Instruction: Generate impression based on findings.

Input: 27 year old with history of bicuspid aortic valve being referred for evaluation of possible aortopathy. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 87 ml/m2 (normal range: 65+/-11), the LVEDV is 172 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 64 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 79 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 45 ml/m2 (normal range 69+/-14), the RVEDV is 89 ml (normal range 110+/-24), the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8), and the RVESV is 89 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The leaflet number cannot be determined on this study. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The sinus of Valsalva is 35 x 31 mm, STJ 30 x 29 mm, ascending aorta 31 x 29 mm, ascending (just proximal the right brachiocephalic) 30 x 29 mm, thoracic aorta (just distal the left subclavian) 21 x 21 mm, descending aorta 18 x 17 mm. No evidence of aortic coarctation. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size and systolic function (LVEF 63%)2. Normal right ventricular size and systolic function (RVEF 55%) 3. No evidence of inflammation, fibrosis or infarct as evidenced by lack of LGE. 4. Aortic dimensions as described above. No evidence of coarctation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 36 years old Reason: h/o Crohn's, s/p 2 resections with possible proximal to previous anastomosis. intermittent obstructions. History: elevated crp, intermittent obstructions with bloating ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Signal dropout on out of phase images consistent with diffuse hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 1.4 cm. It is unchanged in size compared to prior CT 11/27/13. It demonstrates signal dropout on out of phase images and is consistent with adenoma.KIDNEYS, URETERS: Subcentimeter T2 hyperintensity within the left kidney compatible with a renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post ileocecectomy. Second side-to-side small bowel anastomosis in the mid/distal ileum. In the distal ileum in the region of the anastomosis and in the neoterminal ileum there are segments of mild hyper enhancement of the wall of the bowel with minimal edema in this region. There is no significant wall thickening or increased signal high B value diffusion weighted images.There is focal narrowing of the rectum which persists on serial sequences with mild wall edema and hyperenhancement (series 22, image 69).Additionally there is tethering of the neoterminal ileum to rectum in this region suggestive of underlying adhesions (series 22, image 79; series 23, image 24). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral physiologic ovarian follicles. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid.

Output: 1. Mucosal hyperenhancement and mild edema involving the neoterminal ileum and a focal segment of rectum. Focal adhesions are identified between these two abnormal segments of bowel. 2. Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: 23-year-old male with recurrent right shoulder dislocation. Assess for glenoid anterior fracture.IMAGE ACQUISITIONS: CT of the right shoulder without contrast. Coronal oblique and sagittal oblique reformats were obtained. 3-D reconstructions were performed on an independent workstation. There is deficiency of the anterior/inferior glenoid as seen on the prior MRI examination. This results in loss of articulating surface along the inferior aspect of the glenoid. We are uncertain whether this is congenital or due to long-standing trauma (i.e., repeated anterior dislocations). Currently, the margins of the glenoid are corticated.There is a curvilinear focus of calcification along the anterior/inferior margin of the glenoid. This measures just over 1 cm in greatest dimension. This may represent an old adherent fracture fragment or capsular calcification.Currently, the glenohumeral joint alignment is within normal limits. However, there is flattening of the postero-lateral humeral head, indicating Hill-Sachs deformity from prior dislocation.The bones are otherwise within normal limits. The soft tissues are within normal limits given the limitations of CT relative to MRI.

Output: Deficiency of the anterior/inferior glenoid which may be congenital or due to repeated anterior dislocations.


Instruction: Generate impression based on findings.

Input: Necrotizing fasciitis, recent below-knee amputation Knee: The patient has undergone below knee amputation. Very little soft tissue overlies the distal margin of the remaining tibia and areas of signal void are noted within the surrounding soft tissues and within the medullary cavity of the distal tibia which may represent foci of gas. There is edema within the medullary cavity of the distal tibia noted on series 5 which in conjunction with the suspected gas is concerning for osteomyelitis. There is also increased signal intensity within the medullary cavity of the distal end of the remaining fibula on the fat-suppressed T2 sequences; however there is relatively normal corresponding T1 marrow signal and therefore this may reflect reactive osteitis as opposed to true osteomyelitis. There is superficial ulceration along the distal end of the stump with circumferential thickening of the skin which enhances following contrast administration. There is reticulation of the subcutaneous fat which also enhances reflecting cellulitis. There is mild heterogeneous edema and enhancement of the remaining musculature of the calf indicating inflammation but we see no rim-enhancing inter- or intramuscular collection to suggest abscess. There is a small knee joint effusion with synovial enhancement indicating mild synovitis.The study was not tailored for the evaluation of the internal derangement of the knee. There is mild osteoarthritis of the knee but no findings to suggest ligamentous disruption or an unstable meniscal tear. An additional focus of low signal intensity is identified in the proximal tibia which may reflect a bone infarct. An ossicle distal to the patellar tendon may relate to remote trauma but is not necessarily of any clinical significance.Femur: The cellulitis detailed above extends proximally into the proximal thigh to about the level of the lesser trochanter. Although there is reticular enhancement of the subcutaneous fat and mild enhancement of the posterior crural fascia, the degree of enhancement is less pronounced than that seen more distally suggesting a greater proportion of "cold edema" rather than inflammation. There is mild edema of the vastus medialis, vastus lateralis, hamstring musculature, and adductor musculature on the T2-weighted sequences with very mild enhancement of the medial margin of the distal vastus lateralis and its adjacent fascia indicating inflammation. Intramuscular edema is also noted on the T2-weighted images but does not appear to enhance following gadolinium with the exception of a thin area of intramuscular enhancement between the margin of the vastus lateralis and sartorius distally. We see no rim-enhancing inter or intramuscular fluid collection to suggest abscess and the bone marrow signal of the femur is normal. There is mild edema of the distal fibers of the gluteus maximus muscle with mild enhancement. There are several enlarged inguinal lymph nodes which enhance following gadolinium administration.

Output: 1. Surgical changes of below-knee amputation with signal void extending into the medullary canal of the remaining distal tibia that may represent gas, concerning for osteomyelitis. Correlation with radiographs is recommended.2. Soft tissue inflammation as described above indicating cellulitis with additional edema extending into the thigh. We cannot confirm nor exclude necrotizing fasciitis on the basis of these images. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Female 52 years old Reason: evaluate for lymphatic disease History: rectal cancer Pathology states that a proximal rectal lesion from recent colonoscopy is compatible with invasive well-differentiated rectal adenocarcinoma. The lesion on colonoscopy report was described as diffuse flat and multilobulated. Overall image quality: GoodPELVIS:UTERUS, ADNEXA: 3.2 x 1.7 cm ovoid lesion in the left lateral pelvis (801:47) is felt to represent an ovary, however, the right ovary is not well seen. Patients uterus is atrophic/surgically absent.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: 7 mm, anterior to the rectosigmoid colon (801:46). Other tiny nodes are also seen. For example a 5 mm node (801:45) right posterior lateral to the rectosigmoid colon.Lymph nodes outside the mesorectal fascia: Subcentimeter left internal iliac node (801:58) is nonspecific.BOWEL, MESENTERY: No discrete identifiable tumor is seen. Majority of the rectosigmoid colons dark serosal signal is preserved. A small 7 mm T2 gray gently lobulated lesion is seen along the left posterior lateral aspect on axial T2 oblique images (1001:37). This may represent a small focus of T3 tumor, but is very small accurately characterize. There is a denuded appearance of the visualized rectosigmoid colon with hypervascularity and enhancement suggestive of a chronic colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.MRI findings suggestive of chronic colitis, likely ulcerative. 2.No definitive identifiable tumor is seen. A 7 mm lesion described above could represent T3 tumor but is very small accurately characterize. Several lymph nodes are seen, with a few described above. These are indeterminate as to whether they're related to ulcerative colitis or tumor.


Instruction: Generate impression based on findings.

Input: 76-year-old male with history of C4-T1 cervical fusion presents with open wound and exposed spinous process of T1. Evaluate for osteomyelitis. There are postsurgical changes of posterior fusion from C4 to T2 and anterior cervical fusion from C5 to C7 with interbody bone grafts at C5-C6 and C6-7. A fragment of an old pedicle screw is again seen at the right T1 level as identified on the prior CT. There is evidence of wide laminectomies at the C2-3 to C6-7 levels. There is straightening of the cervical spine, which may be due to fusion.  Susceptibility artifact related to hardware limits evaluation. There is a soft tissue defect involving the posterior neck with exposure of the T1 spinous process and surrounding soft tissue edema and enhancement. Foci of susceptibility in the soft tissue adjacent to the T1 spinous process may represent foci of air related to wound dehiscence. There is no evidence of a drainable fluid collection. There is increased T2 and decreased T1 signal with enhancement of the spinous process of T1, which is suspicious for osteomyelitis (best seen on axial series 14, image 17). There is no evidence of discitis, abscess, or epidural collection. There is no evidence of central spinal canal stenosis or cord signal abnormality. There is mild left neuroforaminal stenosis at C3-4 and mild-to-moderate left neuroforaminal stenosis at C4-5.

Output: Bone marrow signal abnormality involving the T1 spinous process is suspicious for osteomyelitis. There are surrounding inflammatory changes in the adjacent soft tissues. There are suspected subcutaneous foci of air which may be related to the open wound. There is no appreciable drainable fluid collection in the paraspinous soft tissues, with susceptibility artifact from hardware slightly limiting evaluation. No findings to suggest discitis or epidural abscess.


Instruction: Generate impression based on findings.

Input: 50-year-old male with headache, elevated BP and diplopia. Elevate for CVA. There is no evidence of intracranial hemorrhage, mass or edema. Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: 49-year-old female with shoulder pain. ROTATOR CUFF: There is thickening with intermediate signal abnormality of the supraspinatus tendon indicating moderate tendinosis. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is thickening and intermediate signal abnormality of the supraspinatus tendon indicating moderate tendinosis The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the glenoid labrum, the labrum appears intact.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps which may represent tenosynovitis. The long head of the biceps tendon appears intact. ADDITIONAL

Output: Interstitial tearing of the rotator cuff without evidence of a full-thickness tear. Rotator cuff tendinosis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:1/4/1975)Reason: hx lumbar med L5-S1 1 month ago. c/o LBP, left leg pain, foot drop. Eval for epidural scar, abnormality or changes History: c/o LBP, left leg pain, foot drop.Referring Attending: EDWIN RAMOS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is loss of disc space height, disc desiccation and a left lateral recess disc extrusion. The patient status post left hemilaminectomy at this level. Disc material extends into the left lateral recess and compresses the nerve roots at the left lateral recess. In addition there is some soft tissue thickening on top of the disc extrusion at the left lateral recess associated with some contrast enhancement. There is some associated contrast enhancement surrounding the disc extrusion. There is additional contrast enhancement at the left lateral recess. There is contrast enhancement along the left medial paraspinous tissues and the adjacent subcutaneous tissues at the surgical site which is likely postoperative in nature.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: Since the prior exam patient has undergone left hemilaminectomy at L5-S1. There is some soft tissue thickening at the left lateral recess at L5-S1 which affects the nerve roots at the left lateral recess. This could represent postoperative change, disc material or inflammation due to infection. Additionally the left lateral recess disc extrusion has not changed substantially since prior exam.


Instruction: Generate impression based on findings.

Input: The dominant mass centered in the right retromolar trigone seen previously has markedly decreased in size with patchy non-masslike enhancement seen in this region. The enhancement abuts the right cervical internal carotid artery. Large left level 2 lymph node seen previously is also smaller measuring up to 10 mm today compared to 19 mm previously. Additional enhancing nodule along the left lateral aspect of the base of the tongue in the left retromolar trigone just anterior to the left pterygoid muscle abutting the left angle of the mandible appears non-masslike today compared to the prior exam.Reference right level Ib lymph node is unchanged measuring 9 mm. Right retropharyngeal lymph node abutting the right cervical internal carotid artery is unchanged measuring up to 10 mm. A smaller right level IIb lymph node seen previously measuring up to 8 mm in short axis now measures up to 5 mm in short axis.The right submandibular gland is not well visualized. The imaged brain appears within normal limits. No other areas of suspicious enhancement are identified. Flow-voids in the neck are grossly patent with the exception of the left internal jugular vein flow void which is not well visualized, possibly artifactual.

Output: 1.Marked interval decrease in size of right retromolar trigone/base of tongue mass with minimal patchy non-masslike enhancement likely representing post treatment change although residual tumor is not entirely excluded. 2.Marked interval decrease in size of left level II lymph node measuring up to 10 mm today.3.Stable to decreased size of other reference lymph nodes as described above.


Instruction: Generate impression based on findings.

Input: Delirium and agitation. History of lupus nephritis. On chronic high-dose steroids. Rule out cerebritis or brain infection. The exam was initially ordered with and without contrast but given the lack of IV access, it was changed to without contrast. The examination is also moderately limited by patient motion, which is most pronounced on the susceptibility-weighted imaging despite being repeated. There is no gross intracranial hemorrhage.There is confluent T2/FLAIR hyperintensity in the left frontal periventricular/deep white-matter associated with ex vacuo enlargement of the anterior body/frontal horn of the left lateral ventricle. This is not significant change since the November 2007 CT scan. In addition, there are symmetric T2/FLAIR hyperintense lesions in the frontoparietal white-matter. There is no diffusion restriction. In addition to dilated perivascular spaces, there are small foci of CSF intensity in the basal ganglia regions and in the frontal periventricular white-matter, especially on the left, which probably represent chronic lacunar infarcts. There is no mass-effect or midline shift and there is no extra-axial fluid collection. The ventricles and other CSF-containing spaces are moderately expanded, reflecting underlying brain volume loss. The major intracranial vascular flow voids are grossly preserved. There is no gross orbital abnormality. There is no large, destructive osseous lesion. There is scattered mucosal thickening in the paranasal sinuses.

Output: 1.The examination is limited by patient motion and by the lack of intravenous contrast given the lack of intravenous access.2.There is no acute infarct. There is no gross intracranial hemorrhage but the hemorrhage-sensitive sequences are markedly limited by motion. With there is no definite sign of cerebritis, the sensitivity of the examination for detecting leptomeningitis is significantly low given the lack of intravenous contrast.3.Left frontal white-matter lesion with associated volume loss most likely represents gliosis related to remote insult, probably ischemic.4.Mild-to-moderate frontoparietal white-matter abnormality is nonspecific but may represent chronic microvascular ischemia. There are also small chronic lacunar infarcts.


Instruction: Generate impression based on findings.

Input: Clinical question: Hemorrhage? Infection? Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrates a well demarcated high density lesion projecting into the left frontal horn and partial involvement of the septum pellucidum. This lesion measures 10.7 x 8.8-mm in size on axial image 12. Differentials for this lesion includes a cavernoma and less likely possibility of a colloid cyst cannot be entirely ruled out. There is no associated edema or any mass effect with this finding and no hydrocephalus is detected. Recommend unenhanced MRI examination for further evaluation.There is no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and CSF cisterns as well as gray -- white matter differentiation all remain within normal.Calvarium, visualized paranasal sinuses, mastoid air cells, middle ear cavities and orbits are unremarkable.

Output: 1.Well demarcated high density mass measuring 10.7 x 8.8-mm in the left frontal horn with involvement of septum pellucidum as described. Recommend further follow-up with a pre-and post enhanced MRI of brain.2.The non-infused head CT is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 66-year-old male with ataxia and right arm weakness. Please rule out CVA. There is limited secondary to motion artifact. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Mucosal thickening of the bilateral maxillary sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.

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


Instruction: Generate impression based on findings.

Input: 21 years Male (DOB:8/7/1995)Reason: evaluate structural changes. Abnormalities History: medically refractory epilepsy, increase in night sweating, increase in seizure activityPROVIDER/ATTENDING NAME: PATRICIA OGDEN PATRICIA OGDEN There is interval development of right frontal temporal parietal craniotomy. In addition, there are encephalomalacia involving right frontal lobe, right temporal lobe with associated ex vacuo changes of the right lateral ventricle.There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Interval development of right frontal parietotemporal craniotomy ostomy with underlying encephalomalacia involving right frontal and temporal lobes.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Status post T10-T11 discectomy, persistent RLE giving way. Compared to 7/30/2014, interval post surgical changes of discectomy and right-sided posterior spinal fusion at the T10-T11 is seen. Susceptibility hardware slightly limits evaluation, however, no residual spinal canal stenosis is appreciated. No epidural collections. There is subtle T2 hyperintensity in the right aspect of the thoracic cord (axial T2 series 9 image 26) which may have been present on the preoperative study but not well appreciable due to the stenosis.There is moderate left T11-T12 neural foraminal narrowing related to disc-osteophyte complex. The vertebral column alignment is anatomic. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Interval T10-T11 discectomy and right-sided posterior spinal fusion. No significant residual spinal canal stenosis is appreciated.2. Artifact somewhat limits evaluation, however, subtle T2 hyperintensity in the right aspect of the thoracic cord is suspected (axial T2 series 9 image 26) which may have also been present on the preoperative study.3. Moderate left T11-T12 neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Male; 67 years old. Reason: 67 yo with lung ca with abnl LFT ABDOMEN:LUNG BASES: Stable appearance of the partially visualized left lung base with loculated left basilar pleural effusion with underlying nonspecific atelectasis/consolidation.LIVER, BILIARY TRACT: Mild hepatic steatosis. No focal hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesions. No pancreatic ductal dilation.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.Mild hepatic steatosis. No focal hepatic lesions. No biliary ductal dilation.2.Stable appearance of the partially visualized left lung base as detailed above.


Instruction: Generate impression based on findings.

Input: New back pain. Thoracic spine: At T7 and T8 vertebral bodies, there are changes of previous augmented vertebroplasty, where central vertebral body height loss remain not significantly changed nor the minimal T8 retropulsion. The compression fracture along the anterior inferior endplate of T6 is unchanged but there are anterior and central compression fractures at T9, T11 and T12, which are new since October 2015 though without associated marrow edema. There is unchanged focal fat in the left T5 lamina. There is mildly exaggerated kyphosis from the multilevel compression fractures. Multilevel disc desiccation is present. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The distal arch/proximal descending aorta is prominent and there is a small left pleural effusion. The paravertebral soft tissues are unremarkable.Lumbar spine: New central compression fractures involve all the lumbar vertebral bodies, which is most pronounced at L2 with up to 50% height loss in addition to fluid subjacent to the superior endplate and adjacent marrow edema, as well as linear hypointense signal in the posterior aspect of the vertebral body. Mild marrow edema is present superiorly at L1, L3 and L4. Sagittal alignment remains anatomic. There is no retropulsion or osseous expansion. Multilevel degenerative disc disease is not significantly changed and results in shallow ventral indentations of the thecal sac but no significant spinal canal stenosis. Facet arthropathy contributes to mild bilateral neural foraminal stenoses in the mid/lower lumbar spine, most pronounced on the left at L3-L4 and on the right at L4-L5 levels, where it is moderate. The conus medullaris displays normal signal and morphology with its tip lying at upper L2 level. The paraspinal muscles are atrophic. The paravertebral soft tissues are unremarkable otherwise.

Output: 1.Thoracic spine: New insufficiency compression fractures are present at T9, T11 and T12 without marrow edema, marrow replacement or retropulsion. T6-T8 compression fractures are unchanged since October 2015 except for changes of augmented vertebroplasty at T7 and T8. No thoracic spinal canal stenosis or cord abnormality. Incidental small left pleural effusion.2.Lumbar spine: New, since October 2015, insufficiency compression fractures at L1-L5, most pronounced at L2, where there is also fluid subjacent to the superior endplate, which may reflect unstable endplate fragment. There is mild marrow edema at the other levels but no retropulsion or osseous expansion. Multilevel degenerative disease has not changed, causing neural foraminal stenoses most on the left at L3-4 and on the right at L4-L5, but no significant spinal canal stenosis. Unremarkable conus medullaris.


Instruction: Generate impression based on findings.

Input: Cervical spine:Alignment is normal. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes and there are no stenoses.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There is no abnormal enhancement. There are no significant degenerative changes and there are no stenoses. Incidental note is made of an anatomic variation of a right azygous vein.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. A 12 mm T2 hyperintense, T1 hypointense, nonenhancing focus within the left kidney is consistent with a simple renal cyst. Other subcentimeter foci with a similar appearance are present in bilateral kidneys, also most consistent with simple renal cysts. Otherwise the visualized intra-abdominal and paraspinal contents are unremarkable. There is no abnormal enhancement. There are no significant degenerative changes and there are no stenoses.

Output: 1.Negative contrast enhanced cervical spine.2.Negative contrast-enhanced thoracic spine.3.Bilateral simple renal cysts, otherwise negative contrast-enhanced lumbar spine.


Instruction: Generate impression based on findings.

Input: Clinical question: 24-year-old male with metastatic Ewing sarcoma, persistent headaches, evaluate for progression of Ewing's, brain abscess or other pathology. Signs and symptoms: Headaches Nonenhanced CT of brain:Examination demonstrate a large extra-axial mass of high density in the right posterior parietal region with associated lytic changes of inner table of the skull (axial images 35 through 38) the mass causes significant mass effect and buckling of the cortex. At this level there is also a large extracranial high-density mass which measures approximately 62 mm times 30 mm in size. This finding is also associated with some irregularity of the outer table of the skull. Considering the provided clinical history of Ewing sarcoma this finding is highly suspected of a metastatic lesion to the calvarium with intracranial and extracranial spread of tumor.There is evidence of associated edema of brain parenchyma adjacent to this finding (axial images 29 through 34). The extra-axial mass has higher density than brain parenchyma and on a few of the images appears like a subdural hematoma. Further evaluation with an enhanced MRI of brain is highly recommended.There is no evidence of parenchymal hemorrhage, hydrocephalus or midline shift.Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: Lytic changes of the inner and outer cortex of right parietal bone with associated large high density mass in the extra-axial intracranial space and within the soft tissues of the scalp. Finding is highly suspected of osseous metastatic lesion with both intracranial and extracranial spread. The combination of these masses measures approximately 40 mm in thickness and 85-mm in longus cranial slice cephalad axis (coronal reformatted image 47). There is evidence of mass effect on the brain parenchyma and vasogenic edema. No midline shift or hydrocephalus.Above findings were discussed with Dr. Gornli Jerome pager number 2841 at the time of interpretation.


Instruction: Generate impression based on findings.

Input: 63 year old man with coronary artery disease s/p PCI x 3 referred to evaluate for ischemia.MEDICATIONS: amlodipine, atorvastatin, ticagrelor, metoprolol First Pass PerfusionDuring hyperemia, there is a perfusion defect involving most of the inferior wall. The defect is predominantly associated with the below described myocardial infarction. The remainder of the myocardium is free of obvious ischemia.Viability/ Myocardial ScarThere is transmural myocardial infarction, involving most of the inferior wall. This territory is not viable. The remainder of the myocardium is free of myocardial infarction and is viable.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 184 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19), the LV mass index is 54 g/m2, and the LV mass is 104 g. There is abnormal septal motion. There is no evidence of underlying myocardial fibrosis (aside from above myocardial infarction), infiltration, or inflammation.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. There is a transmural myocardial infarction involving much of the inferior wall. Most of it is non-viable; however, there is a small amount of peri-infarct ischemia present.2. The remainder of the myocardium is viable and free of ischemia.3. Normal LV size with mildly reduced systolic function (LVEF 49%).4. Normal RV size and systolic function (RVEF 54%).When compared to the prior study, the myocardial infarction-related perfusion defect is more evident now and the LVEF is mildly reduced now.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with asymmetric left sensorineural hearing loss. The IACs are normally sized and patent. No IAC or CP angle masses are present. The vestibular and cochlear nerves are normal bilaterally. No pathologic enhancement is seen. The fluid filled structures of the inner ears show normal morphology. The brainstem shows normal signal characteristics. On limited intracranial views, there is mild patchy white matter hyperintensity, a non-specific finding. Small hippocampal sulcus remnant cysts are present bilaterally.

Output: Unremarkable evaluation of the IACs with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Ms. Egan is a 55-year-old female with recent diagnosis of bilateral breast cancer status post neoadjuvant chemotherapy. She presents today for ultrasound evaluation of both breasts. A targeted right breast ultrasound was performed at the mammographic/MRI areas of concern. - In the right breast 10:00 location, approximately 6 cm from the nipple, there is re-visualization of an irregular hypoechoic mass measuring 16 x 7 x 21 mm, previously measuring previously 19 x 12 mm on ultrasound and 24 x 14 x 15 mm on MRI. A surgical clip is noted in the central aspect of this mass corresponding to the biopsy-proven malignancy at the 10:00 location. - In the right breast 2:00 location, no sonographic correlate is identified to correspond to the MRI findings, at site of biopsy-proven DCIS. No surgical clip is visualized in this region either.

Output: Interval decrease in size of biopsy proven malignancy in the right upper outer breast. Continued follow-up with surgery is recommended. All results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: Left hip pain OSSEOUS STRUCTURES: There is a focus of increased edema within the superior acetabulum best appreciated on series 9 image 5/18. There is otherwise no abnormal marrow signal within the left hip. Cystic changes are also noted in the anterior and superior acetabulum (series 9 image 5/18) which are likely degenerative in nature. Mild osteoarthritis affects the left hip.SOFT TISSUES: There is increased soft tissue edema anterior compartment of the hip, specifically involving the vastus intermedius and anterior capsule. Similar although less prominent increased signal is seen posteriorly affecting the obturator internus muscle. The muscle attachments appear intact.Following contrast administration, there is diffuse enhancement in these areas reflecting inflammation. There is no evidence of an enhancing mass or abnormal marrow enhancement.

Output: 1. Abnormal soft tissue edema and enhancement surrounding the left hip representing nonspecific inflammation which appears most conspicuous within the vastus intermedius muscle.2. Osteoarthritis of the left hip with degenerative marrow edema and cystic changes within the superior acetabulum.


Instruction: Generate impression based on findings.

Input: Clinical question: Right shoulder pain, C5-C6 foraminal stenosis. Signs and symptoms: Right shoulder pain. Nonenhanced cervical MRI:Examination at the level of foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C3-C4 demonstrate degenerative disease with resultant significant right neural foraminal compromise and mild central spinal stenosis.C4 C5 demonstrate mild disc disease and extensive facet hypertrophic changes. Constellation of findings results in moderate left and mild right neural foraminal compromise and mild central spinal stenosis.C5-C6 demonstrate moderate disc disease, loss of disc height, mild to moderate bilateral facet hypertrophic changes and mild grade 1 retrolisthesis. Constellation of findings results in moderate central spinal stenosis and with significant right and moderate left neural foraminal compromise.C6-C7 demonstrate mild disc disease and hypertrophic changes of posterior elements. No central spinal stenosis however mild left neural foraminal compromise is noted.C7-T1 demonstrate mild degenerative disc disease and asymmetric extensive right facet hypertrophy. There is no central spinal stenosis however moderate right neural foraminal compromise is detected.The signal intensity and caliber of the cord remains within normal.Upper most visualized thoracic spine and thoracic cord demonstrate no signal abnormality of the cord or central spinal stenosis.

Output: 1.Degenerative changes of cervical spine results in mild central spinal stenosis at C3-C4, C4-C5 and moderate stenosis at C5-C6 levels.2.There are multilevel neural foraminal compromise (some significantly) as detailed per level above.3.There is mild retrolisthesis at C5-C6 secondary to degenerative disease.4.The signal intensity of the cord remains within normal.


Instruction: Generate impression based on findings.

Input: Reason: 71yr old male with history of MM; pre-auto sct evaluation History: evaluate SKULL: There are a couple of small poorly defined lucencies within the calvarium, which were not clearly seen on the prior study and may reflect myelomatous deposits or venous lakes.CERVICAL SPINE: The bones appear diffusely demineralized but we see no focal myelomatous lesions. There is severe multilevel degenerative disc disease.THORACIC SPINE: The bones appear diffusely demineralized but we see no focal myelomatous lesions. The thoracic spine is kyphotic but there are no frank compression fractures. There is mild multilevel degenerative disc disease.LUMBAR SPINE: Degenerative disc disease affects the lower lumbar spine. There are no focal myelomatous lesions.RIBS: Small lucencies are noted within the left clavicle and a couple of the right ribs, which appear more prominent on the current study than on the prior study and are suspicious for myelomatous lesions.PELVIS: There is a lytic lesion of the right iliac wing, which appears similar to that seen on the prior study. Small lucency in the left pubic bone is slightly more prominent on the current study than on the prior study.UPPER EXTREMITY: There are a few small lucencies in the proximal left humeral diaphysis, which may represent small myelomatous lesions but appear similar to those seen on the prior study. Small lucency in the left proximal radial diaphysis may also represent a small myelomatous deposit but appears similar to the prior study. Mild osteoarthritis affects the right shoulder. No definite myelomatous lesions are seen in the right upper extremity.LOWER EXTREMITY: We see no discrete myelomatous lesions in the bilateral femurs although numerous lesions are seen on the recent MRI exam. Calcifications adjacent to the right greater trochanter appear similar to prior. Poorly defined lucency in the proximal right tibial metaphysis may represent a myelomatous deposit but is unchanged from the prior study.

Output: Multiple myeloma as described above. A few small lesions appear slightly more prominent on the current study than on the prior study. While this may be simply due to differences in technique, we cannot exclude the possibility of disease progression.


Instruction: Generate impression based on findings.

Input: Patient is a 60-year-old female with recent biopsy proven left breast cancer who presents for ultrasound-guided biopsy of the additional lesion in the left breast. Upon review the mammogram from outside facility, there is a satellite lesion posterior to the index mass on the mammogram without a sonographic correlate. Repeat ultrasound of the left breast reidentified the index lesion with the clip at 12:00, 1 cm from the nipple. Subsequently, 1 cm lateral and inferomedial to the index mass, in the left breast, 1:00 location, 1 cm from the nipple, there is a 10 x 9 x 5 mm slightly hypoechoic irregular mass with increased flow, which likely corresponds to the posterior satellite lesion on the mammogram. In addition, in the left breast, 2:00 location, 1 cm from the nipple, there is a 6 mm lesion 6 mm inferior and lateral to the index mass and likely corresponding to the findings on the MRI 10/26/2015. These findings were reviewed with Dr. Jaskowiak in the reading room. The 2:00 satellite lesion would be targeted for biopsy and clip placed along the lateral/posterior aspect of the 2:00 mass, towards the 1:00 finding. PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, three 14-gauge core needle (Achieve) specimens were obtained of the lesion. Targeting was judged very good. Two specimens sank to the bottom of the prefilled container of 10% formalin. One specimen floated. The floating specimen was the initial core, towards the 1:00 lesion obtained with open trough technique. Subsequently, firing technique was needed to get through the patient's dense tissue and more accurately target the 2:00 finding. Both subsequent cores sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed near the 2:00 lesion, towards the 1:00 lesion. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Schacht. Dr. Schacht was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the left breast satellite lesion and clip placement. Pathology is pending at this time.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 75-year-old female with mental status changes status post fall on face. Evaluate for acute bleed. Extensive areas of low-attenuation in the deep, subcortical, and periventricular white matter consistent with small vessel ischemic disease of indeterminate age. They appear grossly stable when comparing to prior MRI of the brain. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Additionally, there is a mottled appearance to the bones of the skull base and frontal bone that is of uncertain etiology. Given patient's history of malignancy, bone metastasis is a differential consideration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Extensive small vessel ischemic disease of indeterminate age.2. Mottled appearance of the bones of the skull base and frontal bone is of uncertain etiology. Given patient's history of malignancy, metastatic disease to bone is a differential consideration. Nuclear medicine bone scan may be helpful for further evaluation as clinically indicated.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post tumor resection. Signs and symptoms: Status post craniotomy. Pre-and post-enhanced brain MRI:Examination demonstrates a large well-demarcated hemorrhagic mass and high convexity right posterior frontal lobe with large internal focus of enhancement. The combination of findings measures at 33 x 43 mm in transaxial dimensions. There is surrounding vasogenic edema and with resultant effacement of adjacent cortical sulci and trace deviation of midline to the left.Two tiny additional enhancing foci are metastatic lesion is also noted in the high convexity left posterior frontal and anterior parietal lobes with a larger lesion measuring only 4.5-mm in size. An additional small superficially located metastatic lesion approximately 4 mm is noted in the right posterior temporal -- occipital junction.Post-enhanced images also demonstrate a small developmental venous anomaly of the left frontal lobe.Calvarium demonstrate a tiny focus of enhancement in the left parietal (axial post enhanced series 1 to zero image 24 measuring approximately 4.5 mm. This finding demonstrate T2 hypointense signal pattern on axial T2 and T2 flair image 24 and could represent an additional metastatic lesion.Unremarkable images through the orbits. Mild extensive chronic sinusitis is noted. Its

Output: 1.Large hemorrhagic partially enhancing metastatic lesion in right posterior frontal measuring 43 x 33-mm in transaxial dimensions.2.Multiple additional subcentimeter metastatic lesions as detailed.3.4.5-mm focus of enhancement in the left parietal bone as detailed.


Instruction: Generate impression based on findings.

Input: Acute and chronic back pain, rule-out fracture, worsening disk protrusion, cord compression. Thoracic Spine:Vertebral body heights in the thoracic spine are normal without evidence of compression fracture. Alignment is maintained. Patient motion limits evaluation for cord signal abnormalities, however, no definite cord signal abnormality is appreciated. No abnormal enhancement. There are mild degenerative changes with small disk bulges, most prominent at the T10-T11 level, with there is a disk protrusion resulting in mild spinal canal stenosis with effacement of the left greater than right ventral thecal sac. Appearance is unchanged since 6/23/2014. Dorsal thecal sac is preserved.There is no high grade spinal canal or neural foramina stenosis at any level in the thoracic spine.Lumbar Spine:Please note for the purposes of numbering, the most inferior well-defined disk space is labeled L5-S1 consistent with prior numbering.Again seen is mild congenital narrowing of the spinal canal. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a right paracentral disk protrusion which effaces the right lateral recess and not significantly change since prior. There is mild central spinal canal stenosis on a congenital basis and related to prominence of the dorsal epidural fat. There is mild right neural foramina narrowing and minimal on the left.L3-L4: There is disk dessication and mild disk bulge with small central protrusion component versus osteophyte. There is mild spinal canal stenosis, which is predominantly on a congenital basis. There is a small right dorsal annular fissure. There is mild to moderate spinal canal stenosis on the right and mild on the left. Mild facet arthropathy.L4-L5: There is disk dessication and bulge with small left dorsal annular fissure. There is mild right and moderate to severe left neural foraminal stenosis. There is mild facet arthropathy. There is mild central canal stenosis predominantly on a congenital basis.L5-S1: There is transitional anatomy. There is disc dessication and mild disk bulge. There is mild left neural foramina stenosis. No significant right neural foramina narrowing. No spinal canal stenosis.There is edema involving the paraspinous musculature with bilateral superficial fluid collections right larger than left extending along the muscle fascial planes from T12 to L3. There is peripheral enhancement. Collection on the right measures up to 15 mm in thickness and 36 mm in the AP dimension. Smaller fluid collections on the left measure approximately 6 mm in thickness.

Output: 1. Mild degenerative changes in the thoracic spine without significant spinal canal or neural foramina stenosis. There is a small disk protrusion at the left T10-T11 level with mild spinal canal stenosis and not significantly changed since prior. No compression fractures in the thoracic or lumbar spine. 2. Degenerative changes in the lumbar spine not significantly changed since prior. There is mild spinal canal stenosis, which is mostly on a congenital basis. No high-grade spinal canal stenosis is appreciated at any level. There is effacement of the right lateral recess at the L2-L3 level and multilevel neural foramina narrowing, relatively worse at the L4-L5 level where there is moderate to severe left foraminal stenosis.3. Multiple small fluid collections involving the bilateral paraspinous musculature from T12 to L3 levels. There is mild peripheral enhancement. Fluid may be related to inflammatory process with muscle injury/myositis/myonecrosis or perhaps prolonged supine position; however given multiple loculations of fluid and mild peripheral enhancement, abscesses are not excluded. Consider ultrasound-guided aspiration. No evidence of epidural abscess or discitis-osteomyelitis. Dr. Ali discussed findings with Dr. Sheth at 1538 hrs on 3/12/2015.


Instruction: Generate impression based on findings.

Input: Clinical question: Memory deterioration; evaluate for CNS disease. Signs and symptoms: As above. Pre-and post enhanced brain MRI:No acute intracranial process and in particular no evidence of acute ischemic stroke.Examination demonstrates prominence of cerebral cortical sulci which are more prominent in bilateral parietal lobes. There is no associated signal abnormality.There are small patchy foci of flair hyperintensity only in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the right thalamus and bilateral basal ganglia. Findings considering patient's stated age of 88 are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.There is normal appearing ventricular system and with maintained midline.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits. Minimal patchy opacification of bilateral mastoid air cells and unremarkable paranasal sinuses with the exception of mild left maxillary and coastal thickening.Post enhanced images are unremarkable and demonstrate no detectable abnormal enhancement the brain parenchyma, leptomeninges, calvarium or retro-orbital spaces.

Output: 1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Slight prominence of cortical sulci primarily in the bilateral parietal lobes which likely still within normal range for patient stated age of 88.4.No detectable abnormal enhancement the brain parenchyma, leptomeninges or the calvarium.


Instruction: Generate impression based on findings.

Input: Female, 12 months old, with new onset generalized tonic-clonic seizures. No evidence of parenchymal edema or mass effect is seen. No structural abnormalities are detected. Mild ill-defined T2 hyperintensity is seen in the periatrial white matter, left side more so than right.The pituitary region is unremarkable. The corpus callosum is fully formed and intact. The brainstem, cerebellar vermis and cerebellar hemispheres are within normal limits. The pattern of white matter myelination is appropriate for age.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. The ventricular system is normal in size and morphology. The medial temporal lobe structures are symmetric and free of pathologic signal abnormality.

Output: 1.Mild periatrial white matter T2 hyperintensity is seen, left side more so than right. This is favored to represent the normal terminal zones of myelination.2.No definite focal parenchymal lesion, structural abnormality or other specific finding to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: 86 year old male with posttransplant lymphoproliferative disease involving the CNS. History of renal transplant in 2005 presented with PTLD involving the CNS and 2013. There are no diffusion weighted abnormalities. Redemonstrated are stable foci of FLAIR hyperintensity primarily within the periventricular white matter, most prominent involving the left frontal centrum semiovale and left cingulate gyrus with out evidence of mass effect. As before, there is a small focus of susceptibility near the vertex of the left-sided process. Mild ex vacuo dilatation of bilateral frontal horns of lateral ventricles (left slightly greater than right) is stable with maintained midline anatomy. Prominence of cortical sulci likely within normal range for patient's stated age and stable since prior exams. There are no detectable new foci of parenchymal signal abnormality. The signal voids of major intracranial arterial branches are identified.. The visualized paranasal sinuses and the mastoid air cells are clear

Output: 1.No evidence of acute or new findings since prior exams.2.Stable focus of hemorrhagic encephalomalacia in the left frontal centrum semiovale and left cingulate gyrus.3.Stable periventricular chronic small vessel ischemic disease.4.Stable mild ex vacuo dilatation of the lateral ventricles and prominence of cortical sulci


Instruction: Generate impression based on findings.

Input: Rule-out AVN versus fracture in the lunate. Prior traumaIMAGE ACQUISITIONS: Ultrahigh routine CT of the right wrist was performed with 0.3-mm reconstruction. No enhancement The osseous structures remain in proper alignment with particular attention placed on the lunate relative to the radius, triquetrum and scaphoid. The shape of the lunate is normal without abnormality. Specifically no evidence of fracture or dislocation. No additional CT findings to suggest AVN, however please note MRI would be more sensitive in this early stage.A small benign-appearing cyst noted in the proximal pole of the scaphoid. Small bone island seen in the distal radius. The remainder of the wrist is otherwise unremarkable. Soft tissues normal.

Output: No additional abnormality, specifically no CT findings to suggest AVN or fracture.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate stenosis. Signs and symptoms: Worsening left arm pain. Unenhanced cervical MRI:There is generalized small caliber cervical spinal canal which is believed to be a congenital anatomical variation.Foramen magnum is unremarkable.C2 -- C3 demonstrate minimal left neural foraminal compromise and unremarkable otherwise.C3 -- C4 demonstrate mild degenerative disk disease and loss of disk height and no significant hypertrophy changes of posterior elements. Mild degenerative changes at this level in combination with congenitally small canal results in mild central spinal stenosis. There is moderate (R>L) neuroforaminal compromise and without appreciable change since prior exam.C4 -- C5 demonstrate mild degenerative disk disease and minimal bilateral facet degenerative changes. There is mild bilateral neural foraminal and central spinal stenosis without significant change since prior exam. C5 -- C6 demonstrate mild this disease with mild loss of disk height, mild bulging disk and asymmetric (L > R ) uncovertebral hypertrophic changes. New since prior exam is a right paramedian disk protrusion with resulting subtle flattening deformity of the right ventral aspect of the cord. Constellation of changes and including congenitally small canal results in moderate central spinal stenosis, significant left and moderate right neural foraminal compromise. There is no detectable signal abnormality of the cord.C6 -- C7 demonstrate mild disk disease and loss of disk height, shallow broad-based bulging disk, hypertrophic changes of posterior longitudinal ligament along the dorsal aspect of C6 vertebrae, asymmetric left uncovertebral hypertrophic changes. Constellation of changes results in mild central spinal stenosis, moderate left neural foraminal compromise and mild on the right.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine the thoracic cord to T3 level is unremarkable

Output: 1.There is uniform generalized a smaller caliber of the spinal canal believed to present a congenital anatomical variation. This finding in combination with mild degenerative changes resulting in multilevel mild central spinal stenosis. 2.At C5 -- C6 there is a new right paramedian small disk protrusion with resultant flattening deformity of the right ventral cord, moderate central spinal stenosis and neural foraminal compromise. No detectable cord signal abnormality.3.Mild degenerative changes at other levels without significant change since prior exam as detailed per level.


Instruction: Generate impression based on findings.

Input: Left eye flashes, workup for TIA. No restricted diffusion to suggest acute infarct. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are patchy confluent areas and scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease. Punctate foci of susceptibility consistent with chronic microhemorrhage are noted involving the right frontal lobe and left occipital lobe. There is global parenchymal volume loss which is commensurate with age. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Minimal mucosal thickening is seen in the frontal and maxillary sinuses; paranasal sinuses are otherwise clear. Minimal left mastoid air cell fluid. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct. No intracranial mass or mass effect.2. Foci of T2/FLAIR hyperintensities in periventricular and subcortical white matter are nonspecific but compatible with mild chronic small vessel ischemic disease.3. Two punctate foci of chronic microhemorrhage are nonspecific but given the peripheral lobar distribution, favor amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: 58 years, Male, Reason: 58 yo M with SB-IPMN please r/o growth or tumor History: 58 yo M with SB-IPMN please r/o growth or tumor. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild loss of signal on phase images suggest steatosis. Common bile duct appears normal. No gallstones. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is prominent. Normal response to secretin administration. Mild atrophy of the pancreatic tail. There are 4 punctate cysts within the tail which do not definitively communicate with the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter nonenhancing renal cysts.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.Punctate cystic lesions in the tail of the pancreas are nonspecific and with no definitive communication with the main pancreatic duct. 2.Main pancreatic duct is mildly prominent with mild atrophy of the tail. No suspicious pancreatic lesions.3.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are essentially within normal limits. There is trace anterior wedging involving the L1 and L2 vertebral bodies which may be physiologic. Alignment is within normal limits. Bone marrow signal is benign with a focus of T1 hyperintensity at L1 compatible with a small hemangioma.. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disk desiccation with left dorsal annular fissure and small protrusion. Minimal effacement of the left lateral recess. No significant spinal canal or neural foramina stenosis seen. L3-L4: Minimal disk bulge, ligamentum flavum thickening, and facet arthropathy. No significant spinal canal or neural foraminal stenosis is seen. L4-L5: Minimal disk bulge eccentric to the left with mild left neural foraminal narrowing. No significant spinal canal or right neural foraminal narrowing.L5-S1: Disk desiccation with small dorsal annular fissure, and tiny protrusion. No significant spinal canal or right neural foramina stenosis is seen. Minimal left neural foraminal narrowing. There is mild to moderate bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the lumbar spine as detailed above with small multilevel disk bulges and protrusions. No significant spinal canal or neural foramina stenosis at any level.2. Facet arthropathy in the lower lumbar spine which may be contributing to patient's low back pain. 3. Trace anterior wedging at L1 and L2 vertebral bodies which may be physiologic. No edema to suggest recent compression fracture.


Instruction: Generate impression based on findings.

Input: 42 year old female. Status post vaginal hysterectomy. Now has bandemia and abdominal pain. Right CVA TTP, fever and rigors. DM. Evaluate for perinephric abscess. ABDOMEN:LUNG BASES: Mild bibasilar dependent atelectasis. LIVER, BILIARY TRACT: Hepatomegaly. The liver measures 22 cm overall. Periportal edema seen previously has resolved. There are hepatic hypodensities which are subcentimeter in size and unchanged since prior examination, probably benign. SPLEEN: No significant abnormality noted. Splenules at the hilum and lower pole. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The previous examination found left hydronephrosis and hydroureter which has resolved. No specific renal abnormality was identified.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged pericaval and paraaortic lymph nodes inferior to the kidneys. BOWEL, MESENTERY: No significant abnormality noted. Normal appendix in the right lower quadrant. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No abscess or ascites. The celiac and superior mesenteric arteries share a common origin, a normal anatomic variant. This is seen best on midline sagittal view.Umbilical Richter's hernia contains nonobstructed bowel.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Large central pelvic multiloculated cystic mass with wall enhancement was seen on the prior exam and is much smaller. The mass measures 8.7 x 12 cm. No gas bubbles. May be further evaluated with transvaginal ultrasound and/or MRI, if indicated. BLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged left iliac lymph nodes.BOWEL, MESENTERY: No significant abnormality notedqBONES, SOFT TISSUES: Intramuscular cystic lesion at right rectus femoris muscle image 101 of series 3) is stable since the prior exam and does not have characteristics of an abscess. OTHER: No significant abnormality noted

Output: The multiloculated central pelvic mass seen on the prior exam of 2/21/2010 is much smaller. Interval resolution of left hydroureter and hydronephrosis. Pelvic ultrasound exam may be helpful for further evaluation.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop stealth brain MRI. Signs and symptoms: Preop MRI. Pre- and post enhanced Stealth brain MRI:Examination demonstrates a right posterior parietal dural based paramedian well-demarcated and intensely enhancing mass consistent with meningioma. It measures 16 x 15 mm in transaxial dimensions which is slightly larger than prior exam from April 2015.Additionally there is a more laterally located right posterior parietal dural based enhancing tumor likely representing an additional focus of meningioma measuring at 12 x 9 mm in transaxial dimensions and without convincing evidence of significant change.Diffuse FLAIR hyperintensity in bilateral posterior parietal without associated mass effect and likely representing gliosis/encephalomalacia.

Output: 1.Dural base right posterior parietal paramedian meningioma measuring 16 x 15 in transaxial dimensions with subtle interval increased size.2.A more laterally located dural base right posterior parietal enhancing meningioma measures at 12 x 9 mm and without convincing change since prior exam.3.Extensive bilateral posterior parietal FLAIR hyperintensity without mass effect and suggestive of post treatment


Instruction: Generate impression based on findings.

Input: Cavernous malformation surveillance. There is an unchanged lesion centered in the right cerebral peduncle that measures up to approximately 15 mm. There is circumferential susceptibility effect and central loculated area of intrinsic T1 hyperintensity, as well as patchy enhancement in the lesion. There also appears to be at least one developmental venous anomaly associated with the lesion, but there is no surrounding vasogenic edema. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A lesion centered in the right cerebral peduncle is unchanged and likely represents a cavernous malformation associated with at least one developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Right shoulder pain. ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon at its attachment on the greater tuberosity that measures approximately 1.5 to 2 cm in the AP dimension, with mild (under 1 cm) retraction. There is thickening of the remainder of the supraspinatus tendon indicating tendinosis. There is mild tendinosis of the infraspinatus tendon, but we see no tear. The supraspinatus and infraspinatus muscles appear intact. There is mild edema type signal and cyst formation within the humeral head, posteriorly, perhaps reflecting an overlying tendinosis. There are also cysts more anteriorly within the greater tuberosity. There is minimal tendinosis of the subscapularis tendon distally, otherwise the subscapularis tendon appears normal. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear signal intensity traversing the superior labrum posteriorly which may represent a tear, but the clinical significance of this finding is uncertain. The remainder of the labrum appears normal given the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Full-thickness insertional tear of the supraspinatus with minimal retraction and other findings as described above.


Instruction: Generate impression based on findings.

Input: 70-year-old female with progressive knee pain and known Baker's cyst. Evaluate for meniscus tear or ligament tears and degree of degenerative changes. MENISCI: There is linear increased signal abnormality within the anterior horn of the lateral meniscus which extends to the femoral articular surface consistent with a horizontal tear. There is globular increased signal abnormality within the posterior horn of the meniscus consistent with intrasubstance degeneration. Some of the signal extends to the tibial articular surface consistent with undersurface tearing/fraying.There is globular increased signal abnormality within the body of the medial meniscus consistent with intrasubstance degeneration. Some of this signal abnormality extends to the tibial articular surface consistent with undersurface tearing/fraying. The medial meniscus otherwise appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the posterior aspect of the lateral femoral condyle as well as along the weightbearing portion of the lateral femoral condyle above the posterior horn of the meniscus. There is also full-thickness articular cartilage degeneration along the lateral aspect of the lateral tibial plateau, beneath the posterior horn of the meniscus.There is full-thickness articular cartilage degeneration affecting the patellofemoral articulation with portions of the medial and lateral facet of the patella completely devoid of cartilage. There is underlying degenerative subchondral signal abnormality. There is near full-thickness to full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea with underlying degenerative subchondral signal abnormality. There is tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tear of the lateral meniscus as described above.2. Undersurface tearing/fraying of the medial meniscus.3. Small-to-moderate sized joint effusion and Baker's cyst.4. Osteoarthritic changes including full-thickness articular cartilage degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: There is new mild increased T2 signal within the paravertebral soft tissues posteriorly from the C4/5 through C 6/7 levels associated with slight increased signal in the interspinous ligament at C6/7 (best seen sagittal STIR technique).Previously identified Modic type I discogenic reactive endplate changes at C6-C7 and to a lesser extent C5-C6 now appear as Modic type II. As before, there is multilevel disk desiccation and loss of disk height. Minimal grade 1 retrolisthesis of C5 on C6 is unchanged. There are no acute fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. Right mastoid fluid is unchanged.C1/2: No significant central canal stenosis or neuroforaminal narrowing, unchanged.C2/3: No significant central canal stenosis or neuroforaminal narrowing, unchanged.C3/4: Posterior disk osteophyte complex eccentric to the right has progressed resulting in increased right anterior hemicord flattening, yet still without intrinsic T2 cord signal abnormality. As before, there is bilateral uncovertebral hypertrophy and mild facet hypertrophy resulting in mild to moderate left neural foraminal and moderate to severe right neural foraminal stenosis, unchanged. There is no significant central canal stenosis.C4/5: Posterior disk osteophyte complex, left facet hypertrophy, and posterior ligamentous hypertrophy resulting in bilateral neuroforamina narrowing, mild to moderate on the right and moderate to severe on the left, unchanged. No significant central canal stenosis.C5/6: Posterior disk osteophyte complex, facet hypertrophy, posterior ligamentous hypertrophy resulting in severe right and moderate left neuroforaminal narrowing, unchanged. There is effacement of the CSF space resulting in mild central canal stenosis, unchanged.C6/7: Posterior disk osteophyte complex, facet hypertrophy, uncovertebral hypertrophy, and posterior ligamentous hypertrophy resulting in mild central canal stenosis and mild to moderate bilateral neuroforaminal narrowing, left greater than right, unchanged.C7/T1: Facet hypertrophy results in mild left neuroforaminal narrowing, unchanged. No significant central canal stenosis.

Output: 1.There is new mild increased T2 signal within the paravertebral soft tissues posteriorly from the C4/5 through C 6/7 levels associated with slight increased signal in the interspinous ligament at C6/7. The differential diagnosis for this would include injury if there is been a recent history of trauma or in absence of this history an inflammatory process of uncertain etiology or significance.2.C3/4: Posterior disk osteophyte complex eccentric to the right has progressed resulting in increased right anterior hemicord flattening, yet still without intrinsic T2 cord signal abnormality. Mild to moderate left neural foraminal and moderate to severe right neural foraminal stenosis is unchanged. 3.C4/5: Bilateral neuroforamina narrowing, mild to moderate on the right and moderate to severe on the left, unchanged.4.C5/6: Severe right and moderate left neuroforaminal narrowing, unchanged. Mild central canal stenosis is unchanged.5.C6/7: Mild central canal stenosis and mild to moderate bilateral neuroforaminal narrowing, left greater than right, unchanged.6.C7/T1: Mild left neuroforaminal narrowing, unchanged.


Instruction: Generate impression based on findings.

Input: Diagnosis: Acute myeloblastic leukemia, not having achieved remission. Altered mental status, unspecifiedClinical question: assess for white matter changes, lesionsSigns and Symptoms: altered mental status The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact. There are falcine calcifications present.

Output: There is no evidence for acute cerebral infarction, leptomeningeal disease or intracranial mass. Given the patient's age MRI imaging of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: History of metabolic myopathy. Bone lesion seen on MRI. Patient with complaint of the thigh muscle cramping/soreness. Evaluate for left femur lesion/calcifications. 2 views of the left femur show a lucent lesion in the mid femoral diaphysis with endosteal scalloping corresponding to the abnormality seen on recent MRI. There may be faint calcifications within the lesion but this is equivocal. We see no frank cortical penetration. The remainder of the femur is unremarkable.

Output: Lucent lesion in the mid femoral diaphysis as described above. Its appearance on MRI is suggestive of an enchondroma although we cannot confidently see calcification within the lesion on these radiographs. CT may be considered as a more sensitive modality for detecting calcification.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:9/1/1949)Reason: Eval for ischemia, bleed History: falls, c/f left sided weakness, subacute change in mental statusPROVIDER/ATTENDING NAME: SHANNON K MARTIN SHANNON K MARTIN The CSF spaces are appropriate for the patient's stated age with no midline shift. The exam is somewhat degraded due to patient motion artifact. Susceptibility weighted imaging is degraded significantly patient motion artifact.There is a cystic focus present medial to the left cerebellar hemisphere measuring 20 x 20 mm axial dimensions which follows spinal fluid on all pulse sequences and most likely represents a small arachnoid cyst.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery appears very small relative to the right vertebral artery.The visualized portions of the paranasal sinuses demonstrate scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 24-year-old female with psoriasis and pain. Evaluate for sacroiliitis. BONE MARROW: No bone marrow signal abnormality is identified. The sacroiliac joints are normal in appearance without findings to suggest sacroiliitis, as clinically questioned.SOFT TISSUES: The imaged musculature is normal in appearance. JOINTS: The sacroiliac joints are normal in appearance without findings to suggest sacroiliitis, as clinically questioned.ADDITIONAL

Output: 1. No evidence of sacroiliitis.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female; 49 years old. Reason: uterine anomaly seen on ultrasound. Need MRI to determine exact anatomy and if also has renal anomaly. Abdomen:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: Ventral abdominal wall hernia containing mesenteric fat. Pelvis:UTERUS, ADNEXA: The uterus demonstrates two horns; morphology is borderline between septate and bicornuate uterus but favor bicornuate uterus. No suspicious adnexal lesions. Numerous subcentimeter T2 hyperintense lesions throughout the uterine wall likely represent adenomyosis. Heterogeneous lesion adjacent to the right uterine wall with larger T2 hyperintense cystic areas is suggestive of a focal adenomyoma, but could also represent a degenerated fibroid (series 19, image 11). There is a mildly T2 hyperintense mass located within the endometrial cavity and right uterine horn that demonstrates gray signal on T1 weighted sequences and measures 3.8 x 2.7 cm, best seen on series 19, image 12. This lesion extends to the level of the lower uterine segment and may also extend into the left uterine horn, but does not transgress the myometrium to the serosal surface. BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.BIcornuate uterus containing soft tissue mass of intermediate signal intensity as described above, which does not appear to extend into the myometrium. Findings are suspicious for endometrial carcinoma.2.Uterine adenomyosis with focal adenomyoma vs degenerated fibroid. 3.No structural renal anomalies identified as clinically questioned.


Instruction: Generate impression based on findings.

Input: Other headache syndrome [G44.89], Reason for Study: ^Reason: h/o migraine HA with pulsatile tinnitus and facial numbness, eval for vascular anomaly History: h/o migraine HA with pulsatile tinnitus and facial numbness, eval for vascular anomaly Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is about 16.1 mm tonsilar ectopia through the foramen magnum level indicating Chiari 1 malformation. Ventricle size remains within normal limits.Prominent suprasellar cistern is also shown.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Bilateral Pcom arteries and Acom artery are patent.There is no intracranial arterial aneurysm. No significant arterial luminal stenosis.

Output: 1. Chiari 1 malformation as described above.2. No evidence of acute ischemic or hemorrhagic lesion.3. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Left cranial nerve VI and VII pulse, known multiple sclerosis patient. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal scattered variable sized high signal intensities on FLAIR imaging are identified including left temporal lobe anterior aspect bilateral trigone areas, periventricular white matter, left precentral gyrus, right midbrain posterior aspect, bilateral middle cerebellar peduncles, and left mid to lower pons. These high signal intensity lesions are compatible with multiple sclerosis plaque.Especially the left mid to lower pons and left side middle cerebellar peduncle and left anterior temporal lobe lesions demonstrate periportal irregularity shaped contrast enhancement indicating minimal effective multiple sclerosis plaque. The differential diagnosis of these lesions include high-grade glioma or metastasis but those possibility would be lower.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRI:Multifocal patch high signal intensities on T2 and STIR images were seen on craniocervical junction to the cervical spine. On axial scan, abnormal high signal intensity lesions involve bilateral posterolateral aspect of spinal cord at the level of C1, the lesion involves the central portion of the spinal cord as well. Again, the location and characteristics of this high signal intensity lesions are consistent with multiple sclerosis involvement of the cervical spine.There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement.Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: Disc desiccation no spinal stenosis. Minimal left neural foraminal narrowing. C4-C5: no neuroforaminal narrowing or spinal stenosis. C5-C6: Minimal thickening of the ligamentum flavum, otherwise no neuroforaminal narrowing or spinal stenosis. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multifocal patch high signal intensities on FLAIR imaging as described above, consistent with multiple sclerosis plaque.2. Irregular walled enhancing lesions especially on the left temporal lobe anterior aspect as well as left-sided mid to lower pons and the left middle cerebellar peduncle suggestive possibility of tumefactive multiple sclerosis lesions. Differential diagnosis includes high-grade glioma in metastatic lesions, but the possibility is low.3. Multifocal patch high signal intensity lesions on T2 and STIR images on all cervical spine consistent with multiple sclerosis involvement of C-spine.


Instruction: Generate impression based on findings.

Input: Seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no evidence of heterotopia or hippocampal sclerosis. There is mild asymmetry of the lateral ventricle, left smaller than right, which can be a developmental variant. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No potential seizure foci are identified.


Instruction: Generate impression based on findings.

Input: 42-year-old female with pT2(m)N1a IDC of the R breast s/p mastectomy and axillary lymph node dissection (3/17 total + LNs), ER/PR+, Her-2- in 7/2013. S/p Chemo and XRT. She was on Tam but stopped after one month due intolerable hot flashes. Discussed AI/ovarain suppressio History: with pT2(m)N1a IDC of the R breast s/p mastectomy and axillary lymph node dissection (3/17 total + LNs), ER/PR+, Her-2- in 7/201 RIGHT BREAST:Again seen are postsurgical changes in the right breast which are unchanged. The retropectoral saline implant appears intact. No abnormal sized axillary lymph nodes are identified in the right axillary region.LEFT BREAST:There is unchanged heterogeneity of fibroglandular tissue in the left breast with minimal parenchymal enhancement noted. The retropectoral saline implant appears intact. The previously described enhancing focus in the 5 o'clock position near the implant is is no longer seen. However a more benign round 5 x 4 x 4 mm enhancing focus is identified in the anterior depth of the left breast in the 5:00 position adjacent to the implant which could represent fat necrosis. However this area should be followed in subsequent exams to ensure stability. There are stable prominent left-sided axillary lymph nodes.

Output: 1.The previously described enhancing focus in the 5 o'clock position near the implant is is no longer seen. However a more benign appearing round 5 x 4 x 4 mm enhancing focus is identified in the anterior depth of the left breast in the 5:00 position adjacent to the implant which could represent fat necrosis. However this area should be followed in subsequent exams to ensure stability.2.Stable post-surgical changes in the reconstructed right breast without evidence of malignancy.3.Stable slightly prominent left-sided axillary lymph nodes.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Spastic quadriplegic with history of cerebral palsy and TORCH infection. Evaluate for seizure focus or cerebellar lesion: horizontal nystagmus. There are extensive areas of cystic encephalomalacia within the bilateral parietal and posterior frontal lobes, with associated scattered areas of susceptibility effect, marked thinning and bulging of the body of the corpus callosum, and ex-vacuo dilatation of the lateral ventricles. There are also smaller areas of encephalomalacia and susceptibility effect in the bilateral basal ganglia. There are multiple additional scattered small foci of abnormal susceptibility throughout cerebral hemispheres bilaterally. There is diffuse prominence of the cerebellar sulci, left more than right. There is also patchy T2 hyperintensity in the left cerebellar hemisphere white matter. There is no evidence of acute infarction. There is no intracranial mass lesion or midline shift. The cranium has a microcephalic appearance and there appears to be hypertelorism. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Areas of chronic hemorrhagic infarction in the bilateral cerebral hemispheres, particularly the frontal and parietal lobes and basal ganglia, as well as multiple scattered cerebral calcifications are compatible with the history of cerebral palsy and of TORCH infection.2. Diffuse left greater than right cerebellar volume loss and patchy signal abnormality in the left cerebellar hemisphere white matter may be related to the supratentorial infarcts with superimposed crossed cerebellar diaschises.  I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right sided hand and arm weakness, intermittent; h/o fungal sinusitis. There are postoperative findings related to osteoplastic flap reconstruction of the frontal sinuses and endoscopic sinus surgery with resection of the uncinate processes and middle turbinates. There is predominantly low T1 and high T2 signal material within the bilateral frontal sinuses. There is also mild mucosal thickening within the anterior right ethmoid sinuses and subcentimeter retention cysts in the right maxillary sinus and right sphenoethmoid recess. 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.

Output: 1. Postoperative findings related to osteoplastic flap reconstruction of the frontal sinuses with what appear to be persistent obstructed secretions in the bilateral frontal sinuses, but no intracranial extension.2. No evidence of acute infarct or intracranial mass.


Instruction: Generate impression based on findings.

Input: Female, 3 years old, history of bilateral sensorineural hearing loss. Pre-cochlear implantation evaluation. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.No masslike lesions are seen in the IACs. The vestibules and semicircular canals demonstrate a normal MRI morphology. Cochlear morphology, however, was better assessed on temporal bone CT. Cochlear nerves are evident bilaterally entering the cochlear apertures.

Output: 1.No specific findings are seen to account for the patient's hearing loss. Please note that cochlear morphology was better assessed on dedicated temporal bone CT imaging.2.Cochlear nerves are present bilaterally.


Instruction: Generate impression based on findings.

Input: Unknown congenital spinal cord tumor, presenting with severe lumbosacral pain, radiculopathy, inability to ambulate. There is clumping, irregularity and predominantly posterior displacement of the cauda equina nerve roots at the L5-S1 level, along with what appear to be linear low attenuation bands around the nerve roots. There is a perineural cyst at the S3 level that measures up to approximately 45 mm in width associated with remodeling of the surrounding bone. There are also subcentimeter perineural cysts in the spinal canal at the S2 level. There is mild degenerative spondylosis, including disc bulges and facet hypertrophic changes with trace effusions, in the lower lumbar spine, which result in up to mild bilateral neural foraminal stenosis at L4-5. Otherwise, there is no significant spinal canal stenosis. There are Schmorl nodes at T11-12 level. Otherwise the vertebral body heights and alignment are intact. There are renal cysts bilaterally. There is a partially-imaged infrarenal aortic aneurysm.

Output: 1. Findings suggestive of arachnoiditis and/or arachnoid cyst and adhesion formation versus inclusion cyst at the L5-S1 level, which may be iatrogenic in nature. Otherwise, evaluation for tumor is limited without contrast.2. Sacral perineural cysts, the largest of which measures 45 mm in width at the S3 level.3. No significant lumbar spinal canal stenosis.4. Partially-imaged infrarenal aortic aneurysm. Dedicated vascular imaging may be useful for further characterization.


Instruction: Generate impression based on findings.

Input: Lymphoma, follow-up evaluation. Compared to most recent study, there is no significant change in mild enlargement and diffuse enhancement of the bilateral trigeminal nerves particularly in its cisternal segment and right foramen ovale. There is no new parenchymal or meningeal enhancement to suggest progression of disease. There is a stable right frontal approach Ommaya catheter. The ventricles and sulci are stable. There remains a similar extent of confluent T2/FLAIR hyperintensity within the bilateral cerebral white matter. The cisterns remain patent. There is no midline shift or mass effect. 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 an unchanged small left maxillary sinus mucosal retention cyst.CERVICAL SPINE

Output: 1. No evidence of progression of lymphoma in the brain or cervical spine. Cranial nerve enhancement as well as cervical nerve root enhancement is not appreciably changed since 8/4/2016.2. Stable extent of confluent areas of bilateral cerebral white matter signal abnormality, likely posttreatment changes.


Instruction: Generate impression based on findings.

Input: Acute onset of dizziness, unsteadiness and difficulty with word finding. Images through posterior fossa are unremarkable.Images through supratentorial space demonstrate findings consistent with small vessel disease of indeterminate age. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Considering provided clinical data an MRI examination is recommended.

Output: Small vessel disease of indeterminate age.