Instruction: Generate impression based on findings.

Input: 61 year old man with history of ischemic cardiomyopathy s/p heart transplant in May 2015 complicated by early grade 1A rejection, now admitted after surveillance right heart catheterization demonstrated elevated filling pressures. He is referred for cardiac MRI to evaluate for possible rejection. Left VentricleThe left ventricle is normal in size with low-normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVEDV is 153 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 33 g/m2 (normal range 85+/-15), and the LV mass is 76 g (normal range 164+/-36). There are no regional wall motion abnormalities present. The T2-STIR ratio between myocardium and skeletal muscle is 1.9 (normal is <2). Global relative enhancement is 2.8 (normal is <4). Native T1 relaxation time is 980ms, which is not elevated. ECV is slightly elevated at 32%. There is a focus of transmural late gadolinium enhancement in the basal inferior wall which involves 1/2 of the wall thickness and could be consistent with previous infarction, infiltration, inflammation or fibrosis. Aside from this segment, there is no late gadolinium enhancement noted.Left AtriumThe left atrium is enlarged consistent with history of transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 83 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (31mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are bilateral pleural effusions (right greater than left). There are sternotomy wires present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size LV with low normal systolic function (EF 54%).2. Global relative enhancement, T2-STIR myocardium:skeletal muscle ratios and native T1 relaxation times are normal, but there is a focus of late gadolinium enhancement in the basal inferior wall. While the pattern could suggest infarction (endocardial involvement), given the patient's clinical history a infiltrative, inflammatory, or fibrotic process is also possible.3. Normal size RV with mildly reduced systolic function (EF 45%).4. Mildly dilated main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 38 years, Female, facial twitching. Again seen are numerous periventricular and subcortical white matter T2/FLAIR hyperintense lesions in both hemispheres of the brain. Multiple infratentorial lesions including the brainstem, middle cerebellar peduncles, and cerebellar hemispheres are also again seen. Extent of confluent signal abnormality may limit detection of small new lesions, but there are at least 2 new lesions including the right inferior aspect of the mid callosal body (axial series 401 image 59, sagittal series 301 image 100) as well as the left frontal corona radiata (axial series 401 image 55, sagittal series 301 image 71). Upper cervical lesions are again seen but not well assessed.There is mild to moderate degree of parenchymal volume loss with thinning of the corpus callosum. There is a moderate burden of T1 hypointense lesions. No intracranial mass effect, midline shift, or herniation. No hydrocephalus. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Numerous chronic supratentorial and infratentorial demyelinating lesions with at least two new lesions since 11/9/2015 as described above.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: stroke? Mass lesion? History: R sided weakness. Limited evaluation demonstrates no evidence of intracranial hemorrhage or mass. There is hyperintensity on the diffusion and isointense signal on the ADC bilaterally in the prefrontal gyri, hippocampal, and left mesial temporal lobe. There is no convincing T2 signal to suggest that this is T2 shine through. These areas of apparent restriction do not reflect vascular territories. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a large mucous retention cyst in the left maxillary sinus, occupying approximately half the sinus. The partially evaluated orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Findings of multiple areas of apparent diffusion restriction on this limited MRI may reflect the patient's recent toxic exposure, possibly representing early leukoencephalopathy. Recommend repeat study to fully evaluate when clinically possible.


Instruction: Generate impression based on findings.

Input: Recurrent right temporal field visual loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. 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 mild mucosal thickening in the paranasal sinuses. The pituitary gland has a convex superior border with height remaining within the normal range, at a maximum height of 9 mm. It also shows no definite focal lesion and does not impinge on the optic chiasm or efface the suprasellar cistern.

Output: No evidence of acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 26 years Male (DOB:1/25/1990)Reason: looking for parenchymal etiology of seizure today History: seizure 12/21 AMPROVIDER/ATTENDING NAME: JUSTIN P. KLINE The CSF spaces are appropriate for the patient's stated age with no midline shift. Small focus of encephalomalacia is present in the left cuneus. This associated with some susceptibility effect related to hemosiderin deposition. This has not changed since the prior exam. There is an adjacent craniotomy site.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The examination is stable. There is a small focus of encephalomalacia and prior surgery in the left occipital lobe.


Instruction: Generate impression based on findings.

Input: 55-year-old female with pain. Evaluate for AVN. MENISCI: The medial meniscus appears intact. The anterior horn of the lateral meniscus is markedly truncated consistent with a radial tear. The posterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness articular cartilage degeneration of the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is fluid between the superficial and deep fibers of the MCL which may represent an MCL bursitis.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tear of the anterior horn of the lateral meniscus. No evidence of avascular necrosis.2. Near full-thickness articular cartilage degeneration as described above.3. Findings consistent with a MCL bursitis.4. Small-to-moderate size joint effusion.5. Nonspecific subcutaneous edema about the knee.


Instruction: Generate impression based on findings.

Input: Amputation of the right foot, swelling of the lower extremity There has been resection of the distal tibia and fibula at the level of the talocalcaneal articulation.There is cortical thinning and irregularity of the distal tibia and fibula. There is increased T2 signal within the marrow distally without definite corresponding low T1 signal. These findings are thought to reflect a combination of postsurgical change and reactive osteitis without definite osteomyelitis. The remaining marrow signal of the more proximal tibia and fibula is normal.There is diffuse soft tissue and muscular edema and inflammation of the lower leg. Following contrast administration, there is an irregular peripherally enhancing thick-walled fluid collection in the distalmost soft tissues overlying the amputation. Scattered areas of susceptibility artifact are noted relating to prior surgical intervention.

Output: 1. Surgical resection of the distal tibia and fibula with cortical thinning and irregularity of the remaining cortex. There is abnormal T2 signal without definite corresponding abnormal T1 signal in these findings are thought to represent a combination of postsurgical change and reactive osteitis without definite osteomyelitis.2. Irregular enhancing fluid collection within the distalmost soft tissues concerning for abscess.These findings were discussed with the ordering physician Dr. R. Krishnamoorthi at the time of interpretation.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with vertigo, slurred speech. Evaluate for stroke. Minimal scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres showing no significant interval change. No restricted diffusion is demonstrated. No evidence of edema or mass effect is seen. A focus of susceptibility along the right lateral ventricle may represent chronic microhemorrhage or mineralization. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.Conventional aortic branching is seen. The origins of the great vessels are not well assessed due to technical artifact. Otherwise no significant stenosis is detected in the carotid vessels of the neck by NASCET criteria. The right vertebral artery is well visualized and free of significant stenosis through its cervical course. The left vertebral artery is diffusely smaller than the and does not opacify as uniformly as the right which could represent atherosclerotic disease or a technical artifact. No high-grade stenosis is suspected.

Output: 1.No acute intracranial abnormality. In particular, no evidence of acute ischemia is seen.2.MRA imaging of the neck is of somewhat limited quality, but no definite high-grade vascular stenosis is suspected.


Instruction: Generate impression based on findings.

Input: 35-year-old female with catatonia. Evaluate for intracranial cause. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered punctate foci of FLAIR abnormality in the subcortical white matter which are nonspecific. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.A few scattered nonenhancing punctate foci of T2/FLAIR signal abnormality which are nonspecific.


Instruction: Generate impression based on findings.

Input: Reason: pre-op for craniotomy on 2/24 History: olfactory meningioma, crani on 2/24 The patient has undergone frontal craniotomy for removal of a frontal lobe meningioma. There are some attendant postoperative changes present within the scalp tissues.There are foci of residual tumor present along the anterior cranial fossa at the floor in the midline measuring 53 x 34 mm in axial dimensions involving the cribriform plate and the adjacent intracranial fossa floor. Another residual component is present which is adjacent to the corpus callosum along the midline measuring 25 x 11 mm sagittal dimensions and 23 x 40 mm axial dimensions. There is some leptomeningeal enhancement present along the anterior-inferior aspect of the left frontal lobe and to a lesser degree medial inferior aspect of the right frontal lobe. This is non-specific.There is elevated T2 signal involving medial aspects of the frontal lobes bilaterally associated with some microhemorrhages. More prominently the portion of the frontal lobe brain parenchyma previously anterior to the contain some microhemorrhages and signal change and has a reexpanded into the tumor bed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the frontal sinuses and mucosal thickening ethmoid air cells and the maxillary sinuses as well as the sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient is status post bifrontal craniotomy for removal of large meningioma . The clear majority of the meningioma has been removed. There are a couple foci of residual tumor present along the floor of the intracranial fossa and cribriform plate as well as adjacent to the corpus callosum.2.There are attendant postoperative changes present as detailed above.The posterior wall of the frontal sinus is not clearly defined.3.Examination was performed for stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Female 56 years old with cirrhosis. Assess liver lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology without arterially enhancing or washout lesion. Specifically, the previously described lesion in the right hepatic dome is not seen on today's study. TIPS catheter with associated susceptibility artifact is again noted.SPLEEN: The spleen measures 11 cm in craniocaudal dimension. Stable 1.5 cm left artery aneurysm.PANCREAS: There is a 4 mm T2 hyperintense lesion in the pancreatic tail (series 7, image 22), not significantly changed compared to the previous exam. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of a duodenal diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver without suspicious liver lesion.2.Stable 1.5 cm splenic artery aneurysm.


Instruction: Generate impression based on findings.

Input: Vestibular schwannoma 6 months surveillance. There are postoperative findings related to left retrosigmoid craniotomy. There is persistent intermediate T2 and enhancement within the left internal auditory canal, measuring up to approximately 1 cm in length. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a left maxillary sinus retention cyst.

Output: Postoperative findings related to left retrosigmoid craniotomy with persistent intermediate T2 and enhancement within the left internal auditory canal, measuring up to approximately 1 cm in length, which may represent a combination of tumor and treatment effects.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and her family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-outform was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine.Targeted CT examination demonstrates a lucent lesion with sclerotic borders within the right femoral head neck junction corresponding to the findings on recent CT and MRI examinations. The imaging findings are most consistent with that of an osteoid osteoma. Using CT guidance, a 13-gauge OnControl core biopsy needle was advanced into the lesion and 2 attempted biopsies were performed. The specimens were obtained and placed in 10% formalin. Subsequently, CT guidance was used to advance an AngioDynamics SDE RFA probe into the lesion. The lesion was heated to 70-80 degrees centigrade for 2:30 minutes at 35 W. The RFA probe was removed.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient complained of right hip pain following the procedure but otherwise had no immediate complications. This was addressed with IV pain medication in conjunction with anesthesiology as documented in the in the medical record. A discussion was had with the family regarding the patient's pain which is thought to most likely be the result of the biopsy attempts and difficulty seeding the access system prior to ablation also a component of synovitis following the ablation may be a contributing factor. Routine post procedure instructions were communicated to the patient and her family.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient's skin.

Output: CT-guided biopsy and radiofrequency ablation of right femoral neck osteoid osteoma.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, history of brain metastases and CVA, esophageal cancer, on chemotherapy, status post whole brain radiation therapy, assess response. Redemonstrated is evidence of left frontal craniotomy. A resection cavity within the subjacent frontal lobe as well as surrounding T2 hyperintensity are not significant changed. Enhancement along the margins of the cavity has also not significantly changed.Also seen is evidence of a prior small left posterior parietal craniotomy. Small areas of T2 hyperintensity within the subjacent left temporal lobe are unchanged. No pathologic enhancement is seen within this resection bed.Four previously demonstrated enhancing lesions are again seen involving the right orbital gyrus, the right medial temporal lobe, and both cerebellar hemispheres. There has been no significant interval change in the size or morphology of these lesions, and no significant change in the degree of surrounding T2 hyperintensity. Several punctate foci of cortically-based enhancement are again seen involving the right middle frontal gyrus, right parietal lobe, and in the left occipital lobe (see key images). Most of these have not significantly changed from prior, and some lesions which were seen on the prior exam are no longer evident. They all correspond to areas of acute ischemia as demonstrated on the examination of 10/9/14.Sequelae of prior bilateral watershed and cortical ischemia are redemonstrated within the cerebral hemispheres and cerebellum. T1 hyperintensity along the superior frontal sulci may reflect cortical laminar necrosis. No evidence of new acute ischemia is seen.Scattered small foci of T2 hyperintensity within the periventricular white matter are demonstrated, not significantly changed and likely representative of chronic ischemic injury. A diffuse ill-defined periventricular hyperintensity, particularly along the occipital horns, has mildly progressed and may reflect the secondary effect of radiation.

Output: 1. Multiple intracranial enhancing lesions presumed to represent metastases have not significantly changed from the prior exam. No definite evidence of any new metastatic lesion is seen.2. Sites of prior surgery in the left frontal and left temporal lobes demonstrate a stable appearance with no evidence to suggest recurrent/progressive disease.3. Fluctuating punctate foci of cortically-based enhancement correspond to the sites of prior ischemic injury, likely representing evolution of ischemic injury, perhaps compounded by the effects of radiation. Continued attention to these lesions will be necessary on subsequent studies.


Instruction: Generate impression based on findings.

Input: Pancreatic cysts. Abdominal pain. Recently found to have pancreatic, omental and lung masses status post exploratory laparotomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour and normal in morphology. No focal hepatic lesion is identified. Artifact from a biliary stent is identified.SPLEEN: No significant abnormality noted.PANCREAS: Within the pancreatic head, there is a round, smoothly marginated, solid, T2 hyperintense lesion with minimal central necrosis and delayed enhancement measuring 2.5 x 1.8 cm (series 31, image 56). The SMA, SMV and portal vein are not involved. Two well defined, nonenhancing, T2 hyperintense cystic lesions are identified within the pancreatic body abutting the main pancreatic duct (series 501, image 25), the largest measuring 2.2 x 1.6 cm. The pancreatic duct is not significantly dilated. The pancreatic head appears edematous with some surrounding inflammation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no evidence of bowel obstruction. Mesenteric edema is present. Peritoneal nodularity is identified on series 1204, image 354.BONES, SOFT TISSUES: No suspicious osseous lesion is identified.OTHER: A right lower lobe nodule with rim enhancement measures 2.3 x 2.0 cm (series 702, image 139), incompletely imaged, previously identified on CT chest January 6, 2015. Left basilar subsegmental atelectasis. Small bilateral pleural effusions. Nonspecific 5 mm well-circumscribed left breast enhancing nodule (series 1204, image 524).

Output: 1.Solid T2 hyperintense, enhancing pancreatic head lesion, for which differential considerations including neuroendocrine tumor (Given the lesion is well defined and does not frankly invade surrounding structures) versus adenocarcinoma. Correlation with biopsy results, CA 19-9 levels recommended. 2.Cystic lesions in the pancreatic body, possible pseudocysts versus mucinous neoplasm.3.Right lower lobe lung nodule better evaluated on CT. 4.Nonspecific peritoneal nodularity.


Instruction: Generate impression based on findings.

Input: 73 years Female (DOB:8/15/1943)Reason: glioblastoma History: glioblastomaPROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2 and FLAIR hyperintense lesion involving the left hippocampus and adjacent choroid associated with peripheral contrast enhancement. This is associated with punctate foci of signal loss on susceptibility imaging within the left hippocampal lesion. It measured 17 mm width on the prior exam and measures 19 mm with on the current exam. It appears to extend further posteriorly on the current exam. The temporal horn of the left lateral ventricle appears to be slightly dilated. There is associated elevation of cerebral blood volume with this lesion.There is a 29 x 32 mm axial dimension focus of signal hyperintensity extending from the ependymal lining of the left lateral ventricle into the centrum semiovale as well as the body of the corpus callosum which previously measured 25 x 22 mm axial dimensions. Additionally, there is T2 and FLAIR signal hyperintensity present within the splenium of the corpus callosum which is stable and in a focus measuring 19 x 17 mm in the right inferior parietal lobule which previously measured 14 mm. Additionally there is T2 and FLAIR signal hyperintensity present along the right hippocampus and a 6 mm lesion present within the left superior frontal gyrus which have not significantly changed. Within the larger lesions are associated elevation of cerebral blood volume.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.There are multiple lesions present within the brain parenchyma as detailed above some of which have increased in size and others which have not. In particular lesion present within the left hippocampus and choroid region has a more aggressive appearance and has enlarged and is associated with widening of the involved left lateral ventricle. This is consistent with the diagnosis of glioblastoma and could represent primary multifocal neoplasm.


Instruction: Generate impression based on findings.

Input: Breast cancer. There has been interval decrease in size and number of enhancing bilateral cerebellar lesions that are essentially leptomeningeal in distribution. The supratentorial compartment appears to be unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration with a mildly T1 hyperintense subcentimeter cystic nodule associated with the roof of the third ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval decrease in the burden of leptomeningeal metastatic disease involving the cerebellum.2. Subcentimeter third ventricular colloid cyst.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of thymic carcinoma. Status post chemo/RT, please evaluate, CHEST:LUNGS AND PLEURA: Multiple small calcified micronodules are identified consistent with a previous granulomatous infection. Centrilobular emphysema is again noted. No pleural effusion can be identified.MEDIASTINUM AND HILA: There is redemonstration of an anterior mediastinal mass measuring 28 mm x 14.3 mm (image 47, series 4), previously, measuring 15 mm x 28.8 mm. Port-A-Cath with its tip in the SVC. A coronary artery and aortic calcifications. Cardiac size is normal. There is no evidence of pericardial effusion.No mediastinal or hilar lymphadenopathyCHEST WALL: Right-sided port. Degenerative changes in the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Hypodense subcentimeter lesions, most likely representing cystsSPLEEN: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule is stable, measuring 14.1 mm x 18.5 mm (image 92, series 4).KIDNEYS, URETERS: Redemonstration of a small exophytic mass arising from the superior pole. The left kidney. (Image 96, series 4). Dedicated CT or MRI is recommended to evaluate this lesion. Several subcentimeter hypodense lesions in the right kidney, most represent cysts. Again noted is an accessory right renal artery.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic diseaseBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Anterior mediastinal soft tissue mass is stable and presumably represents the residual of this patient's thymic carcinoma.2. Stable right adrenal nodule and small exophytic left renal mass that is indeterminate. Dedicated CT or MRI is recommended to evaluate these lesions.3. Centrilobular emphysema with evidence of a previous granulomatous infection.4. No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 17 years old, with a low-grade neural glial tumor in the right temporal lobe with history of seizures, presenting following recent head trauma. An ill-defined region of T2 hyperintensity and parenchymal thickening is again seen in the posterior medial right temporal lobe showing no significant change in size or morphology. As before, this lesion does not enhance. Sequelae of prior stereotactic biopsy of this lesion are redemonstrated.Elsewhere intracranially, no areas of significant parenchymal signal abnormality, edema or mass effect are seen. No pathologic parenchymal or extra-axial enhancement is observed. There are no findings to suggest acute intracranial hemorrhage or any other posttraumatic sequelae. No abnormal fluid collections are evident and the ventricular system is normal in size and morphology.

Output: 1.Stable nonenhancing lesion in the posterior medial right temporal lobe.2.No acute intracranial abnormality or any obvious posttraumatic sequelae.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer, EGFR+, on Erlotinib and immunotherapy. There is no significant interval change in the enhancing lesion in the right cerebellar hemisphere that measures 3 x 3 mm in axial cross-section. There is a an unchanged enhancing extra-axial lesion along the left anterior clinoid process region. There is encephalomalacia within the left gyrus rectus associated with postoperative changes. There is a chronic lacunar infarct in the left basal ganglia with hemosiderin deposition. There are a few unchanged scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute intracranial hemorrhage or acute infarction. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is metal susceptibility effect in the left frontal calvarium.

Output: 1. Unchanged punctate metastasis in the right cerebellar hemisphere.2. Unchanged paraclinoid lesion may represent a meningioma.3. Encephalomalacia in the left gyrus rectus related to prior surgery.4. Chronic lacunar infarct in the left basal ganglia and a background of probable mild white matter chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: T1N2b p16 negative right retromolar trigone squamous cell carcinoma, status post induction chemotherapy with carboplatin/taxol followed by 5/5 cycles of DFHx and right neck dissection now reporting persistent posterior left sided neck pain. There are interval postoperative findings related to right neck dissection. There is no evidence of residual significant cervical lymphadenopathy. There is extensive dental artifact, which limits assessment for the possibility of tumor in the upper aerodigestive tract. There is a right vallecular retention cyst that measures up to 15 mm. The thyroid and major salivary glands are unremarkable. There is multilevel degenerative cervical spondylosis. The imaged intracranial structures are unremarkable. There are bilateral lens implants. There is a persistent irregular right apical pulmonary nodule.

Output: 1. Interval postoperative findings related to right neck dissection, without evidence of residual significant cervical lymphadenopathy. 2. Extensive dental artifact, which limits assessment for potential tumor in the upper aerodigestive tract.


Instruction: Generate impression based on findings.

Input: 72-year-old male patient with gait difficulty. Evaluate for cerebral ischemia. There is no diffusion diffusion abnormality to suggest acute infarct. Again seen is encephalomalacia with adjacent increased T2 signal involving the right occipital and posterior temporal lobes from remote infarct. There is associated susceptibility effect consistent with chronic blood products associated with the prior infarct. Patchy foci of T2 signal hyperintensity in the periventricular white matter and in the pons is compatible with chronic small vessel ischemic disease. Mild prominence of the ventricles and sulci likely from age-related atrophy.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.No evidence of acute infarct, hemorrhage, or mass effect.2.Chronic right temporal occipital infarct and chronic small vessel ischemic disease similar to prior.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with assess for compulsive disorder, preoperative planning exam for laser fiber placement. Bilateral T2 hyperintense foci are redemonstrated adjacent to the frontal horns of the lateral ventricles representing sequelae of prior laser ablation. As before, the focus on the right is more conspicuous than the focus on the left. However, there has been no significant interval change in the size or morphology of these lesions. On postcontrast images, there is minimal enhancement at the left focus but no convincing enhancement on the right. Brain parenchymal morphology is otherwise unremarkable. No abnormal fluid collections are seen. Ventricular size and morphology are unchanged.

Output: Expected findings are seen compatible with prior laser ablation adjacent to the bilateral frontal horns.


Instruction: Generate impression based on findings.

Input: 19 year-old male swimmer with shoulder pain, rule out labral tear. ROTATOR CUFF: The rotator cuff tendons and muscles appear intact and within normal limits. SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. No frank fluid is noted within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum and articular cartilage appear normal. BICEPS TENDON: The tendon of the long head of the biceps is within normal limits.

Output: Normal shoulder without specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: any paraspinal neurofibromas? History: girl with nf1 and rather severe lower back pain. There is an incompletely characterized T2 hyperintense lesion that measures up 11 mm in the right posterior abdomen lateral to the psoas muscle at the level of L3-4. There is disc space narrowing and decreased T2 signal within the L3-4 disc with associated endplate marrow signal alterations. However, there is no significant spinal canal or neural foramen stenosis. There is an ovoid T2 hyperintense lesion in the right S2-3 neural foramen that measures 6 mm in width. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is a partially-imaged cystic left adnexal structure.

Output: 1. An ovoid T2 hyperintense lesion in the right S2-3 neural foramen that measures 6 mm in width may represent a perineural cyst or neurofibroma. Characterization is limited without intravenous contrast.2. An incompletely characterized T2 hyperintense lesion that measures up 11 mm in the right posterior abdomen may represent a neurofibroma among other possibilities. Dedicated abdominal imaging may be useful for further evaluation.3. Degenerative disc disease at L3-4 without significant spinal canal or neural foramen stenosis.4. Partially-imaged cystic left adnexal structure. Dedicated pelvic imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness and numbness and history of metastatic RCC. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are multiple prominent vessels within the iliac bones and sacrum of uncertain significance. The vertebral bone marrow signal is otherwise unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are multiple partially imaged liver lesions. There is an intrinsically T1 and T2 hyperintense lesion. There are multiple enlarged retroperineal lymph nodes. There are bilateral pleural effusions, right larger than left.

Output: 1. No evidence of metastases involving the thoracic or lumbar spine.2. Multiple partially imaged liver metastases.3. Nonspecific left renal lesion, which may represent a hemorrhagic cyst.4. Retroperitoneal lymphadenopathy likely represents metastatic disease.5. Bilateral pleural effusions, right larger than left.


Instruction: Generate impression based on findings.

Input: 5-year-old male with HgbSS and osteo of distal right humerus status post surgical intervention. Interval drainage of the previously seen enhancing fluid collection along the anterior margin of the distal humeral metaphysis. There is no residual fluid collection or any additional fluid collection in the proximal humerus. BONE AND MARROW: Cortex underlying the site of the previous fluid collection appears intact. There is heterogeneous signal and enhancement within the distal humerus which likely represent postprocedural changes. The bone marrow of the proximal humerus is homogeneous without enhancement.SYNOVIUM: Normal.MUSCULATURE: Increased T2 signal in the musculature adjacent to the distal humerus compatible with edema/inflammation.ADDITIONAL

Output: 1. No additional fluid collection in the proximal humerus or residual fluid collection at the surgical site.2. Postprocedural changes in the distal humerus and adjacent soft tissues.


Instruction: Generate impression based on findings.

Input: Male, 44 years old, with back pain and history of metastasis to the spine, evaluate for change of the lesion. A pathologic compression deformity of the L4 vertebral body with evidence of prior kyphoplasty is redemonstrated. Complete loss of vertebral body height is seen, similar to the prior examination. Retropulsion results in a similar mild degree of spinal canal stenosis particularly affecting the left lateral recess. As on the prior examination, there is severe narrowing of the left L4-5 neural foramen and moderate narrowing of the left L3-4 neural foramen.Signal abnormality and patchy enhancement involving the left L4 pedicle and transverse process have become less conspicuous than on the prior examination. A hemorrhagic cavity seen previously in the adjacent posterior paraspinal soft tissues has resolved. Generalized inflammation within the left posterior soft tissues has improved.A small sclerotic lesion within the T12 vertebral body is unchanged. A lesion within the L1 vertebral body has become more sclerotic than on the prior examination and perhaps slightly smaller. No new marrow space lesions are identified.

Output: 1.Stable pathologic compression deformity of the L4 vertebral body. This results in a mild generalized spinal canal stenosis with significant narrowing of the left L4-5 and L3-4 neural foramina, similar to that seen previously.2.Interval resolution of a hemorrhagic cavity seen previously within the left posterior paraspinal soft tissues. Inflammation in these soft tissues has also improved.3.A small sclerotic lesion in the T12 vertebral body is unchanged. A lesion within the L1 vertebral body has become more sclerotic and slightly smaller. No new osseous lesions are identified.


Instruction: Generate impression based on findings.

Input: 59 years Female (DOB:5/2/1956)Reason: history of brain mets s/p RT History: nonePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 3 mm enhancing focus along the left parietal lobe in the superior parietal lobule which is also identified on the prior exam and appears similar in size.. A couple punctate foci of enhancement present in the left middle frontal gyrus which are stable compared to the prior exam. There is a punctate focus of enhancement in the right orbital gyrus along its medial aspect which is also present on the prior exam and is stable. There are a couple punctate lesions present in the right inferior parietal lobule which are stable compared to the prior exam .On susceptibility imaging there is a punctate focus of signal loss in the left inferior parietal lobule which is not associated with contrast enhancement in those also present prior exam. An additional nodular focus of signal loss and susceptibility is present in the right precentral gyrus.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: There is redemonstration of multiple tiny lesions in the supratentorial brain which are compatible with metastatic disease. These appear stable compared to the previous exam.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. There is perhaps minimal narrowing along the proximal inferior left M2 segment. The middle and anterior cerebral arteries are otherwise unremarkable. There is a fetal type right posterior cerebral artery, with nonvisualized right P1 segment. The post-PICA left V4 segment is developmentally diminutive. The right vertebral artery is dominant. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.There is redemonstration of the rounded T1 hyperintense lesion within the anterior third ventricle near the foramen of Monro measuring up to 1.4 cm, most likely representing a colloid cyst. There is a prominent mucosal retention cyst in the right maxillary sinus.MRA NECK

Output: 1.No evidence of flow-limiting stenosis or vascular occlusion.2.Mild focal narrowing at the left carotid bifurcation.3.Suboptimal visualization of proximal V1 segments likely in part due to tortuosity.4.Redemonstration of probable colloid cyst.5.Hypoenhancing lesions within the thyroid gland bilaterally which are nonspecific. Thyroid ultrasound recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 29-year-old female with neutropenic fever, sore throat for 1 week and an enlarged lymph node in the right neck. Evaluate for abscess. Enlarged right cervical lymph node near the carotid bifurcation (image 47, series 10535) does not appear necrotic and measures 15 mm in short dimension, indicating inflammation. No other enlarged lymph nodes or evidence of abscess.Patent and unremarkable vasculature. Asymmetric prominence of the right adenoids. Nonspecific thickening of the tongue base is symmetric and may be correlated clinically for significance. Airway appears patent. Paranasal sinuses and mastoid air cells are well-pneumatized. No significant prevertebral soft tissue swelling. Cervical spine with unremarkable alignment.Visualized upper lungs are unremarkable.

Output: Enlarged right cervical lymph node and nonspecific tongue base thickening associated with right parapharyngeal adenoidal enlargement. Please correlate with clinical exam findings.


Instruction: Generate impression based on findings.

Input: Aneurysm CTA of intracranial circulation:60 cc of Omnipaque 350 was administered for this study.Axial 0.9 contiguous CT images of head after administration of contrast were obtained. 3-D reformatted images were acquired utilizing an independent workstation.Axial, coronal and sagittal 2-D MIP images are also rendered.Examination demonstrates an aneurysm of anterior communicating artery which involves the entire length of the anterior communicating artery. The aneurysm extends from the junction of the right A1 with anterior communicating artery to the junction of the left A1 with the anterior communicating artery. It also appears to incorporate the origins of the A2 segments of anterior cerebral arteries. The aneurysm measures 8.2 mm in transverse axis, 7.2-mm in AP axis and 7.7-mm in cranial -- cephalad axis. The aneurysm is smooth and rounded and with no evidence of any intraluminal defect.The bilateral A1 segments of anterior anterior cerebral arteries are symmetrical in size. There is also normal visualization of bilateral A2 segments and distal branches of the anterior cerebral arteries with no additional abnormality.There is normal visualization of bilateral middle cerebral arteries without evidence of aneurysm.Normal appearing bilateral supraclinoid internal carotid arteries and a single dominant right posterior communicating artery without aneurysm.Intracondylar components of vertebral arteries are normal bilaterally and the normal visualization of bilateral pica branches.Vaso-artery, superior cerebellar arteries and posterior cerebral arteries are also well visualized and without evidence of pathology.In comparison with MRA of intracranial circulation from Ingalls open MRI study dated 8 -- 3 -- 11 there is no appreciable interval change.Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.New patchy subcortical and periventricular foci of increased signal intensity in bilateral cerebral hemispheres as was noted on prior MRI are brief to represent small vessel ischemic disease of indeterminate age.The cortical sulci and ventricular systems as well as CSF cisterns remain within normal for patient's stated age of 73.Calvarium is intact. Visualized mastoid air cells and paranasal sinuses are unremarkable.Incidental note is made of bilateral soft tissue density within the external auditory canals with no evidence of any bony changes. Findings are believed to represent debris within the external auditory canals. Recommend And further evaluation by direct inspection.

Output: 1.Single locule anterior communicating artery aneurysm which appears to incorporate the entire length of anterior communicating artery. The aneurysm has a smooth round configuration and measures 8.2 x 7.2 X 7.7 mm in three dimensional measurements. There is no evidence of hemorrhage, vasospasm or mass effect.2.Negative CTA of intracranial circulation otherwise.3.Nonenhanced head CT demonstrates moderate findings of small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Female, 26 years old. Knee pain, anterior joint line. MENISCI: The menisci are normal.ARTICULAR CARTILAGE AND BONE: Foci of low signal within the articular cartilage of the lateral patellar facet inferiorly and the central femoral trochlea inferiorly may represent small foci of degeneration, but we see no fluid-filled cartilage defects. Bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is focal intermediate signal intensity within the medial insertional fibers of the quadriceps tendon, perhaps representing very mild focal tendinosis. There is also mild edema of the quadriceps fat pad which is of questionable significance. There is mild increased signal intensity within the proximal patellar tendon, which may reflect mild tendinosis, but the patellar tendon otherwise appears normal. ADDITIONAL

Output: 1.No meniscal tear.2.Minimal insertional tendinosis of the distal quadriceps and proximal patellar tendons.3.Small foci of cartilage degeneration involving the patellofemoral joint.


Instruction: Generate impression based on findings.

Input: lower extremity weakness There is a minimal kyphotic angulation from C4 to C6 with disc disc desiccation indicating degenerative spondylosis.The cranial-cervical junction is normal. 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 paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: there is minimal uncovertebral joint hypertrophy on the left, no neuroforaminal narrowing or spinal stenosis. C5-C6: diffuse bulging of disc with minimal uncovertebral joint hypertrophy on the right side inducing minimal spinal canal narrowing as well as minimal to mild right neuroforaminal narrowing. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Degenerative spondylosis of C spine with disc degenerations.2. Minimal to mild spinal canal stenosis at the level of C56, with minimal to mild neural foraminal stenosis on the right side of C56.3. Spinal cord signal intensity is normal and no abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Unspecified hearing loss, right ear [H91.91], Reason for Study: ^Reason: evaluate partially enhancing lesion from prior exam History: evaluate partially enhancing lesion from prior exam Redemonstration of multifocal variable sized ring-enhancing lesions on bilateral hemisphere with the susceptibility artifacts, unchanged since prior scan. There is no associated surrounding edema. Considering those lesions correspond to the CT findings of calcifications, differential diagnosis remained as neurocysticercosis, or other granulomatous infections. The ventricles, sulci and cisterns are unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Unchanged multiple bihemispheric ring enhancing nodular lesions without surrounding edema since prior scan.2. No evidence of new ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 65 year old woman with sarcoidosis referred to evaluate for possible cardiac sarcoidosis. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 99 ml/m2 (normal range: 65+/-11), the LVEDV is 225 ml (normal range 109+/-23), the LV end systolic volume index is 64 ml/m2 (normal range 18+/-5), the LVESV is 145 ml (normal range 31+/-10), the LV mass index is 68 g/m2 (normal range 67+/-11), and the LV mass is 155 g (normal range 114+/-24). There is global hypokinesis with regional wall motion abnormalities. The basal to mid inferior and inferolateral walls are thinned and most hypokinetic. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 160 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 91 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a large burden of mediastinal lymphadenopathy. 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. Moderate left ventricular dilation with moderately reduced systolic function (LVEF 36%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. There is pronounced thinning and hypokinesis of the basal inferior and inferolateral walls. These segments are free of myocardial infarction. This abnormality could represent hibernating myocardium due to the presence of a severe coronary artery stenosis supplying viable myocardium. 3. Normal right ventricular size with mildly reduced systolic function (RVEF 43%).4. Severe left atrial dilation.5. At least moderate mitral regurgitation. 6. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Female 81 years old with right ankle pain and radiograph showing periosteal reaction. Evaluate for osteomyelitis. The study was ordered with contrast but the patient declined contrast at the time of the exam. ARTICULAR SURFACES AND BONE: Soft tissue ulceration along the lateral ankle measures approximately 3 cm in AP and 5 cm in craniocaudal dimension. The marrow signal in the underlying fibula is normal.There is narrowing, sclerosis and cyst formation at the articulation of the medial cuneiform and the navicular bone as well as at the median cuneiform - second metatarsal joint and lateral cuneiform - third metatarsal joint indicating osteoarthritis. No fractures are identified. There is no tibiotalar joint effusion.TENDONS: The Achilles tendon, flexor and extensor tendons are normal in appearance.LIGAMENTS: The lateral ligaments and deltoid ligament are intact.ADDITIONAL

Output: Soft tissue ulceration but no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with bilateral lower extremity pain, numbness and possible weakness in the setting of prior surgery. Evidence of posterior instrumented fusion is seen with bilateral pedicle screws and stabilization rods spanning L5 and S1. Interbody devices have also been placed in the L5-S1 disc space.A very mild scoliotic curvature of the lumbar spine is seen. Sagittal alignment is within normal limits. Vertebral body height and morphology are unremarkable. Mild fatty endplate degenerative signal change is seen anteroinferiorly at L4. Elsewhere, marrow signal characteristics are within normal limits. No evidence of marrow edema is detected. No evidence of worrisome spinal or paraspinal enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits, except as discussed by level below.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Left foraminal and far lateral disc protrusion which effaces the inferior aspect of the neural foramen. The exiting L3 nerve root does not appear to be significantly affected, but the protrusion does partially efface the left lateral recess and may contact the transiting L4 nerve root. No significant generalized spinal canal stenosis. No significant right foraminal narrowing. L4-5: Marked facet hypertrophy with ligamentum flavum thickening. Bulging disc. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina nerve roots. Moderate bilateral foraminal narrowing. L5-S1: Postoperative findings. No significant spinal canal stenosis. No significant foraminal narrowing suspected within the limitations of some artifactual distortion due to the orthopedic instruments. A small defect within the left iliac bone may represent a bone graft harvest site.

Output: 1.Postoperative findings compatible with instrumented posterior fusion from L5 to S1.2.Left foraminal and far lateral disc protrusion at L3-4 which narrows the neural foramen and effaces the left lateral recess. The transiting L4 nerve root may be affected by this process.3.Moderate to severe generalized spinal canal stenosis at L4-5 due to a combination of disc bulge and posterior element hypertrophy. Moderate foraminal narrowing is also evident at this level.4.Although the L5-S1 level is slightly degraded by artifact, no significant spinal canal or foraminal stenosis is suspected.


Instruction: Generate impression based on findings.

Input: Coccygeal dimple, r/o spina bifida History: Hair coming from dimple. There is a vitamin E capsule positioned on the skin overlying the coccyx. However, there is no evidence of underlying cyt or sinus tract. There is appears to be slight sacral dysraphism, although MRI is rather insensitive for such abnormalities. 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 spinal cord displays normal signal and morphology. The conus medullaris is positioned at the T12-L1 level, which is normal. There is no evidence of fibrofatty filum. The paravertebral soft tissues are unremarkable. The cerebellar tonsils are not low-lying. The urinary bladder appears to be distended.

Output: 1. No evidence of underlying cyt or sinus tract. 2. Suggestion of possible mild sacral spina bifida occulta, although MRI is rather insensitive for such abnormalities. 3. The conus medullaris is positioned at the T12-L1 level, which is normal. 4. No evidence of fibrofatty filum.


Instruction: Generate impression based on findings.

Input: 17 years Female (DOB:2/14/1999)Reason: CCM Protocol, QSM/Permeability, 3T Scanner, CCM3, yearly follow up please evaluate for changes History: CCM3 SurveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple lesions identified on susceptibility imaging present in both hemispheres of the supratentorial brain as well as the brainstem. The largest one is located in the left side of the brainstem at the junction of the pons and the left middle cerebellar peduncle and measures 12 mm on T2 imaging. It appears stableOne in the right periventricular white matter in the right parietal lobe measures 10 mm on the current exam and the 5 mm on the prior exam.One in the right postcentral gyrus which on the prior exam measured 13 x 10 mm on current exam represents hemosiderin and is smaller. A smaller on in the right precuneus is stable . One in the left periventricular white matter is also stable.On susceptibility imaging many small punctate foci of susceptibility effect are identified in the frontal lobes and periventricular white matter which are also identified on the prior exams unchanged.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: There are multiple cavernous hemangiomas present. Compared to the previous exam the lesion in the right periventricular white matter in the right parietal lobe has enlarged. Another lesion in the right postcentral gyrus has decreased in size. The rest of the lesions do not appear to have changed substantially. Findings were communicated to Dr. Issam Awad at the time of this interpretation.


Instruction: Generate impression based on findings.

Input: History of bladder cancer status post cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. Subcentimeter punctate T2 hyperintensities in the medial and anterior segments are too small to characterize, unchanged and likely cysts. Normal postcontrast enhancement without a suspicious lesion, ductal dilatation or vascular abnormality. Cholelithiasis within a normally distended gallbladder.SPLEEN: The spleen is normal in size and signal intensity without a discrete lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small benign-appearing retroperitoneal/left paraaortic nodes similar to prior study.BOWEL, MESENTERY: Small fat-containing umbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral fat containing inguinal hernias, unchanged small widemouthed periumbilical hernia. OTHER: No significant abnormality noted.

Output: Stable examination with no evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 16-year-old girl with history of lymphatic malformation of the posterior left chest status post debulking. CHEST:LUNGS AND PLEURA: No significant abnormality of the lungs or pleura.MEDIASTINUM AND HILA: The heart and pericardium are normal. No mediastinal or hilar lymphadenopathy noted.CHEST WALL: A marker was placed over the palpable mass.A lobulated, T1 iso and T2 hyperintense mass measuring approximately 54 x 34 mm is seen within the left erector spinae musculature at the level of T9/T10 (series 601, image 22). This mass enhances and contains multiple flow voids on T2 weighted images. The mass extends anteriorly to the left T9 neural foramen (series 1505, image 255). A second mass with similar signal and enhancement characteristics is seen in the inferior latissimus dorsi. This mass measures approximately 39 x 19 mm (series 601, image 14) and extends through the chest wall but is extrapleural. A third, 12 x 9 mm mass is seen in the inferior left paraspinal musculature (series 601, image 4) with similar signal and enhancement characteristics. These masses appear to have increased in size and extent from the CT. Scattered foci of diffusion restriction are noted within these masses.Additional fat signal is seen throughout the left paraspinal and posterior chest wall musculature.Left thoracic curve noted. The spinal canal appears normal.UPPER ABDOMEN: The partially visualized liver, spleen, and kidneys appear normal. The gallbladder is normal.

Output: Multiple masses in the left paraspinal and posterior chest wall musculature with signal and enhancement characteristics most suggestive of hemangiomas. These masses have increased in size compared to 2008.


Instruction: Generate impression based on findings.

Input: Reason: History of meningioma ,yearly follow up , eval for changes History: yearly follow up eval for changes. Extra-axial homogenously enhancing lesion in the left cerebellum along the tentorium is unchanged in size measuring 1.7 x 1.8 cm, previously 1.5 x 1.8 cm. This lesion is adjacent to the left transverse sinus which is focally narrowed but patent proximally and distally, similar to the prior exam. There is an additional enhancing lesion in the left frontal high convexity which is calcified on prior CTs measuring 7 mm in thickness and is also unchanged in size. No new enhancing lesions are present.A few punctate scattered foci of T2 hyperintensity in the periventricular white matter are nonspecific and unchanged. Prominent ventricles and sulci likely reflects mild volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Meningioma along the left cerebellum is stable.2.Subcentimeter enhancing extra-axial lesion along the left high convexity with calcification is consistent with an additional meningioma and also remain stable.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, with vertigo. Concern for stroke. Small foci of restricted diffusion are seen within the right inferior cerebellar hemisphere and the right cerebellar tonsil. There is also a punctate focus of restricted diffusion within the medulla. No supratentorial restricted diffusion is seen.A chronic right cerebellar infarct is redemonstrated similar to prior. Scattered foci of periventricular T2 hyperintensity are also demonstrated appearing grossly similar to prior. No pathologic parenchymal or extra-axial enhancement is observed.No evidence of significant generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricles are normal in size and morphology.Sequelae of sinonasal surgery are redemonstrated. Scattered paranasal sinus opacification appears similar to prior.The right vertebral artery is of small caliber and demonstrates only thready opacification through its cervical segments. The left vertebral artery is unremarkable. The carotid vessels are free of significant stenosis in the neck.

Output: 1.Small foci of restricted diffusion are seen within the right cerebellar tonsil, the right cerebellar hemisphere and the medulla. Findings were discussed with Dr. Bernard at 3:30 PM on 5/18/2016.2.In correlation, the right vertebral artery is of small caliber and demonstrates only thready opacification throughout its extent.3.A large chronic right PICA territory cerebellar infarct is unchanged.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: cause of intrahepatic and extrahepatic biliary dilation History: chest pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology, no suspicious hepatic lesions. The vasculature are patent. The gallbladder contains multiple tiny layering stones without wall thickening or surrounding inflammation. The gallbladder is mildly distended.The CBD is mildly dilated measuring 12mm up to the level of the ampulla where it tapers smoothly. The ampulla is prominent and projects into the duodenum. T2 hypointense stone is seen in the distal CBD as seen in image 21 of series 201.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is mildly dilated at 4mm. No evident mass. No parenchymal or surrounding inflammationADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colon is distended with above average stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings suspicious for a small distal CBD stone causing obstruction.2. Above average stool burden in the colon.3.Cholelithiasis without specific findings of acute cholecystitis. Gallbladder is mildly distended.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. There are type II endplate degenerative changes at L4-5, along with mild reactive edema in the L4-5 disk. There is moderate loss of T2 signal in L4-5 disk with mild loss of disk height. There is mild loss of T2 signal in all other lumbar disks without significant loss of disk height at any other level. The conus terminates at L1-2 and shows normal caliber and signal.T11-12: No disk herniation or spinal stenosis.T12-L1: No disk herniation or spinal stenosis.L1-2: Right far lateral disk protrusion without significant spinal canal or neural foraminal stenosis.L2-3: Minimal diffuse disk bulge, moderate bilateral facet arthropathy and ligamentum flavum thickening causing no significant neural foraminal or spinal canal stenosis.L3-4: Mild disk bulge with central annular fissure, moderate bilateral facet arthropathy and ligamentum flavum thickening causing no significant spinal canal or neural foraminal stenosis.L4-5: Diffuse disk bulge, moderate bilateral facet arthropathy causing no significant spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis, with disk material approaching the right exiting L4 nerve root in the neural foramen.L5-S1: Diffuse disk bulge, mild facet arthropathy with no significant spinal canal stenosis or neural foraminal stenosis.

Output: 1.Type II endplate degenerative changes at L4-5 with mild reactive degenerative edema in the L4-5 disk. Mild right and minimal left neural foraminal stenosis at L4-5, with disk material approaching the right exiting L4 nerve root in the neural foramen.2.Moderate multilevel facet degenerative disease as described above.


Instruction: Generate impression based on findings.

Input: Assess for neuropathy/radiculopathy versus inflammation versus less likely spinal involvement: neck pain with extension. There has been near-interval resolution of findings related to pharyngitis with minimal residual retropharyngeal edema. There is no evidence of significant cervical lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The osseous structures and cervical spinal are unremarkable. The imaged intracranial structures are also unremarkable. There is a subcentimeter left maxillary sinus retention cyst.

Output: 1. Near-interval resolution of findings related to pharyngitis with minimal residual retropharyngeal edema.2. The osseous structures and cervical spinal are unremarkable. Please refer to the separate shoulder MRI report for additional details.


Instruction: Generate impression based on findings.

Input: 74 year old male patient with history of heart transplant and prostate cancer, Gleason 6. Last biopsy in 1/2012. PELVIS:PROSTATE:Prostate Size: 4.8 x 6.4 x 5.0 cm.Peripheral Zone: There is a lesion within the right apex with mild T2 hypointensity, moderate hypointensity on ADC, and some early enhancement measuring approximately 10 x 4 mm (image 124, series 804). Central Gland: There are BPH nodules. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No definite 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: Tumor in the right apex without specific evidence of extraprostatic extension.


Instruction: Generate impression based on findings.

Input: There has been interval decrease in size of the dominant left temporoparietal lesion, now measuring up to are approximately 15 mm. Otherwise, there is no significant interval change in the multiple smaller periventricular and pericallosal T2 hyperintense white matter lesions, accounting for differences in technique. There is no evidence of acute hemorrhage or infarction. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval decrease in size of the tumefactive demyelinating lesion in the left temporoparietal region. Otherwise, no significant interval change in the intracranial demyelinating lesions.


Instruction: Generate impression based on findings.

Input: 56-year-old female with bilateral lower extremity weakness status post L3 perispinal tumor resection, L3 left hemilaminectomy and hemipediculotomy and fusion. Evaluate for cord compression. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. Degenerative changes are also seen involving the cervical spine most prominently in the affecting the C4-5 level where there is grade 1 anterolisthesis of C4 on C5 and disc height loss. At this level there is also mild to moderate spinal canal stenosis but no compromise of the spinal cord. Redemonstrated are postoperative findings compatible with resection of the tumor from the left L3 paraspinal region which are unchanged and better characterized on the dedicated lumbar spine MRI from 12/2/2016. There is some additional neural foraminal encroachment involving the lumbar spine mainly at L2-3. There is mild posterior subluxation of L3 on L4 which is unchanged since the prior exam.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Postoperative findings involving previous resection of a left L3 paraspinous tumor are grossly unchanged although not completely evaluated. Refer to the dedicated lumbar spine MRI performed on 12/3/2016 for further characterization. There is encroachment of the left-sided exiting nerve roots at L3-4.Additional degenerative changes are seen in the cervical spine including grade 1 anterolisthesis of C4 on C5 with at most mild-to-moderate spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: question avascular necrosis History: pain in knees. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Curvilinear bands of signal abnormality within the medial and lateral femoral condyles as well as the lateral aspect of the patella are compatible with avascular necrosis. The overlying cartilage appears intact. We see no subchondral fracture or articular surface collapse. No edema is associated with osteonecrosis. The articular cartilage appears normal.LIGAMENTS: The anterior cruciate ligament and posterior cruciate ligament are intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Uncomplicated avascular necrosis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapse Syncope and collapseClinical question: evaluate for stroke vs. Seizure nidusSigns and Symptoms: as above MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense foci are present in the brainstem.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disc desiccation presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is some disc desiccation present at this level.At C3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some uncovertebral osteophytes predominantly in the left side and ligamentum flavum hypertrophy. There is associated flattening of the spinal cord and effacement of spinal fluid ventral and posterior the spinal cord. There is cord T2 signal hyperintensity within the spinal cord at this level especially the left hemicord. There is encroachment of left-sided exiting nerve roots at this level due to disc material and osteophytes Overall there is severe spinal stenosis present associated with findings suggesting cord edema.At C4-5 there is loss of disc space height, disc desiccation as well as endplate uncovertebral osteophytes. The uncovertebral osteophytes and disc material is more prevalent on the left side where there is encroachment of the left-sided exiting nerve roots. There is also effacement of spinal fluid ventral and posterior the left hemicord at this level and partial effacement of spinal fluid ventral and posterior the right hemicord. There is hypertrophy of the ligamentum flavum present. Overall there is moderate spinal stenosis at this level. There is mild flattening of the spinal cord.At C5-6 there is loss of disc space height, disc desiccation as well as endplate and uncovertebral osteophytes associated with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is hypertrophy of the ligamentum flavum present. There is also effacement of the spinal fluid ventral and posterior the spinal cord at this level. Overall there is moderate spinal stenosis at this level with mild cord flatteningAt C6-7 there is loss of disc space height, endplate and uncovertebral osteophytes as well as encroachment of the exiting nerve roots within the neural foramina bilaterally. There is partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal. Disc material extends into the neural foramina bilaterally at this level and is associated with some encroachment of the exiting nerve roots within the neural foramina bilaterally.The vertebral artery flow voids appear to be intact.There is enlargement of the left thyroid lobe with a heterogeneous lesion which is incompletely visualized on this exam.

Output: 1.There is severe spinal stenosis present at C3-4 associated with flattening the spinal cord and cord signal change suspicious for cord edema suspicious for spondylitic myelopathy. Please correlate with patient's clinical history for spondylitic myelopathy.2.There is a moderate degree of spinal stenosis present at C4-5 associated with mild cord flattening due to degenerative changes.3.There is a moderate degree of spinal stenosis at C5-6 associated with some mild/minimal cord flattening related to degenerative changes.4.There is encroachment of exiting nerve roots bilaterally at C5-6 and C6-7 as well as on the left-sided C3-4 and C4-5 due to degenerative changes.5.The left lobe of the thyroid gland appears enlarged and heterogeneous. This is not adequately imaged on this examination. Please correlate with patient's clinical history and symptoms.6.Periventricular and subcortical white matter lesions of a mild to moderate degree as well as some patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 7.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Reason: low back pain, eval disc dz History: low back pain, radicular pain, degenerative disc dz Five lumbar type vertebral bodies are presumed to be present. The lumbar spine appears slightly straightened. The vertebral body heights are well-maintained. There is mild loss of disc height at L5-S1. The remaining intervertebral disc heights are well-maintained. There is loss of the normal T2 signal within the intervertebral discs of L4-5 and L5-S1, consistent with disc desiccation. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is mild disc bulge with superimposed right foraminal disc protrusion, which may exert slight mass effect on the descending L5 nerve root. There is a small tear of the right far lateral annular fissure. Mild to moderate right greater than left facet arthropathy is present. There is no significant compromise to the spinal canal or neural foramina.L5-S1: There is mild disc bulge with left foraminal prominence. Mild right and moderate left neuroforaminal stenosis. There is no significant compromise to the spinal canal.

Output: 1. Mild disc bulge at L4-5 with superimposed right foraminal disc protrusion, which may exert slight mass effect on the descending right L5 nerve root.2. Mild disc bulge at L5-S1 with left foraminal prominence and mild right and moderate left neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: 38 years Male (DOB:8/14/1977)Reason: ? extent of resection History: panhypopituitarismPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE MRI pituitary:Since prior examination patient has undergone transsphenoidal surgery for a pituitary mass. On the current exam the overall dimensions of the patient's mass were 29 x 20 x 24 mm. On the prior exam the mass measured 36 x 24 x 26 mm. There is a central nonenhancing component which has T1 signal hyperintensity within it suggestive of blood products. There is suprasellar extension. The mass is 1 or 2 mm below the level of the optic chiasm on the current exam whereas previously it was abutting the. There is no opacification of the sphenoid sinus and there is mucosal thickening in the maxillary sinuses and ethmoid air cells.

Output: Since the prior exam there is been surgical debulking of the patient's pituitary mass suspected to represent pituitary adenoma. There is somewhat less mass effect on the current exam when compared to the prior.


Instruction: Generate impression based on findings.

Input: Evaluate for biliary leak. Status post OLT with perihepatic fluid collections. ABDOMEN:LIVER, BILIARY TRACT: The portal vein and its branches are patent. There is increased biliary ductal dilatation with branching pulmonary defect within the biliary tree compatible with pneumobilia seen on recent CT. No hepatic lesion is identified. Rim-enhancing fluid collection in the gallbladder fossa measures 2.7 x 0.8 cm coronally, from previously 4.0 x 4.2 cm. At 20 minutes hepatobiliary phase, contrast is seen avidly enhancing the biliary system and does not appear to fill the drained collection, suggesting against a biliary leak or fistulous communication. Drainage catheter again noted within the collection.SPLEEN: Mild splenomegaly is redemonstrated.PANCREAS: Fatty involution of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple and proteinaceous cysts, stable from prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Significant interval decrease in size of drained abscess in the gallbladder fossa without evidence of biliary leak or fistula.


Instruction: Generate impression based on findings.

Input: Lower back pain, left leg occasionally gives out Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is congenital narrowing of the lumbar spine with superimposed prominence of the epidural fat consistent with epidural lipomatosis. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. There is mild mass effect on the thecal sac related to epidural lipomatosis. No significant neural foraminal stenosis.L3-L4: No significant disc disease. There is moderate degree of mass effect on the thecal sac related to epidural lipomatosis. Mild bilateral neural foraminal stenosis. Moderate bilateral facet arthropathy.L4-L5: No significant disc disease. There is moderate mass effect on the thecal sac related to epidural lipomatosis. No significant neural foraminal stenosis. Mild facet arthropathy.L5-S1: No significant disc disease. There is moderate degree of mass effect on the thecal sac related to epidural lipomatosis. No significant neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues demonstrate prominence of the subcutaneous fat but are otherwise within normal limits.

Output: Diffuse epidural lipomatosis involving the lumbar spinal canal associated with at least moderate degree of spinal canal stenosis at the L3-L4, L4-L5, and L5-S1 levels. No significant disc disease or high-grade neural foraminal stenosis at any level.Multilevel facet arthropathy, relatively worse at the L3-L4 level, which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma, history of resection: yearly follow up. Pituitary: There are postoperative findings related to transphenoidal surgery. There is no significant interval change in size of the lobulated enhancing sellar and suprasellar mass, which measures up to approximately 15 mm and abuts the left lateral aspect of the optic apparatus, which otherwise demonstrates normal signal characteristics. The cavernous sinus appear to be unchanged.Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles are unchanged in size and configuration. There is no midline shift or herniation.

Output: No significant interval change in the residual macroadenoma, which abuts the left lateral aspect of the optic apparatus.


Instruction: Generate impression based on findings.

Input: Right intranasal mass asses for intracranial invasion: right nasal congestion. There is a lobulated and heterogeneous mass within the right nasal cavity that measures up to 55 mm in length. There is mucosal thickening and fluid in the right maxillary and ethmoid sinuses, as well as mucosal thickening in the right frontal sinus, a left maxillary sinus retention cyst, and fluid in the bilateral sphenoid sinuses. There is deviation of the nasal septum to the left. There are secretions in the nasopharynx. There are bilateral lens implants. There is a chronic lacunar infarct in the right basal ganglia and scattered foci of nonspecific cerebral white matter T2 hyperintensity.

Output: 1. Preoperative planning MRI demonstrates a mass centered in the right nasal cavity with superimposed obstructed sinonasal inflammatory disease, likely both acute and chronic.2. Chronic lacunar infarct in the right basal ganglia.


Instruction: Generate impression based on findings.

Input: 19 year-old male with right lower quadrant pain. Rule out appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatomegaly. The liver measures more than 22 cm craniocaudally. No focal hepatic parenchymal lesions. Gallbladder is normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lateral subcapsular renal hematoma probably arises from a right lower pole multiloculated cystic lesion which measures approximately 3.5 by 4.5 cm at axial image 55/152 of series 3. A second similar lesion is in the anterior upper pole of the right kidney measuring 2.6 cm in diameter at axial image 37/152 of series 3. These lesions most likely represent benign angiomyolipomas, but this cannot be confirmed on a post contrast CT scan examination alone. Further evaluation with precontrast noncontrast views of the kidneys and/or MRI of the kidneys would be helpful for further evaluation. The left kidney is normal. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Difficult to identify the appendix with the presence of constipation involving the cecum and ascending colon, but no evidence of abscess, free air or local inflammatory changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: L5 vertebral segment is transitional with sacralization on the left side.OTHER: No significant abnormality noted

Output: Subcapsular hematoma in the right renal midpole, probably due to angiomyolipoma. This could be confirmed with noncontrast scan of the kidneys and/or kidney MRI examination. No definite evidence of appendicitis. Hepatomegaly. Transitional L5 vertebral segment, sacralized on the left.


Instruction: Generate impression based on findings.

Input: Female 69 years old; Reason: third ventriculostomy,suspected aqueductal stenosis History: 6 month follow up. No acute intracranial hemorrhage. No intra- or extra-axial fluid collections. Again seen is a recumbent AP paramedian frontal burr hole. Linear low attenuation traversing the right frontal lobe and terminating into the right lateral ventricle likely result of prior instrumentation. Punctate focus of air within the right frontal horn has resolved.Redemonstration of enlargement of the lateral and third ventricles, which are unchanged compared to previous exam. Periventricular low attenuation of white matter is similar to prior exam corresponding to regions of small vessel ischemic strokes on prior MRI study and are unchanged. Possibility of underlying periventricular exudate of CSF should also be considered.The visualized osseous structures and soft tissue extracranial components are without abnormalities.

Output: 1.No significant interval change in the size of the supratentorial enlarged ventricular system.


Instruction: Generate impression based on findings.

Input: Loss of smell and taste sense. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate nonspecific foci of T2 hyperintensity in the bilateral frontal lobe white matter. The brain parenchyma and olfactory bulbs appear unremarkable. 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, nasal cavity, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. The olfactory bulbs are grossly intact.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, there are 5 lumbar type vertebral bodies. Alignment is anatomic. There is no marrow edema or replacement. Vertebral body heights and intervertebral disc spaces are preserved. The conus is normal in signal and morphology and terminates at the mid L2 level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: No significant spinal canal or neural foraminal stenosis.L1/2: No significant spinal canal or neural foraminal stenosis.L2/3: No significant spinal canal or neural foraminal stenosis.L3/4: Mild disc desiccation. No significant spinal canal or neural foraminal stenosis.L4/5: Mild disc desiccation. There is minimal right foraminal bulging of the intervertebral disc with no significant spinal canal or neural foraminal stenosis.L5/S1:Minimal facet joint arthropathy with no significant spinal canal or foraminal stenosis.SI Joints: No significant abnormalities noted.

Output: Minimal degenerative changes of the lumbar spine with no specific findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of myelofibrosis. Screening for clinical trial. Needs specific measurement of the spleen. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Small right hepatic cyst. No enhancing hepatic lesions. No biliary ductal dilatation. Patent vasculature.SPLEEN: Marked splenomegaly measuring 21.5 cm in length (prior 23 cm). Multiple subcentimeter foci of T2 signal intensity are again seen and show no contrast enhancement.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: Stable hemangiomas at L2, L3,, and S1.OTHER: No significant abnormality noted.

Output: 1.Marked splenomegaly, which has slightly decreased in the interval measuring 21.5 cm (prior 23 cm).


Instruction: Generate impression based on findings.

Input: There is continued evolution of postsurgical changes from T6 to T9 including left T7, T8 and T9 hemilaminectomies and left T8 pedicle resection for resection of aneurysmal bone cyst. There is no definite residual osseous tumor. Interval resolution of enhancement superior and inferior to the resection site which was reactive. There is mild dorsal epidural enhancement from the T9 to T11 levels which may represent postsurgical change. There is no evidence of abscess. There is interval resolution of the left pleural effusion.The vertebral column alignment is within normal limits. The vertebral body and disc space heights are otherwise preserved. The spinal cord displays normal signal and morphology with the conus terminating at L1.

Output: 1. Evolution of postsurgical changes from T6 to T9, including left T7, T8 and T9 hemilaminectomies and resection of the left T8 pedicle, without definite evidence of residual or recurrent tumor. 2. Decrease in previously seen epidural enhancement superior and inferior to the resection site which represented reactive change. Minimal residual epidural and soft tissue enhancement at the resection site may represent postsurgical change.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and weakness ROTATOR CUFF: Metallic susceptibility artifact overlies the greater tuberosity relating to prior rotator cuff repair. There is a small full-thickness tear of the supraspinatus tendon at the level of the distal acromion best appreciated on series 9 image 16 of 24. There is otherwise no full-thickness rotator cuff tear identified. There is mild atrophy of the supraspinatus muscle with a minimal amount of atrophy along the myotendinous junction of the infraspinatus. The remaining rotator cuff musculature is normal inSUPRASPINATUS OUTLET: There is mild osteoarthritis of the and acromioclavicular joint. A trace amount of fluid is seen in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degeneration of the labrum without evidence of full-thickness tear/detachment.BICEPS TENDON: The biceps tendon is intact although there is a small amount of circumferential fluid present within the biceps tendon sheath which is likely the result of communication with a small amount of joint fluid. ADDITIONAL

Output: Small full-thickness tear of the supraspinatus tendon. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer with diffuse bone metastases, on Nivolumab, now with blurred and double vision due to left lateral rectus palsy. There is an infiltrative enhancing lesion that measures up to approximately 3 cm involving the left aspect of the clivus, in the region of Dorello's canal. There is also a subcentimeter lesion in midline of the frontal bone. There are postoperative findings related to decompression of the upper cervical spine with an expansile mass involving C2 with indentation of the spinal cord. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific scattered cerebral white matter T2 hyperintensity, as well as unchanged areas of encephalomalacia in the right perirolandic region and anterior right frontal lobe. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the maxillary sinuses. There is also a small amount of fluid within the left mastoid air cells.

Output: 1. A lesion involving the left aspect of the clivus likely represents metastatic disease and may account for the double vision. Another subcentimeter lesion in the frontal bone also likely represents a metastasis. Otherwise, no evidence of intracranial metastases.2. Partially-imaged postoperative findings related to decompression of the upper cervical spine with a metastasis involving C2 with compression of the spinal cord. Discussed with Dr. Maitland at 3PM on 5/8/15.