Instruction: Generate impression based on findings.

Input: Male, 20 years old, with back pain. Assess for stenosis. The lumbar lordosis is straightened but spinal alignment is otherwise unremarkable. Vertebral body height and morphology are normal. No concerning marrow replacement or marrow edema is seen. The visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed below.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Very mild loss of disc height and disc T2 signal. Small central disc protrusion which mildly effaces the ventral thecal sac. No significant generalized spinal canal stenosis or specific nerve root impingement is suspected. The neural foramina are patent. No interval changes are seen. L4-5: Mild facet hypertrophy is otherwise unremarkable. No significant interval changes. L5-S1: Loss of disc height and T2 signal. Moderately sized right paracentral disc protrusion which effaces the right lateral recess and which contacts and displaces the transiting right S1 nerve root. The right neural foramen is only mildly narrowed and the exiting right L5 nerve root does not appear to be impinged. The left neural foramen is patent. These findings are unchanged.

Output: 1.No significant change in the size or morphology of a right paracentral disc protrusion at L5-S1 which effaces the right lateral recess and potentially impinges the transiting right S1 nerve root.2.No significant change in the size or morphology of a small central disc protrusion at L3-4 which causes no significant generalized spinal canal stenosis or nerve root impingement.3.No new or acute findings are identified.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 26 seconds

Output: Successful right hip arthrogram.


Instruction: Generate impression based on findings.

Input: Hepatocellular carcinoma with metastases, re-staging Again seen is an intramuscular mass in the right biceps femoris at the level of the mid femur. This has significantly decreased in size from the prior exam now measuring 2.6 x 2.2 x 5.3 cm in the greatest transaxial and craniocaudal dimensions as compared to 5.6 x 5.3 x 10.4 cm previously. The mass is hypo-/isointense to skeletal muscle on T1 with heterogeneous T2 signal. Areas of hypointensity are new from the prior exam and may reflect calcification. No additional soft tissue masses are identified. The marrow signal of the femur and visualized pelvis is normal. There is mild osteoarthritis of the left hip.The soft tissues of the left thigh and the left femur are grossly unremarkable as seen on the coronal view.

Output: Significant interval decrease in size of right thigh soft tissue metastasis.


Instruction: Generate impression based on findings.

Input: History of right breast cancer status post lumpectomy in 2012 presents for screening MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Stable post operative change in the right outer breast. No abnormal lymph nodes are identified in either axillary region.Port-A-Cath in the left chest wall again noted.

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


Instruction: Generate impression based on findings.

Input: Reason: radiculopathy on EMG History: pain Mild straightening of the lumbar spine, otherwise alignment is anatomic. Vertebral body heights are maintained. Multilevel disc desiccation with moderate disc space loss at L4-L5. No abnormal signal within the cord or conus which ends at L1-L2. Endplate degenerative marrow signal changes at L4-L5.T12-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Mild diffuse disc bulge. Moderate facet arthropathy and ligamentum flavum thickening. Moderate spinal canal stenosis. Mild bilateral neural foraminal stenosis.L4-L5: Diffuse disc bulge with moderate facet arthropathy and ligamentum flavum thickening. There is severe spinal canal stenosis at this level. There is low T2 signal filling the spinal canal at this level which may represent extruded disc material, Mild to moderate bilateral neural foraminal stenosisL5-S1: Diffuse disc bulge. Mild effacement of the right lateral recess without central canal stenosis. No significant neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes as detailed above with severe spinal canal stenosis at L4-L5 and moderate L3-L4 spinal canal stenosis. Mild L3-L4 and L4-L5 neural foraminal stenosis.There is low T2 signal filling the spinal canal at the L4-L5 level which is suspected to represent extruded disc material; component of flow-related artifact however is not entirely excluded. Additional imaging with a 3D T2 FIESTA sequence would be helpful.


Instruction: Generate impression based on findings.

Input: Stabbing right-sided headache, worse in life. Assess for vascular dissection or subarachnoid hemorrhage. The study is limited by patient motion. Also, immediately following gadolinium injection, the patient reported warm sensation in her chest and significant nausea. The examination was halted. Symptoms resolved within 2 minutes without treatment but no postcontrast images were obtained for the MRA of the neck or MRV of the cranium.MRI BRAIN WITHOUT CONTRAST:The brain demonstrates normal morphology and signal characteristics. There is no space-occupying lesion, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal accounting for predominantly CSF filled sella, compatible with partially empty sella. There is no abnormal diffusion restriction or susceptibility effect to indicate acute stroke or intracranial hemorrhage.There is no gross orbital abnormality. There is no destructive skull lesion. Thickening of the subcutaneous fat along the scalp likely relates to patient body habitus. There is mild prominence of the optic nerve sheath although remaining within normal limits. No definite posterior scleral flattening is identified.CRANIAL MR VENOGRAPHY WITHOUT AND WITH CONTRAST:As discussed above, no postcontrast MR venography was performed. Motion also limits the examination.There is no sign of significant dural venous thromboses on the noncontrast MR venography. Attenuation of the flow-related signal at the junction of the transverse and sigmoid sinuses is a common imaging finding of no clinical significance.CRANIAL MR ANGIOGRAPHY WITHOUT CONTRAST:Flow-related signal in the intracranial internal carotid arteries and the paired anterior and middle cerebral arteries and their major branches is preserved as well as the vessel caliber. Similarly, the vertebrobasilar system shows no significant stenosis or aneurysm.NECK MR ANGIOGRAPHY WITHOUT AND WITH CONTRAST:As discussed above, only noncontrast enhanced images are available. There is bilateral attenuation of flow-related signal in the carotid bulbs which likely relates to turbulent flow. Otherwise, the cervical carotid arteries show preserved flow-related signal and caliber. Similarly, the cervical vertebral arteries are also preserved except for suboptimal visualization of the origin of the left vertebral artery which may reflect technical limitation of noncontrast enhanced cervical MR angiography. Aortic arch branching pattern is conventional.The fat saturated precontrast axial images of the neck show no sign of intramural hematoma/vessel dissection. There is asymmetric enlargement and lobulation of thyroid gland, more pronounced on the left, probably reflecting the presence of thyroid nodules.

Output: 1.The examination is limited as described above because of inability to complete the examination following the contrast injection as well as patient motion throughout the remainder of the examination.2.There is no definitive intracranial abnormality.3.There is no definite cervical or intracranial artery stenosis accounting for the above described limitations. There is also no sign of vessel dissection.4.No gross evidence dural venous thrombosis.5.Partially empty sella is nonspecific and may represent a normal variant. However, given the incidental note of increased fat within the scalp suggestive of patient's body habitus, as well as history of headaches and relatively young age, clinical correlation should be made for idiopathic intracranial hypertension.6.Asymmetric thyroid gland enlargement and lobulation probably reflect multinodular goiter.


Instruction: Generate impression based on findings.

Input: Reason: prior ACL injury, r/o tear History: pain MENISCI: There is abnormal intermediate signal intensity within the periphery of the posterior horn of the medial meniscus which extends to the tibial articular surface, seen on multiple sequential sagittal images, indicating a longitudinal tear. The extent of the signal abnormality is slightly less than that seen on the prior study, which could reflect some interval healing. However, there is a small residual fluid-filled defect along the inferior fibers of the periphery of the posterior horn, along the lateral margin of this tear. We see no definite lateral meniscus tear.ARTICULAR CARTILAGE AND BONE: There are full-thickness articular cartilage defects involving the central portion of the femoral trochlea, appearing similar to the prior study. There are also partial thickness defects of the articular cartilage of the patella which are better seen on the current study than on the prior examination.LIGAMENTS: The proximal fibers of the anterior cruciate ligament are not well visualized and furthermore the slope of the distal fibers is abnormal and there appears to be slight anterior translation of the tibia relative to the long axis of the femur, suggesting a full-thickness tear. The PCL appears intact. The LCL and MCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Chronic rupture of the proximal fibers of the ACL.2. Tear of the posterior horn of the medial meniscus as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Yearly surveillance of AVM and meningioma, right side finger and toe numbness, occasional vision "unsteadiness" lasting 1-2seconds. MRI: There is an unchanged extra-axial left parafalcine enhancing mass measuring up to 28 mm, with mass effect upon the superior sagittal sinus and underlying brain parenchyma, but no associated edema. There is mild high T2 signal in the parenchyma surrounding the right central sulcus arteriovenous malformation. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.MRA: There is an unchanged nidus related to an arteriovenous malformation in the right central sulcus, measuring up to 30 mm. There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. Unchanged left parafalcine meningioma.2. No significant interval change in the right central sulcus arteriovenous malformation.


Instruction: Generate impression based on findings.

Input: 87-year-old female with basal ganglia lesion seen on recent head CT. Please further evaluate. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are subcentimeter areas of high T2 signal in the bilateral basal ganglia and right thalamus distinct from accompanying prominent perivascular spaces (etat crible). There is mild scattered T2 hyperintensity in the periventricular and subcortical white matter. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The right periorbital contusion has resolved.

Output: 1. FIndings suggestive of chronic infarcts in the bilateral basal ganglia and right thalamus superimposed upon mild probable chronic small vessel ischemic white matter disease. 2. No evidence of acute 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: There are stable postsurgical findings related right parietal craniotomy with underlying encephalomalacia along the surgical approach extending to the ventricle and bifrontal ventricular catheter tracks. The glomus of the right lateral ventricle choroid plexus is surgically absent and there is no abnormal enhancement to suggest residual or recurrent tumor. There lateral and third ventricles appear to have slightly decreased in size. There is a small amount of unchanged chronic residual hemorrhage within the occipital horns. There is unchanged cystic encephalomalacia within the right basal ganglia. There is an unchanged 5 mm diameter left peritrigonal cystic lesion. There is no evidence of acute infarct or hemorrhage. The major cerebral flow voids are grossly intact. There is persistent mucosal thickening within the bilateral maxillary and ethmoid sinuses. The extracranial structures are unremarkable.

Output: 1.Stable postsurgical findings related to right lateral ventricle choroid plexus tumor removal without evidence of residual or recurrent tumor.2.Unchanged 5 mm wide cystic encephalomalacia versus prominent perivesicular space in the left peritrigonal region. Right basal ganglia cystic encephalomalacia is also unchanged. 3.Slight interval decrease in ventricular size.


Instruction: Generate impression based on findings.

Input: 14-year-old male with posterior thigh mass in the pain. There is a large mass centered within the popliteal fossa of the knee, surrounding the popliteal artery and vein as well as the tibial nerve. The mass extends approximately 10 cm above the knee joint superiorly, abutting the posterior cortex of the distal femur, the medial aspect of the biceps femoris, and the posterolateral aspect of the vastus medialis. There appears to be a thin fat plane between the mass and the distal semimembranosus. At the level of the knee joint, the bulk of the mass is situated between the heads of the gastrocnemius with a small "tail" extending along the anterior margin of the lateral head of the gastrocnemius and additional tissue entering the posterior aspect of the intercondylar notch. The mass does appear to focally invade the medial head of the gastrocnemius, with streaky elements also invading the lateral head of the gastrocnemius along its length distally. Overall the craniocaudal dimension is at least 30 cm with a cross-sectional diameter of up to 6 cm. The mass also abuts the soleus and popliteus muscles. The mass has a lobulated appearance with some focal fatty septa within the mass, but it is predominantly isointense to muscle on T1-weighted images and is predominantly hyperintense on T2-weighted images, with near-fluid signal intensity. The mass enhances in a predominantly peripheral and septal distribution with a more nodular component of enhancement along the posterior aspect at the level of the distal femur. Poorly defined infiltrative enhancement is noted as the mass extends into the lateral head of the gastrocnemius.The menisci are intact and the articular cartilage appears normal. The anterior and posterior cruciate ligaments are intact as are the medial collateral ligament and lateral collateral ligament complex. The extensor mechanism is intact. The bone marrow signal is within normal limits.

Output: Large lobulated mass centered in the popliteal fossa of the knee as described above. Based on its morphology and signal characteristics, the mass may represent a lymphatic malformation. Given its intimate association with the popliteal vessels, extremely extensive cystic adventitial disease is considered a possibility, albeit less likely. The high signal intensity of the mass on T2WI with what appear to be fatty components raise the possibility of a myxoliposarcoma, although the fatty components may simply represent entrapped fat within the lobules of the tumor. Synovial sarcoma may also have a predominantly cystic appearance, although the mass surrounds the neurovascular bundles rather than displacing them, which would be atypical for most malignancies. Follow-up with orthopedic oncology is recommended.


Instruction: Generate impression based on findings.

Input: 24 year-old female with swelling and pain, evaluate for injury TENDONS: The extensor and flexor tendons are intact. The Achilles tendon appears within normal limits.LIGAMENTS: The lateral collateral ligaments, including the ATFL and PTFL are intact. The medial collateral ligaments appear within normal limits.ARTICULAR SURFACES AND BONE: Moderate tibiotalar joint effusion. The tibiotalar articular surface appears within normal limits.ADDITIONAL

Output: 1. Moderate tibiotalar joint effusion2. Mild soft tissue edema adjacent to the base of the fifth metatarsal without underlying osseous abnormality.


Instruction: Generate impression based on findings.

Input: Clinical question: R/O R cervical radiculopathy. Signs and Symptoms: Intermittent numbness in the RUE mostly in a R C6 distribution Nonenhanced cervical MRI:There is mild uniform generalized smaller than expected size of the spinal canal which is believed to represent a congenital anatomical variation.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes, mild bilateral ligamentum flavum hypertrophy and mild bilateral facet degenerative changes. There is a tiny right lateral disc protrusion and uncovertebral hypertrophy which results in moderate right neural foraminal compromise (sagittal oblique series 901 image 5 and sagittal T2 series 401 image 9). Patent left neural foraminal and no central spinal stenosis.C4-C5 demonstrate mild disc desiccation, mild bilateral (right greater than left) uncovertebral hypertrophic changes, mild bilateral ligamentum flavum and facet degenerative/hypertrophic findings. No central spinal stenosis. Moderate right and neural foraminal compromise (sagittal T2 oblique series 901 image 5 and 6) and patent left neural foramen.C5-C6 demonstrate moderate disease on loss of disc height, mild bilateral (right greater than left) uncovertebral hypertrophic changes and mild ligamentum flavum hypertrophy. No central spinal stenosis however moderate bilateral neural foraminal compromise secondary to degenerative changes is detected (sagittal oblique series 901 and 1001).C6-C7 demonstrate moderate disc disease and loss of disc height, bilateral significant uncovertebral hypertrophy changes, mild bilateral facet and ligamentum flavum hypertrophy. There is a shallow broad-based disc protrusion with resultant effacement of subarachnoid space, mild flattening and posterior displacement of the cord and mild central spinal stenosis. Significant bilateral (right greater than left) neural foraminal compromise is also detected.C7-T1 demonstrate mild degenerative disease and unremarkable otherwise.There is subtle increased T2 signal intensity of the cord anteriorly at this level suspected of myelopathy.

Output: 1.At C6-C7 degenerative changes including uncovertebral hypertrophic changes and a broad-based disc protrusion results in central spinal stenosis and significant (right greater than left) neural foraminal compromise. Subtle T2 hyperintensity of the cord at this level is concerning for myelopathy.2.Uniform generalized smaller size of spinal canal represent a congenital anatomical variation of small canal.3.Mild degenerative changes at other levels however without convincing evidence of central spinal stenosis.4.There are multilevel bilateral (right greater than left) neural foraminal compromise at other levels as detailed.5.Please review detailed report above.


Instruction: Generate impression based on findings.

Input: New persistent headache. Abnormality of gait. There is no acute infarct or intracranial hemorrhage. There is no mass, mass-effect, midline shift or herniation. There are few punctate T2-hyperintense foci in the cerebral white-matter, which are nonspecific. Examination is otherwise unremarkable. The ventricles and the other CSF-containing spaces are normal in size. The major intracranial vascular flow voids are preserved. The orbits are grossly unremarkable and mastoid air cells are clear. There is minimal mucosal thickening in the paranasal sinuses.

Output: Noncontrast MRI is essentially within normal limits for age. Few punctate T2-hyperintense cerebral white-matter foci are nonspecific.


Instruction: Generate impression based on findings.

Input: Ms. Holmes is a 53 year old female with a personal history of right breast lumpectomy in 2009 for IDC with treated metastases to the lumbar vertebrae. Patient currently complains of subacute diffuse and focal pain to the right breast and axillary region. Recent diagnostic workup and PET was negative. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Minimal postsurgical changes are identified in the right breast. No abnormal enhancement is seen in either breast. Left chest wall port is present. No abnormal axillary 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: Clinical question: please do dr Javed MS protocol and compare to prior MRI on 3 T. Signs and Symptoms: fatigue and headaches. Pre and post enhanced brain MRI:Mild to moderate supratentorial and minute infratentorial findings of chronic demyelinating disease are again identified and without convincing evidence of any appreciable interval change since prior exam. Lesions extensively involving the periventricular white matter and the corpus callosum and minimally of the subcortical white matter of cerebral hemispheres.There is mild prominence of cortical sulci for patient's stated age of 24 similar to prior exam and concerning for underlying parenchymal volume loss.Similar to prior exam there is a single small focus of FLAIR hyperintensity/demyelinating plaque in the dorsal aspect of cervical cord at C2-C3 disc level.There is no detectable abnormal enhancement of the above detailed lesions. There is revisualization of a tiny developmental venous anomaly in the paramedian left frontal lobe.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Stable chronic findings of demyelinating disease primarily in the supratentorial white matter and corpus callosum and minutely in the posterior fossa.2.Stable mild prominence of cerebral cortical sulci for patient's stated age.


Instruction: Generate impression based on findings.

Input: There is mild nonspecific prominence of the ventricles, right greater than left. The cortical sulci appear appropriate for patient age. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Unremarkable MRI of the brain with and without contrast.


Instruction: Generate impression based on findings.

Input: 11-year-old boy with history of lupus and 6 weeks of shoulder pain. ROTATOR CUFF: The rotator cuff tendons are intact. There is inflammatory change surrounding the muscle bellies of the infraspinatus and teres minor. The supraspinatus and subscapularis appear normal.SUPRASPINATUS OUTLET: There is a minimal amount of fluid in the subacromion/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal and the glenoid labrum is intact. A very small amount of fluid is seen in the joint space.BICEPS TENDON: The biceps tendon is well-positioned within the bicipital groove and intact. A minimal, normal amount of fluid is seen in the biceps tendon sheath. ADDITIONAL

Output: Inflammation of the infraspinatus and teres minor muscles without rotator cuff tear. These findings are most suggestive of myositis and, given the patient's history, likely due to lupus. Other, less likely differential considerations include dermatomyositis, polymyositis, trauma, or infection.


Instruction: Generate impression based on findings.

Input: Reason: rule out MCP radial collateral ligament tear of the thumb-would like to locate level of tear History: pain Patient motion artifact limits multiple sequences.LIGAMENTS: There is disruption of the distal fibers of the ulnar collateral ligament of the first MCP joint. The proximal fibers of the ulnar collateral ligament appear to be retracted and portions are external to the adductor aponeurosis. The radial collateral ligament appears intact.TENDONS: The flexor and extensor tendons appear intact. The adductor tendons appear intact. BONES: There is increased abnormality within the ulnar aspect of the head of the first metacarpal which may reflect a bone contusion.ADDITIONAL

Output: Findings indicating disruption of the ulnar collateral ligament. Portions of the ulnar collateral ligament appear retracted and external to the adductor aponeurosis indicating a Stener lesion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Ataxia, stroke, diabetes type II. 44-year-old female The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hyperdense focus along the lower aspect of the right postcentral gyrus representing a focus of infarction identified and a recent MRI of the brain it measures approximately 3.5 cm by 9 mm in axial dimensions. There is also a small hypodense focus along the left cingulate gyrus extending towards the left paracentral lobule and another smaller one along the left inferior parietal lobule. These are also identified on a recent MRI of the brain . Atherosclerotic calcifications are present along the distal internal carotid arteries.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. The visualized portions of the paranasal sinuses demonstrate partial opacification of right and middle ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate a hyperdense left eyeball probably postoperative. It is unchanged since prior exam.

Output: 1.The patient has a focus of infarction in the right postcentral gyrus. 2.There are small foci of encephalomalacia along the left cingulate gyrus extending towards the left paracentral lobule and along the left inferior parietal lobule. 3.No evidence for acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Unspecified epilepsy without mention of intractable epilepsy [345.90], Reason for Study: ^Reason: focal lesion History: right abd pain Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is about 7 mm sized focal patchy enhancing lesion on the right cerebellar hemisphere (series 3801, image 27/80). Possibility of this lesion include capillary telangiectasia, small developmental venous anomaly or an artifact. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-spine MRIThe cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. There are 12 mm x 15 mm sized right thyroid gland mixed intensity lesion as well as about 4 mm sized multiple centimeters nodular lesions on the left thyroid gland. Further investigations using ultrasound examination may need to be considered.There is no evidence of abnormal enhancement, cord compression or mass. Minimal bulging of disc C5-6 and C6-7 were seen without evidence of spinal canal stenosis or neuroforaminal stenosis.T-Spine MRIThere is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Right cerebellar hemisphere patchy enhancing lesion diagnostic possibilities include capillary telangiectasia, developmental venous anomaly or an artifact.3. Normal cervical and thoracic MRI.4. Multiple variable sized thyroid nodules as described above, further imaging evaluation using ultrasound can be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Assess for osteochondroma. Again seen is the small bony excrescence from the posterior margin of the proximal humerus that has decreased in size in comparison from study obtained 2/4/2014. We see no associated soft tissue mass and suspect that this represents spontaneous resolution of the osteochondroma, however if the patient complains of pain or there is a palpable mass, MRI can be considered.

Output: Osteochondroma as described above.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. There is a prominent Schmorl's node along the superior endplate of T12. No worrisome focal marrow signal abnormality is appreciated. There is disc desiccation at L3-L4. There is linear T2 hyperintensity in the conus at the level of L1 consistent with known syrinx, which was partially visualized on previous thoracic spine MRI. Otherwise, the distal spinal cord and conus are within normal limits with the conus terminating at the lower L1 level. There is no fat signal intensity in the distal canal. There are postoperative changes at L4-L5 and L5-S1 presumably related to cord untethering with deformity of the distal thecal sac.At T11-T12, T12-L1, L1-L2 and L2-L3: There is no evidence of disc disease or spinal canal or foraminal narrowing.At L3-4: There is disc bulge, mild facet arthropathy and ligamentum flavum thickening resulting in mild to moderate right and mild left neuroforaminal narrowing. There is no spinal canal stenosis.At L4-L5: There is minimal disc bulge and facet arthropathy. No significant neuroforaminal or spinal canal stenosis.At L5-S1: No significant disc bulge, neural foraminal, or spinal canal stenosis.

Output: 1. Mild degenerative disc disease mostly at L3-L4 resulting in mild to moderate right and mild left neural foraminal narrowing. No spinal canal stenosis at any level. 2. Linear T2 signal in the conus at L1 level consistent with previously questioned small syrinx.3. Postsurgical changes of cord untethering. Prone imaging not performed.


Instruction: Generate impression based on findings.

Input: History of epidural abscess, back pain No evidence of epidural abscess is appreciated. Previously demonstrated peripheral enhancing soft tissue in the left ventral epidural space at L1 level extending into the left L1-L2 neural foramen is significantly decreased in size and compatible with evolution of postsurgical change and/or resorption of minimal residual disc material.Unchanged compression deformity of L1 with approximately 70% loss of height. Unchanged associated bone marrow edema. There are mild compression fractures of L2 and L3 vertebral bodies also unchanged since 11/11/2014. Additional scattered areas of T1 hypointensity throughout the spine are nonspecific. Areas of T1 hyperintensity are compatible with focal fat or hemangiomas.Degenerative changes throughout the lumbar spine also again seen without evidence of high-grade spinal canal or neural foraminal stenosis. Again seen is mild spinal canal and mild-to-moderate left neural foramina stenosis at L4-L5 related to disk bulge, facet arthropathy, and ligamentum flavum buckling as well as mild left L3-4 neural foraminal narrowing. Multilevel facet arthropathy. No paraspinous fluid collections are demonstrated.

Output: 1. No evidence of epidural abscess or active infection. Previously demonstrated peripheral enhancing soft tissue in the left ventral epidural space at L1 level extending into the left L1-L2 neural foramen is significantly decreased in size and most compatible with evolution of postsurgical change and/or resorption of minimal residual disc material.2. Multiple compression fractures, worst at L1, are unchanged since 11/11/2014. Again seen is focal kyphosis at the L1-L2 level similar to prior. Please note L1-L3 compression fractures and L1-2 kyphosis is clearly progressed since 8/29/2014. Bone marrow signal remains heterogeneous which is nonspecific. Compression fractures are favored to be benign in etiology.


Instruction: Generate impression based on findings.

Input: Reason: evaluate medial compartment- evaluate for chondral injury vs meniscus tear History: left knee pain MENISCI: There is deformity of the medial meniscus. The posterior horn of the medial meniscus appears unusually small with a radial tear noted just medial to its root. The contour of the anterior horn is abnormal with portions appearing square-shaped in sagittal cross-section, perhaps representing an adherent displaced meniscal fragment. There is increased signal intensity within the body of the medial meniscus indicating intrasubstance degeneration. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritis of the medial tibiofemoral compartment with full-thickness cartilage loss along the weightbearing portions of the medial femoral condyle and medial tibial plateau with degenerative subchondral changes in the underlying marrow. The lateral compartment is preserved. There is near full-thickness degeneration of the articular cartilage of the patella along the lateral facet with blistering of the articular cartilage at the median eminence. Relatively mild degeneration is seen along the medial facet of the patella. There is also full-thickness cartilage loss and delamination along the medial facet of the trochlea. Note is made of a bipartite patella.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The patellar and quadriceps tendons appear intact. There is patella alta. There is ossification of the distal patellar tendon at its tibial attachment, which is not necessarily of any clinical significance.ADDITIONAL

Output: Severe osteoarthritis predominantly affecting the medial tibiofemoral compartment with deformity of the medial meniscus likely representing a complex tear with displaced meniscal fragment. Other findings as above.


Instruction: Generate impression based on findings.

Input: History of low back pain. Evaluate for nerve impingement, vertebral compression. Examination is limited due to motion degradation. There is grade 1 anterolisthesis of L5 on S1. Vertebral body heights and disc heights are grossly maintained. There is nonspecific heterogeneous bone marrow signal. Conus medullaris is normal in appearance and terminates at the T12-L1 level. Fat at the L4-5 level is thought to be in the dorsal epidural space. Right renal cyst.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: Advanced facet arthropathy with small amount of fluid in the joint. Small synovial cysts posterior to the facet joints. There is no significant compromise to spinal canal or neural foramina.L5-S1: Advanced facet arthropathy with small amount of fluid in the joint. Small synovial cysts posterior to the facet joints. Mild disc bulge. There is moderate to severe right and moderate left neural foraminal narrowing. There may be impingement of the exiting L5 nerve roots. There is no spinal canal stenosis.

Output: 1.Grade 1 anterolisthesis of L5 on S1 with advanced facet arthropathy at L4-5 and L5-S1.2.Moderate to severe right and moderate left neural foraminal narrowing at L5-S1, where there may be impingement of the exiting L5 nerve roots.


Instruction: Generate impression based on findings.

Input: Lung cancer with bone metastases and fracture: pain, surveillance. There are postoperative findings related to upper thoracic laminectomy. There is a persistent pathological fracture of the T1 vertebral body with near complete loss of height and retropulsion of bone and tumor posterior into the spinal canal measuring 7 mm in width, which results in mild spinal cord impingement. There is no definite spinal cord edema. There is also approximately 9 mm of anterior subluxation of the cervical vertebral column. The rest of the thoracic spinal column alignment is intact. There is marked interval decrease in size of the soft tissue tumor arising from the left T1 posterior elements that projects into the paraspinal soft tissues. There is also decrease in size of a mass situated alongside the right T11-12 level that projects into the paraspinal soft tissues. The previously demonstrated pulmonary nodules are better depicted on the prior chest CT.

Output: 1. Pathological fracture of the T1 vertebral body with near complete loss of height and retropulsion of bone and tumor posterior into the spinal canal with mild indentation upon the spinal cord, as well as persistent 9 mm of anterior subluxation of the cervical vertebral column. Soft tissue tumor arising from the left T1 posterior elements projecting into the paraspinal soft tissues has diminished. 2. A metastasis situated alongside the right T11-12 level that projects into the paraspinal soft tissues has also markedly diminished.


Instruction: Generate impression based on findings.

Input: 45-year-old female with multiple sclerosis. Performed Dr. Javed MS protocol version 1.1, no DTI. Redemonstrated are numerous foci of T2 hyperintensity in the white matter which appear unchanged. There are no new lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are stable in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Stable demyelinating lesions.


Instruction: Generate impression based on findings.

Input: 53 year old female with pain at the 1-3 metatarsals. Evaluate for stress fracture, bursitis or sesamoiditis. The bone marrow signal intensity is within normal limits without evidence of stress fracture. The sesamoid bones appear normal. There is a subcentimeter collection of near-fluid-signal intensity between the first and second metatarsal heads, which may represent a very mild bursitis, but this is equivocal and we otherwise see no abnormal fluid collections. The remaining visualized soft tissue structures appear normal.

Output: Tiny focus of fluid signal intensity between the first and second metatarsal heads could conceivably represent a very mild bursitis, but we otherwise see no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Male 62 years old with malignant melanoma s/p 6 cycles of immunotherapy. Please evaluate disease status and provide measurements for all lesions. ABDOMEN:LIVER, BILIARY TRACT: There are multiple subcentimeter T2 hyperintense, circumscribed nonenhancing hepatic lesions are consistent with simple cysts. The referenced right hepatic dome lesion is not seen on today's exam. A small area of enhancement within hepatic segment 7 is unchanged and consistent with a portal to hepatic venous shunt. Normal morphology of liver with no suspicious lesion. No biliary ductal dilatation. The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The reference celiac bifurcation lymph node measures 2.6 x 0.8 cm (series 11, image 53), previously 2.6 x 1.0 cm.BOWEL, MESENTERY: Moderate hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple subcentimeter hepatic cysts and stable hepatic venous shunt. No suspicious liver lesion.2.Stable reference celiac bifurcation lymph node.3.No new sites of disease.


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain. History of mucinous neoplasm of the pancreas. ABDOMEN: Several of the imaging sequences are degraded by respiratory motion and wrap around artifact.LIVER, BILIARY TRACT: Diffuse hepatic steatosis. Significant hepatomegaly measuring 29 cm in craniocaudal dimension. Otherwise the liver is normal in morphology. No intrahepatic or extrahepatic biliary ductal dilatation. No filling defect in the common bile duct. Normally distended gallbladder.SPLEEN: Status post splenectomy.PANCREAS: Postsurgical changes from distal pancreatectomy. No evidence of residual or recurrent tumor.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: Ventral subcutaneous postsurgical changes.OTHER: No significant abnormality noted.

Output: Hepatomegaly with diffuse steatosis. No focal lesion or other specific findings to account for the patient's abdominal pain.


Instruction: Generate impression based on findings.

Input: Pseudotumor, on Cytoxan, follow up. Compared to 11/13/2014, subcentimeter thick dural-based enhancing lesion measuring 6 to 8 mm in the coronal plane underlying the left parietal craniotomy flap has not significantly changed in size. There is unchanged encephalomalacia involving the left paracentral lobule. No new mass or edema. No significant mass effect. No hydrocephalus. Stenosis involving the anterior and mid superior sagittal sinus is better assessed on prior MRV. There is no evidence of acute infarct. There are postoperative findings related to right mastoidectomy with unchanged enhancement. Ectopic cerebellar tonsils again seen.

Output: 1. No significant change in dural thickening along the left parietal convexity compatible with known pseudotumor. Unchanged encephalomalacia involving the left frontoparietal lobes. No new mass or mass-effect.2. Unchanged postoperative appearance of the right mastoid cavity.


Instruction: Generate impression based on findings.

Input: Female, 45 years old. Fall, now with medial knee pain and instability MENISCI: The posterior horn of the medial meniscus shows intrasubstance intermediate signal compatible with degeneration, without discrete meniscal tear identified. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. No focal articular cartilage defects are identified.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Degeneration of the posterior horn of the medial meniscus without discrete meniscal tear identified.


Instruction: Generate impression based on findings.

Input: 33-year-old male with ulcerative colitis and primary sclerosing cholangitis. Assess for stricturing or suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and contour. Subcentimeter T2 hyperintense focus in hepatic segment one that begins to fill in on delayed postcontrast images compatible with slow filling hemangioma, unchanged. No focal suspicious hepatic lesion is identified. The gallbladder is normally distended without cholelithiasis.There is mild dilation of the intrahepatic bile ducts and the common duct. The common duct measures up to 11 mm with smooth tapering near the level of the ampulla suggestive of distal common bile duct stricture, unchanged. There is mild scattered intrahepatic biliary ductal dilatation and extensive areas of bleeding of the intrahepatic biliary ducts, configuration is not significantly changed since the previous exam. No abnormal biliary ductal enhancement.The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances normally. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Symmetric renal enhancement without focal lesion.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.Stable mild intrahepatic and common bile duct dilation with suggestion of stricture near the level of the ampulla.2.Areas of intrahepatic biliary beading the configuration of which is not significantly changed.


Instruction: Generate impression based on findings.

Input: Compared to 12/10/2015, interval evolution of postoperative changes at the C1 and C2 levels related to tumor resection are seen. Postoperative epidural blood products and fluid collection have resolved with reexpansion of the thecal sac. Minimal residual intradural enhancement is seen without mass effect. Residual extradural tumor remains at these levels similar to prior without mass effect on the thecal sac. Increased enhancement is noted in the midline paraspinous soft tissues consistent with postoperative change.Enhancing mildly expansile masses are seen at all levels in the cervical neural foramina which are not significantly changed since prior and without significant intraspinal extension. The previously noted enhancing oval mass in the left posterior paraspinal soft tissues at C2 measures 30 x 18 mm x 30 which is not significantly changed for differences in measurement technique although gradually enlarged since study from 8/8/2013 when this mass measured approximately 19 x 14 x 24 mm.Enhancing mass involving the left upper thoracic neural foramen extending into the lung apex is partially imaged. No expansile intramedullary lesions are seen. There is T2 hyperintensity with significant volume loss involving the cervical cord at the C2 level consistent with myelomalacia. Kyphosis of the cervical spine with apex at C4 is again seen, not significantly changed. Vertebral body heights are maintained. No concerning marrow replacement is seen. Multiple prior cervical laminectomies are noted extending inferiorly to the C5 level. There is no significant spinal canal stenosis at any level.

Output: 1. Compared to 12/10/2015, there has been evolution of postsurgical changes related to intradural and extradural tumor resection at C1 and C2. There has been resolution of the previously seen postoperative fluid and blood products which were previously effacing the thecal sac. There is no residual mass effect on the thecal sac. Noted is T2 hyperintensity and moderate focal volume loss involving the cervical cord at the C1-C2 level compatible with myelomalacia and presumably related to previous chronic compression. 2. Multiple additional neurofibromas involving the cervical spine and paraspinous soft tissues demonstrate no significant interval change. No findings to suggest intramedullary neoplasm.3. Left posterior paraspinous soft tissues lesion at the C2 level demonstrates enlargement compared to 2013.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for low grade disseminated glial tumor. Signs and symptoms: Brain tumor. Pre-and post-enhanced brain MRI:Examination demonstrates extensive bilateral frontal white matter flair hyperintensity and with resultant ex vacuo dilatation of ventricles without evidence of appreciable interval change since prior exam. Extensive susceptibility signal changes primarily in the frontal horn of the left lateral ventricle remains similar to prior exam. Also similar to prior exam there is a thin fairly uniform band of enhancement along the ependymal lining of left frontal horn and body of lateral ventricle.Also stable since prior exam are additional nonenhancing patchy foci of flair hyperintensity in the periventricular white matter of the cerebral hemispheres as well as bilateral basal ganglia. There is no detectable new foci of flair hyperintensity or abnormal enhancement since prior study.Prominence of cortical sulci for patient's stated age of 51 similar to prior exam and suggestive of underlying parenchymal volume loss.Unremarkable calvarium and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhances.All visualized paranasal sinuses demonstrate normal pneumatization signal pattern.

Output: 1.No evidence of an acute or new finding since prior study.2.Diffuse bilateral anterior frontal encephalomalacia, ex vacuo dilatation of the ventricles and a thin uniform enhancement along the ependymal lining of the left frontal horn remains similar to prior exam.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: paresthesias. There is no significant interval change in the multiple white matter lesions that are predominantly in a periventricular distribution. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the intracranial demyelinating lesions.


Instruction: Generate impression based on findings.

Input: MRI Brain: There is no diffusion abnormality. No intracranial mass or mass effect. There is scattered mild T2/Flair signal abnormality in the periventricular and subcortical regions which is nonspecific but likely from small vessel ischemic changes. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Incidental note is made of a mucous retention cyst or polyp in the right sphenoid sinus.MRA Head: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. The right AICA is not visualized. No evidence of aneurysms or vascular malformations.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Mild chronic small vessel ischemic changes.3.MRA of the brain within normal limits.


Instruction: Generate impression based on findings.

Input: Bilateral upper extremity weakness and hyperreflexia, status post MVA Cervical: Craniovertebral junction appears within normal limits. There is evidence of osseous fusion involving the C5-C7 vertebral bodies which is postsurgical. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from mild loss of cervical lordosis. Bone marrow signal is benign with T1 hyperintense lesion involving the C7 vertebral body compatible with a hemangioma..The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is mild right neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. No significant compromise to the spinal canal or left neural foramen.C4-5: Disc osteophyte complex and prominent uncovertebral hypertrophy on the left. There is partial effacement of the ventral thecal sac without significant spinal canal stenosis at this level overall. There is moderate left and mild right neural foraminal stenosis.C5-6: No significant compromise to the spinal canal or neural foramina. There is mild effacement of the ventral thecal sac.C6-7: No significant compromise to the spinal canal or neural foramina. There is mild effacement of the ventral thecal sac.C7-T1: There is mild left neural foraminal stenosis related to facet arthropathy. No significant compromise to the spinal canal or right neural foramen.Small perineural cysts incidentally noted at C6-C7 and C7-T1. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Thoracic: Thoracic vertebral body heights are maintained. Alignment is maintained. There is trace prominence of the central canal/tiny syrinx involving the lower thoracic cord, measures 1.3 mm in the AP dimension, and is of doubtful significance. Thoracic cord signal is otherwise unremarkable. Bone marrow signal is benign with no suspicious lesions. Scattered foci of T1 hyperintensity are compatible with hemangiomas and focal fat.No significant spinal canal stenosis is seen. Degenerative changes include partial effacement of the dorsal thecal sac at the T9-T10 level related to ligamentum flavum thickening and facet arthropathy. There is mild right T1-T2 neural foraminal stenosis. There is also mild neural foraminal stenosis at the T5-T6 and T6-7 levels. Small multiple Schmorl's nodes are noted in the lower thoracic spine.T2 hyperintense lesion is partially imaged involving the right hepatic lobe. Small left renal cyst is also noted.

Output: 1. Evidence of remote anterior cervical fusion involving the C5 to C7 vertebral bodies. There is no evidence of high-grade spinal canal stenosis at any level in the cervical spine or evidence of cervical cord signal abnormality.2. Adjacent segment disease with degenerative changes at C4-C5, where there is moderate left and mild right neural foraminal stenosis. There is also partial effacement of the ventral thecal sac at the C4-C5, C5-C6, and C6-C7 levels. Additional levels as detailed above.3. Mild degenerative changes in the thoracic spine without significant spinal canal stenosis at any level. There is trace prominence of the central canal in the distal thoracic cord which is of doubtful clinical significance. Thoracic cord signal is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with elevated protein in CSF, nuchal rigidity, status post OHT. Cervical:Within the limitations of a motion degraded exam, the following observations are made. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. Minimal disc osteophyte formation is seen without high-grade spinal canal stenosis. At most minimal scattered foraminal narrowing is demonstrated.Thoracic:Within the limitations of a motion degraded exam, the following observations are made. A mild scoliotic curvature is seen. Sagittal alignment is within normal limits. Mild anterior wedging of the T6 vertebral body is seen without marrow edema. The remaining vertebral bodies demonstrate preservation of height. No pathologic marrow replacement or edema is detected. The spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are seen. Mild scattered disc degeneration is seen without significant spinal canal or foraminal compromise. Small pleural effusions are seen bilaterally.Lumbar:Within the limitations of a motion degraded exam, the following observations are made. Grade 1 retrolisthesis of L2 relative to L3 and L3 relative to L4 is seen. Vertebral body heights are preserved. Marrow signal characteristics are somewhat heterogeneous with scattered Schmorl's node deformities. However, no pathologic marrow replacement or edema is detected.A fluid-fluid level is evident dependently within the sacral thecal sac. In addition, the distal cauda equina nerve roots are clumped and disorganized with intermixed T1 hyperintense strands. The distal spinal cord and conus are unremarkable. No epidural abnormalities are suspected.L1-2: Loss of disc T2 signal but no significant compromise of the spinal canal or neural foramina. L2-3: Loss of disc T2 signal and disc bulging with a left far lateral annular fissure. No significant compromise of the spinal canal. Mild narrowing of the neural foramina. L3-4: Loss of disc T2 signal. Mild disc bulging. Mild compromise of the spinal canal and neural foramina. L4-5: Mild facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild compromise of the neural foramina. L5-S1: Moderate facet arthropathy. Mild disc bulging. No significant compromise spinal canal. Mild narrowing of the left neural foramen.

Output: 1.A fluid-fluid level is evident layering dependently within the sacral thecal sac along with clumping and disorganization of the nerve roots and intermixed T1 hyperintense strands. This is favored to represent blood degradation product with scattered blood clots. The possibility of infection is not excluded, and infection may certainly coexist with hemorrhage. However, meningitis on its own typically does not produce this amount of gross intrathecal debris.2.Very mild disc degeneration is seen in the cervical and thoracic spine with moderate degenerative findings in the lumbar spine. No areas of high-grade spinal canal stenosis are detected.


Instruction: Generate impression based on findings.

Input: MRI CARDIAC W/FLOW W/STRESS WWO, 11/16/2016 8:15 AM First Pass PerfusionDuring hyperemia, no perfusion defects were present. Mild dark rim artifact is present. Viability/ Myocardial ScarThere is mid-myocardial late gadolinium enhancement of the septum from the mid wall to the base which represents an infiltrative process, inflammation, or fibrosis. The finding is not typical for prior myocardial infarction. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 161 ml/m2 (normal range: 65+/-11), the LVEDV is 334 ml (normal range 109+/-23), the LV end systolic volume index is 133 ml/m2 (normal range 18+/-5), the LVESV is 277 ml (normal range 31+/-10), the LV mass index is 41 g/m2, and the LV mass is 69 g. There is global hypokinesis with regional variation. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 117 ml/m2 (normal range 69+/-14), the RVEDV is 243 ml (normal range 110+/-24), the RV end systolic volume index is 97 ml/m2 (normal range 22+/-8), and the RVESV is 200 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is mildly dilated. 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 mildly dilatedVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions (right greater than left). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity of any vasodilator stress test is likely reduced in the face of severe LV dilation and dysfunction. 2. The left ventricle is severely dilated with severely reduced systolic function (LVEF 17%). There is evidence of myocardial fibrosis involving the mid-myocardial layer of the basal septum. This finding is not typical for prior myocardial infarction and has been commonly described in non-ischemic/ dilated cardiomyopathy. 4. The right ventricle is severely dilated with severely reduced systolic function (RVEF 17%).5. At least moderate mitral regurgitation.6. Severe biatrial enlargement.7. Mild dilation of main pulmonary artery and aortic root. 8. Small pericardial and pleural effusions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 75 year old female with a history of hepatic mass. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology without evidence of cirrhosis. There is a 4.8 x 4.2 cm lobulated mass in segment 2/3 of the liver with associated central scar, slight increased T2 signal abnormality and homogeneous enhancement on postcontrast sequences, which persists on the two and half hour delayed contrast enhanced sequence. These findings are most consistent with a benign FNH in a non cirrhotic liver. There is no washout on delayed postcontrast sequences.Simple cyst in the right lobe of the liver. The gallbladder is filled with numerous gallstones without evidence of acute cholecystitis. No intra hepatic biliary ductal dilation is identified. There is dilation of the common duct measuring up to 9 mm in diameter. Note is made of numerous common duct stones measuring up to 3 mm in diameter, which appear similar to the prior study performed at an outside hospital.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of a 10.0 cm simple cyst in the interpolar region of the left kidney.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: 1.4.8-cm mass in the left lobe of the liver with imaging characteristics most consistent with an benign FNH, as detailed above.2.Choledocholithiasis with slight dilation of the common bile duct.3.Innumerable gallstones without evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of COPD, hundred pack year smoker infiltrate on CXR. Assess for infiltrate versus oncologic process. Limited examination due to lack of contrast. MRI may be considered for further evaluation.BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.NECK:Limited value of the exam due to lack of contrast. With this limitation, imaging through the skull base and the cavernous sinus is unremarkable. Examination demonstrates no evidence of mass or pathologic lymphadenopathy in the neck. The airway and vasculature are patent. The osseous structures are intact. Effacement of the pyriform sinus is stable when compared to previous examinations dating back as far as one year ago 05/20/07.Limited view of the chest shows bilateral apical scarring.

Output: Stable examination without evidence of an oncologic process as clinically questioned.


Instruction: Generate impression based on findings.

Input: 60-year-old female with popping, locking and catching. Mild osteoarthritis on recent radiographs. Evaluate medial meniscus. MENISCI: Note is made of increased branching linear signal abnormality within the posterior of the medial meniscus which extends to the tibial and femoral articular surface consistent with a complex tear with both a radial and horizontal component. There is also linear increased signal abnormality within the posterior horn and body of the medial meniscus which does not definitively extend to either articular surface. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow signal abnormality within the medial aspect of the tibial plateau and to a lesser degree within the medial femoral condyle consistent with bone contusion. No full-thickness or near full-thickness articular cartilage defects are identified. There is a partial-thickness articular cartilage fissure along the lateral facet of the patella, centrally.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above.2. Partial-thickness articular cartilage fissure along the patella and bone contusions as described above. 3. Small joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Known cavernoma: surveillance. There is a mass with circumferential susceptibility effect and internal high T1 and T2 signal components that measures 15 mm in diameter in the right inferior frontal lobe, adjacent to the basal ganglia. There are a few scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of vasogenic edema or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are bilateral small maxillary sinus retention cysts.

Output: A right inferior frontal lobe cavernous malformation measures 15 mm.


Instruction: Generate impression based on findings.

Input: Clinical question: Arnold-Chiari evaluate for syrinx. Signs and symptoms: dysphagia. Unenhanced cervical spine MRI:There is herniation of cerebellar tonsils to the foramen magnum of approximately 8.5 mm and with subtle flattening deformity of the tonsil. Findings consistent with Chiari malformation.There is normal signal intensity and caliber the cervical cord and without evidence of syrinx.There is normal anatomical development of cervical vertebral column and no evidence of spinal canal or neural foraminal compromise.Nonenhanced thoracic spine MRI:There is normal anatomical development, alignment and signal intensity of the vertebral column.There is normal signal intensity and caliber of thoracic cord.There is no evidence of spinal canal or neuroforaminal compromise.Nonenhanced lumbar spine MRI:There are 6 lumbar type vertebral bodies which is an anatomical variation. There is no detectable congenital malformation of the vertebral column.There is normal signal intensity of the conus and with termination of the cord at L1 -- L2 disk level.There is normal signal intensity and morphology of cauda equina and in particular there is no evidence of fatty filum or tethered cord.The perispinal soft tissues are unremarkable.

Output: 1.MRI of the cervical spine demonstrate 8.5-mm herniation of cerebellar tonsils through the foramen magnum with mild flattening deformity. Unremarkable MRI of cervical spine otherwise in particular without evidence of syrinx.2.Nonenhanced MRI of thoracic spine is unremarkable.3.Nonenhanced MRI of the lumber spine demonstrates 6 lumbar type vertebrae which is a normal anatomical variation. There is normal signal intensity and morphology of the conus and cauda equina without evidence of abnormalities. There is termination of the cord at L1 -- L2 level.


Instruction: Generate impression based on findings.

Input: Limited sagittal images of the entire spine do not demonstrate any evidence of acute cord compression. Vertebral body heights are grossly preserved. There is nonspecific, patchy increased STIR signal within the T3 vertebral body with corresponding decreased T1 signal. There is no associated apparent destruction of the T3 vertebral body. Soft tissue edema is present within the lumbar posterior subcutaneous soft tissues which is nonspecific.

Output: 1.No evidence of acute cord compression. 2.Bone marrow signal abnormality within the T3 vertebral body is nonspecific and could be related to both benign or malignant etiologies. CT can be considered for further evaluation to assess bony integrity. Discussed with SANTOS DE LIMA, FABIANE.


Instruction: Generate impression based on findings.

Input: Reason: Patient w/ R. Hip and groin pain X 1 wk, please evaluate for dislocation/ fracture History: As above On the AP view, there is a step-off of the cortex along the medial aspect of the femoral head/neck junction. The underlying trabeculae do not appear disrupted and this is not clearly evident on the frog-leg lateral view. We suspect this represents a peculiar osteophyte, but if there is strong clinical concern for an acute fracture, MRI could be considered.

Output: Step-off of the cortex along the medial aspect of the femoral head/neck junction. While we suspect this represents a peculiar osteophyte, if there is strong clinical concern for an acute fracture, MRI could be considered. These findings were discussed with Dr. Soundarrajan by phone at 12:30 PM on 3/30/2016.


Instruction: Generate impression based on findings.

Input: Radicular left leg pain and urinary retention Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Focus of T1 hyperintensity within the L5 vertebral body is compatible with small hemangioma or focus of fat. No suspicious osseous lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. No significant spinal canal stenosis. There is minimal bilateral neural foraminal narrowing.L4-L5: Disc desiccation with disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening result in mild spinal canal stenosis. There is mild effacement of the lateral recesses, left greater than right, which may be affecting the left descending L5 nerve root. There is also mild bilateral neural foraminal stenosis, left relatively greater than right. L5-S1: There is disc desiccation with mild height loss. There is also a disc bulge which contributes to mild effacement of the lateral recesses. No significant central canal stenosis. There is moderate bilateral facet arthropathy and ligamentum flavum thickening. There is moderate bilateral neural foraminal stenosis which may be affecting the exiting L5 nerve roots.Paraspinous soft tissues are within normal limits.

Output: 1. Degenerative changes in the lumbar spine at the L4-L5 and L5-S1 levels. There is moderate bilateral neural foraminal stenosis at the L5-S1 levels where there may be impingement of the exiting L5 nerve roots. 2. Mild central spinal canal stenosis at the L4-L5 level. No high-grade spinal canal stenosis at any level. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Reason: 64 YO male with hx of pancreas mass; please evaluate for changes and or abnormalities History: pancreas mass. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: Complex multiloculated cystic lesion with enhancing septations in the pancreatic head measures approximately 3.8 x 2.3 cm (series 4 image 30), previously 3.6 x 1.7 cm. This lesion again communicates with the pancreatic duct, which is mildly dilated measuring 5 mm, previously 4 mm. No new lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 3.5 cm solid nonenhancing lesion within the gastric body which follows fat on all sequences and compatible with an intramural lipoma has slightly increased in size, previously measuring 2.8 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight interval increase in size of multiloculated cystic lesion in the pancreatic head that communicates with the mildly dilated pancreatic duct, these characteristics suggestive of a mixed main duct and side branch IPMN. Gastric lipoma.


Instruction: Generate impression based on findings.

Input: 55-year-old female with ESRD, diabetes, severe peripheral vascular disease, and hypertension with gangrenous toes of the right foot and sacrum decubitus ulcerIMAGE ACQUISITIONS: Pelvis CT after intravenous administration of 120 mL Omnipaque 350 There is soft tissue ulceration adjacent to the sacrum. Anteroverted coccyx bone is noted which could be posttraumatic. This bone is demineralized, and we cannot rule out infection. MRI is recommended if further imaging is indicated.L5-S1 degenerative changes with vacuum disk phenomenon.Calcified uterine fibroids are noted.

Output: 1. Sacral soft tissue ulceration2. Anteroverted coccyx which is demineralized. Infection cannot be excluded.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: r/o stroke vs mas lesion History: 1st onset seizure Motion artifacts degraded exam quality.No evidence of acute ischemic or hemorrhagic lesion on the scan.On FLAIR images especially coronal scan, there are relatively diffuse high signal intensities on bilateral hippocampi (left side more prominent than right). However, on axial FLAIR images those increased signal intensities were not as conspicuous as those of coronal FLAIR images. In addition, there is no evidence of hippocampal volume loss or deformity. Thus, this finding may suggest possible post ictal status or artifacts. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The bilateral mastoid air cells show opacifications. Mucosal thickening on the left maxillary sinus.

Output: 1. Diffuse bilateral hippocampal high signal intensity on FLAIR coronal images which may indicate acute post ictal status or artifact. Follow up scan can be considered for further imaging evaluation.2. No evidence of acute ischemic or hemorrhagic lesion. No mass lesion identified.


Instruction: Generate impression based on findings.

Input: 28-year-old male with right lower extremity cellulitis involving the knee down, with concern for underlying osteomyelitis. Diffuse soft tissue edema about the lower extremity, with a prominent collection along the medial tibial plateau with foci of low signal intensity, likely gas, extending to the bone surface of the medial tibial plateau. There is minimal enhancement after contrast administration with no discrete rim-enhancing collection identified to suggest an abscess. There is a depressed medial tibial plateau fracture, better evaluated on subsequent CT study. There is abnormal bone marrow signal in the medial tibial plateau demonstrating low T1 and low T2 signal intensity however no findings to suggest bone marrow edema and there is no enhancement after contrast administration.There is edema type signal in the adjacent musculature. Bone marrow signal of the remaining tibia and fibula appear normal.

Output: Diffuse soft tissue swelling with a more pronounced collection adjacent to the medial proximal tibia with soft tissue gas extending to the bone surface of the medial tibial plateau where there is a depressed fracture better evaluated on subsequent CT study. There is low T1, low T2 signal intensity of the bone marrow of the medial tibial plateau, however no evidence of bone marrow edema. Given the above findings however, osteomyelitis is not entirely excluded.


Instruction: Generate impression based on findings.

Input: Status post prostatectomy in 2007. PSA now 0.8. Possible nodule on digital rectal exam. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy, with surgical clips noted. A 4 mm T2-hypointense diffusion-restricting enhancing nodule in the posterior surgical bed at midline (series 801, image 7) (series 604, image 144) is suspicious for recurrent/residual carcinoma.Seminal Vesicles: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. No lymphadenopathy by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 4 mm nodule in the posterior midline surgical bed suspicious for recurrent/residual carcinoma.


Instruction: Generate impression based on findings.

Input: Peritoneal mesothelioma status post CRS/HIPEC. Evaluate extent of disease. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Few subcentimeter hepatic cysts. No suspicious hepatic lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: Tiny T2 hyperintense posterior pancreatic head lesion, may represent side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple renal cysts, some of which contain layering hemorrhage. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are several sites of new peritoneal deposits including peripancreatic, along the left hepatic lobe and along the lesser curvature of the stomach. A representative left hepatic lobe peritoneal nodule measures 4.4 x 2.5 cm (series 4, image 16). Nonspecific anterior midline metallic artifact limits evaluation of the ventral abdominal wall.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple sites suspicious for recurrent abdominal peritoneal disease.2.Nonspecific oval nodularity between the rectum and seminal vesicles, stable since 3/18/2015. Attention on subsequent imaging.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB: 5/20/1965)Reason: fall down flight of stairs following syncopal event, now with severe mid back pain (interscapularly) and low back pain with left leg numbness and pain, eval for fracture eval disk herniation History: severe mid back pain (interscapularly) and low back pain, left leg numbness, weakness and burning sensationPROVIDER NAME: KEVIN C CONCORDIA TIEN S DONG 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. No abnormal lesions are identified in the thoracic spine.There are Schmorl's nodes present at the T7-T8 disc space level. At the T2-3 interspinous ligaments there is T2 signal hyperintensity present on the T2 STIR images. There is a small right paramedian disc protrusion at T6-7. Additional Schmorl's node is present at T10-T11. A sclerotic focus is present within the T12 vertebral body measuring approximately 5 mm in size. In isolation this is of unknown clinical significance.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal lesions are identified in the lumbar spine. There is mild multilevel disc desiccation present. Some mild epidural lipomatosis present in the lower lumbar spine at the L5 level and the sacral level. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge 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: 1.There are mild degenerative changes present in the thoracic and lumbar spine without significant compromise to the spinal canal or exiting nerve roots.2.Findings raise the question of some ligamentous injury at the T2 -T3 interspinous ligament


Instruction: Generate impression based on findings.

Input: 48 years Female (DOB:10/9/1967)Reason: assess for stroke History: right sided weakness and numbnessPROVIDER/ATTENDING NAME: DAVID HOWES RAYMOND ROOS MRA brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam periventricular white matter signal hyperintensity on FLAIR and T2 imaging has regressed but not completely resolved.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are serpiginous flow-voids in the right parietal lobe on susceptibility imaging and on FLAIR MRI which are suggestive of a developmental venous anomaly in the right parietal lobe. This appearance has not changed compared to the prior examNormal 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 some thickening of the posterior longitudinal ligament present. There is some straightening of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present this level is desiccation and narrowing of the left neural foramen with encroachment of the left-sided exiting nerve roots..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. There is some encroachment of the right-sided exiting nerve roots within the neural foramen and result material and osteophytes..At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Some ill-defined periventricular white matter lesions are less conspicuous on the current exam compared to the prior. They're nonspecific.3.A subtle lesion in the right parietal lobe is suggested to be a developmental venous anomaly. The appearance has not changed since the prior exam from 2008. Developmental venous anomaly can be confirmed with post contrast imaging if felt to be clinically appropriate.4.There are degenerative changes present in the cervical spine with encroachment of left-sided exiting nerve roots at C2-3 and right-sided exiting nerve roots at C4-5.


Instruction: Generate impression based on findings.

Input: Redemonstrated are cystic structures within the right parietal white matter demonstrating CSF isointensity on all sequences without enhancement or adjacent parenchymal abnormality. When compared to the recent CT, there are more of these foci within this small cluster given the better soft tissue discrimination of MRI. These have no associated mass effect.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is mature. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. There are no abnormal enhancing foci.

Output: Redemonstrated are cystic structures within the right parietal white matter demonstrating CSF isointensity on all sequences without enhancement or adjacent parenchymal abnormality. This constellation of features is consistent with dilated perivascular spaces which have no clinical significance.


Instruction: Generate impression based on findings.

Input: Reason: eval for progression of HCC History: mildly enlarging liver lesion. Limited exam without the use of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Stable ablation cavity in the right hepatic lobe with internal debris/hemorrhage. Enhancement cannot be assessed.Previously seen mildly T2 hyperintense arterial enhancing lesion in segment 3 is not visualized on the T2 sequences possibly due to slice selection.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst with thin septation, unchanged. Subcentimeter left renal cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Esophageal varices.BONES, SOFT TISSUES: Fat-containing ventral hernia. L1 and L2 vertebral body hemangiomas. OTHER: No significant abnormality noted.

Output: 1.Previously seen subcentimeter T2 hyperintense arterial enhancing lesion is not identified on the T2 sequences, possibly due to slice selection. If continued follow up is required, recommend pre and post contrast MRI when patient's acute renal failure has resolved. 2.Stable right hepatic lobe ablation cavity. Recurrence cannot be assessed without contrast.


Instruction: Generate impression based on findings.

Input: Female, 15 years old. Reason: Evaluate for TFCC tear History: ulnar sided pain LIGAMENTS: Scapholunate and lunate triquetral ligament appear intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Triangular fibrocartilage complex is grossly intact.TENDONS: No significant abnormality noted. BONES: Focus of decreased T1 signal in the proximal pole of the scaphoid likely represents a bone island. Bone marrow signal is normal.ADDITIONAL

Output: Triangular fibrocartilage complex is grossly intact. This can be better visualized with MRI arthrogram if clinically warranted.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges: left vision loss. There is an unchanged enhancing dural based lesion that measures 7 mm in width along the right inferior frontal gyrus. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged scattered areas of high T2 signal in the cerebral white matter. There are also unchanged nonsecpfic punctate foci of susceptibility effect in the cerebral hemisphere, which may represent chronic microhemorrhages. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus with associated secretions.

Output: 1. Unchanged subcentimeter right frontal convexity probable meningioma.2. Unchanged scattered areas of high T2 signal in the cerebral white matter, which are nonspecific, but likely represent chronic small vessel ischemic disease. 3. Left maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: 70 year-old male presenting with transient alteration of awareness and ataxia, with likely TIA. Evaluate for bleed or other cause. There is no evidence of intracranial hemorrhage, mass or edema. Soft tissue mass extending from the sella is identified, incompletely evaluated without contrast administration, resulting in mass effect upon the suprasellar cistern. No internal calcifications or adjacent bone erosion is evident. Further evaluation with MRI is recommended. The ventricles are midline, and demonstrate normal volume and morphology.The calvaria and skull base are radiographically normal. Crescentic high density is noted in the subcutaneous tissues along the superior aspect of the left parietal lobe, which may represent hematoma. No underlying fracture is evident. Partial opacification of the maxillary and sphenoid sinuses and numerous ethmoid air cells is evident.

Output: 1. Subcutaneous hematoma overlying the postero-superior left parietal bone, with no underlying fractures or intracranial hemorrhage. 2. Sellar mass as described above. Differential considerations include pituitary macroadenoma, among others. Further evaluation with MRI is recommended. 3. Sinus disease as described above.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post prostatectomy. 4+3 disease. Extraprostatic extension and lymphovascular invasion was present. Positive margins and left seminal vesicle invasion. Negative lymph nodes. PELVIS:PROSTATE: Status post prostatectomy. No evidence of recurrent or residual tumor at the cystourethral anastomosis.BLADDER: No evidence of recurrent or residual tumor at the cystourethral anastomosis.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: Small fat-containing inguinal hernias.OTHER: No significant abnormality noted.

Output: No specific findings of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Female, 23 years old, with headache and pseudotumor cerebri, question of left frontal encephalocele seen on outside sinus CT. The left frontal bone lesion in question correlates to a small CSF filled defect within the inner table of the frontal bone. A venous structure enters into this defect, but no involvement of the brain parenchyma is seen.The brain parenchyma as visualized on this examination is within normal limits. No pathologic enhancement is seen. Incidental note is made of a cavum vellum interpositum. The pituitary gland is slightly small in size for a patient of this age.

Output: 1.The lesion in question within the left frontal bone most likely represents a small pacchionian granulation or some other small developmental osseous anomaly. No evidence of encephalocele is seen.2.The pituitary gland is slightly small for a patient of this age. Findings may reflect normal anatomic variation but they could also represent a secondary finding related to elevated intracranial pressure as the history of pseudotumor cerebri would suggest.


Instruction: Generate impression based on findings.

Input: Evaluate for vascular formation of orbit, glaucoma: Sturge Weber with right sided eye pain/headache. Brain: There is diffuse leptomeningeal enhancement in the right parietal and occipital lobes, as well as a small portions of the posterior right temporal lobe. The brain parenchyma otherwise appears to be unremarkable. There is a 10 mm wide arachnoid cysts in the medial right middle cranial fossa. There is no evidence of intracranial hemorrhage or acute infarct. 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 skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There appears to be thinning of the right temporal scalp.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. Stigmata of Sturge Weber syndrome involving the posterior right cerebral hemisphere.2. No gross orbital lesions.3. Apparent thinning of the right temporal scalp may also be related to Sturge Weber syndrome or an injury.


Instruction: Generate impression based on findings.

Input: 21-year-old male. Pain along the lateral joint line and anterior. MENISCI: Medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Small bone contusion of the anterior medial femoral condyle (series 501, image 13). Tibiofemoral and patellofemoral compartment cartilage is normal in thickness and signal.LIGAMENTS: ACL and PCL are intact.EXTENSOR MECHANISM: Intact.ADDITIONAL

Output: 1. Fluid signal intensity collection mostly in the superficial lateral aspect of the knee consistent with a Morel-Lavelle lesion. 2. Small bone contusion of the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: 2-month-old male with a reported history of an enlarging perianal mass.EXAMINATION: MRI Pelvis without and with IV contrast 6/30/2016 8:39 Focus of high T2 signal (series 801, image 22) with an arrowhead configuration and several branching curvilinear tendrils arising from the 6:00 position of the anal verge. The focus measures approximately 1.5 cm in length, 0.3 cm in thickness, and demonstrates enhancement (series 1001, image 26). Bilateral hydroceles are noted.

Output: Enhancing abnormal signal adjacent to the anal verge is favored to represent a vascular lesion. A sonogram is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: No evidence of acute infarct, intracranial mass or mass effect. There are mild patchy T2 hyperintense foci in the subcortical, periventricular and deep white matter which are nonspecific but compatible with mild chronic small vessel ischemic disease. No hydrocephalus or extra-axial collections. Small mild cystic changes are noted in the right greater than left hippocampi and choroidal fissures, likely of no clinical significance. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement. Normal flow-voids are demonstrated in the major intracranial vascular structures. Bone marrow signal is within normal limits.

Output: 1. No evidence of acute infarct. No intracranial mass or mass effect.2. Mild chronic small vessel ischemic disease.