Instruction: Generate impression based on findings.

Input: Female 73 years old Reason: rectal cancer 1cm from the anal verge History: rectal cancer 1cm from the anal verge PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Note is made of multiple small perirectal lymph nodes, with a reference node, measuring 6 x 4 mm (20; series 4).Lymph nodes outside the mesorectal fascia: Note is made of small external iliac lymph nodes.BOWEL, MESENTERY: Rectal Tumor:Size: 4.9 x 1.3 cm (image 18/series 7)Tumor appearance on T2-weighted images: Heterogeneous, but predominantly increased signal intensity relative to musculature. There is probable invasion to the level of the serosa without convincing evidence of invasion of the mesorectal fat or mesorectal fascia. There is slight upstream dilation of the imaged sigmoid colon.Tumor location: Right anterior and lateral wall of the rectum.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): Approximately 2.4 cmCircumference of the rectum involved: 180 degreesBONES, SOFT TISSUES: No bone marrow signal abnormality is identified.OTHER: No significant abnormality noted.

Output: Note is made of eccentric wall thickening with associated increased signal abnormality and enhancement of the rectum, consistent with the stated history of rectal carcinoma, extending to approximately 2.4 cm from the level of the anal verge. There are multiple perirectal lymph nodes in the surrounding area, with reference measurements provided above.


Instruction: Generate impression based on findings.

Input: 81 year old woman. Evaluate for ICH/CVA. There is no evidence of intracranial hemorrhage, mass or edema. There are extensive periventricular and subcortical regions of hypoattenuation consistent with small vessel ischemic disease. These findings are age-indeterminate. If acute stroke remains a clinical concern, recommend evaluation with MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Extensive, age-indeterminate findings of small vessel ischemic disease. 2. No CT findings of acute cortical stroke or hemorrhage.


Instruction: Generate impression based on findings.

Input: 55-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.4 x 2.6 x 3.5 cm (TR x AP x CC)Peripheral Zone: There is a focus of decreased T2 signal abnormality with apparent restricted diffusion in the right posterior mid body of the peripheral zone of the prostate gland. However, there is no convincing abnormal enhancement on the dynamic contrast enhanced sequences. These findings are indeterminant, however, prostate carcinoma is not excluded.Seminal Vesicles: No evidence of extension to involve the seminal vesicles.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: Mild concentric thickening of the wall of the bladder suggestive of chronic outlet obstruction.LYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: No bone marrow signal abnormality is identified.OTHER: No significant abnormality noted.

Output: Focus of signal abnormality in the right posterior mid body of the peripheral zone of the prostate gland with indeterminate imaging characteristics. Prostate carcinoma is not completely excluded. These findings were discussed directly with the patient.


Instruction: Generate impression based on findings.

Input: Patient with pain and crepitus of the right shoulder, with concern for SLAP lesion. ROTATOR CUFF: There is an intermediate signal in the supraspinatus tendon, consistent with supraspinatus tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Posterior subchondral cysts are noted in the humeral head, raising the possibility of internal impingement. No labral tear is present.BICEPS TENDON: No abnormalities in the biceps tendon. ADDITIONAL

Output: 1.Subchondral cysts in the posterior humeral head, raising the possibility of internal impingement.2.Supraspinatus tendinopathy.


Instruction: Generate impression based on findings.

Input: 3 day old female with history open myelomeningocele. Evaluate ventricles. There is no evidence of intracranial hemorrhage, mass or edema. Moderately enlarged ventricles for age; recommend MRI for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Moderately enlarged ventricles for age; recommend MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: Persistent hyperprolactinemia. Rule out prolactinoma: Galactorrhea. There is an apparent hypoenhancing or nonenhancing focus along the posterior aspect of the adenohypophysis that measures up to 3 mm. The pituitary gland is otherwise neither enlarged or atrophic. The pituitary infundibulum and posterior bright spot are intact. There is no compromise of the cavernous sinuses or

Output: An apparent hypoenhancing or nonenhancing focus along the posterior aspect of the adenohypophysis that measures up to 3 mm may represent a pars intermedia cyst or microadenoma.


Instruction: Generate impression based on findings.

Input: T4N2cM1 tonsil ca admitted for cycle 4/7-8 FHX elderly frail. There is a lingual cortex defect and diffuse enhancement in the right mandible, with ill-defined enhancement in the adjacent soft tissues measuring up to approximately 30 mm. There is diffuse thickening of the right trigeminal nerve from the inferior alveolar canal to the cavernous sinus and perhaps into the right foramen rotundum. There is also mildly prominent enhancement and thickening of the adjacent dura along the floor of the middle cranial fossa. There are denervation changes in the right tongue and right masticator muscles. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is a lesion in the C7 vertebral body with endplate deformities. There is a punctate lesion in the superior portion of the C5 vertebra. There is multilevel degenerative cervical spondylosis with disc-osteophyte complexes at C3 through C7 that mildly indent the spinal cord. There is fluid within the bilateral mastoid air cells. There is mild mucosal thickening in the right maxillary sinus.

Output: 1. A lingual cortex defect and diffuse enhancement in the right mandible, with ill-defined enhancement in the soft tissues, measuring up to approximately 30 mm, which likely corresponds to the previously treated tumor, superimposed upon right tongue denervation changed. 2. Diffuse thickening of the right trigeminal nerve from the inferior alveolar canal to the cavernous sinus is compatible with perineural tumor spread, with denervation changes in the right masseter muscles.3. Treated metastatic lesion in the C7 vertebral body with endplate deformities. A punctate lesion in the superior portion of the C5 vertebra is nonspecific.4. No significant residual cervical lymphadenopathy based on size criteria. 5. Nonspecific fluid within the bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: 46-year-old female with biopsy-proven left breast malignancy and enlarged left axillary lymph nodes on MRI. Evaluate for axillary adenopathy. A targeted left ultrasound was performed for the MRI area of concern in the left axilla. Multiple benign morphology lymph nodes are present within the left axilla. The largest is identified within the inferior left axillary region and measures 2.6 x 1.3 x 1.6 cm. This lymph node demonstrates thin cortex with preservation of the fatty hilum and hilar vascularity.

Output: Multiple benign morphology lymph nodes within the left axilla. The largest measures 2.6 cm in greatest dimension, and corresponds to the lymph node visualized on MRI examination. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: Assess for R achilles degeneration/tear/cystic changes History: Swollen, painful lump 4-5cm proximal to achilles insertion on calcaneus; pain with walking TENDONS: There is thickening and intermediate signal intensity within the Achilles tendon indicating moderate to severe tendinosis. There is linear fluid signal intensity within the medial fibers of the Achilles tendon approximately 4 cm proximal to its insertion on the calcaneus indicating partial thickness tearing. There is no significant retraction. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. There is circumferential fluid within the tendon sheath of the flexor hallucis longus just proximal to the master knot of Henry which may represent a tenosynovitis/intersection syndrome.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The components of the deltoid ligament appear intactARTICULAR SURFACES AND BONE: There is increased bone marrow signal abnormality within the base of the second metatarsal which may reflect degenerative change. No additional bone marrow signal abnormality is identified. ADDITIONAL

Output: Moderate to severe tendinosis of the Achilles tendon with partial thickness tearing as described. No significant retraction is identified. Other findings as above.


Instruction: Generate impression based on findings.

Input: 47 years Female (DOB: 5/1/1969)Reason: HISTORY OF CERVICAL RADICULOPATHY History: AS ABOVEPROVIDER/ATTENDING NAME: KATARINA VESKOVIC KATARINA VESKOVIC The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level associated with some disc desiccation. There are small uncovertebral osteophytes present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a left-sided perineural cyst 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 to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 49 year old female with a personal history of right simple skin sparing mastectomy with immediate implant based reconstruction in 10/2012 for IDC/DCIS and a benign right axillary lymph node biopsy in 2015. RIGHT RECONSTRUCTED BREAST:Status post skin sparing mastectomy with implant based reconstruction. The retropectoral silicone implant appears unchanged in contour and appearance. No abnormal enhancement is seen.LEFT BREAST:There is scattered fibroglandular tissue in the left breast.Minimal parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of anal cancer and anorectal fistulas with fecal incontinence. Evaluate fistulous disease. PELVIS:PROSTATE/SEMINAL VESICLES: The peripheral zone is homogeneously T2 hyperintense aside from a 3 mm T2 weighted hypointense lesion in the medial aspect of the mid gland.BLADDER: Partially distended bladder without a focal abnormality.LYMPH NODES: No enlarged pelvic lymphadenopathy.BOWEL, MESENTERY: The visualized pelvic bowel loops are normal in caliber. In the distal rectum/anal canal at the 6:00 position there is a short fluid tract extending dorsally to T2 very hypointense granulated/fibrotic tissue tract which extend caudally along the gluteal cleft to the skin surface on the right. The granulation extends caudally along the left in the ischioanal fossa towards the dorsal column of the acetabulum. Granulation tissue extends along the left aspect of the anal canal as well. There is a 1.0 x 0.5 cm fluid locule in the right intersphincteric space (series 1000 1/24) without associated rim enhancement or inflammatory changes. Overall the appearance is similar to 2004.Note is made of mild near-circumferential thickening and gradual enhancement of the anorectum, which may be treatment related without a discrete nodular component. BONES, SOFT TISSUES: Heterogeneous bone marrow signal intensity is nonspecific and may represent red marrow conversion.Thickening and enhancement of the left hamstring tendons.OTHER: No significant abnormality noted.

Output: Complex predominantly granulated perianal fistulous tracts with a 1.0 cm fluid locule in the right intersphincteric space. Overall the configuration and extent of disease is similar to 2004 at which time there tracts were fluid filled. Mild near-circumferential thickening and gradual enhancement of the anorectum, which may be treatment related without a discrete nodular component.


Instruction: Generate impression based on findings.

Input: Reason: cuff tear? History: pain ROTATOR CUFF: There is a full-thickness tear of the anterior fibers of the supraspinatus tendon at its insertion on the greater tuberosity with minimal (5 mm) retraction of the tendon. This tear measures approximately 1 cm in the AP dimension. There is intermediate signal intensity within the supraspinatus tendon more proximally and posteriorly, which indicates moderate tendinosis with fraying of both tendinous surfaces. A thin elongated collection of near fluid signal intensity extending along the myotendinous junction of the infraspinatus tendon indicates intrasubstance cyst formation with equivocal extension to the articular surface. There is mild fatty atrophy of the infraspinatus along the myotendinous junction. The teres minor muscle and tendon appear intact. There is thickening and increased signal intensity of the distal fibers of the subscapularis likely representing a combination of tendinosis and redundancy due to internal rotation of the humerus. There is mild fatty atrophy of the subscapularis along the myotendinous junction.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthrosis affects the glenohumeral joint. There is minimal posterior translation of the humeral head relative to the center of the glenoid. There is a small amount of fluid within the joint and there is intermediate signal intensity within the anterior aspect of the joint that we suspect represents synovitis. Additional heterogeneous low signal intensity situated between the glenoid and undersurface of the subscapularis likely represents a combination of redundancy of the capsular structures and synovitis. The superior labrum is largely replaced with intermediate signal intensity reflecting degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps is perched along the lateral aspect of the lesser tuberosity and we cannot exclude the possibility of a pulley injury.

Output: 1. Rotator cuff tears and tendinosis as described above including a full-thickness tear of the anterior fibers of the supraspinatus tendon at its insertion.2. Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 70 year-old female. Prior concern for malignancy. Evaluate for any suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: 1.5 x 1.5 cm segment 2 homogeneously arterially enhancing lesion with mild T2 hyperintensity and mild diffusion restriction, not significantly changed from 2012. Delayed images show that this lesion retains contrast and is mildly hyperintense to background liver without evidence of washout.Nodular contour of the liver consistent with a cirrhotic morphology.Patent hepatic artery, portal vein, and hepatic veins. No biliary ductal dilatation. No evidence of portal hypertension.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas with a mildly, diffusely dilated duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.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: 1.5-cm arterially enhancing lesion without washout in segment two of the liver, not significantly changed from 2012, and likely benign.


Instruction: Generate impression based on findings.

Input: Foot weakness. Evaluation of the left lumbosacral plexus is requested. There is diffuse heterogeneity of the bone marrow signal which is nonspecific and may be related to marrow reconversion. No discrete destructive osseous lesion is demonstrated.There is no abnormal T2 signal or enhancement involving the lumbosacral nerve roots or the lumbosacral plexus more peripherally in the pelvis. No abnormal signal or enlargement of the sciatic nerves is present. No masses to suggest extrinsic compression. Aortoiliac ectasia again noted. Small disc bulges at L4-L5 and L5-S1 with minimal left neural foraminal narrowing again seen, without clear evidence of impingement.

Output: 1. No abnormal signal or evidence of extrinsic compression involving the lumbosacral plexus.2. Diffuse heterogeneity of the bone marrow signal is nonspecific and may represent marrow reconversion. No discrete destructive osseous lesion is appreciated.


Instruction: Generate impression based on findings.

Input: Female 76 years old with stocking glove neuropathy and numbness in her hands. Evaluate for cervical spine compression. There is moderate degenerative disc disease at C5-6 and C6-7 and mild degenerative disc disease at C4-5. There is loss of the normal cervical lordosis and minimal retrolisthesis at C5. Moderate multilevel neural foraminal narrowing is seen bilaterally which may in part be exaggerated by patient positioning.

Output: Degenerative disc disease and other findings as described above.


Instruction: Generate impression based on findings.

Input: Persistent left sciatica which has been increasing. Known spinal DJD. There is reversal of the lordosis with 3 mm of grade 1 retrolisthesis of L3 on L4 and 4 mm of retrolisthesis of L5 on S1. There is also levoscoliosis and moderate to severe degenerative disc narrowing at multiple levels. The bone marrow demonstrates a heterogeneous signal which is nonspecific. The spinal cord displays normal signal and morphology and terminates at the L1 level. The paravertebral soft tissues are unremarkable. T10-T11: On sagittal views, there is a small diffuse disc bulge but no significant central canal or neuroforaminal stenosis.T11-T12: A disc bulge is noted with facet hypertrophy and ligamentum flavum thickening. There is mild to moderate bilateral neural foraminal and mild to moderate central canal stenosis.T12-L1: There is a disc bulge with moderate facet hypertrophy and ligamentum flavum thickening which causes moderate bilateral neural foraminal stenosis and at most mild to moderate central canal stenosis.L1-L2: There is a disc bulge and left greater than right facet hypertrophy and ligamentum flavum thickening which causes mild right and moderate to severe left neuroforaminal stenosis and moderate central canal stenosis.L2-L3: There is a disc bulge with severe facet hypertrophy and ligamentum flavum thickening which causes minimal right and moderate to severe left neural foraminal stenosis as well as moderate central canal stenosis.L3-L4: A shallow left foraminal/far lateral disc protrusion is superimposed on the uncovering of the disc. There is also severe facet hypertrophy, right greater than left, and ligamentum flavum thickening which causes severe right and moderate to severe left neural foraminal stenosis. This also causes moderate to severe central canal stenosis with effacement of the right lateral recess.L4-5: A disc bulge is seen at this level with severe facet hypertrophy and ligamentum flavum thickening with moderate to severe bilateral neural foraminal stenosis and mild to moderate central canal stenosis.L5-S1: A disc bulge is noted with a superimposed left to right paracentral shallow disc protrusion with facet and ligamentum flavum hypertrophy. This causes left greater than right neural foraminal stenosis with effacement of the left lateral recess. There is also moderate central canal stenosis.A small rounded T2 hyperintense lesion is noted within the upper pole of the right kidney which is nonspecific but statistically most likely represents a renal cyst.

Output: 1.Diffuse moderate to severe degenerative disease of the lower thoracic and lumbar spine with at most moderate-severe central spinal canal stenosis at L3-4 and multilevel neural foraminal stenosis, and multiple levels of moderate-severe to severe foraminal narrowing as detailed above.2.There is also lumbar levoscoliosis and degenerative grade 1 retrolisthesis of L3 on L4 and L5 on S1.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis with slurred speech and weakness. Also recent sore throat with fevers. There are numerous, greater than 10, T2 hyperintense lesions involving the cerebral white matter, predominantly in a periventricular distribution. There are also T2 hyperintense lesion in the pons and bilateral middle cerebral peduncles. Many of the lesions are also T1 hypointense, but there is no associated enhancement. There may also be a T2 hyperintense lesion in the imaged upper cervical spine. There are nonspecific areas of susceptibility effect in the bilateral basal ganglia. However, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and sulci are diffusely prominent due to mild cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, mastoid air cells, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is diffuse thickening of the calvarium.There is mild prominence of the adenoids and there is a small amount of secretions in the nasopharynx.

Output: 1. Stigmata of multiple sclerosis, but no evidence of acute intracranial hemorrhage, abscess, or acute infarct. 2. Mild prominence of the adenoids and there is a small amount of secretions in the nasopharynx may be attributable to an upper respiratory tract infection.


Instruction: Generate impression based on findings.

Input: 46 years, Female, metastatic cervical cancer status post whole brain radiation therapy.. Compared to MRI dated 7/31/2015 and 7/23/2015, interval postsurgical changes of right frontal craniotomy for biopsy are seen. Again seen is abnormal dural thickening and enhancement as well as leptomeningeal enhancement along the right middle frontal gyrus, which is mildly decreased compared to 7/23/2015. Associated vasogenic edema also is decreased in the interval. Dural and leptomeningeal enhancement at the right anterior frontal pole appears similar to prior from 7/31/2015. Vasogenic edema in this region is minimally decreased in the interval.No new parenchymal or meningeal enhancement or mass is appreciated. No significant intracranial mass effect. No evidence of recent ischemia or hemorrhage. Minimal chronic blood products are noted in the right middle frontal gyrus. No extra-axial collections. No hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Compared to preoperative MRI studies from 7/23/2015 and 7/31/2015, there is slight decrease in dural and leptomeningeal enhancement related to known metastatic disease along the right middle frontal gyrus with also decrease in associated edema. Dural and leptomeningeal enhancement along the right anterior frontal pole is not significantly changed. There is however mild decrease in associated edema. 2. No new parenchymal or meningeal enhancement or new mass lesion is evident.


Instruction: Generate impression based on findings.

Input: 23-year-old male with right knee lateral joint line pain. MENISCI: Linear signal abnormality extends from the free edge of the body of the lateral meniscus through the peripheral fibers decompressing into a lobulated, slightly heterogeneous perimeniscal cyst. The configuration of the signal abnormality suggests a radial tear centrally that propagates as a horizontal tear peripherally. The anterior and posterior horns of the lateral meniscus appear normal. We see no tear of the medial meniscus.ARTICULAR CARTILAGE AND BONE: Articular cartilage and bone appear normal.LIGAMENTS: There is lateral bowing of the lateral collateral ligament due to the underlying perimeniscal cyst, but we see no ligament tear. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Lateral meniscal tear with perimeniscal cyst.


Instruction: Generate impression based on findings.

Input: 69-year-old female with C7 fracture, evaluate for healing As seen on prior, there is mild loss of height of the C7 vertebral body involving depression of the superior endplate. Band of T2 hyperintensity and T1 hypointensity abnormality indicating edema along the superior endplate, more so on the right than on the left is slightly improved since 9/25/2014. Edema extending involving the C7 right pedicle and lamina is also improved in the interval. Edema within the interspinous soft tissues extending from C4 to C7 is also improved in the interval. Subtle edema involving the posterior longitudinal ligament is also noted at the C6 level. No evidence of frank ligamentous disruption. Anterior longitudinal ligament and ligamentum flavum also are intact.There is a central disk protrusion at the C6-C7 level similar to prior. There is possible T2 hyperintense in the right ventral cord at the C6-7 level which is more apparent than on prior. No cord swelling.Vertebral body heights are maintained. There is minimal anterolisthesis of C6 on C7 which was present on prior. Alignment is otherwise maintained.C2-3: Mild central posterior disk osteophyte with partial effacement of the ventral thecal sac. No significant spinal canal or foraminal narrowing. Mild facet arthropathy.C3-4: Mild central posterior disk osteophyte with effacement of the ventral thecal sac. No significant spinal canal or neuroforaminal narrowing. Mild facet arthropathy.C4-5: Mild central posterior disk osteophyte with effacement of the ventral thecal sac. No significant spinal canal or foraminal narrowing. C5-6: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal narrowing. C6-7: Central disk protrusion with mild ventral cord deformity, similar to prior allowing for differences in position. There is also foraminal component of the disk on the right with mild narrowing of the right neural foramina. Left neural foramen is patent.C7-T1: Unremarkable.

Output: 1. Fractures involving the superior endplate of the C7 vertebral body extending into the posterior elements on the right are better seen on prior CT. There is mild decrease in associated bone marrow edema compared to prior MRI from 9/25/2014, suggestive of healing.2. Mild anterolisthesis of C6 on C7. There is subtle edema involving the posterior longitudinal ligament and interspinous ligaments suggestive of ligamentous injury, which is decreased in the interval. No evidence of frank ligamentous disruption.3. Disk protrusion at C6-7 again seen with mild deformity of the ventral cord and mild narrowing of the right neural foramen. Given above findings, this disc herniation may be traumatic in etiology. 4. Possible minimal T2 hyperintensity in the right ventral cord at C6-7.


Instruction: Generate impression based on findings.

Input: Clinical question: Is there change in cerebellum or ?olivary lesionSigns and Symptoms: ataxia MRI brain:There is redemonstration of cystic lesions in the medulla bilaterally at the expected location of the all of which is larger on the left compared to the right side. There is no associated diffusion restriction. There is no associated susceptibility effect. There is no associated contrast enhancement on the prior exam. The one on the left measures 4 x 5 mm axial dimensions and 4 x 9 mm coronal dimensions whereas the one on the right measures 3 x 3 mm axial dimensions and 3 x 3 mm coronal dimensions. These cystic lesions are slightly more prominent on the current prior exam though this appearance of a larger on the current versus the prior exam may be due to difference in slice thickness and gap on the prior MR acquisition and therefore may not be valid. This there is no convincing evidence for interval change in size of these lesions.There is associated cerebellar atrophy present. This is also present on the prior exam. The degree of cerebellar atrophy appears similar compared to the prior exam.There are no associated lesions appreciated in the dentate nuclei nor in the right nuclei.The supratentorial CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells 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. There is a disc bulge present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present 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: 1.There are cystic lesions centered in olivary nuclei bilaterally (left larger than right) - suspected to represent cystic degeneration - associated with relatively symmetric cerebellar atrophy.2.No intrinsic spinal cord lesions are appreciated3.There are mild degenerative changes present in the cervical spine mainly in the form of disk degeneration without significant compromise to the spinal canal or neural foramina. At age 22 this is more disk dessication than usually expected.


Instruction: Generate impression based on findings.

Input: Intra-articular contrast extends into the distal radioulnar joint through the expected location of the triangular fibrocartilage complex. No intra-articular contrast is identified within the mid carpal joint. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 10 seconds.

Output: Fluoroscopic guided right wrist arthrogram with findings indicating disruption of the triangular fibrocartilage complex. Please refer to the subsequent MRI arthrogram report for additional details.


Instruction: Generate impression based on findings.

Input: Female, 32 years old, with multiple sclerosis. Comparison is complicated by artifact from dental appliances on both the present and prior examinations. A large T2 hyperintense lesion within the genu of the corpus callosum appears to be new and also appears to produce edema with mild local mass effect. This lesion, and a small lesion at the margin of the right frontal horn, both demonstrate enhancement on postcontrast images. Scattered additional smaller nonenhancing periventricular and corpus callosum T2 hyperintense lesions are seen which do not appear to have changed significantly in the interval. Slight effacement of the right lateral ventricle is seen due to the genu lesion. Otherwise, the ventricular system is within normal limits.

Output: A large lesion within the genu of the corpus callosum appears to be new and is associated with edema and mild local mass effect. This lesion, and a smaller lesion at the margin of the right frontal horn, demonstrate enhancement. Multiple additional smaller nonenhancing lesions do not appear to have changed significantly.


Instruction: Generate impression based on findings.

Input: History of right posterior thigh mass, evaluate for heterotopic bone. No fractures or osseous lesions are identified. No mineralization is present in the soft tissues, specifically at the site of the soft tissue mass seen on prior outside MRI. A small os acetabuli, a normal variant, is present.

Output: No calcifications at site of soft tissue mass seen on outside MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for disk herniation. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.The marrow signal intensity of vertebral column demonstrate changes secondary to mild degenerative disease and unremarkable otherwise.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild to moderate disk disease and loss of disk height and mild to moderate bilateral ligamentum flavum hypertrophy. There is a tiny centrally located disk protrusion with resultant subtle indentation of thecal sac however without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is a broad based shallow central and rightward disk protrusion with resultant slight flattening and posterior displacement of thecal sac on the right. There is no neural foraminal compromise however mild right lateral recess compromise is detected. No central spinal stenosis.L4 -- L5 demonstrate moderate bilateral ligamentum flavum hypertrophy and without evidence of disk disease, central spinal stenosis or neural foraminal compromise.L5 -- S1 demonstrate moderate disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy and no appreciable facet disease. There is a right paramedian shallow disk protrusion present at this level. No central spinal stenosis. Mild right neural foraminal compromise secondary to degenerative changes. Unremarkable lowermost visualized thoracic spine and thoracic cord from T10 inferior. Unremarkable perispinal soft tissues.

Output: 1.Normal anatomical alignment the vertebral column and without evidence of fracture.2.Multi-level shallow disk protrusions at L2 -- L3, L3 -- L4 and L5 -- S1 levels as detailed.3.There is no evidence of central spinal stenosis at any level. 4.Mild right neural foraminal compromise at L5 -- S1 on the right and patent at all other levels. Mild right lateral recess compromise at L3 -- L4.5.Please review detailed report per level above.


Instruction: Generate impression based on findings.

Input: Torticollis and plagiocephaly, not making progress with helmet and irritable. Brain: There is mild plagiocephaly. There is slight prominence of the bilateral frontal convexity extra-axial CSF spaces. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There is no evidence of rotatory subluxation or spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There appears to be mild asymmetry of the sternocleidomastoid muscle thickness without altered signal characteristics. There are prominent suprahyoid lymph nodes bilaterally. The paravertebral soft tissues are otherwise unremarkable.

Output: 1. Mild plagiocephaly, but no evidence of acute intracranial mass.2. Apparent mild asymmetric thickness of the sternocleidomastoid muscles may be due to torticollis, but no evidence of rotatory subluxation or spondylolisthesis in the cervical spine. 3. Prominent suprahyoid lymph nodes can be a normal feature for age. However, ultrasound may be useful for further evaluation if clinically warranted.


Instruction: Generate impression based on findings.

Input: Biliary ductal dilatation seen on recent CT. Patient is asymptomatic. History of treated anal cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. There is diffuse fatty infiltration. It demonstrates normal enhancement without a focal lesion.The patient is status post cholecystectomy. The common bile duct is dilated up to 1.2 cm. It tapers smoothly to the level of the ampulla without a focal lesion or obstructing stone.SPLEEN: The spleen is normal in size morphology and signal intensity without a focal lesion.PANCREAS: The pancreas is normal in morphology and signal intensity. The main pancreatic duct is normal in caliber. Bifid configuration of the main pancreatic suggestion of dominant duct of Santorini drainage, a normal variant. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral cysts. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted. Small hiatal hernia.BONES, SOFT TISSUES: Mild degenerative endplate changes.OTHER: No significant abnormality noted.

Output: Common bile duct dilatation up to 1.2 cm may be partly due to postcholecystectomy state as there is no obstructing stone or discrete lesion. Correlate with LFTs.


Instruction: Generate impression based on findings.

Input: Left parietal lesion for stability. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered areas of high T2 signal in the cerebral white matter bilaterally, without associated enhancement, which may represent chronic microvascular disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an enhancing lesion in the left parietal skull that measures up to 10 mm, which is unchanged. The orbits, mastoid air cells, and scalp soft tissues are grossly unremarkable. There are several paranasal sinus retention cysts.

Output: 1. No evidence of brain metastases. 2. An enhancing lesion in the left parietal skull that measures up to 10 mm may represent a metastasis, but is unchanged in size.


Instruction: Generate impression based on findings.

Input: There is no no abnormal enhancement, acute infarct, mass effect, or cerebral edema. There are moderate periventricular and subcortical white matter T2 hyperintensities which are nonspecific, likely representing chronic small vessel ischemic changes with involvement of the central pons. There is age related sulcal prominence. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No intracranial metastases. Moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Altered mental status. Non-enhanced CT of brain:Heavy vascular calcification of vertebral and cavernous carotid arteries are again identified.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Findings consistent with small vessel disease are again identified and made no gross interval change since prior exam.Calvarium is intact. Mastoid air cells, middle ear cavities and limited view of paranasal sinuses are well pneumatized.A very small calcific dural based lesion is believed to represent a very small meningioma which was also noted on prior MRI examination from 2 -- 26 -- 2010. On coronal postinfusion image 14 of prior MRI exam this lesion measures approximately 5 mm in transaxial dimensions.

Output: 1.No evidence of acute intracranial findings.2.Small vessel disease of indeterminate age with no gross interval change since prior exam.3.A tiny 5-mm left frontal calcific meningioma with no change since prior exam.


Instruction: Generate impression based on findings.

Input: Memory, behavior changes and tremor. Evaluate for inflammatory changes. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are several punctate foci of nonspecific T2 hyperintensities scattered in the white matter of the cerebral hemispheres bilaterally, most likely representing chronic small vessel ischemic change and similar to prior. Again seen is bilateral symmetric high T2/FLAIR signal in the inferior dorsal pons at the level of the aqueduct and superior cerebellar peduncles. The ventricles and basal cisterns are unchanged in size and configuration. There is mild global parenchymal volume loss including the hippocampi in a nonspecific pattern. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Unchanged appearance of the globes which are enlarged.

Output: 1. No evidence of acute infarct, hemorrhage, mass, or edema. No findings to suggest an active inflammatory process although gadolinium might be helpful.2. Compared to 5/5/2011, no significant change in bilateral symmetric high T2/FLAIR signal in the inferior dorsal pons which may be related to remote inflammatory, toxic-metabolic, or demyelinating injury.3. Nonspecific mild white matter changes which are nonspecific but compatible with mild chronic small vessel ischemic disease. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: 48-year-old female with C6 numbness, evaluate cervical spine or for changes/abnormalities. Signs and symptoms: Numbness. No unenhanced cervical MRI,The alignment of vertebral column is anatomic, however there is mild reversal of cervical lordosis if to be secondary to degenerative disease.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild disc desiccation with decreased T2 signal intensity and height, shallow broad-based bulge of the disc and no significant facet or ligamentum flavum hypertrophy. There is moderate bilateral (L>R) neural foraminal compromise and no central spinal stenosis.C4-C5 demonstrate mild disc disease and loss of disc height, asymmetric left-sided uncovertebral hypertrophy and no significant facet or ligamentum flavum hypertrophy. There is moderate left and mild right neural foraminal compromise. There is also mild central spinal stenosis.C5-C6 demonstrate moderate disc disease and loss of disc height, asymmetric (L>R) uncovertebral hypertrophy and no significant facet or ligamentum flavum degenerative changes. Findings results in significant right neural foraminal compromise and mild central spinal stenosis. C7-T1 demonstrate minimal degenerative changes without spinal canal or neural foraminal compromise.There is no convincing evidence of cord signal abnormality at any level.Spinal soft tissues remain unremarkable.

Output: 1.Degenerative changes at C5-C6 results in significant right neural foraminal compromise and mild central spinal stenosis.2.Degenerative changes at C4-C5 results in moderate left and mild right neural foraminal compromise and mild central spinal stenosis.3.Degenerative changes at C3-C4 results in moderate bilateral (left greater than right) neural foraminal compromise.4.The signal intensity of the cord remains within normal.


Instruction: Generate impression based on findings.

Input: Primary biliary cirrhosis. Evaluate changes in cysts/hemangiomas. ABDOMEN:LIVER, BILIARY TRACT: No new hepatic lesion is identified. Unchanged segment 6, T2 hyperintense lesion measuring 1.2 x 1.0 cm (series 7, image 23), with progressive enhancement, consistent with a hemangioma. Unchanged subcapsular anterior T2 hyperintense lesion, retains contrast on delayed imaging and measures 0.9 x 0.6 cm (series 7, image 7), compatible with a hemangioma. An additional T2 hyperintense focus measuring 0.5 x 0.4 cm in segment 8/7 (series 7, image 10) demonstrates no definite enhancement, most likely a hepatic cyst, unchanged from prior. There is no biliary ductal dilatation. The liver is smooth in contour and normal in morphology.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Right anterior cardiophrenic lymph node measures 1.8 x 1.0 cm (series 3, image 9), unchanged. A right paracardiac lymph node near the hepatic dome measures 1.2 x 0.7 cm (series 3, image 5), unchanged. Stable prominent gastrohepatic, periportal and peripancreatic lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged hepatic lesions, probably hemangiomas and a subcentimeter cyst. 2.Unchanged lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Reason: Left arm weakness History: Left arm weakness The exam is limited by patient motion.The cervical vertebral bodies are appropriate in overall alignment and height. The patient is status post recent laminectomies and posterior fusion with facet screws and at C2, C3 and C4. Previously noted spinal stenosis at C2-3, C3-4 and C4-5 has been alleviated.The patient has a focal signal hyperintensity at the C3-4 involving predominantly the spinal cord centrally - left more than right. Comparing to the prior exam it appears to have been previously present to some degree (see images 11 on series #4 and #7 of the prior exam) but may have been obscured by the severe spinal stenosis.Detailed evaluation of he neural foramina is partly obscured by patient motion. There are disk bulges present at C3-4, C4-5 , C5-6 associated with loss of disk space height and disk dessication. Bilateral neural foramen encroachment of exiting nerve roots is present at C3-4.The vertebral artery flow voids appear to be intact.

Output: 1.Since the prior exam the patient has undergone multilevel laminectomies and posterior fusion in the upper cervical spine.2.A central spinal cord abnormality at C3-4 eccentric to the left hemicord is more obvious on the current exam. The possibility of progression of edema cannot be excluded. Most likely this is related to spondylitic myelopathy status post decompression. It is conceivable that there is new superimposed injury. Please correlate with clinical exam findings.3.Exam is limited by patient motion which can obscure more subtle abnormalities and changes. The patient was not able to tolerate more imaging.


Instruction: Generate impression based on findings.

Input: left lower back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal cana. There is a broad-based left lateral recess disc protrusion present at this level which extends from the midline to the proximal left neural foramen at this level mildly displacing the nerve root at the left lateral recess and mildly encroaching on the left-sided exiting nerve root within the neural foramen but not effacing the fat surrounding the left lateral recess nor the fat surrounding the left-sided exiting nerve root. There are endplate reactive changes with heterogeneous T2 high signal present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There is a broad-based left lateral recess disc protrusion at L5-S1 which mildly displaces the nerve root at the left lateral recess and mildly encroaches on the nerve root in the left neural foramen. Associated endplate reactive changes appear to be subacute.


Instruction: Generate impression based on findings.

Input: MRI Brain: Motion degraded examination.There is restricted diffusion involving the posterior limb of the left internal capsule extending into the left cerebral peduncle as well as involving the left periventricular white matter compatible with an acute infarct. Small additional chronic lacunar infarcts are noted along the superolateral aspect of the thalamus on the right. There is T1 shortening involving the right basal ganglia with suggestion of enhancement which may reflect subacute ischemia or metabolic injury.Enhancing mass involving the right aspect of the sella measures approximately 2.4 x 2.3 cm (series 1702, image 119). The mass extends into the right cavernous sinus and encases the cavernous segment of the right internal carotid artery. It also abuts the bifurcation of the right internal carotid artery. The pituitary infundibulum is displaced leftward. Enhancing tissue along the left aspect of the sella is compatible with residual pituitary tissue. There is mild effacement of the lateral aspect of the suprasellar cistern on the right, however, there is no mass effect on the optic chiasm.There is suggestion of prior surgery involving the sella with focal defect along the anterior aspect of the sella. Correlation with history is suggested. Tiny (~5 mm) meningioma is present along the anterior aspect of the falx abutting the inferior frontal lobe without significant mass effect.There is no midline shift or herniation. No hydrocephalus. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mucosal thickening in the paranasal sinuses most notably in the right maxillary sinus. The midline structures and craniocervical junction are within normal limits. MRA Head: Markedly motion degraded examination without evidence of high-grade stenosis.The intracranial internal carotid arteries are patent and demonstrate no significant stenosis. The sellar mass encases the cavernous segment of the right internal carotid artery and abuts the bifurcation. The middle and anterior cerebral arteries are also patent. The vertebral basilar artery system is diminutive, at least predominant due to developmental variant with prominent posterior communicating arteries and diminutive P1 segments. There are focal areas of signal loss along the bilateral posterior cerebral arteries which are likely artifactual with better visualization on the postcontrast MRI. No evidence of aneurysms or vascular malformations within the limits of motion degradation.

Output: 1. Acute infarct involving the posterior limb the left internal capsule, left cerebral peduncle, and the left periventricular white matter.2. T1 shortening in the right basal ganglia with suggestion of enhancement may reflect subacute ischemia versus metabolic injury (such as non-ketotic hyperglycemia).3. Enhancing mass involving the right aspect of the sella with extension into the right cavernous sinus and encasement of the cavernous segment of the right internal carotid artery. Overall findings likely reflect residual or recurrent pituitary macroadenoma.4. Moderate chronic small vessel ischemic disease.5. Motion degraded MRA without evidence of high-grade stenosis.The above findings were communicated via telephone to Fabiane Santos de Lima at 11:00 AM on 10/18/16.


Instruction: Generate impression based on findings.

Input: Brain parenchymal morphology is within normal limits. Myelination is age-appropriate. One questionable nonspecific punctate focus of T2/FLAIR abnormality in the periventricular white matter. No edema or mass effect is detected. No diffusion-weighted abnormality. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. Ventricular size and morphology are within normal limits.

Output: No structural lesions or potential seizure foci are identified.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with rheumatoid arthritis and severe pain with downward head and sideways head movement. Spinal alignment is anatomic. In particular, the craniocervical junction is normal. No evidence is seen to suggest C1-C2 instability on this non-dynamic examination.Vertebral body height and morphology are unremarkable. No concerning marrow replacement or marrow edema is seen.The visualized spinal cord is normal in signal intensity and morphology.C2-3: Left facet hypertrophy. Mild left foraminal narrowing. Mild interval progression.C3-4: Left facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C4-5: Mild facet hypertrophy. Minimal right foraminal narrowing. No significant interval changes.C5-6: Mild facet hypertrophy. Suspected small annular fissure seen on the prior examination is no longer visualized. No significant spinal canal or foraminal stenosis. C6-7: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C7-T1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: 1.No evidence of C1-2 instability on this non-dynamic examination.2.No other significant finding which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Acute myeloid leukemia in relapse with bilateral lower extremity weakness and low back pain. The bone marrow is diffusely heterogeneous. There is lack of the usual lumbar lordosis and slight anterolisthesis if L2 on L3. The cervical and thoracic vertebral column alignment is otherwise within normal limits. There are disc bulges at L4-5 and L5-S1, as well as ligamentum flavum thickening that result in mild to moderate neural foraminal narrowing and spinal canal narrowing. Less prominent degenerative spondylosis in the rest of the lumbar spine do not results in significant spinal canal or neural foraminal narrowing. LIkewise, there is no significant cervical or thoracic spinal canal stenosis. The vertebral body heights are preserved. The spinal cord is unremarkable, aside from diffuse linear artifact on STIR. The paravertebral soft tissues are unremarkable. There are multiple bilateral renal cysts.

Output: 1. Diffuse bone marrow heterogeneity is likely attributable to acute myeloid leukemia.2. Degenerative spondylosis at L4-5 and L5-S1 result in mild to moderate neural foraminal narrowing and spinal canal narrowing. 3. No evidence of discitis-osteomyelitis.


Instruction: Generate impression based on findings.

Input: Right frontal mass: preoperative planning for biopsy. There is a cystic lesion with a centrally hypoattenuating nodule with thin peripheral enhancement that measures up to 12 mm in the anterior right superior frontal gyrus. There is mild surrounding vasogenic edema, but no midline shift. The ventricles are within normal limits in size and configuration. Thre is a right maxillary sinus retention cyst.

Output: A cystic lesion that measures up to 12 mm in the anterior right superior frontal gyrus has features suggestive of neurocysticercosis, although neoplasm is also a consideration.


Instruction: Generate impression based on findings.

Input: History of multiple prior myocardial infarctions. Additional history of polysubstance abuse. Evaluate for viability. Left VentricleThe left ventricle is non dilated. The lateral wall and inferior wall are thinned with compensatory hypertrophy of the anterior septum. The apex is also markedly thinned and aneurysmal. The inferior and lateral wall are akinetic and the apex is dyskinetic. Within the apical aneurysm there is an approximately 2 cm thrombus. The overall LV ejection fraction is 37% Transmural delayed gadolinium enhancement is present in the inferior wall, lateral wall, and apex compatible with prior infarcts of the RCA, circumflex, and distal LAD. There is an additional small patchy subendocardial focus in the mid septum also compatible with ischemia (series 2001 image 1).Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 56%. Right AtriumThe right atrium is unremarkable. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study. The valve leaflets appear mildly thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study. The valve leaflets appear mildly thickened.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumSmall pericardial effusion.Extracardiac FindingsIncompletely evaluated cystic focus in the superior pole of the left kidney.

Output: 1. Findings of prior left circumflex, RCA, and distal LAD infarcts with transmural delayed gadolinium enhancement as described. Additional focus of subendocardial enhancement in the mid septum compatible with ischemia. The infarcted territories demonstrate marked wall thinning and there is associated compensatory hypertrophy of the anterior septum.2. Left ventricular apical aneurysm containing a 2 cm thrombus.3. Left ventricular wall motion abnormalities as described with an ejection fraction of 37%. Cardiac parameters will be listed as an addendum when they become available.


Instruction: Generate impression based on findings.

Input: Clinical question: Acute L5 fracture with anterior/posterior fascicle involvement c/f instability. Signs and symptoms: Status post fall. Nonenhanced lumbar MRI:Examination demonstrate an acute wedge compression fracture of vertebral body of L5 anteriorly and with evidence of edematous changes of bone marrow. There is preserved normal anatomical alignment of compressed vertebrae and no evidence of spinal canal. Minimal left neural foraminal compromise secondary to degenerative changes is noted.There is no evidence of perispinal soft tissue abnormality with this finding. The maximum height of compressed fractured vertebrae measures at 9.9 -mm compared to maximum height of vertebrae posteriorly at 26.4-mm. There is intraosseous hemorrhage within the compressed vertebrae which minimally extend through the superior endplate into the disk space.There is no detectable epidural widening or abnormal signal intensity to suggest hemorrhage. There is no compromise of spinal canal T12 -- L1 and L1 -- L2 levels demonstrate mild degenerative changes and unremarkable otherwise.L2 -- L3 demonstrate mild disk disease and hypertrophic changes of facet/ligamentum flavum posteriorly. No central spinal stenosis or neural foraminal compromise. There is a chronic mild compression deformity of the superior endplate of L3.L4 -- L5 demonstrates above detailed which compression fracture of L5. L5 -- S1 demonstrate mild to moderate disk disease and loss of disk height without spinal stenosis. Mild left neural foraminal compromise secondary to degenerative changes is present.  This examination covers from T10 through S3. Examination of lumbar spine was performed as a complete MRI of the lumbar spine the study which includes all axial series. However due to patient's inability to continue and excess motion artifact the service was notified and the rest of the exam for evaluation of thoracic spine was not performed.Normal as visualized thoracic spine and thoracic cord from T10 inferiorly demonstrate no evidence of acute abnormality, no central spinal stenosis, no significant neural foraminal compromise and normal signal intensity of the cord.

Output: 1.Complete nonenhanced MRI of the lumber spine demonstrate more than 50% wedge shaped fracture of the anterior L5 vertebrae without evidence of spinal canal or neural foramina compromise. Intraosseous hemorrhage at the fracture site extends minimally into the disk space at L4 -- L5 level.2.Mild to moderate degenerative changes of lumbar spine otherwise however without spinal stenosis or any significant neural foraminal compromise.3.Almost visualized thoracic spine from T10 inferiorly is unremarkable with the exception of mild degenerative changes.4.Examination was terminated at this point due to patient's inability to continue.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, with history of hemoglobin SS undergoing pre-stem cell transplant evaluation. No significant parenchymal signal abnormality is seen. There is no evidence of edema or mass effect. Diffusion-weighted images are within normal limits. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology. A normal variant subcentimeter hippocampal sulcus remnant cyst is seen along the left medial temporal lobe. A subcentimeter focus of T1/T2 hyperintense signal is seen along the inner table of the left parietal bone, likely benign and of doubtful significance.On angiographic imaging, no significant intracranial vascular stenosis or occlusion is seen. The vessels of the anterior and posterior circulation demonstrate normal flow related signal. No aneurysm or vascular malformation is detected.

Output: 1.No significant brain parenchymal abnormalities are seen.2.Unremarkable evaluation of the intracranial vasculature.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with prostate cancer, and abnormal balance, concern for cord compression. Cervical:The marrow spaces are diffusely heterogeneous compatible with widespread osseous metastatic disease. Vertebral body heights are preserved. The normal cervical lordosis is slightly reversed along with a very mild scoliotic curvature.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed by level below. No epidural abnormalities are suspected.C2-3: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C3-4: Facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left paracentral and foraminal zones. The disc osteophyte effaces the left ventral thecal sac and just contacts the cord with slight cord flattening but no evidence of cord compression or significant spinal canal stenosis. Severe left and moderate right foraminal narrowing. C4-5: Facet hypertrophy left more than right. Uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C5-6: Facet hypertrophy left more than right. Uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C6-7: Facet hypertrophy left more than right. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe right and mild left foraminal narrowing C7-T1: Facet hypertrophy. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. Thoracic:Diffuse marrow heterogeneity is again seen compatible with widespread osseous metastatic disease. Vertebral body heights are preserved. There is a mild scoliotic curvature of the thoracic spine. Sagittal alignment is within normal limits.Beginning at the T8 level and continuing down to the T10 level, the left lateral epidural space is encroached upon by soft tissue. This is most severe at the T8-9 level where the spinal cord is displaced right laterally and mildly compressed. There is complete effacement of CSF and a significant generalized stenosis at this level. No definite cord signal abnormality is seen.At the T11 level, there may be mild soft tissue encroachment upon the lateral and right dorsal epidural spaces. However, this causes no significant spinal canal stenosis or cord compression.Scattered disc bulges and/or disc protrusions are seen at multiple levels, some of which contact and/or mildly deform the cord such as at T3-4. These, however, cause no significant generalized spinal canal stenosis. The left-sided neural foramina at T8-9 and T9-10 are infiltrated and narrowed by epidural tumor as above. The foramina are otherwise unremarkable.Multiple tumor deposits are seen along the posterior thoracic wall of the left lung apex.

Output: 1.Significant epidural tumor encroaching upon the left lateral spinal canal from T8 through T10. The lesion is most severe at the T8-9 level where there is displacement of the spinal cord to the right and mild cord compression but no definite evidence of cord edema.2.There may be a few additional small areas of epidural tumor as above, but these cause no significant spinal canal stenosis and no evidence of cord compression.3.No evidence of cord compression is seen in the cervical spine.4.Multilevel degenerative findings as discussed above.


Instruction: Generate impression based on findings.

Input: New gait abnormality and confusion. Recent CT with intratemporal bleed on the left side. A lesion is again noted in the left temporal lobe which contains increased peripheral T1 signal intensity and susceptibility weighted abnormalities measuring 2.6 x 2.0 cm. There is surrounding vasogenic edema which appears similar to the previous exam. Within the limitations of the motion degraded enhanced exam, there is no evidence of abnormal enhancement to indicate an underlying mass and no abnormal surrounding flow voids are appreciated. This lesion corresponds to the intraparenchymal hematoma described on the recent CT from a few days ago, and appears slightly larger taking into account differences in technique. These findings are compatible with an acute to subacute evolving hemorrhage without discrete evidence of an underlying mass. Additional T2/FLAIR hyperintensities in the periventricular, subcortical region as well as within the pons are nonspecific but compatible with moderate small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Again seen is a left temporal intraparenchymal hematoma with surrounding vasogenic edema. The hematoma appears slightly larger compared to the noncontrast CT exam from 10/26/2015, with differences in technique limiting comparison. There is mild local mass effect. No underlying mass, abnormal enhancement or abnormal flow voids are noted within the area of hemorrhage. Follow-up MRI may be helpful to assess for underlying lesion once the intraparenchymal hematoma resolves, especially given the motion degradation on the current study.2.No foci of additional hemorrhage or abnormal enhancement are noted elsewhere in the brain.3.Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: cavernous aneurysm; vertebral pseudo aneurysm, history of cerebellar stroke; changes? History: transient right visual change, dizziness MRI of the brainNo diffusion weighted abnormalities are appreciated. There is encephalomalacia along the right cerebellar hemisphere.A couple punctate T2 and FLAIR hyperintense lesions are present in the cerebellar hemispheres . There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is a 2mm aneurysm at the left ICA at the origin of the left anterior choroidal artery which is unchanged since a CTA from 12/18/2008 CTA.There is a 3.5 mm left cavernous carotid aneurysm present directed medially at the level of the posterior bend which is unchanged since a CTA from 12/18/2008 CTA.There is a 1.5mm aneurysm present along the proximal ophthalmic segment of the RICA which is directed inferiorly and laterally which is unchanged since a CTA from 12/18/2008 CTA.There is a small infundibulum at the origin of the left PCOMA.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is hypoplastic. The posterior communicating arteries are small. The vertebral arteries are asymmetric in size - right larger than left. There is a mild focal dilation of the intracranial LVA distal to the PICA origin. The left PICA and right PICA each have an infundibulum.

Output: 1.There is a 2mm aneurysm at the left ICA at the origin of the left anterior choroidal artery which is unchanged since a CTA from 12/18/2008 CTA.2.There is a 3.5 mm left cavernous carotid aneurysm present directed medially at the level of the posterior bend which is unchanged since a CTA from 12/18/2008 CTA.3.There is a 1.5mm aneurysm present along the proximal ophthalmic segment of the RICA which is directed inferiorly and laterally which is unchanged since a CTA from 12/18/2008 CTA.4.There is mild focal dilation of the intracranial LVA which is stable.5.There are infundibulae present at the origins of the left PCOMA and left and right PICA. 6.No evidence for cerebrovascular occlusive disease.7.There is encephalomalacia along the right cerebellar hemisphere.8.Periventricular, subcortical and cerebellar white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 46-year-old female with elevated LFTs. Patient with widely metastatic cancer of unknown primary. Abdominal pain. LIVER: The liver measures 15.5 cm in length. No suspicious parenchymal lesions. The main portal vein demonstrates normal hepatopedal flow.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The gallbladder is collapsed, which limits evaluation for wall thickening. No intraluminal stones identified. The common bile duct measures 4.2 mm in diameter.PANCREAS: The visualized aspect of the pancreas is unremarkable. Incomplete visualization of the distal pancreatic body and tail due to overlying bowel gas.SPLEEN: The spleen measures 9.7 cm in length.RIGHT KIDNEY: The right kidney measures 11.2 cm in length. No hydronephrosis. OTHER: Bilateral pleural effusions. The left kidney measures 11.9 cm in length. Mild left-sided hydronephrosis, unchanged. The partially visualized (better characterized on the 11th/22/2016 MRI pelvis exam.

Output: 1. No suspicious hepatic lesions.2. Partially visualized uterine mass is better characterized on the 11/22/2016 MRI pelvis exam.3. Bilateral pleural effusions, unchanged.4. Mild left hydronephrosis, unchanged.


Instruction: Generate impression based on findings.

Input: Metastatic squamous cell carcinoma of the lung staging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution, which likely represent chronic small vessel ischemic disease. 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 metastases.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:4/20/1964)Reason: bilateral painful lumbar radiculopathy not improving with conservative measures, eval for e/o disc herniation or other compressive lesion History: numbness/tingling painReferring Attending: TODD STERN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet and ligamentum flavum hypertrophy at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal or neural foramina. There are mild degenerative changes present in the lower lumbar spine.2.No mass lesions are appreciated within the lumbar spinal canal


Instruction: Generate impression based on findings.

Input: 12-year-old female with blurry vision and concern for infectious extension from meningitis and mastoiditis. MRI Brain:Redemonstrated is prominent abnormal thickening and enhancement involving the bilateral cavernous sinuses, pituitary region, dura along the inferomedial frontotemporal lobes, and cisternal segments of the trigeminal nerves. The right VII/VIII nerve complex is also enhancing. Diffuse sulcal enhancement/vascularity has progressed. However, there are no areas of abnormal brain parenchymal enhancement, restricted diffusion, edema, discrete or rim-enhancing fluid collections or other evidence of abscess formation. The ventricles remain normal in size and morphology.There is persistent extensive fluid through the bilateral mastoid air cells, middle ear cavities and petrous apices with associated enhancement. The material filling the mastoid air cells may be mildly diffusion restricted. There is also persistent paranasal sinus thickening and enhancement with fluid, particularly within the sphenoid sinuses. The left external auditory canals remains completely opacified with scattered patchy enhancement. The right external auditory canal is now at least partially patent on today's exam. MRI Orbits:Thin section MRI through the orbits demonstrates abnormal enhancement involving the optic nerve sheaths bilaterally. The extraocular muscles, orbital soft tissues and globes appear unremarkable. As noted above and on the prior examination, the cavernous sinuses are expanded and abnormally enhancing. Patchy diffusion restricting material is seen within the petrous apices and to a lesser extent the cavernous sinuses. The pituitary gland is again noted to be large.MRV Brain:There is mild normal variant hypoplasia of the left transverse sinus. The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and visualized cortical veins are patent. There is no evidence of venous thrombosis.

Output: 1.Findings are redemonstrated compatible with extensive bilateral otomastoiditis and sinusitis. Associated dural thickening and enhancement as well as sulcal enhancement are seen compatible with meningitis. No discrete or rim-enhancing intracranial collections are demonstrated to suggest abscess formation.2.As on the prior examination, the cavernous sinuses are expanded and abnormally enhancing likely indicating infectious involvement. This alone could produce visual symptoms due to cranial nerve irritation. However, note is also made of abnormal enhancement along the intraorbital optic nerve sheaths which may reflect elevated intracranial/orbital pressures, reactive inflammation or spread of infection.3.The intracranial MRV is within normal limits.4.As on the prior examination, the pituitary is noted to be enlarged. This may reflect infectious involvement of the sella, though it could also be physiologic in a patient of this age.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Nausea with vomiting [787.01], Reason for Study: ^Reason: 54 y.o. with h/o head trauma 2 years ago in MVA. Now with persistent nausea and emesis. Please eval for compression or possible etiology. Pt has tolerated MRI's in past. History: persistent N/V No evidence of acute ischemic or hemorrhagic lesion.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. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Patient with right shoulder pain, evaluate for labral versus cuff tear. ROTATOR CUFF: There is a complete longitudinal split tear of the infraspinatus tendon near its attachment to the humeral head, with intact fibers distally and no evidence of retraction or buckling. Abnormal globular signal is noted in the subscapularis tendon, consistent with tendinopathy without evidence of distinct tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is marked labral defect extending anteriorly and inferiorly, which appears largely degenerated. Additionally, there is extensive underlying chondral defect.BICEPS TENDON: Biceps tendon is intact. ADDITIONAL

Output: 1.Complete longitudinal split tear of the infraspinatus tendon, without evidence of retraction or buckling.2.Abnormal globular signal in the subscapularis tendon, consistent with tendinopathy.3.Marked labral defect extending anteriorly and inferiorly, with underlying chondral defects, consistent with extensive degenerative changes.4.Cystic changes in the superior lateral aspect of the humeral head, consistent with moderate degenerative changes.5.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Male 66 years old Reason: Right knee x 5 months, no improvement with NSAIDs and injection or therapy. Pain is around patella, evaluate for chondral injury vs meniscus tear History: Right knee pain MENISCI: Both menisci are normal in morphology and signal intensity.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the cartilage overlying the medial patellar facet and edema type signal within the superior aspect of the patella. There is no full thickness defect. The medial and lateral joint compartment cartilage is relatively well-preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Chondromalacia of the medial patellar facet cartilage with subchondral edema. No full thickness cartilage defect.2. No evidence of meniscal tear.


Instruction: Generate impression based on findings.

Input: Proximal tibia pain, fever, leukocytosis, elevated ESR/CRP, assess for progression of osteomyelitis Worsening osseous T1 hypointensity signal involving the proximal tibial epiphysis, metaphysis, and diaphysis, with improvement on the the proximal fibular proximal epiphysis and metaphysis. There is also worsening of the associated T2 hyperintensity in these regions. The cortex of the proximal tibial laterally, appears to be disrupted with a subperiosteal fluid collection and peripheral enhancement after administration of contrast (arrows on image 9 on series 2 and image 16 on series 9). These findings are compatible with subperiosteal abscess. There is an increase in right knee joint effusion with associated enhancement of the synovium after administration of contrast rising the possibility of septic joint. More extensive cellulitis and myositis of the right lower leg is noted. Nonspecific bone marrow changes of the proximal third of the tibial diaphysis with lack of contrast-enhancement, may represent early development of intramedullary abscess.

Output: Worsening osteomyelitis with development of subperiosteal abscess of the proximal metaphyses of the right tibia. Right knee septic joint. Worsening in the extension of the cellulitis and myositis.


Instruction: Generate impression based on findings.

Input: Shoulder pain Age-appropriate nonfused growth plate without evidence of associated additional radiographic acute abnormality. If internal derangement is suspected with rotator cuff or laboring, follow-up MRI may be indicated

Output: Normal for age


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Midazolam and fentanyl were administered IV by the nurses during continuous hemodynamic monitoring. Targeted CT examination demonstrates a 3 cm soft tissue pelvic mass along the anterior aspect of the left ilium which may reside within the left iliacus muscle, corresponding to the findings on recent MRI and PET/CT examinations. Using CT guidance, a 14-gauge Achieve core biopsy needle was advanced into the lesion. 3 14-gauge core needle biopsy specimens were obtained and placed in formalin. Touch preparations were performed and handed to cytopathology to confirm specimen adequacy. 2 biopsy specimens sunk, 1 biopsy specimen floated.The core biopsy specimens were hand carried to the Surgical Pathology lab.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT guided biopsy of left pelvic/iliacus muscle lesion.