Instruction: Generate impression based on findings.

Input: 69-year-old male to assess for central sleep apnea. Again seen are multiple punctate foci of susceptibility effect scattered in the subcortical white matter of the supratentorial brain as well as multiple foci in the cerebellum. There is also a punctate focus of susceptibility effect that appears to be along the anterior aspect of the medulla and also seen previously. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are a few scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. These are not significantly changed from the prior examination.Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Multiple scattered foci of susceptibility effect in the bilateral cerebral hemispheres, cerebellum, as well as one in the medulla. Findings are consistent with chronic microhemorrhages and similar to recent MRI from 8/8/2016. Distribution of these microhemorrhages is nonspecific but may be related to amyloid angiopathy and/or chronic hypertension.2. Mild chronic small vessel ischemic changes. 3. Brain parenchyma is otherwise unremarkable with no acute findings.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of renal cysts. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple cystic lesions are present bilaterally.Left kidney:Left mid pole posterior partially exophytic cystic lesion with thin septations and layering high T1 signal measuring 3.9 x 3.5 cm (image 26 of series 9). No enhancement. This may represent a proteinaceous or hemorrhagic cyst.Left midpole anterior exophytic cystic lesion without septations or nodularity measuring 4.7 x 6.9 cm (image 31 of series 9). No enhancement. This likely represents a simple cyst.Exophytic left inferior pole T2 intermediate lesion without enhancement significantly decreased in size now measuring 4.0 x 3.9 cm (image 46 of series 9). No enhancement. This likely represents a resolving cyst.Right kidney:Multiple small complex and simple cysts. For reference, a right lower pole complex lesion has not significantly changed from prior and measures 1.9 x 1.2 cm (imaged 62 of series 110)RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Right cystic renal lesions, some of which have decreased in size, likely benign.2. Multiple simple and complex left renal cystic lesions for which followup is recommended.


Instruction: Generate impression based on findings.

Input: Encephalomyelitis. Evaluate for change of the inflammatory CNS lesions. Also headache and back pain.Additional clinical history from electronic medical records: 14 year old girl with a complex past medical history including a multi-system autoimmune disease which is thought to be caused by a mutation of the CTLA4 pathway who presented with brain and spine lesions on previous MRI. BRAIN:The few contrast-enhancing left frontal lobe lesions on the prior examination have resolved. Associated T2-hyperintensity is significantly improved to resolved. T2-hyperintense lesion in the left parietal white-matter with associated volume loss remains unchanged. The other smaller foci of T2-hyperintensity in the occipital lobes and in the right frontal lobe as well as the posterior corpus callosal body are also unchanged. These lesions are noncontrast enhancing. There is apparent faint focal contrast enhancement in the right frontal white-matter but no definite correlate on the coronal postcontrast imaging or T2/FLAIR, and may be artifactual. Otherwise, there is no new brain lesion and no abnormal intracranial contrast enhancement. Focus of susceptibility effect overlying the left frontal lobe is unchanged, related to previous biopsy. Otherwise, there is no acute intracranial hemorrhage. There is no acute infarct.Accounting for mild ex vacuo ventricular and sulcal enlargement in the left parietal region, the ventricles and other CSF-containing spaces are fairly symmetric. There is no mass-effect or midline shift. The major intracranial vascular flow voids are preserved.The orbits, skull and scalp are grossly unremarkable accounting for expected findings of previous left frontal lobe lesion biopsy. There is mild mucosal thickening in the maxillary and ethmoid sinuses.COMPLETE SPINE:There has been remarkable improvement of the expansile T2-hyperintense lesion involving the lower cervical/upper thoracic spinal cord. Residual abnormality is located predominantly on the left side at at T1-T2 level and is faint and subtle. The associated cord expansion is almost resolved. Associated contrast enhancement is remarkably improved.The remainder of the spinal cord is unremarkable. The sagittal spinal alignment is anatomic. There is a mild broad-based right convex curvature which can be positional. The vertebral bodies are preserved in height. The marrow signal is also unremarkable.Small lymph nodes in both sides of the neck are not enlarged by size criteria. The patient is intubated. Lungs show dependent abnormality likely reflecting atelectasis.

Output: 1.Left frontal lobe brain contrast enhancing lesions have resolved with improvement of the associated T2-hyperintensity. Other T2-hyperintense lesions remain unchanged, most pronounced in the left parietal lobe, with associated volume loss but no contrast enhancement or diffusion restriction, probably represent gliosis/chronic sequela of the previous, resolved inflammatory lesions. 2.Faint focal contrast enhancement in the right frontal white-matter on axial imaging does not correlate with abnormality on the other sequences or on the coronal postcontrast imaging and is likely artifactual. Otherwise, there is no definite new brain lesion.3.There is also marked decrease in size and enhancement of the upper thoracic spinal cord lesion.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with fasciculations of the left hand and forearm, status post foraminotomy on the left 1.5 years ago because of weakness. Postoperative findings are seen along the posterior elements on the left at C6-7 suggesting at least partial laminectomy and facetectomy.Mild reversal of the normal cervical lordosis is seen, likely degenerative in nature. Sagittal alignment is otherwise unremarkable. Vertebral body heights are grossly preserved. Degenerative endplate signal abnormality is seen at C4, C5 and C6. No worrisome marrow replacement or evidence of significant marrow edema is observed.The visualized spinal cord is free of pathologic signal abnormality. Level specific findings are detailed as follows:C2-3: Left greater than right facet hypertrophy. Right paracentral and foraminal disc osteophyte formation resulting in effacement of the right lateral recess, but no significant generalized canal stenosis and no cord impingement. The right neural foramen is severely narrowed. The left neural foramen is patent. C3-4: Left facet hypertrophy. Right paracentral and foraminal disc osteophyte formation which effaces the right ventral thecal sac and mildly deforms the ventral spinal cord. Mild generalized spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C4-5: Mild facet hypertrophy. Broad disc osteophyte formation slightly asymmetric to the right. Effacement of the ventral thecal sac with slight flattening of the ventral cord. Mild generalized spinal canal narrowing. Severe right and moderate left foraminal narrowing. C5-6: Right facet hypertrophy. Broad posterior disc osteophyte formation. No cord impingement or significant spinal canal narrowing. Severe left and moderate to severe right foraminal narrowing. C6-7: Disc osteophyte formation asymmetric to the left and particularly along the left uncovertebral joint. Superimposed PLL thickening is also seen below the disc space level. These findings contribute to produce a mild to moderate spinal canal stenosis with very slight impingement of the spinal cord. Severe left and moderate right foraminal narrowing. Postoperative findings as discussed above. C7-T1: Bilateral facet hypertrophy. Left subarticular and foraminal zone disc osteophyte formation. No significant generalized spinal canal stenosis. Severe left and mild right foraminal narrowing.

Output: 1.Postoperative findings on the left at C6-7 compatible with the stated history of prior foraminotomy. The left, the left neural foramen at C6-7 remains severely narrowed due to disc osteophyte formation and left uncovertebral hypertrophy.2.Significant foraminal narrowing is also evident at most of the additional cervical levels as detailed above.3.Degenerative spinal canal stenosis is seen at multiple levels, most severely affecting the C6-7 level where there is a mild to moderate stenosis and slight impingement of the spinal cord. At no level is there any spinal cord signal abnormality to suggest cord edema.


Instruction: Generate impression based on findings.

Input: Male, 31 years old, with stiff legs and dizziness. Evaluate for multiple sclerosis. Brain:Numerous periventricular and, to a lesser degree, juxtacortical T2 hyperintense, T1 hypointense lesions are evident, many of which are oriented radially with respect to the ventricles. Some involve the corpus callosum or contact the callososeptal junction. Scattered lesions are also seen within the brainstem and cerebellum.No edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra axial fluid collection is detected. Ventricular size and morphology are within normal limits. Brain parenchymal volume is grossly preserved.Cervical spine:Multiple patchy and ill-defined areas of abnormal spinal cord T2 hyperintensity are seen. The lesions are primarily evident beginning at C3 and continuing through C6.Spinal alignment is grossly anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen.C2-3: Left facet arthropathy. Mild left foraminal narrowing. C3-4: Facet arthropathy. Mild bilateral foraminal narrowing. C4-5: Facet arthropathy. Small left paracentral disc protrusion. No significant spinal canal or foraminal compromise. C5-6: Facet arthropathy. Tiny central disc protrusion. Moderate right foraminal narrowing. C6-7: Facet arthropathy. Mild generalized posterior disc-osteophyte complex formation. No significant spinal canal compromise. Mild bilateral foraminal narrowing. C7-T1: No significant spinal canal or foraminal compromise.

Output: 1.Multiple lesions are evident within the cerebral hemispheres, brainstem and cerebellum suggestive of demyelinating disease.2.Multiple lesions are also seen within the visualized spinal cord also suggestive of demyelinating disease.3.Mild multilevel degenerative findings are evident in the cervical spine as discussed above.


Instruction: Generate impression based on findings.

Input: 76 year old female with IPH. Evaluate for cervical fracture. Brain:There are postoperative findings related to left craniotomy. There is residual subdural blood product along the left hemisphere which is hyperintense on T1 and T2 weighted images and which was isoattenuating on the prior CT. This collection, likely representing subacute subdural blood, measures up to 10 mm in thickness similar to prior study. A more recent subdural hematoma along the left interhemispheric falx which demonstrates intermediate T1 signal and hypointense T2 signal measuring a maximum of 16 mm in thickness in the left occipital region is also unchanged from recent CT. Accounting for differences in technique, the left temporal parenchymal hematomas appear essentially identical to recent CT and the degree of vasogenic edema seems to be similar as well. There is generalized mass effect with effacement of the left lateral ventricle and right midline shift of approximately 5 mm, all unchanged. There is probably a small amount of layering blood product in the right occipital horn of the lateral ventricle which appears to have been present on prior study although was not as conspicuous at that time. 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 persistent opacification of the right maxillary sinus with an air-fluid level. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Cervical Spine:Susceptibility artifact is seen related to orthopedic instrumentation which appears to be centered at C5/6 and C6/7 disk spaces. The spine alignment is straightened. The bone marrow signal is unremarkable. There is mild STIR hyperintensity within the soft tissues of the upper neck along the nuchal ligament. There is fluid along the oral cavity and hypopharynx which is likely related to ET tube placement. A congenital narrowness of the spinal canal is seen, with level specific degenerative changes as listed below: At C2-C3, there is no significant compromise to the spinal cord or neural foramina. At C3-C4, there is likely thickening of the posterior longitudinal ligament and suggestion of a central disk protrusion with no significant cord impingement. The neural foramina are patent bilaterally. At C4-C5, there appears to be thickening of the posterior longitudinal ligament or disk osteophyte formation and ligamentum flavum hypertrophy associated with significant narrowing of the spinal canal and what appears to be a chronic thinning of the cord. There is mild left neural foraminal narrowing.At C5-C6, there also appears to be thickening of the posterior longitudinal ligament or disk osteophyte formation which causes generalized spinal canal narrowing and also what appears to be chronic thinning of the cord. There is mild neural foraminal narrowing bilaterally. At C6-C7, there is mild generalized spinal canal and neural foraminal narrowing. At C7-T1, there is no significant compromise to the spinal cord or neural foramina.

Output: 1. Stable left temporal lobe parenchymal hematomas which are probably relatively acute given the MRI signal characteristics. 2. Stable acute to early subacute parafalcine subdural hematoma on the left. 3. Stable somewhat older likely subacute subdural hematoma along the left lateral temporal lobe. 4. There is stable generalized mass effect and midline shift. 5. There is minimal layering blood product within the right occipital horn. 6. There is evidence of prior surgery in the cervical spine. 7. There is congenital narrowing of the spinal canal which is exacerbated at several levels by either posterior longitudinal ligament thickening, disk protrusion, or la combination of both. The cord seems to be thinned chronically at these levels. 8. No definite trauma of the cervical spine.


Instruction: Generate impression based on findings.

Input: Female 29 years old; Reason: right knee anterior pain, multiple patellar realignment procedures. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: No abnormal bone marrow signal. There is marked thinning of the articular cartilage of the patellofemoral joint. the cartilage of the femorotibial compartments are intact.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Marked chondromalacia of the patellofemoral cartilage.2.Postsurgical changes within the prepatellar subcutaneous tissues likely from the multiple patellar realignment procedures.


Instruction: Generate impression based on findings.

Input: 69 year-old female with altered mental status, dysarthria, pronator drift. Evaluate for acute stroke. There is no CT evidence of acute territorial ischemia. There are patchy areas of hypodensity within the subcortical, deep, and periventricular white matter that are nonspecific, however most commonly small vessel ischemic disease of indeterminate age. If there is a high index of suspicion for acute infarct, MRI would be more sensitive.The ventricles and sulci are mildly prominent, likely due to age-related volume loss. There is no acute intracranial hemorrhage or extraaxial collection. There is no midline shift or basal cistern effacement.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are clear.There is moderate atherosclerotic calcification of the intracranial vessels.

Output: 1.No CT evidence of acute territorial ischemia. MRI would be more sensitive for acute infarction if there is strong clinical suspicion for acute infarct. 2.Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Cervical spine:There is slight reversal of upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The left thyroid lobe is only partially imaged, yet appears signal heterogeneous and enlarged with slight displacement of the airway right laterally. This most likely represents goiter which could be more thoroughly evaluated with a neck CT.C2/3: Posterior osteophyte disc complex and bilateral facet hypertrophy. There is mild bilateral neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, uncinate hypertrophy, and facet hypertrophy. There is mild central and moderate to severe bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex with an extruded disc component (extending superiorly). There is also bilateral uncinate hypertrophy and facet hypertrophy. There is mild-to-moderate central and moderate to severe bilateral neural foraminal stenosis. There is subtle T2 cord hyperintensity suggestive of myelopathy.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and facet hypertrophy. There is mild left neural foraminal and severe right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex without stenosis.C7/T1: Minimal disc bulge without stenosis.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. T1/2 demonstrates facet hypertrophy and mild bilateral neural foraminal stenosis.T2/3 demonstrates left facet hypertrophy and mild left neural foraminal stenosis.T3/4 demonstrates facet hypertrophy with moderate left and severe right neural foraminal stenosis.T4/5 demonstrates left facet hypertrophy with moderate to severe left neural foraminal stenosis.T5/6 demonstrates left facet hypertrophy with moderate left neural foraminal stenosis.T6/7 demonstrates left facet hypertrophy with mild to moderate left neural foraminal stenosis. There is also a small central disc protrusion causing anterior cord flattening without intrinsic cord signal abnormality.T7/8 demonstrates a small right paracentral disc protrusion causing slight anterior hemicord flattening without intrinsic cord signal abnormality.T8/9 demonstrates disc bulge and facet hypertrophy. There is slight anterior hemicord flattening without intrinsic cord signal abnormality. There is severe bilateral neural foraminal stenosis.T9/10 demonstrates a small right paracentral disc protrusion causing minimal anterior right hemicord flattening without intrinsic cord signal abnormality. There is also facet hypertrophy. There is mild bilateral neural foraminal stenosis.T10/11 demonstrates disc bulge and herniation causing deformation of the spinal cord with associated intrinsic T2 cord signal abnormality suggestive of myelopathy. There is also facet hypertrophy. There is severe central and mild bilateral neural foraminal stenosis.T11/12 demonstrates asymmetric bulge to the right causing mild left and moderate right neural foraminal stenosis.T12/L1 demonstrates disc bulge and bilateral facet hypertrophy. There is mild bilateral neural foraminal stenosis.

Output: 1.The left thyroid lobe is only partially imaged, yet appears signal heterogeneous and enlarged with slight displacement of the airway right laterally. This most likely represents goiter which could be more thoroughly evaluated with a neck CT.2.Multilevel cervical spine stenoses, worse at C4/5 where there is posterior osteophyte disc complex including an extruded disc component (extending superiorly). There is mild-to-moderate central and moderate to severe bilateral neural foraminal stenosis. There is subtle T2 cord hyperintensity suggestive of myelopathy.3. Multilevel thoracic spine stenoses, worse at T10/11 where disc bulge and herniation cause deformation of the spinal cord with associated intrinsic T2 cord signal abnormality suggestive of myelopathy. There is severe central and mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out tethered cord. Signs and symptoms: Constipation. Nonenhanced lumbar MRI:There is normal anatomical development of lumbosacral spine and the normal anatomical alignment.No evidence of spinal stenosis or neural foraminal compromise at any level. There is normal signal intensity and caliber of the lowest most visualized thoracic cord and, conus and the cauda equina. There is normal anatomical termination of the cord at L1-L2 level.There is normal anterior movement of the lower cord, conus and proximal cauda equina on prone sagittal T2-weighted series.Perispinal soft tissues are unremarkable. The bladder is full and expanded and with evidence of mild generalized thickening of the bladder wall.

Output: 1.Unremarkable nonenhanced lumbar MRI and in particular no evidence of tethered cord.2.Bladder is full and expanded and demonstrate mild diffuse wall thickening.


Instruction: Generate impression based on findings.

Input: 47-year-old male with history of neuroendocrine carcinoid now experiencing flushing and hot flashes. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Loss of signal on opposed phased images diffusely, compatible with hepatic steatosis. No biliary ductal dilation.SPLEEN: Small splenules redemonstrated. Occlusion of the splenic vein is redemonstrated.PANCREAS: 13 x 18 mm T2 hyperintense lesion at the posterior aspect of the pancreatic tail demonstrating restricted diffusion and enhancement, suspicious for neuroendocrine tumor given the provided history (series 901/223 and 701/343). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged lymph nodes by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 13 x 18 mm lesion in the pancreatic tail as described, suspicious for neuroendocrine tumor given the provided history.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, history of neurofibromatosis type II with acoustic neuroma and intracranial meningiomas, spinal cord lesions, status post cervical tumor debulking. Brain:Sequela of multiple prior craniotomies are again seen. Scattered areas of encephalomalacia in both frontal lobes are unchanged. The CSF space along the left lateral cerebellar hemisphere remains widened similar to prior.No restricted diffusion or parenchymal edema is suspected. No new intracranial hemorrhage or extra-axial collections are seen. Scattered areas of susceptibility artifact are unchanged and likely reflect a combination of calcification and chronic blood product. Ventricular size and morphology are stable.Multiple intracranial masses are demonstrated with details as follows:1. A bulky right CP angle/IAC tumor seems to slightly increased in size, at least along its inferior aspect, where it measures 34 x 22 mm (image 8 series 201) previously 32 x 20 mm.2. A left CP angle tumor also seems to have increased slightly in size measuring 16 x 10 mm (image 9 series 2 on), previously 12 x 8 mm.3. Residual enhancing tumor along the surgically altered left IAC and within the temporal bone centered at the geniculate ganglion may be slightly more prominent than on the prior examination, but comparison is difficult due to differences in technique.4. Tumor along the bilateral cisternal trigeminal nerves, with probable involvement of the cavernous sinuses, is unchanged.5. A small intraconal mass along the left lateral rectus muscle has probably not significantly changed.6. A tumor along the planum sphenoidale is at most minimally enlarged measuring 18 x 14 mm (image 34 series 302), previously 17 x 12 mm.7. Enhancing lesions in the left parietal scalp and right suboccipital scalp are not convincingly changed.8. A cystic and solid lesion with mild associated enhancement in the left brachium pontis is minimally increased in size with slightly more prominent enhancement.Spine:Postop findings are again seen with evidence of multilevel cervical laminectomy and partial resection of a cervical spinal cord tumor. Since the prior examination, postoperative findings including fluid and air within the soft tissue resection bed have resolved. T2 hyperintensity extending through the cervical cord has also significantly improved with only mild residual scattered T2 hyperintensity.Nodular intramedullary tumor at the cervicomedullary junction has slightly increased in size now measuring 20 x 16 mm in cross-sectional dimensions, previously 19 x 14 mm.Numerous enhancing tumors are seen along the cervical nerve roots including small lesions along the intradural portions of the nerves, for example at the C3 level on the left, at the C1-2 level bilaterally and along the foramen magnum on the left. These lesions were present on the prior examination but are better seen on today's study which could reflect differences in technique or very slight increased size.Also redemonstrated are bulky foraminal tumors which expand the neural foramina bilaterally beginning with the C5-6 neural foramina and continuing down. The lesion on the left at C5-6 projects from the foramen into the intradural space. All these lesions appears slightly larger than on the prior exam.In the thoracic region, a very bulky foraminal and extraforaminal tumor on the right at T2-3 has increased in size now measuring 54 x 33 mm (image 20 on series 4101) previously 47 x 32 mm. An intramedullary tumor at the T6 level has increased slightly in size. Two or three small extramedullary intradural nodules on the left at the T6 level have not convincingly changed. Additional small intradural nodules at lower thoracic levels have not significantly changed.Innumerable small nodules along the nerve roots of the cauda equina are seen. Some of these may be mildly increased in size relative to the prior examination, but overall, there has been no substantial change. A nodule along the lumbar plexus on the right at the L4 level is probably mildly increased in size measuring up to 14 mm in thickness, previously 12 mm.

Output: 1. Multiple intra-cranial masses are redemonstrated representing a mixture of presumed schwannomas and meningiomas. Most of these lesions demonstrate a mild interval increase in size. 2. An intramedullary lesion within the left brachium pontis may be minimally larger with slightly more prominent enhancement. 3. Redemonstration of findings related to partial resection of a tumor from the upper spinal cord. Residual nodular tumor at the cervicomedullary junction has increased in size.4. Scattered innumerable intradural, foraminal and extraforaminal tumors are redemonstrated throughout the spine, many of which have increased slightly in size.5. An intramedullary lesion at the T6 level has also increased in size.


Instruction: Generate impression based on findings.

Input: 72-year-old man with history of acute cholecystitis status post cholecystostomy 9/27, continued increase in bilirubinemia. ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter cyst in segment 4, otherwise no focal hepatic lesion. The liver is otherwise normal in signal and morphology.Patient is status post cholecystostomy with decompressed gallbladder. The gallbladder wall still thickened and edematous measuring up to 1 cm. There is no intra or extrahepatic biliary ductal dilatation. The ducts are smooth without intraluminal filling defect or evidence of extrinsic compression.SPLEEN: Multiple round mildly T1 hyperintense, T2 isointense lesions with mild enhancement compatible with known history of lymphoma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are normal. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral pleural effusions.

Output: 1.Cholecystostomy with collapsed but edematous gallbladder compatible with decompressed acute cholecystitis.2.No intra or extrahepatic biliary ductal dilatation, intraluminal filling defect, or evidence of extrinsic compression of the bile duct.3.Splenic lymphomatous lesions, previously demonstrated on imaging.


Instruction: Generate impression based on findings.

Input: Evaluate for osteochondral defect of the talar dome. Right ankle pain. TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: The cartilage appears intact. There is an osteochondral lesion at the anterior medial aspect of the talar dome that is hypointense on T1 and hyperintense on T2, with an adjacent subchondral cyst within the medial malleolus. Mild bone marrow edema is identified within the anterior talus and middle cuneiform.ADDITIONAL

Output: Osteochondral defect at the talar dome and bone marrow edema involving the base of the talus and middle cuneiform.


Instruction: Generate impression based on findings.

Input: Male 30 years old Reason: US shows new 1.7 cm segment 2 lesion History: hep B, hemangiomas ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are at least 3 T2 hyperintense lesions involving the right hepatic lobe the largest measuring 1.3 x 1.3 cm on image 47 of series 8. The lesions show peripheral nodular discontinuous enhancement which fill-in over time, compatible with hemangiomas. A subcentimeter lesion near the anterior aspect of the right hepatic lobe in segment 8 as seen on image 227/series 9 is too small to characterize. No suspicious hepatic lesions are identified. Multiple small polypoid lesions within the gallbladder adherent to the wall likely represent small gallbladder wall polyps.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.3 right hepatic lobe lesions with imaging features compatible with small hemangiomas. No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: 50-year-old female with history of partial left nephrectomy for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense lesions are benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes in the left kidney of partial nephrectomy.There is a 1.2 cm cystic lesion within the interpolar region of the left kidney with layering high T1 material and no significant enhancement compatible with a benign cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Status post bilateral breast augmentation.

Output: 1.Postoperative changes in the left kidney with no evidence of disease recurrence. 2.Stable left interpolar benign cyst.


Instruction: Generate impression based on findings.

Input: 59-year-old female with pain, evaluate for TFCC tear LIGAMENTS: Evaluation of the intrinsic ligaments of the wrist is limited due to lack of intra-articular contrast. No discrete fluid-filled tear of either ligament is evident.TRIANGULAR FIBROCARTILAGE COMPLEX: No fluid-filled tear is evident. However, there is intermediate signal along the undersurface of the disc suggesting degeneration. Heterogeneity of the fibers of the TFCC adjacent to the ulnar styloid is suggestive of degeneration and/or synovitis.TENDONS: Mild surface irregularity of the tendons of the first dorsal compartment with minimal fluid surrounding the tendons may reflect partial tearing and/or tenosynovitis of questionable current clinical significance. Increased signal along the extensor digitorum tendons dorsal to the the radius may reflect mild tenosynovitis, also of questionable current clinical significance. Volar bowing of the flexor retinaculum probably reflects prior carpal tunnel release.BONES: Small cysts are noted within the proximal pole of the scaphoid and trapezium, likely degenerative. ADDITIONAL

Output: 1.Findings suggestive of degeneration/proximal surface fraying of the TFCC articular disk without discrete fluid-filled tear.2.Mild synovitis and other findings as above.


Instruction: Generate impression based on findings.

Input: 47 years, Female, leg weakness. Multiple sclerosis, evaluate for progression. Brain: There is a T2/FLAIR hyperintense lesion involving the juxtacortical white matter of the right posterior frontal lobe as well as along the medial cortical surface. There is also a juxtacortical lesion along the left intraparietal sulcus. There is also a lesion along the undersurface of the corpus callosum adjacent to the right frontal horn as well as along the inferior aspect of the callosal splenium on the. Additional periventricular lesion is seen adjacent to the right temporal horn. Asymmetric FLAIR hyperintensity along the right medial aspect of the right middle cerebellar peduncle is also unchanged. Allowing for slight differences in technique, there is no definite evidence of a new lesion compared to prior MRI from 1/21/2014. Brain parenchymal volume is preserved. T1 hyperintensity is noted associated with the right frontal and right medial temporal lesions. No intracranial mass or mass effect is identified. Ventricles and sulci are within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable.Thoracic spine: There are multiple T2/STIR hyperintense lesions in the thoracic cord. There is a lesion involving the left hemicord at the T5 level with mild associated volume loss and present previously. Small lesion is suspected at the left dorsal T1 level, not definitively seen on prior study. There is a small left T3-T4 lesion which appears to be present on prior. There is a lesion extending from T6 to T7 levels not definitively seen on prior.Vertebral body heights and alignment in the thoracic spine are normal. Minimal degenerative changes are seen without significant spinal canal or neural foraminal stenosis. Small left paracentral disc protrusion at the T5 level is noted.Partially imaged cervical spine demonstrates diminished changes with multiple disc bulges at C3-C4, C4-C5, C5-C6, and C6-C7. There is moderate associated associated canal stenosis.

Output: 1. Multiple T2/FLAIR hyperintense lesions including the juxtacortical and periventricular white matter as described above are not significantly changed allowing for slight differences in technique compared to 1/21/2014. The morphology and distribution of these lesions is consistent with known demyelinating disease. No new lesion is definitively appreciated in the brain.2. Multiple T2/STIR hyperintense lesions in the thoracic cord consistent with known demyelinating disease. Left T5 lesion was seen on prior studies and is associated with mild volume loss. There are additional smaller lesions, which are described above, not definitively seen on prior, and suspected to represent progression of disease since 1/21/2014.3. Degenerative changes in the cervical spine with multiple disc bulges including C3-C4, C4-C5, C5-C6, and C6-C7. There is at least moderate associated spinal canal stenosis, which can be better assessed with a dedicated cervical spine MRI study.


Instruction: Generate impression based on findings.

Input: Brachial neuritis or radiculitis. Intermittent right C4 radiculopathy The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There are right sided uncovertebral osteophytes at this level associated with disk material which narrow the right neural foramen and encroach on the right sided exiting nerve roots. T1 signal hyperintensity with minimal T2STIR hyperintensity adjacent to the right sided uncovertebral hypertrophy suggests chronic stage of endplate reaction possibly with a minor subacute component.At C5-6 there is no significant compromise to the spinal canal. There are subtle right sided uncovertebral osteophytes at this level associated with adjacent T2 STIR hyperintensity and T1 hypointensity suggesting subacute stage of inflammatory reaction. There is mild narrowing of the right neural foramen. There is minimal posterior ligamentous hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are uncovertebral osteophytes at C4-5 encroaching the right sided exiting nerve roots (right C4 nerve roots) with associated with chronic and possibly some subacute inflammatory changes.2.There is mild narrowing of the right neural foramen at C5-6 associated with subacute inflammatory change (more inflammatory change than at C4-5 but smaller osteophytes).


Instruction: Generate impression based on findings.

Input: 60 year old with coronary artery disease s/p PCI, HTN, dyslipidemia, smoking history and peripheral artery disease presenting for evaluation for ischemia. MEDICATIONS: aspirin, amlodipine, atorvastatin, carvedilol, hydrochlorothiazide First Pass PerfusionDuring hyperemia, there were perfusion defects present in the (1) apical anterior, septal, and inferior walls; (2) mid inferior, inferoseptal, anteroseptal, anterior, and anterolateral walls; (3) and in the basal anterior, anterolateral, inferior and inferoseptal walls.Viability/ Myocardial ScarThere are 3 distinct areas with late gadolinium enhancement. The first is a non-transmural myocardial infarction involving the basal to mid inferoseptum, this territory has an intermediate probability of viability. The second is a non-transmural myocardial infarction involving the mid to apical anterior wall, this territory has an intermediate probability viability. The third is a transmural patch of late gadolinium enhancement in the basal inferolateral wall. Because the late gadolinium enhancement is associated with hypertrophy rather than thinning, it is likely not due to a myocardial infarction and suggests the presence of an infiltrative or inflammatory process. This territory is also not likely to be viable. The remainder of the myocardium (which is a substantial amount of myocardium) is free of late gadolinium enhancement and likely to be viable. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function with moderate concentric left ventricular hypertrophy. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 149 ml/m2 (normal range: 74+/-15), the LVEDV is 336 ml (normal range 142+/-34), the LV end systolic volume index is 87 ml/m2 (normal range 25+/-9), the LVESV is 195 ml (normal range 47+/-19), the LV mass index is 98 g/m2, and the LV mass is 222 g. There is global hypokinesis which is worst in the basal to mid inferior wall. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 77 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 mild 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. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall (<1mm) axillary lymph nodes present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is an extensive amount of ischemia in a multi-vessel coronary distribution as described above. 2. There is an extensive amount of myocardial viability. Aside from the two above described non-transmural myocardial infarctions, much of the remainder of the myocardium is viable.3. There is an atypical pattern of late gadolinium enhancement involving the basal inferolateral wall suggesting the presence of a concomitant non-ischemic (possibly infiltrative or inflammatory) myocardial process.4. Severe LV dilation with mildly reduced systolic function (LVEF 42%) with global hypokinesis, most pronounced in the basal to mid inferior wall.5. Normal RV size with mildly reduced systolic function (RVEF 48%).6. Severe left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 18-year-old female with previously treated right forearm venous malformation, now with recurrent symptoms. Question recanalized malformation versus persistent anomalous vessels. There is a lesion extending from the mid distal anterolateral aspect of the forearm to the proximal first carpal row with an exuberantly serpiginous and dilated appearance. This lesion measures approximately 2.0 x 2.2 cm (series 6, image 21) and 15.2 cm long (series 4, image 15). The lesion contains increased T2 signal and decreased T1 signal and enhances after contrast administration, suggestive of a vascular or lymphatic malformation. There appears to be infiltration into the superior and deep muscles of the forearm. The lesion also traverses through the flexor tendons, for example completely surrounding the flexor pollicis longus tendon (series 6, image 14).

Output: Vascular or lymphatic malformation of the mid distal forearm to the proximal carpal bones.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with intractable headache. Approximately 10 T2 hyperintense lesions are identified located predominantly in the periventricular regions and corpus callosum, though there are several in the juxtacortical white matter as well. The largest lesion is within the left centrum semiovale. Several lesions demonstrate a radial orientation with respect to the ventricles. The remainder of the brain demonstrates relatively normal morphology. No evidence of significant parenchymal edema or mass effect is seen. Overall parenchymal volume is within acceptable limits. No abnormal extra-axial collections are detected. The ventricular system is normal in size and morphology.On MRA imaging of the head, no significant intracranial vascular stenosis or occlusion is identified. No aneurysms are suspected. The region of the ACOM artery is within normal limits. Large bilateral PCOM arteries are seen. The right P1 segment is hypoplastic.

Output: 1. Multiple white matter lesions are seen with a distribution and morphology which are highly suggestive of demyelinating disease, though other etiologies including gliosis, sequelae of prior inflammation, and vasculitis can be entertained.2. No significant vascular abnormality is detected.3. No prior examination is available at the time of this dictation. If prior exams can be made available, we will be happy to compare and make an addendum to this report.


Instruction: Generate impression based on findings.

Input: Neck and arm pain, C6 distribution weakness, left upper extremity. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis with apex at the C4-C5 level. Alignment is otherwise maintained. There is nonspecific subcentimeter focus of low T1 and T2 signal involving the anterior inferior aspect of the C6 vertebral body with adjacent T2 hyperintensity which may be on a degenerative basis but not well evaluated by MRI.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex with mild effacement of the ventral thecal sac. There is moderate narrowing of the left neural foramen related to uncovertebral hypertrophy and facet arthropathy. Overall no significant spinal canal or right neural foraminal stenosis.C4-5: Small disc osteophyte complex with effacement of the ventral thecal sac. There is mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. Overall no significant stenosis of the spinal canal or right neural foramen.C5-6: Small disc osteophyte complex with effacement of the ventral thecal sac. There is mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy and minimal right neural foraminal narrowing. Overall no significant spinal canal stenosis.C6-7: Small disc osteophyte complex with partial effacement of the ventral thecal sac. There is mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy. Overall no significant spinal canal stenosis or right neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine. There is varying mild to moderate degrees of neural foraminal narrowing on the left as detailed above.2. There is partial effacement of the ventral thecal sac related to small disc osteophyte complexes and reversal of cervical lordosis. Dorsal thecal sac remains patent without significant spinal canal stenosis overall at any level.


Instruction: Generate impression based on findings.

Input: 40yoF with congenital nystagmus, episodical tinnitus, history of 3.5 month prematurity presenting with dizziness episodes and has upper motor neuron signs on The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. The pituitary stalk measures up to 2 mm in thickens. There is no diffusion abnormality. There is no acute intracranial hemorrhage. No extra-axial fluid collection is identified.The meatal loop of the right anterior inferior cerebellar artery extends far into the right internal auditory canal. The bilateral vestibulocochlear nerves are intact.

Output: 1. Normal non contrast brain MR.2. The meatal loop of the right anterior inferior cerebellar artery extends far into the right internal auditory canal.3. The pituitary stalk is at the upper limit of normal for thickness.


Instruction: Generate impression based on findings.

Input: 58 year old female. Right breast lumpectomy in 2/2001 for invasive mammary carcinoma. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable postsurgical scarring in the right breast upper outer quadrant. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 78 years Female (DOB:6/5/1937)Reason: evaluate for radiculopathy History: right sciatica, chronic and severePROVIDER/ATTENDING NAME: REEM H JAN DAVID L PITRAK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is mild loss of vertebral body height at L2 and L1. There is some superior endplate compression at L2. These mild compressions were also present on the CT of the abdomen from 11/25/2014 and do not appear to have changed. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. There is encroachment of the nerve roots at the lateral recesses. There is narrowing of the neural foramina as a result of disc material which is worse on the right side where there is encroachment of the right-sided exiting nerve roots within the neural foramina. There are endplate reactive changes at this level which are bright on T2 and dark on T1 suggestive of subacute change.At L4-5 there is loss of disc space height, disc desiccation and a diffuse disc bulge. There are endplate reactive changes which are bright on T1 and T2 at this level. This suggests chronic change. There is bilateral facet and ligamentum flavum hypertrophy at this level. There is effacement of the fat at the lateral recesses bilaterally at this level. Overall there is a moderate degree of spinal stenosis present. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with ligamentum flavum hypertrophy. Is no significant compromise to the spinal canal or neural foramina. There is mild narrowing of the spinal canalAt L2-3 there is no significant compromise to spinal canal or neural foramina. There are Schmorl's nodes at this level. There is some mild loss of disc space height, disc desiccation and diffuse disc bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple cysts present in both kidneys. Some of them have low signal intensity on T1 and some are heterogeneous.

Output: 1.There are multilevel degenerative changes present in the lumbar spine with moderate spinal stenosis at L4-5 and encroachment of the right-sided exiting nerve roots at L5-S1. There are subacute endplate reactive changes present at L5-S1.2.There is mild loss of vertebral body height at L2 and L3 which has been present on prior exams3.Multiple renal cystic lesions are present. Some are suspected to contain blood products. Please refer to ultrasound from 3/29/2016 for further comments.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoDiagnosis Edits: Clinical question: low back painSigns and Symptoms: low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a conjoined right-sided nerve root sleeve present at this level. There is a left far lateral disc protrusion at this level which displaces the left-sided exiting nerve root as it exits the neural foramen. Compared to the previous exam this has not changed substantially. There is a subtle pars defect on the right side at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and endplate reactive change present at this level. There is a broad-based right far lateral disc protrusion at this level which mildly displaces the right-sided exiting nerve root after it exits the neural foramen. Overall these findings have not changed since the prior examAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lumbar spine which are stable when compared to the exam from last year. There are far lateral disc protrusions on the left side at L5-S1 and on the right side at L4-5 which mildly displaces the exiting nerve roots as the exit their respective neural foramina.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass, or cerebral edema. There are scattered periventricular and subcortical white matter T2 hyperintensities which are nonspecific, and likely represent chronic microvascular ischemic changes. The ventricles and basal cisterns are unchanged with apparent absence of the septum pellucidum. The optic chiasm and the optic nerves appear diminutive, most prominent the left optic nerve. The corpus callosum is fully formed, however there are focal areas of thinning best appreciated on the sagittal images. These findings suggest presence of a midline developmental anomaly, such as septo-optic dysplasia.There is no midline shift or herniation. There are few mucous retention cysts in the nasal cavity. The skull and extracranial soft tissues are unremarkable.

Output: 1.No acute infarct or mass effect.2.Mild chronic microvascular ischemic changes.3.Findings suspicious for septo-optic dysplasia.


Instruction: Generate impression based on findings.

Input: 70 year old man with history of recent diagnosis of cardiomyopathy with EF of 20% and no obstructive coronary disease by angiography, now referred for cardiac MRI to assess for possible etiologies as part of an advanced HF therapies evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 194 ml/m2 (normal range: 74+/-15), the LVEDV is 438 ml (normal range 142+/-34), the LV end systolic volume index is 163 ml/m2 (normal range 25+/-9), the LVESV is 368 ml (normal range 47+/-19), the LV mass index is 99 g/m2 (normal range 85+/-15), and the LV mass is 224 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is transmural late gadolinium enhancement in the inferoapical, anteroapical and true apex with thinning suggestive of previous infarction. There is transmural late gadolinium enhancement in the basal inferolateral wall. There is no LV thrombus. In a 4-chamber view there outpouching at the apex compatible with apical aneurysm. Left AtriumThe left atrium is severely dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. There is severe hypokinesia of the apical one half of the right ventricle. The basal one half demonstrates moderate to severe hypokinesia. The overall RV ejection fraction is 13%, the RV end diastolic volume index is 157 ml/m2 (normal range 82+/-16), the RVEDV is 355 ml (normal range 142+/-31), the RV end systolic volume index is 136 ml/m2 (normal range 31+/-9), and the RVESV is 307 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflets are tethered. There is at least moderate mitral regurgitation which appears eccentric. Pulmonic ValveThe pulmonic valve opens widely. There is pulmonary regurgitation, visually this appears trace or mild.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta measures 37mm at the level of pulmonary artery bifurcation. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated (38mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere are bilateral shoulder prostheses present. A portion of the splenic flexure is visualized. There is evidence of diverticulosis without diverticulitis.

Output: 1. Severely dilated left ventricle with severely reduced systolic function (EF = 16%). 2. There is thinning of the apex with transmural late gadolinium enhancement suggestive of previous infarction. This speaks to an ischemic component to his cardiomyopathy. 3. Suspected left ventricular apical aneurysm. 4. Severely dilated right ventricle with severely reduced systolic function (EF = 13%).5. Mitral leaflet tethering with at least moderate mitral regurgitation. 6. Dilated pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of diarrhea and abdominal pain, evaluate small bowel for evidence of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small and large bowel are normal in caliber without evidence of obstruction. There is increased fibrofatty proliferation involving the proximal small bowel mesentery. An approximately 6 cm segment of terminal ileum demonstrates mild luminal narrowing without upstream bowel dilation, mild bowel wall thickening, restricted diffusion, and mildly increased wall enhancement compatible with active inflammation. The remaining small and large bowel are unremarkable in appearance. No fistula or fluid collections are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild stenosis and active inflammation involving an approximately 6 cm segment of terminal ileum without associated obstruction.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of bladder, unspecified Joint derangement, unspecifiedClinical question: 69 y/o female with met urothelial cancer, c/o finger locking, new visual deficit. EvaluateSigns and Symptoms: finger locking, numbness in hand, visual deficit MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No evidence for brain metastases.3.No orbital mass or lesion along the visual pathway is appreciated.


Instruction: Generate impression based on findings.

Input: Clinical question: 69-year-old male with head/neck cancer; evaluate for metastases or any abnormality. Signs and symptoms: Confusion. Pre-and post enhanced brain MRI:No acute intracranial process and negative diffusion-weighted images.Examination demonstrates few tiny foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres which are nonspecific and demonstrate no enhancement. This appearance however often represent microvascular ischemic changes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is within normal otherwise. Examination also fail to demonstrate any abnormal enhancement of brain parenchyma, meninges, calvarium or the retropatellar spaces to suggest metastatic disease.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and within normal pattern of enhancement.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Findings suggestive of minimal chronic small vessel ischemic strokes.3.Unremarkable pre and post enhanced brain MRI otherwise and in particular without evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for foraminal stenosis and disk protrusion. Signs and symptoms: Right foot numbness and pain. Nonenhanced lumbar MRI:T12 -- L1 demonstrate mild changes unremarkable otherwise.L1 -- L2 demonstrate mild degenerative changes and unremarkable otherwise.L2 -- L3 demonstrate mild this disease and mild to moderate bilateral ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk disease and moderate bilateral ligamentum flavum hypertrophy. No spinal stenosis or neuroforaminal compromise.L4 -- L5 demonstrate advanced disk disease with significant loss of disk height, significant right and moderate left ligamentum flavum hypertrophy and mild facet disease. There is no convincing evidence of central spinal stenosis. Asymmetric right-sided ligamentum flavum hypertrophy protrudes into the right neural foraminal with resultant moderate foraminal compromise. Patent left neural foramina.L5 -- S1 demonstrate moderate disk disease and loss of disk height, moderate left facet and moderate bilateral ligamentum flavum hypertrophy. There is a broad-based central and rightward disk protrusion projecting into the epidural space and without significant mass effect on the thecal sac. It results in significant right lateral recess compromise. There is also moderate bilateral neural foraminal compromise secondary to hypertrophic changes of posterior elements.

Output: 1.Degenerative changes primarily centered at L4 -- 5 and L5 -- S1 levels however without evidence of central spinal stenosis. There are moderate bilateral neural foraminal compromise at L5/S1 level and a broad-based central and rightward disk protrusion with resultant significant right lateral recess compromise. Moderate right neuroforaminal compromise at L4 -- 5. 2.Mild degenerative changes at other levels as detailed per level above.


Instruction: Generate impression based on findings.

Input: 59 year old male with history of sarcoid by LN biopsy, aortic aneurysm repair s/p repair who presents for cardiac MRI for further evaluation of cardiac sarcoid involvement. Left VentricleThe left ventricle is normal in size and systolic function. No significant interval change is noted when compared to the previous cardiac MRI. The overall LV ejection fraction is 63% (compared to 61%), the LV end diastolic volume index is 85 ml/m2 (normal range: 74+/-15), the LVEDV is 198 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is linear, mid-myocardial late gadolinium enhancement in the basal inferior wall to suggest an underlying fibrosing, infiltrative, or inflammatory process. No intracardiac thrombus.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 43 % (compared to 46%), the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 237 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 135 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 trace 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 common origin of the innominate and left common carotid arteries. There has been a valve sparing interposition graft procedure. The anastomosis appears to terminate at the expected location of the sinotubular junction. The sinus of Valsalva is mildly dilated, stable at 44 mm using similar measurement technique by the same observer (nonorthogonal/axial technique). Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsLow lung volumes with perihilar increased signal compatible with patient's known pulmonary involvement with sarcoidosis. Stable perihilar lymphadenopathy. Splenomegaly.On the coronal scout images, a portion of the kidneys are included in the field-of-view. There is a right renal cyst with apparent solid exophytic component measuring 15 mm. Further evaluation with a dedicated renal ultrasound is recommended.

Output: 1. The left ventricle remains normal in size and systolic function (LVEF 63%, compared to 61%)2. The right ventricle remains normal in size and systolic function (RVEF 43%, compared to 46%)3. Stable linear, mid-myocardial late gadolinium enhancement in the basal inferior wall suggestive of myocardial involvement with sarcoidosis. 4. Postsurgical changes compatible with valve sparing interposition graft procedure of the ascending aorta. Stable ectasia of the sinus of Valsalva.5. On the coronal scout images, a portion of the kidneys are included in the field-of-view. There is a right renal cyst with apparent solid exophytic component measuring 15 mm. Further evaluation with a dedicated renal ultrasound is recommended. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache, migraine. MRI: The anterior portions of the images are somewhat degraded by dental brace artifacts. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. MRA: There is no evidence of significant proximal steno-occlusive lesions or aneurysms.

Output: 1. No evidence of intracranial demyelinating process, infectious lesions, or acute infarct, within the limits of dental brace artifacts.2. No evidence of significant steno-occlusive cerebrovascular lesions or aneurysms.


Instruction: Generate impression based on findings.

Input: Diagnosis: Slurred speechClinical question: strokeSigns and Symptoms: stroke MRI of the brainThere is a hematoma centered in the right frontal lobe involving the right middle and inferior frontal gyri which is associated with a vasogenic pattern of edema. There is shift of the septum pellucidum approximately 7 mm to the left of midline.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are punctate foci of T2 and FLAIR signal hyperintensity present in the brainstem.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.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.There is a large hematoma centered in the right frontal lobe associated vasogenic edema and midline shift.2.Periventricular and subcortical white matter punctate lesions of a mild degree and punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 3.There is no evidence for dural venous sinus thrombosis to explain the patient's hemorrhage.4.Etiology for the patient's right frontal lobe hemorrhage cannot be established on this exam. It's possible that an underlying mass or other cause may be masked by the sheer size of the hematoma.


Instruction: Generate impression based on findings.

Input: Reason: pt with adenoid cystic carcinoma. Evaluate for brain metastasis History: headache, nausea The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left temporal bone surgery and left parotid surgery. Some enhancing tissue at the surgical site was present on prior CT exams and is suspected to represent postoperative change.There is mild asymmetric enhancement along the left facial nerve compared to the right. Both left and right enhance to the same extent. The left look slightly thicker.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.

Output: 1.Some mild asymmetry in the enhancement along the left facial nerve may be related to postoperative change in the venous plexus but is non-specific. The possibility it represent early perineural spread cannot be excluded. Please correlate with clinical findings of the left facial nerve and if appropriate, a follow-up MRI would be helpful.2.The patient is status post left temporal bone surgery and left parotid surgery. Some enhancing tissue at the surgical site was present on prior CT exams and is suspected to represent postoperative change.3.No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: Reason: 20 y.o. female with likely new onset ileal Crohn's disease. Please eval for signs of small bowel Crohns disease as well as abscess formation. Abd XR suspicious for obstruction. History: N/V with colonoscopy prep, abd XR concerning for SBO ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an approximately 15 to 20 cm segment of narrowing with hyperenhancement and bowel wall thickening, likely corresponding to acute inflammation of a strictured segment. This segment of bowel and is approximately 10 cm from the ileocecal valve. The distal 10 cm of terminal ileum appear normal. Proximal to this segment of narrowing, there is severe small bowel dilatation up to 7.2 cm, consistent with obstruction. A large amount of stools present within the colon.Small mesenteric lymph nodes are noted. No abscesses or fistulas are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Narrowed 15 to 20 cm segment of distal ileum which ends 10 cm proximal to the ileocecal valve likely represents acute on chronic inflammation from Crohn's disease with stricture formation.2.Severely dilated and fecalized proximal small bowel, consistent with high-grade obstruction.Findings discussed with Dr. Rao at 4:30 PM on 5/12/2016.


Instruction: Generate impression based on findings.

Input: Diagnosis: Localized swelling, mass and lump, head Essential (primary) hypertensionDiagnosis Edits: |Clinical question: HISTORY OF RIGHT MANDIBLE MASSSigns and Symptoms: HISTORY OF RIGHT MANDIBLE MASS Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.There is a mass centered in the right mandible associated with contrast enhancement and some mild enlargement. There is disruption of the cortex along the right anterior lateral aspect of the mass with some mild protrusion of the mass through this defect. Masses high signal on T2 and low signal on T1 and without diffusion restriction. No flow voids are identified within the mass to suggest arteriovenous malformation.Within the visceral space the thyroid gland demonstrates multiple small nodules the largest one of which measures 9 x 12 mm axial dimensions. It is high signal on T2 and relatively lower signal on T1. The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. There are patchy high signal foci on T2 imaging in the brainstem which are most likely vascular related. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are multilevel degenerative changes present in the cervical spine with reversal of the normal cervical curvature at C3-4, loss of disc space height, disc desiccation and endplate and uncovertebral osteophytes resulting in encroachment of right-sided exiting nerve roots at C6-7 and C5-6 and some narrowing of the spinal canal due to endplate osteophytes at C3-4, C4-5 and C5-6 .MRA neck:The right inferior alveolar artery is asymmetrically larger than the left side and courses along the superior aspect of the mass. No convincing evidence for arteriovenous malformation. The anterior aspect of the mandible was not included on this exam.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is fetal origin of the right posterior cerebral artery.

Output: 1.An expansile mass along the right mandible suspected represent a hemangioma. There is a small amount of extraosseous extension along the right anterolateral aspect of the mass. However, the entire mandible was not included on the MR angiogram. As a result of the convenience of the patient and noncontrast MRA of the mandible with specific attention this area would be helpful.2.Multiple thyroid nodules.3.Multilevel degenerative changes are present in the cervical spine.


Instruction: Generate impression based on findings.

Input: 12-year-old male status post liver transplant 4/2015. Chronic elevation of transaminases with nodular contour of the liver seen on recent ultrasound. Evaluate for bile duct abnormalities and liver morphology.EXAMINATION: MRI MRCP with and without intravenous contrast 12/13/2016 The intrahepatic bile ducts are very straight. Focal narrowing of the common bile duct (series 901, image 55) with no intra or extrahepatic biliary ductal dilatation. The common bile duct proximal and distal to this area of narrowing measures 5 mm in caliber, normal.The liver demonstrates normal signal intensity. No focal hepatic lesions.The spleen is normal.The pancreas is normal.The adrenal glands are normal.The kidneys are normal.No free fluid.The soft tissues are normal.The lung bases are normal.Bone marrow signal intensity is normal.

Output: Focal narrowing of the common bile duct with no intra or extrahepatic biliary ductal dilatation. This may be related to stenosis and a noncompliant biliary tree.


Instruction: Generate impression based on findings.

Input: Assess prepontine cistern for tuberculosis: history of potential TB meningitis, incompletely treated meningitis recently finished therapy. Now persistent headaches and photophobia. There is interval progression of leptomeningeal enhancement along the surface of the pons, medulla, basal cisterns, and along the surface of the cerebellum. There is also interval progression of high T2 signal with punctate foci of enhancement and mild susceptibility effect in the medial left thalamus. There are also scattered punctate foci in the white matter of the bilateral cerebral hemispheres, which are stable to perhaps slightly more conspicuous in some cases. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. There is redemonstration of an ovoid enhancing lesion in the right frontal calvarium that measures up to 12 mm, without associated soft tissue swelling.

Output: 1. Interval progression of leptomeningeal enhancement along the surface of the pons, medulla, basal cisterns, and along the surface of the cerebellum, which may represent tuberculous meningitis.2. Interval progression of high T2 signal with punctate foci of enhancement in the medial left thalamus may represent evolving tuberculous cerebritis. 3. Mild bilateral cerebral white matter hyperintensities are nonspecific.4. A right frontal calvarial lesion is nonspecific, but may also represent a manifestation of tuberculosis versus an atypical hemangioma. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari malformation, status post decompression. Syrinx and developmental delay. Brain MRI:There is no abnormal diffusion restriction. A few prominent perivascular spaces are again noted in the brain. No abnormal signal to suggest a developmental abnormality is evident in the supratentorial brain. Stable postoperative changes of suboccipital craniectomy and removal of the posterior arch of C1 with resultant expanded CSF space at the foramen magnum. The cerebellar tonsils have a rounded/uncrowded morphology. Stable mild platybasia, dorsi flexion and invagination of the dens. The ventricles are stable in size with normal configuration.CSF flow study:There is good, stable to slightly improved, biphasic flow demonstrated anterior and posterior to the upper cervical cord. At the foramen magnum, flow remains attenuated anteriorly and barely detectable posteriorly. Cervical spine MRI:Examination demonstrates further interval decreased size of cervical syrinx with resultant decreased caliber of cervical cord. The largest AP axis of the most expanded component of cervical syrinx is at C6-7 measuring 2.8 mm compared to prior study at this level of 8.7 mm.The vertebral body heights and alignments are maintained. No suspicious bone marrow signal abnormality is identified in the cervical spine. Intervertebral discs demonstrate normal height and signal. No significant spinal canal or neural foraminal narrowing is evident.Thoracic spine MRI:There has again been significant interval decreased size of the thoracic syrinx. The largest AP axis of syrinx in the upper thoracic spinal cord measures approximately 2 mm compared to prior study measurement of 5.6 mm. The syrinx does still extending to the level of the T10 vertebral body. The vertebral body heights and alignments are maintained. No suspicious bone marrow signal abnormality is identified in the thoracic spine. Intervertebral discs demonstrate normal height and signal. No significant spinal canal or neural foraminal narrowing is evident.

Output: 1.Postoperative changes related to Chiari decompression surgery are redemonstrated. Decompressed posterior fossa contents with stable to slight interval improvement in CSF flow along the upper cord, and stable attenuated flow through the foramen magnum. 2. Significantly decreased syrinx caliber in both the cervical and thoracic regions.


Instruction: Generate impression based on findings.

Input: Right lower extremity pain, evaluate for right L5-S1 synovial cyst. Radiculopathy. There are small disc bulges and facet hypertrophy at L4-5 and L5-S1 with up to mild to moderate right L4-5 neural foraminal narrowing, but no significant spinal canal stenosis. The vertebral column alignment is within normal limits. There is mild loss of anterior vertebral body height of T12, with a superior end plate disc herniation, which is unchanged since October 2014. The disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a subcentimeter sacral perineural cyst. There are bilateral probable inferior renal cysts.

Output: Degenerative spondylosis at L4-5 and L5-S1 with up to mild to moderate right L4-5 neural foraminal narrowing, but no significant spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 23-year-old male patient with history of tuberous sclerosis, evaluate for angiomyolipoma.EXAMINATION: MR renal protocol with and without contrast. ABDOMEN:LIVER, BILIARY TRACT: Layering gallstones noted without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Reference exophytic lesion in the left mid kidney (series 501 image 21) currently measures 1.7 x 1.8 cm, previously 2.7 x 2.7 cm and now has a more discrete region of T2 hypointensity compared to prior examination. This lesion does not demonstrate enhancement and does not contain fat on in and out of phase images.A lesion in the mid/inferior pole of the left kidney again demonstrates fat on in and out of phase imaging and currently measures 2.0 x 1.3 cm (series 401 image 22).Multiple T1 and T2 hypointense lesions are noted in the kidneys bilaterally, which may represent hemorrhagic cysts. Many T2 hyperintense renal cysts are noted bilaterally, measuring up to 2.3 cm in the inferior pole of the right kidney, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Exophytic lesion in the mid left kidney has decreased in size compared to prior examination and does not contain fat. Recommend continued follow up of this lesion.2.Angiomyolipoma in the mid/inferior pole of the left kidney is unchanged in size.3.Numerous bilateral renal cysts.4.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Gowing right parotid mass, please evaluate. There is a relatively well-defined, enhancing mass in the deep left parotid gland that measures up to 15 mm. There is no gross evidence of perineural tumor extension. There is no evidence of cervical lymphadenopathy. The right parotid and bilateral submandibular glands, thyroid gland, and upper aerodigestive tract appear to be unremarkable. There is multilevel degenerative cervical spondylosis. There are multiple T2 hyperintense lesions in the cervical spinal cord, brainstem, and cerebellum.

Output: 1. A mass in the deep left parotid gland that measures up to 15 mm may represent a salivary neoplasm, such as a pleomorphic adenoma.2. Demyelinating lesions in the cervical spinal cord, brainstem, and cerebellum are better delineated on the recent brain and cervical spine MRI.


Instruction: Generate impression based on findings.

Input: Acute hypoxic event at birth. Evaluate brain structures. There is no evidence of intracranial hemorrhage, mass or edema. There is diffuse low attenuation in the subcortical tissues consistent with unmyelinated brain tissue, an expected finding given the patient's age. There are no CT findings of hypoxic injury -- if clinical concern remains recommend noncontrast MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Unremarkable brain CT. If clinical concern remains for hypoxic injury, recommend noncontrast MRI.


Instruction: Generate impression based on findings.

Input: right lower extremity weakness and numbness There is linear diffusion restriction lesion on the left lower pons without evidence of susceptibility artifacts indicating acute ischemic infarction without hemorrhagic transformation.Previously seen diffuse patchy high signal intensities on pons on FLAIR images are not shown on today's scan indicating resolution of possible central pontine myelinolysis.Scattered high signal intensities on bilateral periventricular white matters on FLAIR images indicate 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. 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. Acute ischemic infarction without hemorrhagic transformation on the lower pons, left side.2. Resolution of possible findings of central pontine myelinolysis since prior exam.3. No change of non specific small vessel disease.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with stage IV lung cancer and ongoing upper back pain. Mild compression of the T1 vertebral body is seen with approximately 20% loss of vertebral body height. Mild edema is seen along the superior endplate more than the inferior endplate with edema also evident in the left T1 pedicle and lamina. On postcontrast images, enhancement is seen in a pattern similar to that of the edema.The anterior paravertebral soft tissues around the T1 level are thickened and edematous. Particularly on the left, there is a well defined area of soft tissue thickening which measures 12 x 12 mm transaxial and up to 33 mm in the craniocaudal dimension.The remaining vertebral bodies demonstrate relative preservation of height allowing for endplate irregularity throughout the cervical region. Spinal alignment is anatomic. No other pathologic marrow signal or enhancement is seen.The spinal cord demonstrates normal signal intensity throughout. Details of cord morphology will be discussed by level below.C2-3: Mild facet hypertrophy. Minimal disk osteophyte complex. No significant spinal canal or neuroforaminal stenosis. C3-4: Facet hypertrophy. Posterior disk osteophyte. Mild generalized spinal canal stenosis with mild flattening of the ventral cord. No cord signal abnormality. Mild left foraminal narrowing.C4-5: Facet hypertrophy. Mild posterior disk osteophyte. Mild generalized spinal canal stenosis without definite cord deformation. Moderate right and mild left foraminal narrowing. C5-6: Facet hypertrophy. Posterior disk osteophyte asymmetric to the left. Mild generalized spinal canal narrowing without definite cord deformation. Severe left and moderate right foraminal narrowing.C6-7: Facet hypertrophy. Mild posterior disk osteophyte. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. C7-T1: Facet hypertrophy worse on the left. No significant spinal canal stenosis. Moderate left foraminal narrowing.Multiple pulmonary nodules are visualized in the lung apices.

Output: A mild compression deformity of the T1 vertebral body is seen with associated edema and enhancement. Also noted is inflammation in the anterior paravertebral soft tissues adjacent to T1 with a more mass-like soft tissue lesion on the left. The constellation of findings is suspicious for metastatic involvement of the T1 vertebral body and possibly the adjacent anterior paravertebral tissues. A benign process is considered much less likely.


Instruction: Generate impression based on findings.

Input: Evaluate/monitor for neurovascular assessment. The current invasive squamous cell cancer concern for sinus/skull/left ORBIT/current artery. CTA of intracranial circulation:45 cc of Omnipaque 350 is administered for this exam.Vertebral -- basilar system.Taken bilateral vertebral arteries, basilar artery, posterior cerebral arteries and superior cerebellar arteries. It is some mild intracranial atherosclerotic disease with moderate to severe compromise of the origin and proximal portion of the right superior cerebellar artery and high-grade stenosis of the perimesencephalic component of right superior cerebellar artery. Atherosclerotic irregularity of basilar artery and posterior cerebral arteries with no vascular lumen compromise. There is no evidence of tumor involvement/encasement of these vasculature from patient's known skull base destructive tumor.Right internal carotid is patent across the skull base and mid neuritis of compromise of the lumen or encasement by tumor in the skull base. The right anterior and middle cerebral arteries and their branches are well visualized and unremarkable. There is hypoplastic right A1 segment of anterior cerebral artery. There is a single trunk of the anterior subdural tree beyond the anterior communicating level consistent with azygos anterior cerebral artery.Left internal carotid artery demonstrate slight decreased in its caliber is pre-cavernous and its posterior genu within the cavernous sinus. This appears to be result of extension of tumor into the left cavernous sinus which applies to mass effect on the left internal carotid artery anteriorly. In the left internal carotid artery proximal and distal to these segments demonstrate normal caliber. There is no evidence of high-grade stenosis of the muscle and no areas of an aneurysm is identified. Cavernous carotids demonstrate heavy calcifications bilaterally. The branches of left anterior and middle cerebral arteries are unremarkable. There are no posterior communicating arteries visible.  Nonenhanced head CT:Examination demonstrates a large destructive mass in the skull base primarily on the left however with extension across the midline to the right side. The tumor destruction involves the left carotid canal and left cavernous sinus. There is also extensive postoperative changes of left maxillary sinus left nasal cavity, sphenoid sinus. These findings were described more in detail on prior CT of soft tissues of neck.Images through the intracranial space demonstrate no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.There is evidence of minimal periventricular low attenuation of the left posterior frontal -- parietal which was noted on prior MRI exam. Bilateral posterior frontal cortical and subcortical low attenuation likely local small old strokes are again identified and unchanged since prior MRI exam.

Output: 1.Non-infused head CT demonstrate no evidence of acute intracranial process. Small areas of encephalomalacia of bilateral posterior frontal -- parietal lobes remains stable since prior MRI exam. Extensive destructive bony lesion of the skull base with involvement of left cavernous sinus and left carotid canal is partially visualized on this exam.2.CTA of intracranial circulation demonstrate minimal compromise of the lumen of the pre-cavernous left internal carotid artery as well as posterior genu of left internal carotid artery. There is no evidence of any vascular aneurysm or any significant compromise of any intracranial vasculature secondary to tumor encasement. There is evidence of intracranial atherosclerotic disease with moderate stenosis at the origin of the right superior cerebellar artery and perimesencephalic component of left superior cerebellar artery. Minimal atherosclerotic vascular irregularity of other intracranial vasculature with no hemodynamically significant stenosis. There is azygos anterior cerebral artery as described above.