Instruction: Generate impression based on findings.

Input: 4-year-old female is status post peak versus auto . Nonenhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and gray -- white matter differentiation is unremarkable. There is mild crowding of cerebellar tonsils into the foramina magnum. This finding is best appreciated on sagittal reformatted images. Please correlate with clinical history and follow-up with an MRI may be necessary.Calvarium is intact. No definitive abnormality of soft tissues of the scalp.Limited view of the orbits, mastoid air cells, middle ear cavities and paranasal sinuses are unremarkable.

Output: 1.No evidence of acute posttraumatic findings.2.With the exception of mildly ectopic cerebellar tonsils this non-infused CT examination of brain is unremarkable.


Instruction: Generate impression based on findings.

Input: Male 30 years old with left knee pain. Evaluate for meniscus tear. MENISCI: The anterior meniscus is slightly diminutive in size but we see no meniscal tear.ARTICULAR CARTILAGE AND BONE: There is a small focus of degeneration involving the cartilage of the femoral trochlea centrally. Mild heterogeneous signal in the cartilage of the patella likely also represents degeneration. There are small cysts within the tibial plateau beneath the root of the posterior horn of the medial meniscus but we see no meniscal tear. There is mild edema in the anterior tibial tuberosity.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is a longitudinal tear of the distal patellar tendon centrally at its insertion on the anterior tibial tuberosity. The tear involves the majority of the thickness of the tendon disrupting the undersurface fibers but sparing the superficial fibers. The tear is approximately 3 cm in longitudinal dimension and 1 cm in width. The remainder of the tendon appears thickened indicating tendinosis. The distal quadriceps tendon appears normal. Fluid in the deep infrapatellar bursa indicates bursitis. There is mild adjacent soft tissue edema.ADDITIONAL

Output: 1.Partial-thickness tear of the distal patellar tendon at its insertion as described above.2.No meniscal tear.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: 47-year-old female. Status post cholecystectomy complaining of abdominal pain. Per OSH MRCP patient has cholelithiasis. Please evaluate and confirm diagnosis. Examination is limited due to significant motion artifact and lack of pre-contrast T1 sequences.ABDOMEN:LIVER, BILIARY TRACT: Post-surgical findings of cholecystectomy. Central moderate intrahepatic and marked extrahepatic biliary ductal dilatation with transition point at a 7 mm distal CBD stone near the ampulla (series 11, image 13).Hepatomegaly measuring 19 mm in length.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered small T2 hyperintense foci in the kidneys, incompletely characterized without intravenous contrast, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Postsurgical changes in the small bowel.BONES, SOFT TISSUES: Small ventral hernia containing unobstructed loop of bowel.OTHER: No significant abnormality noted.

Output: Diffuse biliary ductal dilatation with transition point at an obstructing 7 mm distal CBD stone near the ampulla.


Instruction: Generate impression based on findings.

Input: 15 years Male (DOB:8/3/2000)Reason: Recurrent JPA History: post opPROVIDER/ATTENDING NAME: ELIZABETH M DRUMM ELIZABETH M DRUMM Since the prior exam and heterogeneously enhancing mass located at the right pontomedullary junction associated with a septated multicystic component has remained in general stable. The enhancing component currently measures 46 x 26 mm axial dimensions and on 12/22/2015 measured the same. Please note that the postcontrast study from 12/23/2015 had minimal contrast enhancement likely due to injection. The appearance of the mass is similar to the 12/17/2015 exam where it is multiseptated and heterogeneous on T2 and FLAIR pulse sequences and enhances heterogeneously. The overall dimensions of the lesion also appear stable compared to that exam. There is associated distortion of the adjacent brainstem. The mass effects the right internal auditory canal and hypoglossal canal structures and abuts the right trigeminal nerve. The mass displaces the right trigeminal nerve.There is redemonstration of ventriculomegaly with enlargement of the temporal horns of the lateral ventricles. Biventricular diameter on coronal imaging at the level of foramen of Monro is currently approximately 66 mm and previously was approximately 67 mm. Third ventricular diameter remains at 17 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since prior exam of 12/17/2015, a posterior fossa neoplasm which is consistent with the patient's diagnosis of pilocytic astrocytoma and is centered at the right half of the pontomedullary junction has not changed substantially in size.2.Since the prior exam ventriculomegaly has remained stable.


Instruction: Generate impression based on findings.

Input: 73-year-old male with mental status. Evaluation for cerebral infarction. Extremely limited exam due to patient motion. Area of susceptibility effect corresponding to hyperattenuation in the left inferior parietal lobule seen on CT is compatible with blood product. Additional focus of susceptibility in the left superior cerebellum and several scattered foci in the inferior cerebellum, likely representing chronic blood product.Prominence of the ventricles and sulci compatible with diffuse parenchymal volume loss. The basal cisterns remain patent. There is no definitive parenchymal edema. There is no midline shift or mass effect. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Extensive patchy periventricular FLAIR hyperintensity without restricted diffusion compatible with chronic small vessel ischemic disease. Left frontal scalp lipoma.

Output: 1.The hyperattenuating area of concern on prior CT demonstrates susceptibility effect on MR compatible with trace acute blood product.2.Several additional scattered small foci of susceptibility likely representing chronic blood product.3.Advanced chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 20-year-old with history of hepatomegaly, evaluate for hepatic venous thrombosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The portal and hepatic veins are seen opacifying with contrast. No correlate for the periportal edema seen on the prior CT is present on this examination.The gallbladder is normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal examination. Specifically, no finding to correlate to periportal edema seen on prior CT which may have been related to patient's volume status.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Considering active surveillance. 6/19/2015 biopsy demonstrated 3+3 tumor in the right apex medially. PELVIS:PROSTATE:Prostate Size: 3.8 x 6.0 x 6.0 cmPeripheral Zone: In the right apex there is a 4 mm focus of restricted diffusion (series 704/224) associated with T2 weighted hypointensity which may correspond to the patient's prostatic adenocarcinoma.Central Gland: Benign prostatic hyperplasia. Mild medial lobe hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.4 mm focus in the peripheral zone of the right apex may correspond to the patient's prostatic adenocarcinoma.2.No evidence of seminal vesicle invasion, extraprostatic extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Altered gait, weakness. Evaluate for cervical stenosis. The study is degraded by motion artifact. Given his caveat:The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.C2-C3: No significant spinal canal stenosis or neuroforaminal narrowing. C3-C4: Posterior disc-osteophyte complex without significant spinal canal stenosis. Uncinate hypertrophy with mild neuroforaminal narrowing. C4-C5: Posterior disc-osteophyte complex with mild spinal canal stenosis. Right greater than left uncinate hypertrophy with right and mild left neuroforaminal narrowing. C5-C6: No significant spinal canal stenosis. Uncinate hypertrophy and neuroforaminal narrowing.C6-C7: Mild disc bulge without spinal canal stenosis. No significant neuroforaminal narrowing. C7-T1: No significant spinal canal or neuroforaminal narrowing.

Output: Multilevel cervical spondylosis most predominant at C4-C5 with mild spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Male 20 years old Reason: Assess for any dominant strictures and CCA History: PSC ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is persistent mild intrahepatic ductal dilatation and a stricture extending from the Klatskin point to the common hepatic duct. The length of the narrowing is approximately 2 cm, previously 2 cm. The distal common bile duct also is irregular with mild narrowing, appearing similar to the prior study. No definite mass lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: No significant interval change in mild intrahepatic biliary ductal dilatation with mild narrowing of the common bile duct.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no acute infarct, mass effect, or cerebral edema. There are scattered periventricular and subcortical white matter T2 signal abnormalities which are nonspecific, but likely vascular related. There is mild to moderate diffuse lateral and third ventricular prominence with a relatively normal sized fourth ventricle which is likely secondary to greater degree of central parenchymal volume loss, with possible superimposed normal pressure hydrocephalus. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. LUMBAR: The last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. There is no osseous marrow signal abnormality. The conus terminates at L2 which is within normal limits.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis. L2-3: No disk herniation or spinal stenosis.L3-4: Minimal disk bulge, bilateral facet arthropathy and ligamenta flava thickening causing mild bilateral neural foraminal stenosis. No spinal canal stenosis.L4-5: Mild disk bulge, ligamenta flava thickening and facet arthropathy causing mild to moderate bilateral neural foraminal stenosis. No spinal canal stenosis.L5-S1: Mild diffuse disk bulge, facet arthropathy and ligamenta flava thickening causing moderate to severe bilateral neural foraminal stenosis. No spinal canal stenosis.

Output: 1.No acute infarct.2.Mild to moderate nonspecific white matter T2 signal abnormalities likely vascular related.3.Mild to moderate cerebral central parenchymal volume loss with possible superimposed normal pressure hydrocephalus.4.Multilevel lumbar spondylosis with bilateral neural foraminal stenosis at L3-4 through L5-S1, worst at L5-S1. No spinal canal stenosis. Please see details above.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, status post transhiatal esophagectomy 08/17/15 after neoadjuvant chemoradiotherapy, now presenting with left scapular pain radiating to the neck and back. Abnormal T1 hypointensity and STIR hyperintensity is evident within the T1 and T2 vertebral bodies. The intervening disc space also shows abnormal STIR hyperintensity. The vertebral bodies and intervening disc are enhancing with extension of ill-defined enhancement to the anterior and left anterior paraspinal soft tissues where it becomes contiguous with a presumed gastric pull-up. No obvious fluid collection is detected. The left T1-2 and T2-3 neural foramina are encompassed by this process. In addition, there is mild thickening of the left ventral epidural tissues at T1 and T2. However, no high-grade spinal canal stenosis is suspected. No abnormal signal intensity or pathologic enhancement is detected within the spinal cord parenchyma.The remaining vertebral bodies demonstrate normal signal characteristics and are free of pathologic enhancement. Spinal alignment is anatomic. Vertebral body heights are preserved. Scattered mild degenerative findings are seen but there are no areas of associated spinal canal or foraminal stenosis.

Output: Findings are seen compatible with discitis osteomyelitis at T1-2. Inflammation extends to the anterior and left anterior paraspinal soft tissues where it becomes contiguous with the adjacent gastric pull-up. No frank abscess is identified.There is mild inflammatory thickening of the epidural soft tissues as well but no significant spinal canal compromise is detected. The left neural foramina at T1-2 and T2-3 appear to be encompassed by inflammation as well.


Instruction: Generate impression based on findings.

Input: Oropharyngeal fibroma status post biopsy. There is a residual focus of subcentimeter mildly nodular mucosal thickening in the region of the right tongue base and glossotonsillar sulcus without extension into the deeper tissues of the tongue. There is no significant lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The major cervical flow voids appear to be patent. There is a 15 mm diameter perineural cyst in the left T1-2 neural foramen, which is unchanged. Other subcentimeter perineural cysts are present within the cervical spine neural foramina at several levels. The temporal bones, imaged intracranial structures, and orbits are grossly unremarkable. There appears to be filler material within the bilateral nasolabial folds. There are bilateral maxillary sinus retention cysts. There has been interval enlargement of left axillary lymph nodes, which measure up to 15 mm.

Output: 1. A subcentimeter lesion in the right oropharyngeal region is compatible with residual fibroma and/or inflammatory changes. 2. Unchanged left T1-2 neural foramen perineural cyst. 3. Interval enlargement of left axillary lymph nodes, which measure up to 15 mm, which is non-specific.


Instruction: Generate impression based on findings.

Input: History of recurrent cholangitis of unclear etiology, evaluate for biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The hepatic vasculature is patent. The gallbladder is surgically absent. There is no intrahepatic biliary ductal dilatation. The common bile duct measures up to 7 mm in diameter. There is slight smooth narrowing of the distal common bile duct measuring down to approximately 2 to 3 mm which remains patent. There is no abnormal enhancement of the bile ducts or secondary evidence of cholangitis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement. The pancreatic duct is not dilated. There are a few small cystic foci within the body of the pancreas measuring up to 4 mm (series 9, image 17). Though these do not definitively connect to the pancreatic duct, they likely represent side branch IPMNs. ADRENAL GLANDS: There is a 1.3 x 2.5 cm right adrenal nodule which demonstrates loss of signal on out of phase images and is compatible with a benign adrenal adenoma.KIDNEYS, URETERS: Status post right nephrectomy. Left renal cysts, some of which are too small to characterize.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.Smooth slight narrowing of the distal common bile duct without definite stricture, stone, or obstructing lesion. No specific imaging evidence of cholangitis currently.2.Benign right adrenal adenoma.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with intractable epilepsy, functional MRI requested for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical stimulation maps along the calcarine sulci.All tested language paradigms produced reliable language related cortical activation. Language is overall left dominant. On two of the three paradigms (word generation and verb generation), a substantial language related activation is seen in the expected location of Wernicke's area on the right. Broca's area is identified within the left inferior frontal gyrus (pars opercularis and pars triangularis). Wernicke's area is identified (bilaterally) along the posterior aspect of the superior temporal gyrus.

Output: 1.Sensorimotor cortical activation maps as expected along the pre- and post-central gyri.2.Primary visual cortical stimulation maps along the calcarine sulci.3.Language is overall left dominant. On two of three language paradigms, however, a substantial contribution is seen from Wernicke's area on the right. The significance of this is uncertain, but it suggests the possibility that some task-specific language processing may reside in the right cerebral hemisphere.


Instruction: Generate impression based on findings.

Input: Left ulnar radicular pain, is there nerve impingement? Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis with apex at the C4-C5 level. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Disc desiccation and minimal bulge. No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge and dorsal annular fissure. No significant compromise to the spinal canal or neural foramina.C6-7: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. There is a tiny left-sided perineural cyst which is a frequently seen incidental finding and of doubtful clinical significance.Paraspinous soft tissue structures appear within normal limits. There is a 6 mm right thyroid nodule.

Output: 1. Minimal degenerative changes in the cervical spine without significant spinal canal or neural foraminal stenosis at any level.2. Minor incidental findings as above.


Instruction: Generate impression based on findings.

Input: Male, 31 years old, with weakness, history of MS. Evaluate for progression. Brain:Numerous round, oval or linear T2 hyperintense lesions are evident predominantly involving the periventricular and juxtacortical white matter of the cerebral hemispheres. No definite involvement of the brainstem or cerebellum is seen.Since the prior examination, a lesion adjacent to the right occipital horn has decreased in size. In addition, a cortically based lesion within the left anterior frontal lobe has also decreased in size. However, two new lesions are seen within the left frontal lobe, one within the superior frontal white matter, and another large lesion situated in the left frontal white matter nearly spanning between the left frontal horn and the peripheral frontal cortex. Both lesions demonstrate a rim of moderate T2 hyperintensity and a core of marked T2 hyperintensity with marked T1 hypointensity.No significant generalized mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricles remain normal in size and morphology. Brain parenchymal volume is preserved. The cerebellar tonsils descend below the level of the foramen magnum compatible with Chiari I malformation.Cervical spine:One discrete T2 hyperintense lesion is evident within the anterior aspect of the spinal cord centered at C3-4. Elsewhere, cord shows normal morphology and signal characteristics. No epidural abnormalities are seen.The cervical lordosis is straightened but this is likely positional. Sagittal alignment is unremarkable. Marrow signal characteristics are within normal limits. The intervertebral discs are preserved with no significant compromise of the spinal canal or neural foramina.

Output: 1.Numerous lesions are evident within the supratentorial brain compatible with multiple sclerosis. On comparison with the prior examination, two lesions did become smaller. However, two relatively large new lesions also developed.2.A single lesion is identified within the cervical spinal cord which is also compatible with multiple sclerosis. No prior cervical spine imaging is available for comparison.3.Incidental note is made of a Chiari I malformation.


Instruction: Generate impression based on findings.

Input: Left knee pain and swelling MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration of the articular cartilage along the patella. A defect noted along the median eminence seen on the prior exam is less prominent currently. However there is a new near full-thickness cleft along the medial facet. Additional near full-thickness cleft is seen inferiorly along the median eminence which was likely present on the prior exam. There is a near full-thickness defect of the femoral trochlear cartilage centrally and inferiorly measuring approximately 8 mm. This appears more prominent on the current exam.There is mild heterogeneity of the lateral tibial plateau suggesting mild cartilage degeneration, which is similar to the prior exam.There is mild heterogeneity of the articular cartilage of the medial femoral condyle above the free edge of the posterior horn of the meniscus suggesting mild degeneration. This appears less prominent on the current exam. There is also increased signal intensity more anteriorly within the articular cartilage of the medial femoral condyle suggesting delamination. There is a small cyst within the medial tibial plateau posteriorly which was present on the prior exam. The surrounding bone marrow edema in this area has resolved. The remaining bone marrow signal is otherwise normal.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Articular cartilage abnormalities and additional findings described above.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with altered mental status. Diffuse gyral swelling is suspected given the lack of visualization of fluid in any of the cerebral sulci. On T2 weighted images, there appears to be a diffuse symmetric pattern of hyperintensity involving the cerebral cortex and the immediate subcortical tissues. Areas of more pronounced abnormal signal are suspected within the bilateral insulae and the hippocampi. On diffusion weighted imaging, there is a striking pattern of diffuse white matter hyperintensity with corresponding low signal on the ADC maps involving the cerebral white matter bilaterally and symmetrically, including the corpus callosum. On the top several slices through the brain, similar imaging characteristics may affect the cortex, but at lower levels, it is primarily found in the white matter.The basal ganglia and thalami may also be somewhat T2 hyperintense, but given the extensive background abnormality, these findings are not definitive. T2 hyperintensity seems to involve the midbrain and to a lesser degree the pons. The cerebellum does not appear to be as severely affected as the supratentorial brain, but it too shows some abnormal diffuse T2 signal. On post contrast imaging, there is prominence of the sulcal vasculature which could reflect slow flow or compression effect from edema. No discrete pathologic parenchymal enhancement is detected.No evidence of intracranial hemorrhage is seen. No abnormal extra axial fluid collections are present. The ventricular system is essentially normal in morphology and perhaps slightly smaller than what is typically seen.Pansinusitis inflammation is seen.

Output: A pattern of extensive T2 signal abnormality is seen involving the bilateral cerebral cortex and immediate subcortical white matter, the insulae and hippocampi. Less convincing is the possibility of involvement of the basal ganglia and thalami. The midbrain is suspected to be affected, with less severe findings noted in the pons and posterior fossa. A fairly striking pattern of restricted diffusion is also demonstrated involving primarily the supratentorial white matter with questionable cortical involvement in the superior most brain.The differential diagnosis for these findings would include hypoglycemic injury, though the findings as present here are not entirely typical of those reported in either the pediatric or adult populations. Additionally, injury related to hyperammonemia or some other abnormality of the urea cycle should be considered. Hypoxic-ischemic injury can be considered, though again the imaging features are not entirely typical. If these possibilities are disproved, consideration might be given to other inborn errors of metabolism.


Instruction: Generate impression based on findings.

Input: Female, 16 years old, with diagnosis of PRES, lupus, with altered mental status and seizures, on steroid treatment. Previously seen areas of cortical and subcortical T2 hyperintensity along the cerebral watershed zones and the occipitotemporal regions have completely or nearly completely resolved. A few scattered foci of periventricular T2 hyperintensity are seen, along with mild T2 cuffing of the ventricular atria. No diffusion restriction is seen. No evidence of significant parenchymal edema or mass effect is detected. There are no findings to indicate acute or chronic intracranial hemorrhage. Ventricular size and morphology are stable. No pathologic intracranial enhancement is detected.

Output: Complete or near complete resolution of scattered cortical and subcortical signal abnormality which was compatible with PRES. Small areas of residual periventricular signal abnormality may reflect pre-existing chronic lesions perhaps related to the patient's diagnosis of lupus.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: The rotator cuff tendons are intact. There is mild increased signal intensity within the distal supraspinatus tendon compatible with tendinopathy.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. No gadolinium is observed in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The glenoid articular cartilage is intact.The labrum is intact. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Mild supraspinatus tendinopathy.2. Intact labrum.


Instruction: Generate impression based on findings.

Input: 66 years Female (DOB:7/25/1949)Reason: please assess if subacute stroke vs degenerative cause for PD symptoms, History: left body tremor at rest, paratonia and weakness left sidePROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD 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.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. A couple T2 and FLAIR hyperintense punctate foci are present in the brainstem.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree as well as a couple punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: 64-year-old female status distal pancreatectomy for IPMN and in mid March 20, 2015 percent for follow-up. ABDOMEN:LIVER, BILIARY TRACT: Common bile duct is prominent measuring up to 12 mm proximally, unchanged. No evidence of choledocholithiasis, strictures, or mass. There is persistent unchanged mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Postoperative changes of distal pancreatectomy. Again noted are multiple subcentimeter outpouchings from the pancreatic duct in the pancreatic body. The reference pancreatic duct outpouching in the pancreatic head measures 14 mm (series 9, image 5), previously measuring 14 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previously noted saccular left renal artery aneurysm is no longer present; findings compatible with history of aortorenal artery bypass graft.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.Postoperative changes of distal pancreatectomy.2.Stable pancreatic head main duct IPMN. 3.Postoperative changes of left aortorenal artery bypass graft.


Instruction: Generate impression based on findings.

Input: Worsening mental status, aphasia, and right hemiparesis. Several sequences are degraded by motion.There is restricted diffusion involving the anterior and lateral aspects of the left thalamus as well as an additional punctate focus within the splenium of the left corpus callosum with associated increased T2 signal compatible with acute/subacute ischemic infarctions. There is also mild associated swelling of the left thalamus without associated significant mass effect, although there is mild convexity of its medial margin. Susceptibility weighted images are significantly degraded by motion but demonstrate punctate foci of susceptibility artifact in the bilateral deep gray nuclei as well as within the right temporal occipital region which are compatible with microhemorrhages and which are favored to be chronic, however, recent petechial hemorrhage is not entirely excluded. There is encephalomalacia involving the medial aspect of the left occipital lobe compatible with chronic infarction. Confluent areas of increased T2/FLAIR signal within the periventricular white matter, basal ganglia, and brainstem are nonspecific but compatible with chronic small vessel changes. The ventricles and sulci are within normal limits for age. The basal cisterns remain patent. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits.There is dilation of the left horizontal portion of the cavernous internal carotid artery which bulges into the cavernous sinus and left middle cranial fossa as characterized on recent CTA. The occlusion of the left posterior cerebral artery is better visualized on recent CTA. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Acute/subacute infarction involving the left thalamus with additional punctate acute/subacute infarct involving the left splenium of the corpus callosum.2.Chronic left occipital lobe infarction.3.Occlusion of the left posterior cerebral artery as well as left cavernous internal carotid artery fusiform aneurysm more fully characterized on CTA from 8/18/2016.4.Moderate chronic small vessel ischemic changes.5.Scattered punctate foci of susceptibility artifact compatible with microhemorrhages, favor chronic though recent petechial hemorrhage associated with left thalamic infarction is not entirely excluded.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with multiple sclerosis and worsening weakness. Assess for MS lesions and meningioma. Brain:Numerous T2 hyperintense lesions are seen prominently within the periventricular white matter but also to a lesser degree in the juxtacortical white matter and the brainstem. Several of these lesions show evidence of enhancement including two lesions along the left lateral ventricle, a lesion in the left lower parietal lobe, a lesion in the right parietal lobe, a lesion along the posterior medial right temporal lobe, and lesions in the brainstem.Evidence of frontal craniotomy is seen with encephalomalacia and gliosis of the left orbital gyri. A fairly homogeneously enhancing mass is present centered within the left suprasellar cistern measuring up to 28 x 17 mm in the axial plane and up to 16 mm craniocaudally. The lesion probably invades the left cavernous sinus and partially encases the left ICA. It also projects into the prepontine cistern and contacts the basilar artery. The lesion encroaches upon the sella and exerts mass effect upon the pituitary gland and pituitary stalk. The left optic nerve and chiasm are not clearly visualized and may be embedded within the tumor.No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. A focus of susceptibility within the left cerebellum without edema is compatible with chronic microhemorrhage. Generalized parenchymal volume loss is seen with prominent sulci and ventricles. A focally prominent CSF space along the right parietal lobe may represent an arachnoid cyst.C-spine:Multiple T2 hyperintense lesions are seen within the spinal cord including anteriorly at the cervico medullary junction, centrally and left laterally at C2, left laterally at C3-4, left laterally at C5-6 and anteriorly at C7. As assessed on sagittal images, several additional lesions are seen in the thoracic region. None of these lesions shows definite corresponding enhancement.The cervical lordosis is reversed but spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality or enhancement is seen.C2-3: Right uncovertebral hypertrophy. Minimal right foraminal narrowing. C3-4: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C5-6: Facet hypertrophy on the right. Posterior disc-osteophyte complex formation with a large component in the right paracentral region. This causes effacement of the ventral thecal sac and some flattening of the ventral cord with a mild generalized spinal canal stenosis. Mild right foraminal narrowing. C6-7: Right facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C7-T1: Unremarkable.

Output: 1.Numerous white matter lesions are evident within the brain compatible with the diagnosis of multiple sclerosis. Several of these lesions show evidence of enhancement compatible with active inflammation.2.A left suprasellar mass is again seen compatible with history of meningioma. This lesion likely invades the left cavernous sinus and at least partially encases the left ICA. The lesion exerts mass effect upon the pituitary gland and pituitary stalk. The left optic nerve and chiasm may be embedded within the lesion. Sequelae of left frontal approach surgery are seen perhaps related to this lesion.3.Multiple lesions are evident within the cervical and partially visualized thoracic spinal cord, but without clear evidence of enhancement.4.Degenerative disc disease is seen most severely affecting the C5-6 level where there is a right paracentral disc osteophyte which mildly impinges upon the cord.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (8/7/2015) performed at Northwestern Memorial Hospital .For comparison,mammogram and ultrasound 7/17/2015 and 7/27/2015 are available. MRI: There is mild parenchymal background enhancement. There is an enhancing spiculated mass in the left breast upper-outer quadrant 2:00 position, consistent with biopsy-proven cancer. Clip artifact noted within it. The mass measures approximately 17 x 14 x 10 mm (previous study measured 15 x 13 mm on ultrasound 7/27/2015). There is an eccentric thickened left axillary node which is most likely reactive.No abnormal enhancement in the right breast or right axilla.

Output: Biopsy-proven unifocal left breast mass as described. Most likely reactive lymph node noted in the left axillary region. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Lumbar stenosis. MRI thoracic spine: There is redemonstration of fairly extensive patchy T2 hyperintense foci of the spinal cord with areas of volume loss. Lesions are most prominent at the left aspect of the T4-T5 level, right aspect of the T5-T6 level, left aspect of T9-T10 and right aspect of T10-T11. On post enhanced images there is no convincing evidence of an enhancing plaque. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.MRI of lumbar spine: The vertebral column is straightened but otherwise within normal limits in alignment. The vertebral body heights are preserved. There is disc desiccation at L4-L5 and L5-S1 and to a lesser degree at L3-L4 as before. Conus is in normal position.There is no significant spinal canal or neural foraminal stenosis at L1-L2 or L2-L3. At L3-L4, there is a disc bulge eccentric to the right with minimal narrowing of the right neural foramen as before. Otherwise no significant spinal canal or neural foraminal stenosis.At L4-L5, there is disc bulge eccentric to the right which contacts the right L4 nerve root extraforaminally. Otherwise no significant spinal canal or neural foraminal stenosis.At L5-S1: There is central and left paracentral disc protrusion which partially effaces the left lateral recess and contacts the left S1 nerve root similar to 11/30/2015. Disc herniation at this level is significantly improved when compared to 5/2/2015. Mild left neural foraminal stenosis similar to prior. Central spinal canal and right neural foramen remain patent.No suspicious enhancement. The paravertebral soft tissues are unremarkable. Again noted is a leiomyomatous uterus.

Output: 1. Patchy T2 hyperintensity throughout the thoracic cord consistent with known demyelinating disease. No new lesion or enhancement within the extensive background of T2 signal abnormality is definitively appreciated.2. Degenerative changes in the lumbar spine are not significantly changed since 11/30/2015. Please see above for more details.


Instruction: Generate impression based on findings.

Input: There are no foci of restricted diffusion. No susceptibility abnormalities visualized.A small circumscribed area of high signal in T2 and FLAIR with abnormal enhancement is again seen in the left inferior cerebellar lobe, which is intra-axial and peripherally located, measuring up to 7 mm in transaxial view. There is no surrounding edema. The lesion is unchanged since the previous study.The cerebellar tonsils extend 5 mm below the level of the foreman magnum, unchanged from the previous study. The cerebellar tonsils are rounded in configuration. There is moderate crowding at this level.The ventricles and basal cisterns are unchanged in volume and configuration. No midline shift or herniation. The skull and extra-axial soft tissues are unremarkable.

Output: 1. Continued stability of a subcentimeter FLAIR hyperintense enhancing lesion in the inferior left cerebellar hemisphere, peripherally located, now over a course of 2.5 years. This is nonspecific but continued follow up is recommended to exclude low grade neoplasm. Differential includes inflammatory processes.2. Slightly low lying cerebellar tonsils, unchanged since the previous study.


Instruction: Generate impression based on findings.

Input: 39-year-old female with history of paresthesias. Evaluate for structural lesions. Brain: There are no areas of restricted diffusion to suggest an acute ischemic infarction. There is no evidence of acute intracranial hemorrhage. There are minimal curvilinear and punctate foci of increased T2/FLAIR signal within the frontal and parietal periventricular and subcortical white matter bilaterally. The corpus collosum appears spared. The ventricles and sulci are symmetric. The basal cisterns are intact. The visualized paranasal sinuses and mastoid air cells are clear. Flow voids are appreciated in the major intracranial vessels.Lumbar spine: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. THere is mild facet arthropathy at L4-5 and L5-S1. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.There is a partially imaged large fluid filled structure only seen on axial series within the anterior aspect of the pelvis which likely represents a distended bladder. Additionally, there is a large T2 hypointense structure with adjacent septated cystic structure only partially imaged on sagittal series. These findings may represent normal structures, although dedicated imaging is recommended for confirmation and to exclude any pathologic process.

Output: 1. Curvilinear and punctate foci of increased T2/FLAIR signal within the frontal and parietal periventricular and subcortical white matter bilaterally have the morphology of benign perivascular spaces, although signal abnormality persists on FLAIR imaging. Another diagnostic consideration is a demyelinating process such as multiple sclerosis, however this appearance is not classic and thus these findings are ultimately nonspecific.2. Mild facet arthropathy of the lower lumbar spine.3. Nonspecific and partially imaged findings in the pelvis as above for which dedicated pelvic imaging is recommended. Ultrasound would be an appropriate first choice for this imaging.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapseClinical question: r/o acute ischemiaSigns and Symptoms: dysarthria, right sided weakness There is diffusion restriction involving the right inferior parietal lobule, portions of the precentral gyrus, the midportion and posterior aspect of the right superior and middle temporal gyri as well as the posterior half of the right insular cortex and a small patchy area of the right frontal lobe centered in the precentral gyrus in an area measuring 24x74mm axial dimensions.There is encephalomalacia present in the left middle frontal gyrus.There is encephalomalacia involving the central portions of the right SCA territory of the right cerebellar hemisphere.There is cerebellar atrophy presentThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are foci of T2 hyperintensity in the pons and thalami.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.Images are degraded due to artifacts related to patient motion.

Output: 1.Acute infarction involving the right MCA territory as detailed above.2.Encephalomalacia is present in the left frontal lobe and right cerebellar hemisphere as detailed above.3.Cerebellar atrophy.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Lesions in the pons and thalami of a moderate degree are likely related to old lacunar infarcts.6.Images are degraded due to artifacts related to patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Stage IV T2N2bM0 squamous cell carcinoma of the left lateral tongue, on IRB 121712 clinical trial, 1 month post TFHX ending 9/16/16. There are post-treatment findings without evidence of measurable mass in the left oral tongue, which measures up to approximately 40 mm. There has been interval decrease in size of the necrotic left cervical lymphadenopathy. In particular, there is a cystic or necrotic left level 2B lymph node measures 25 x 32 mm in axial cross-section, previously 43 x 47 mm. The lymph node tumor appears to slight infiltrate into the adjacent left parotid gland. A left level 1 lymph node measures 5 x 6 mm in axial cross-section, previously 12 x 13 mm. The left lateral retropharyngeal lymph node is asymmetrically prominent and measures 3 x 4 mm in axial cross-section, previously 4 x 8 mm. There is a right level 2A lymph node with a rounded morphology, which measures 7 x 10 mm in axial cross-section, which is not enlarged by size criteria. There is no significant right cervical lymphadenopathy. There is a cystic right thyroid nodule that measures up to 9 mm. There are small maxillary sinus retention cysts. There are also secretions in the left sphenoid sinus. The orbits and imaged intracranial structures are unremarkable. There is a small posterior disc-osteophyte complex at C5-C6 that mildly indents the spinal cord.

Output: 1. Post-treatment findings without measurable residual left oral tongue mass.2. Interval decrease in size of the metastatic left cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 57-year-old male with alcoholic cirrhosis. Evaluate for HCC. Reviewed head CT and confirmed with neuroradiology that MRI is safe given prior AVM surgery. There are no metallic objects or clips on recent head CT. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Subcentimeter T2 hyperintense focus in hepatic segment 7 (axial series 6 image 9) shows no significant enhancement on arterial phase and progressive enhancement in the portal venous and delayed phases (axial series 10 images 288, 391). No suspicious lesions with washout are identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter T2 hyperintense focus in hepatic segment 7 most likely represents a small hemangioma. Small size of lesion may make visualization of typically seen interrupted peripheral nodular enhancement difficult; lesion seen filling in with contrast on venous and delayed phases.2.No suspicious hepatic lesion with washout visualized.


Instruction: Generate impression based on findings.

Input: Clinical question: Bleed/mass. Signs and symptoms: Headaches, nausea and vomiting. Nonenhanced CT of head:Images through posterior fossa demonstrate ectopia of cerebellar tonsils consistent with Chiari malformation. The inferior pole of cerebellar tonsils are beyond the field of study. There is complete effacement of subarachnoid space at the level of foramina magnum with deformity of cerebellar tonsils. Follow-up with an MRI is recommended.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci and ventricular system remain within normal limits.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Chiari malformation with resultant deformity of cerebellar tonsils and total effacement of subarachnoid space at the level of foramen magnum . CT examination of brain is otherwise unremarkable.2.Recommend follow-up with an MRI examination of brain and including CSF flow study at the level of foramen magnum.


Instruction: Generate impression based on findings.

Input: Disturbance of skin sensation, sarcoidosis, history of neurosarcoid, new left No evidence of acute ischemic or hemorrhagic lesion on this scan.Subtle enhancement of the slightly thickened optic chiasm, optic tract especially left and hypothalamus was again demonstrated, no change since prior scan.Otherwise no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Bilateral maxillary sinus opacifications.

Output: No evidence of acute ischemic or hemorrhagic lesion.No change of subtle enhancement of optic chiasm, left optic tract and hypothalamus since prior exam.


Instruction: Generate impression based on findings.

Input: History of hepatitis B. HCC and cholangiocarcinoma status post resection. ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy with compensatory left hepatic lobe hypertrophy. Status post cholecystectomy. Mild common bile duct prominence, unchanged. No intrahepatic biliary ductal dilatation. No focal liver lesion.Patent hepatic vasculature.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right hepatectomy without a suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: Call is headache numbness in all. Signs and symptoms: Headache. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates normal anatomical development of brain and right normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination of brain. This signal void of major intracranial arterial branches are identified and unremarkable. Post-enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series. Images through the calvarium demonstrate multiple foci of marrow signal replacement with diffuse enhancement and highly suspected of metastatic disease. None of the lesions demonstrate extension of enhancement beyond the calvarium into the epidural space or into the soft tissues of the scalp.Pre-and post enhanced complete spine MRI:Examination of the cervical spine demonstrate normal anatomical alignment of the vertebral column.There is uniform diffuse marrow signal changes of vertebral bodies of C2, C3 with mild diffuse enhancement. There is no detectable fixation enhancement beyond the vertebral bodies into the epidural space or the perivertebral soft tissues. This findings also are similar in signal and pattern of enhancement to the findings of the calvarium and suggesting metastatic disease.There is normal signal intensity and caliber of the cervical cord without abnormal enhancement.There is mild degenerative changes of cervical spine however without evidence of spinal stenosis or clinically significant neural foraminal compromise.The perispinal soft tissues also remain within normal and without abnormal enhancement.Examination of thoracic spine also demonstrate normal anatomical alignment the vertebral column.There are uniform marrow signal replacement involving vertebral bodies of T1 and T2 with evidence of involvement of the posterior elements of both levels (worse at T11). This finding demonstrate uniform diffuse enhancement and suggestive of metastatic disease. There is minimal extraosseous spread of enhancement from the spinous process of T1.Normal signal intensity of the rest of the vertebral column and without abnormal enhancement.Normal signal intensity and caliber of thoracic cord without abnormal enhancement.No spinal stenosis or neuroforaminal compromise at any level.Examination of lumbosacral spine also demonstrate diffuse marrow signal and replacement with enhancement of the L1 vertebrae without extraosseous spread of enhancement.Patchy foci of matter signal replacement with enhancement is also present in the vertebral body of L2, L3, 5 and S3 as well as the spinous process of L3. There is mild compression deformity of the superior endplate of L1.There is normal signal intensity and morphology of cauda equina without abnormal enhancement.There is no evidence of spinal stenosis or neural foraminal compromise.There is however a centrally located disk protrusion at the specialty with resultant mild flattening deformity of the thecal sac. There is also a large central and leftward disk protrusion at the L4 -- L5 level resulting in left lateral recess compromise.There is a tiny annular fissure at L5 -- S1 in the left paramedian location best appreciated on sagittal T2 series 38 image 11.

Output: 1.Pre--and post enhanced brain MRI demonstrating unremarkable intracranial content and without abnormal enhancement. Multiple foci of calvarial marrow signal replacement with enhancement are noted and highly suspected for metastatic disease.2.Pre-and post enhanced MRI of the cervical spine demonstrate uniform marrow signal changes of C2 and C3 vertebral bodies with mild diffuse enhancement suggestive of metastatic disease. Mild degenerative changes of the cervical spine without spinal stenosis or neural foraminal compromise. Normal signal intensity and caliber of cervical cord without abnormal enhancement.3.Pre-and post enhanced MRI of thoracic spine demonstrate marrow signal replacement with mild diffuse enhancement involving vertebral bodies and the posterior elements of T1 and T2 as detailed. Unremarkable exam otherwise.4.Pre-and post enhanced MRI of lumbosacral spine also demonstrate foci of marrow signal replacement with enhancement involving vertebral bodies of L1, L2, spinous processes of L3, body of L4 and L5 as well as S3 as detailed. Normal signal intensity of cauda equina and without abnormal enhancement. A small central disk protrusion at L2 -- 3 and a central and leftward disk protrusion at L4 -- L5 resulting in left lateral recess compromise.


Instruction: Generate impression based on findings.

Input: Clinical question: History of HNC. Signs and symptoms: Multiple brain metastases per last CT. Pre and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrate multiple enhancing (some hemorrhagic) metastatic lesions in bilateral cerebral and cerebellar hemispheres.The largest supratentorial metastatic lesion is epicentered in the left caudate nucleus and measures at 21 x 15 mm in transaxial dimensions.The largest right hemispheric metastatic lesion in the posterior parietal lobe measures at approximately 23 x 10 mm in transaxial dimensions. The largest metastatic lesion in the posterior fossa is in the anterior right cerebellum measuring at 29 x 21 mm.Although there is surrounding vasogenic edema of all metastatic lesions and mass effect remains regional and without evidence of midline shift, effacement of basal cisterns, quadrigeminal plate cistern or the foramen magnum. Additionally examination demonstrates a focus of enhancement in the left posterior parietal bone measuring approximately at 12 x 8 mm in transaxial dimensions (axial post enhanced series 10 image 29).Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.Multiple enhancing metastatic lesions (some hemorrhagic) in supra and infratentorial brain parenchyma as detailed/measured above.2.There is no evidence of midline shift or hydrocephalus.3.There is a single nonspecific focus of enhancement in the left parietal bone measuring at 12 x 8 mm and could represent a metastatic focus however possibility of benign lesion cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: right leg pain, postoperative status of L5S1. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is evidence of right L5 laminectomy.Anterior epidural fat appears to be obliterated with soft tissue signal intensity which may indicate postoperative changes (granulation tissue), however, there is no evidence of adjacent nerve root compression.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc which abuts thecal sac, otherwise unremarkable. L5-S1: Evidence of right L5 laminectomy with soft tissue signals within the anterior epidural fat which may represent postoperative changes such as granulation tissues. No evidence of neural foraminal narrowing or nerve root compression on this scan.

Output: 1. Postop (L5 right laminectomy) changes at the level of L5S1 as described above.2. Diffuse bulging of disc, L45.Comment: if clinically indicated Gad enhanced L spine MRI can be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Memory problems and headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive mucosal thickening and fluid within the left maxillary sinus. There is also mild right maxillary sinus mucosal thickening.

Output: 1. Findings suggestive of acute left maxillary sinusitis.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Ms. Detrick is a 31 year old female with a family history of breast cancer in her sister (diagnosed at the age of 29. She has a history of bilateral breast reduction. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 61-year-old male with mass. Evaluate for pseudotumor status post metal on metal hip Metallic artifact reduction protocol was used. Despite this, evaluation of the hip and surrounding tissues is limited by metallic susceptibility artifact from the patient's left total hip arthroplasty. Large collection of near-fluid signal intensity extending from the posterior aspect of the intertrochanteric region of the proximal femur through the soft tissues posterior to the greater trochanter to the lateral skin surface of the hip. The posterior component of this collection measures approximately 13.0 cm x 7.0 cm in transverse dimension and 7.5 cm in craniocaudal dimension. It is surrounded by a low signal intensity rim which could either represent hemosiderin or metal particle deposition. The collection also extends anterior to the hip joint into the iliopsoas muscle forming a collection that is approximately 4.0 cm x 3.5 cm in transverse dimension and 7.5 cm in craniocaudal dimension. There is also a lobulated collection of near fluid signal intensity within the supra-acetabular left ilium measuring approximately 4.0 cm in greatest dimension and correlates to a geographic lucent lesion on prior radiographs. On the fat suppressed T2 weighted images there is thin increased signal intensity within the intertrochanteric region of the femur along the lateral aspect of the femoral component that may represent the same disease process or simply artifact. The gluteus medius and gluteus minimus tendons can be followed to their insertions on the greater trochanter. Severe osteoarthritis affects the right hip and severe degenerative arthritis affects the visualized lumbar spine

Output: Left total hip arthroplasty with adverse soft tissue reaction and focal osteolysis as described above.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with history of metastatic adenoid cystic carcinoma of the palate diagnosed in 2004, with newly found metastatic disease to the lung/pleura. The visualized aerodigestive and sinonasal mucosal surfaces are free of mass lesions and pathologic enhancement. The skull base is intact and in particular, there is no evidence to suggest perineural disease spread. The soft tissues of the neck are only partially visualized on the field-of-view of this examination, but no evidence of pathologic adenopathy is seen in the regions assessed. Likewise, partial visualization of the intracranial structures shows no evidence of metastatic disease.

Output: No evidence of active disease involving the skull base, upper aerodigestive tract, or upper neck.


Instruction: Generate impression based on findings.

Input: Biopsy proven DCIS in the right breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is suspicious nonmass enhancement extending primarily anterior and posterior to the posterior biopsy site in the right inner breast. Extent of nonmass enhancement is 4.9 x 1.6 x 1.1 cm. Non-mass enhancement extends to within 5 mm of the pectoralis posteriorly. The anterior extent of nonmass enhancement extends 2.7 cm anterior to the posterior biopsy clip, similar to the extent of residual calcifications visible on post biopsy mammograms. Thin peripheral enhancement is seen surrounding each of the 2 biopsy sites. Inconclusive of the anterior biopsy site, AP measurement is 7.3 cm back to the most posterior area of nonmass enhancement near the chest wall.Elsewhere in each breast, a few scattered enhancing foci are present, though none are uniquely suspicious in appearance or kinetics. There is also a normal sized intramammary lymph node in the far posterior depth of the central inferior left breast.No abnormal lymph nodes are identified in either axillary region.

Output: Nonmass enhancement in the right inner breast measures 4.9 cm AP and extends to within 5 mm of the pectoralis. For needle localization prior to breast conservation, the anterior extent of calcifications or anterior biopsy clip could be localized. The posterior-most extent of calcifications/enhancement may be difficult to localize based on its position near the pectoralis. Given the enhancing foci elsewhere and her dense breasts, an MRI follow up in 1 year to establish stability is recommended. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Severe neck pain. History of trauma. Postcontrast images are requested after paraspinous edema seen on earlier noncontrast study. Examination is limited to post contrast sequences and demonstrates moderate degree of enhancement in the left paraspinous musculature, maximal at the left C4-C5 level but extending craniocaudally from approximately the upper C3 to the C6-C7 levels. There also appears to be mildly increased enhancement in the right lower cervical paraspinous soft tissues.Degenerative changes including multilevel facet arthropathy, particularly on the left are noted. There is no evidence of discitis osteomyelitis or clear evidence of septic arthritis involving a particular facet joint.There is no abnormal enhancement within the spinal canal. There are also no enhancing bony lesions.

Output: Examination limited to post contrast sequences demonstrates enhancement in the left paraspinous soft tissues corresponding to the paraspinous edema noted on earlier noncontrast cervical spine study. Differentials again include inflammation related to prior trauma or inflammation related to facet arthropathy. Infection is not excluded although there is no discrete fluid collection to indicate abscess.


Instruction: Generate impression based on findings.

Input: Pain. Question of hindfoot mass. Markers denote the site of the patient's pain.There is thickening and increased T2 signal within the plantar aponeurosis approximately 2 cm distal to the calcaneal attachment. On postcontrast imaging there is enhancement within the aponeurosis and surrounding soft tissues.There are areas of low T1 and high T2 signal within the bone marrow of the mid-talus and talar dome compatible with non-specifc edema. Bone marrow signal is otherwise within normal limits. The tendons of the ankle appear intact.

Output: Probable plantar fasciitis.


Instruction: Generate impression based on findings.

Input: Recurrence of pain following relief of symptoms for approximately 8 months following vertebroplasty at L5 and RF ablation of metastatic renal cell carcinoma with painful compression fracture of L2. There are postoperative findings related to vertebroplasty of a compression at L5 and RF ablation of metastatic renal cell carcinoma with compression fracture of L2. There has been interval increase in size of an intermediate T1 and high T2 signal lesion in the left posterior vertebral and pedicle of L2, resulting in marked spinal canal stenosis, in which the cauda equina nerve roots are compressed. There is no significant interval change in the treated L5 vertebra with mild loss of height and high T2 signal surrounding the cement. There is also no significant interval change in the L1 compression fracture with approximately 50 % loss of height. There is a probable small hemangioma in the T6 vertebral body. There are mild superior endplate depressions at T3 and T5. The rest of the vertebral body heights are intact and the alignment is unchanged. There are mild degenerative spondylitis changes in the lumbar spine without associated significant spinal canal or neural foraminal narrowing. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The right kidney is absent.

Output: Postoperative findings related to vertebroplasty of a compression at L5 and RF ablation of metastatic renal cell carcinoma with compression fracture of L2, with interval increase in size of tumor involving the eft posterior vertebral and pedicle of L2, which results in marked cauda equina nerve root compression. Otherwise, no significant interval change in the L1 and L5 compression fractures, as well as the mild superior endplate depressions at T3 and T5. Assessment for tumor is otherwise limited without contrast.


Instruction: Generate impression based on findings.

Input: 4 y/o male with headaches. Evaluation of ventricular size s/p Chiari I decompression There is no evidence of intracranial hemorrhage, mass or edema. The lateral, third, and fourth ventricles are enlarged, compatible with hydrocephalus. The ventricles appear larger when compared to the MRI dated 6/18/2009.There is evidence of an occipital decompression with post-surgical changes. There is fluid present in the post-surgical bed. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Enlarged lateral, third, and fourth ventricles. Hydrocephalus consistent with prior history of Chiari I malformation. 2. Post-operative changes as described above.


Instruction: Generate impression based on findings.

Input: History of prematurity, global developmental delay, and chronic head banging. Evaluate for structural abnormality. No abnormal signal is seen on the T2, FLAIR or diffusion weighted images. Myelination is within normal limits for age. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Normal unenhanced brain MR.


Instruction: Generate impression based on findings.

Input: Status post TACE RFA. Assess for treatment response. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with fibrotic changes.Segment 6 ablation cavity measuring 5.0 x 4.6 cm without evidence of marginal recurrent or residual disease. Mild intrinsic T1 weighted signal intensity.No suspicious arterial enhancing or washing out liver lesion.Cholelithiasis without evidence of acute cholecystitis. No intra or extrahepatic biliary ductal dilatation. The portal and hepatic veins are patent.Trace perihepatic ascites.SPLEEN: Splenomegaly, measuring 18 cm in AP dimension. Trace perisplenic ascites.PANCREAS: Multiple small peripancreatic and porta hepatis lymph nodes, nonspecific in the setting of chronic liver disease. No pancreatic ductal dilatation or focal lesion. No peripancreatic inflammatory changes.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple small peripancreatic and porta hepatis lymph nodes, nonspecific in the setting of chronic liver disease. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Posttreatment changes from segment 6 radiofrequency ablation without evidence of residual or recurrent disease. No new suspicious liver lesion.Cirrhosis with trace ascites and splenomegaly.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:8/25/1970)Reason: please do dr javed MS protocol, dx MS, SLE as well as strokes History: progression weaknessPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular and subcortical T2 and FLAIR small hyperintense lesions identified in the periventricular and subcortical white matter. Additionally there are patchy T2 and FLAIR hyperintense lesions in the brainstem. There is no associated abnormal enhancing lesion within the brain parenchyma. There is a developmental venous anomaly present in the left frontal lobe.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.Multiple periventricular and subcortical white matter lesions are present. These are nonspecific. These are usual for age 45. Demyelinating disorder is one explanation for this. Other explanations include vasculitis and vascular related lesions.2.Patchy lesions in the brainstem are present. These are nonspecific. There could be vascular related or related to demyelination or vasculitis.


Instruction: Generate impression based on findings.

Input: Left oropharyngeal, status post treatment. Persistent left facial and ear pain. There are treatment effects in the left upper neck. The left oropharyngeal mass is no longer discretely measurable. There is persistent fatty atrophy of the adjacent left tongue and there are stigmata of left vocal cord paralysis. There is also atrophy of the left facial expression muscles. There no significant cervical lymphadenopathy. The skull base and temporomandibular joints appear to be intact. The thyroid and salivary glands are unremarkable. The orbits are unremarkable, but there is a small right lateral periorbital skin nodule. There is an aberrant right subclavian artery. There is bilateral mastoid fluid.

Output: 1. Post-treatment findings in the neck and denervation changes involving multiple left cranial nerves, but no evidence of gross measurable tumor, including perineural tumor.2. Fluid in the bilateral mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: Recent craniotomy for posterior fossa tumor resection and history of NF2. There are recent postoperative findings related to suboccipital craniotomy with a small amount of expected fluid in the surgical bed. There interval decrease in size of a cystic component in a heterogeneously enhancing tumor within the medulla. The cystic component now measures up to 8 mm, previously 12 mm, and the tumor overall measures up to 31 mm, previously 33 mm. There is decreased effacement of the foramen of Magendie. Other stigmata of neurofibromatosis type 2 are otherwise unchanged, including small bilateral vestibular schwannomas, small intracranial meningiomas, and a left optic nerve sheath meningioma. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. There is no ventriculomegaly. There is no midline shift or herniation. The major cerebral flow voids are intact. There are scattered foci of enhancement in the scalp, which correspond to the sites of the previously inserted stereotactic frame screws. There is mucosal thickening and fluid within the left maxillary sinus, as well as scattered mucosal thickening elsewhere within the paranasal sinuses. There is also a small amount of bilateral tympanomastoid fluid, which is nonspecific.

Output: 1. Recent postoperative findings related to suboccipital craniotomy for subtotal resection of an ependymoma within the medulla with decreased effacement of the foramen of Magendie.2. Other stigmata of neurofibromatosis type 2 are otherwise unchanged, including small bilateral vestibular schwannomas, small intracranial meningiomas, and a left optic nerve sheath meningioma. 3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Subarachnoid hemorrhage [430], Reason for Study: ^Reason: eval for bleeding History: s/p SAH, failing EVD clamping trials Motion artifacts degraded exam quality.No evidence of new ischemic infarct on the scan.Previously seen minimal subdural hematomas on tentorium, posterior fossa and left hemisphere appears to be slightly reduced or no change since prior scan.The interpeduncular fossa subarachnoid hemorrhage has been reduced in its extent since prior scan. On gradient echo image, there is evidence of susceptibility artifacts on the surface of corresponding area indicating possible hemosiderin deposition.Ventricle size is stable with right frontal approached ventriculostomy tube which is clamped.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of new acute ischemic or hemorrhagic lesion on this scan.2. Interval decrease of interpeduncular fossa subarachnoid hemorrhage extent with hemosiderin deposition on the surface of corresponding area.3. No change of ventricle size since prior scan.4. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other intervertebral disc degeneration, lumbosacral region Other spondylosis with myelopathy, lumbar regionClinical question: Evaluate pathology of new left LE weaknessSigns and Symptoms: New LLE weaknessComments: H/o spinal stenosis Cervical laminectomy 2006 | Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present in the lower lumbar spineAt L5-S1 there is a left lateral recess disc extrusion present which impresses upon the nerve roots at the left lateral recess and displaces them and further extends into the left neural foramen where it encroaches on the left-sided exiting nerve roots. There are endplate reactive changes present at this level which are heterogeneous signal on T1 and T2. The disc extrusion was also present on the prior exams dating back to 2006. The endplate reactive change has progressed since 2006. Loss of disc space height at this level has progressed compared to 2006 is not significantly different than 2015.At L4-5 there is loss of disc space height associated with diffuse disc bulge and are shown effacement of the fat at the lateral recess bilaterally but worse on the right lateral recess versus the left lateral recess. Some disc material extends into the right neural foramen where it encroaches on the right-sided exiting nerve roots. There are endplate reactive changes present this level with large Schmorl's nodes. The disc bulge was also present on the prior exams dating back to 2006. The endplate reactive change has progressed since 2006. Loss of disc space height at this level has progressed compared to 2006 is not significantly different than 2015.At L3-4 there is redemonstration of a diffuse disc bulge which was also present on exams dating back to 2006. There is narrowing of the neural foramina present bilaterally with partial effacement of the fat surrounding the exiting nerve roots within the neural foramina. Endplate reactive changes are present at this level with Schmorl's nodes which has progressed since the 2006 exam.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the lower lumbar spine which have been present dating back to 2006. There is associated encroachment of the left-sided exiting nerve roots at L5-S1 and right-sided exiting nerve roots at L4-5 with a mild degree of spinal stenosis at L4-5 which was also present in 2006. Endplate reactive changes and loss of disk space height have progressed since 2006.


Instruction: Generate impression based on findings.

Input: 52-year-old male patient with left knee pain. Evaluate for medial meniscus repair and healing of trochlear microfracture. MENISCI: There is increased T2 signal within the body and posterior horn of the medial meniscus and the medial meniscus is diminutive in size, these findings are compatible with prior meniscal tear and meniscectomy. There is no new tear in the medial or lateral menisci.ARTICULAR CARTILAGE AND BONE: There is inhomogenous increased T2 signal intensity in the articular cartilage of the trochlea, compatible with history of microfracturing with production of fibrocartilage. There are no focal chondral defects identified.LIGAMENTS: Again seen is a chronic partial tear of the anterior cruciate ligament. The posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Findings consistent with prior surgery in the medial meniscus without new meniscal tear identified.2.Inhomogeneity of the femoral trochlea compatible with prior microfracturing and production of fibrocartilage. No focal chondral defect is identified.3.Chronic partial tear of the anterior cruciate ligament.


Instruction: Generate impression based on findings.

Input: Multiple myeloma, pelvic pain The examination is limited by patient motion artifact.Although we see no dominant focal myelomatous lesion, there is diffuse intermediate signal intensity of the marrow on both T1 and T2 sequences. This finding is nonspecific but could reflect myelomatous involvement. There is similar signal abnormality affecting the proximal femora and lower lumbar spine with a compression deformity of L4 noted. For further details regarding the spine, please refer to the accompanying lumbar MRI exam report. There is no evidence of fracture within the pelvis or proximal femora. The hip joints, sacroiliac joints, and pubic symphysis appear normal. The visualized soft tissues of the pelvis are unremarkable as well.

Output: Although there is no dominant focal bone marrow lesion evident, there is diffuse intermediate signal intensity of the visualized marrow which is nonspecific in nature but could reflect myelomatous involvement. Other findings are described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Critical cervical stenosis requiring surgery. Signs and symptoms: Weak grip. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.Unremarkable signal intensity of the vertebral column other than changes related to degenerative disease.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative degenerative disease and unremarkable otherwise.C3-C4 demonstrate moderate disc disease and loss of disc height, mild bulging disc and mild ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis, severe right and moderate left neural foraminal compromise.C4-C5 demonstrate mild disc disease and loss of disc height, shallow bulge of disc and moderate ligamentum flavum hypertrophy. Constellation of changes results in flattening and posterior displacement of the cord and severe central spinal stenosis with moderate right neural foraminal compromise.C5-C6 demonstrate mild degenerative disc and hypertrophic changes of posterior elements without spinal stenosis and mild right neural foraminal compromise.C6/C7 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C7-T1 demonstrate mild disc disease and mild bilateral facet and ligamentum flavum hypertrophy. There is no spinal stenosis however moderate right and mild-to-moderate left neural foraminal compromise is present.There is no evidence of signal abnormality of cervical or upper most visualized thoracic cord.

Output: 1.Degenerative changes at C3-C4 results in moderate central spinal stenosis and with severe right and moderate left neural foraminal compromise.2.Degenerative changes at C4-C5 resulting in severe central spinal stenosis an moderate right neural foraminal compromise.3.Normal signal intensity of the cervical and upper most visualized thoracic cord.4.Mild degenerative changes at other levels however without central spinal stenosis as detailed per level above.


Instruction: Generate impression based on findings.

Input: 73 year old male with CAD (unclear history), cardiomyopathy, HTN, hyperlipidemia. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 117 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There is global hypokinesis. There is late gadolinium enhancement present along the mid-wall and epicardial boundary circumferentially along the base and mid ventricle to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is atypical for myocardial infarction and also for cardiac amyloidosis. No evidence of myocardial iron overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 155 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThe esophagus is patulous. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild left ventricular dilation with mildly reduced systolic function (LVEF 43%). 2. There is late gadolinium enhancement present along the mid-wall and epicardial boundary circumferentially along the base and mid ventricle to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is atypical for myocardial infarction and also for cardiac amyloidosis.3. Normal right ventricular size with mildly reduced systolic function (RVEF 49%).4. Mild dilation of the main pulmonary artery.5. Patulous esophagus noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Other epilepsy, not intractable, without status epilepticus [G40.802], Reason for Study: ^Reason: please re-evaluate s/p lupus cerebritis with seizures History: Lupus cerebritis, temporal lobe epileptiform discharges Previously seen mass like lesions with peripheral enhancement and susceptibility artifacts at the right frontal lobe and left basal ganglia have been significantly reduced in size and changed MR characteristics. Specifically, the right frontal lobe lesion shows gyriform cortical encephalomalacia with enhancement and the left basal ganglia lesion only shows focal enhancement. Both lesions do not show surrounding edema. And both lesions show susceptibility artifacts indicating prior intralesional hemorrhages. There are remained FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter which again have been significantly decreased in their extent.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no other abnormal enhancing lesion.Constellation of above findings indicate interval improvement of multifocal brain lesions likely related to patient's SLE. Continuous enhancement of both right frontal and left basal ganglia lesions may indicate sustained inflammatory reactions. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Multiple enhancing nodules within the right parotid gland indicating benign lesions such as pleomorphic adenoma, unchanged.

Output: 1. Significant interval reduction of peripheral enhancement, surrounding edema and mass effects of both right frontal lobe and left basal ganglia lesions since prior scan since prior scan.2. Remained enhancement of above lesions may indicate sustained inflammatory reactions.3. No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: 42-year-old female with a history of right adrenal mass ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a wedge-shaped hypodense area within the left lobe liver likely representing focal fatty infiltration. MRI of the liver may be obtained for further evaluation.3.1 x 2.1 cm hypodense mass in the left lobe liver image number 55, series number 10 highly suspicious for metastatic disease.SPLEEN: Nonspecific 1.2-cm hypodense lesion in the spleen on image number 34, series number 10. Metastatic disease cannot be excluded.PANCREAS: No significant abnormality notedADRENAL GLANDS: There is an 18 by 16.5 by 22-cm mass superior to the right kidney. The mass indents and possibly invades the liver, IVC and the right kidney. This mass likely represents an adrenocortical carcinoma arising from the right adrenal gland. Left adrenal glands unremarkable.KIDNEYS, URETERS: Left kidney is unremarkable. Right suprarenal mass likely representing adrenocortical carcinoma inmates the right kidney. Venous collaterals posterior and lateral to the right kidney.RETROPERITONEUM, LYMPH NODES: IVC filter is in place. Retroperitoneal adenopathy. An index retrocaval lymph node measures 1.9 by 1.4 cm on image number 72, series number 10.IVC is invaded by the large mass. Major retroperitoneal vessels are displaced laterally and anteriorly by the mass.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Right suprarenal mass concerning for adrenocortical l carcinoma. The mass invades the IVC, right kidney and possibly liver.Left lobe lesion in the liver highly suspicious for metastatic disease. Focal fatty infiltration in the liver likely secondary to invasion of the IVC.Metastatic adenopathy.Nonspecific hypodense lesion in the spleen. Metastatic disease cannot be excluded.


Instruction: Generate impression based on findings.

Input: 60-year-old woman with history of myelofibrosis on clinical trial, please measure spleen size. ABDOMEN:LIVER, BILIARY TRACT: The right hepatic lobe is relatively atrophied. Scattered T2 hyperintense hepatic cysts are stable.Patient is status post cholecystectomy. Additional perihepatic surgical clips are noted. There is mild, stable intrahepatic biliary ductal dilatation.The portal vein is thrombosed chronically with extensive collateralization and large splenorenal shunts.SPLEEN: The spleen is markedly enlarged but stable measuring 22.6 cm in craniocaudal dimension (12/19) and 16.3 x 11.5 cm in axial dimension (13/30). Small foci of heterogeneous T1 and T2 signal are again noted. Additionally, there are scattered foci of susceptibility artifact compatible with iron deposition.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple and hemorrhagic/proteinaceous renal cysts 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.Marked splenomegaly similar in size to prior exams.2.No additional significant change from priors with persistent portal vein thrombosis and collateral shunting.


Instruction: Generate impression based on findings.

Input: Chronic back pain with signs of nerve impingement. There is multilevel degenerative spondylosis. At T12-L1, there is loss of disc space height and fatty endplate signal in the T12 vertebral body, but no significant spinal canal or neural foraminal stenosis. At L1 through L4, there is no significant spinal canal or neural foraminal stenosis either. At L4-5, there is a disc bulge, mild facet hypertrophy bilaterally, and ligamentum flavum thickening with mild neural foraminal stenosis, but no significant spinal canal narrowing. At L5-S1, there is a disc bulge, mild facet hypertrophy bilaterally, and ligamentum flavum thickening with mild neural foraminal stenosis, but no significant spinal canal narrowing. The vertebral column alignment is within normal limits. The vertebral body heights are preserved, aside from a Schmorl node in the inferior T11 vertebral body. There is no evidence of tumors. The imaged portions of the spinal cord display normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis, with mild bilateral neural foraminal narrowing at L4-5 and L5-S1, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Biceps pain LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted. Specifically, the biceps tendon is intact.ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: No evidence of internal derangement of the right elbow. Specifically the biceps tendon appears normal.