Instruction: Generate impression based on findings.

Input: Brain MRI: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. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Lumbar spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no significant degenerative changes or stenoses.

Output: Negative MRI of the brain and lumbar spine including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 11 years old, with history of acute lymphoblastic leukemia, presenting with the right eye conjunctival lesion. Need to evaluate for ophthalmologic or CNS lesions. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.Mild thickening, edema and hyperenhancement of the right eyelid is seen. However, no intraorbital abnormalities are detected. Globes are round and symmetric. The extraocular muscles demonstrate normal morphology and enhancement. The optic nerves are free of pathologic signal abnormality and enhancement. The lacrimal glands are symmetric and normal. The intraconal fat is clean.

Output: 1.Nonspecific thickening and inflammation of the right eyelid is seen.2.Examination of the brain and orbits is otherwise within normal limits.


Instruction: Generate impression based on findings.

Input: Reason: R lobe lesion, followup History: PBC, pancreatic cysts ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. TIPS is redemonstrated. Peripheral right hepatic lobe segment 7 lesion demonstrates arterial enhancement and hyper to isointense signal on delayed phase images. The lesion demonstrates increased T2 and DWI signal intensity. It measures approximately 1.6 x 1.5 cm (series 11, image 26), unchanged from previously 1.7 x 1.6 cm on 3/18/2015 MRI but new from 2013 exam. While these findings do not meet criteria for diagnosis, this lesion remains suspicious for hepatocellular carcinoma.Common bile duct dilation, as below.SPLEEN: No significant abnormality noted.PANCREAS: There are innumerable cysts of varying sizes replacing the pancreas. These have increased gradually since 9/30/2008 CT exam and likely represent combined main and side-branch type IPMNs. The common bile duct is also markedly dilated, which may reflect obstruction by cystic pancreatic lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right hepatic lobe lesion new from 2013 with signal characteristics suspicious for hepatocellular carcinoma, though not meeting criteria for diagnosis.2.Innumerable cystic lesions replacing the pancreas have increased gradually since 2008, likely representing combined main and side-branch type IPMNs.3.Marked dilation of the common bile duct may reflect obstruction by cystic pancreatic lesions.


Instruction: Generate impression based on findings.

Input: T11 sensory level, lower extremity weakness. There is a 3 mm wide filum terminale fibrolipoma, without a low-lying conus medullaris. There is no evidence of enhancing mass lesions. At L4-5, there is a small disc bulge and annular fissure, but no significant spinal canal or neural foraminal stenosis. There is no significant spinal canal stenosis at the other thoracic and lumbar spine levels either. The spinal cord displays normal signal and morphology, without evidence of acute infarction. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Incidental 3 mm wide filum terminale fibrolipoma.2. No evidence of thoracic spinal cord infarction.3. Degenerative spondylosis at L4-5 without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 54-year-old female with osteomyelitis status post laminectomy, persistent back pain. Evaluate alignment, fracture, degeneration. There is severe disc space narrowing at L5-S1 with associated endplate cortical irregularity and indistinctness corresponding to the inflammatory changes seen on recent MRI study appear most compatible with discitis/osteomyelitis. Alignment is anatomic. The remaining lumbar vertebral bodies appear normal with mild anterior osteophyte formation.

Output: Findings most compatible with discitis/osteomyelitis at L5/S1 corresponding to findings seen on recent MRI study.


Instruction: Generate impression based on findings.

Input: 26 year old man with history of D-TGA, s/p corrective arterial switch surgery, referred for evaluation of anatomy and fibrosis. Situs /positionCardiac situs is normal as is abdominal organ position. L and R ventricles are normally positioned, as are the RA and LA. The IVC and SVC are normally positioned. The PA is anterior to the aorta c/w D-TGA arterial switch surgical correction.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 181 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 81 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No shunts are noted.Left AtriumThe left atrium is normal in size. The interatrial septum is thickened ? surgical repair.Right VentricleThe right ventricle is normal in size with lower normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 193 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 92 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch that arises from the morphologic left ventricle. There is a normal brachiocephalic branching pattern. The left coronary artery originates from the usual location on the left coronary cusp. The right coronary artery origin is not well seen. There is no aortic coarctation. The aortic root dimensions are as follows:Sinus of Valsalva: 38mm x 39mm x 38mmSinotubular Junction: 28mm x 26mmAscending Aorta: 30mm x 30mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe pulmonary artery arises form the morphologic right ventricle and is anterior to the ascending aorta. The R PA appears normal, there is narrowing in the proximal L PA (12-14 mm) as it courses next to the aorta, then enlarges to a more normal diameter.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 55%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 2. The right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 52%.3. D-TGA s/p corrective arterial switch surgery with aorta arising from morphologic LV and PA arising anterior to the Ao from morphologic RV. 4. No significant shunts or congenital structural abnormalities noted.5. There is narrowing in the proximal L PA. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 53-year-old man with elevating PSA. PELVIS:PROSTATE:Prostate Size: 38 x 25 mmPeripheral Zone: The peripheral zone is diffusely heterogeneous likely representing prostatitis. There is a large area which is hypointense on T2-weighted images and dark on ADC maps measuring 2 x 0.8 cm on image number 224, series number 703 suspicious for prostate cancer in the anterior prostate. This lesion extends to transition zone and abuts the capsule and extends from the apex to the mid prostate in the anterior prostate. Central Gland: BPH nodules are noted in the central gland bilaterally.Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: The bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large anterior lesion suspicious for carcinoma in the left anterior apex to mid prostate, and area amenable to MR guided biopsy.


Instruction: Generate impression based on findings.

Input: 73-year-old male with left knee pain and question of medial meniscal tear. MENISCI: Laterally, there is a complex predominantly transverse tear of the posterior horn. The lateral posterior horn also appears small, indicative of multifocal tearing. There is also desiccation of the superior aspect of the anterior horn of the lateral meniscus. Incidentally noted is a well visualized anterior meniscal femoral ligament seen just anterior to the PCL.ARTICULAR CARTILAGE AND BONE: There is thinning with associated sclerosis within the posterior femoral articulation of the medial epicondyle. The far medial aspect of the tibial articular cartilage appears degraded with bony uncovering.LIGAMENTS: There is mild fraying and signal abnormality of the ACL though fibers appear to be intact. The PCL is within normal limits. The LCL complex appears intact. There is mild signal abnormality about the MCL, likely indicative of strain, however the fibers of the MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Degenerative changes including complex tearing of the medial meniscus as specifically outlined above.2. Osteoarthritis with articular cartilage degeneration of the medial tibiofemoral articulation as above. 3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Moyamoya with history of transient ischemic attack, aneurysm and subarachnoid hemorrhage. Please assess for degree of stenosis and for aneurysms. Brain MRI:There is no evidence of acute infarct or discrete area of encephalomalacia to suggest prior infarct. No appreciable evidence of intracranial hemorrhage. The ventricles and other CSF-containing spaces are normal in size. No intracranial mass or mass effect. There is no midline shift or brain herniation. A partially empty sella is noted and a may be normal variant in this age group. The orbits are grossly unremarkable. Mastoid air cells are clear. There is trace mucosal thickening in the ethmoid sinuses.Cranial MRA:The included cervical right internal carotid artery is small, especially in its supraclinoid segment which has not significant changed since the previous examination. The right M1 segment is occluded proximally, but flow reconstitutes in its distal part and along its more distal branches through enlarged right lenticulostriate arteries; distal MCA branches however remain asymmetrically attenuated compared to the contralateral side. The right A1 segment is not clearly visualized and may at least in part be related to hypoplasia. Flow in the A2 segments and distally is preserved and symmetric. Overall appearance has not significantly changed since the previous examination. In addition, the fusiform dilatation of the anterior communicating artery is also unchanged nor the two small (2-3 mm each) wide-neck aneurysms; one pointing inferior-left laterally and another superior and right laterally. There is also an unchanged small aneurysm arising from the cavernous left internal carotid artery measures 4 mm at its base and 2 mm in height. The vertebrobasilar circulation is preserved. Large right posterior communicating artery, which is a normal variation.

Output: 1.Right-sided moyamoya pattern has not significantly changed since previous CT angiogram from November 2015 with nonvisualization of the distal right ICA and proximal right M1 segment with flow partially reconstituting through prominent lenticulostriate arteries. 2.Flow in the distal right middle cerebral artery branches is attenuated. There is no evidence of infarct or hemorrhage.3.Small aneurysms along the dilated anterior communicating artery as well as the small aneurysm of the cavernous segment of the left internal carotid artery remain unchanged.


Instruction: Generate impression based on findings.

Input: Compared to the previous study dated 3/24/2015 the T2 and FLAIR high signal that was noted in the left periventricular white matter is less prominent, consistent of normal evolution of the infarction.Additionally, FLAIR and T2-weighted images demonstrate moderate chronic small vessel ischemic strokes of bilateral subcortical and periventricular white matter as well as left bilateral basal ganglia, the thalamus and extensively of the pons, unchanged from the previous study.There are new T2 and FLAIR high signal foci in the left cerebral peduncle, pons, and medulla. In addition, the size of the left cerebral peduncle appears to be a bit smaller than that of the right which likely representing Wallerian degeneration.Small retention cyst is seen in the sphenoid sinus.3D TOF MRA demonstrates nonvisualization of the right vertebral artery. Irregularities seen in the basilar and the vertebral arteries. There are luminal irregularities of the cavernous segments of bilateral ICAs.There is fetal origin of the right PCA.There is 10-20% narrowing of the carotid canal segment of the left ICA.There is 10-20% narrowing of the cavernous segment of the bilateral ICAs.No intracranial arterial aneurysm.MRV demonstrates a filling defect in the distal superior sagittal sinus, most likely due to intradural fibrous septa, forward flow through the region appears to be maintained.The left transverse sinus is not seen, likely represent hypoplastic dural sinus.Left sigmoid sinus also appears to be hypoplastic.Other major dural sinuses including deep venous drainage appears to be normal.

Output: 1.The left periventricular infarct that was noted in the previous study is less prominent, consistent with normal evolution. Otherwise, the study is unchanged. 2.Left vertebral artery not visualized.3.10-20% narrowing of the carotid canal segment of the left ICA and 10-20% narrowing of the cavernous segment of both ICAs.4.Normal MRV.


Instruction: Generate impression based on findings.

Input: Headache and possible subdural hematoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Unspecified fall, initial encounter [W19.XXXA], Reason for Study: ^Reason: stroke History: syncope Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There are multifocal bilateral patchy T2/FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating non-specific small vessel ischemic disease.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, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate subtle irregularity of vascular lumen but otherwise normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. There is no significant arterial luminal stenosis. No aneurysm is seen. Bilateral Pcom and Acom arteries are patent. The right ACA A1 segment is hypoplastic.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous but normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease, as described above.3. Minimal atherosclerotic changes of both intra and extracranial arterial system. No significant arterial luminal stenosis. No intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: Back pain. Compression fracture. Suspicion of cord compression. Examination is obtained of the total spine per limited cord compression protocol.Diffuse marrow heterogeneity is noted consistent with known multiple myeloma. There is a mild compression fracture along the superior endplate of T5. There is a relatively worse compression fracture along the superior endplate of T12 with approximately 50% loss of height and minimal retropulsion involving the superior endplate. Vertebral body heights are otherwise maintained. Alignment is grossly maintained. Fractures are not associated with retropulsion or soft tissue component. Diffuse edema is noted involving the L1 spinous process likely related to myelomatous involvement.There is partial ankylosis involving the C4 and C5 vertebral bodies with disc osteophyte complex at C5-C6 mildly narrowing the spinal canal. No definite cord signal abnormality. There is no significant thoracic or lumbar neural foraminal stenosis.

Output: 1. No cord compression is identified. Please note this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine.2. Diffuse heterogeneous marrow abnormality is compatible with the diagnosis of multiple myeloma.3. Pathologic compression fractures involving the T12 and T5 vertebral bodies as above without significant spinal canal stenosis.4. Mild spinal canal stenosis C5-6.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 left leg weakness. There is no evidence of intracranial hemorrhage, mass or edema. Extensive, periventricular hypodensities consistent with small vessel disease common age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered. Prominence of the sulci may be within normal limits for the patient's age.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate, if there is clinical concern for acute ischemia an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 75-year-old male patient with chronic hip pain. Bone marrow signal is within normal limits.Mild osteoarthritis affects the right hip. The right ligamentum teres is intact. A small amount of fluid within the right hip joint is within physiologic limits. There is increased signal intensity within the anterior and superior labrum likely representing degeneration and partial thickness tearing. There is increased signal intensity within the main tendon of the right gluteus medius at its insertion at the greater tuberosity representing insertional tendinosis and partial-thickness tearing. There is also mild tendinosis of the right gluteus minimus tendon at its insertion as well. There is mild edema in the peritrochanteric tissues. Similar abnormalities affect the left hip as seen on the large field-of-view images.Minimal insertional tendinosis of the hamstring tendons at their origins are not necessarily of any clinical significance. Moderate osteoarthritis affects the symphysis pubis. Severe degenerative disc disease affects the lower lumbar spine.There is a right-sided inguinal hernia containing small bowel. There is a fat-containing left inguinal hernia.

Output: Mild osteoarthritis of both hips with insertional tendinosis and interstitial tearing of the gluteus medius tendons bilaterally and other findings as described above.


Instruction: Generate impression based on findings.

Input: Right adrenal adenoma. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule measuring 1.9 x 1.6 cm demonstrating homogeneous low T1 and T2 weighted signal intensity with homogeneous enhancement. The lesion demonstrates loss of signal intensity on out of phase imaging.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable right adrenal lesion with imaging features most compatible with a lipid rich adrenal adenoma.


Instruction: Generate impression based on findings.

Input: Chiari decompression with worsening headache and difficulty swallowing. Brain: There are postoperative findings related to Chiari decompression surgery. There is persistent tenting of the posteroinferior cerebellum to the overlying dura associated with intervening hypointense bands. There is also blunted cerebrospinal fluid flow across the posterior aspect of the neo-foramen magnum. Otherwise, there is intact cerebrospinal fluid flow across the anterior neo-foramen magnum and the inferior cerebellum extends to the level of tip of the dens, which is unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are slightly smaller in . There is no midline shift. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology, without evidence of syrinx. The vertebral column alignment is unchanged, with paucity of the usual cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression surgery with persistent evidence of adhesion formation along the posteroinferior cerebellum.2. No evidence of syringohydromyelia in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Sudden onset vertigo and headache. Remote history of right carotid artery reconstruction. BRAIN MRI:Tiny focus of susceptibility effect involving the paramedian right frontal lobe has not changed since the previous examination and may represent hemosiderin staining from prior hemorrhage. There is no new intracranial hemorrhage or acute infarct. There is no space-occupying or contrast-enhancing brain lesion. Nonspecific T2 FLAIR hyperintense foci involving the cerebral white-matter are minimally increased since the previous examination.Minimal mucosal thickening in the paranasal sinuses is nonspecific. The mastoid air cells are clear. There is no gross orbital abnormality or destructive skull lesion.CRANIAL MRA:There is no significant stenosis or asymmetry of flow-related signal involving the major intracranial arteries. Of note, the left posterior cerebral artery has fetal origin, which is a common variation. 1 mm, focal thickening involving the undersurface of the mid portion of the anterior communicating artery, which may represent a small aneurysm. The previous examination was mildly degraded in quality. In retrospect, there was suggestion of a similar finding on the previous examination. Of note, the upper most left internal carotid artery assumes medial course in the left lateral retropharyngeal space but without significant mass-effect on the overlying nasopharyngeal mucosa.

Output: 1.Minimal increase in the cerebral white-matter lesions since August 2010. The lesions are nonspecific but likely reflect chronic microvascular ischemia.2.Tiny focus of right frontal susceptibility effect is unchanged since August 2010 and may reflect sequela of chronic hemorrhage. There is no new intracranial hemorrhage or acute infarct.3.There is no evidence of significant intracranial arterial luminal stenosis. However, there is a luminal bulging at Acom artery which may suggest possible 1 mm aneurysm. The lesion does not show any interval change since prior exam. Follow up examination is suggested.Dr. Monther Qandeel discussed the above findings and recommendations with Susan Curtis over the phone on 2/12/2016 4:47 PM.


Instruction: Generate impression based on findings.

Input: Reason: small bowel involvement ? History: abdominal and rectal pain after colectomy with ileo-anal anastomosis in a crohn's disease patient. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of a colectomy with ileorectal anastomosis. Diffuse small bowel dilatation measuring up to 3.7 cm, greater involving the ileum and rectum. Mild bowel wall thickening involving the rectum, which may represent mild proctitis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal fluid collections.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of a colectomy with ileorectal anastomosis. Diffuse small bowel dilatation measuring up to 3.7 cm, greater involving the ileum and rectum. Mild bowel wall thickening involving the rectum, which may represent mild proctitis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal fluid collections.

Output: Postsurgical changes of total colectomy with ileorectal anastomosis. Mild bowel wall thickening and dilatation of the rectum with upstream small bowel dilatation may represent proctitis.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a mass within the right frontal lobe that measures approximately 3.0 x 4.1 x 2.4 cm (CC x AP x T) with heterogenous signal in the FLAIR, mostly low to intermediate signal, and increased T2 signal. It contains peripheral nodular enhancement although center of the lesion is nonenhancing. Susceptibility images demonstrates low signal which is consistent with hemorrhage. There is associated high T2 signal in the adjacent brain parenchyma which corresponds to vasogenic edema and involves the right frontal, right parietal, and the right temporal lobes. Portions of the mass also involves the left frontal lobe with 7 mm midline shift to the left and vasogenic edema surrounding the portion of the mass in the left frontal lobe. Mass effect is seen partially obstructing the anterior horn of both lateral ventricles and deforms the genu of the corpus callosum. Basal cisterns are patent. No evidence of uncal herniation.There are mild chronic periventricular white matter and pons small vessel ischemic changes. Diffusion images demonstrates no restricted diffusion. No evidence of extra-axial fluid. Paranasal sinuses and the mastoid air cells are well pneumatized.

Output: Mass in the right frontal lobe with extensive vasogenic edema surrounding the mass extending to the right parietal and right temporal lobes. The mass extends also involves the left frontal lobe with midline shift to the left, deformation of the corpus callosum genu, and compression of the anterior horns of the lateral ventricles.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:4/20/1960)Reason: memorry changes, hx of heart transplant, mood changes, left sided headache History: left sided headache, mood changes, immunosuppressedPROVIDER/ATTENDING NAME: GENE H. KIM GENE H. KIM The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple punctate foci of signal loss along the periventricular and subcortical white matter as well as the left thalamus.On coronal T2 imaging there is redemonstration of a right parotid mass which can also be identified on sagittal T1 imaging. It does not appear to have changed substantially when compared to prior exams there is not entirely included on this exam. It measures approximately 3 cm in size. It has been present on prior exams and although it has not changed since the prior exam there appears larger than on the 2012 exam when it measured 20mm x 15 mm coronal dimensions.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the left maxillary sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Redemonstration of multiple microhemorrhages scattered in the supratentorial white matter as well as the left thalamus. This is relatively stable. Etiology is unclear on the basis of this exam.2.Redemonstration of a right parotid mass which is not adequately imaged on this exam. It has been present on prior exams and although it has not changed since the prior exam there appears larger than on the 2012 exam.3.No intracranial mass lesions are appreciated.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage or acute infarct. There are multiple unchanged subcentimeter minimally enhancing subependymal nodules lining the lateral ventricles. There are multiple unchanged cortical and subcortical nonenhancing T2 hyperintense lesions bilaterally. 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 and paranasal sinuses are unremarkable. There is a mildly enhancing cutaneous lesion overlying the right forehead that is minimally increased in thickness, currently measuring up to 10 mm, previously 7 mm, but unchanged in length, measuring 37 mm.

Output: Intracranial stigmata stigmata of tuberous sclerosis are unchanged, including subependymal nodules and cortical/subcortical tubers.The forehead cutaneous lesion has minimally increased in thickness.


Instruction: Generate impression based on findings.

Input: Sacral dimple with ultrasound showing possible tethered cord when she was a newborn. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved and there is no gross dysraphism. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There may be a trace fluid within the inferior central canal of the spinal cord. The imaged portion of the spinal cord otherwise appears unremarkable and appears to shift anteriorly in the prone position. The conus medullaris is situated at the L1-2 level. There is no evidence of filar fibrolipoma. The paravertebral soft tissues are unremarkable.

Output: Possible trace partially imaged ventriculus terminalis. Otherwise, no evidence of gross lumbosacral spine anomalies.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with generalized abdominal pain, sharp severe shooting pain along the left and right flank and abdomen, other abdominal and cardiac etiologies has been ruled out assess for spinal cord compression or foraminal stenosis/nerve impingement. Cervical:Alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement or marrow edema is detected. The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed below. Postcontrast images are degraded by motion artifact, but within this limitation, no significant pathologic enhancement is suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C4-5: Mild posterior disc-osteophyte complex formation asymmetric to the right foraminal zone. Mild effacement of the ventral thecal sac. Moderate to severe foraminal narrowing on the right. C5-6: Posterior disc-osteophyte complex formation and right uncovertebral hypertrophy particularly affecting the right foraminal zone. Mild generalized spinal canal narrowing. Severe right foraminal narrowing with possible nerve root impingement.C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic:Compression deformities of the T7 and T8 vertebral bodies are seen with approximately 50% loss of the original vertebral body height. The marrow space is edematous compatible with a relatively acute time course. The T6 vertebral body is also compressed to approximately 50% its original height, but there is no associated edema within the marrow and therefore this compression is probably chronic.There is no significant retropulsion of the compressed vertebral body material. The thecal sac is generally narrowed through this region but this narrowing is due largely to prominence of the dorsal epidural fat. No cord compression or cord impingement is seen. The spinal cord maintains normal signal characteristics throughout this region.There is a slight focal kyphosis of the thoracic spine centered at the compressed vertebrae. Elsewhere spinal alignment is unremarkable. The remaining vertebral bodies demonstrate normal morphology and signal characteristics. No evidence of significant degenerative disc disease, spinal canal or neuroforaminal narrowing is seen.Lumbar:Alignment is anatomic. Vertebral body marrow characteristics are within normal limits. No pathologic spinal enhancement is suspected. The conus and cauda equina show normal morphology and signal characteristics.The L1-2 through L4-5 discs show loss of T2 signal. Additional level specific findings are as follows:L1-2: Small right paracentral disc protrusion. No significant spinal canal or foraminal stenosis. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a right foraminal protrusion. No significant generalized spinal canal stenosis. Mild right foraminal narrowing. L3-4: Mild to moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Mild generalized narrowing of the spinal canal. Mild left foraminal narrowing. L4-5: Mild to moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc asymmetric to the right foraminal zone. No significant generalized spinal canal stenosis. Moderate to severe right foraminal narrowing. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Compression deformities of the T7 and T8 vertebral bodies, both showing approximately 50% loss of original height. The presence of marrow edema would suggest a relatively acute time course.2.Compression deformity of the T6 vertebral body with approximately 50% loss of vertebral height. No associated marrow edema is seen which would suggest that this compression is more chronic.3.Degenerative findings in the cervical and lumbar spine with areas of canal stenosis and foraminal narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: 47-year-old male with history of chronic periumbilical abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 6.2 x 2.8 x 3.1 cm lipoma in the right abdominal wall musculature (series 401, image 4; series 801, image 27). No evidence of periumbilical abnormality.OTHER: No significant abnormality noted.

Output: 1.No anterior abdominal wall or periumbilical abnormality to account for patient's chronic pain.2.Right abdominal wall lipoma.


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 minimal multilevel degenerative changes in the lumbar spine. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.L1-L2: There is no significant disc disease, neuroforaminal narrowing or spinal canal stenosis.L2-L3: Mild facet arthropathy. There is no significant disc disease, neuroforaminal narrowing or spinal canal stenosis.L3-L4: Mild facet arthropathy. There is no significant disc disease, neuroforaminal narrowing or spinal canal stenosis.L4-5: Mild facet arthropathy. There is no significant disc disease, neuroforaminal narrowing or spinal canal stenosis.L5-S1: Mild facet arthropathy. There is no significant disc disease, neuroforaminal narrowing or spinal canal stenosis.

Output: Minimal degenerative disease in the lumbar spine without significant interval changes. No findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Clinical question: Evidence of herniation, please evaluate for brainstem and foramina magnum. Signs and symptoms: Status post PEA arrest, nonresponsive. Nonenhanced CT of brain:Portable CT at bedside is performed. Images through posterior fossa are severely obscured due to extensive artifact from patient's multiple bilateral dental fillings. The brainstem cannot be properly evaluated due to extensive artifact. Recommend follow-up with a standard nonportable CT. The fourth ventricle is identified in the midline. The prior portable CT did not include the fourth ventricle and comparison cannot be made.Images through supratentorial space demonstrate no gross evidence of hemorrhage, mass-effect, hydrocephalus or midline shift. Possibility of edema cannot be evaluated due to very poor quality of the study. There is however no visualization of cortical sulci this may indicate underlying diffuse cerebral edema. Follow-up exam with a dedicated nonportable CT or an MRI is recommended.

Output: Suboptimal study due to extensive artifact however no gross abnormality since prior exam. Possibility of cerebral edema cannot be evaluated.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of cirrhosis. Evaluate portal vein. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The portal vein is diminutive but remains patent. Hepatic veins and hepatic arteries are patent. Perigastric and esophageal varices. No suspicious arterially enhancing lesion. There is a subcentimeter segment 8 lesion which appears to washout on delayed images (series 14, image 241; this does not demonstrate arterial enhancement.SPLEEN: Splenomegaly. Subcentimeter hypervascular lesion in spleen is nonspecific and unchanged; this may represent a hemangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Persistent perihepatic and perisplenic ascites. Small to moderate-sized hiatal hernia.

Output: 1.No suspicious hepatic arterially enhancing lesions identified in a cirrhotic liver. Questionable washout of a subcentimeter segment 8 lesion. Attention on follow-up imaging is recommended.2.Diminutive portal vein, which remains patent.3.Persistent perihepatic and perisplenic ascites.


Instruction: Generate impression based on findings.

Input: Diagnosis: Spinal stenosis, cervical regionClinical question: cervical stenosisSigns and Symptoms: cervical stenosis The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C6-7 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with endplate and uncovertebral osteophytes, effacement of the spinal fluid ventral and posterior the spinal cord and encroachment of the neural foramina bilaterally with encroachment of the exiting nerve roots bilaterally. The encroachment of the exiting nerve roots is worse on the right side compared to the left. There is mild posterior ligamentum flavum hypertrophy present at this level. There are endplate reactive changes at this level which are high signal on T2 and lower signal on T1 and are worse on the right than the left side.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine which are worse at C6-7 where there is a mild to moderate degree of spinal stenosis and moderate encroachment of the right-sided exiting nerve roots within the right neural foramen and mild to moderate encroachment of the left-sided exiting nerve roots within the left neural foramen. There are acute endplate reactive changes at this level which are worse on the right than the left side.


Instruction: Generate impression based on findings.

Input: 7-year-old male with right knee pain MENISCI: The menisci are intact and normal in signal intensity with no evidence of tear or degeneration. ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The anterior cruciate ligament demonstrates intermediate signal intensity and is discontinuous throughout its course. The posterior cruciate ligament, medial and lateral collateral ligaments are intact. The patellar ligament demonstrates a wavy contour throughout its course, however is normal in signal intensity with no evidence of tear or degeneration. EXTENSOR MECHANISM: The extensor mechanism is intact with no significant abnormality noted.ADDITIONAL

Output: Wavy patellar ligament and an abnormal anterior cruciate ligament without a joint effusion suggesting a chronic anterior cruciate ligament tear.


Instruction: Generate impression based on findings.

Input: Reason: Patient w/ LE wounds, elevated inflammatory markers-eval for osteo History: LE wounds Some sequences are limited by patient motion artifact. There is thickening and mild enhancement of the skin with edema of the underlying subcutaneous fat, compatible with cellulitis. There is mild atrophy of the musculature of the leg with patchy increased signal intensity within the musculature on T2-weighted images which may represent superimposed edema, but we see no enhancement of the muscle, nor do we see any fluid collection to indicate abscess formation. The bone marrow signal intensity is within normal limits without findings to suggest osteomyelitis. There is a small joint effusion of the knee as well as osteoarthritis of the knee.

Output: Cellulitis and other findings as described above without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: BRAIN: There has been overall worsening in numerous (greater than 20) demyelinating lesions, many of which enhance (approximately 13). There is a larger lesion in the right aspect of the medulla (series 701 image 4). Posterior fossa lesions have worsened from the prior examination overall with multiple lesions involving bilateral middle cerebellar peduncles (some new), a new lesion in the left cerebellar hemisphere, and a new lesion in the right midbrain (series 701 image 10). There is a new enhancing lesion in the left medial cerebellar hemisphere on series 3601 image 8/series 701 image 8. There appears to be a new lesion in the left thalamus on series 701 image 13. There is worsening of lesion in the left corona radiata on series 70 on image 15 with enhancement. There is a dominant new rounded lesion in the right corona radiata on series 701 image 16 with enhancement. There is a new rounded lesion in the left superior frontal gyrus on series 701 image 18 with enhancement. There is a new rounded lesion in the right centrum semiovale on series 701 image 18 with enhancement. Many of the lesions show high diffusion signal without corresponding low ADC signal. While this limits sensitivity of diffusion images, no definite focus of true restricted diffusion is seen to suggest acute infarction. There is no significant mass effect or midline shift. Several lesions with T1 hypointensity again seen.None of the enhancing lesion seen on the prior exam appear to enhance on current exam. Once again there is extensive involvement of the corpus callosum and the periventricular white matter as noted on the prior exam. There is demyelination involving the periaqueductal region.A lesion in the right temporal lobe has resolved, previously seen on series 401 image 14.There is no hydrocephalus.THORACIC: There is normal alignment of the thoracic spine. The vertebral body osseous marrow signal is low on T1 diffusely without a discrete lesion. This may be secondary to marrow infiltrative process of any cause; clinical correlation is advised. There is no significant disk herniation or spinal canal stenosis and thoracic spine.There is a non-expansile high T2 signal thoracic cord lesion extending from mid T8 vertebral body to mid T9. There is a second similar cord lesion at inferior aspect of T10 vertebral body extending to the mid aspect of T11. There is some intrinsic T1 hyperintensity and possible mild enhancement of these lesions, better appreciated on the sagittal sequence.

Output: 1.Overall interval worsening with numerous (greater than 20) demyelinating lesions, many of which enhance (approximately 13). Multiple new/worsened lesions involve the brainstem, cerebellum, as well as the supratentorial brain as detailed above.2.Two discrete demyelinating lesions in the mid to lower thoracic cord with mild enhancement also seen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 40-year-old male with left knee pain. Evaluate healing of OATS and microfracture. Again seen are extensive postoperative changes, including orthopedic screws in the proximal tibia, that result in metallic susceptibility artifact and poor fat saturation. Additional extensive artifact anteriorly may reflect suture material or metallic shavings.MENISCI: Again seen is attenuation of the posterior horn and body of medial meniscus suggesting prior meniscectomy, appearing similar to the prior study. We see no fluid signal intensity entering the meniscus to suggest a tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Again seen is scalloping of the femoral trochlea centrally, presumably representing a site of OATS allograft/microfracture that appears to be largely filled with articular cartilage with minimal surface irregularity, appearing similar to the prior study. There is mild to moderate thinning of the remaining articular cartilage along the medial and lateral facets with small osteophytes, appearing similar to the prior study. There are patellar osteophytes with mild thinning of the articular cartilage superiorly and inferiorly, appearing similar to the prior study. We see no fluid-filled articular cartilage defects. There is slight progression of degeneration of the articular cartilage of the medial femoral condyle with increase in signal heterogeneity, particularly along the medial aspect of the weightbearing portion of the condyle. There is mild edema type signal in the underlying subchondral bone which is also new and likely degenerative in etiology. There is cartilage degeneration along the medial femoral condyle above the posterior horn of the medial meniscus, appearing similar to the prior study. There is also progression of degeneration of the articular cartilage of the far medial aspect of the weightbearing portion of the medial tibial plateau with new degenerative edema type signal abnormality in the underlying subchondral bone. Articular cartilage of the lateral compartment is relatively spared, although there are lateral compartment osteophytes with mild thinning of the overlying cartilage.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Postoperative changes as described above. There is tricompartmental osteoarthritis with slight progression of cartilage degeneration of the medial compartment. The postoperative changes of the patellofemoral compartment appear similar to the prior study.


Instruction: Generate impression based on findings.

Input: 18 years, Female, status post occipital craniectomy for Chiari malformation, C1 laminectomy and dural graft. Evaluate for postoperative changes. BRAIN: Interval postsurgical changes of Chiari decompression are seen with suboccipital craniectomy and resection of the posterior arch of C1. There is increased fluid/CSF space dorsally at the C1 level. There are foci of hemorrhage. The CSF spaces, both ventrally and dorsally, are improved. There are new areas of restricted diffusion within the inferior aspect of the cerebellum bilaterally, right greater than left, consistent with acute infarcts. The ventricles are unchanged in size and configuration. There is no evidence of hydrocephalus. The corpus callosum appears mildly dysmorphic, but fully formed unchanged from prior. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There are secretions within the bilateral mastoid air cells. There is mild mucosal thickening of the ethmoid air cells, unchanged. There is decreased opacification of the bilateral maxillary sinuses and persistent left mucous retention cyst. CERVICAL SPINE: There is decrease in size of the cervical cord related to improved edema. There is mild ill-defined hyperintense T2 signal within the upper cervical spinal cord including a small syrinx, markedly decreased compared to May 13, 2015 and slightly decreased compared to June 15, 2015. The cervical spine alignment is within normal limits, with preserved cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1.Postsurgical changes of Chiari decompression with improvement in CSF spaces and flow at the foramen magnum. 2.Interval development of acute infarcts involving the bilateral cerebellar hemispheres, right greater than left, in a PICA distribution. 3.Edema within the cervical cord including a small syrinx is markedly improved from May 13, 2015 and slightly decreased from the prior study June 15, 2015.Findings were discussed with Advanced Practice Nurse Gina Bradley at 4:54 PM on July 2, 2015.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. 10/8/2015 biopsy demonstrated 3+4 left lateral apex adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 3.3 x 4.9 x 4.7 cmPeripheral Zone: Scattered foci of T1 weighted hyperintensity compatible with postbiopsy blood product. No discrete suspicious lesion.Note is made of a prostatic utricle cyst with adjacent linear T2-hypointensity, favoring scarring.Central Gland: Mild BPH. Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No discrete suspicious lesion identified.


Instruction: Generate impression based on findings.

Input: Transient cerebral ischemic attack, unspecified [G45.9], Reason for Study: ^Reason: Stroke workup History: R hand clumsiness Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Scattered T2/FLAIR high signal intensity lesions on periventricular white matter indicate nonspecific small vessel ischemic disease.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, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickening on bilateral maxillary sinuses, frontal sinus and ethmoid sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease.3. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Headache, daily for 3 months with worsening. Brain parenchyma is within normal limits for age. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No extra-axial collections. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is within normal limits for age. No intracranial mass or mass-effect.


Instruction: Generate impression based on findings.

Input: Seizure like activity, developmental delay. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci or gross structural abnormalities.


Instruction: Generate impression based on findings.

Input: Clinical question: History of lung cancer, please compare to prior study and measure. Signs and symptoms: None. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate stable post surgical/treatment changes of left frontal region without interval change or recurrence of disease.Findings at the site include a focus of cortical and subcortical encephalomalacia at the resection site.Additionally examination demonstrate diffuse T2/FLAIR hyperintensity of bilateral hemispheric white matter similar to prior exam and consistent with post treatment/radiation change.Ventricular system are mildly dilated similar to prior study and with maintained midline.Small focus of encephalomalacia in the right inferior frontal lobe and the surrounding gliosis and without intravenous enhancement is again noted and representing focus of treated metastatic lesion.Calvarium demonstrate postop changes and unremarkable otherwise.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.No acute intracranial process or evidence of new findings since prior study.2.Stable extensive post treatment and surgical changes for treatment of metastatic lesions since prior study.3.No detectable metastatic lesion on this exam.4.Stable diffuse white matter FLAIR hyperintensity of cerebral hemispheres consistent with posttreatment/radiation change.


Instruction: Generate impression based on findings.

Input: Amyloidosis, unspecified [E85.9], Reason for Study: ^Reason: amyloidosis with worsening lumbar back pain, evaluate for lytic ds vs DDD History: amyloidosis with worsening lumbar back pain, evaluate for lytic ds vs DDD For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. 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 conus medullaris terminates at the T12-L1 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: broad based focal bulging of disc with the base of diffuse bulging of disc which abuts thecal sac, no neuroforaminal narrowing. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. No evidence of vertebral body abnormality such as osteolytic lesion.2. Diffuse bulging of disc with central focal bulging of disc at the level of L45 as described above.


Instruction: Generate impression based on findings.

Input: History of von Hippel-Landau syndrome. Evaluate renal lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size measuring 13.8 cm in craniocaudal dimension. Scattered subcentimeter hepatic cysts. No focal suspicious liver lesion, biliary ductal dilatation or vascular abnormality. No biliary ductal dilatation.SPLEEN: The spleen is normal in size, morphology and signal intensity without a focal lesion.PANCREAS: The main pancreatic duct is prominent up to 5 mm, slightly increased from the prior where it measured up to 3 mm. There is suggestion of pancreatic divisum. The main pancreatic duct is irregular and tortuous with a transition point at the level of the pancreatic head which may represent a benign stricture, as there is no evidence of a discrete mass lesion. The parenchyma is normal in morphology, signal intensity and enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple and minimally complex right renal cyst the largest measuring 1.9 x 1.6 cm with several thin non-enhancing septations, not significantly changed from prior MR. Punctate left renal simple cyst. Partially exophytic left renal inferior pole intermediate T2-weighted signal intensity lesion measuring 1.8 x 1.9 cm demonstrates no postcontrast enhancement and is compatible with a minimally complex proteinaceous or hemorrhagic cyst, unchanged from the prior.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. Simple and minimally complex renal cysts. No suspicious renal lesion.2. Increasing dilatation of the main pancreatic duct up to 5 mm without a discrete lesion evident. This may be related to a focal stricture. Possible pancreas divisum. ERCP/US as clinically indicated should be considered.


Instruction: Generate impression based on findings.

Input: History of multiple episodes of pancreatitis, chronic abdominal pain, and multiple prior ERCPs with stent placements. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal parenchymal lesion.No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 5 mm in diameter. Status post cholecystectomy. No evidence of stones or obstructing lesion.The hepatic vasculature is widely patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in signal and morphology. The main pancreatic duct is normal in caliber. The duct has a tortuous course through the pancreatic head forming a loop, but no stricture is evident. The pancreatic duct joins the common bile duct at the level of the ampulla. No evidence of pancreatic divisum. There is no appreciable abnormality after administration of secretin in the duct itself, however the projection of evaluation is suboptimal. Fluid appears to increase in the duodenum after administration of secretin, implying good exocrine function, but again is suboptimal given the projection of post-secretin images. 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: Extensive susceptibility artifact in the thoracolumbar spine presumably related to spinal hardware. This limits evaluation of this region.OTHER: No significant abnormality noted.

Output: 1.Meandering main pancreatic duct (loop type) which joins the common bile duct at the level of the ampulla. Post-secretin changes described above.2.Normal appearance of the pancreatic parenchyma.


Instruction: Generate impression based on findings.

Input: 26 year old with history of hypertension and alcohol abuse presenting with heart failure. Left VentricleThe left ventricle is severely enlarged with severely reduced systolic function. There is global severe hypokinesis. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 177 ml/m2 (normal range: 74+/-15), the LVEDV is 326 ml (normal range 142+/-34), the LV end systolic volume index is 153 ml/m2 (normal range 25+/-9), the LVESV is 282 ml (normal range 47+/-19), the LV mass index is 86 g/m2 (normal range 85+/-15), and the LV mass is 158 g (normal range 164+/-36).  There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no left ventricular thrombus. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is borderline in size with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 112 ml/m2 (normal range 82+/-16), the RVEDV is 206 ml (normal range 142+/-31), the RV end systolic volume index is 93 ml/m2 (normal range 31+/-9), and the RVESV is 172 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions and bilateral foci of high signal better characterized on recent CT.

Output: 1. The left ventricle is severely dilated with severely reduced left ventricular systolic function (LVEF13%). The left ventricular dysfunction is global and the entire myocardium is viable. There is no LV thrombus. 2. The right ventricle is normal in size with severely reduced systolic function (RVEF17%). 3. Biatrial enlargement.


Instruction: Generate impression based on findings.

Input: Calvarium metastases from breast cancer. There has been gradual decrease in size of multiple heterogenously enhancing skull lesions. The largest of these is located in the occipital lobe with epidural extension and mass effect upon the torcula herophili. This lesion now measures approximately 20 x 65 mm in cross section versus 32 x 72 mm in January 2015. There is no evidence of abnormal brain parenchymal or leptomeningeal enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The pituitary gland appears unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is unchanged deformity of the right lamina papyracea defect with protrusion of orbital fat. There is nonspecific fluid within the mastoid air cells, right more than left.

Output: 1. Gradual decrease in size of multiple skull metastases.2. No evidence of leptomeningeal or intraparenchymal brain metastases.


Instruction: Generate impression based on findings.

Input: 52-year-old female with right shoulder pain ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinous tendon indicating moderate tendinosis. Intermediate signal intensity extending to the articular surface of the tendon perhaps reflects undersurface fraying. The aforementioned tendinosis extends posteriorly to involve the anterior fibers of the infraspinatus. Small linear focus of increased signal intensity along the infraspinatus myotendinous junction could conceivably represent a small interstitial tear. No full-thickness tear is evident. Teres minor tendon and muscle are within normal limits. Subscapularis tendon and muscle are within normal limits.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint with osteophytes that result in mild impression of the superior fibers of the supraspinatus. No frank fluid is within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Intermediate signal intensity within the superior labrum extending anteriorly likely represents degeneration. The anterior inferior labrum also appears enlarged and with increased signal intensity likely representing degeneration. A small focus of increased signal intensity within the articular cartilage of the posterior inferior labrum may reflect a tiny defect. Small amount of joint fluid without frank effusion.BICEPS TENDON: Given the limitations of a nonarthrogram study, the tendon of the long head of the biceps appears within normal limits.

Output: Rotator cuff tendinosis and other degenerative findings as described above.


Instruction: Generate impression based on findings.

Input: Sequela of multiple prior craniotomies is again noted. Scattered areas of encephalomalacia in both frontal lobes are unchanged. The CSF space along the left lateral cerebellar hemisphere remains widened similar to prior. Ventricular size and morphology are stable.Multiple intracranial masses are redemonstrated: A bulky right CP angle/IAC tumor, a left CP angle tumor, residual enhancing tumor along the surgically altered left IAC and within the temporal bone centered at the geniculate ganglion, tumor along the bilateral cisternal trigeminal nerves with probable involvement of the cavernous sinuses, a small intraconal mass along the left lateral rectus muscle, a tumor along the planum sphenoidale, enhancing lesions in the left parietal scalp and right suboccipital scalp, a cystic and solid lesion with mild associated enhancement in the left brachium pontis, and nodular intramedullary tumor at the cervicomedullary junction.Fiducials are in place. Expected vascular flow voids are demonstrated. The visualized paranasal sinuses are clear.

Output: Multiple intracranial masses are redemonstrated including a bulky right CP angle/IAC tumor. Fiducials are in place.


Instruction: Generate impression based on findings.

Input: There is a large cystic intra-axial mass centered in the right medial frontal lobe in the right superior/middle frontal gyri with no significant enhancement and numerous foci of susceptibility representing calcification as seen on outside CT imaging documented on patient's electronic medical record. There is infiltrative masslike appearance involving the right superior frontal and cingulate gyri.The overall mass measures 79 x 50 mm on axial image series 501 image 26, and up to 51 mm AP on series 1002 image 93. There is no associated restricted diffusion within the cystic component or rim enhancement. There is moderate surrounding nonenhancing T2 hyperintense signal abnormality without extension across the corpus callosum. There is mass effect with midline shift to the left of 14 mm, with mass effect on the bilateral frontal horns, right greater than left and downward mass effect on the anterior corpus callosum.There is no acute infarct or separate focus of abnormal intracranial enhancement. There is mild entrapment of the left lateral ventricle. There is no transtentorial, uncal or cerebellar tonsillar herniation. There are bilateral maxillary sinus mucus retention cysts.

Output: Intra-axial nonenhancing right frontal lobe mass with masslike infiltration involving the right superior frontal gyrus and cingulate gyrus and surrounding edema. There are foci of calcifications and a cystic component laterally. Mass is most favored to represent a primary brain neoplasm such as oligodendroglioma or oligoastrocytoma. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Lung cancer with history of brain metastases status post SRS. There are multiple subcentimeter supratentorial and infratentorial enhancing lesions. A previously identified ring-enhancing lesion within the right cerebellum measures 0.4 x 0.3 cm, previously 0.6 x 0.5 cm. A ring-enhancing lesion within the left occipital lobe measures 0.4 x 0.3 cm, previously 0.5 x 0.5 cm. There is mild adjacent vasogenic edema. A new left posterior parietal enhancing lesion measures 0.3 x 0.3 cm. There is a new left superior frontal ring-enhancing lesion measuring 0.4 x 0.4 cm. There is new linear T2 hyperintensity along the right occipital lobe, best identified on series 6, image 14, with no associated enhancement. There is subcortical T2 hyperintensity within the posterior right parietal lobe, with no associated enhancement. A T2 hyperintense lesion within the right inferior frontal white matter is unchanged. There is encephalomalacia within the left gyrus rectus. There is also a chronic lacunar infarct in the left basal ganglia with hemosiderin deposition. There is no evidence of acute intracranial hemorrhage or acute infarction. The pituitary gland appears unremarkable. However, there is a subcentimeter enhancing extra-axial lesion along the left jugulum sphenoidale. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Multiple subcentimeter supratentorial and infratentorial metastases. The lesions within the right cerebellum and left occipital lobes are decreased in size. However, at least two enhancing lesions within the left cerebral hemisphere appear to be new.2. A subcentimeter enhancing lesion along the left jugulum sphenoidale may represent a metastasis or meningioma.3. Encephalomalacia of the left gyrus rectus and new scattered areas of T2 hyperintensity, which are perhaps treatment related.


Instruction: Generate impression based on findings.

Input: THORACIC: The thoracic vertebral body alignment and signal are within normal limits with a small probable sclerotic T1/T2 hypointense bone island in T8 vertebral body. There is minimal desiccation and loss of disk height at T7-T8. The remaining disk spaces, and vertebral body heights are preserved. The cord signal and caliber are within normal limits. There is mild posterior epidural lipomatosis which diffusely narrows the spinal canal caliber without significant spinal canal stenosis. There is no evidence of acute cord compression of the thoracic spine.There is a small central disk protrusion at T7-8 which effaces the ventral CSF space without significant cord deformity. There is a small right paracentral disk protrusion at T10-11 without significant spinal stenosis. Otherwise, there is no significant disk herniation, or spinal stenosis.There may be minimal dependent atelectasis in the posterior lungs.LUMBAR: There are 5 lumbar type vertebral bodies. The L5-S1 disk is somewhat diminutive but well formed (when counting from the top of the cervical spine). There is normal alignment of the lumbar spine. The vertebral body heights are preserved. The osseous marrow signal is somewhat heterogeneous without a focal lesion except for scattered benign hemangiomas. The conus terminates at L1. The conus shows normal caliber and signal. There is no filum lipoma.L1-2: No disk herniation or spinal stenosis.L2-3: No disk herniation or spinal stenosis.L3-4: Mild disk bulge and moderate bilateral facet arthropathy with no significant spinal stenosis.L4-5: Mild diffuse disk bulge and facet arthropathy with minimal bilateral neural foraminal narrowing and no significant spinal canal stenosis.L5-S1: No significant disk herniation or spinal stenosis.

Output: 1.No evidence of acute cord compression.2.Small central disk protrusion at T7-8 which effaces the ventral CSF without significant cord deformity.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, with progressive supranuclear palsy, IRB approved brain MRI. Since the prior examination, progressive thinning of the midbrain is demonstrated with a mildly convex contour of the superior midbrain surface. The pons is relatively preserved. A moderate degree of generalized cerebral volume loss is demonstrated. No edema or mass effect is detected. No abnormal fluid collections are seen. Ventricular morphology is unremarkable.

Output: Imaging findings are seen compatible with the stated history of PSP.


Instruction: Generate impression based on findings.

Input: Tension-type headache, unspecified, not intractable [G44.209], Reason for Study: ^Reason: Assess response to radiation and chemotherapy. Pt experiencing muscle contraction sensation along left skull History: Previously seen left frontal extra dural enhancing lesion appears to be slightly thinner than prior (4.2mm, 6.3mm in maximum thickness previously).Overlying sclerotic left frontal skull metastatic lesion does not show any interval change.There is no evidence of new abnormal enhancement on the scan.There is no evidence of acute ischemic or hemorrhagic lesion.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval decrease in thickness of left frontal lobe extra dural enhancing lesion since prior scan.2. Stable left frontal skull sclerotic metastatic lesion since prior scan.


Instruction: Generate impression based on findings.

Input: 11-year-old female with: sexual precocity on Lupron and GH. Evaluate for pituitary abnormality. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a centrally T2 hyperintense focus with marginal FLAIR hyperintense signal along the posterior right basal ganglia, along the anterior commissure, in the expected location of a prominent perivascular space. The brain parenchyma otherwise appears unremarkable. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small left maxillary sinus mucus retention cyst.MRI Pituitary:Dedicated images through the sella demonstrate a normal height of the pituitary gland. There is diffuse heterogeneous enhancement pattern involving the pituitary gland which can be expected for this age group. No mass is seen within the pituitary gland. There is minimal deviation of the pituitary stalk to the right which is most likely a normal variant. The suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.

Output: Brain parenchyma and pituitary gland are without abnormalities.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of spinal cord . C1 vertebral mass. Please provide biopsy Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the C1 vertebral lesion. There is a soft tisse mass eroding and replacing the right half of the C1 vertebral body which partially involves right vertebral artery compresses the right jugular vein against the styloid process and displaces the right internal coronary inferiorly. The tumor extends to the dural surface and into the perivertebral space and measures 5.3 by 3.3 cm greatest axial dimensions and 3.3 cm greatest superior inferior dimension with a 5 cm AP dimension. The mass enhances following contrast administration. Follow-up scan indicates the biopsy was obtained from the center of the tumor. The right jugulodigastric node there measures 11 x 11 mm axial dimensions but does not meet the size criteria for lymphadenopathyIncidental note is made of numerous tonsilliths

Output: 1.C1 vertebral bone biopsy under CT guidance. samples were delivered to pathology for analysis. The cytologist preliminarily reported suspected plasmacytoma. The tumor essentially replaces the right sided bony elements of C1 and extends to displace adjacent critical vessels . It compresses RIJV against the styloid, displaces and mildly encases RVA which is the nondominant vertebral artery and displaces RICA.


Instruction: Generate impression based on findings.

Input: Male 16 years old; Reason: Right hip FAI History: right hip pain ACETABULAR LABRUM: A defect is noted in the anterosuperior labrum best appreciated on the radial images (series 1301, image 1) and axial images (series 701, image 20). ARTICULAR CARTILAGE AND BONE: A bony prominence is noted at the right femoral head-neck junction consistent with a Cam type femoroacetabular impingement. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Small tear of the right anterosuperior labrum2.bony prominence at the right femoral head-neck junction consistent with a Cam-type FAI.


Instruction: Generate impression based on findings.

Input: New onset bilateral hand numbness over one month with cervical radiculopathy. Bilateral C5-C6 radiculopathy. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is grade 1 anterolisthesis of C3 on C4 measuring 4 mm. There is minimal anterolisthesis of C7 on T1. Alignment is otherwise maintained. Bone marrow signal is within normal limits. Subtle cord signal abnormality suspected at C3-C4. Cord signal and morphology is normal at the other levels.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Partial effacement of the dorsal thecal sac related to ligamentum flavum thickening. Bilateral facet arthropathy.C3-4: There is moderate to severe spinal canal stenosis with mild flattening of the cord related to disc osteophyte complex including a central protrusion. Grade 1 anterolisthesis also contributes. There is mild right and moderate left neural foraminal stenosis. There is moderate degree of bilateral facet arthropathy with fluid distention involving the facet joints.C4-5: Small disc osteophyte complex and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is also mild right neural foraminal narrowing. Bilateral facet arthropathy.C5-6: Minimal disc osteophyte complex. No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.C6-7: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.C7-T1: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.Paraspinous soft tissue structures appear within normal limits. Partially empty sella incidentally noted which can be normal variant in this age group.

Output: 1. Degenerative changes in the cervical spine particularly at the C3-C4 level, where anterolisthesis, disc osteophyte complex, and ligamentum flavum thickening contribute to moderate to severe spinal canal stenosis. There is subtle associated cord signal abnormality suspected at this level.2. There is mild right and moderate left neural foraminal stenosis at C3-C4 as well as mild spinal canal and mild right neural foraminal narrowing at C4-C5.


Instruction: Generate impression based on findings.

Input: 68 year old female with abdominal pain. Evaluate for colitis, diverticulitis, appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass measures 3 cm in diameter. This may be further characterized with noncontrast CT or MRI examination, if indicated.KIDNEYS, URETERS: Fat stranding surrounding the right kidney. Focal decreased areas of attenuation, especially in the right upper pole and left upper pole regions are most consistent with pyelonephritis. Multiple punctate nonobstructing right renal calculus. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted.

Output: Nonenhancing lesions of the renal parenchyma bilaterally are most compatible with pyelonephritis. No hydronephrosis. Nonobstructing right nephrolithiasis. 3-cm diameter left adrenal mass.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Disorientation, unspecified [R41.0], Reason for Study: ^Reason: Evaluate for possible recurrence of seizures with new headache and intermittent LUE/LLE weakness History: pls see above No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.There are scattered high signal intensity foci on bilateral frontal lobe white matter on FLAIR images which are nonspecific.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Male, 71 years old. Multiple Myeloma; new onset low back pain A previously seen mass in the right ilium with low T1 and high T2 signal is significantly decreased in size from the prior MR study dated 07/18/2014 likely related to prior radiation therapy. The remainder of the right ilium is free of focal lesions. Additional patchy marrow signal abnormality and enhancement throughout the left ilium, ischium, sacrum, and both proximal femurs is markedly progressed from the prior MR exam with innumerable scattered lesions of varying sizes. Partially imaged lesions in the lumbar spine are also noted. See same day lumbar spine MR for additional details. No fracture is evident.Status post prostatectomy.

Output: Innumerable lesions within the pelvis sparing the right ilium as well as the proximal femurs, compatible with extensive involvement of multiple myeloma. No fracture is evident.


Instruction: Generate impression based on findings.

Input: MRI cervical spine: Vertebral body heights in the cervical spine are normal. There is straightening of the upper and mid cervical spine. Alignment is otherwise maintained. Bone marrow signal is benign. The cord demonstrates no abnormal signal. There is increased T2 signal in the pons, corresponding to the finding that were demonstrated in the previous brain MRI dated 12/15/2015. There is minimal thickening of the posterior longitudinal ligament at the C3 and C4 levels. Multilevel degenerative changes are seen with significant height loss at the C4-C5 level. Individual levels as below: C2-C3: No spinal canal or neural foraminal compromise.C3-C4: Minimal disc bulge with no spinal canal or neural foraminal compromise. C4-C5: There is loss of disc height with disc osteophyte complex and uncovertebral hypertrophy at this level. There is no significant spinal canal stenosis. There is moderate right neural foraminal stenosis and mild left neural foraminal narrowing.C5-C6: There is minimal right neural foraminal narrowing related to facet arthropathy. No significant spinal canal or left neural foraminal stenosis.C6-C7: There are is no spinal canal or neural foraminal compromise.C7-T1: There is no spinal canal or neural foraminal compromise.MRA brain: There is no significant stenosis involving the anterior or posterior circulation. There is mild narrowing of the mid basilar artery without flow-limiting stenosis. Focal signal loss is also seen involving the M2 segments of the middle cerebral arteries which is favored to be artifactual. Intracranial internal carotid, anterior, middle, and posterior cerebral arteries are patent. Distal vertebral, basilar, and posterior cerebral arteries are also patent. Right posterior communicating artery and anterior communicating artery are patent. Left posterior communicating artery is not definitively visualized. No aneurysms are appreciated.MRA neck: The common carotid arteries, the cervical internal carotid arteries, and the vertebral arteries are patent with no evidence of flow-limiting stenosis. No findings to suggest arterial dissection.

Output: 1. Mild degenerative changes in the cervical spine. There is no significant spinal canal stenosis at any level or cord signal abnormality. There is moderate right neural foraminal stenosis at the C4-C5 level. Otherwise no significant spinal canal or neural foraminal stenosis.2. There is no flow-limiting stenosis in the intracranial anterior or posterior circulation.3. No flow-limiting stenosis or evidence of arterial dissection in the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:7/6/1975)Reason: MS? Brainstem lesion History: sudden L VI and IV palsy 6-2016PROVIDER/ATTENDING NAME: ANTHONY T. REDER ANTHONY T. REDER There is redemonstration of T2 and FLAIR hyperintense lesions several millimeters in size in the left anterior lateral medulla extending to the pontomedullary junction on its lateral aspect, the right posterior lateral medulla, the left fusiform gyrus subcortical white matter in the left half of the splenium of the corpus callosum. Additionally several punctate lesions are present in the periventricular white matter and subcortical white matter. The lesions in the midbrain appear more extensive on the current exam when compared to the previous exam. These lesions are hypointense on T1-weighted imagingNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Lesions within the brainstem, corpus callosum, periventricular white matter and subcortical white matter are present. It is possible that the left sixth nerve fibers are affected. The possibility this is related to demyelinating process cannot be excluded. The lesions in the midbrain appear slightly more extensive on the current exam when compared to the previous exam. This perceived difference could be a result difference in imaging technique.


Instruction: Generate impression based on findings.

Input: Other intervertebral disc degeneration, lumbar region [M51.36], Reason for Study: ^Reason: back pain History: back pain Cervical spine MRIThere is normal cervical lordosis. The cranial-cervical junction is normal. Spinal cord signal intensity is normal.Vertebral height is preserved. There is no abnormal signal intensity of the vertebral body.Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: There is diffuse central bulging of disc which abuts thecal sac. No neuroforaminal narrowing. No spinal stenosis. C4-C5: Broad-based disc protrusion which abuts thecal sac results minimal spinal canal stenosis. No neuroforaminal narrowing. C5-C6: Diffuse bulging of disc in association with bilateral ligamentum flavum thickening results mild to moderate spinal canal stenosis. C6-C7: Broad-based disc protrusion which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis. Lumbar MRIThe spine alignment is anatomic. The vertebral body height is preserved. The cord signal is normal. The conus medullaris terminates at the level of T12-L1. Degenerative changes are specified by the intervertebral level as follows: L1-L2: Disc desiccation, diffuse bulging of disc with bilateral ligamentum flavum thickening results minimal spinal canal stenosis. There is a low signal intensity on T1 weighted image of the inferior endplate of L1 and superior endplate of L2 indicate Modic 1 changes.L2-L3: Diffuse bulging of disc in association with bilateral ligamentum flavum thickening result minimal to mild spinal canal stenosis. L3-L4: Diffuse bulging of disc with proliferation of the left side facet joint result minimal left side lateral recess stenosis. No spinal stenosis. L4-L5: There is broad-based disc protrusion towards left side neural foramen result left neural foraminal stenosis. L5-S1: Diffuse bulging of disc with bilateral neural foraminal narrowing.

Output: 1. Multilevel various degree degenerative changes of spinal column.2. In cervical spine, minimal to mild spinal canal stenosis at the level of C45 and C56. 3. In lumbar spine, minimal spinal canal stenosis at the level of L12 and L23. In addition, left side neuroforaminal and lateral recess narrowing at the level of L34 and L45.


Instruction: Generate impression based on findings.

Input: Male, 87 years old, history of lung cancer with new left scapula pain suspicious for metastasis. Straightening of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic cord or leptomeningeal enhancement is seen.The paraspinal soft tissues are within normal limits. Please note, however, that the scapulae are not included within the field-of-view of this examination.C2-3: Facet arthropathy. Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C3-4: Left greater than right facet arthropathy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing. C4-5: Left facet arthropathy. Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation. No significant spinal canal narrowing. Mild bilateral foraminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe right and moderate left foraminal narrowing. C7-T1: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis.

Output: 1.No evidence of any metastatic disease is seen in the cervical spine. Please note that the scapulae are not included within the field-of-view of this examination.2.Multilevel disc degeneration is seen but without any high-grade spinal canal stenosis or cord impingement.3.Scattered variable foraminal narrowing is seen ranging from mild to severe, as discussed above.


Instruction: Generate impression based on findings.

Input: 72 year old woman with possible stress cardiomyopathy, referred for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 113 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 53 ml (normal range 31+/-10). There is hypokinesis of the apical inferior/inferolateral wall. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 132 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 64 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsModerate right pleural effusion. There are multiple nodules/masses in the lung consistent with known metastatic cancer as delineated on the chest CT 5-2016.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. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 53%. There is hypokinesis of the apical inferior/inferolateral wall. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.