seizures. Follow-up white matter lesions in the posterior quadrant. Mild FLAIR hyperintensity is seen along the right occipital horn without obvious edema or mass effect. This finding has diminished in conspicuity when compared to the prior examination. Previously seen similar hyperintensity along the left occipital horn has resolved. A small focus of FLAIR hyperintensity within the right centrum semiovale is unchanged.No evidence of parenchymal edema or mass effect is seen. Brain parenchymal morphology is within normal limits. No definite structural abnormalities are seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Diffusion weighted images are within normal limits. Ventricular size and morphology are normal.The region of the pituitary is unremarkable. The brainstem and cerebellum are normally formed and intact. The corpus callosum is within normal limits. The pattern of white matter myelination is appropriate for age, and has matured when compared to the prior study. The mesial temporal lobe structures are symmetric and free of focal lesions.

Output: 1.No definite or specific lesions are seen which would account for the patient's seizures.2.FLAIR hyperintensity along the occipital horns as seen on the prior examination has diminished on the present study. This could simply represent maturation of the terminal zones of myelination. The possibility of mild superimposed gliosis, at least along the right occipital horn, could also be entertained. A small focus of nonspecific FLAIR signal abnormality in the right centrum semiovale may also represent minimal gliosis.


Instruction: Generate impression based on findings.

Input: Assess for hip osteoarthritis. Tiny right hip joint osteophytes indicate minimal osteoarthritis essentially within normal limits considering the patient's age. There is trace fluid seen in both hip joints but no frank effusion.We see no large fluid-filled articular cartilage defects, nor do we see any subchondral marrow signal abnormalities.There is abnormal signal intensity extending through the anterior labrum indicating a tear of questionable significance in this 77-year-old patient.Bone marrow signal intensity is within normal limits for age.There is mild muscular atrophy compatible with the patient's age. There is minimal edema within the anterior abductor musculature of both hips which is not necessarily of any clinical significance.The right sacroiliac joint appears normal. Mild degenerative arthritic changes affect the left sacroiliac joint. Mild degenerative arthritis also of the symphysis pubis.Severe degenerative disc disease affects the visualized lower lumbar spine, along with a scoliosis is incompletely imaged on this study. There is approximately 1 cm of leftward translation of L4 vertebral body relative to the L5 vertebral body.

Output: Severe degenerative disc disease of the visualized lower lumbar spine with minimal osteoarthritis of the right hip and left sacroiliac joint. Other findings as above.


Instruction: Generate impression based on findings.

Input: 71-year-old female with fatty infiltration of the pancreas, needs three-month follow-up. Enhancing lesion on prior CT, EUS negative ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are evident. The common bile duct measures 1.0 cm, which may be normal for age status post cholecystectomy. Mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant enhancement is seen within the neck of the gallbladder to correspond with lesion found on prior CT.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple nonenhancing bilateral renal cysts, some of which have intrinsic T1 signal, possibly hemorrhagic/mucinous. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No abnormal pancreatic enhancement to to correspond to findings on prior CT.


Instruction: Generate impression based on findings.

Input: 58-year-old female with two years history of left cheek swelling on 3 separate occasions. Swelling decreases with antibiotics. Patient has bony defect in the left maxillary sinus anterior wall in the region of intra-orbital foramina. Also asymmetric enlargement of the left infera-orbital canal along the roof of the left maxillary sinus with a small defect in orbital floor. Examination demonstrates soft tissue thickening anteriorly to the anterior wall of left maxillary sinus which appears to extend superiorly anterior to the body of the zygoma. There is also evidence of increased soft tissue density along the floor of the orbit lateral to the infraorbital nerve groove. There is also soft tissue thickening within the maxillary sinus immediately posterior to the anterior wall of the left maxillary sinus. Soft tissue prominence appears to extend slightly posteriorly and posterior laterally to the left maxillary sinus. Bony density of area of the exam demonstrates subtle suspected lytic changes of the left zygoma. There is also uniformly enlarged infraorbital nerve groove which is filled with soft tissue density which is contiguous with above described soft tissue changes. Considering provided clinical data the findings are suspicious for an infectious process. However possibility of a mass cannot be entirely ruled out particularly considering presence of expansion of infraorbital nerve groove (V2). Further evaluation with an MRI examination with infusion is recommended. The retro-orbital fat remains within normal limits. Extraocular musculature and globe remain within normal limits. No definitive abnormality of cavernous sinus or Meckel's cave on this exam is detected. Limited view of nasopharynx demonstrates no abnormality. Minimal chronic sinus disease of bilateral ethmoids is also present.

Output: Abnormal soft tissue within the left maxillary sinus, left orbit, left inter-temporalis fossa with associated bony changes of zygoma and anterior wall of the maxillary sinus as well as left infraorbital nerve groove as detailed. Follow-up been an MRI examination with infusion is highly recommended. Please see above comments.


Instruction: Generate impression based on findings.

Input: History of does Desmoid tumor. Evaluate for progression. ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense segment 7 focus demonstrating arterial enhancement without washout, unchanged. No additional focal liver lesion. Stable mild common bile duct prominence without a focal lesion or stone. Normally distended gallbladder.SPLEEN: The spleen measures 12.4 cm in craniocaudal length without a focal lesion.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: Mass centered in the small bowel mesentery measures 6.1 x 4.0 cm (series 22/376) compared to 6.2 x 3.5 cm previously. The mass encases the SMV and SMA which remain patent.BONES, SOFT TISSUES: Broad-based ventral hernias in the central and right abdomen without evidence of complication.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is lobular and enlarged containing multiple masses. A mass in the right uterine fundus measuring 6.9 x 3.6 cm has imaging features which are somewhat atypical for leiomyoma. The endometrial canal is thickened an heterogeneous with postcontrast enhancement. Nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in the small bowel mesentery mass which encases the SMA and SMV.2.Enlarged lobular uterus containing multiple masses most of which demonstrate signal characteristics typical of leiomyomata, however a right fundal mass is somewhat atypical (increased T2-weighted signal intensity restricted diffusion and lobular heterogeneous enhancement) and demonstrates gradual growth since 2013. 3.Also the endometrium/individual cavity is heterogeneously thickened with postcontrast enhancement, which may be seen in the proliferative phase of the menstrual cycle, however given the patient's age correlation clinically for endometrial pathology is recommended.


Instruction: Generate impression based on findings.

Input: 15 years, Male, pineal germinoma, now with hallucinations and shaking episodes. Evaluate mass and rule out other intracranial abnormality. Motion degradation mildly limits evaluation. A right frontal approach Ommaya catheter tip terminates at the foramen of Monro, unchanged. There is interval decreased size of a mixed cystic and solid mass within the pineal gland extending into the bilateral thalami, left greater than right, with the largest component measuring 1.8 x 1.2 cm (series 901, image 14), previously 2.0 x 2.0 cm on MRI June 12, 2015. The enhancing solid component extending along the medial aspect of the left thalamus is much reduced.There is persistent mass effect on the cerebral aqueduct and posterior aspect of the third ventricle. The lateral ventricles are mildly enlarged, but decreased in size compared to prior MRI June 12, 2015. A small defect is suggested along the floor of the third ventricle with T1 hypointense flow void (series 1301, image 6), suggesting patency of known endoscopic third ventriculostomy. There is no evidence of acute infarction. There is no intracranial hemorrhage. The remaining brain parenchyma is unremarkable. Bone marrow signal is within normal limits. There is no meningeal enhancement.

Output: 1.Compared to prior MRI 2/12/2015, there is decreased size of a mixed cystic and solid lesion within the pineal gland extending into the thalami, consistent with known germinoma. 2.Ventricular size decreased since MRI brain June 12, 2015, unchanged since CT head July 16, 2015, with suggestion of patent third ventriculostomy.3.Unchanged right frontal approach Ommaya catheter terminating in the foramen of Monro.


Instruction: Generate impression based on findings.

Input: There is a large infiltrating T2 hyperintense mass centered within the body of the corpus callosum extending to involve the cingulate gyrus and thalami bilaterally along the corticospinal tracts. The mass measures approximately up to 4.8 x 4.1 cm in the axial plane with moderate mass effect upon the body of the lateral ventricles. There is no hydrocephalus. There are multiple areas of peripheral enhancement and central necrosis. There are additional T2 hyperintense lesions demonstrating patchy enhancement within the right inferior frontal gyrus/precentral gyrus laterally as well as the left temporal lobe. Portions of the enhancing tissue demonstrate mild diffusion restriction and the majority of the lesions demonstrate markedly elevated relative cerebral blood volume. There is minimal susceptibility effect associated with the callosal lesion compatible with blood products.There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Large infiltrating necrotic mass centered within the callosal body with additional lesions in the right frontal and left temporal lobes. The appearance is most compatible with multifocal grade 4 astrocytoma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other headache syndromes(339.89)Clinical question: structural abnormalities?Signs and Symptoms: Headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cyst in the right maxillary sinus and some mucosal thickening in the left maxillary sinus is also some scattered opacities in the ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.MRI of the brain is within normal limits.2.Opacification of paranasal sinuses is nonspecific but most likely inflammatory in nature.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with history of glioma and growing lesion on a recent prior MRI scan. Assess for disease progression. Single voxel spectroscopy was performed on a region of progressive thickening and T2 signal abnormality within the right frontal periventricular white matter. The lesion spectrum is compared to a control spectrum obtained more posteriorly within the right frontal lobe from tissue which appears radiographically normal.The lesion spectrum demonstrates a reversal of the choline and NAA peaks, and when comparison is made to the control spectrum, the choline peak obtained from the lesion is indeed seen to be elevated relative to normal tissue.

Output: MR spectroscopic findings concerning for progressive tumor.


Instruction: Generate impression based on findings.

Input: 32 year-old female with headache rule out masses. There is no evidence of intracranial hemorrhage, mass or edema. There is suspected crowding at the foramen magnum as there is lack of visualization of the subarachnoid space. This may be due to patient positioning for the exam or Chiari malformation. MRI is recommended for further evaluation of the intracranial structures at this level. There is no visualization of the sulci, however, the gray-white junction remains distinct. Ventricular volumes are small but this may be normal for the patient's age. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Suspected crowding at the foramen magnum may be due to patient positioning or Chiari malformation. Further evaluation with MRI is recommended to further define intracranial structures at this level. 2. Etiology of patient's headache may be due to pseudotumor cerebri, clinical correlation advised.


Instruction: Generate impression based on findings.

Input: Again seen are postoperative changes related to resection of two right parietal meningiomas. Compared to 6/26/2015, there is been decrease in size of the resection cavity in the right paramedian parietal region. More inferiorly irregular areas of enhancement in the right parieto-occipital region and are not significantly changed. Unchanged nodular areas of enhancement along the right parietal convexity. No new or enlarging mass is seen to suggest tumor recurrence. Minimal parieto-occipital extra-axial collection is again seen. Chronic segmental occlusion of the posterior superior sagittal sinus is again seen with patency more anteriorly and posteriorly.The T2/FLAIR signal abnormality within the brain parenchyma surrounding all of these areas is similar to prior study. The remaining brain parenchyma is otherwise unremarkable. There are no other intracranial lesions identified.

Output: Compared to 6/26/2015, there is evolution of postsurgical changes related to resection of two right parietal meningiomas. Minimal areas of nodular dural thickening and enhancement in the right parieto-occipital region have not significantly changed. No findings to definitively suggest tumor recurrence.


Instruction: Generate impression based on findings.

Input: Right hip pain, possible labral tear ACETABULAR LABRUM: There appears to be loss of labral tissue along the anterior superior acetabular rim from the 1:00 to 2:00 position which is likely the result of chronic attritional tearing. The posterior labrum is normal.ARTICULAR CARTILAGE AND BONE: There is no focal fluid-filled articular cartilage defect. There is slight prominence of the anterior femoral head-neck junction with a borderline elevated alpha angle between 50 and 55 degrees. There is no abnormal bone marrow signal within the pelvis or right hip.SOFT TISSUES: There is mild peritrochanteric inflammation, left greater than right, which is not necessarily of any clinical significance and can be seen in asymptomatic patients. There is mild gadolinium extravasation amidst the anterior hip musculature but otherwise the musculature appears normal.ADDITIONAL

Output: Loss of labral tissue along the anterior superior acetabular rim suggesting chronic attritional tearing. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other disorders of meninges, not elsewhere classifiedClinical question: biopsy of cervical massSigns and Symptoms: RUE weakness/numbness Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the prevertebral lesion. Following needle removal images were obtained that demonstrate no complications.

Output: 1.T4 prevertebral and paravertebral biopsy and aspiration. Purulent material was aspirated. Biopsies were also obtained. 2.Touch preps from each specimen were obtained and analyzed by cytopathologist who was present throughout the procedure. They suggested this represents inflammation with possible granuloma.


Instruction: Generate impression based on findings.

Input: 70 year old with history of prostate cancer, hypertension and known aortic root dilation presenting for evaluation of aortic root prior to surgery. Left VentricleThe left ventricle is mildy dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 117 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 174 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 76 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and is trileaflet. There is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mild mitral valve prolapse of the posterior leaflet without significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root and ascending aorta are dilated. The measurements are:Sinus of Valsalva: 51x54x51mmST Junction: 41mm x 42mmAscending Aorta: 40x41mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Significant aortic root and mild ascending aorta dilation, as measured above.2. Mild mitral valve prolapse without significant mitral valve regurgitation.3. Mild LV dilation with normal systolic function (LVEF 56%). No evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 56%).


Instruction: Generate impression based on findings.

Input: Clinical question: History of a smoldering multiple myeloma. Evaluate for myelomatous lesions. Signs and symptoms: Most recent bone marrow with 30% plasma cells; 2 Right iliac lucencies seen on CT. Pre and post enhanced cervical MRI:Examination demonstrates a focus of T2 STIR hyperintensity measuring at 7 x 8 mm (sagittal T2 STIR series 501 image 12) with enhancement in the right lateral mass of C1 which considering patient's history of multiple myeloma possibility of a myelomatous infiltrate should be considered. The signal intensity and the anatomical alignment of vertebral column is otherwise unremarkable and without detectable abnormal enhancement.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes with resultant moderate left neural foraminal compromise and no central spinal stenosis.C4-C5 demonstrate moderate disc disease, loss of disc height, moderate right and mild left facet and ligamentum flavum hypertrophy. There is resultant significant right neural foraminal compromise and mild to moderate on the left and no central spinal stenosis.C5-C6 demonstrate disc disease and moderate bilateral ligamentum flavum hypertrophy with mild facet disease. There is a small right paramedian disc/osteophyte complex which is in contact and mildly flattens the ventral aspect of the cord on the right without central spinal stenosis or neural foraminal compromise.C6-C7 demonstrate mild disc disease, mild bilateral facet and moderate bilateral ligamentum flavum hypertrophy. No central spinal stenosis however mild bilateral neural foraminal compromise is present.C7-T1 is unremarkable.Pre and post enhanced thoracic MRI:There is normal anatomical alignment of vertebral column.Examination demonstrates no detectable foci of abnormal signal intensity or enhancement to suggest presence of myelomatous infiltrate.Degenerative disc disease at T11-T12 and including the tiny enhancing Schmorl's node along the inferior endplate of T11 is noted.There is normal signal intensity and caliber of the thoracic cord without abnormal enhancement.There is no evidence of spinal stenosis at any level. There is no clinically significant neural foraminal compromise at any level.There is no detectable. Spinal soft tissue abnormalities.Pre- and post enhanced lumbar MRI:Examination demonstrates no detectable foci of abnormal signal intensity or enhancement of the vertebral column to suggest metastatic myelomatous disease.There is normal anatomical alignment of vertebral column.There is mild to moderate disc disease and hypertrophic changes of posterior elements however without evidence of central spinal stenosis at any level. There is also no evidence of clinically significant neural foraminal compromise.Unremarkable perispinal soft tissues.Normal signal intensity, caliber and morphology of conus and the cauda equina without detectable abnormal enhancement.

Output: 1.MRI of cervical spine demonstrate a single 7 x 8 mm focus of T2Stir hyperintensity with enhancement in the right lateral mass of C1 as detailed. This finding is nonspecific however considering patient's history of multiple myeloma possibility of metastatic lesion should be considered and follow-up is recommended. Degenerative changes of cervical spine with resultant mild central spinal stenosis without evidence of central spinal stenosis. There is however multilevel neural foraminal compromise (some significantly) as detailed per level above. Normal signal intensity of the cord and without abnormal enhancement.2.MRI of thoracic spine demonstrate no detectable metastatic multiple myeloma. Normal signal intensity and caliber of the cord without abnormal enhancement. No spinal stenosis or neural foraminal compromise at any level. Degenerative changes and including a tiny Schmorl's node along the inferior endplate of T11 as detailed above.3.MRI of the lumbosacral spine demonstrate no detectable metastatic disease. Mild degenerative changes of lumbar spine without spinal stenosis or neural foraminal compromise. No detectable abnormal signal or enhancement of the conus or the cauda equina.


Instruction: Generate impression based on findings.

Input: Cerebrospinal fluid leak [G96.0]. Possible meningocele. Patient presented with CSF rhinorrhea on the left and has a history of remote left sinus surgery. There is a low T2 signal likely enhancing extra-axial 1.1 x 0.9 cm mass overlying the left parietal lobe near the vertex with a small dural tail most consistent with meningioma (series 4 image 175). No additional enhancing intracranial masses are identified. There is no significant intracranial mass effect or hydrocephalus.The left cribriform plate dehiscence was better visualized on prior CT. However, a small amount of fluid is again illustrated in the left olfactory recess. No gross brain herniation is seen, though this limited postoperative examination is not optimized for detection of such findings. The defect in the right tegmen was better seen on prior CT as well. There is again with partial filling of the right mastoid air cells and upper right middle ear cavity with fluid signal. Postoperative findings related to partial ethmoidectomy and uncinectomy bilaterally are again noted. Bilateral Haller cells are redemonstrated. The left Haller cells again demonstrates mild mucosal thickening and secretions. There is also mild mucosal thickening of the maxillary sinuses and a small retention cysts in the left maxillary sinuses.

Output: 1. Defect in the left cribriform plate was better assessed on prior CT. However, fluid signal in the left olfactory recess is again suggestive of cerebrospinal fluid leakage at this location. No gross brain parenchymal herniation is suspected. 2. Defect in the right tegmen with partial opacification of the right mastoid air cells and upper right middle ear cavity, also better seen on prior CT, which may represent an additional site of potential CSF leakage. 3. Postoperative findings related to partial ethmoid sinus resection and resection of the medial walls of the bilateral maxillary sinuses, unchanged and better seen on prior CT.4. 1.1 cm extra-axial mass overlying the left parietal lobe near the vertex likely relates to a meningioma. No significant intracranial mass effect. Correlation with outside imaging may be beneficial.


Instruction: Generate impression based on findings.

Input: Status post OLT with increasing LFTs and dilatation of common bile duct seen on sonography ABDOMEN:LIVER, BILIARY TRACT: Marked extrahepatic and moderate intrahepatic biliary duct dilatation. Common bile duct measures up to 1.5 cm, at midportion, at this level also somewhat kinked in appearance and beyond this point tapers to 0.9 cm, however duct remains widely patent. No intraluminal signal void seen to suggest choledocholithiasis. Patent portal veins, splenic vein and SMV. Visualized hepatic arteries patent.SPLEEN: No significant abnormality noted.PANCREAS: Mildly prominent pancreatic duct but within normal limits.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal T2 hyperintense foci, most likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES, OTHER: Small right pleural effusion. Mild cardiomegaly.

Output: 1. Moderate to marked biliary ductal dilatation as above, with common bile duct measuring 1.5 cm at midportion and tapering to 0.9 cm til level of ampulla, no obstructing lesion delineated, findings may be related to a benign distal stricture, correlation with patient's history/laboratory values and further evaluation with ERCP recommended. No evidence of choledocholithiasis. 2. Small right pleural effusion.


Instruction: Generate impression based on findings.

Input: 46 years, Female, Reason: history of Bosniak II right renal cyst, please evaluate characteristics and change from previous exam History: see above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions. Hepatic vasculature are patent.SPLEEN: Small splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Pedunculated right renal cyst is slightly decreased in size measuring 5.0 x 3.3 cm (3/19), previously 5.3 x 2.6 cm. There is thin peripheral enhancement with a nonenhancing thin septation. No solid enhancing components.The renal parenchyma is otherwise unremarkable. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimally complex right renal cyst is slightly decreased in size. Continued follow up is recommended.


Instruction: Generate impression based on findings.

Input: 48-year-old female with left knee pain and clicking. Evaluate for meniscal tear. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus. There is increased signal abnormality and blunting/deformity of the free edge of the body of the medial meniscus which appears to extend to the femoral articular surface, which has an irregular contour, consistent with degenerative tearing. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal near full-thickness articular cartilage degeneration along the medial femoral condyle with underlying bone marrow edema type signal abnormality. There is also focal full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle overlying the body and posterior horn of the medial meniscus.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: Tearing of the medial meniscus and articular cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Pain greater than 90 ROTATOR CUFF: Full thickness tear of the distal supraspinatus tendon, without tendon retraction or muscle atrophy. Tendinosis of the infraspinatus, without muscle atrophy. The remaining muscles and tendons of the rotator cuff appear normal.SUPRASPINATUS OUTLET: Small amount of fluid in the subacromial bursa. Otherwise, no significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Full thickness tear of the supraspinatus tendon, without retraction.


Instruction: Generate impression based on findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: New onset seizure, concern for organic process History: New onset seizure No evidence of acute ischemic or hemorrhagic lesion.Myelination pattern appears to be normal.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, 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: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Patient is a 48-year-old female with newly diagnosed left breast cancer with metastatic left axillary lymph node. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left breast, approximately 1:00 location, posterior depth, there is a enhancing mass with irregular margin measuring 1.9 x 1.8 x 3.2 cm. A signal void is identified in the central aspect of this mass and is compatible with recent biopsy. The mass is close to the chest wall without definite involvement of the pectoralis muscle. No additional suspicious enhancement is seen in either breast. There is a 1.5 x 0.7 cm enlarged lymph node with cortical thickening in the left axilla. Signal void in this enlarged lymph node is consistent with the biopsy clip. No abnormal lymph nodes are identified in the right axillary region.

Output: Unifocal malignancy in the posterior left breast with metastatic left axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Low back pain/facet, (unclear wording). Nonenhanced CT of the lumber spine:Axial 3 mm CT images of the entire lumbosacral spine with zero degree angulation of the gantry were attained. Sagittal and coronal 2-D reformatted images were also obtained.A bony density of vertebral column and its alignment is within normal limits. There is no evidence of bony central canal stenosis is detected. Note should be made that CT examination is insensitive for evaluation of intra-canalicular soft tissues of disk and the cord ligamentum flavum. Precise assessment for central spinal stenosis is not possible on CT of lumber spine.Minimal degenerative disk disease in the lower lumbar spine is noted. There is minimal degenerative changes of posterior elements in the lower lumbar spine is identified. There is no significant hypertrophic changes of facets and no evidence for widening of the facet spaces are detected. Although not sensitive on this examination there is no detectable neural foramina compromise. Mild bulge of disk material at L3 -- L4 and L4 -- L5 levels are noted. Perispinal soft tissues are unremarkable.Examination at the level of sacrum demonstrate degenerative changes of SI joints bilaterally with vacuum phenomenon.MRI examination is significantly more sensitive for detection of degenerative changes.

Output: 1.Minimal degenerative changes of disk and posterior elements in the lower lumbar spine. There is however no evidence of any significant degenerative changes of disk or posterior elements. No significant hypertrophic changes of the facets or widening of the spaces is detected.2.No evidence of central spinal stenosis or neural foramina compromise at any level. This exam is insensitive for precise evaluation.3.Degenerative changes of the SI joints bilaterally with vacuum phenomenon. No bony sclerotic changes.4.MRI is significantly more sensitive for detection of subtle findings.


Instruction: Generate impression based on findings.

Input: Unable to run, possible gastrocnemius tear There is a small focus of edema within the medial fibers of the soleus muscle at the level of the mid leg with a mild amount of edema within the overlying fascia. There is no hematoma or evidence of muscle retraction. There is no abnormal signal intensity in either the medial or lateral head of the gastrocnemius and the remaining leg musculature is also normal in signal intensity.A tiny focus of increased signal intensity is noted in the distal Achilles which may represent a small area of focal degeneration but this is not necessarily of any clinical significance. There is a small amount of fluid within the knee joint which extends posteriorly into a small Baker's cyst. The marrow signal intensity of the tibia and fibula is normal.

Output: Focal edema within the soleus muscle and overlying fascia suggesting a mild myofascial strain injury.


Instruction: Generate impression based on findings.

Input: Left trigeminal neuralgia. A venous structure appears to abut and perhaps mildly indent the superolateral aspect of the cisternal segment of the left trigeminal nerve. The cavernous sinuses and Meckel caves appear to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal nonspecific cerebral white matter T2 hyperintense foci. 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 arterial flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Potential venous vascular loop syndrome affecting the left trigeminal nerve cisternal segment. Otherwise, no evidence of intracranial mass lesions.


Instruction: Generate impression based on findings.

Input: Status post fall. Questionable loss of consciousness. Please evaluate. Positive headache. There is no evidence of intracranial hemorrhage, mass effect, edema or midline shift. Areas of hypodensity in the left superior frontal gyrus are unlikely related to the patient's trauma and may represent volume averaging. The cerebellar tonsils are low lying and appear at the level of the foramen magnum. Further imaging, such as with an MRI, is recommended.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal without evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No intracranial hemorrhage or calvarial fracture. There is an area of hypodensity in the left superior frontal gyrus and the cerebellar tonsils are low-lying. MRI imaging is recommended as clinically indicated.These findings were discussed with Dr. Paik at the time of interpretation.


Instruction: Generate impression based on findings.

Input: History of cholangiocarcinoma, status post chemotherapy and TARE, now with bilirubin of 8. Evaluate for cholangiocarcinoma recurrence and dominant biliary obstruction. ABDOMEN:Scattered artifacts throughout the exam are noted due to patient motion and ascites.LIVER, BILIARY TRACT: Liver with nodular cirrhotic contour and moderate ascites. A dominant mass at the hepatic dome measuring 8.4 x 6.4 cm is stable or slightly decreased in size compared to the 2/2/2016 CT exam. The mass is again located at the confluence of the hepatic veins and extends inferomedially into the caudate lobe. There is mild intralesional amorphous enhancement, however majority of the lesion is nonenhancing. Biliary ductal dilatation has increased in the interval. At the level of the hepatic hilum, portal venous branches are narrowed, and occlusion of the right anterior portal vein cannot be excluded.SPLEEN: Stable splenomegaly.PANCREAS: Stable pancreatic atrophy.Imaging before and after administration of secretin demonstrate pancreatic ductal diameter increase at least 1 mm, indicating satisfactory ductal compliance. Increased duodenal distention indicates appropriate exocrine response. Motion artifacts limit the evaluation of side branch dilatation for the body and tail, which limits the exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical changes of a cholecystectomy, distal gastrectomy, presumed gastrojejunostomy, and a blind-ending duodenal stump abutting the hepatic hilum are better appreciated on the 2/2/2016 CT exam. Suboptimal evaluation of the GI tract due to motion artifacts. BONES, SOFT TISSUES: Multiple osseous hemangiomas, unchanged.OTHER: New small right pleural effusion.

Output: 1.Central hepatic dome mass is grossly stable in size. There is worsening intrahepatic biliary ductal dilatation, mild amorphous intralesional contrast enhancement, and narrowing of the central portal venous branches. Occlusion of the right anterior portal vein cannot be excluded. A small right pleural effusion is also new. Given the extensive artifacts related to patient motion and ascites, follow-up imaging with CT should be considered.2.Cirrhotic liver morphology with splenomegaly and ascites compatible with portal hypertension.3.Surgical changes of the upper GI tract.


Instruction: Generate impression based on findings.

Input: Study is degraded by metallic artifact of the patient's braces that limits the evaluation on certain sequences. The right frontal epidural abscess that was noted on prior studies is completely resolved and the area appears unchanged including sequelae of frontal craniotomy. The right paramedian occipital abscess that was seen on prior exams has also completely resolved with only a layer of granulation tissue remaining. The right parietal abscess that was seen on previous studies is also resolved.The ventricular size is normal. The basal cisterns are patent. There is no midline shift. No bleed, mass effect, or edema.Frontal sinuses remain obliterated, likely due to surgery.

Output: Resolution of previously seen multifocal abscesses along the right occipital, right parietal, and right frontal lobes. No new collections are seen. No parenchymal abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Right hip pain Single AP view of the pelvis reveals marked sclerosis in the right femoral head representing avascular necrosis. The left hip does not demonstrate definite avascular necrosis. A MRI exam would be helpful.

Output: Marked sclerosis of avascular necrosis in the right hip


Instruction: Generate impression based on findings.

Input: Male; 73 years old. Reason: 73yo w/ETOH cirrhosis, decompensated with tbili >25. Requesting MRCP for further eval History: jaundice Lack of intravenous contrast limits sensitivity for subtle organ pathology. Moderate motion artifact limits multiple sequences. Pleural effusions and ascites causing dielectric artifact limits multiple sequences. As a result of these artifacts, the examination is overall very limited.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular surface contour and widened fissures. Evaluation limited for focal hepatic lesions. Evaluation limited for biliary ductal dilation. Cholelithiasis. Nonspecific gallbladder wall thickening, which may be related to generalized ascites.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter T2 bright renal lesions, most likely due to cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild body wall anasarca. Bilateral gynecomastia.OTHER: Very large right pleural effusion and small left pleural effusion. Large amount of abdominopelvic ascites.

Output: 1. Cirrhotic liver morphology with sequela of portal hypertension including splenomegaly and large amount of abdominopelvic ascites.2. Very large right pleural effusion.3. Very limited examination as detailed above, including for focal hepatic lesions and biliary ductal dilation. For future studies, consider thoracentesis and/or paracentesis before MRI.


Instruction: Generate impression based on findings.

Input: 65 years Female (DOB:2/18/1951)Reason: preop planning for skull/brain lesion removal. History: preop evalPROVIDER/ATTENDING NAME: BAKHTIAR D. YAMINI BAKHTIAR D. YAMINI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an enhancing lesion present along the left parietal calvarium with heterogeneous T2 signal.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Lytic lesions in the left parietal calvarium. 2.Please note that this examination was obtained for stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Post resection of meningioma follow up. There is no evidence of acute ischemic or hemorrhagic lesion.There is evidence of right frontotemporal craniotomy with thickening of the underlying dura. On post gadolinium enhanced the scan, the right shows a thick enhancement however the pattern of enhancement and thickness of the dura do not show any significant interval change since prior scan.There is no discrete masslike enhancement on the scan either.Right inferior frontal and temporal lobe anterior aspect shows high signal intensity with encephalomalacia seen on FLAIR imaging indicating postoperative changes, again no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable except extraocular changes of the right lateral ventricle temporal horn. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Right frontal temporal craniotomy with tumor resection status and postoperative changes as described above, no change since prior scan.No evidence of residual or recurrent tumor on this scan.


Instruction: Generate impression based on findings.

Input: Band like thoracic pain, constant, course with breathing. Evaluate for spinal metastasis or compression fracture. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. Degenerative changes are noted at the C5-6 level with a disc osteophyte complex with associated anterior effacement of the thecal sac but there is no significant compromise of the spinal cord. There are mild disc bulges scattered elsewhere within the thoracic spine. A partial empty sella is incidentally noted.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Ovarian cancer and renal cell cancer ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense foci throughout the liver, similar in distribution/size to CT 1/26/2011, and likely benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right partial nephrectomy.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral oophorectomy. No evidence of recurrent tumor.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall.

Output: Postsurgical changes without evidence of recurrent or residual disease.


Instruction: Generate impression based on findings.

Input: History of autoimmune pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. The previously described peripheral filling defect in the mid common bile duct is less discernible on today's study where there appears to be mild stricturing of the common bile duct.There is also stricturing of the proximal common hepatic duct extending to Klatskin's point with associated intrahepatic biliary ductal dilatation, unchanged.No discrete lesion is evident.SPLEEN: No significant abnormality noted. Small caliber splenic vein with gastroepiploic collateral vessel formation.PANCREAS: Mild thickening of the pancreatic tail is similar to the prior study with a thin hypoenhancing rim, compatible with history of autoimmune pancreatitis. No peripancreatic fluid collection or inflammatory changes. The main pancreatic duct is not significantly dilated. On MRCP images it demonstrates irregular narrowing and dilatation with side branch ectasia.Small cystic lesion of the pancreatic head is unchanged and likely represents a sidebranch IPMN measuring 6 cm without suspicious imaging features.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.Decreased prominence of the peripheral filling defect in the mid common bile duct where there is a mild stricture. Unchanged appearance of the stricture involving Klatskin's point and associated intrahepatic biliary ductal dilatation. No discrete lesion is identified. Findings are compatible with history of autoimmune sclerosing cholangiopancreatitis. 2.Mild thickening of the pancreatic tail without evidence of acute inflammation, similar to prior study. Irregularly narrowed non-dilated main pancreatic duct with side-branch ectasia unchanged.3.Stable 6 mm pancreatic head probable side-branch IPMN.


Instruction: Generate impression based on findings.

Input: 4-year-old male with right forearm mass, biopsy revealed Plexiform Schwannoma. Evaluate for progression.EXAMINATION: MRI right forearm with and without intravenous contrast 12/9/2016 8:17 Lobular mildly enhancing mass is present in the right forearm occupying the anterior, lateral and posterior compartments. The mass has increased in size and now measures 5.8 cm (AP) x 3.9 cm (ML) x 13.7 cm (CC) (series 1201, image 14; series 1301, image 10), previously 4.2 cm (AP) x 2.8 cm (ML) x 11.8 cm (CC). The mass demonstrates slightly increased T1 signal intensity relative to skeletal muscle and hyperintense T2/STIR signal. The mass abuts the cortex of the radius and interosseous membrane with focal disruption of the cortex of the radius similar to prior (series 1201, image 21). Bone marrow signal intensity of the radius and ulna are normal. The mass displaces the adjacent tendinous and vascular structures.

Output: Increasing size of biopsy proven plexiform schwannoma.


Instruction: Generate impression based on findings.

Input: Low back pain positive straight leg raise. There is prominent right L5-S1 facet hypertrophy and ligamentum flavum thickening, which indent the right neural foraminal nerve roots. There is mild facet hypertrophy on the left side of L5-S1 and bilaterally at L4-5, with slight level neural foraminal narrowing at this level. Otherwise, there are no significant disc bulges or herniations. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no evidence of tumor in the lumbar spine. The paravertebral soft tissues are unremarkable.

Output: Prominent right L5-S1 facet hypertrophy and ligamentum flavum thickening, which indent the right neural foraminal nerve roots.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, syrinx and tethered cord, six-month follow-up Extensive postoperative findings are again seen in the lumbar spine related to lipomyelomeningocele repair and cord detethering. Syringohydromyelia of the distal spinal cord spanning from approximately T12 to L2 is unchanged in caliber and extent. At its widest point it measures approximately 5 x 3 mm.The distal spinal cord remains closely apposed to the posterior aspect of the spinal canal where it splays and tapers, ultimately becoming indistinguishable from the posterior canal wall. No change in cord position is seen on prone imaging.The distal lumbar spinal canal is ectatic. Partial fusion of the posterior aspects of the L4 and L5 vertebral bodies is again seen.There is prominence of the thoracic kyphosis which can be better assessed with standing radiographs. Vertebral body heights are preserved. No marrow replacement or marrow edema is detected. Again seen are mild degenerative changes including a left paracentral disc extrusion at the T12-L1 level and to a milder degree at the T11-T12 level which are present previously.Again seen is marked fatty atrophy of the lower lumbar paraspinal musculature.

Output: 1.Stable small syrinx involving the distal spinal cord.2.No significant change in position of the distal cord which does not demonstrate ventral motion on the prone sequence and may represent re-tethering in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: facial numbness, possible stroke No evidence of acute ischemic or hemorrhagic lesion.The right mastoid shows fluid collection which could imply possible mastoiditis. If clinically indicated, ENT consultation and dedicated temporal bone CT scan can be considered for further evaluation.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate segmental signal loss on bilateral paraclinoid segments and proximal left MCA M1 segment on MIP images. Source image review shows linear signal void lesions were seen within the lumen which degraded MIP signal. These linear signal loss likely represent flow artifacts but may represent segmental intra luminal filling defects such as luminal irregularity or intra luminal blood clots. Thus, if clinically indicated, CT angiography can be considered for further anatomical evaluation. The proximal left MCA M1 segment lesion could represent early development of sickle cell disease related moyamoya syndrome, thus follow up MRA is recommended.Otherwise, vertebrobasilar system appears to be normal, bilateral PCAs are fetal origin, Acom artery is patent and bilateral ACAs and right MCA appear to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Likely represent artifacts for bilateral paraclinoid ICAs' segmental signal decrease. Anatomical vascular imaging such as CTA can be considered if clinically indicated.3. Subtle luminal narrowing of the left MCA proximal portion which may indicate early development of the Moyamoya syndrome, thus follow up MRA is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: 60-year-old with history of lung cancer and headache. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.There is degradation of images due to motion artifact. This precludes precise assessment for detection of very subtle abnormal enhancement.Within this limitation there is normal anatomical development and morphology of brain and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease. Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: Unremarkable pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Male, 10 years old, with autism and concern for epilepsy. A cystic lesion is evident along the superior aspect of the mid left hippocampal body which follows CSF signal on all sequences. This lesion exerts some degree of mass effect upon the underlying hippocampus which is slightly flattened as a result. The lesion does not appear to arise from the hippocampus, but instead may be intraventricular in origin, possibly related to the choroid plexus.Brain parenchymal morphology is otherwise within normal limits. No evidence of edema or mass effect is seen. No structural abnormalities or evidence of dysplasia or migrational abnormality are noted. There is no significant parenchymal edema. No evidence of intracranial hemorrhage is seen. The ventricles are unremarkable. The mesial temporal lobes are otherwise unremarkable.

Output: A cystic lesion is evident centered along the superior aspect of the mid left hippocampal body. This lesion is too far posterior to represent a choroidal fissure cyst, and the location and orientation are not appropriate for a hippocampal sulcus remnant cyst. Instead, it appears that the lesion may be intraventricular in origin, possibly representing an arachnoid cyst or a choroid plexus cyst.


Instruction: Generate impression based on findings.

Input: Reason: MS. f/u progression History: paresthesias Numerous supratentorial T2 hyperintense lesions throughout the periventricular white matter, including pericallosal lesions and scattered subcortical lesions, with a single new lesion in the left anterior temporal lobe (series 601, image 38). The remaining lesions are unchanged. T1 hypointense lesions again seen Associated mild to moderate diffuse volume loss is unchanged. Major cerebral flow voids are intact. The skull, paranasal sinuses and scalp soft tissues are unremarkable.

Output: Extensive demyelinating lesions with a single new lesion in the left anterior temporal lobe compared to 8/22/2014.


Instruction: Generate impression based on findings.

Input: 1-year-old female with history of poor feeding and syringomyelia. Evaluate for hydronephrosis. KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 1  Length*** Right: 7.2 cm Left: 6.5 cm   Mean for age: 6 cm  Range for age: 5 - 7.75 cmADDITIONAL OBSERVATIONS: None

Output: Mild/grade 1 pelvicalyceal dilation on the left, without additional abnormality.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning.Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on findings.

Input: Reason: R/O Tear History: Right knee pain MENISCI: There is a complex tear of the posterior horn of the medial meniscus with a radial component. There is associated medial extrusion of the body of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing portion of the medial femoral condyle and medial tibial plateau with underlying degenerative subchondral signal abnormality. There is relative sparing of the lateral tibiofemoral compartment articular cartilage. There is superficial fraying of the articular cartilage along the lateral facet of the patella. There is a linear focus of low signal abnormality within the femoral trochlea, centrally, consistent with an articular cartilage cleft. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus with extrusion of the body of the medial meniscus.2. Moderate-sized joint effusion.3. Osteoarthritis of the right knee with articular cartilage degeneration/clefts as described above.


Instruction: Generate impression based on findings.

Input: Other complicated headache syndrome, evaluate for the cause of secondary headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right thumb mass Note that a marker was placed along the volar aspect of the thumb at the metacarpophalangeal joint. Just deep to this marker there is a small mass of near fluid signal intensity which measures 6 x 3 x 3 mm in the greatest transverse and longitudinal dimensions. The mass is situated adjacent to the volar aspect of the flexor pollicis longus with a small tail of fluid signal intensity extending into the tendon. This mass does not demonstrate enhancement although there is mild associated edema within the surrounding soft tissues. There is increased signal and thickening of the flexor pollicis longus tendon at this location, which is also noted to overlie the ulnar sesamoid. A small curvilinear collection of fluid signal is noted along the dorsal and ulnar aspect of the first metatarsal head that may represent joint fluid or perhaps a ganglion. Additionally, there is a lobulated collection noted between the base of the second metacarpal and distal trapezium which may represent a synovial cyst or small ganglion.The radial and ulnar collateral ligaments are intact.There is mild arthrosis of the interphalangeal joint with a mild to moderate changes noted at the basilar joint.

Output: Findings compatible with a small ganglion measuring 6 x 3 x 3 mm arising from a degenerated flexor pollicis longus tendon at the level of the MCP joint, likely corresponding to the mass in question. Additional findings described above.


Instruction: Generate impression based on findings.

Input: 37 years Male (DOB: 10/13/1978)Reason: r/o cavernoma History: recurrent ICHsPROVIDER NAME: CHRISTOPHER M GOMEZ CHRISTOPHER M GOMEZ MRI brain:There is an arachnoid cyst within the fourth ventricle measuring 26 x 19 mm in sagittal dimensions which displaces the quadrigeminal plate superiorly. This cyst is stable in size compared to the prior exam.The aqueduct of Sylvius is visualized.There is intraventricular blood layering within the trigones of the lateral ventricles which was also present on the prior exam does not appear to have changed substantially. There is redemonstration of subdural collections. On coronal imaging the right subdural collection measures 5 mm in thickness and previously measured the same. The left subdural collection measures 17 mm in thickness and is unchanged. These collections are septated. The septations do demonstrate some contrast enhancement. There is redemonstration of bilateral frontal porencephaly.There is redemonstration of ventriculomegaly which appears stable and compared to the prior exam. The third ventricle measures 14 mm in width on the current exam and previously measured the same. Biventricular diameter is approximately 53 mm on the current exam and previously was the same. There is absence of the septum pellucidum. The pituitary gland measures approximately 5 mm in height and 12 mm AP dimension. The sella appears to be distorted. The optic nerves do not appear to be particularly atrophic. The optic nerves are however tortuous and the dural sleeves are relatively dilated. Findings raise the question of papilledema based on its impression on the retina.The right eye is significantly larger than the left eyeThere is redemonstration of siderosis.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.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is siderosis present along the surface of the cervical spinal cord.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. There is a mild disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is siderosis present along the surface of the thoracic spinal cord.There are small pleural effusions present associated with some atelectatic changes.

Output: 1.There is a stable ventriculomegaly associated. The aqueduct of Sylvius is identified.2.There is an arachnoid cyst which occupies and deforms the fourth ventricle. In the face of ventriculomegaly this suggests that this may be a potential cause for the ventriculomegaly.3.There is intraventricular blood present associated with superficial siderosis along the brain and spinal cord surfaces.4.Bilateral frontal porencephaly.5.Bilateral multiseptated subdural effusions are present which are stable compared to prior exam.6.Buphthalmos is suspected on the right eye. Please correlate with clinical history.7.Findings are suggestive of papilledema. Please correlate with physical findings on clinical exam.8.Small pleural effusions


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/21/15, 10/14/15), ultrasound images of right breast (10/14/15), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (10/21/2015) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (5/27/14, 12/6/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (4/21/15, 10/14/15):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. Multiple surgical clips are present at 12:00 position in the right breast, at the site of prior surgery. There is a developing mass at the site of prior surgery in the right breast, measuring 35 x 30 mm on CC view of 10/14/2015. No abnormal findings are seen in the right retroareolar region, where breast MRI (11/2/15) demonstrated an enhancing mass.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/14/15):An irregularly shaped hypoechoic mass is visualized at 12:00 position in the right breast, measuring 21 x 18 x 23 mm, corresponding to the mass seen on the mammogram. No abnormal lymph nodes are visualized in 4 images of right axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (10/21/2015):Ultrasound guided needle biopsy was performed for the mass in the right breast with an appropriate needle placement. A marker clip (coil shaped) is present within the mass at anterior aspect.Per outside radiology report, the result was malignant; invasive ductal carcinoma.

Output: Biopsy proven carcinoma in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Possible retrocochlear pathology: asymmetric SNHL, left worse than right. There is deficiency of bone overlying the left superior semicircular canal. The other left inner ear structures are unremarkable. The right inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The bilateral mastoid air cells and middle ears also appear unremarkable. There is extension of cerebrospinal fluid into the bilateral geniculate fossae, which is an anatomic variant.

Output: Apparent left superior semicircular canal dehiscence. A temporal bone CT may be useful for confirmation.


Instruction: Generate impression based on findings.

Input: 68 years Female (DOB:11/9/1947)Reason: back pain History: chronic back painPROVIDER/ATTENDING NAME: MINDY ALYCE SCHWARTZ MINDY ALYCE SCHWARTZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a levo curvature and rotatory scoliosis to the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is marked left-sided facet hypertrophy at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy present there is a disc bulge present at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. There is mild encroachment on the left-sided exiting nerve root within the neural foramen.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is bilateral ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Abdominal aorta measures up to 3 cm in diameter below the level of the renal arteriesThere are multiple cysts present along the right kidney.

Output: 1.There is a scoliotic curvature to the lumbar spine associated with degenerative changes present in the lumbar spine. There is no significant spinal stenosis appreciated. There are some mild encroachment of left-sided exiting nerve roots within the neural foramina at L4-5.2.The abdominal aorta measures up to 3 cm in diameter.


Instruction: Generate impression based on findings.

Input: Female, 23 years old, with right eye blurry vision. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. A mucus retention cyst is evident in the left maxillary sinus.Orbits:The globes are symmetric and unremarkable. The extraocular muscles and intraconal fat show no abnormalities. Slight asymmetrically prominent T2 signal surrounding the distal right optic nerve is probably related to tortuosity and imaging artifact. Within the limitations of a noncontrast examination, no definite abnormalities of the optic nerve or chiasm are seen.

Output: 1. No evidence of demyelinating disease or any other definite intracranial abnormality.2. Within the limitations of a noncontrast examination, no definite orbital abnormalities are detected. If clinical concern warrants, postcontrast imaging may be considered to provide a more sensitive evaluation.


Instruction: Generate impression based on findings.

Input: Again seen are postoperative findings related to a right posterior parietal craniotomy. The resection cavity is unchanged with stable mild T2/FLAIR signal surrounding the CSF-filled cavity. There are no areas of pathologic enhancement. Curvilinear susceptibility abnormality along the lateral aspect of the right frontal lobe and within the central sulcus/post central gyrus, likely reflects old blood product and is unchanged.The ventricles and sulci are within normal limits and the basal cisterns remain patent. No areas of diffusion restriction are present to suggest an acute ischemic event. No extra-axial fluid collection is identified. The cerebellar tonsils are in normal position. Pituitary gland is unremarkable. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Left maxillary sinus mucous retention cyst. The orbits are unremarkable.

Output: 1. Compared to most recent prior from 3/27/2015 and more remote priors dating back to 10/4/2013, there is no significant interval change in appearance of the right posterior parietal resection cavity with small areas of surrounding FLAIR hyperintensity without enhancement. No evidence of tumor recurrence. 2. Stable small focus of chronic hemosiderin deposition in the right central sulcus/post central gyrus.


Instruction: Generate impression based on findings.

Input: Torticollis [M43.6], Severely decreased ROM at neck in all directions. Evaluate for spondyloarthropathy or DDD. The examination is significantly degraded by patient motion. There is a nonspecific heterogeneous bone marrow signal intensity. The vertebral body heights are grossly maintained. There is multilevel loss of intervertebral disc space, particularly at C6-7. The spinal cord demonstrates normal signal intensity, within the limitations of motion artifact. There is paucity of the left vertebral artery flow-void diffusely. The paraspinal soft tissues are grossly within normal limits.C2-3: There is no significant disc herniation, neural foraminal stenosis, or spinal stenosis.C3-4: There is a disc bulge causing mild effacement of the ventral thecal sac and perhaps mild bilateral neural foraminal stenosis.C4-5: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in mild spinal stenosis and left neural foraminal stenosis.C5-6: There is mild left neural foraminal stenosis secondary to posterior disc osteophyte complex and hypertrophy of the ligamentum flavum.C6-7: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in moderate spinal and moderate right neural foraminal stenosis.C7-T1: There is a small posterior disc osteophyte complex without significant spinal or neural foraminal stenosis.

Output: 1. Nonspecific diffusely heterogeneous appearance of the vertebral bone marrow.2. Multilevel degenerative spondylosis of the cervical spine, which is most pronounced at C6-7 due to at least moderate spinal stenosis associated with disc-osteophyte formation.3. The left vertebral artery does not demonstrate normal flow-voids, perhaps due to steno-occlusive disease. MRA or CTA may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:7/12/1953)Reason: 62 yo M with ETOH abuse, chronic pancreatitis, p/w 6 months of LE weakness, urinary incontinence and FTT History: LE weakness, weight loss, etoh abusePROVIDER/ATTENDING NAME: KEVIN C CONCORDIA CHARLES M WRAY MRI brain: There are T2 and FLAIR hyperintense lesions present within the basal ganglia and thalami. Some patchy T2 and FLAIR hyperintense foci are present in the brainstem. On susceptibility imaging there are multiple punctate foci of signal loss identified in the brainstem, thalami and external capsule on the left. Additional punctate foci of signal loss and susceptibility are identified in the subcortical white matter of the left temporal lobe. 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. There is multilevel disc desiccation present.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 loss of disc space height, diffuse disc bulge as well as some endplate osteophytes. There is mild right-sided facet hypertrophy at this level. There is effacement of spinal fluid ventral and posterior the spinal cord with overall mild to moderate degree of spinal stenosis. There is ligamentum flavum hypertrophy at this level. There is mild encroachment of the right-sided exiting nerve roots at this level.At C5-6 there is loss of disc space height, disc desiccation, right-sided facet hypertrophy of a moderate degree as well as endplate and uncovertebral osteophytes with narrowing of the neural foramina bilaterally but worse on the right side where there is encroachment of the exiting nerve roots. There is ligamentum flavum hypertrophy at this level. There are some mild spinal stenosis at this level. There are chronic endplate reactive changes at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height at this level. There are some subacute endplate reactive changes at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height at this level. There are some subacute endplate reactive changes at this level.The vertebral artery flow voids appear to be intact. The left vertebral artery is smallNo abnormal enhancing lesions are appreciated in the cervical spine.

Output: 1.There are multiple lesions in the basal ganglia thalami and brainstem which are suspected to represent prior lacunar infarcts.2.There are multiple microhemorrhages present predominantly in the deep gray nuclei and brainstem was pattern is suggestive of hypertension related microhemorrhages.3.There are degenerative changes present in the cervical spine worse at C4-5 and C5-6 where there is encroachment of the exiting nerve roots on the right side more than the left. There is also mild to moderate spinal stenosis at C4-5 and mild spinal stenosis at C5-6.


Instruction: Generate impression based on findings.

Input: Male, 41 years old. Pain MENISCI: The medial and lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is an area of chondral thinning involving the weightbearing portion of the medial femoral condyle measuring 19 x 9 mm (series 6, image 21; series 8, image 21) with foci of full-thickness cartilage loss and underlying marrow reactive changes. There is cartilage thinning of the lateral compartment without full-thickness defect. There is full-thickness cartilage fissuring along the femoral trochlea as well as partial-thickness cartilage loss of the lateral patellar facet.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Osteoarthritis with areas of cartilage loss in the medial femoral condyle and the femoral trochlea as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out metastases. Signs and symptoms: Back pain. Pre-and post-enhanced lumbar MRI:Examination double straight a focus of marrow signal abnormality in the anterior/inferior aspect of L5 vertebrae which demonstrates uniform enhancement. This finding measures approximately at 8.8 times 9-mm on sagittal post enhanced series. The finding about the inferior and anterior bony cortex of vertebrae and without detectable destructive changes. There is no associated extra osseous enhancement with this finding which is suspected of a small metastatic lesion. Finding correspond to the previously suspected focus of hypermetabolic lesion on PET scan.There is no detectable additional foci of marrow signal abnormality or enhancement of vertebral column. There is also normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without detectable abnormal enhancement.Mild degenerative disk disease and mild to moderate hypertrophic changes of facets and ligamentum flavum is noted. There is however no evidence of spinal canal or neural foraminal compromise/stenosis at any level. There is a prominent Schmorl's node along the superior endplate of L5.Partially visualized SI joints are unremarkable.There is no detectable perispinal soft tissue abnormality or enhancement.

Output: 1.L5 vertebral body demonstrate an approximately 9 x 9 focus of marrow signal change with enhancement corresponding to region of hypermetabolic focus on prior PET scan and suspected of a metastatic lesion. No evidence of any additional foci of acute column enhancement. No detectable abnormal leptomeningeal enhancement.2.Mild degenerative changes of lumber spine without spinal canal or neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: Headaches, neck pain C3 -- C4. Clinical question: Is there evidence of fracture/dislocation. Non-enhanced CT of brain:M. there is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray -- white matter differentiation remains to be normal.Calvarium is intact.CT of the cervical spine:There is no evidence of fracture or subluxation. Very minimal degenerative changes of cervical spine is noted. Reformatted images demonstrate normal alignment the vertebral column. No definitive neural foramina compromise or central spinal stenosis. Limited images through the apices of the lungs demonstrate emphysematous pole I bilaterally. Multi-level subtle bulge of disk material is present. This is more pronounced at C3 -- C4 and apparent subtle mass effect on the cord. This findings can be better evaluated with an MRI exam.

Output: 1.Unremarkable nonenhanced CT of brain.No evidence of fracture or subluxation of cervical spine. Minimal degenerative disk disease.


Instruction: Generate impression based on findings.

Input: There is redemonstration of a marrow replacing lesion in the right posterior T6 vertebral body extending into the right pedicle, transverse process, and lamina. It appears lower in signal on T1 indicating progressive sclerosis. There is also involvement of the superior and inferior articulating processes as well the pars interarticularis. There is increased anterior extent of the posterior body component of the marrow signal abnormality as seen on 6/25-27, corresponding to an area of subtle ground glass opacity on CT. There is slightly greater conspicuity of confluent enhancement than on the prior exam on the fat saturated postcontrast images. There is no definite epidural extension. There is surrounding mild STIR hyperintensity.At the T7 level, there is additional abnormal marrow signal in the midline posterior elements and along the right lamina with minimal extension along the right posterior pedicle which demonstrates STIR hyperintensity and enhancement on the current exam. This is new since the previous MRI but is consistent with a hypermetabolic lesion on PET/CT.There remains ill-defined somewhat linear opacity in the right lower lobe near the T6 level, which appears slightly decreased in confluence since the previous MRI.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.Incidental note is again made of a heterogeneous oval left thyroid lobe lesion.

Output: 1. Slight progression of the anterior margin of the right T6 vertebral body metastatic lesion.2. Interval development since prior MRI of right T7 posterior element metastatic lesion corresponding to hypermetabolic lesion on PET scan.3. Redemonstration of linear opacity in the right lung which may represent an area of scarring.4. Grossly stable heterogeneous left thyroid lesion. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: Hx of prostate cancer. Evaluate for suspicious lesions for uronav biopsy. Additional history per electronic medical record: MRI prostate 4/2015: 27g prostate, suspicious abnormality of the right apical posteromedial/posterolateral peripheral zone.  Biopsy results from 6/17/2015: Gleason 3+4=7 at region of interest measuring 14mms total. He also had biopsy of hypoechoic area that was noted with findings of Gleason 3+3=6 prostate cancer measuring 7mm. PELVIS:PROSTATE:Prostate Size: 4.0 x 3.8 x 5.0 cm.Peripheral Zone: There is an area of decreased T2 and ADC signal (measuring 11 x 8 mm) within the lateral aspect of the right apex and mid gland which is suspicious for neoplasm. No additional areas of suspicious signal are identified within the peripheral zone.Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: There does not appear to be definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent non-specific right greater than left pelvic sidewall lymph nodes. Mildly prominent bilateral inguinal lymph nodes. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diverticulosis.

Output: Focus of abnormal signal within the right apex/mid gland suspicious for neoplasm.


Instruction: Generate impression based on findings.

Input: Female 32 years old Reason: R knee pain, evaluate for lateral meniscus tear or OCD lesion MENISCI: We see no lateral or medial meniscal tears.ARTICULAR CARTILAGE AND BONE: We see no osteochondral defect. Mildly increased signal intensity of the articular cartilage of the medial facet of the patella may represent early degeneration, but we see no focal fluid-filled defect.LIGAMENTS: ACL, PCL, MCL, and lateral collateral complex are intact. EXTENSOR MECHANISM: Extensor mechanism is intact. The Insall-Salvati ratio is 1.2.

Output: 1.No evidence of meniscal tear or osteochondral defect.2.Borderline patella alta. Findings suggestive of mild degeneration of the articular cartilage of the lateral patellar facet.