Instruction: Generate impression based on findings.

Input: Reason: episodes of bilateral visual loss, h/o stroke History: bilat visual loss MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.There is volume loss present in the posterior fossa with subdural effusions.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.Findings suggest a 4-mm sized right posterior communicating artery aneurysm which is directed laterally and inferiorlyFindings suggest a small infundibulum measuring 1.5 mm at the left posterior communicating artery origin.There is no evidence for cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is a little bit larger than the left A1 segment. The posterior communicating arteries are not readily identified. The vertebral arteries are asymmetric in size- left larger than right.There is extracranial origin of the left posterior inferior cerebellar artery.

Output: 1.Findings suggest a 4 millimeter aneurysm at the communicating segment of the LICA. This can be confirmed with CTA. 2.Findings suggest 1.5mm Infundibulum at the origin of the left posterior communicating artery. This can be confirmed with CTA. 3.No evidence for cerebrovascular occlusive disease.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Reason: Rt long finger A2 pully rupture? History: pain and inability to straighten finger. LIGAMENTS: The flexor pulley system is intact, particularly the A2 pulley is intact as clinically questioned.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: Mild bone marrow edema involving the base of the proximal phalanx of the middle finger.ADDITIONAL

Output: 1.Intact flexor pulley system.2.Mild nonspecific bone marrow edema involving the base of the proximal phalanx of the middle finger.


Instruction: Generate impression based on findings.

Input: Clinical question: History of meningioma status post XRT. Please evaluate/computer. Signs and symptoms: Right blurry vision. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.There is revisualization of a meningioma within the right cavernous sinus with resultant expansion of the cavernous sinus, extension into the sella, minimal extension into the right Meckel's cave, right orbital apex and right paramedian subfrontal spread along the planum sphenoidale without convincing evidence of any significant interval change since prior study from 9-20 3-14. The largest transverse diameter of meningioma in the cavernous sinus and sella measures at 31 mm which compared to prior exam demonstrate no appreciable interval change. Minute extension of tumor into the right orbital apex to the right of optic nerve also remains identical to prior study. This finding is best appreciated on axial T2 series 701 image 12 axial post enhanced series 1001 image 12. If further more precise assessment of this finding is clinically desired dedicated pre- and post enhanced MRI of orbits would be helpful.The tumor similar to prior exam minimally bulges superiorly into the basal cistern however without mass effect on the chiasm. Minute spread of tumor into the prepontine cistern along the dorsal aspect of the dorsum sella remains also similar to prior exam. Similar to prior exam there is no convincing evidence of decreased caliber of right cavernous carotid which is encased by tumor.Similar to prior exam there is a tiny developmental venous anomaly in the right rectus jugular venous and is best appreciated on axial post enhanced series 1001 images 14 and 15 and sagittal reformatted post enhanced series 1/1/2002 on images 39 through 46.Multiple tiny foci of FLAIR hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres demonstrate no significant change and highly suggestive of mild chronic small vessel ischemic strokes without change. Ventricular system remains within normal and maintained midline. Unremarkable images through the calvarium, soft tissues of the scalp, mastoid air cells, middle ear cavities and visualized paranasal sinuses.

Output: 1.No acute intracranial process and stable findings suggestive of mild chronic small vessel ischemic strokes.2.Stable size, morphology, signal intensity and homogeneous pattern of enhancement of a meningioma within the right cavernous sinus and sella turcica with minimal expansion superiorly into the basal cistern, minimally into the right orbital apex and minimally in the right Meckel's cave and right paramedian subfrontal as detailed above.3.Revisualization of a tiny right paramedian inferior frontal developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Reason: eval for meniscus tear/chondromalacia History: knee pain. MENISCI: The posterior horn and posterior body of the lateral meniscus are diminutive with a low signal intensity structure anterior to the anterior horn of the lateral meniscus suspicious for a flipped fragment of the posterior horn and body. The anterior horn is diffusely degenerated. There is fraying of the free edge and undersurface of the anterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Tear of the posterior body and horn of the lateral meniscus with a fragment flipped anterior to the anterior horn of the lateral meniscus. 2.Fraying of the free edge and undersurface of the anterior horn of the medial meniscus.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease admitted with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No intra or extrahepatic biliary ductal dilatation. No focal suspicious lesion.The gallbladder is normally distended with a large gallstone at the gallbladder body/neck junction. No gallbladder wall thickening or pericholecystic fluid. No choledocholithiasis, discrete stricture or mass lesion. SPLEEN: The spleen is normal in size and morphology without a focal lesion.PANCREAS: The pancreas is normal in morphology and size without a focal lesion. Normal main pancreatic duct caliber draining into the major papilla. 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: Mild scoliosis. Partially imaged pelvis demonstrates endometrial thickening within physiologic limits. Small volume of free pelvic fluid is within physiologic limits. Sacral Tarlov cysts are noted.

Output: Gallstone at gallbladder body/neck junction of a normally distended gallbladder without specific findings of acute cholecystitis or biliary ductal dilatation. No choledocholithiasis, discrete stricture or lesion is evident. The findings seen on the patient's HIDA scan may reflect ampullary stenosis.


Instruction: Generate impression based on findings.

Input: 31-year-old male with lateral meniscus repair 9 months ago now with new injury MENISCI: Mild globular intermediate signal within the medial meniscus may represent intrasubstance degeneration without discrete tear. Globular intermediate signal within an enlarged lateral meniscus is compatible with intrasubstance degeneration and degenerative fraying. Complex fragmentation of the posterior horn with vertical and horizontal components. Blunting of the anterior horn of the lateral meniscus is compatible with a radial tear.ARTICULAR CARTILAGE AND BONE: Edema type signal is noted within the lateral femoral condyle. The articular cartilage is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Blunting of the anterior horn of the lateral meniscus compatible with a radial tear. Complex fragmentation of the posterior horn with vertical and horizontal components. 2.Edema within the lateral femoral condyle.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: 60-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 4.7 x 3.1 x 3.5 cmPeripheral Zone: No significant abnormality.Central Gland: There is a lesion in the right transition zone extending into the anterior prostate measuring 1.1 x 0.9 cm which is hypointense on ADC, hyperintense on DWI, has ill-defined T2 signal and exhibits early enhancement, suspicious for prostate cancer.Seminal Vesicles: No significant abnormality.Extracapsular Extension: None identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the right transition zone extending into the anterior prostate is suspicious for prostate cancer.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: vertigo, vomiting and truncal ataxia No evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal scattered bihemispheric high signal intensity lesions on FLAIR indicate age indeterminate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of right cerebellar pontine angle meningioma status post cyber knife and resection. Limited exam secondary to lack of IV contrast.Postsurgical changes from a right sided suboccipital craniotomy and CP angle tumor resection are seen. There is significantly reduced T2/flair hyperintensity in the right cerebellum, right middle cerebral peduncle, and right aspect of the pons. Additionally, there is reduced effacement of the fourth ventricle. There is slightly increased right cerebellar encephalomalacia with associated increased extra-axial fluid adjacent to the right cerebellar hemisphere, likely postsurgical. Small area of susceptibility within the surgical bed likely represent chronic blood product. There are scattered punctate foci of T2/flair hyperintensity in the periventricular and subcortical white matter. No acute ischemia is seen. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.

Output: 1.Limited exam secondary to lack of IV contrast which decreases sensitivity for the detection of recurrence.2.Postsurgical changes of right CP angle meningioma resection with evidence of decreased local edema.3.No definitive evidence of bulky tumor recurrence without the benefit of IV contrast. If warranted, the patient may return to obtain just the post contrast imaging to complete her evaluation.4.Nonspecific T2/flair hyperintensity in the periventricular and subcortical white matter is likely secondary to chronic ischemic small vessel disease.


Instruction: Generate impression based on findings.

Input: 37-year-old female with newly diagnosed right breast IDC with metastatic right axillary lymph node. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT:There is an irregularly shaped enhancing mass at 8:00 position in the right breast measuring 36 x 27 x 24 mm (AP x LR x CC), consistent with biopsy-proven carcinoma. The tumor demonstrates high signal on T2-weighted images. A marker clip is identified at superior-anterior aspect of this mass.There is a linear branching, clumped non-mass enhancing lesion, measuring 41 x 27 x 20 mm at right retroareolar region.In the right axilla, a proven metastatic lymph node is visualized, measuring 25 x 25 x 22 mm. No other abnormal lymph nodes are present in the right axilla.LEFT:No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in left axillary region.A port is present in the superior-medial chest wall.

Output: 1. Biopsy proven right breast cancer with metastatic right axillary lymph node.2. Linear branching, clumped non-mass enhancing lesion in the right retroareolar region. MR-directed ultrasound is recommended. If no sonographic correlation is detected, MR guided biopsy should be considered.3. No MR evidence for malignancy in the left breast or left axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: see below History: Rt hand pain eval for etiology Multiple sequences are severely limited secondary to patient motion artifact. Evaluation of the intrinsic ligaments and triangular fibrocartilage complex of the wrist is limited due to lack of intra-articular contrast as well as extensive patient motion artifact.TENDONS: The flexor and extensor tendons appear intact BONES: There is subchondral cyst formation within the lunate and capitate. Note is made of negative ulnar variance. There is increased signal abnormality and fluid sensitive sequences within the lunate bone.ADDITIONAL

Output: 1. Limited examination secondary to extensive patient motion artifact. Negative ulnar variance with increased signal abnormality within the lunate which may reflect early Kienböck's disease/avascular necrosis.2. Nonspecific edema within the pronator quadratus muscle belly. Although there is no corresponding edema within the flexor digitorum profundus and flexor pollicis longus muscle bellies, the possibility of anterior interosseous nerve syndrome could be considered in the correct clinical setting.


Instruction: Generate impression based on findings.

Input: 75 year old female with metastatic breast cancer and pancreatitis status post ERCP on 10/27 with stent placement now with abdominal pain, nausea/vomiting, increasing lipase. Please evaluate for pancreatitis. ABDOMEN:LUNG BASES: Increase in bilateral pleural effusions since prior MRI, right greater than left with adjacent atelectasis/consolidation.LIVER, BILIARY TRACT: Air seen throughout the biliary tract consistent with recent biliary stent placement. Biliary stent appears patent. The portal vein is not well visualized. The SMV at the level of the confluence, confluence and the entire splenic vein are not visualized. The SMV proximal to the confluence appears patent. The gallbladder at the level of the gallbladder neck demonstrates a diffuse low attenuation lesion which enhances on arterial phase is suspicious for metastatic lesion measuring 1 cm x 1 cm best seen on image 4477, series 8.Re-identification of multiple scattered hypodense lesions throughout the liver the largest of which previously measured 1.4 x 1 cm best seen on image 64/97, series 4 now measures 1.1 cm best seen on image 16/138, series 10.SPLEEN: Splenic vein is not visualized however spleen appears unremarkable.PANCREAS: Diffuse pancreas enlargement with some posterior peripancreatic stranding out of proportion to ascites consistent with pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left-sided hydronephrosis and hydroureter with narrowing and loss of visualization of the distal ureter with resultant obstruction, best seen on image 70/138, series 10.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Re-identification of new multiple, sclerotic lesions due to metastatic disease.OTHER: Moderate intra-abdominal ascites.PELVIS:UTERUS, ADNEXAE: Calcified fibroid uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: As described above.OTHER: No significant abnormality noted

Output: 1. Worsening of bilateral pleural effusions.2. Poor visualization of the portal vein, confluence, splenic vein and distal SMV consistent with thrombosis.3. New left-sided hydronephrosis and hydroureter with lack of visualization of the distal ureter consistent with obstruction.4. Apparent worsening of intra-abdominal ascites.


Instruction: Generate impression based on findings.

Input: 44-year-old female with invasive ductal carcinoma in the lower inner left breast 2:00 location and metastatic disease in the left axillary lymph node presents for preop staging. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is no abnormal enhancement in the right breast.LEFT BREAST:There is high T2 and susceptibility artifact from the biopsy clip is identified in an enhancing mass in the left breast, 2:00 position, far posterior depth, which corresponds to the biopsy proven invasive ductal carcinoma in the left breast. This mass measures 2.5 x 2.6 x 3.1 cm (AP x LR x SI). This mass directly abuts the superficial skin with skin enhancement, which may represent skin involvement of the cancer and/or postbiopsy change in the skin. There is no involvement of the pectoralis muscle.No abnormal enhancement is seen elsewhere in the left breast. Axillae:The biopsied left axillary lymph node with Hydromark clip measures 1.5 cm. In addition, multiple abnormal appearing lymph nodes are identified in the left axilla and left subpectoral region. For example, one of the subpectoral lymph nodes measures 2.1 cm.No abnormal lymph nodes are identified in the right axillary region.

Output: 1. Unifocal 3.1 cm biopsied malignancy in the far posterior left breast 2:00 position. Enhancement of the overlying skin is highly suggestive of skin involvement of cancer and/or postbiopsy change of the skin.2. Multiple abnormal-appearing lymph nodes in the left axilla including the subpectoral region compatible with metastatic disease.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: seizure History: complex partial seizure. No evidence of acute ischemic or hemorrhagic lesion on the scan. There is no evidence of abnormal enhancement either.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.There is a however, well circumscribed lobulated right high convexity scalp lesion [13.3mm (RL) x 21mm(AP) x 12.1mm (CC)] which shows low on T1, mixed high on T2 without showing evidence of enhancement. The lesion also shows evidence of restricted diffusion especially center portion. Constellation of these findings suggest benign subcutaneous lesion such as sebaceous cyst.

Output: Normal brain MRI.Sebaceous cyst on the right high convexity.


Instruction: Generate impression based on findings.

Input: History of relapsed follicular lymphoma with bone lesions in the left humerus. Within the mid diaphyseal region of the left humerus is a somewhat ill-defined lesion that is dark on T1 and bright on T2 images with probable mild endosteal scalloping. This lesion enhances on postcontrast imaging. There is no adjacent soft tissue involvement.

Output: Intraosseous lesion in the left mid-humeral diaphysis most consistent with the patient's history of lymphoma.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE:Degenerative disc disease is noted within the cervical spine with disc dessication and mild loss of disc height. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. C1/2: Normal atlantodental interval.C2/3-C4/5: No significant spinal canal stenosis or neuroforaminal narrowing. C5/6: There is a left C5 laminectomy defect present. There is also mild left uncovertebral hypertrophy but no significant spinal canal stenosis or neural foraminal narrowing. C6/7: Mild facet hypertrophy and ligamentum flavum thickening is present without significant spinal canal stenosis or neuroforaminal narrowing.C7/T1: No significant spinal canal stenosis or neural foraminal narrowing.THORACIC SPINE:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. No significant disc bulge or cord encroachment from the T1/2-T9/10 levels. At T10/11 and T11/12 there is mild facet hypertrophy and ligamentum flavum thickening without significant central canal stenosis or neuroforaminal narrowing. There is no abnormal enhancement. The visualized intrathoracic and paraspinal soft tissues are unremarkable.

Output: 1.Degenerative and post-surgical changes of the cervical spine as described above without significant spinal canal stenosis or neural foraminal narrowing.2.No cervical spine of thoracic spine compression fracture is identified.


Instruction: Generate impression based on findings.

Input: Reason: R shoulder pain and popping after injury. Assess for rotator cuff pathology. ROTATOR CUFF: There is a full-thickness tear of the posterior aspect of the supraspinatus tendon which also involves the anterior aspect of the infraspinatus tendon, and extends over AP diameter of at least 12 mm. There is retraction of the proximal muscle belly of the supraspinatus to the level of the glenohumeral joint. There is a small amount of fluid in the subacromial/subdeltoid bursa, compatible with a full-thickness tear. This is superimposed on severe tendinopathy of the supraspinatus and infraspinatus tendons. There is mild fatty infiltration muscle atrophy of the supraspinatus and infraspinatus muscles. There is mild tendinosis of the subscapularis tendon. The teres minor is intact. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is diffuse grade 3 chondral thinning at the glenohumeral joint with reactive marrow changes in the humeral head.Within the limitations of a non-arthrographic study there appears near circumferential, degenerative tearing of the glenoid labrum.BICEPS TENDON: The extracapsular portion of the biceps is intact however, it is not well visualized within the joint, which may represent severe tendinopathy or chronic partial tearing.ADDITIONAL

Output: 1.Full-thickness tear of the posterior supraspinatus/anterior infraspinatus tendons with associated retraction, tendinopathy, and mild muscular atrophy.2.Moderate degenerative arthritic changes at the glenohumeral joint with moderate chondral loss and near circumferential degenerative tearing of the glenoid labrum.3.The intra-articular portion of the long head of the biceps tendon is not well-visualized which may reflect severe tendinopathy or chronic partial tearing.


Instruction: Generate impression based on findings.

Input: New onset slurred speech, now resolved, but residual left-sided weakness. There is a punctate focus of mildly restricted diffusion in the posterior limb of the right internal capsule. There is encephalomalacia with hemosiderin staining in the right basal ganglia and corona radiata. There is prominent underlying diffuse low susceptibility signal in the basal ganglia bilaterally, which may represent mineralization. There are a few scattered punctate foci of susceptibility effect in the cerebral hemisphere, which may represent chronic microhemorrhages. There is no evidence of acute intracranial hemorrhage. There is moderate predominantly periventricular white matter T2 hyperintensity without restricted diffusion. The ventricles are unchanged 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. Recent punctate infarction involving the posterior limb of the right internal capsule.2. Evolution of the hemorrhagic infarction involving the right basal ganglia and corona radiata, which is now in the chronic phase.3. Moderate probable chronic small vessel ischemic white matter disease.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for structural lesions History: paresthesias 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.There is a punctate signal hypointensity on susceptibility imaging along the posterior aspect of the putamen of the right basal ganglia.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 right vertebral artery appears to be hypoplastic distally.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for intracranial mass lesion or demyelination to explain the patient's paresthesias.2.A microhemorrhage along the right basal ganglia is of uncertain clinical significance in isolation. It is conceivable that this could be the source of paresthesia. Please correlate with clinical exam.


Instruction: Generate impression based on findings.

Input: Four month-old female presents with infantile spasms. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There may mild thinning of the posterior corpus callosum, measuring 2 mm in thickness, but otherwise the degree of myelination appears to be appropriate. The brain parenchyma and pituitary gland appear unremarkable. There are prominent subarachnoid spaces in the bilateral anterior cerebral convexities.. The ventricles and basal cisterns are normal in size and configuration. However, there is a persistent cavum septum pellucidum. 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. No evidence of hypoxic ischemic encephalopathy. 2. Prominent subarachnoid spaces in the bilateral anterior cerebral convexities.3. Perhaps mild thinning of the posterior corpus callosum, but otherwise the degree of myelination appears to be appropriate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal adenoid cystic carcinoma status post radiation therapy. There is no significant interval change in size of the enhancing perineural tumor in the left parapharyngeal space along the V3 segment of the left trigeminal nerve into the left cavernous sinus, measuring up to 6 mm in thickness. The left foramen rotundum and pterygopalatine fossa appear unchanged. There is an unchanged defect in the left greater with of the sphenoid with associated enhancement in this area. There is diffuse atrophy and T2 hyperintensity of the left optic nerve. The right orbital contents are unremarkable. There is persistent left otomastoid fluid and mucosal enhancement. There is a gradually enlarging tubular T2 hyperintense lesion in the right retromaxillary fat pad, with what may represent associated enhancement. There is mild mucosal thickening within the atelectatic left maxillary sinus.

Output: 1. No significant interval change in the appearance of the treated perineural tumor related to nasopharyngeal adenoid cystic carcinoma involving the left trigeminal nerve.2. Unchanged nonspecific defect in the left greater with of the sphenoid with enhancement, which may be vascular rather than neoplastic in nature.3. Diffuse left optic nerve atrophy.4. Findings suggestive of left Eustachian tube dysfunction.5. A gradually enlarging tubular T2 hyperintense lesion in the right retromaxillary fat pad, with what may represent associated enhancement, may represent a peripheral nerve sheath tumor, for example.


Instruction: Generate impression based on findings.

Input: 54-year-old male with right shoulder pain not improving despite injection. ROTATOR CUFF: There is fluid signal abnormality along the posterior aspect of the humeral head which may reflect a ganglion within the infraspinatus muscle or less likely a small interstitial tear. The supraspinatus and infraspinatus muscles and tendons otherwise appear intact. There is thickening and intermediate signal abnormality within the supraspinatus tendon consistent with mild tendinosis. There is mild fatty atrophy of the infraspinatus along the myotendinous junction. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid within the subacromial subdeltoid bursa. There is extensive increased bone marrow signal abnormality about the acromioclavicular joint and subcutaneous edema. There is subchondral cyst and osteophyte formation about the distal clavicle.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate degenerative changes affect the glenohumeral joint. There is heterogeneity and increased signal abnormality within the superior labrum suggestive of degenerative tearing.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Extensive bone marrow edema and subcutaneous inflammatory change about the AC joint, which may be degenerative in etiology. Further evaluation with dedicated radiographs is recommended.2. Rotator cuff tendinosis without evidence of a full-thickness rotator cuff tear. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: H/o left shoulder lymphoma please restage History: prior mass and pain There is abnormal heterogeneous signal intensity within the glenoid and neck of the scapula compatible with the patient's known history of lymphoma with pathologic fracture. The fragmentation seen on the prior MRI study is not as evident indicating some interval healing. Signal abnormality extends along the lateral aspect of the body of the scapula also compatible with treated lymphoma. There is a focus of increased signal intensity again seen along the lateral body of the scapula, the enhancement of which appears less than on the prior study perhaps due to interval treatment. There is minimal edema along the body of the scapula which also appears decreased when compared to the prior study. There is edema within the infraspinatus and teres minor muscles which has also decreased when compared to the prior study. The small foci of enhancement seen within the muscle belly of the subscapularis on the prior study are no longer evident. There is residual posttraumatic deformity of the glenoid. There is slight posterior translation of the humeral head with respect to the glenoid. There is loss of cartilage along the surface of the glenoid as well as a small glenohumeral joint effusion and synovitis of the glenohumeral joint that is comparable to that seen on the prior study. . Mild osteoarthritis affects the acromioclavicular joint. Although this study was not optimally protocoled for detailed evaluation of the rotator cuff, we see no rotator cuff tear. There is a small amount of fluid and enhancement within the tendon sheath of long head of the biceps indicating a tenosynovitis. The reference enlarged axillary lymph node now measures approximately 2.7 x 1.5 x 2.5 cm which is decreased slightly when compared to the prior study.

Output: 1. Findings indicating treatment of scapular lymphoma with an overall favorable response and continued healing of a pathologic fracture.2. Synovitis of the glenohumeral joint appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a primarily T2 hyperintense mass lesion in the parietal lobe containing some central T2 hypointense components. On recent comparison brain MRI this demonstrated ring enhancement with adjacent vasogenic edema. There is no significant associated mass effect. The ventricles are unchanged in size or shape. Expected vascular flow voids are demonstrated. Mucosal thickening is again noted within the right maxillary sinus and a single anterior left ethmoid air cell. The remaining paranasal sinuses and the mastoid air cells are clear.Incidental note is made of a 5 mm transverse x 5 mm AP x 7 mm craniocaudal focus within the posterior sella which is T1 hypointense and T2 hyperintense. This is unchanged when compared to the 2 prior comparison studies. Although not mentioned previously, it is felt to represent a benign entity such as a pars media or Rathke's cleft cyst.

Output: 1.Redemonstrated is a primarily T2 hyperintense mass lesion in the parietal lobe containing some central T2 hypointense components2.Incidental note is made of a 5 mm transverse x 5 mm AP x 7 mm craniocaudal focus within the posterior sella which is T1 hypointense and T2 hyperintense. This is unchanged when compared to the 2 prior comparison studies. Although not mentioned previously, it is felt to represent a benign entity such as a pars media or Rathke's cleft cyst.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for growth of AA status post RT/TMZ+ TMZ. Now off all treatments. Signs and symptoms: Right frontal anaplastic astrocytoma. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates a focus of FLAIR hyperintensity with underlying parenchymal volume loss and minimal chronic hemorrhage in the right frontal lobe and extending from cortex to the right lateral ventricle. Finding consistent with postsurgical and treatment changes of a anaplastic astrocytoma which remains nearly identical to prior exam.There is no detectable abnormal enhancement at the site which is also a similar observation as prior study.Unremarkable signal intensity of brain parenchyma otherwise on all MRI sequences and without detectable abnormal enhancement of brain parenchyma or the leptomeninges.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Unremarkable calvarium other than expected postoperative changes of right frontal craniotomy.Unremarkable images through the orbits including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Stable post surgical/treatment changes of right frontal lobe astrocytoma.2.Unremarkable pre and post enhanced brain MRI otherwise and stable since prior study.


Instruction: Generate impression based on findings.

Input: 67 year old with personal history of prior left lumpectomy, radiation therapy and chemotherapy in 2002. Family history of breast cancer in her sister and maternal aunt. BRCA2 positive. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Post surgical volume loss and scarring is noted in the left breast.No abnormal enhancement is seen in either breast. Intramammary lymph node in the left posterior 3:00 position is unchanged. No abnormal lymph nodes are identified in either axillary region.Trace pleural effusions. Probable hepatic cysts again noted.

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


Instruction: Generate impression based on findings.

Input: 46 year old man with history of non-ischemic cardiomyopathy with worsening LV function on serial echocardiograms. He was referred for cardiac MRI to evaluate cardiac function. Left VentricleThe left ventricle is normal in size with mild to moderate reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 214 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 129 ml (normal range 47+/-19). There is mild concentric hypertrophy. There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 38%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 216 ml (normal range 142+/-31), the RV end systolic volume index is 62 ml/m2 (normal range 31+/-9), and the RVESV is 135 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is trace 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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild to moderately reduced LV systolic function (EF 40%) with normal LV size. When compared to the previous MRI of 5/13/2014, LV function appears slightly worse.2. No evidence of late gadolinium enhancement to suggest a myocardial infiltrative, inflammatory or fibrosis process. 3. Normal sized RV with moderately reduced function ( EF 38%). RV function has worsened since the previous MRI of 5/13/2014. 4. Mild LA dilation and moderate RA dilation. 5. Mild tricuspid regurgitation.  I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Gait abnormality The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord. The vertebral bodies are appropriate in overall height. There is straightening with loss of normal thoracic kyphosis and lumbar lordosis. There are degenerative changes in the cervical spine from C3-C4 to C6-C7 with mild to moderate spinal canal stenosis related to small disc osteophyte complexes and ligamentum flavum thickening. There are also multilevel degenerative changes in the lumbar spine including disc extrusion at the L4-L5 level which appears to cause high-grade spinal canal stenosis and cauda equina nerve root compression.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. There is however large disc extrusion at the L4-L5 level which appears to cause high-grade spinal canal stenosis and mass effect on the cauda equina nerve roots.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: metastatic NSCLC with brain mets s/p SRS; assess for stability History: stability Redemonstration of enhancing nodules at bilateral cerebellar hemispheres, right posterior aspect of the pons and left occipital lobe, unchanged in terms of size since prior scan.Previously described right inferior parietal lobule and left inferior parietal lobule lesions are not as conspicuous as prior.There is no new abnormal enhancing lesion.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal enhancing lesions involving bilateral cerebellar hemispheres, pons and right occipital lobe as described above, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Previously reported bilateral inferior parietal lobule enhancing nodules are not as conspicuous as prior.4. No evidence of new abnormal enhancing lesion.


Instruction: Generate impression based on findings.

Input: 14-year-old male with a history of left ureteral reimplantation presents with left flank pain, evaluate for renal stones or obstruction. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Present.  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 9.5 cm Left: 10 cm   Mean for age: 10 cm  Range for age: 8.5 - 11.1 cmADDITIONAL OBSERVATIONS: None.

Output: Normal sonographic evaluation of the kidneys. Specifically, no evidence of nephrolithiasis or hydronephrosis.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on findings.

Input: Clinical question: Compared to x-ray of the lumbar spine. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:At T12-L1 there is a T2 hypointense left lateral epidural defect (sagittal T2 image 7 and axial T2 series 601 images 38 through 40) finding extends into the left neural foraminal at T12-L1 level and is suspected of an extruded disc fragment. There is resultant moderate left neural foraminal compromise and no central spinal stenosis.L1-L2 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise.L2-L3 demonstrates advanced disc disease with loss of disc height, grade 1 retrolisthesis, mild bilateral facet (right greater than left) and ligamentum flavum hypertrophy with resultant moderate right neural foraminal compromise and moderate central spinal stenosis.L3-L4 demonstrate advanced disc disease and loss of disc height, moderate bilateral (right greater than left) facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is resultant moderate central spinal stenosis with moderate to severe right neural foraminal compromise and mild left.L4-L5 demonstrate mild disc disease and minimal loss of disc height, significant bilateral facet hypertrophic changes (right greater than left) and moderate bilateral ligamentum flavum hypertrophy. No central spinal stenosis however bilateral moderate neural foraminal compromise is present.L5-S1 demonstrate moderate disc disease and loss of disc height however the extensive (left greater than right) facet hypertrophic changes and to a lesser degree of the ligamentum flavum. No central spinal stenosis however severe bilateral neural foraminal compromise is present.No detectable signal abnormality of cauda equina or the conus, lower thoracic cord.Small bilateral renal cysts are identified.

Output: 1.Extensive degenerative changes of lumbar spine in particular hypertrophic changes of posterior elements are present.2.There is moderate central spinal stenosis at L2-L3 and L3-L4 levels.3.There is an extruded disc fragment posterior to the vertebral body of T12 and extending into the left T12-L1 neural foramina with resultant moderate compromise and no central spinal stenosis.4.Multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above.


Instruction: Generate impression based on findings.

Input: 11 years Female (DOB:11/7/2004)Reason: Please evaluate for tumor or dysplasia - seizure focus History: Complex partial epilepsy with staring and eye fluttering, seizure focus R frontal on EEGPROVIDER/ATTENDING NAME: CHALONGCHAI PHITSANUWONG YULIYA YANOVSKAYA The CSF spaces are appropriate for the patient's stated age with no midline shift. The hippocampi appear symmetric bilaterally. No abnormal signals appreciated within the hippocampi. No abnormal enhancing lesion is appreciated hippocampi.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a T2 hyperintense well circumscribed mass present in the left parotid gland measuring 31 x 24 mm coronal dimensions. There are additional nodules scattered in the left and right upper neck measuring up to 16 mm short axis diameter.

Output: 1.There are multiple lesions present in the upper neck in particular in the left parotid space but also along the jugular chains. There is concern for lymphadenopathy and possibly a mass in the left parotid gland. This is incompletely imaged on this exam which is tailored for the brain and not the neck. If clinically appropriate evaluation of the patient's neck may be of benefit.


Instruction: Generate impression based on findings.

Input: Left frontal meningioma resection in 1981. Reresection in 1994. Left falcine meningioma RT in 2009. There are postoperative findings related to left frontal meningioma resection with encephalomalacia in the underlying brain parenchyma and a small amount of enhancing tissue overlying the left middle frontal gyrus, which measures up to 5 mm in width. There is a falcine meningioma that measures up to 32 mm, previously 24 mm, with associated vasogenic edema in the adjacent portions of the bilateral frontal lobes. There is also an unchanged left lateral temporal convexity meningioma that measures up to 7 mm in width. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is unchanged enhancement within a presumed the left temporal craniotomy gap and within the left frontal craniotomy flap.

Output: 1. Postoperative findings related to left frontal meningioma resection with encephalomalacia in the underlying brain parenchyma and a small amount of enhancing tissue overlying the left middle frontal gyrus, which measures up to 5 mm in width and may represent residual meningioma. 2. Interval increase in size of the falcine meningioma that measures up to 32 mm and associated vasogenic edema in the adjacent portions of the bilateral frontal lobes.3. Unchanged left lateral temporal convexity meningioma that measures up to 7 mm in width. 4. Unchanged nonspecific enhancement within a presumed the left temporal craniotomy gap and within the left frontal craniotomy flap.


Instruction: Generate impression based on findings.

Input: Infection Note that the examination is significantly limited given the presence of metallic susceptibility artifact, and the lack of contrast, and extensive patient motion.The components of a total knee arthroplasty are noted. There is a extensive marrow abnormality within the distal femur, proximal tibia, proximal fibula and anterior surface of the patella. Extensive metallic susceptibility artifact overlies the soft tissues from prior surgical intervention. There is a small suprapatellar effusion. There is diffuse soft tissue edema and muscle atrophy.

Output: 1. Significantly limited examination secondary to orthopedic hardware, extensive patient motion, and a lack of complete sequences.2. Diffusely abnormal marrow signal which may relate to known leukemia or be post-treatment in nature.3. Small joint effusion and diffuse soft tissue edema.


Instruction: Generate impression based on findings.

Input: Reason: cognitive impairment - h/o breast CA History: cognitive decline, behavioral changes The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There also punctate lesions present in the brainstem which are high signal on T2 and flair MRI.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eyeball lens is thin.

Output: 1.Periventricular and subcortical white matter changes of a moderate degree and a small lesion in the brainstem are nonspecific. At this age they are most likely vascular related. 2.No abnormal enhancing lesions are identified intracranially to suggest brain metastases


Instruction: Generate impression based on findings.

Input: 57-year-old male, evaluate right total rotator cuff ROTATOR CUFF: There is a full-thickness tear of the distal supraspinatus tendon with approximately 1 cm retraction. Extensive increased T2 signal in the distal supraspinous infraspinous tendons indicate associated tendinosis. The teres minor and subscapularis are intact. There is no significant muscular atrophy.SUPRASPINATUS OUTLET: Moderate acromioclavicular joint osteoarthritis. Fluid extends within the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is globular increased signal within the superior labrum, likely representing degeneration.BICEPS TENDON: The long head of biceps tendon is normally situated within the bicipital groove.ADDITIONAL

Output: 1. Full thickness rotator cuff tear with retraction as described above.2. Acromioclavicular and glenohumeral degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Lumbar spine CT for planning pedicle screw fusion at L4-L5. There is grade 1 anterolisthesis of L4. Vertebral body heights are maintained. Multilevel anterior osteophytes are consistent with osteoarthritis. The caliber of the lumbar spinal canal appears small.At L1/L2, L2/L3, and L3/L4, there is mild diffuse disk bulge and disk space narrowing without significant compromise to the spinal canal or neural foramina. Schmorl's nodes are again identified at the superior endplate of L2 and inferior endplate of L3.At L4/L5 there is grade 1 anterolisthesis of L4. In addition, there is a diffuse disk bulge, subchondral sclerosis, bilateral facet and ligamentum flavum hypertrophy causing moderate to marked central spinal stenosis and bilateral encroachment of the lateral recesses, right greater than left. Neural foraminal narrowing is identified on the right. Synovial cyst identified at this level on the prior MRI is not identified on today's CT.At L5/S1, there is diffuse disk bulge and loss of disk space height without compromise to the central spinal canal or neural foramina.

Output: Degenerative changes most prominent at L4-L5 consisting of a diffuse disk bulge, hypertrophic facet and ligamentum flavum changes, and mild anterolisthesis causing central spinal stenosis, encroachment of bilateral lateral recesses, right greater than left, and neural foramina narrowing on the right. The patient had a synovial cyst demonstrated on the prior exam at L4-5. This exam is not sensitive to detecting synovial cyst.


Instruction: Generate impression based on findings.

Input: 59-year-old male with history of right renal mass. ABDOMEN:LIVER, BILIARY TRACT: Multiple enhancing liver lesions likely representing metastatic disease. For reference, a segment 7 lesion measures 1.7 x 1.1 cm (image 7 of series 10).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left inferior pole solid lesion with peripheral enhancement and central necrosis measures 9.3 x 9.1 cm (image 66 of series 10). This lesion is compatible with RCC. There is a persistent, nonenhancing filling defect extending from the right renal vein into the infrahepatic IVC approaching the intrahepatic segment.The left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There are multiple nodules located within the right lower lobe likely representing metastatic disease.

Output: 1. Large left inferior pole renal mass compatible with RCC. Persistent filling defect extending from the right renal vein to the infrahepatic IVC compatible with bland thrombus.2. Multiple enhancing hepatic lesions, nonspecific, but likely compatible with metastatic disease.3. Partially imaged pulmonary nodules compatible with metastatic disease. CT chest recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: End-stage renal disease on hemodialysis with left toe stump infection. Evaluate for osteomyelitis. TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Patient is status post amputation of the first toe through the base of the proximal phalanx. There is no bone marrow edema to suggest osteomyelitis. ADDITIONAL

Output: Lobulated collection about the distal first metatarsal stump, may represent an abscess. No bone marrow abnormality to suggest osteomyelitis.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils are in appropriate position, without ectopia, demonstrating a normal rounded morphology. Sagittal CSF flow demonstrates biphasic flow anteriorly and posteriorly at the level of the foramen magnum and cerebellar tonsils.Brain MRI:The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Complete spine MRI:Alignment is anatomic. There are no fractures or subluxations. There are no osseous dysplasias. The marrow signal is benign. The cord and conus are normal in signal characteristics and caliber throughout. The conus terminates at L1/2. The visualized intra-abdominal and paraspinal contents are unremarkable. No fat signal abnormality is noted within the filum terminale.

Output: 1.The cerebellar tonsils are in appropriate position, without ectopia, demonstrating a normal rounded morphology.2.Negative noncontrast MRI of the brain and complete spine.


Instruction: Generate impression based on findings.

Input: Male, 79 years old, with left lower back pain. Evaluate for lumbar spine/sacroiliac disease. A moderate compression deformity of the T12 vertebral body with evidence of prior kyphoplasty is redemonstrated without significant interval change. The remaining vertebral bodies demonstrate preservation of height. Straightening of the cervical lordosis is seen. Endplate degenerative marrow signal is seen at L4-5, worse than on the prior examination, and to a lesser degree at L3-4, improved from prior.The visualized distal spinal cord, conus and cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: Loss of disc T2 signal but relative preservation of disc height. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy and ligamentum flavum thickening. Loss of disc T2 signal but relative preservation of disc height. Mild predominantly lateral disc bulging. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. Findings have slightly progressed from prior. L3-4: Facet arthropathy and ligamentum flavum thickening. Mild loss of disc height and disc bulging. A previously seen left paracentral/foraminal protrusion is less conspicuous, but bilateral lateral bulging results in effacement of both lateral recesses and moderately severe narrowing of the neural foramina. These findings have progressed from prior. There is also a moderate generalized spinal canal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate to severe spinal canal narrowing with crowding of the cauda equina. Severe left foraminal narrowing with likely nerve impingement. Moderate to severe right foraminal narrowing. Findings have progressed from prior. L5-S1: Facet arthropathy and ligamentum flavum thickening. Bulging disc with a right paracentral protrusion. No significant generalized spinal canal stenosis. Severe right and moderate to severe left foraminal narrowing. Findings have progressed from prior. Sclerosis and osteophyte formation at the sacroiliac joints is partially visualized on this examination.

Output: Disc and posterior element degeneration has progressed at multiple levels. At L3-4, this results in moderate generalized spinal canal stenosis and moderate left foraminal narrowing. At L4-5, this results in a moderate to severe spinal canal stenosis, severe left and moderate to severe right foraminal narrowing.


Instruction: Generate impression based on findings.

Input: 47-year-old male with right knee pain. Evaluate for meniscal tear. MENISCI: There is globular increased signal intensity within the anterior horn of the lateral meniscus that appears to extend to the tibial articular surface suggestive of a degenerative undersurface tear. There is edema type signal abnormality within the soft tissues anterior to the lateral meniscus which may represent extension of mucoid material from the anterior horn. There is globular signal intensity within the posterior horn of the medial meniscus which likely represents mucoid degeneration, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There appears to be diffuse articular cartilage loss along the medial facet of the patella. The articular cartilage otherwise appears normal for age. The bone marrow signal intensity is within normal limits. There is a broad-based bony excrescence extending from the medial aspect of the proximal fibula which may represent a 'tug lesion' at the soleus muscle origin, of doubtful significance. LIGAMENTS: There is mild increased signal intensity within the proximal fibers of the lateral collateral ligament proper which may reflect degeneration. There is also mild intermediate signal intensity between the IT band and lateral femoral condyle which may reflect mild inflammation. The cruciate ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings suggestive of a degenerative tear of the anterior horn of the lateral meniscus.2. Edema and fluid tracking along the medial aspect of the gastrocnemius may represent a ruptured Baker's cyst.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 56 year old female with history of myocardial bridging, pericardial cyst and aortic regurgitation presenting for evaluation of chest painMEDICATIONS: aspirin First Pass PerfusionDuring hyperemia, no perfusion defects were present. There is dark rim artifact seen. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 147 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 22 g/m2, and the LV mass is 42 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVEDV is 160 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size and function. Aortic ValveThe aortic valve opens widely and there is at least mild regurgitation. The regurgitant fraction is 13%. 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.AortaThe aortic root is normal in size (SoV 32 mm, ascending aorta 24mm). There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are drains normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 55%).4. Normal RV size and systolic function (RVEF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 86-year-old female with altered mental status and history of transient ischemic attack x 2. Rule out ischemia. There is no evidence of intracranial hemorrhage, mass or edema. Small lacunae in the right basal ganglia. Few diffuse hypodensities consistent with minimal small vessel disease, age indeterminate, essentially within normal limits for the patient's age. If there is clinical concern for acute ischemia an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: Lateral knee pain. Evaluate meniscus. MENISCI: There is a radial tear of the body of the lateral meniscus with a horizontal component. There is an adjacent increased T2 signal collection compatible with parameniscal cyst formation. The medial meniscus is intact. ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage within all three compartments is intact.LIGAMENTS: The cruciate ligaments, collateral ligaments, and popliteus muscle/tendon are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tear of the body of the lateral meniscus with radial and horizontal components.


Instruction: Generate impression based on findings.

Input: 50 years Male (DOB:8/19/1966)Reason: lumbar DDD History: back painPROVIDER/ATTENDING NAME: TARIQ MUSLIM MALIK SERVICES ANCILLARY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is accumulation of epidural fat within the lower lumbar spine especially below the L3 level associated with crowding of nerve roots in the sacral spinal canal and to a lesser degree elsewhere.At L5-S1 there is disc desiccation and diffuse disc bulge associated with marked bilateral facet hypertrophy and encroachment of the nerve roots of the left neural foramen.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.Epidural lipomatosis is associated with stenosis in the lower lumbar spine especially the sacral spinal canal.2.There are degenerative changes present in the lumbar spine worse at L5-S1 there is marked facet hypertrophy in the chronic treatment of exiting nerve roots within the left neural foramen.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for epidural hematoma after epidural steroid injection last week. Signs and symptoms: Subjective right leg weakness and increased urinary frequency. Pre- and post enhanced lumbar MRI:Examination demonstrates a posterior epidural collection with mixed T2 and T1 signal intensity along the dorsal aspect of the spinal canal at L4-L5 disc level. It measures approximately 25 mm in cranial cephalad axis and 7 x 12 mm in transaxial dimensions. Finding is highly suspected of a small epidural hemorrhage. It results in subtle mass effect on the thecal sac posteriorly. On prior MRI exam from 3-20 2-15 from St. Alexius Medical Center there is also a central disc protrusion at this level with mass effect on the thecal sac which in combination with the epidural collection results in significant central spinal stenosis at this level. There is no significant neural foraminal compromise.Advanced degenerative disc disease at L4-L5 and moderate bilateral facet and ligamentum flavum hypertrophy is also noted at this level.Examination at L3-L4 demonstrate moderate disc disease, broad base bulging disc and moderate hypertrophic changes of posterior elements with resultant significant central spinal stenosis. There is no significant change of this finding since prior outside institution lumbar MRI. A tiny central disc extrusion at this level is also noted.Moderate disc disease and hypertrophic changes of posterior elements at L5-S1 as well as a small left paramedian disc protrusion without central spinal stenosis or significant neural foraminal compromise is noted. Mild degenerative changes at other levels however without central spinal stenosis.

Output: 1.At L4-L5 there is a small posterior epidural hemorrhage which in combination with a large central disc protrusion results in significant central spinal stenosis.2.At L3-L4 extensive degenerative changes also results in significant central spinal stenosis. No change since prior outside institute exam.3.At L5-S1 degenerative changes and including a left paramedian disc protrusion without spinal stenosis is present.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with adenocarcinoma of the lung and brain metastases, on chemotherapy. Image quality is somewhat reduced relative to the prior examination which reduces sensitivity for lesional changes.Linear enhancement without edema in the right superior parietal lobule may be slightly smaller than on the prior examination, now measuring up to 8 mm, previously 10 mm. A right cerebellar enhancing lesion without edema measures up to 7 mm, previously 7 mm. Three or four small foci of enhancement within the left perirolandic white matter are not as well seen on the present examination which could simply reflect differences in image quality.An enhancing nodule within the left middle frontal gyrus is less well-defined than on the prior examination and difficult to measure accurately. However, the degree of edema associated with this lesion has decreased.No convincing evidence of any new enhancing lesion is seen. Scattered foci of nonenhancing, nonspecific white matter T2 hyperintensity are seen, some of which may be new from prior. No significant mass effect is detected. The ventricular system is stable and within normal limits.

Output: 1.No definite evidence of any progression in the numerous previously described enhancing lesions.2.No convincing evidence of any new intracranial lesion is seen. However, the image quality on this examination is somewhat less than on the prior exam, which reduces the accuracy of comparison and the sensitivity for new lesion detection.


Instruction: Generate impression based on findings.

Input: 16 year old male with history of recent myocarditis and clinical VT, with recurrent arrhythmias now referred for repeat cardiac MR to evaluate scar burden and function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 146 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 43 g/m2 (normal range 85+/-15), and the LV mass is 87 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is persistence of epicardial late gadolinium enhancement in the basal anterolateral and small segment of the mid inferolateral walls, but overall there is less myocardial involvement on this study. This pattern of late gadolinium enhancement is typical for prior myocarditis. The T2-STIR signal in the inferolateral and lateral walls seen on the previous study suggesting myocardial edema are no longer present; additionally the global relative enhancement ratio is normal.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 158 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 significant pericardial disease noted.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with normal systolic function (EF 61%), which is improved when compared to the prior study. LV diastolic volumes are similar to the previous study.2. There is persistence of epicardial late gadolinium enhancement in the basal anterolateral and small segment of the mid inferolateral walls, but overall there is less myocardial involvement on this study. 3. Normal size RV with normal systolic function (EF 50%).


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with, and parkinsonism, question of central tremor versus Parkinson's disease or both. Moderately extensive patchy foci of white matter T2 hyperintensity are seen in the bilateral cerebral hemispheres and the pons. No evidence of restricted diffusion is seen. No parenchymal edema or significant generalized mass effect is detected. No abnormal extra-axial collections are seen. There are no findings to suggest acute intracranial hemorrhage. The ventricular system is normal in size and morphology. Overall brain parenchymal volume is within normal limits.

Output: Moderately extensive patchy white matter lesions are seen, predominantly in the cerebral hemispheres. The differential for this finding is broad and would include chronic microvascular ischemic disease, sequelae of demyelination, as well as sequelae of other inflammatory processes and/or vasculitis. No other specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Many shunt revisions, hydrocephalus, headache, stroke, yearly follow up: evaluate for changes. There are postoperative findings related to right hemispherectomy with an unchanged heterogeneous fluid collection in the right extradural space deep to the craniectomy flap that measures up to approximately 15 mm in thickness and midline shift to the right. The deformed third and lateral ventricles are not significantly changed in appearance. However, there is slight interval decrease in size of some cystic compartments in the left occipital lobe that appear to communicate with ventricular system, while other cystic compartments assocated with the ventricular system appear to be unchanged or perhaps slightly larger, although precise comparison is limited due to differences in head positioning. There is unchanged diffuse confluent cerebral white matter T2 hyperintensity in a large portion of the left hemisphere, particularly in the periventricular region. There is a left transparietal tract, but no shunt catheter is present. There is unchanged posterior deviation and areas of encephalomalacia in the upper cervical spinal cord. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Chronic postoperative findings related to right hemispherectomy with no significant change in the deformed ventricular system and gliotic portions of the left cerebral hemisphere, although cyst compartments in the left cerebral hemisphere that seem to be associated with the ventricular system appear to have fluctuated slightly in size.2. Unchanged posterior deviation and areas of encephalomalacia in the upper cervical spinal cord, which may be attributable to adhesions and chronic infarction, respectively. A dedicated cervical spine MRI may be useful for further characterization.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:3/5/1958)Reason: primary CNS lymphoma s/p treatment History: please compare with previous MRI in the systemPROVIDER/ATTENDING NAME: CHADI NABHAN CHADI NABHAN The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post burr hole placement along the left parietal calvarium for a previous left parietal lobe stereotactic biopsy.There is confluent signal change present within the left periventricular subcortical white matter centered in the left parietal lobe which has extended further compared to the prior exam. The area involved canal measures 60 x 27 mm axial dimensions and previously measured 47 x 20 mm axial dimensions. There is no associated contrast enhancement. There is susceptibility effect within the left parietal lobe in the location where there was a ring-enhancing lesion on the 9/4/2015 exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR punctate hyperintense foci present in the range stem, internal capsules and deep gray nuclei.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam, white matter changes associated with a left parietal lesion have extended further. It is conceivable that this white matter change is related to posttreatment change.2.No enhancing mass lesion is appreciated intracranially to suggest recurrence of the lymphoma.3.Periventricular and subcortical white matter lesions as well as punctate lesions in the deep gray nuclei and brainstem are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Male 63 years old with elevated PSA of 30 and two negative biopsies. Evaluate for prostate masses. PELVIS:PROSTATE:Prostate Size: 5.1 x 4.2 x 4.8 cmPeripheral Zone: No suspicious lesion.Central Gland: Benign nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a 1.3 x 1.0 cm utricle cyst.

Output: 1.Benign prostatic hypertrophy.2.No suspicious prostatic lesion.


Instruction: Generate impression based on findings.

Input: Female 64 years old with right knee pain. Evaluate for right knee meniscal tear. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage in the medial and lateral compartments without evidence of full-thickness defect. The patellar cartilage is thinned and irregular with full-thickness loss over the median facet with underlying reactive marrow change. There is also thinning and irregularity of the cartilage in the femoral trochlea. Other than reactive marrow change, bone marrow signal intensity is within normal limits.There are lateral and tiny medial compartment osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.No evidence of meniscal tear.2.2 loose bodies within the joint.3.Osteoarthritis as described above.


Instruction: Generate impression based on findings.

Input: 49-year-old woman with history of metastatic breast cancer, now with lower back pain radiating down the legs bilaterally. There is a nodular enhancing mass involving the conus medullaris and cauda equina roots. The largest of these lesions appears intramedullary and measures 10 x 9 mm in axial dimension and 22 mm in craniocaudal dimension centered at the T12 level. There appears to be associated intraparenchymal invasion, with surrounding edema. Additionally, there are nodular enhancing lesions along the dural surface of the cauda slightly superiorly at the T11/T12 level and involving the left L4 cauda equina roots. In addition, there is amorphous enhancing tumor in the sacral spinal canal, with extension into the right S1/S2 neural foramen. The conus medullaris is situated at L1/L2 level. The vertebral body and intervertebral disc heights are within normal limits. The lumbar spinal alignment is within normal limits. The bone marrow signal is unremarkable. There are slight disc bulges at L3/L4, L4/L5, and L5/S1, but no significant spinal canal or neural foraminal narrowing. The paraspinous soft tissues are within normal limits.

Output: Multiple tumors involving the conus medullaris, cauda equina, and sacral spinal canal are compatible with metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Migraine without aura, intractable, without status migrainosus [G43.019] / Obesity, unspecified [E66.9], Reason for Study: ^Reason: 46 y.o,. with worsening headaches c/w migraine but hx of cancer - tumor, other mass lesion? History: worsening headache, Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Right parieto-temporal lobe high signal focus on FLAIR images is non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. A small left maxillary sinus retention cyst.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral PCAs are fetal origin.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB:9/24/1966)Reason: Chronic LBP without sciatica, + radiculopathy RLE; worsening History: PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY 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. A 7 mm T1 hyperintense well-circumscribed round lesion is present within the L1 vertebral body which most likely represents a hemangioma.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. There is bilateral facet hypertrophy present at this level left more than right without significant compromise.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: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: please do Dr Javed MS protocol and compare to priorSigns and Symptoms: vertigo, headache MRI brain:There is redemonstration of a 4 mm x 5 mm focus of enhancement in the right pons which is hypointense on T1 and was previously hyperintense on FLAIR imaging. On the T2 sagittal cervical spine images it is hyperintense on the STIR T2 images. Susceptibility weighted imaging on the prior exam demonstrates some susceptibility effect.There is a mild degree of periventricular and subcortical white matter lesions present which are asymmetrically more numerous in the left hemisphere relative to the right. Compared to the previous exam these lesions appear somewhat more conspicuous on the current exam but have not changed in number or size. The difference in conspicuity can be accounted for on the basis of slice thickness.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is mild reversal of the normal cervical curvature present. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level which was also present on the prior examAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is redemonstration of a small central disc protrusion at this levelAt 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. There is a small central disc protrusion at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.The left lobe of the thyroid is heterogeneousLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine. There is a T1 hyperintense focus in the L3 vertebral body which is eccentric towards the right side and measures 11 mm in diameter and most likely represents a vertebral body hemangioma. It suppresses on the inversion recovery images and the fat suppressed images. No abnormal enhancing lesions are appreciated in the spinal canal.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild bilateral facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level. There is disc desiccation and a minor disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some mild loss of disc space height and a minor disc bulge at this level.. There is mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a punctate enhancing lesion in the pons. It was also present on the prior exams from 2010 and 2009 and has not changed substantially. It is possible this represents capillary telangiectasia 2.There is a mild degree of periventricular and subcortical white matter lesions present which are nonspecific. Although it is conceivable that these are related to demyelinating disorder at this age they're more likely vascular related based on the imaging appearance and frequency of occurrence.3.There are mild degenerative changes present in the lumbar spine and the cervical spine without significant compromise to spinal canal or exiting nerve roots.4.Heterogeneous left lobe of thyroid is nonspecific finding.


Instruction: Generate impression based on findings.

Input: Right-sided weakness. Acute CVA. Non-enhanced CT of brain:There is evidence of a nonhemorrhagic acute left MCA cortical stroke in the left frontal lobe. There is subtle associated mass effect and effacement of adjacent cortical sulci. No evidence of midline shift.Patchy periventricular foci of low-attenuation is concerning for small vessel ischemic disease of indeterminate age. Follow-up with an MRI is recommended. Ventricular system is within normal range of size for patient's stated age of 70. No abnormalities of basal ganglia, thalami, pons or the cerebellum is detected. Mild vascular calcification of bilateral cavernous carotid are noted. Limited view of orbits, paranasal sinuses and mastoid air cells are unremarkable. Old healed fracture of posterior lateral wall of right maxillary sinus in this limited view is identified.

Output: 1.Acute left MCA frontal lobe nonhemorrhagic cortical stroke.2.Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Long-standing knee pain. Status post soccer injury MENISCI: The medial meniscus is normal. Examination of the lateral meniscus reveals a complex tear of the posterior horn with both a vertical and a horizontal component.ARTICULAR CARTILAGE AND BONE: There is a bone contusion in the lateral posterior proximal tibiaLIGAMENTS: The PCL is normal. The medial collateral ligament and the lateral collateral complex are normal.Examination of the anterior cruciate ligament reveals abnormal increased signal on the T2-weighted images. Although some fibers may be intact there is at least a partial tear of the anterior cruciate ligament. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tear of the posterior horn of the lateral meniscus. At least a partial tear of the anterior cruciate ligament.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement. The distal spinal cord and conus are within normal limits with the conus terminating at the L2 level. No abnormal postcontrast enhancement is visualized. There is developmental narrowing of the lower lumbar spinal canal with prominent dorsal and ventral epidural fat.On sagittal views, T10-T11 and T11-T12 discs demonstrate mild diffuse disc bulges without significant neuroforaminal stenosis or central spinal stenosis.T12-L1 demonstrates a right paracentral disc protrusion causing mild right neural foraminal narrowing without spinal canal stenosis. There is left greater than right ligamentum flavum and facet hypertrophic degenerative change. L1-L2 demonstrates a central disc protrusion causing mild spinal canal stenosis and mild left neuroforaminal stenosis without right neuroforaminal stenosis. Hypertrophic degenerative changes of the facets and ligamentum appears similar to prior examination. L2-L3 demonstrate mild disk disease and mild bilateral facet and ligamentum flavum degenerative changes with associated mild to moderate left neuroforaminal narrowing. There is moderate spinal canal stenosis primarily on the basis of developmental narrowing. L3-L4 demonstrates mild degenerative disk disease with subtle loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophic changes. There is moderate spinal canal stenosis primarily on the basis of developmental narrowing. L4-L5 demonstrates moderate disk disease with loss of disk height and moderate bilateral facet and ligamentum flavum hypertrophic changes. There is a diffuse disc bulge with a right paramedian prominence causing mild to moderate right neuroforaminal stenosis without spinal canal stenosis or left neural foraminal stenosis. There is a right far lateral annular fissure. L5-S1 demonstrates minimal disk disease and moderate bilateral facet and ligamentum flavum hypertrophic changes. No central spinal stenosis or neural foraminal compromise.Degenerative changes of the bilateral sacroiliac joints are partially visualized.

Output: 1. No evidence for metastatic disease to the lumbar spine. 2. No significant interval change in multilevel spondylotic changes. Moderate spinal canal stenosis at L2-L3 predominantly on the basis of developmental narrowing with superimposed disc and facet/ligamentous hypertrophic degenerative disease causing mild to moderate left neuroforaminal narrowing.3. There is moderate central spinal canal stenosis at L3-L4 primarily on the basis of developmental narrowing. 4. There is stable right far lateral annular fissure involving the L4-L5 disc with right paramedian prominent disc bulge causing mild to moderate right neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, status post resection for cavernoma. Follow-up exam. Findings are seen compatible with left frontal craniotomy and resection of a portion of the left frontal lobe. The resection margin demonstrates a thin rim of diffusion restriction which likely reflects postoperative cytotoxic edema. The surgical cavity contains a mixture of CSF, blood product and debris. Parenchymal edema is evident in the surrounding tissues. The previously demonstrated cavernous malformation is not identified on this examination and has therefore likely been included within the resection. Elsewhere, a few scattered nonspecific foci of FLAIR hyperintensity are seen. No other areas of edema or mass effect are detected. Ventricular size and morphology remain within normal limits.

Output: Expected post operative findings are seen compatible with resection of a left frontal cavernous malformation.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stenosis. Signs and symptoms: Pain. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column. There is mild straightening of cervical lordosis likely secondary to degenerative disease.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C5-C6 demonstrate moderate disc disease and loss of disc height and mild facet disease. There is moderate (left greater than right) neural foraminal compromise and no central spinal stenosis.C6-C7 demonstrate advanced disc disease and loss of disc height. There is a disc-osteophyte complex in the midline and to the right. There is resultant significant right neural foraminal compromise, moderate left neural foraminal compromise and no central spinal stenosis.C7-T1 is unremarkable.Upper most visualized thoracic spine to T3 level demonstrate no spinal stenosis.

Output: 1.At C6-C7 degenerative changes and including a disc-osteophyte complex results in significant bilateral (right greater than left) neural foraminal compromise and no central spinal stenosis.2.At C5-C6 degenerative changes results in moderate bilateral neural foraminal compromise (left greater than right) and no central spinal stenosis.3.Mild degenerative changes at other levels as detailed4.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: Pain. Cuff tear? Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. Scattered calcific densities along the greater tuberosity and within the acromiohumeral interval likely reflect calcific tendinosis. The acromiohumeral interval is preserved, but please note that the previous MRI exam showed a full-thickness rotator cuff tear. Glenohumeral joint alignment is within normal limits. Degenerative arthritic changes affect the visualized thoracic spine. Orthopedic fixation of the cervical spine is incompletely imaged on this study.

Output: Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male 64 years old with prostate cancer. Biopsy showed Gleason 3+4 =7 in 4 of 6 cores. The positive finding was on the left mid, left apex, right base and right mid lobes. Evaluation is limited due to artifact from metallic hardware.PELVIS:PROSTATE:Prostate Size: 4.0 x 3.2 cmPeripheral Zone: There are left mid and left apex lesions. The largest is in the left apex and measures 6 x 4 mm. It is dark on T2 and ADC. No lesion is seen on the right. There is no extracapsular extension.Central Gland: Multiple benign nodules are noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Artifact from bilateral hip arthroplasties limits evaluation of the bones and soft tissues of the pelvis.OTHER: No significant abnormality noted.

Output: 1.Limited evaluation due to artifact from metallic hardware.2.Left mid and left apex lesions are compatible with prostate carcinoma. No lesion is seen on the right. 3.No extracapsular extension or pelvic lymphadenopathy.