Instruction: Generate impression based on findings.

Input: 55-year-old woman with sarcoidosis. Assess for cardiac sarcoidosis. Left VentricleNormal-appearing ventricular appearance and function. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal.Right VentricleNormal-appearing ventricular appearance and function. Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSplenic T1 and T2 hypointensities, likely related to the patient's underlying history of sarcoidosis. Large patient body habitus. 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: No convincing evidence of cardiac sarcoidosis.


Instruction: Generate impression based on findings.

Input: Male 47 years old; Reason: Evaluate patella for chondral damage vs subchondral changes, s/p left knee microfracture October 2013. History: Left knee pain MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Again seen is mild irregularity of the subchondral bone of the lateral patellar facet, likely representing the site prior microfracture surgery. There is less bone marrow edema at the microfracture site, with new bone formation within the defect. The overlying cartilage appears slightly thinned, with a tiny partial thickness defect (series 4, image 6) also appearing similar to the prior study accounting for technical differences. No definite fluid-filled full-thickness defect is seen. The remainder of the articular cartilage of the patella is intact. The articular cartilage of the trochlea subjectively appears slightly thinned, without fluid filled full thickness defect seen. No fluid-filled full-thickness cartilage defect is seen elsewhere. Small intra-articular osteophytes are noted along the lateral femoral condyle, which are new. LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Postoperative changes of a patellar microfracture surgery, as described above, with overlying tiny partial thickness cartilage defect, similar to the prior study, which may be of no clinical significance.2. Small intra-articular osteophytes along the lateral femoral condyle.3. Removal of the previously seen intra-articular loose bodies.


Instruction: Generate impression based on findings.

Input: Right ear and eye pain in an immunosuppressed patient. Per EPIC: "feels like a burning pain and believes it is from acid reflux." Brain: 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.Orbits: The bilateral globes, lacrimal glands, extra-ocular muscles, optic nerves, and orbital fat are unremarkable. There is no evidence of intraorbital mass lesions.Neck: There is no evidence of measurable mass lesions or cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is straightening of the cervical spine alignment in the sagittal plane, but no significant spinal canal stenosis. There are postoperative findings related to sternotomy.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of orbital or temporal bone region lesions.3. No evidence of tumor or abscess in the neck.


Instruction: Generate impression based on findings.

Input: History of medulloblastoma status post treatment: weakness. There are postoperative findings related to posterior fossa tumor resection and prior transfrontal ventricular shunting. There is extensive encephalomalacia in the cerebellum and scattered punctate foci of susceptibility effect in the cerebellum and cerebral white matter, which are likely treatment-related. There is an unchanged nodular area along the distorted superior vermis with areas of intrinsically T1 hyperintensity. However, there is no evidence of enhancing tumor. There are unchanged patchy areas of T2 hyperintensity in the right frontal and occipital periventricular white matter. There is a small right superior frontal gyrus developmental venous anomaly. There are punctate foci of susceptibility effect in the left amygdala and left parietal lobe white matter. There is no evidence of acute infarct. The ventricles are diffusely prominent, but unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fatty marrow in the skull base related to radiation therapy. There are bilateral lens implants. There are persistent secretions within the left maxillary sinus.

Output: Post-treatment findings related to fourth ventricular medulloblastoma resection and irradiation without evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils now extend up to 7 mm inferior to the foramen magnum. In addition, the dens is retroflexed effacing the ventral foramen magnum representing an anatomic cranio-cervical junction variant. Cerebrospinal fluid flow is markedly reduced posterior to the cerebellar tonsils, but is intact anterior to the cord. There is a persistent long-segment linear high T2 signal within the central canal of the spinal cord extending from the level of lower cervical region to the conus medullaris is consistent with syringohydromyelia and is similar in size as on the prior exam, measuring up to 4 mm in maximum cross-section. There is no evidence of spinal canal stenosis within the cervical or thoracic spine. There is loss of the cervical lordosis, but no spondylolisthesis.

Output: Decreased inferior extension of the cerebellar tonsils, but persistent small-caliber diffuse cervicothoracic syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with persistent back pain and radiation to the left leg. Straightening of the cervical lordosis is seen. Vertebral body heights are preserved. No evidence of pathologic marrow replacement or edema is demonstrated. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. Focal volume loss and scarring of the left kidney are seen, stable from prior 2008 CT.L1-2: Unremarkable. L2-3: Facet hypertrophy and ligamentum flavum thickening. Left disc height with disc bulging. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Mild loss of disc height with disc bulging. Moderate spinal canal stenosis with slight crowding of the cauda equina. Severe right and moderate left foraminal narrowing. L4-5: Advanced facet hypertrophy and ligamentum flavum thickening. Disc bulging. Posterior spinal canal stenosis with crowding of the cauda equina. Severe bilateral foraminal narrowing. L5-S1: Advanced facet hypertrophy and ligamentum flavum thickening. Disc bulging asymmetric to the left with a left paracentral protrusion. No significant spinal canal stenosis. Severe left foraminal narrowing. Mild right foraminal narrowing.

Output: Multilevel disc and posterior element degeneration is seen. Specifically, there is moderate spinal canal stenosis at L3-4 with severe right-sided foraminal narrowing; severe spinal canal stenosis at L4-5 with severe bilateral foraminal narrowing; and severe left foraminal narrowing at L5-S1.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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 skull and scalp soft tissues are unremarkable. There is mild mucosal thickening within the maxillary and ethmoid sinuses as well as mild fluid within the right mastoid air cells. There is a small focus of T2 hyperintensity within the midline nasopharyngeal soft tissues that is decreased in size compared with the prior exam and may represent a Tornwaldt or retention cyst.LUMBAR SPINE: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable. There mild degenerative changes throughout the lumbar spine with mild facet arthropathy and borderline ligamentum flavum thickening. In addition, there is disc desiccation and mild disc height loss at L5-S1 with a very mild disc bulge asymmetric to the left. There is no significant spinal canal or neural foramen stenosis at any level.

Output: 1. No evidence of intracranial or lumbar spine metastasis. 2. Evidence of acute sinusitis and non-specific right mastoid air cell fluid. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question : evaluate for bleed. Signs and symptoms: Headaches. Nonenhanced head CT:No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal.Calvarium demonstrate a sclerotic lesion measuring 15 times 7-mm in size in the diploic space are right parietal bone. There is no erosive changes of outer or the inner table of the skull. There is no associated soft tissue abnormality with this finding and the scalp or in the epidural space. A second similar lesion is noted in the left parietal bone measuring 7 times 10-mm in size. A questionable low density lesion of calvarium in the left parietal bone is also suspected. Recommend correlation with history and follow-up with an MRI exam to exclude metastatic lesions.Visualized orbits, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of intracranial abnormality.2.Two small focus of sclerotic bony changes of calvarium may represent bony islands. Less likely possibility of sclerotic metastatic disease cannot be ruled out. A questionable left parietal lucent lesion is also noted measuring 7 times 7-mm in size which could represent a mass. Recommend correlation with history and follow-up with an MRI exam.


Instruction: Generate impression based on findings.

Input: Acute onset of facial droop and slurred speech. There are new punctate foci of restricted diffusion involving the right frontal centrum semiovale in a linear distribution. There is extensive encephalomalacia in the right posterior cerebral artery territory involving the occipital lobe and medial temporal lobe. There are patchy areas as well as scattered foci of T2 hyperintensity in the bilateral subcortical and periventricular white matter. There are chronic right pontine lacunar and right inferior cerebellum lacunar infracts. There is susceptibility effect indicative of hemosiderin staining along the right posterior cerebral artery territory and right inferior cerebellar infarcts. Additional punctate foci of susceptibility effect compatible chronic microhemorrhages in the cerebellum are also present. There is volume loss with surrounding T2 hyperintensity in the anterior and medial temporal lobes is noted with ex vacuo dilatation of the temporal horns. There is no intracranial mass or mass effect. There are several scattered foci of low signal involving the calvarium such as in the left parietal and right frontal regions and the left sphenoid triangle.

Output: 1. New punctate foci of restricted diffusion involving the right frontal centrum semiovale in a watershed distribution.2. Multiple supratentorial and infratentorial chronic infarcts, foci of chronic microhemorrhage in the bilateral cerebellar hemispheres, and a background of chronic small vessel ischemic disease may be related to chronic hypertension.3. Disproportionate volume loss involving the bilateral anterior and medial temporal lobes, which may indicate underlying Altheimer disease. 4. Multiple small area of signal abnormality involving the calvarial bone marrow with recent CT demonstrating multiple sclerotic foci, which may represent sclerotic metastases. Follow up with bone scan or a contrast-enhanced MRI may be useful.Urgent findings discussed with Dr. Bickley on 6/18/2015 at 4:50pm.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the left shoulder.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with headaches. Assess for Chiari, dural enhancement. Numerous peri-ventricular and subcortical foci of T2 hyperintensity are seen bilaterally within the cerebral hemispheres. There is no evidence of parenchymal edema or mass effect. No restricted diffusion is seen. No abnormal extra-axial fluid collection or intracranial hemorrhage is detected. The ventricular system is normal in size and morphology. The cerebellar tonsils terminate above the level of the foramen magnum. The globes are slightly misshapen, particularly the right which is elongated in the AP dimension.

Output: 1. No evidence of Chiari malformation. Please note that due to lack of IV contrast, dural abnormalities could not be assessed.2. Numerous scattered small foci of periventricular and subcortical T2 hyperintensity are seen. These are nonspecific and may reflect chronic microvascular disease, a demyelinating process, vasculitis or the sequelae of migraines among many other possibilities.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: eval for lumbar disk herniationSigns and Symptoms: lumbar radiculopathy, h/o herniation s/p surgery in 2001 Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation at this level as well as a mild disc bulge. There is effacement of the fat at the lateral recess bilaterally at this level but worse on the right than the left side. There is encroachment of the nerve roots at the lateral recess bilaterally.At L4-5 there is loss of disc space height and a broad-based central disc protrusion associated with some mild triangulation of the thecal sac and partial effacement of fat at the lateral recess bilaterally but worse on the right side. The encroachment of the nerve roots is worse at the right lateral recess versus the left. There is mild ligamentum flavum hypertrophy at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is encroachment of the nerve roots at the lateral recess bilaterally at L5-S1 and on the right at L4-5 due to disk disease as detailed above.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma surveillance. There is a heterogeneously enhancing mass within the pituitary gland that measures up to 18 mm in craniocaudal dimension. The mass extends into the right cavernous sinus, without encasement of the internal carotid artery. In addition, there is mass effect upon the optic apparatus. There is left lateral deviation of the infundibulum.

Output: No significant interval change in the pituitary mass that likely represents a macroadenoma.


Instruction: Generate impression based on findings.

Input: Again seen is an acute intraparenchymal hematoma in the left paramedian cerebellum that measures approximately 22 x 25 mm with surrounding vasogenic edema. There is also a small hematoma in the right lateral cerebellum also seen on the recent CT.There are multiple additional foci of susceptibility effect in the brain including the bilateral basal ganglia, right thalamus, right subinsular white matter, and right medial temporal lobe, compatible with chronic microhemorrhages.There are areas of restricted diffusion in the left paramedian cerebellum likely related to the acute hemorrhage itself. Otherwise, there is no restricted diffusion in the brain.T2/FLAIR hyperintensities are seen in the subcortical and the periventricular white matter, in the central semiovale, and in the pons, which are nonspecific and likely representing chronic ischemic small vessel disease.There is FLAIR hyperintensity at the level of the left sigmoid sinus which likely represents slow flow with preserved enhancement on the postcontrast sequences.There is mucous retention cyst in the left maxillary sinus with fluid in the nasal cavity.

Output: 1. Acute intraparenchymal hematoma involving the left paramedian cerebellum and a smaller focus in the right lateral cerebellar hemisphere as seen on recent CT. There is minimal restricted diffusion associated with the left cerebellar hematoma which is favored to be related to the blood products themselves. No evidence of acute infarct elsewhere in the brain. No abnormal enhancing lesions in the brain.2. Multiple chronic microhemorrhages with a distribution favoring chronic hypertensive etiology.3. Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of liver transplant in 2013 for HCC. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant and cholecystectomy. No significant perihepatic fluid.The liver is normal in morphology.The hepatic and portal veins are patent. The artery is not optimally visualized but opacifies intrahepatically consistent with patency.No intra or extrahepatic biliary ductal dilatation. The anastomosis is patent. No focal suspicious lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Single right and single left simple renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious hepatic lesion. Unremarkable biliary tree. Patent hepatic veins and portal veins. Opacified hepatic artery consistent with patency.


Instruction: Generate impression based on findings.

Input: 46 years Female (DOB:3/7/1970)Reason: possible osteoporosis, radiculopathy, facet joint inflammation History: pain in multiple sitesPROVIDER/ATTENDING NAME: ANDREA H. SHASHOUA ANDREA H. SHASHOUA Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is some subtle T2 signal hyperintensity present along the cervical spinal cord which is suspected to be artifactual.. The patient status post anterior fusion using anterior plate and screws at C6-7.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. There is left-sided facet hypertrophy at this level associated with mild narrowing of the left neural foramen.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes at this level associated with a disc bulge.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a mild levocurvature to the upper thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There are 4 nonrib-bearing lumbar-type vertebrae and a sacralized lumbar vertebra present. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is loss of disc space height, disc desiccation and broad-based central disc protrusion associated with some partial effacement of the fat at the lateral recesses bilaterally. There is mild encroachment of the nerve roots at the lateral recesses at this level which is worse on the right when compared to the left side.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation and a mild disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Please note that L5 is sacralized with articulation with the sacral ala.2.There are multilevel degenerative changes present in the lumbar spine. There is some mild to moderate encroachment of nerve roots of the right lateral recess at L4-5 due to degenerative changes.3.Patient status post cervical spine surgery. There is no significant compromise to the cervical spinal canal or exiting nerve roots.4.No compression fractures are identified in the spine.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:5/5/1981)Reason: Pt with transient neurological symptoms in R arm, hx of autoimmune hepatitis, ? diagnosis of Ankylosing Spondylitis; rule out inflammatory/demyelinating changes of brain History: see abovePROVIDER/ATTENDING NAME: MAHESH PADMANABAN MAHESH PADMANABAN The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some susceptibility effect is present at the C3-4 disc space level probably related to screws from the patient's known anterior cervical fusion.

Output: MRI of the brain is within normal limits. There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: There is no suspicious intracranial enhancement, acute infarct, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No MRI findings to explain the patient's severe headaches.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of cerebellumClinical question: history of ATRT s/p craniotomy, laminectomy, chemotherapy and radiation therapySigns and Symptoms: off therapy 4 1/2 years MRI brain:A ventriculostomy tube courses through the right occipital lobe into the trigone of the right lateral ventricle and has its tip at the quadrigeminal plate cistern. It is in stable position. There is redemonstration of a small focus of susceptibility effect at the tip of the ventriculostomy tube. The trigone of the right lateral ventricle is larger than the trigone of the left lateral ventricle. The temporal horns of the lateral ventricles are not dilated. These findings are stable.The patient is status post posterior fossa surgery. There is no evidence for abnormal enhancing mass intracranially. There is redemonstration and no change in the appearance of the cerebellum which is somewhat deformed.There is a punctate focus of signal hypointensity in the inferior aspect of the left cerebellar hemisphere on susceptibility imaging.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a minor opacity in the right maxillary sinus. The paranasal sinuses have not fully developed. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There is a large syrinx present which encompasses the majority of the spinal cord. Its superior extent is at the C2-3 disc space level. It is associated with enlargement of the spinal cord compared to the prior exam is not changed substantially.The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is diffuse a syrinx present which is stable compared to the prior exam.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine:The inferior extent of the spinal cord is the L2-3 disc space level. There is redemonstration of a large syrinx is inferior extent is at the conus medullaris.The patient is status post lumbar spine surgery at the L4 vertebral level.There is redemonstration of a cystic type fluid collection in the right hemicanal which extends from the C2 vertebral body level down to the L5-S1 disc space level. It measures approximately 5 x 8 mm maximum axial dimensions. The nerve roots are displaced around this collection and possibly clumped.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Examination is stable compared to prior exam. There is redemonstration of status post posterior fossa surgery and diffuse syrinx as well as a tethered cord and postoperative changes status post tethered cord release. 2.A cystic lesion in the lower lumbar spine is suspected to represent an arachnoid cyst. It is unchanged since the prior exam. The nerve roots are displaced around this collection and possibly clumped. Arachnoiditis cannot be excluded.


Instruction: Generate impression based on findings.

Input: There is disproportionate prominence of the superior vermis and hemispheres. There is no appreciable parenchymal signal abnormality otherwise. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Isolated volume loss affecting the superior vermis and hemispheres, which may be developmental in nature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for CSF dissemination of grade 3 PXA. Signs and symptoms: Supratentorial anaplastic PXA. Pre- and post enhanced total spine MRI:Evaluation of the cervical spine demonstrate normal signal intensity and alignment of vertebral column without detectable degenerative changes, spinal stenosis or neural foraminal compromise and no detectable abnormal enhancement. There is normal signal intensity and caliber of the cervical cord and without abnormal enhancement of the cord or the leptomeninges.Evaluation of thoracic spine demonstrate unremarkable signal intensity of the vertebral column with normal anatomical alignment and without detectable abnormal enhancement. There is also normal signal intensity and caliber of thoracic cord and without detectable cord or leptomeningeal enhancement.There is a tiny left paramedian disc protrusion at T3-T4 (axial T2 series 17 image 17) resulting in minimal flattening deformity of the cord without spinal stenosis or neural foraminal compromise.There is a small right median disc protrusion at T4-T5 (axial T2 series 17 image 24) which resulting indentation of the ventral aspect of the cord however without spinal stenosis or neural foraminal compromise.There is a small broad-based left paramedian disc protrusion at T8-T9 (axial T2 series 17 image 36) with subtle flattening of the ventral aspect of the cord without spinal stenosis or neural foraminal compromise.Evaluation of the lumbosacral spine demonstrate no abnormal enhancement of the conus or the cauda equina.There is no spinal stenosis or neural foraminal compromise at any level.Mild degenerative disc disease and mild bilateral facet and ligamentum flavum hypertrophy at L4-L5 is noted. There is a left lateral mild bulge and an annular fissure with expected enhancement present at this level.Moderate disc disease and loss of disc height and mild facet and ligamentum flavum hypertrophy at L5-S1 level is noted.

Output: 1.Pre- and post enhanced total spine MRI demonstrate no evidence of metastatic disease.2.No evidence of spinal canal or neural foraminal compromise at any level.3.Small disc protrusions with subtle associated cord flattening deformity are present at T3-T4, T4-T5 and T8-T9 levels as detailed above.4.Mild degenerative changes of the lower lumbar spine as detailed.


Instruction: Generate impression based on findings.

Input: 81-year-old female with abdominal pain. CT showing adrenal and renal mass. Evaluate for metastatic disease.Patient with history of cavitary mass in the left lung apex. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Heterogeneous left adrenal gland lesion with T2 heterogeneous signal and evidence of enhancement. This lesion measures 3.4 x 3.5 cm (series 6, image 66).KIDNEYS, URETERS: There is a bilobed T2 hyperintense and T1 hypointense focus in the right kidney consistent with benign cyst. Additionally, there are 2 subcentimeter left renal cysts.The kidneys enhance symmetrically without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Infrarenal aorta is ectatic with the largest dimension measuring approximately 2.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Heterogeneous enhancing left adrenal gland lesion is most compatible with metastatic disease2.Benign renal cysts.3.Cystic lesion abutting the portion of the duodenum may represent duplication cyst.4.Infrarenal aortic ectasia.5.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Loss of vision for 4 mins, MVR and AVR. MRI: There is no evidence of intracranial mass or acute infarct. There are mild scattered foci of white matter T2 hyperintensity in the anterior frontal lobes bilaterally. There are also numerous scattered foci of susceptibility effect in the bilateral cerebral hemispheres, midbrain, and cerebellum. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small bilateral maxillary sinus retention cysts. MRA: The left vertebral artery is diminutive. Otherwise, there is no evidence of significant steno-occlusive lesions. There is no evidence of saccular aneurysms.

Output: 1. Nonspecific mild scattered foci of white matter T2 hyperintensity in the anterior frontal lobes bilaterally, but no evidence of acute infarct or significant steno-occlusive lesions in the cerebral arteries.2. Numerous scattered supratentorial and infratentorial foci of susceptibility effect are nonspecific, but may represent cavernous malformations, chronic microhemorrhages, or perhaps sequela of prior embolic events.


Instruction: Generate impression based on findings.

Input: 37-year-old man with history of right shoulder pain. ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor muscles appear normal without evidence of abnormal tendon signal.SUPRASPINATUS OUTLET: There is a small amount of fluid in the subacromial bursa which is within normal limits. The acromioclavicular joint appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Although this is a non-arthrogram study, the glenoid labrum appears intact.BICEPS TENDON: There is a normal amount of fluid in the biceps tendon sheath and the long head of the biceps tendon is intact. ADDITIONAL

Output: No finding to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Ms. Perkins is a 60 year old female with a strong family history of breast cancer in three sisters (diagnosed at the ages of 21, 54, and 67 years) and a maternal niece (diagnosed in her 40's). History of bilateral benign biopsies (benign US biopsy of left breast in 2005 and benign MR biopsy of right breast in 2010). She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally.Few scattered enhancing foci are identified bilaterally, all of which are stable in distribution and appearance when compared to prior exams. No new abnormal enhancement is seen in either breast. Postsurgical distortion in the left breast and benign biopsy marker clip in the right breast are stable. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: There is no evidence of cord compression or cord signal abnormality. There is heterogeneous bone marrow with multiple vertebral body lesions suspicious for metastases, including one within the C3 vertebral body that demonstrates possible minimal posterior cortical disruption and epidural extension. The vertebral column alignment is within normal limits. There is also more diffuse abnormal low T1 marrow signal which is nonspecific. The vertebral body and disc space heights are grossly preserved. There appear to be lobulated retroperitoneal masses which can be correlated with CT abdomen study.

Output: 1. Limited exam per cord compression protocol. There is no evidence of cord compression or high grade spinal canal stenosis. 2. Diffuse osseous metastases, the burden of which can be further evaluated with bone scan or PET. There is questionable epidural extension at C3 without evidence of spinal canal narrowing or cord signal abnormality. Dedicated spine MRI with gadolinium can be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: eval for abscess vs septic joint History: Pain with walking Red marrow noted in the proximal femoral metaphysis. Normal appearing left hip. Incompletely imaged left sacroiliac joint is widened and indistinct compared to the right suggestive of bony destruction.

Output: 1.Normal left hip.2.Incompletely imaged abnormal left sacroiliac joint. MR of the pelvis is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Female 25 years old Reason: 25yo G5P0132 at 15w4d with complete previa, 1 prior C/S with concern for C-section scar ectopic vs accreta History: no visible placenta plane on CLI U/S PELVIS:UTERUS, ADNEXA: Fetus identified within the uterus. This study is not performed for dedicated evaluation of the fetus and should not be considered as an anatomical assessment. The placenta covers the cervical os consistent with placenta previa. The exact site of the patient's reported c-section defect is not definitely seen, but the placenta covers the expected region. The plane between the bladder and placenta is preserved. The placenta-myometrial junction has irregular contours however (series 3, image 16; series 6, image 14). Based on this appearance, while there is no evidence of placenta percreta, placenta accreta or increta cannot be excluded.Unremarkable appearance of the right ovary. Within the superior pelvis on the left side there is 4.9 x 8.6 cm mass which cannot be separated from the left ovary. This contains fluid and fat and although it is incompletely evaluated in the absence of intravenous contrast, the appearance is suggestive of a dermoid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Placenta previa. No evidence of placenta percreta. Placenta increta or accreta is not excluded.2.8.6 cm lesion which appears to arise from the left ovary. This is incompletely evaluated in the absence of intravenous contrast however the appearance is suggestive of an ovarian dermoid.


Instruction: Generate impression based on findings.

Input: Right shoulder pain The examination is limited by motion artifact.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon with retraction to the level of the acromioclavicular joint. This tear extends posteriorly to involve the distal fibers of the infraspinatus tendon which also appear fully torn. There is moderate fatty atrophy of the supraspinatus muscle with mild fatty atrophy of the infraspinatus muscle. Large degenerative cysts are identified along the greater tuberosity. The teres minor tendon and muscle are normal. The teres minor tendon and muscle are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint. The humeral head is high riding secondary to the chronic rotator cuff tear. Evaluation of the glenoid labrum is limited due to the lack of intra-articular contrast however there is abnormal morphology and signal intensity of the superior labrum suggesting degenerative tearing.BICEPS TENDON: Evaluation of the biceps tendon is limited secondary to internal rotation. The intra-articular portion of the biceps tendon is poorly visualized likely reflecting a component of interstitial tearing.ADDITIONAL

Output: 1. Massive full-thickness rotator cuff tears involving the supraspinatus and infraspinatus tendons. There is mild to moderate fatty atrophy of the associated musculature.2. Degenerative tearing of the superior labrum with probable intra-articular tearing of the biceps tendon although this is unclear given the internal rotation of the patient.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out lumbar stenosis. Signs and symptoms: Weakness in left ankle dorsiflexor, numbness and sacral than left, region, increased weakness when walks. Nonenhanced lumbar MRI:T11-T12 demonstrates advanced disc disease and loss of disc height and mild central spinal stenosis.T12-L1 demonstrate mild degenerative disc disease, mild bilateral ligamentum flavum hypertrophy and facet disease. There is a small right-sided ligamentum flavum synovial cyst measuring 5 x 6 mm in transaxial dimensions and 13 mm in cranial cephalad axis. Finding is best appreciated on axial T2 series 5 image 4, sagittal T2 STIR series 4 image 9. Findings results in effacement of right posterior subarachnoid space without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is resultant mild central spinal stenosis and bilateral neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, moderate to significant bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of findings results in moderate to severe central spinal stenosis and mild to moderate bilateral neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. Constellation of findings results in moderate to severe central spinal stenosis and severe left neural foraminal compromise.L4-L5 demonstrate advanced disc disease and loss of disc height, significant bilateral (L>R) ligamentum flavum hypertrophy and moderate facet hypertrophic changes. Degenerative changes also resulting in grade 1 anterolisthesis and significant central spinal stenosis and bilateral (L>R).L5-S1 demonstrate moderate to advanced disc disease and loss of disc height, diffuse broad-based pseudo bulge of disc, and moderate bilateral ligamentum flavum hypertrophy. Degenerative changes also results in mild grade 1 anterolisthesis and moderate central spinal stenosis and bilateral neural foraminal compromise.

Output: 1.Extensive degenerative changes of lumbar spine with resultant grade 1 anterolisthesis at L4-L5 and to a lesser degree at L5-S1 levels.2.Severe central spinal stenosis at L2-L3, L4-5 and L5-S1 levels and to a lesser degree at L1-L2 and L3-L4 level as detailed above.3.Multilevel neural foraminal compromise (some significantly) as detailed per level above.4.There is a right ligamentum flavum synovial cyst at L2-L3 as detailed/measured above.5.Partially evaluated lower thoracic spine demonstrate mild central spinal stenosis at T11-T12.


Instruction: Generate impression based on findings.

Input: 37-year-old male with left knee pain. MENISCI: The medial and lateral menisci are morphologically normal with no evidence of meniscal tear.ARTICULAR CARTILAGE AND BONE: Similar to prior study there is degeneration of the articular cartilage along the weightbearing portion of the medial femoral condyle as well as the medial tibial plateau unchanged in extent and distribution. There is mild underlying subchondral marrow edema. In addition there is superficial fraying of the articular cartilage of the medial patellar facet with a full-thickness cleft also unchanged. There is mild increased signal intensity of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus also unchanged.LIGAMENTS: The anterior and posterior cruciate ligaments are normal. Medial and lateral collateral ligaments are morphologically normal.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No interval change in the extent of degeneration of the articular cartilage along the medial femoral condyle and patella as described above.


Instruction: Generate impression based on findings.

Input: History of kidney and liver transplant February 2008. Evaluate for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant. The liver is normal in morphology, size and signal intensity.The liver is not entirely included in the field-of-view on several imaging sequences as the study was protocoled for evaluation of the renal lesion. Given this limitation no focal abnormality is evident.The portal vein appears patent. Interval placement of a percutaneous right-sided biliary drain with persistent moderate right greater than left intrahepatic biliary ductal dilatation, appearing similar to the prior. MRCP images were not obtained.SPLEEN: Mild splenomegaly measuring 14 cm in craniocaudal dimension without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval resolution of the previously seen complex left renal cyst. No new suspicious renal lesion. No hydronephrosis.The native kidneys are atrophic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Persistent focal narrowing of the celiac artery origin, appearing similar to the prior.The right iliac fossa transplant kidney is partially imaged without hydroureteronephrosis. Several simple cysts are noted.OTHER: No significant abnormality noted.

Output: 1.Interval resolution of the complex left renal cyst. No suspicious renal lesion.2.Status post liver transplant. Interval right-sided biliary drain with persistent right greater than left intrahepatic biliary ductal dilatation appearing similar to the prior. No focal liver lesion. Please note that the study was protocolled for evaluation of the kidney and did not include MRCP images or complete evaluation of the liver parenchyma.


Instruction: Generate impression based on findings.

Input: Evaluate for biliary obstruction or cholestatic liver disease. Status post heart transplant. Persistent elevated alkaline phosphatase. ABDOMEN:LIVER, BILIARY TRACT: Unchanged intrahepatic ductal dilatation, left greater than right, and mild extrahepatic ductal dilatation. The common bile duct measures 9 mm, unchanged. Similar appearing stricture at the ampulla is again identified (series 4, image 85). No focal mass lesion is identified. Low insertion of the cystic duct. Patient is status post cholecystectomy.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: No significant abnormality noted.OTHER: Status post median sternotomy.

Output: Intra and extrahepatic biliary ductal dilatation with distal common bile duct stricture, similar to prior.


Instruction: Generate impression based on findings.

Input: Bacteremia. Back pain, L4-L5 facet joint fluid collection. Assess for resolution. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is a Schmorl's node involving the superior T12 endplate. Alignment is within normal limits. Bone marrow signal is benign with mild nonspecific heterogeneity. The conus medullaris is normal in position.Mild degenerative changes are present including minimal disc bulges at L3-L4, L4-L5, and L5-S1. There is no significant spinal canal stenosis at any level. There is mild left and minimal narrowing of the right L3-L4 and L4-L5 neural foramina related to minimal disc bulges and moderate bilateral facet arthropathy. There is also at least moderate facet arthropathy involving the L5-S1 facet joints, worse on the left than the right. There is moderate narrowing of the left L5-S1 neural foramen related to enhancing soft tissue as described below:Subcentimeter fluid collection posterior to the left L4-L5 facet joint is no longer present. There remains edema in the left posterior paraspinous musculature at the left L4-L5 level which is not significantly changed. There is increase in enhancement extending into the left L4-L5 neural foramen. There is more significant interval increase in enhancement surrounding and within the left L5-S1 facet joint, adjacent paraspinous musculature, new epidural enhancement along the left lateral L5 to S1 levels, left L5-S1 neural foramen surrounding the S1 nerve root and to a milder degree left S1-S2 neural foramen. There is trace fluid in the left L5-S1 facet joint which is increased in the interval.There is no edema or abnormal enhancement within the intervertebral discs or endplates to suggest discitis-osteomyelitis.There are small cysts in the bilateral kidneys which are incidentally noted.

Output: 1. Previously seen fluid collection posterior to the L4-L5 facet joint is no longer present. 2. There is significant interval increase in enhancement within and adjacent to the left L5-S1 facet joint which extends into the left L5 to S1 lateral epidural space, adjacent paraspinous soft tissues as well as the left L5-S1 neural foramen surrounding the left L5 nerve root. Milder increase in enhancement surrounding the left L4-L5 and left S1-S2 neural foramina is also noted. These findings are highly suspicious for progression of infection. No new fluid collection to suggest paraspinous or epidural abscess.


Instruction: Generate impression based on findings.

Input: 38-year-old female with history of right upper extremity paresthesias. The cervical-thoracic junction is obscured by overlying anatomy on the lateral view. Small osteophytes project along the anterior aspect of C3 through C6. Intervertebral disc spaces and vertebral body heights are well-maintained. There is mild narrowing of the C3-4 and C4-5 neuroforamina on the right secondary to posterior osteophytes. There is perhaps mild narrowing of the C3-4 neuroforamina on the left as well. These abnormalities would be better evaluated on MRI. There is loss of the normal cervical lordosis.

Output: Findings compatible with mild neuroforaminal narrowing as above. If patient care warrants further imaging, MRI may be obtained.


Instruction: Generate impression based on findings.

Input: 12-year-old female with repeat shoulder subluxation ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. No fluid is seen within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. The labrum appears normal. The articular cartilage appears normal.BICEPS TENDON: The tendon of the long head of the biceps appears intact and appropriately situated in the bicipital groove.ADDITIONAL

Output: Type II joint capsule with no labral tear evident.


Instruction: Generate impression based on findings.

Input: Again demonstrated are posttreatment changes related to surgical resection of left occipital lobe mass with associated susceptibility effects related to blood products. There has been interval increase in heterogeneous contrast enhancement in the left occipital lobe with a more focal mass-like area involving the left paramedian occipital lobe with associated restricted diffusion, overall measuring 2.2 x 1.7 cm. Much of the surrounding enhancement is favored to represent radiation related changes as seen previously. Perfusion images demonstrates elevated cerebral blood volume within the medial aspect of the left occipital lobe. There is extensive T2 FLAIR hyperintensity surrounding the left occipital lesion extending into the left parietal lobe superiorly and the left posterior temporal lobe, mildly progressed since prior. There is slight interval enlargement of the lateral ventricles predominantly left occipital lobe. There is mild rightward midline shift.Additional new rounded, rim enhancing lesion with internal punctate heterogeneous enhancement measuring 1.4 x 1.3 cm is seen along the posterior aspect of the right medial orbital gyrus. There is mild surrounding T2 hyperintensity suggesting vasogenic edema. There is another enhancing lesion measuring 0.7 x 0.5 cm in the right post central gyrus with surrounding edema (image 38, series 15).

Output: 1.Extensive posttreatment changes in the left occipital lobe related to prior surgery and radiation. Compared to 3/2/2015, there is interval increase in more masslike area of enhancement in the left paramedian occipital lobe measuring approximately 2.2 x 1.7 cm with elevated CBV and suspicious for tumor recurrence. Much of the surrounding enhancement is likely reflective of radiation change as seen previously. Mild interval increase in surrounding edema.2. Two new enhancing lesions involving the right inferior frontal lobe and the right parietal lobe (post central gyrus) consistent with progression of metastatic disease.


Instruction: Generate impression based on findings.

Input: History of pituitary adenoma: follow up study. There are postoperative findings related to pituitary surgery with an unchanged punctate focus of enhancing tissue posterior to the infundibulum, which may represent an adhesion. There is otherwise no evidence of pituitary mass lesions. The pituitary infundibulum is intact. The optic apparatus and cavernous sinuses are intact. The imaged portions of the paranasal sinuses are unremarkable.

Output: No evidence of recurrent pituitary adenoma.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with lower back pain and left lower extremity pain. Trace retrolisthesis of L4 relative to L5 is demonstrated. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. Marrow signal characteristics are unremarkable.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2 and L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disc T2 signal, mild loss of disc height and mild disc bulging. Mild generalized spinal canal narrowing without nerve root impingement or crowding. Mild bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Loss of disc height and T2 signal. Disc bulging with a superimposed central/left paracentral disc protrusion. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina nerve roots. Mild bilateral foraminal narrowing. L5-S1: Advanced facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis.

Output: 1.Disc degeneration at L4-5 with a central/left paracentral disc protrusion which causes a moderate to severe spinal canal stenosis and crowding of the nerve roots of the cauda equina.2.Relatively mild degenerative disc disease is seen at L3-4. Facet arthropathy is also noted at lower lumbar levels.


Instruction: Generate impression based on findings.

Input: Neurosarcoidosis with recent visual changes. Evaluate for any interim changes. Orbits: There is persistent enhancement and T2 hyperintensity of the orbital segment of the right orbital nerve. Otherwise, there has been interval resolution of enhancement and swelling of the rest of the right optic nerve, optic chiasm, and left optic nerve. The bilateral globes, extraocular muscles and orbital fat appear unremarkable. There is an enhancing skin excrescence along the lateral aspect of the left lateral orbital rim that measures up to 5 mm. Brain: There has been interval resolution of the abnormal leptomeningeal enhancement. Furthermore, there has been marked interval decrease in the degree of abnormal perivascular enhancement. There is no evidence of intracranial hemorrhage, mass, or acute cerebral 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. There is a right maxillary sinus retention cyst. The skull and scalp soft tissues are grossly unremarkable.

Output: 1. Persistent abnormality of the orbital segment of the right orbital nerve related to neurosarcoidosis. Otherwise, the inflammation involving the rest of the right optic nerve, optic chiasm, and left optic nerve has resolved. 2. Interval resolution of the abnormal leptomeningeal and markedly decreased perivascular enhancement related to neurosarcoidosis.


Instruction: Generate impression based on findings.

Input: Ms. Williams is a 34-year-old female with a personal history of left breast lumpectomy in February 2013 for triple negative IDC. Patient did not receive any chemotherapy or radiation therapy. She has no current breast related complaints. There are innumerable scattered foci of enhancement seen in both breasts, compatible with marked background parenchymal enhancement. Left breast: Postsurgical changes are identified in the upper outer left breast, at site of prior lumpectomy. In the left lateral breast, anterior to the lumpectomy site, there is a 3.5 cm span of linear non-mass-enhancement identified with persistent type kinetics. This was not definitively seen on prior MRI. Right breast: Few scattered cysts are seen in the right breast. No abnormal enhancement is identified in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 3.5 cm span of linear non-mass-enhancement in the lateral left breast located anterior to the lumpectomy changes. MR-guided biopsy is recommended for further evaluation. (2) Bilateral marked background parenchymal enhancement, which lowers the sensitivity and specificity of MRI. Of note, MRI is optimally performed during the second week of the patient's menstrual cycle.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.All results and recommendations were relayed to Nanna Sulai on 2/18/2015.


Instruction: Generate impression based on findings.

Input: 71-year-old male with history of CKD 4 on bisphosphates with low platelets and lung mass on CT. Evaluate lymph node size. Known right renal complex cysts. Status post right midpole partial nephrectomy in 9/07. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: Extensive coronary artery calcifications. Transvenous pacemaker leads are present in the right ventricular apex. Old right posterior lateral rib fracture at image 35 of series 3.LIVER, BILIARY TRACT: Cholelithiasis. Punctate calcification in the right hepatic lobe is probably due to old granulomatous disease.SPLEEN: Splenomegaly with overall length of 16 cm. PANCREAS: Atrophic pancreas. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Exophytic 2 cm diameter cyst at right upper pole has attenuation of 23 HU, so contrast enhanced evaluation with CT or MRI would be helpful to better characterize the lesion. This lesion has increased in size since 2007, from 1.5 then to 2 cm now. Deformity of the right kidney lower pole is probably post-operative. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There are numerous enlarged pelvic lymph nodes which are predominately replaced with fat, unchanged from 2008.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes involve the spine and pelvis.OTHER: Superficial anterior left thigh collateral vessels are enlarged. Probably due to iliac vein occlusion on the left.

Output: Slowly enlarging right upper pole lesion is now 2 cm in diameter. Enlarged benign fat-replaced pelvic lymph nodes are stable since 2008. No other significant interval change.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital right mammographic images (7/31/15), ultrasound images of right breast (7/31/15) performed at Northshore University Healthsystem. breast MRI (7/15/15) are available for comparison. Following studies were performed to look for a MR detected enhancing lesion in the right breast.DIGITAL RIGHT MAMMOGRAPHIC IMAGES (7/31/15):The breast parenchyma is composed of scattered fibroglandular elements. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF RIGHT BREAST (7/31/15):Several sonographic images of right upper outer quadrant are submitted. There are no abnormal findings. No sonographic correlation is detected for the enhancing lesion seen on MRI.

Output: No mammographic or sonographic evidence for malignancy. No mammographic or sonographic correlation is detected. Follow-up MRI in 6 months is recommended.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 14 years old, history of pars fracture with fusion, hardware complications status post removal, status post fall. Assess for disc herniation or other abnormality. Patient presenting with stabbing back pain and shooting right leg pain. Since the prior examination, the interconnecting rods and the pedicle screws at L5 have been removed. Pedicle screw fragments remain in place bilaterally at S1.Apart from the screw tracks, no abnormal marrow signal intensity is seen. Evidence of bilateral pars defects is redemonstrated at L5. The osseous structures otherwise appear intact. Vertebral body heights are preserved.Endplate irregularity and a Schmorl's node deformity are evident at the inferior T11 endplate. This irregularity is better appreciated on same day radiographs.A grade 1 anterolisthesis of L5 relative to S1 appears slightly more pronounced than on the prior MRI. Spinal alignment is otherwise unremarkable.The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural collections are suspected.Mild disc uncovering is seen at L5-S1. No significant disc herniations are demonstrated. No spinal canal or neuroforaminal stenosis is suspected.

Output: 1.Evidence of surgical revision with removal of the posterior interconnecting rods and pedicle screws at L5. Pedicle screw fragments remain at S1.2.No evidence of marrow edema or other significant marrow signal abnormality. L5 pars defects are again seen. A grade 1 anterolisthesis of L5 relative to S1 is slightly more pronounced than on the prior MRI.3.No spinal canal or neuroforaminal stenosis.4.Incidental note is made of endplate irregularity and a Schmorl's node along the inferior endplate of T11. These findings are only partially visualized on this examination but are better appreciated on the same day radiographs. If pain localizes to this area or if there is concern for a thoracic spine abnormality, further evaluation with dedicated thoracic MRI can be considered.


Instruction: Generate impression based on findings.

Input: Unspecified transient cerebral ischemia [435.9], Reason for Study: ^Reason: RULE OUT STROKE History: Right hand weakness + aphasia No evidence of acute ischemic or hemorrhagic lesion.Patchy high signal intensity on FLAIR images on bilateral periventricular white matter indicate non specific small vessel ischemic disease.There are two extra axial masses, one on the anterior aspect of falx (8.5mm x 6.2mm x 10mm) and another on the left temporal area with broad based on dura (10mm x 5.4mm x 10.1mm) which show low signal intensity on T2 and iso or slightly lower signal intensity on T1 with susceptibility artifacts. Constellation of these findings indicate possible calcification or calcified meningioma. If clinically indicated, Gad enhanced MRI can be considered.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Anterior falcine and left temporal area extra axial lesions indicating possible calcified meningioma or calcifications as described above. Gad enhanced MRI can be considered for further imaging evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Clinical question: Worsening back pain despite physical therapy. Signs and symptoms: Severe leg pain and numbness. Nonenhanced lumbar MRI:There is mild generalized narrowing of the spinal canal which is believed to be at least partially secondary to congenital anatomical variation of the short pedicles.T11 -- T12 demonstrates significant asymmetric left-sided ligamentum flavum hypertrophy which results in mass-effect and forward displacement of the cord and central spinal stenosis. Moderate to significant right neural foraminal compromise is also detected.On axial T2-weighted images (series 701 image 47 and 48) there is a suggestion of mild increased T2 signal intensity of the cord which could represent edema.T12 -- L1 demonstrate asymmetric right-sided ligamentum flavum hypertrophy and mild bilateral facet disease. There is significant right neural foraminal compromise, no central spinal stenosis and patent the left neural foramina.L1 -- L2 demonstrate moderate bilateral (right greater than left) ligamentum flavum hypertrophy and mild right facet hypertrophy. There is significant right neural foraminal compromise, no central spinal stenosis and patent the left neural foramina.L2 -- L3 demonstrate mild disk disease and loss of disk height, mild left and moderate right facet and ligamentum flavum hypertrophy. There is a linear T2 hyperintensity in the annulus of the disk laterally on the left consistent with an annular fissure. There is mild to moderate central spinal stenosis and moderate bilateral neural foraminal compromise. Incidental note at this level is a superficially located single locule left renal cyst.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy, mild degenerative facet disease and evidence of bilateral facet effusion. There is mild central spinal stenosis with mild to moderate bilateral neural foramina compromise.L4 -- L5 demonstrate mild degenerative disk disease and loss of disk height, mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is a left-sided far lateral annular fissure which is best appreciated on axial T2 series 701 image 17 and sagittal T2 severe on images 3 through 5.No spinal stenosis, however moderate bilateral neural foraminal compromise is present.L5 -- S1 demonstrate mild disc disease and loss of disk height, moderate bilateral facet hypertrophy and mild ligamentum flavum. No central spinal stenosis. Moderate (left greater than right) neural foraminal compromise is present.Unremarkable visualized SI joints.Unremarkable paraspinal soft tissues other than above mentioned left renal cyst.

Output: 1.Generalized mild narrowing of the spinal canal believed to represent a congenital anatomical variation of short pedicles.2.Degenerative changes of disks and posterior elements in combination with congenitally short pedicles results in multilevel central spinal stenosis most noticeably at L2- L3 and L3 -- 4 levels. 3.There are multi-level neuroforaminal compromise throughout the lumbar and lower most visualized thoracic spine as detailed per level above.4.Significant asymmetric ligamentum flavum hypertrophy on the left at T11 -- T12 with resultant central spinal stenosis and neural foraminal compromise as detailed. There is suspected subtle T2 hyperintensity of the cord at this level.5.Please review detailed report per level above.


Instruction: Generate impression based on findings.

Input: Radicular pain in the left upper extremity, left C5/6. History of surgery to cervical spine. Craniocervical junction is within normal limits. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. Bone marrow signal is benign. There is straightening of the cervical spinal curvature similar to prior and grade 1 anterolisthesis of C7 on T1 measuring 3 mm, which is unchanged. Again seen is anterior cervical spinal fusion at C6-C7 with intervertebral disc spacer and wide decompressive laminectomies at C3-C7. C6 screw fractures better seen on prior CT.Multilevel degenerative changes are again seen which are not significantly changed since 3/28/2015. There are endplate degenerative changes at C4-C5 with severe loss of disc space. There is also mild loss of disc height at C3-C4, moderate loss of disc height at C5-C6, and severe loss of disc height at C7-T1. There is also mild multilevel facet arthropathy. The paravertebral soft tissues are unremarkable. There is a 10 mm nodule in the left thyroid lobe similar to prior. No abnormal enhancement in the spine.Individual levels as below:C2-C3: Unchanged small left paracentral disc osteophyte complex and ligamentum flavum thickening with mild spinal canal stenosis. No neural foraminal stenosis.C3-C4: Status post laminectomy. Large left paracentral osteophyte contributing to mild flattening of the left ventral cord similar to prior. There is likely mild mass effect on the left-sided nerve root although more laterally the neural foramen is patent.C4-C5: Status post laminectomy. Disc osteophyte complex with left uncinate spur, contributing to mild left foraminal stenosis. No significant right foraminal stenosis. These findings are also similar to prior.C5-C6: Status post laminectomy. Small disc osteophyte complex. Minimal narrowing of the left neural foramen as before. Right neural foramen is patent. Findings are similar to prior.C6-C7: Status post laminectomy. Disc osteophyte complex with large central osteophyte, contributing to mild flattening of the ventral cord. There is mild to moderate left foraminal stenosis. Findings are similar to prior.C7-T1: Status post laminectomy. No significant spinal canal or right neural foraminal stenosis. Mild to moderate left neural foraminal stenosis similar to prior. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine are again seen and not significantly changed since prior study from 3/28/2015. There is multilevel, mild or mild to moderate left-sided neural foraminal stenosis, as described above. There are also prominent left paracentral C3-C4 and central C6-C7 disc osteophyte complexes with mild impression on the ventral aspect of the cord. Spinal canal remains otherwise surgically well decompressed without evidence of high-grade stenosis at any level.


Instruction: Generate impression based on findings.

Input: 11-year-old male with bilateral weakness. Rule out demyelinating injury. Limited view of the cervical spine on nondedicated localizer images shows no obvious Chiari malformation. The thoracic vertebral bodies are appropriate in overall alignment and height. There is prominence of the central canal of the spinal cord versus small syrinx extending to the level of T8-9, measuring up to 2.3 mm at the level of T6. The surrounding cord signal is normal. There is no compromise of thoracic spinal canal or exiting nerve roots. Axial images of the lumbar spine are virtually nondiagnostic due to degradation by motion artifact. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is no abnormal cord signal or abnormal cord morphology. Reading through the artifact on axial images and seen in limited fashion on sagittal images, there is suspicion of minimal fat within the filum terminale.The conus medullaris on sagittal imaging is grossly intact and in normal position at the level of L1-2. Rudimentary disk space is seen between S1 and S2. There is no significant compromise to the spinal canal or neural foramina at any level.

Output: Prominent central canal versus small syrinx extending to the level of T8-9. Despite motion artifact, there is also suspicion for minimal fat signal within the filum terminale. These findings raise concern for tethered cord, and repeat exam of the lumbar spine with tethered cord protocol is recommended, as well as MRI of the brain/cervical spine to evaluate for Chiari malformation. Pediatric neurosurgical consultation is also advised.Findings related telephone to Dr. Green at 11:03 a.m. on 4/30/2015.


Instruction: Generate impression based on findings.

Input: daily headache No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with grade 1 meningioma status post subtotal resection and radiotherapy (in 2004). Evaluate extent of disease. A round craniotomy defect is redemonstrated centered at midline and encompassing the bilateral parietal bones. Nonspecific dural/epidural thickening and enhancement overlying the operative region is again seen, and a small fluid collection deep to the craniotomy has decreased in size from the prior exam.A nodule of solidly enhancing tumor-like tissue along the left aspect of the parietal interhemispheric falx measures 18 x 11 x 13 mm, previously 12 x 9 x 9 mm. This nodule appears to project into what remains of the adjacent, partially resected superior sagittal sinus.Confluent T2 hyperintensity involving the white matter of both parietal lobes and the left greater than right occipital lobe is unchanged. Additional scattered foci of white matter T2 hyperintensity elsewhere in the cerebral hemispheres and the pons are likewise unchanged. No new enhancing lesions are seen. The ventricles are stable in size and morphology. Incidental note is made of a partially empty sella.

Output: Mild interval increase in the size of a small residual tumor nodule along the left surface of the parietal interhemispheric falx.


Instruction: Generate impression based on findings.

Input: MRI Brain: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.MRA Brain: The intracranial internal carotid, middle and anterior cerebral arteries are patent. The AComA is not well seen by MRI. The left PComA is small. The right PComA is medium sized. The right vertebral artery is bigger than the left but both are patent. The basilar artery and posterior cerebral arteries are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. The left vertebral artery is smaller than the right and arises from a common origin with the left subclavian artery from the aorta. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion. MRI C-Spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. No significant compromise to the spinal canal or neural foramina. The paraspinous soft tissue structures appear within normal limits.

Output: 1.No evidence of acute intracranial hemorrhage, mass or abnormal mass lesion.2.No evidence for cervicocerebral occlusive disease, including no evidence of vertebral or carotid artery dissection.3.No evidence for cervical spinal cord compression or cord signal abnormality. There is no significant compromise to cervical spinal canal or neural foramina4.Tonsilar ectopia which may represent an incidental finding.


Instruction: Generate impression based on findings.

Input: 44-year-old female with diffuse large B-cell non-Hodgkin's lymphoma. Completed 4 cycles cycles of CHOP/R chemotherapy on 10/17/07. Restaging. CHEST: LUNGS AND PLEURA: Probable intrapulmonary lymph node (image 53; series 5) stable.MEDIASTINUM AND HILA: No significant abnormality noted. CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Multiple enhancing lesions scattered throughout all lobes liver which have been discussed at length previously appear stable in size. Again these were thought to represent multiple FNHs verses hepatic adenomas. These could be further differentiated using MRI as clinically indicated. No intrahepatic biliary ductal dilatation. Hepatic vessels appear to be patent.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: No significant abnormality noted. OTHER: No significant abnormality noted. PELVIS: UTERUS, ADNEXAE: No significant abnormality noted. BLADDER: No significant abnormality noted. LYMPH NODES: Slight interval decrease in size of previously noted pelvic adenopathy. Reference left external iliac node (image 168; series 4) difficult to measure on the current examination. An approximate measurement is 1.8 x 1.1 cm, decreased in size compared to prior. BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted.

Output: Slight interval regression in size of pelvic adenopathy. No new adenopathy appreciated. Stable enhancing liver lesions as noted above.


Instruction: Generate impression based on findings.

Input: 10month female with posterior midline neck mass, ultrasound suggests lipoma versus lymphovascular malformation. There is a fairly well-defined avidly enhancing T2 hyperintense mass that contains multiple prominent flow voids within the subcutaneous tissues of the superior right posterior neck. The mass measures up to approximately 4 cm. There is no significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The imaged portions of the intracranial structures and orbits are also unremarkable. The osseous structures are intact. There is left tympanomastoid fluid signal.

Output: 1. Findings suggestive of an infantile hemangioma in the subcutaneous tissues of the superior right posterior neck that measures up to approximately 4 cm.2. Left tympanomastoid fluid may represent effusions, perhaps in the setting of otomastoiditis.


Instruction: Generate impression based on findings.

Input: Low back pain, radiculopathy lumbar right side. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is heterogeneous which is nonspecific but without discrete suspicious lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen including multilevel disc desiccation. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or left neural foraminal stenosis. Minimal right foraminal stenosis. L3-L4: Minimal disc bulge. No significant spinal canal stenosis. Minimal right neural foraminal narrowing. No significant left neural foraminal narrowing.L4-L5: There is mild disc bulge eccentric to the right. There is a left sided annular fissure. No significant spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis. There is mild facet arthropathy, worse on the right. There is enhancement surrounding the right facet joint which is likely on a degenerative basis. There is mild bone marrow edema involving the posterior elements on the right.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.No suspicious enhancement in the lumbar spine. Small multilevel perineural cysts are incidentally noted. Paraspinous soft tissues are within normal limits.

Output: 1. Mild multilevel degenerative changes in the lumbar spine as detailed above with minimal to mild neural foraminal stenosis, relatively worse at the right L4-L5 level. No significant spinal canal stenosis at any level.2. Facet arthropathy at the right L4-L5 level with mild associated enhancement, which is likely on a degenerative basis and may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: 67 years, Male, metastatic melanoma enrolling in immunotherapy trial. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. A few small foci of susceptibility effect are demonstrated in the bilateral posterior frontal periventricular white matter, compatible with chronic microhemorrhages. A few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is a punctate focus of high T1 signal involving the choroid plexus of the left lateral ventricle with suggestion of hypoattenuation on prior PET/CT suggesting tiny lipoma. The ventricles are within normal limits in size and configuration. 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: 1. No evidence of intracranial metastatic disease. 2. Few nonspecific chronic microhemorrhages in the bilateral posterior frontal lobes.3. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 60-year-old female, evaluate for Morton's neuroma. Please note evaluation for Morton's neuromas is limited given the lack of intravenous contrast administration. Some sequences are slightly limited by patient motion artifact.Left foot:There is a small 3 x 5 mm ovoid focus of low to intermediate signal intensity on non-fat-suppressed sequences and increased signal intensity on fat-suppressed sequences within the plantar fat beneath the interspace between the bases of the second and third proximal phalanges. While it is possible that this could represent a small Morton's neuroma, this is equivocal. No findings to suggest a Morton's neuroma within the interspace between the third and fourth rays or elsewhere.Mild osteoarthritis affects the first metatarsophalangeal joint with foci of metallic susceptibility artifact in the adjacent soft tissues suggesting prior surgery.The remainder of the forefoot appears normal.Right foot: There is an approximately 5 x 5 mm rounded focus of intermediate signal intensity on non-fat-suppressed sequences and slightly increased signal intensity on fat-suppressed sequences within the plantar fat beneath the interspace between the second and third metacarpal heads that could represent a small Morton's neuroma, slightly more prominent than that seen on the right.There is small amount of fluid in the intermetatarsal bursa between the third and fourth metacarpal heads, but no definite neuroma at this location. Mild osteoarthritis affects the first metatarsophalangeal joint with adjacent foci of signal voids suggesting metallic susceptibility artifact from prior surgery.The remainder of the forefoot appears normal.

Output: 1. Limited study due to lack of intravenous contrast administration showing a small nodular focus of signal abnormality within the plantar soft tissues beneath the interspace between the second and third metatarsal heads on the right that could represent a Morton's neuroma. A similar, but smaller finding is noted on the left.2. Osteoarthritis of the first metatarsophalangeal joint bilaterally with findings indicating prior surgery to this site.


Instruction: Generate impression based on findings.

Input: History of an L4/L5 laminectomy, titanium rods, recently assaulted and now with back pain, RLE weakness, decreased rectal tone, and urinary incontinence. Redemonstrated are postoperative changes of a laminectomy and posterior spinal fusion at the L4-5 level with transpedicular screws. Additionally, there is a interbody anterior fusion of L4-5 vertebral bodies. There is no evidence of traumatic subluxation, fracture or hardware complication. The lumbar spine alignment remains within normal limits. The vertebral body and disc space heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. A small CSF fluid collection is seen dorsal to the L4-5 thecal sac compatible with a small pseudomeningocele which is grossly unchanged compared to the prior exam and without mass effect on the thecal sac. No evidence of an epidural or paraspinous hematoma.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L3-L4: There is mild facet arthropathy but no significant compromise to spinal canal or neural foramina. L4-5: There is mild facet arthropathy and postsurgical changes but no significant compromise to spinal canal or neural foramina.L5-S1: There is mild facet arthropathy but no significant compromise to spinal canal or neural foramina.

Output: Remote postoperative changes of L4-5 spinal fusion. No significant spinal canal or neural foraminal stenosis at any level. No evidence of an epidural or paraspinous hematoma.


Instruction: Generate impression based on findings.

Input: History of medulloblastoma treated with surgery, chemotherapy, and radiotherapy. Since the previous examination, the patient underwent right cochlear implantation. The safety of the MR procedure was verified by ENT prior to the examination. The artifact induced by the cochlear implant is substantial and obscures a large part of the right head posteriorly, including the cerebellar treatment bed at midline in the posterior fossa. Otherwise, the brain and meninges show no abnormal contrast enhancement. The left frontal ventriculostomy tract has not changed nor the chronic lacunar infarct in the corona radiata just lateral to the head of the left caudate nucleus. Ventricles remain mildly dilated, reflecting volume loss. Extensive scattered susceptibility on the previous examination is obscured by the artifact. There is no midline shift or herniation. A small CSF collection at the suboccipital craniectomy site is new likely representing a pseudomeningocele. There is mild right maxillary mucosal thickening without fluid. The imaged paranasal sinuses are clear otherwise. A left eyelid weight produces local susceptibility artifact.

Output: 1.The examination is markedly limited by artifact related to cochlear implant with complete obscuration of the resection bed. 2.Where evaluable, no significant intracranial changes are seen.


Instruction: Generate impression based on findings.

Input: Positive HLA-B27, Ankylosing spondylitis The sacroiliac joints appear normal with no erosive change, abnormal fluid signal, or abnormal enhancement following intravenous contrast. The remaining marrow signal of the pelvis and lower spine is normal.A small amount of fluid is noted within the pelvis, likely physiologic in nature given the patient's age.

Output: Normal appearance of the sacroiliac joints.


Instruction: Generate impression based on findings.

Input: Vertebral osteomyelitis at the T12, L1, L2 and L3 levels with the main focus at the L1/L2 level. Status post three months of antibiotic treatment, now with continued pain. There has been interval significant loss of height of the L2 vertebral body with retropulsion of osseous fragments and disc material into the spinal canal which now causes severe spinal canal stenosis compared to the prior MRI from 6/17/2015. However, these findings appear similar to the CT abdomen and pelvis exam from 8/29/2015 taking into account differences in modality. The spinal canal diameter at the L1/2 level measures at most 5 mm in AP dimension. Redemonstrated are additional foci compatible with osteomyelitis involving the T12 and L3 vertebral bodies. There is more extensive enhancement within the L1-2 disc and adjacent endplates and the L1 vertebral body indicating more extensive discitis and osteomyelitis. Ill-defined enhancement of soft tissues along the medial aspect of bilateral psoas muscles and prevertebral space especially area again demonstrated, especially at the level of L2 vertebral body. The previously described microabscesses are not as readily apparent on today's exam. There is no visible evidence of an epidural abscess. Again seen are cystic lesions in the kidneys bilaterally, most likely representing benign renal cysts. On the right side, external to the back muscle group fascia, there is a very subtle well circumscribed fat containing lesion within the subcutaneous tissue likely representing a lipoma. This has been characterized on the recent CT of the abdomen and pelvis.

Output: 1.Redemonstration of multilevel vertebral osteomyelitis with interval development of significant discitis at the L1/2 level, significant loss of height of the L2 vertebral body and progression of enhancement of the L1 vertebral body. 2.At the L1/2 level there is retropulsion of osseous and disc material into the spinal canal, and significant spinal canal stenosis compared to the prior MRI from 6/17/2015. These findings appear similar to the CT abdomen and pelvis exam from 8/29/2015.3.Additional foci of osteomyelitis are again demonstrated involving the T12 and L3 vertebral bodies.4.Persistent paravertebral and pre vertebral inflammation and phlegmon but without visible abscess formation.These findings were discussed with the primary physician (Dr. Stephenson Pager 5731) at the time of the findings by Dr. Veronesi of the Radiology service.


Instruction: Generate impression based on findings.

Input: 53-year-old female with lateral meniscal sign positive on exam, knee pain. Evaluate for tear. MENISCI: There is intermediate signal intensity within the body of the lateral meniscus compatible with a radial tear. The medial meniscus is intact with no significant abnormalities noted.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. The articular cartilage is intact. LIGAMENTS: The anterior and posterior cruciate ligament are normal in thickness and signal intensity. The medial and lateral collateral ligaments are also normal in thickness and signal intensity.EXTENSOR MECHANISM: Intact with no significant abnormality noted.ADDITIONAL

Output: Findings compatible with a radial tear within the body of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: Male, 7 years old. Pain, wounds. Evaluate for osteomyelitis. There is a skin defect along the lateral aspect of the right forearm with a tract extending from the skin, through the soft tissues, and to the site of a fracture in the mid-distal radial diaphysis. There is extensive edema and enhancement of the soft tissues and abnormal bone marrow signal in this region, compatible with cellulitis and osteomyelitis. No evidence of discrete fluid collection, sequestrum, or involucrum.Question of nonunion of the fracture line.A metal rod traverses the length of the ulna, markedly limiting evaluation.

Output: Osteomyelitis of the radial diaphysis associated with a tract extending from the skin to a radial fracture.


Instruction: Generate impression based on findings.

Input: Hearing loss- history of EVA. Internal Auditory Canals: The bilateral endolymphatic ducts are enlarged bilaterally, as well as the left endolymphatic sac. There is also mild dysplasia of the bilateral cochleas with deficiency of the apical turns and modioli. The bilateral semicircular canals and vestibules appear to be intact bilaterally. The bilateral cranial nerve 7 and 8 complexes are also intact. There is no evidence of mass lesions in this region.Brain: 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: 1. Findings compatible with bilateral incomplete partition type 2.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The myelination is within normal limits for age. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a 6 mm presumed pineal cyst. There is fluid within the bilateral mastoid air cells and middle ear cavities. The skull and scalp soft tissues are unremarkable. SPINE: There is transitional anatomy with either 13 thoracic type vertebrae or 6 lumbar type vertebrae (the latter counting scheme will be used for the purposes of this exam). The cerebellar tonsils have a normal configuration without herniation. There is normal biphasic CSF flow anteriorly and slightly decreased flow posteriorly at the craniocervical junction. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at the L2-L3 level. The filum is upper normal at the L3 level measuring up to 2 mm without abnormal T1 hyperintensity or thickening below this level. However, the filum tapers by the L5-L6 level. There is normal anterior translation of the conus upon prone positioning. There is no evidence of a sinus tract at the location of the skin marker. The paravertebral soft tissues are unremarkable.

Output: 1.No evidence of Chiari malformation. 2.Transitional anatomy with either 13 thoracic type vertebrae or 6 lumbar type vertebrae (the latter counting scheme is used for the purposes of this exam). If surgery is to be contemplated, please correlate with imaging of the entire spine.3.Low normal positioning of the conus (although the significance of this is indeterminate in transitional anatomy) without evidence of fibrofatty infiltration or restricted motion upon prone positioning. No definite MR evidence of tethered cord.4.No evidence of a sinus tract deep to marked sacral dimple.


Instruction: Generate impression based on findings.

Input: 15-year-old female with lower abdominal pain, hx of Crohn's disease EXAMINATION: MR enterography without and with IV contrast 3/4/1513:52 ABDOMEN:LIVER, BILIARY TRACT: Normal morphology and signal intensity. No biliary ductal dilatation.SPLEEN: No focal lesion.PANCREAS: Normal enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No focal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: There is mild distention of the distal/neoterminal ileum without evidence of obstruction. No wall thickening or abnormal enhancement. No fistula or abscess. Moderate colonic stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus and adnexa appear physiologic for age.BLADDER: Collapsed.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Mild distention of the distal/neoterminal ileum, without evidence of obstruction. No wall thickening or abnormal enhancement. No fistula or abscess. Moderate colonic stool burden.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild pelvic ascites, physiologic for the patient's age.

Output: No evidence of active inflammation or obstruction.