Instruction: Generate impression based on findings.

Input: Sensory neuropathy legs to nipple and dysmetria. Assess for myelitis. Cervical:Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning areas of marrow replacement or marrow edema are seen. The pattern of marrow enhancement is within normal limits.The visualized spinal cord shows normal signal intensity and caliber. There is no abnormal enhancement involving the cervical cord. There is minimally increased epidural enhancement C6-C7 level similar to prior and on a degenerative basis. Mild degenerative changes in the cervical spine are again seen and are unchanged. Individual levels as below.C2-3: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Facet hypertrophy.C3-4: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Mild facet arthropathy.C4-5: No significant disk degeneration, spinal canal stenosis or neuroforaminal narrowing. Mild facet arthropathy.C5-6: Mild disk height loss and osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Mild facet arthropathy.C6-7: There is loss of disk height, disk osteophyte complex and uncovertebral hypertrophy on the left with mild to moderate narrowing of the left neural foramen. There is partial effacement of the ventral thecal sac and minimal spinal canal stenosis. No significant right neural foraminal narrowing. There is mild facet arthropathy.C7-T1: No significant disk degeneration, spinal canal or neuroforaminal stenosis. Mild facet arthropathy. Thoracic:The thoracic spine is in normal alignment with a normal thoracic kyphosis. There are minimal degenerative changes; the vertebral body and disk heights are otherwise well maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.Mild apparent patchy T2 signal in the mid to lower thoracic cord is most likely artifactual. No abnormal cord signal or abnormal enhancement is seen. Paraspinous soft tissue structures in the thoracic spine are unremarkable.

Output: 1. No abnormal signal in the cervical cord or abnormal enhancement. 2.No high-grade spinal canal or neural foramina stenosis in the cervical spine. There are mild degenerative changes with minimal spinal canal narrowing and mild to moderate left neural foraminal narrowing at the C6-C7 level.3.No abnormal signal within the thoracic cord or abnormal enhancement. No significant spinal canal or neural foraminal stenosis in the thoracic spine.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with transverse myelitis. Assess for MS. Brain:A few nonspecific T2 hyperintensities are seen in the periventricular white matter, most prominently adjacent to the left ventricular atrium. A nonspecific focus of T2 hyperintensity is also seen within the right pons.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.Bone marrow signal characteristics are unremarkable. Incidental note is made of two subcentimeter cutaneous nodules along the left face.C-spine:A mild reversal of the normal cervical lordosis is seen. Alignment is otherwise unremarkable. Vertebral body height and morphology are preserved. No evidence of concerning marrow replacement or marrow edema is detected.The spinal canal is slender, most notably between C3 and C5, which is at least partially congenital but with some contribution from disk osteophyte formation and PLL thickening.The cervical spinal cord is also slender and demonstrates patchy parenchymal T2 hyperintensity beginning approximately at the C2-3 level and continuing down to at least C5-6.C2-3: Facet hypertrophy, right side more than left. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Mild right foraminal narrowing.C3-4: Facet hypertrophy. Mild posterior disk osteophyte formation. Mild spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C4-5: Posterior disk osteophyte formation, asymmetric to the right. Mild to moderate spinal canal stenosis with particular effacement of the right lateral recess. Moderate to severe bilateral foraminal narrowing. C5-6: Thickening of the PLL between C4-5 and C5-6. Posterior disk osteophyte formation, asymmetric to the left. Moderate spinal canal stenosis with particular effacement of the left lateral recess. Severe bilateral foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. T-spine:Spinal alignment is anatomic. Vertebral body height and morphology are unremarkable. No concerning marrow replacement or marrow edema is detected.Again, the spinal canal is diffusely congenitally narrowed.The visualized spinal cord shows no evidence of any definite or convincing signal alteration.At T5-6, there is a small left paracentral/foraminal disk protrusion, in conjunction with left costovertebral joint hypertrophy.At T8-9 and T9-10, there are small central disk protrusions.At T10-11, there is a mildly bulging disk.At none of the above levels is there any evidence of cord impingement or significant spinal canal stenosis. Foraminal narrowing is suspected bilaterally at T10-11 and T11-12.At L1-2, a bulging disk and right paracentral disk protrusion, along with posterior element hypertrophy, contribute to produce a moderate generalized spinal canal stenosis with some crowding of the cauda equina. The neural foramina are mildly narrowed.

Output: 1. A few scattered small T2 hyperintense lesions are detected within the brain. These lesions are nonspecific, and while demyelinating disease may be considered, numerous additional etiologies could also produce this appearance.2. Patchy T2 signal abnormality is evident within the parenchyma of the cervical spinal cord involving the region from C2-3 down to C5-6. The cord does not appear edematous, and if anything, there seems to be some volume loss. Sequela of chronic demyelination could certainly be considered, and with the relative lack of specific findings in the brain, both MS and NMO would be in the differential. However, additional etiologies might include myelomalacia from chronic spinal canal stenosis, as well as sequelae of prior infectious or inflammatory conditions.3. Spinal canal stenosis is seen at several levels in the cervical spine, which reflects a congenitally slender spinal canal with superimposed disk osteophyte complexes and perhaps some PLL thickening.4. Aside from relatively mild degenerative disk findings, no significant abnormalities are detected in the thoracic spine.5. Disk degeneration at L1-2, just barely visualized on this examination, results in at least moderate spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 73-year-old male with left shoulder pain. ROTATOR CUFF: There is a full thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 11 mm in AP dimension. There is approximately 13 mm of retraction. There is increased signal abnormality within the supraspinatus tendon at the level of the myotendinous junction consistent with interstitial tearing. There may be mild atrophy of the supraspinatus muscle. The infraspinatus muscle and tendon appear intact. Note is made of a focus of low signal intensity within the infraspinatus tendon at the level of its insertion on the greater tuberosity which appears to correspond to the previously described findings consistent with calcific tendinopathy. There is thickening and increased signal abnormality within the subscapularis tendon consistent with tendinosis. There is increased signal abnormality consistent with interstitial and undersurface tearing of the subscapularis tendon. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Moderate degenerative changes affect the acromioclavicular joint. There is fluid within the acromioclavicular joint with foci of low signal intensity internally, which may represent the previously described chondrocalcinosis. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: There is subluxation of the long head of the biceps tendon which is perched upon the lesser tuberosity suggestive of disruption of the transverse humeral ligament. ADDITIONAL

Output: 1. Full-thickness rotator cuff tear as described above.2. Subluxation of the long head of the biceps tendon.3. Findings suggestive of calcific tendinopathy and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: Evalute for pancreatitis etiology History: Pancreatitis, abdominal painEXAMINATION: MRI MRCP with and without intravenous contrast. The liver, gallbladder, pancreas, spleen, adrenal glands and kidneys demonstrate a normal MRI appearance. The pancreatic duct is also normal in appearance without evidence of dilatation.

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: History of a type I aortic dissection status post repair. CHEST:LUNGS AND PLEURA: Basilar pulmonary opacities which are nonspecific but may reflect atelectasis.MEDIASTINUM AND HILA: Postsurgical changes from a type A aortic dissection repair. The dissection flap extends into the left subclavian, proximal left common carotid and right brachiocephalic arteries, appearing grossly similar to the prior study, although the great vessels are not well visualized due to technical factors.The aortic root measures 4.8 cm in AP dimension (series 1101, image 134), not significantly changed.The ascending aorta measures approximately 3.1 cm in AP dimension (series 1101, image 145), not significantly changed.The descending aorta measures 4.4 cm in AP dimension (series 1101, image 145), not significantly changed.The abdominal aorta measures 3.5 cm in AP dimension (series 1101, image 65), not significantly changed.Focal ulcerations within mural plaque within the false lumen appears similar to prior examinations.The celiac, superior mesenteric and right renal arteries appear to arise from the true lumen. The left renal and inferior mesenteric arteries appear to arise from the false lumen. The dissection flap extends to the iliac bifurcation beyond the inferior margin of the images.CHEST WALL: Sternotomy changes.ABDOMEN:LIVER, BILIARY TRACT: Probable subcentimeter hepatic cysts. No focal suspicious liver lesions. No biliary ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged and are without evidence of enhancement.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. See above for discussion of the aorta.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in type A aortic dissection status post repair. However, the components of the dissection within the great vessels are not well evaluated on this examination, and dedicated imaging of the neck (such as with a CTA) can be considered if clinically warranted.


Instruction: Generate impression based on findings.

Input: History of uterine fibroids status post uterine artery embolization. PELVIS:UTERUS, ADNEXA: The uterus measures 10.7 x 7.6 x 8.1 cm, previously 11.7 x 8.7 x 11.2 cm.There are numerous foci of mildly increased T1 and low T2 signal compatible with uterine fibroids. These are predominantly intramural in location with a single moderate size subserosal fibroid arising from the dorsal fundus. The majority of these are slightly decreased in size compared to prior. The largest fibroid is in the right mid uterine body and measures 5.1 x 3.9 x 4.1 cm, previously 5.9 x 4.9 x 5.2 cm. Compared to prior, the majority of the fibroids do not demonstrate postcontrast enhancement. There is mild residual enhancement of 2 smaller fibroids in the lower uterine segment measuring up to 2.3 cm in maximum dimension.The uterine cavity is distorted by the adjacent intramural fibroids, but is otherwise unremarkable. The junctional zone is normal in thickness.Resolution of previous right ovarian cyst, likely follicle. The left ovary is unremarkable.BLADDER: No significant abnormality noted.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.Enlarged lobular uterus containing numerous moderate to large fibroids a predominantly intramural distribution. Compared to prior, individual fibroids in the uterus overall are slightly decreased in size. There is mild residual enhancement of 2 smaller fibroids in the lower uterine segment, otherwise the most of the fibroids do not enhance on the postcontrast images indicating interval necrosis.


Instruction: Generate impression based on findings.

Input: 72 year old with history of hypertension, frequent premature ventricular contractions, and mildly reduced systolic function Left VentricleThe left ventricle is mild to moderately dilated (quantitative measurements suggest more severe left ventricular dilation but qualitative assessment is more suggestive of mild to moderate enlargement) with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 118 ml/m2 (normal range: 65+/-11), the LVEDV is 188 ml (normal range 109+/-23), the LV end systolic volume index is 54 ml/m2 (normal range 18+/-5), the LVESV is 85 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 92 g (normal range 114+/-24). There is late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process on the epicardial side of the basal anteroseptal, anterior and anterolateral walls with associated hypokinesis of the basal antero-septal wall. This pattern of LGE is more on the apical side and is atypical for myocardial infarction. Left AtriumThe left atrium is at least moderately dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 134 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 63 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly to moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small circumferential pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mild to moderately dilated (quantitative measurements suggest more severe left ventricular dilation but qualitative assessment is more suggestive of mild to moderate enlargement) with low normal systolic function. The overall LV ejection fraction is 54% There is LGE of the subepicardial basal anteroseptal, anterior and anterolateral walls with associated hypokinesis of the basal antero-septal wall. This pattern of LGE is more on the apical side and is atypical for myocardial infarction. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%


Instruction: Generate impression based on findings.

Input: Ms. Kasprzak is a 36-year-old female with personal history of left breast lumpectomy in July 2012 for DCIS and microinvasion treated with radiation and tamoxifen therapy. Personal history of benign right breast biopsy in 2012 for intraductal papilloma. Family history of breast cancer in maternal grandmother (diagnosed at the age of 37) and maternal aunt (diagnosed at the age of 42). There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the left upper breast. Mildly enhancing focus anterior to the biopsy clip in the right inferior breast is stable, compatible with prior history of benign breast biopsy. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 36 year old with family history of breast cancer presents for screening MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, with drug resistant focal epilepsy, fMRI for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical stimulation maps as expected along the calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Language is left dominant. Broca's area is well visualized on all paradigms and identified as several foci of activation within the inferior left frontal gyrus. Wernicke's area is visualized only on the sentence completion paradigm and identified as a focus of activation along the posterior aspect of the left superior temporal sulcus.

Output: Technically successful functional MRI for surgical planning. The sensorimotor and primary visual cortices are well demarcated. Language is left dominant with Broca's and Wernicke's areas identified in their customary locations.


Instruction: Generate impression based on findings.

Input: Right foot mass Tendons and ligaments: The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. The Lisfranc ligament is intact. There is no subluxation or dislocation in the tarsometatarsal articulations.Bones: There is increased signal within the medial aspect of the navicular without a discrete fracture line identified. There is mildly increased signal within the soft tissue surrounding the navicular as well. Following contrast there is mild diffuse enhancement of the soft tissues surrounding the navicular however no discrete mass or fluid collection is identified. The remaining bone marrow signal is normal. There is no joint effusion. There are no osteochondral lesions identified.Alignment: There is normal alignment of the metatarsals. There is no hallux valgus deformity.Muscles: The plantar musculature is unremarkable.

Output: Mild edema within the navicular which may represent a stress injury. There is surrounding edema and inflammation which is likely reactive but there is no discrete fluid collection, mass, or fracture line evident.


Instruction: Generate impression based on findings.

Input: Leg pain and swelling Left: Note that evaluation of the left proximal femur is limited secondary to metallic susceptibility artifact from the patient's left hip arthroplasty. There is diffuse skin thickening and subcutaneous edema of the medial compartment of the thigh. Scattered pockets of lobulated fluid are identified within the medial compartment particularly proximally at level of the sartorius. There is no definite abnormal signal intra or intermuscularly. Following contrast enhancement, there is mild diffuse soft tissue enhancement and mild peripheral enhancement of these lobulated, simple fluid collections but no findings suspicious for abscess. There is no abnormal marrow signal intensity.Right: There is diffuse skin thickening and subcutaneous edema of the medial compartment of the thigh. Scattered pockets of lobulated fluid are identified within the medial compartment particularly proximally at level of the sartorius. There is no definite abnormal signal intra or intermuscularly. Following contrast enhancement, there is mild diffuse soft tissue enhancement and mild peripheral enhancement of these lobulated, simple fluid collections but no findings suspicious for abscess. There is no abnormal marrow signal intensity.

Output: Diffuse skin thickening, subcutaneous edema, and inflammation of the medial compartment of the thighs bilaterally. There are scattered lobulated pockets of fluid signal intensity within the medial compartment which may be reactive in nature or reflect areas of of surgical intervention however there are no findings to suggest abscess.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with history of multiple sclerosis and numbness. The previously demonstrated oval tumefactive lesion within the left posterior corona radiata has significantly decreased in size compared to prior examination. This lesion demonstrates a FLAIR hyperintense and minimally diffusion restricting rim with a T1 hypointense, T2 hyperintense and partially FLAIR suppressing center. Single voxel spectroscopy of this lesion demonstrates mild elevation of choline, reduction of creatine and NAA, and pathologic quantities of both lactate and lipid.Numerous additional smaller FLAIR hyperintense lesions are again seen within the juxtacortical and periventricular white matter and the corpus callosum without significant interval change. The brainstem and cerebellum are relatively preserved. Mild callosal thinning and generalized parenchymal volume loss are demonstrated. No evidence of significant mass effect is observed. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricles are stable in size and morphology.

Output: 1.Numerous small lesions are identified in the juxtacortical and periventricular regions compatible with multiple sclerosis. No new or growing lesions are evident.2.A dominant tumefactive lesion within the left posterior corona radiata has significantly diminished in size. Single voxel spectroscopy of this lesion demonstrates a spectrum with characteristic features of active inflammation. Decreased NAA within the center of the lesion likely reflects some degree of neuronal loss.


Instruction: Generate impression based on findings.

Input: Clinical question: 40-year-old with presumed viral meningoencephalitis and worsening neuro exam. Please reevaluate with Fiesta sequence. Signs and symptoms: Abnormal gaze, weakness and decreased tone. Pre and post enhanced brain MRI:Unremarkable diffusion weighted images.Examination demonstrates subtle diffuse FLAIR hyperintensity of bilateral cerebellar hemispheres and vermis (more conspicuous in the left cerebellum) with evidence of subtle associated mass effect however without hemorrhagic changes. This finding demonstrate diffuse enhancement on post enhanced series. Findings are suggestive of an inflammatory/infectious process and meningoencephalitis should be considered.There is no convincing evidence of signal abnormality of pons, medulla or the cerebral hemispheres and without abnormal enhancement.There is mild decreased size of fourth ventricle secondary to mass effect however the supratentorial ventricular system remain within normal size and without deviation of midline. The quadrigeminal plate and the cisterna magna remain patent.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are within normal with normal pattern of enhancement.Pre- and post enhanced total spine MRI:Images through the cervical spine are degraded in particular on sagittal T2 STIR and post enhanced series. Within this limitation there is no convincing evidence of signal abnormality of the cord or abnormal enhancement. No spinal stenosis or neural foraminal compromise is detected.Examination of the thoracolumbar spine demonstrate no evidence of cord signal abnormality or increased cord caliber and without detectable abnormal enhancement. No spinal stenosis or neural foraminal compromise at any level.Normal signal intensity and morphology of cauda equina without abnormal enhancement.Findings and concerns on this exam were discussed by phone with the clinical service Christine Carlos pager # 3729 at the time of review of the study at 8:15 AM.

Output: 1.Pre and postcontrast enhanced brain MRI demonstrates subtle diffuse FLAIR hyperintensity of cerebellar hemispheres and vermis and with diffuse enhancement however without associated hemorrhage or significant mass effect. Findings are highly suggestive of an inflammatory process and including meningoencephalitis. Unremarkable images through supratentorial space and without convincing evidence of abnormal signal intensity or enhancement.2.Pre- and post enhanced total spine MRI demonstrate no convincing evidence of abnormal cord signal intensity or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Newly diagnosed left severe sensorineural hearing loss: sickle cell disease with stroke. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for metastases, history of prostate cancer. Signs and symptoms: Bilateral lower extremity weakness. Pre- and post enhanced cervical MRI:Examination demonstrates a large focus of marrow signal replacement with enhancement involving vertebral body of C6 and with involvement of left pedicle and left articulating facet with enhancement. Finding is consistent with a metastatic lesion. There is no detectable extraosseous spread of tumor into the spinal canal. There is no convincing evidence of any additional osseous metastatic lesions of the cervical spine and no detectable metastatic lesion to the cord or the leptomeninges.Degenerative changes at C4-C5 and to a lesser degree at C3-C4 and C5-C6 results in central spinal stenosis. Significant bilateral neural foraminal compromise at C4-C5, C5-C6 secondary to degenerative changes are noted. Mild neural foraminal compromise at other levels.Pre and post enhanced thoracic MRI:Examination demonstrates extensive osseous metastatic lesions involving T2, T3, T4, T5, T6, T7, T8, T10, T11 and T12 vertebral bodies and some with involvement of posterior elements. No evidence of fracture or malalignment.There is evidence of tumor also in the epidural space posteriorly at T3, T4 and to a lesser degree T5 levels with resultant mass effect and flattening deformity of the cord and central spinal stenosis at C3 and C4 level. Although difficult to assess due to flattening deformity there is no convincing evidence of cord edema on this study, however this possibility cannot be entirely excluded. There is no evidence of central spinal stenosis or appreciable mass effect on the cord at any other level.There is normal signal intensity and caliber of thoracic cord otherwise and without detectable enhancement of the cord or the meninges.Pre and post enhanced lumbar MRI:Examination demonstrates diffuse osseous metastatic lesions of the vertebral column however without evidence of malalignment. Fracture of L4 vertebral body is again noted as well as seen on prior CT of the abdomen from 4-7-15.There is no detectable extraosseous spread of tumor into the spinal canal.There is normal signal intensity of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.Degenerative changes at L4-L5 and including a small central disc protrusion results in significant central spinal stenosis and moderate bilateral neural foraminal compromise. Degenerative changes at L3-L4 also result in moderate central spinal stenosis and moderate right neural foraminal compromise. Degenerative changes at L2-L3 results in mild central spinal stenosis and without neural foraminal compromise.

Output: 1.Pre and post enhanced MRI of cervical spine demonstrate metastatic lesion involving the vertebral body of C6, left pedicle and articulating facets with enhancement. No detectable extraosseous spread of tumor. Moderate central spinal stenosis at C4-C5 and to a lesser degree at C3-C4 and C5-C6 levels and significant bilateral neural foraminal compromise C4-C5 and C5-C6 levels secondary to degenerative changes are noted. No detectable but the meningeal enhancement.2.Pre and post enhanced MRI of thoracic spine demonstrate diffuse osseous metastatic lesions involving vertebral bodies and to a lesser degree of the posterior elements. There is also evidence of metastatic lesion in the dorsal epidural space at T3-T5 levels and with evidence of mass effect, flattening deformity and central spinal stenosis which is most noticeable at T3 and T4 levels. No fracture or malalignment and normal signal intensity of the cord without enhancement.3.Pre- and post enhanced lumbar MRI demonstrates diffuse intraosseous metastatic lesions. Fracture of metastatic L4 vertebral body without significant change since prior CT of abdomen. No evidence of leptomeningeal metastatic lesions. Significant central spinal stenosis secondary to degenerative disease at L4-L5 and moderate central spinal stenosis at L3-L4 as detailed above. Multilevel neural foraminal compromise as mentioned in the body of report.


Instruction: Generate impression based on findings.

Input: There are multiple punctate foci of T2 hyperintensity in bilateral frontal and parietal lobe subcortical white matter locations without restricted diffusion, enhancement, or susceptibility abnormality. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mild mucosal thickening is present in the left axilla sinus. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Redemonstrated are changes from previous transsphenoidal approach pituitary tumor resection. Multisequence hyperintensity within the right aspect of the sella likely represents susceptibility related to chronic blood product and/or mineralization. The residual pituitary gland is heterogeneous and small. The pituitary infundibulum enhances normally and is deviated towards the right. The suprasellar space is clear and there is no impingement upon the optic apparatus. These findings are unchanged.

Output: 1.There are multiple punctate foci of T2 hyperintensity in bilateral frontal and parietal lobe subcortical white matter locations without restricted diffusion, enhancement, or susceptibility abnormality. These are nonspecific in appearance but abnormal for a patient aged 43 years. The differential diagnosis would most likely include small vessel disease or migraine sequelae and less likely residua from prior head trauma or from vasculitides. Given lesional appearance and locations, demyelination is unlikely.2.Stable MRI findings status post resection of a pituitary mass. The residual pituitary gland is small and heterogeneous, unchanged in appearance.


Instruction: Generate impression based on findings.

Input: 53-year-old female with cervicalgia and radiculopathy The cranial-cervical junction is normal. Redemonstrated is reversal of the cervical lordosis. The cervical spine alignment is anatomic. The vertebral body heights are preserved. The bone marrow and end plates demonstrate a benign MR appearance. The signal of the visualized cord is normal. The paraspinal soft tissues are unremarkable.C2-C3: No neuroforaminal narrowing or spinal stenosis, unchanged. C3-C4: Mild disc bulge without neuroforaminal narrowing or spinal stenosis, unchanged. C4-C5: Left paracentral disc protrusion causing anterior left hemicord flattening without intrinsic cord signal abnormality. There is mild left neuroforaminal narrowing however no spinal stenosis. These findings are unchanged.C5-C6: A previously demonstrated central disc protrusion with partial effacement of the ventral thecal sac has progressed and is larger in the right paracentral location and has a new central extruded component extending inferiorly. There is new anterior cord flattening without intrinsic cord signal abnormality as well as new effacement of the CSF both anteriorly and posteriorly. There is no central stenosis, unchanged mild left neural foraminal stenosis, and worse proximal moderate right neural foraminal stenosis.C6-C7: No neuroforaminal narrowing or spinal stenosis, unchanged. C7-T1: No neuroforaminal narrowing or spinal stenosis, unchanged.Facet hypertrophy at T1/2 and T3/4 encroach bilateral neural foramina, unchanged.

Output: 1.C4-C5: Left paracentral disc protrusion causing anterior left hemicord flattening without intrinsic cord signal abnormality. There is mild left neuroforaminal narrowing however no spinal stenosis. These findings are unchanged.2.C5-C6: A previously demonstrated central disc protrusion with partial effacement of the ventral thecal sac has progressed and is larger in the right paracentral location and has a new central extruded component extending inferiorly. There is new anterior cord flattening without intrinsic cord signal abnormality as well as new effacement of the CSF both anteriorly and posteriorly. There is no central stenosis, unchanged mild left neural foraminal stenosis, and worse proximal moderate right neural foraminal stenosis.3.Facet hypertrophy at T1/2 and T3/4 encroach bilateral neural foramina, unchanged.


Instruction: Generate impression based on findings.

Input: 55 years, Female, structural abnormality underlying epilepsy, seizure protocol.. Multiple sequences are motion degraded which limits assessment for subtle abnormalities. No focal lesion to suggest seizure focus is appreciated. No intracranial mass or mass effect. Bilateral hippocampi are symmetric in size and without signal abnormality. No evidence of infarct or hemorrhage. There is abnormal configuration of the lateral ventricles with dilation of the bodies and occipital horns of the lateral ventricles, right greater than left, which may be developmental or related to remote white matter injury. There is thinning of the adjacent white matter without discrete signal abnormality. No hydrocephalus. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific and may represent mild chronic small vessel ischemic changes. Major flow-voids are preserved. There are bilateral lens implants. There is mild right maxillary sinus mucosal thickening and minimal mucosal thickening elsewhere. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.

Output: 1. No findings to suggest a seizure focus are appreciated within the limits of motion degraded study.2. Abnormal configuration of the lateral ventricles which are disproportionately enlarged in the parieto-occipital region (colpocephaly). This finding may be developmental or related to remote white matter injury.3. Scattered foci of T2/FLAIR hyperintensity in the white matter are nonspecific and may represent mild chronic small vessel ischemic changes, sequela of prior inflammation, or less likely demyelination.


Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: 73 y/o M with metastatic colon ca, altered mental status, r/o brain metastasis History: altered mental status There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Mild diffuse brain atrophy with appropriate ventricular system size.Multifocal patchy bihemispheric periventricular white matter indicate non specific small vessel ischemic disease.On gradient echo images, there are multiple variable sized susceptibility lesions on bilateral hemispheres without evidence of surrounding edema or restricted diffusion. These lesions may indicate chronic petechial hemorrhagic foci or calcifications. The midline structures and cranial-cervical junction are normal. Intracranial arterial system appears to be tortuous in course and slightly ectatic indicating atherosclerotic changes.The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Diffuse mild brain atrophy with non specific small vessel ischemic changes.3. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:9/5/1962)Reason: radiculopathy History: right hand weaknessPROVIDER/ATTENDING NAME: AASIM I PADELA JAMES R. BRORSON The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation. There is a disc bulge at this level. There are endplate uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally. There is encroachment of the exiting nerve roots on the right side and to a lesser degree the left side.At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation. There is a disc bulge at this level. There are endplate uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally with mild encroachment of exiting nerve roots.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: There are degenerative changes present in the cervical spine which are worse at C5 and C6. There are some encroachment of the exiting nerve roots on the right side at C5-6.


Instruction: Generate impression based on findings.

Input: 45 year old male patient with prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.1 x 2.4 x 3.4 cm. Peripheral Zone: There are areas of T2 hypointensity in the right apex measuring 1.1 x 0.5 cm (image 13, series 501), right mid-gland measuring 1.2 x 0.6 cm (image 16, series 401), and left mid-gland measuring 0.8 x 0.7 cm (image 15, series 401). The ADC sequences are technically limited, however, there is the suggestion of corresponding low signal for these lesions. Additional bilateral smaller T2 hypointense foci are also seen.Central Gland: Scattered BPH nodules.Seminal Vesicles: No evidence of involvement.Extracapsular Extension: There is focal capsular thickening with indistinct margins overlying a right mid-gland lesion and may represent focal extra-prostatic extension (image 16, series 401).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple foci of signal abnormality compatible with tumor with possible focal extraprostatic extension of tumor in the right mid-gland.


Instruction: Generate impression based on findings.

Input: 55-year-old female with right lateral epicondylitis. Evaluate common extensor tendon and median nerve for compression. LIGAMENTS: Although this examination was not protocoled for detailed evaluation of the ligaments, the ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact, within the limitations of a non arthrogram study.TENDONS: There is increased signal abnormality and thickening of the common extensor tendon indicating tendinosis. There are small foci of fluid signal intensity within the origin of the common extensor tendon indicating a small partial-thickness interstitial tear. The common flexor tendon appears intact. The triceps tendon appears intact. The biceps and brachialis tendons appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: The imaged musculature of the elbow is normal in appearance.ADDITIONAL

Output: 1. Findings consistent with moderate to severe common extensor tendinosis with a small interstitial tear.2. Increased signal abnormality within the ulnar nerve proximal to and within the cubital tunnel indicating a neuritis.3. No evidence of median nerve compression as clinically questioned.


Instruction: Generate impression based on findings.

Input: 53-year-old woman with history of right upper quadrant pain, nausea, and vomiting. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma appears normal.The patient is status post cholecystectomy. There is mild intra and extrahepatic biliary duct dilatation with the common bile duct measuring up to 8 mm to the level of the distal common bile duct.SPLEEN: Spleen is normal.PANCREAS: The pancreas is normal and there is no mass in the pancreatic head. Pancreatic duct size is at the upper limits of normal.ADRENAL GLANDS: Adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: Small perineural cysts are noted.OTHER: No significant abnormality noted.

Output: Mild intra and extrahepatic biliary duct dilatation, likely due to a benign stricture at the level of the distal common bile duct or ampulla (latter considered less likely considering pancreatic duct only measures upper limits normal). No obstructing mass or stone identified.


Instruction: Generate impression based on findings.

Input: 73 year old with hypertension and dyslipidemia now with acute myeloid leukemia found to have left ventricular systolic dysfunction and a possible LV apical thrombus. MEDICATIONS: metoprolol and lasix First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere was no evidence of myocardial infarction. There is a small amount of an atypical pattern of late gadolinium enhancement involving the epicardial half of the basal inferior wall suggesting the presence of underlying myocardial fibrosis, inflammation, or infiltration. This segment has an indeterminate probability of viability. The remainder of the myocardium is likely to be viable. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 217 ml (normal range 109+/-23), the LV end systolic volume index is 70 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 69 g/m2, and the LV mass is 136 g. The left ventricular systolic dysfunction is global with regional variation. The apical "mass" noted on echo most likely represents a small muscular band rather than a thrombus or tumor.Left AtriumThe left atrium is moderate to severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 132 ml/m2 (normal range 69+/-14), the RVEDV is 260 ml (normal range 110+/-24), the RV end systolic volume index is 96 ml/m2 (normal range 22+/-8), and the RVESV is 189 ml (normal range 35+/-13). Right AtriumThe right atrium is moderate to severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a variant brachiocephalic branching pattern. There is an aberrant brachiocephalic vessel (either the innominate artery or just the right subclavian artery) originating from the proximal portion of the descending aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate bilateral pleural effusions and right lower lung consolidation. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. There was no evidence of myocardial infarction. There is a small amount of an atypical pattern of late gadolinium enhancement involving the epicardial half of the basal inferior wall suggesting the presence of underlying myocardial fibrosis, inflammation, or infiltration. This segment has an indeterminate probability of viability. The remainder of the myocardium is likely to be viable. 3. Severe LV dilation with moderately reduced systolic function (LVEF 36%). No evidence of LV apical mass or thrombus. The finding noted on echo most likely represents a small muscular band.4. Severe RV dilation with severely reduced systolic function (RVEF 28%).5. Mild mitral and tricuspid regurgitation.6. Mild dilation of the main pulmonary artery. 7. Variant brachiocephalic arch branching pattern.8. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: History of atypical meningioma status post partial resection. Signs and symptoms: Surveillance prior to additional resection. Pre and post enhanced brain MRI:Examination demonstrates interval improvement of postoperative changes of a large right sided craniotomy for removal of tumor.Examination redemonstrates a large irregular and loculated tumor in the entire length of right cerebellopontine angle and into the right petrous bone, right internal auditory canal, right jugular fossa, right carotid canal, right cavernous sinus, right Meckel's cave, right medial aspect of the middle cranial fossa and through the expanded right foramen ovale into the right infratemporal fossa, extensively in the skull base on the right, sella turcica, left cavernous sinus and the sphenoid sinus. Although there is no significant change in the extent of tumor there is evidence of interval increased size of this meningioma in particular in the right cerebellopontine region.There is resultant interval increased vasogenic edema in the right cerebellum, right middle cerebellar peduncle and pons. Increased tumor size as well as surrounding edema results in increased mass effect on the fourth ventricle which appears smaller than prior study. Similar to prior exam to mass is abutting and mildly displacing the basilar artery without evidence of encasement or change in caliber of basilar artery. This is similar to prior exam. Dedicated vascular imaging, however is needed for better assessment.The tumor in the right petrous bone and carotid canal results in encasement, irregularity and mild decreased caliber of right internal carotid artery through the skull base, right cavernous sinus and proximal supraclinoid segments. This appearance is relatively similar to prior exam.Significantly expanded right cavernous sinus secondary to tumor and the component of tumor extends through the foramen ovale into right infratemporal fossa demonstrate no significant change either. There is however mild interval increased size of tumor component in the sphenoid and right orbital apex since prior exam.Extensive interval right temporal lobe cystic encephalomalacia at the site of previously noted parenchymal edema is identified. There is resultant ex vacuo dilatation of right lateral ventricle since prior exam.Interval significant decreased extra axial collection at the surgical site on the right results in resolution of midline shift to the left since prior study.

Output: 1.There is interval increased size of a large loculated extra-axial meningioma in the right cerebellopontine angle and with resultant increased vasogenic edema and mass effect as detailed.2.Extensive residual tumor in the right skull base, right jugular fossa, right carotid canal, right cavernous sinuses, right Meckel's cave, right orbital apex, sphenoid sinus, right middle cranial fossa and right infratemporal fossa as detailed above. The measurement suggests subtle interval increased size of different components of tumor at other locations as detailed above.3.Significant interval improvement of postoperative changes of right-sided craniotomy and interval evolution of previously noted right temporal lobe edema into a large focus of encephalomalacia as detailed.4.Interval decreased overall mass effect in the supratentorial space and with resolution of leftward midline deviation since prior exam. Please see above comments.


Instruction: Generate impression based on findings.

Input: 37-year-old female with history of shunt, now with difficult to control seizures and altered mental status. Evaluate ventricles. Evaluate shunt. CT at outside hospital two weeks ago said there was subarachnoid hemorrhage. Possible PRES. There is diffuse cerebral edema with increased density surrounding the basal cisterns and cerebellar tentorium compatible with pseudo-subarachnoid hemorrhage. Low attenuation is seen throughout the cerebral convexities bilaterally involving the bilateral frontal and occipital lobes. There is crowding at the level of the foramen magnum suggestive of ectopia versus artifact. All the cisterns are effaced.There is a focus of high attenuation within the right posterior occipital lobe compatible with hemorrhage this may be secondary to hypertensive hemorrhage.The ventricles are mildly enlarged however not significantly different compared to the previous MRI brain dated 3/11/2005.Again noted is a shunt catheter which traverses the right lateral neck soft tissues the catheter tip terminates within the foramen magnum and upper cervical spine. Within the limits of CT examination there is no evidence of shunt discontinuity or kinking.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Diffuse cerebral edema with multifocal patchy white matter hypoattenuation with focus of parenchymal hemorrhage in the right occipital lobe compatible with hypertensive hemorrhage. Further evaluation with MRI may be considered as clinically indicated2. No evidence of subarachnoid hemorrhage as clinically questioned.3. Shunt catheter at the level of the foramen magnum and upper cervical spine without evidence of discontinuity or kinking.


Instruction: Generate impression based on findings.

Input: 24 year old with hypertrophic cardiomyopathy presenting for CMR as part of VANISH trial. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 42 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is a small amount of nontransmural, mid myocardial late gadolinium enhancement in the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The LV walls are mostly normal in thickness (8-10 mm) with slight asymmetric hypertrophy in the basal anteroseptum (maximal15 mm). Native T1 time is normal ( < 1000 ms) including in hypertrophied area. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 156 ml (normal range 142+/-31), the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9), and the RVESV is 42 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 leaflets appear elongated with chordal SAM. There is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is scoliosis of the thoracic spine. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 72%. There are no regional wall motion abnormalities present. There is a small amount of nontransmural, mid myocardial late gadolinium enhancement in the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The LV walls are mostly normal in size with slight asymmetric hypertrophy in the basal anteroseptum (max 15 mm). Native T1 time is normal ( < 1000 ms) including in hypertrophied area. 2. Normal right ventricular size and function.


Instruction: Generate impression based on findings.

Input: Diagnosis: Brachial neuritis or radiculitis NOSClinical question: assess for L.C 6/7 radiculopathySigns and Symptoms: LUE radicular pain and weakness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is T2 signal hyperintensity within the C6 and C7 vertebral bodies. The endplates appear intact at C6-7 and the disc has similar signal to other levels. There is no associated perivertebral signal hyperintensityAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based right lateral recess disc protrusion at this level which mildly narrows the right neural foramen and mildly encroaches on the right-sided exiting nerve roots at this levelAt C5-6 there is no significant compromise to the spinal canal. There are small bilateral uncovertebral osteophytes present at this level associated with a diffuse disc bulge and some mild narrowing of the neural foramina with mild encroachment of the exiting nerve roots..At C6-7 there is no significant compromise to the spinal canal. There is a broad-based left lateral recess disc extrusion present which extends into the left lateral recess and left neural foramen and encroaches on the left-sided exiting nerve roots within the left neural foramen. Some disc material tracks behind the C7 vertebral body. There are associated uncovertebral osteophytes present.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The left vertebral artery flow-void is not readily identified. There is an MRI of the brain from July 10, 2009 demonstrating that the left vertebral artery was patent at that time intracranially. The right vertebral artery flow voids appears to be intact.

Output: 1.The left vertebral artery flow-void is not readily identified. This raises the question of occlusion or near occlusion of the left vertebral artery. If clinically appropriate additional imaging of the vertebrobasilar vascular system may be helpful to further evaluate this. There is an MRI of the brain from July 10, 2009 demonstrating that the left vertebral artery was patent at that time. 2.There is encroachment of the left exiting nerve roots at C6-7 due to disk extrusion and uncovertebral osteophytes.3.There are degenerative changes present in the cervical spine. There are associated signal changes within the C6 and C7 vertebral bodies which are suggestive of subacute inflammatory change most likely due to degenerative change. There is mild encroachment of exiting nerve roots bilaterally at C5-6 and on the right side at C4-5 due to degenerative change.4.An email and an alphanumeric page were sent to Dr. Rezania regarding the above findings.


Instruction: Generate impression based on findings.

Input: Diabetes insipidus with right ptosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution. There is a punctate focus of susceptibility effect in the left posterior temporal lobe, which may represent chronic microhemorrhage. There is no abnormal intracranial enhancement. There is septum cavum pellucidum and vergae. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Scattered cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution is nonspecific, but may represent chronic small vessel disease. 3. Diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of meningioma resection, surveillance exam Post operative changes of high right posterior frontal/parietal paramedian craniotomy. Residual parenchymal encephalomalacia and gliosis at the site of resected meningioma is redemonstrated. Mild dural thickening and enhancement immediately adjacent to the right side of the superior sagittal sinus and the craniotomy flap is not significantly changed. Left anterior middle cranial fossa arachnoid cyst with mild mass effect on the left temporal tip is unchanged.The cerebral cortex and ventricles are otherwise unremarkable. No diffusion-weighted signal abnormality. Trace fluid in the mastoid air cells. The visualized paranasal sinuses are clear.

Output: 1. Postoperative changes of high right paramedian meningioma resection without evidence of recurrence.2. Stable left middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on findings.

Input: 32 year old female with a strong family history of breast cancer in her mother at age 48 and maternal grandmother at age 43. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Moderate motion artifacts are noted in the subtraction images.A focal non-mass enhancement is again seen in the right breast at 6 o'clock position without any interval changes.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Ms. Klipstein is a 69-year-old woman with a personal history of right simple mastectomy for invasive mammary carcinoma in 2007 presents for follow-up. Patient also received hormonal therapy for 8 years. There is heterogeneous amount of fibroglandular tissue in the left breast. Minimal parenchymal enhancement is noted in the left breast. There is no abnormal enhancement seen in the left breast. A few cysts are seen in the left breast. There are postsurgical changes of right breast mastectomy with implant-based reconstruction. There is no abnormal enhancement surrounding the retropectoral silicone implant or in the right chest wall. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Possible T1 lucency on recent CT, status post recent chemoRT for head and neck cancer. There is diffuse fatty bone marrow signal in the imaged C6 through T1 vertebrae. There are also more focal areas of fat signal with spiculated bony trabeculae and minimal enhancement in the T2 vertebral body that measure up to 12 mm. Otherwise, there is no evidence of abnormal enhancement or tumors elsewhere in the thoracic spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a small posterior disc-osteophyte complex at C6-7, but no significant spinal canal stenosis in the thoracic spine. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Radiation effects in the C6 through T1 vertebrae and hemangiomas in the T2 vertebral body. Otherwise, no evidence of metastatic disease in the thoracic spine.


Instruction: Generate impression based on findings.

Input: 55-year-old male with HCV and cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Small right transient hepatic intensity difference (THID) is redemonstrated. No evidence of HCC. The portal vein appears patent.SPLEEN: Mildly enlarged.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.Cirrhotic liver morphology without evidence of HCC. Unchanged right THID.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: STROKE ROSigns and Symptoms: L WEAKNESS MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is proximal bifurcation of the right middle cerebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally with associated small P1 segments. The A1 segments are similar in diameter.MRA neck: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. The thyroid gland has a somewhat heterogeneous appearance.

Output: 1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.There is no evidence for acute cerebral ischemic infarction.4.Heterogeneous appearance to the thyroid gland is a nonspecific finding.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other intervertebral disc displacement, lumbar region Sacrococcygeal disorders, not elsewhere classified Low back painClinical question: eval for disc herniationSigns and Symptoms: lbp for 2 years 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 small central disc protrusion present at this level. This is stable compared to the prior exam.At L4-5 there is a right lateral recess disc extrusion present which encroaches on the nerve roots of the right lateral recess and extends behind the L5 vertebral body at the right lateral recess. There is also loss of disc space height and endplate reactive change present at this level. The endplate reactive changes T1 hyperintense. When compared to the exam from 6/5/2014 the disc extrusion has changed. It now tracks behind the L5 vertebral body whereas it previously was centered at the disc space level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: Since the prior exam, a disc extrusion at L4-5 which compresses the nerve roots of the right lateral recess has migrated further behind the L5 vertebral body that on the prior exam.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is redemonstration of a chronic right orbital floor blowout fracture with caudal extension of orbital fat. There is also associated deformity with rounding of the right inferior rectus muscle. There is minimal adjacent patchy opacity within the right maxillary sinus.MRA HEAD

Output: 1.No MR evidence of demyelinating disease within the brain or cervical spine.2.Unremarkable MRA of the head and neck, although with limited evaluation of the V2 segments secondary to venous contamination. Grossly, cervical vertebral artery flow voids are present on MRI of the cervical spine.3.Minimal lower cervical spondylotic changes without significant stenosis at any level.4.Redemonstration of chronic right orbital floor blowout fracture.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:9/22/1946)Reason: new stroke, normal pressure hydrocephalus? History: weakness, falls, hx of dementiaPROVIDER/ATTENDING NAME: AMBER T PINCAVAGE AMBER T PINCAVAGE There is a moderate degree of confluent periventricular T2 and FLAIR hyperintense and T1 hypointense white matter lesions associated with punctate T2 and FLAIR hyperintense lesions. Additional patchy T2 and FLAIR hyperintensity is present in the brainstem and left anterior limb of the internal capsule. This is stable compared to the previous exam from 1/19/2015.There is ventriculomegaly present. This is stable compared to the previous exam from 1/19/2015.No foci of diffusion restriction are appreciated within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Moderate to marked degree of periventricular and subcortical white matter lesions associated with brainstem lesions which were also present on the prior exam. Most likely these are vascular related. Please, the patient's clinical history. This is stable compared to the previous exam from 1/19/20152.Mildly enlarged lateral ventricles could be related to atrophy or normal pressure hydrocephalus. This correlates clinical symptoms. This is stable compared to the previous exam from 1/19/20153.Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.4.There is no evidence for acute ischemic cerebral infarction on the current exam.


Instruction: Generate impression based on findings.

Input: Encounter for other preprocedural examination [Z01.818] / Hemangioma of intracranial structures [D18.02] / Unspecified convulsions [R56.9], Reason for Study: ^Reason: PRE-OP please do in CCD at 6:00am - PLEASE PAGE NEUROSURGERY RESIDENT TO PLACE FIDUCIALS Multiple fiducial markers attached on scalp for the preparation of stealth registration.There is a 13.2 mm x 14 mm x 12.7 mm sized cavernous malformation on the right side anterior inferior aspect of middle temporal gyrus with the peripheral hemosiderin deposition, unchanged since prior scan.There is a developmental venous anomaly at the right cerebellar hemisphere, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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: Right middle temporal gyrus cavernous malformation as described above.


Instruction: Generate impression based on findings.

Input: Evaluation is limited due to lack of coronal T2-weighted images, and axial T2-weighted images are not of usual FSE technique. 3-D SPGR images are degraded by artifact. Axial T1 inversion recovery images are also not available to aid with myelination evaluation.There are numerous scattered foci of susceptibility, slightly more tubular in appearance along the right parietal lobe near the convexity, possibly representing hemosiderin deposition along the gray-white junction. Additional punctate foci are seen along the left anterior mid frontal lobe, the right anterior temporal lobe, the right greater than left occipital lobe, along the left greater than right tentorium, as well as near the cerebellar tonsils, perhaps along the fourth ventricular outflow on the left side. These are predominantly peripheral in location, possibly at the gray-white junction. The most conspicuous area of abnormal susceptibility is seen along the anterior left temporal lobe which may be subarachnoid in location given its plaque-like configuration. The right occipital lobe finding may involve the peripheral cortex, with possible foci in the adjacent extraparenchymal space.On axial T2-weighted images, there is prominence of extra-axial space along the frontal lobes with no significant traversing vessels, most conspicuous laterally. The collections are near isointense to CSF on all sequences, and remain only minimally hyperintense as suggested on coronal T1 postcontrast images. These measure up to approximately 5 mm in greatest thickness bilaterally. There is no significant prominence of extra-axial space along the anterior temporal lobes or anterior interhemispheric fissure to suggest underlying benign enlargement of subarachnoid spaces of infancy.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 pathological enhancement. There is no diffusion abnormality.Normal flow-voids are demonstrated in the major intracranial vascular structures. The left cerebellar tonsil is minimally pointed in configuration, although does not appear to extend abnormally below the level of the foramen magnum. The remainder of the midline structures and craniocervical junction are within normal limits. There is scattered paranasal sinus opacification. There is also fluid opacification of bilateral middle ears and mastoids, greater on the right.

Output: 1.Essentially chronic small bilateral predominantly frontal subdural hematomas, with signal only very minimally greater than CSF on T1-weighted images, although evaluation is somewhat limited as detailed above.2.Multiple scattered areas of hemosiderin staining, with most conspicuous areas in the left anterior temporal region which may be subarachnoid in location, as well as more tubular appearing areas along the right parietal cortex likely near the gray-white junction. Other scattered foci are also more peripheral in location as well as possibly along the tentorium. Findings may relate to a shear injury mechanism, resulting in areas of focal axonal injury. Please correlate with any history of trauma, including nonaccidental trauma.3.Bilateral mastoid and middle ear fluid opacification. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: A 56 year-old woman with history of left breast tubular cancer and DCIS diagnosed at age 44, status post left lumpectomy and radiation therapy. History of benign right biopsies. Family history breast cancer in her mother and maternal great-grandmother. There is heterogeneous amount of fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: 2 years s/p resection of MPNST of left posterior thigh, hx of NF1, evaluate for recurrence History: above Again seen are postsurgical changes of prior resection of the patient's reference mass within the posterior compartment of the left thigh. There are multiple foci of metallic susceptibility artifact which are likely postsurgical in etiology. Again seen are multiple subcentimeter foci of enhancement within the subcutaneous tissue along the posterior aspect of the thigh which appear similar to the prior study and may reflect postsurgical granulation tissue. No new foci of enhancement are identified.The reference lobulated heterogeneous mass interposed between the semimembranosus and long head of the biceps femoris along the distal aspect of the femoral metaphysis at the bifurcation of the tibial and peroneal nerve, measures 2.8 x 1.7 cm, previously 2.5 x 1.8 cm (image 71; series 11) consistent with the patient's known history of neurofibromas. The reference cutaneous mass along the medial aspect of the knee measures 4.0 x 1.8 cm, previously 4.0 x 1.7 cm (image 73; series 11), not significantly changed. Multiple additional foci of signal abnormality along the course of the sciatic nerve and cutaneous nodules are also consistent with the patient's known history of neurofibromatosis.

Output: Findings consistent with patient's history of neurofibromatosis. Surgical changes of prior resection of the patient's known left thigh mass. No significant interval change in multiple nonspecific punctate foci of enhancement within the subcutaneous tissues along the posterior aspect of the thigh which likely represent granulation tissue from prior surgery. Otherwise no findings to suggest residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Female, 67 years old. Reason: Rule out cuff tear History: Right shoulder pain ROTATOR CUFF: There is a full-thickness tear of the supraspinatus without muscle retraction. There is thickening and intermediate signal within the infraspinatus tendon likely representing a tendinopathy. There is a small amount of fluid in the subacromial bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus without retraction. 2. Tendinopathy of the infraspinatus tendon.


Instruction: Generate impression based on findings.

Input: Female, 86 years old, with virtigo that woke the patient up from sleep, nystagmus, nausea and vomiting. Evaluate for brain stem stroke from posterior circulation No restricted diffusion is seen. There is, however, patchy and confluent periventricular T2 hyperintensity. Involvement of the subcortical white matter, basal ganglia, thalami, and the pons is also evident. No parenchymal mass effect or edema is seen. No intracranial hemorrhage or any other abnormal extra-axial fluid collection is seen. The ventricles and sulci are proportionately prominent compatible with volume loss.

Output: 1.No acute intracranial abnormality, and in particular, no evidence of acute ischemia.2.Moderately extensive chronic small vessel and lacunar ischemic disease.


Instruction: Generate impression based on findings.

Input: 25 year-old woman with bilateral basal ganglia hypodensity. Evaluate question of increased swelling. Portable head CT. Examination of the brain stem and posterior fossa structures is limited due to artifact.The basal ganglia, surrounding subcortical white matter, and internal capsule exhibit marked hypoattenuation bilaterally consistent with edema. Accounting for differences in technique, these findings appear to be stable from the MRI dated 8/14/2008. On the current study, there are two focal areas of hyperattenuation in the region of the right internal capsule which are consistent with punctate hemorrhage. On the prior MRI, there are no corresponding findings in this region, suggesting interval change.There is effacement of the cortical sulci suggestive of cerebral edema. Gray-white differentiation is preserved. The right basal ganglia exert mass effect upon the right lateral ventricle causing partial effacement. There are no findings of obstructive hydrocephalus.The calvaria and skull base are radiographically normal. Mucosal thickening is present in the sphenoid sinus and ethmoid air cells. There is partial opacification of the mastoid air cells bilaterally.An endotracheal tube is present. A nasogastric tube enters through the left naris.

Output: 1. Bilateral hypoattenuation of the basal ganglia and surrounding white matter consistent with edema. Accounting for differences in technique, this finding appears roughly stable from the prior MRI.2. Focal areas of hyperattenuation in region of right internal capsule consistent with punctate hemorrhage.3. Effacement of cortical sulci consistent with cerebral edema.4. Limited evaluation of brainstem and posterior fossa.


Instruction: Generate impression based on findings.

Input: 83 year old with previously treated right breast cancer and newly diagnosed left axillary cancer. Evaluate for disease. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally. The right breast is smaller than the left, compatible with her surgical history.No abnormal enhancement is seen in either breast. Within the left axilla, multiple (4 or 5) abnormal lymph nodes are seen. The largest contains the Hydromark biopsy clip and measures 1.2 x 1.1 cm. No abnormal lymph nodes are identified in the right axillary region. Post-operative changes are seen.

Output: Multiple suspicious left axillary lymph nodes, including the biopsy proven malignant node. No MRI evidence for malignancy within the breasts. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: There is straightening of the normal lumbar lordosis. The vertebral body heights are well-maintained. There is moderate loss of disc height at L3-4 and severe loss of disc height with endplate degenerative changes at L4-5. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.T12-L1: No significant disc bulge, herniation, spinal canal or foraminal stenosis. L1-L2: No significant disc bulge, herniation, spinal canal or foraminal stenosis.  L2-L3: Mild disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum. No significant spinal canal or foraminal stenosis. L3-L4: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild bilateral foraminal stenosis and mild spinal canal stenosis. L4-L5: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild right and mild to moderate left foraminal stenosis with encroachment at the right lateral recess. No significant spinal canal stenosis. L5-S1: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild to moderate right and mild left foraminal stenosis with encroachment of the nerve roots at the right lateral recess, unchanged. No significant spinal canal stenosis.

Output: No significant interval change in the degenerative changes of the lower lumbar spine, which contribute to mild bilateral foraminal and spinal canal stenosis at L3-L4, variable foraminal stenosis and encroachment of the right lateral recesses at L4-L5 and L5-S1. No significant spinal canal stenosis at the other levels.


Instruction: Generate impression based on findings.

Input: Lower left back pain, grossly reduced sensation in left lower back and left anterior thigh, 3/5 strength in left leg and left ankle Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is straightening of the lumbar spinal curvature; alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Postcontrast images demonstrate no abnormal enhancement within the spine.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Cyst involving the inferior pole of the right kidney incidentally noted.

Output: No compromise to the lumbar spinal canal or neural foramina. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Female, 44 years old, with obesity, left lower extremity weakness, and incontinence of bowel and urine, also with radicular low back pain. Assess for cord compression. No significant spinal canal stenosis or cord compression is seen in the cervical region.In the thoracic spine, there is prominence of the dorsal epidural fat most notably from T3-4 through T8-9 which results in moderate to severe spinal canal narrowing and perhaps some mass effect on the spinal cord. In addition, there is significant facet arthropathy and ligamentum flavum thickening at T4-5, T5-6 and T6-7. At T4-5, there is questionable abnormal cord signal intensity.Beginning with T5, the endplates of the thoracic vertebral bodies are irregular and most levels show a slight anterior wedging which could reflect Scheuermann's disease.In the lumbar spine, disc degeneration and endplate signal abnormality are seen at L5-S1. In addition, there is a large inferiorly directed L5-S1 disc extrusion which narrows the spinal canal at the S1 level, potentially impinging on transiting nerve roots. Elsewhere, no significant stenosis seen within the lumbar spine.Spinal alignment is relatively anatomic allowing for straightening of the cervical lordosis. Except as discussed in the thoracic region, vertebral body heights are preserved. Scattered degenerative marrow signal change is noted.

Output: 1.Prominence of the dorsal epidural fat is seen in the thoracic spine, most notably from T3-4 through T9. This, along with facet hypertrophy and ligamentum flavum thickening at T4-5, T5-6 and T6-7, contributes to a moderate to severe generalized narrowing of the thoracic spinal canal with perhaps some mass effect on the cord. There is questionable cord signal abnormality at T4-5. Findings could be better assessed with dedicated thoracic spine imaging.2.Disc degeneration is seen at L5-S1, and in particular, there is a large inferiorly directed disc extrusion which significantly narrows the spinal canal at the S1 level potentially impinging on traversing nerve roots. Findings could be better assessed with dedicated lumbar spine imaging.


Instruction: Generate impression based on findings.

Input: Male; 71 years old. Reason: eval for fistula vs. abscess History: rectal pain, bleeding PELVIS:PROSTATE/SEMINAL VESICLES: Prostatomegaly with the prostate gland measuring up to 3.7 x 5.2 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Findings of acute proctitis with moderate circumferential rectal wall thickening with enhancement and mild perirectal fluid, particularly posteriorly. 7 x 5 mm intramural rectal abscess located posteriorly near the anus (series 801/124). No perirectal or perianal fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with acute proctitis with small intramural rectal abscess.


Instruction: Generate impression based on findings.

Input: Assess for vascular malformation: neck mass. There is a rather well defined multicystic mass in the left parapharyngeal and retropharyngeal spaces with minimal peripheral enhancing components. The mass measures up to 50 mm in height and spans the C2 through C6 vertebral body levels. The mass displaces the left internal carotid artery and internal jugular vein posteriorly. There is no significant cervical lymphadenopathy. The tumor indents the left thyroid lobe. The thyroid tissue and salivary glands are otherwise unremarkable. There is lack of the usual cervical lordosis. The osseous structures are otherwise intact. The patient is intubated. The orbits and imaged intracranial structures are grossly unremarkable.

Output: A rather well defined multicystic mass in the left parapharyngeal and retropharyngeal spaces that measures up to 50 mm likely represents a macrocystic lymphatic malformation versus less likely a previously infect branchial apparatus anomaly, for example.


Instruction: Generate impression based on findings.

Input: Images are limited by patient motion despite repeated sequences. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is suggestion of mild cord thinning at the cervicothoracic junction. There is a focus of T2/STIR hyperintensity centrally within the cord at the C5-C6 level, not well delineated on the motion degraded axial images. There is an additional linear T2/STIR hyperintensity suggestive the upper thoracic cord at least at the T1 level.At C6-C7, there is a shallow central disc protrusion which indents the thecal sac.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine.There is prominent patchy hyperintensity within the pons and right brachium pontis previously seen on MRI of the brain.

Output: Severely motion degraded exam. Suggestion of mild cord atrophy along the cervicothoracic junction with focal abnormal signal at C5-C6 level and likely spanning the T1 level. Follow-up diagnostic axial imaging through the cervical spine is likely helpful for further characterization although findings are suspicious for demyelinating disease.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review is MRI performed on 2/5/16. For comparison, her previously submitted outside studies are available. MRI MRI was performed as per outside protocol and uploaded to DynaCAD. There is an extreme amount of fibroglandular tissue in the breasts. Mild background parenchymal enhancement is noted. There are total of 4 masses in the right upper central breast which span more than 5 cm. From the superiormost to the inferior most, these masses measure 1.3 x 2.1 x 1.7 cm, 1.6 x 1.4 x 1.5 cm, 0.9 x 1.0 x 1.1 cm, and 0.9 x 0.9 x 1.0 cm. Clip artifacts are within or adjacent to the two most superior masses and the most inferior mass. The most inferior mass approaches to within 7 mm of the nipple. The most superior mass abuts the pectoralis posteriorly over a distance of nearly 2 cm, though there is normal muscle enhancement. No suspicious left breast enhancement. No enlarged axillary lymph nodes are seen.

Output: Four enhancing masses on MRI in the right breast spanning more than 5 cm together, with the largest mass measuring up to 2.1 cm.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 23 years Male (DOB:7/2/1992)Reason: eval acute cva History: acute cva per head ctPROVIDER/ATTENDING NAME: MARION A HOFMANN-BOWMAN MARION A HOFMANN-BOWMAN MRI of the brainThere is a 32x27 mm focus of diffusion restriction associated with T2 and FLAIR signal hyperintensity present involving the left superior parietal lobule associated with subcentimeter foci of diffusion restriction in the left post central gyrus and the posterior aspect of the left middle frontal gyrus. Punctate foci of susceptibility within the left inferior parietal lobule likely represent petechial blood.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The left vertebral artery is large in diameter compared to the right vertebral artery.MRA neck: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.

Output: 1.Subacute infarction involving the middle cerebral artery territory - predominantly left superior parietal lobule with satellite foci of infarction in the left post central gyrus and left middle frontal gyrus. No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.


Instruction: Generate impression based on findings.

Input: Direct comparison to the previous MRIs is difficult, given technical limitations of those studies. Multiple periventricular white matter lesions appear more conspicuous and confluent than on the prior study, which may be due to technique and/or progression. For example, a posterior left frontal lobe lesion was not definitely apparent on the prior study and may represent a new lesion. Additionally, there are several punctate lesions in the bilateral cerebral hemispheres, which were not apparent previously and which may indicate new lesions. Furthermore, the T2 signal surrounding the right occipital horn of the lateral ventricle appears more pronounced than on the prior study. Many of these lesions demonstrate T1 hypointensity indicating chronicity. In particular, a right pons/midbrain lesion appears to have developed T1 hypointensity along with decreased T2 hyperintensity. The ventricles and sulci are unchanged. The basal cisterns remain patent. There is no midline shift or mass effect.

Output: Numerous supratentorial and infratentorial demyelinating lesions. Comparison with the prior exam is limited due to differences in technique, although some lesions may have slightly progressed and some now exhibit more chronic features.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a T2 hyperintense lesion within the cerebellar vermis with regions of intrinsic T1 shortening and several foci of susceptibility artifact corresponding to previously noted calcifications as well as patchy regions of enhancement, not significantly changed from prior exams. Mild mass effect on the posterior wall the fourth ventricle is again noted without associated hydrocephalus. The mass measures 2.9 x 1.9 cm (previously 2.9 x 1.9 cm), not significantly changed compared with multiple prior exams (image 154, series 14). Low-lying cerebellar tonsils extending 6-7mm below the foramen magnum without peg-like appearance. There is moderate crowding. No evidence of acute ischemia or midline shift. No additional suspicious enhancement is identified. Normal flow voids are identified in the major intracranial vessels. Right maxillary sinus retention cyst and mild mucosal thickening.

Output: 1. Unchanged midline cerebellar vermian lesion with foci of calcification and enhancement with unchanged differential.2. Low lying but rounded cerebellar tonsils, equivocal for Chiari I malformation and possibly acquired secondary to the cerebellar vermis lesion - correlate with symptoms.


Instruction: Generate impression based on findings.

Input: Reason: Eval for MPFL tear History: Patellar instability MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema along the anterolateral aspect of the lateral femoral condyle likely from recent patellar dislocation. The superior aspect of the femoral trochlea appears shallow indicating femoral trochlear dysplasia, but the articular cartilage of the patellofemoral articulation appears intact. The articular cartilage of the medial and lateral compartments appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is mild increased signal intensity within the posterior fibers of the superficial band of the MCL which may represent a mild sprain, but we see no tear.EXTENSOR MECHANISM: The patellar tendon appears intact. The quadriceps tendon appears intact. There is thickening and abnormal signal intensity of the medial retinaculum indicating tearing. The MPFL is not well visualized as a discrete structure in this patient and is likely torn. Of note, the retinacular structures appear abnormal and likely torn at both the patellar and femoral attachments. There is also edema superficial to the vastus medialis muscle.ADDITIONAL

Output: Findings indicating prior transient lateral dislocation of the patella including bone marrow edema along the anterolateral aspect of the lateral femoral condyle as well as tearing of the medial retinaculum and MPFL as described above.