Instruction: Generate impression based on findings.

Input: Epilepsy. The left hippocampal head appears to have slightly indistinct internal architecture and slightly volume loss with minimal signal abnormality. There is unchanged minimal asymmetry of the temporal horns of the lateral ventricles. There is also unchanged slight prominence of the bilateral lateral cerebellar hemisphere folia. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. 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: Suggestion of mild left medial temporal sclerosis, but no evidence of acute intracranial tumor.


Instruction: Generate impression based on findings.

Input: 56-year-old with known breast cancer on therapy, assess disease response. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Mild motion artifact does not significantly limit this exam.No residual suspicious enhancement is seen at the site of biopsy proven malignancy. Hydromark clip artifact is well seen in the location of the previously biopsied mass. No suspicious enhancement elsewhere in either breast. The previously noted highly likely benign focus in the left lower outer breast is less conspicuous on this exam, and certainly not enlarged. No abnormal lymph nodes are identified in either axillary region.

Output: No residual suspicious enhancement at the site of biopsy proven malignancy post treatment.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 56-year-old male with a history of squamous cell carcinoma of the nasopharynx status post surgery and chemoradiation therapy with probable metastatic disease to the brain. Evaluate for shift. There is a heterogeneous soft tissue density in the right ethmoid sinus with associated destruction and invasion through the overlying right lamina papyracea consistent with the patient's history of sinonasal squamous cell carcinoma. Additionally, there is an air-fluid level in the left frontal sinus and left ethmoid sinus mucosal thickening.There is a 3-cm isodense mass in the right frontal lobe (10; series 4) with extensive surrounding vasogenic edema highly suspicious for metastatic disease, previously 2 cm on outside MRI examination, significantly enlarged. Additionally, note is made of a 9 x 13 mm focus of hyperdensity in the posterior aspect of the aforementioned mass which likely represents hemorrhage adjacent to the tumor. There is associated local mass-effect with a 6-mm local leftward midline shift of the inferior right frontal cortex. There is no evidence of extra-axial fluid collection. There is preservation of the gray-white matter interface. There is no evidence of acute territorial infarct. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells are within normal limits.

Output: 1. 3 cm mass in the right frontal lobe with extensive surrounding vasogenic edema consistent with intracranial extension of tumor from the ethmoid air cells. There is a hyperdense focus in the posterior aspect of the aforementioned mass which likely represents hemorrhage. There is associated local mass-effect with a focal leftward midline shift of the inferior right frontal cortex. 2. There is a heterogeneous soft tissue density in the right ethmoid sinus with associated destruction and invasion through the overlying right lamina papyracea consistent with the patient's history of sinonasal squamous cell carcinoma. Additionally, there is an air-fluid level in the left frontal sinus and left ethmoid sinus mucosal thickening.


Instruction: Generate impression based on findings.

Input: Multiple myeloma not having achieved remission [C90.00], Reason for Study: ^Reason: myeloma with compression fracture L3 and screws for surgery L5/S1 with persistent pain at that site History: see above Cervical spine:Normal cervical lordosis has been lost but straightened. Multifocal cervical vertebral bodies show high signal intensity on T2 and FLAIR imaging could indicate myeloma involvement. However, there is no evidence of acute compression fracture. There is no evidence of abnormal spinal cord signal intensity on the scan.There is a central focal protrusion of C34, C4-5 which abuts the thecal sac. In addition, at the level of C5-6 and C6-7 shows diffuse broad-based disc protrusion which results mild to moderate spinal canal stenosis.Thoracic spineNormal thoracic kyphotic angulation is seen.Spinal cord signal intensity is normal.Vertebral bodies show multifocal T2/FLAIR high signal foci which may indicate possible myeloma involvement. There is no evidence of neuroforaminal stenosis or spinal canal stenosis.Lumbar spine MRIThere is about 30% vertebral height reduction of L1 vertebral body with bone marrow edema indicating acute/subacute compression fracture.There is no evidence of retropulsion.There is evidence of prior PMMA injection at the level of L3.There is also evidence of L5-S1 external fixation with screws and rods. The conus medullaris terminates at the level of T12. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. Bone marrow edema with about 30% of vertebral height reduction indicate acute/subacute compression fracture.L2-L3: diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal stenosis. L3-L4: diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal stenosis. L4-L5: diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal stenosis. L5-S1: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Acute/subacute compression fracture at the level of L1.2. Multifocal multilevel cervical and thoracic vertebral body lesions indicating possible myeloma involvement. 3. Spinal cord signal intensity is normal.4. Mild to moderate spinal stenosis at the level of C56 and C67.5. Mild to Moderate spinal canal stenosis, from L23 to L45.6. Post PMMA injection status of L3 and external fixation with rods and screws between L5 and S1.


Instruction: Generate impression based on findings.

Input: Early onset of tics. Patient has complex motor tics and speech and fine motor delay. Brain parenchyma appears within normal limits. No parenchymal signal abnormality in the basal ganglia or elsewhere in the brain. No evidence of cortical dysplasia, gray matter heterotopia, or other findings to suggest a possible seizure focus. No intracranial mass or mass effect. Myelination is appropriate for age. No evidence of infarct or hemorrhage. Ventricles are within normal limits without evidence of hydrocephalus. No extra-axial collections. Borderline low cerebellar tonsils are incidentally noted but within normal limits for age; no evidence of Chiari I. Posterior fossa structures and craniocervical junction appear otherwise unremarkable. Bone marrow signal is within normal limits. Extracranial soft tissues are unremarkable.

Output: Brain MRI examination is within normal limits for age.


Instruction: Generate impression based on findings.

Input: Generalized muscle weakness There is mild edema signal within the abductor musculature of the thigh bilaterally, right slightly greater than left. There is also mild edema type signal within the anterior compartment of the distal femur. There is mild diffuse fatty atrophy of the pelvic and lower extremity musculature.Scattered foci of increased marrow signal are noted within the proximal femora bilaterally, particularly on the right. These may represent areas of early bone infarction. Additional areas of osteonecrosis are seen within the right distal femur and proximal tibia. There is a moderate-sized joint effusion of the knee.

Output: 1. Mild edema within the abductor muscles and anterior compartment of the distal femur compatible with mild myositis. There is also mild diffuse fatty atrophy of the pelvic and lower extremity musculature.2. Osteonecrosis of the distal femur and proximal tibia with scattered areas of abnormal marrow signal within the proximal femora which may reflect early bone infarction.


Instruction: Generate impression based on findings.

Input: Female, 87 years old. Reason: eval for osteomyelitis History: left ankle with open wound, purulence, exposed tendon, and CRP 240 There is extensive soft tissue edema about the ankle with associated obliteration of the normal pre-Achilles fat posterior to the ankle joint. Mild heterogeneous soft tissue enhancement diffusely suggests an ongoing inflammatory process. On postcontrast images, an area of low signal in the superficial soft tissues anterior to the distal tibia with peripheral enhancement may reflect a fluid collection within the soft tissues. A small amount of fluid is noted within the retrocalcaneal bursa. Increased T2 signal within the sinus tarsus may reflect additional inflammation.The underlying osseous structures are intact, with and normal cortical thickness and bone marrow signal. The visualized tendons of the ankle are intact. The anterior talofibular ligament is not well visualized. A small ankle joint effusion is noted.

Output: 1.Diffuse soft tissue inflammation/edema, without evidence of osteomyelitis.2.Possible small fluid collection in the superficial soft tissues anterior to the distal tibia.


Instruction: Generate impression based on findings.

Input: 21-year-old female patient with history of sickle cell anemia and severe bilateral knee pain. Evaluate for avascular necrosis. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is patchy ill-defined increased signal intensity in the distal femoral metaphysis. Increased T1 signal intensity is noted in the lateral femoral condyle, extending to the subarticular surface. Similar findings are seen to a lesser degree in the medial femoral condyle. Within the medial femoral condyle there is an area of increased T1 signal intensity with peripheral low T1 signal intensity, compatible with a bone infarct. This measures up to 3 cm in AP dimension. A similar appearing small lesion is noted in the distal femoral metaphysis (series 7 image 11).There are no focal articular cartilage defects. LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament complex, and medial collateral ligament are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Multifocal small bone infarcts in the distal femur. 2.Abnormal marrow signal secondary to sickle cell anemia.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: Male 56 years old Reason: fall on 3/21; radiograph negative but severe pain; cannot bear weight BONE MARROW: There is a T1 hypointense linear signal through the right sacral ala, with corresponding T2 hyperintense signal, consistent with nondisplaced sacral fracture. There is also T1 hypointense linear signal with corresponding T2 hyperintense signal through the right ischium near the pubic symphysis, and as well as in the right ischial tuberosity consistent with additional nondisplaced fractures.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Nondisplaced right sacral, and right ischial fractures as described above.


Instruction: Generate impression based on findings.

Input: 36 years Female (DOB:6/6/1980)Reason: MS; f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There is redemonstration of multiple periventricular and subcortical T2 and FLAIR signal hyperintense lesions as well as punctate lesions in the posterior limbs of internal capsules and the couple lesions in the right cerebellar hemisphere and in the brainstem. These lesions were present on the prior exam and have not changed substantially.Incidental note is made of cavum septum pellucidum and cavum vergae.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 lesions scattered throughout the periventricular and subcortical white matter and to a lesser degree posterior fossa which are stable compared to the previous exam. These are now with patient's clinical diagnosis of demyelinating disorder.


Instruction: Generate impression based on findings.

Input: Reason: PRES History: evaluate progression MRI of the brainpatchy foci of T2 and flair signal hyperintensity are present subtle in the left cerebellar hemisphere, more extensive than the right occipital lobe and adjacent to right posterior temporal lobe, small region in the left occipital pole, right thalamus, bilateral frontal lobes and watershed distribution in the Frommel and parietal lobes right more than left. There are associated mild degree of periventricular white matter lesions compared these findings were present on the previous exam appeared in the extent of these lesions is not clear to have changed tiny significant degree. On the associated susceptibility weighted imaging there is no microhemorrhage appreciated associated with these lesions. On the ADC maps there is very little evidence for diffusion restriction perhaps a little bit in the right subcortical white matter adjacent to the precentral and central gyrus, however, significantly less than the T2 and flair signal abnormalities. Postcontrast imaging demonstrates small foci of patchy enhancement along the cortex of the frontal lobes bilaterally but right more than left. The enhancement is significantly less than the T2 and FLAIR abnormality. Additionally there appears to be intravascular enhancement present in some subtle leptomeningeal enhancement adjacent to the left cerebellar hemisphere and right posterior and inferior aspect of the temporal lobe and adjacent occipital lobe . Overall this pattern is not changed substantially when compared to the prior exam.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.Unopposed contras SPGR T1 images only there is a tubular enhancing structure which projects over the brainstem. It is suspected to represent artifact as it is not seen on any of the pulse sequences other than this one. It likely represents misregistration from the left vertebral artery.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses mainly in the sphenoid sinuses. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are asymmetric left larger than right.There is extracranial origin of the right and left posterior inferior cerebellar artery.

Output: 1.This examination of the brain has not change substantially when compared to the previous exam. There are predominantly cortical but also adjacent white matter patchy lesions involving supratentorial brain as well as left cerebellar hemisphere and right thalamus as detailed above. There is some associated leptomeningeal disease. Although one possibility is that these findings can be explained on the basis of posterior reversible encephalopathy syndrome, the interval lack of change may suggest otherwise and the imply a different etiology. Considerations may include encephalitis as well as vasculitis.2.No evidence for intracranial aneurysm or cerebrovascular occlusion or stenosis. 3.Findings were discussed with Dr Goldenberg.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, status post craniotomy for tumor removal. Postoperative findings are seen compatible with right suboccipital craniotomy for resection of the previously seen right cerebellar lesion. The right cerebellar surgical cavity contains a mixture of air, fluid and blood product which is within expected postoperative limits.No definite residual enhancement is seen within the surgical cavity. Just above the resection cavity, and at a level which is apparently cranial to where the original tumor sat, there is a new 14 mm T1 hypointense cyst or nodule which contains an 8 mm enhancing focus.T2 hyperintensity within the right cerebellar hemisphere extending into the right cerebellar vermis is grossly unchanged from prior. Regional mass effect with effacement of the cerebellar fissures and partial effacement of the fourth ventricle is also unchanged.A teardrop shaped focus of T2 hyperintensity within the right upper pons is unchanged and may simply represent a dilated perivascular space. No additional significant parenchymal signal abnormality is seen supratentorially. The lateral ventricles are very slightly prominent but unchanged from the prior exam.

Output: 1.Expected findings status post resection of an enhancing right cerebellar lesion.2.No definite residual enhancement is seen within the resection cavity or at the original site of the lesion.3.Just cranial to the resection cavity, and at a position which is above the original lesion, a T1 hypointense cyst or nodule is evident containing a small central focus of enhancement. The nature of this finding is uncertain, but as it does not exactly correspond to the site of tumor on the preoperative study, some type of postoperative change is favored. Continued attention to this area on follow-up exams is recommended.


Instruction: Generate impression based on findings.

Input: Right-sided weakness. Evaluate for hemorrhagic conversion. Reidentification of patchy asymmetric hypoattenuating area along the distribution of the left MCA corresponding to abnormality seen on MRI of 12/12/2010 and CT perfusion on 12/11/2003 is compatible with stroke. Peri-ventricular and subcortical white matter hypoattenuating foci bilaterally are consistent with chronic small vessel ischemic disease appearing similar to prior exam.Prominence of extra-axial spaces and ventricular system is compatible with parenchymal volume loss. No extra-axial fluid collections, mass, or hemorrhage. Diffuse sclerosis involves the calvarium. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Left MCA infarct as previously described without evidence of hemorrhagic conversion.2. Small vessel ischemic disease and other findings appearing similar to prior exam.


Instruction: Generate impression based on findings.

Input: A 29 year old female with history of sickle cell disease, repeated red blood cell transfusions and iron overload. A recent echocardiography showed mildly reduced systolic function. Referred to cardiac MRI to assess function and cardiac iron overload. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 142 ml/m2 (normal range: 65+/-11), the LVEDV is 250 ml (normal range 109+/-23), the LV end systolic volume index is 76 ml/m2 (normal range 18+/-5), the LVESV is 134 ml (normal range 31+/-10), the LV mass index is 61 g/m2 (normal range 67+/-11), and the LV mass is 108 g (normal range 114+/-24). There is global mild hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No evidence of myocardial iron overload (average T2-star time above 30ms).No intracavitary thrombus was noted.Left AtriumThe left atrium is mildly dilated. The LA volume is 109 ml.Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 132 ml/m2 (normal range 69+/-14), the RVEDV is 234 ml (normal range 110+/-24), the RV end systolic volume index is 63 ml/m2 (normal range 22+/-8), and the RVESV is 111 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate 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 pericardial pericardial effusion.Extracardiac FindingsIron overload was noted in the liver (T2-star time of 9ms). No spleen was seen, consistent with auto-splenectomy. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with mildly reduced systolic function, the LVEF is 46%. There is global mild hypokinesis with regional variation. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. No evidence of myocardial iron overload.4. There is biatrial mild dilation. 5. The right ventricle is severely dilated with normal systolic function, the RVEF is 52%. 6. There is moderate tricuspid regurgitation.7. Iron overload was noted in the liver.


Instruction: Generate impression based on findings.

Input: Status post fall with subdural hematoma. Evaluate presence of subdural hematoma. Nonenhanced head CT:Examination again demonstrates a thin acute subdural hematoma in the left posterior parietal region. Compared to prior exam there is evidence of reduction in density and size of these subdural. In the current exam the thickest portion of subdural measures approximately 4.7 mm compared to prior measurements of 5.8-mm.Small amount of acute subdural blood is also present along the posterior aspect of falx on the left in the occipital region. This finding was present on prior study and is believed to represent continuation of left parietal subdural as was noted on prior MRI exam. There is no evidence of new hemorrhage. A minute amount of blood in the dependent portion of occipital horn is again identified.Prominence of lateral ventricles is similar to prior study. Area of vasogenic edema in the right posterior frontal is again identified and unchanged.The left posterior temporal cortical stroke is again identified.

Output: 1.No evidence of new hemorrhage since prior exam.2.Smaller size of left parietal subdural. No significant change in the left parafalcine component of subdural.3.Stable right frontal -- parietal vasogenic edema.4.Left posterior temporal lobe cortical stroke.5.Stable prominent size of the lateral ventricles.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with memory loss and confusion. Assess for structural abnormalities, atrophy. Numerous small scattered foci of T2 hyperintensity are seen within the white matter of the cerebral hemispheres, largely in the subcortical regions and to a lesser degree the deep periventricular white matter. No evidence of restricted diffusion is seen. No significant edema or mass effect is detected.There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection. The sulci of the cerebral vertex are perhaps slightly prominent but there is no specific pattern or focality to this finding. Ventricular size and morphology are within normal limits.

Output: 1.No acute intracranial abnormality.2.Numerous scattered small foci of white matter signal abnormality are seen, a nonspecific finding. This carries a broad differential diagnosis which includes sequelae of microvascular ischemic disease, demyelination, migraine headache or vasculitis among many other possible etiologies.3.Prominence of the sulci is seen along the cerebral vertex suggesting the possibility of underlying parenchymal volume loss. However, there is no specific pattern or focality to this finding.


Instruction: Generate impression based on findings.

Input: Again seen is thoracic syringohydromyelia centered at the T7 vertebral body level that measures up to 6 x 7 mm in the AP and transverse dimensions, previously also 6 x 7 mm. Craniocaudally the syrinx measures proximally 2.6 cm which is also not significant changed.The conus medullaris is positioned at the L1 vertebral body level. 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 or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.Limited evaluation of the craniocervical junction on the sagittal counting sequences again demonstrates ectopia of the cerebellar tonsils with a peglike configuration consistent with Chiari I malformation.

Output: 1. Compared to 2/4/2015, there is no significant change in the thoracic syrinx centered at T7 which measures 6 x 7 x 26 mm in the AP, transverse, and craniocaudal dimensions.2. Findings of Chiari I malformation better assessed on prior brain MRI.


Instruction: Generate impression based on findings.

Input: History of cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. In the right hepatic dome there is a 1.6 cm rounded lesion (series 11/33) demonstrating arterial enhancement and washout (series 12/image 31).The previously described ill-defined oblong region of arterial enhancement in the hepatic dome demonstrates no washout and measures approximately 3.2 x 1.5 cm (series 11/37), unchanged.Additional multiple peripheral wedge-shaped early enhancing lesions likely represent transient perfusion differences.Simple cyst in the left lobe of the liver.Cholelithiasis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Atherosclerotic vascular disease. Left lower thoracic wall subcutaneous soft tissue enhancing nodule may represent a small sebaceous cyst, unchanged.OTHER: No significant abnormality noted.

Output: 1.6 cm right hepatic dome lesion with arterial enhancement and washout, meeting imaging criteria for HCC. Otherwise stable examination.Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: History of breast cancer status post neoadjuvant chemotherapy, partial mastectomy and sentinal node biopsy. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. There is post-surgical volume loss and artifact from surgical clips in the right medial breast. Mild focal enhancement near the lumpectomy bed does not have suspicious kinetics. No abnormal lymph nodes are identified in either axillary region. Post surgical changes related to the patient's axillary surgery are present. No enlarged internal mammary lymph node is seen.

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


Instruction: Generate impression based on findings.

Input: Lumbar back pain. There is degenerative spondylosis consisting of facet hypertrophy and disc bulges involving L2 through S1 with resultant mild bilateral neural foraminal stenoses and spinal canal stenosis at all of these levels. There is a small intravertebral disc herniation in the inferior L2 vertebral body. The vertebral body heights are otherwise preserved. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The imaged portion of the spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis consisting of facet hypertrophy and disc bulges involving L2 through S1 with resultant mild bilateral neural foraminal stenoses and spinal canal stenosis at all of these levels, which has slightly progressed overall since 2010.


Instruction: Generate impression based on findings.

Input: Episodes of left leg numbness, weakness, and pain. Rule out cord lesion. Cervical: There is a T2 hyperintense lesion involving the right ventral aspect of the cord at the upper C2 level. Motion degradation limits evaluation however no additional lesions in the cervical cord are definitively appreciated. No abnormal enhancement in the cord or elsewhere in the cervical spine.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from some loss of cervical lordosis which may be in part positional. Bone marrow signal is benign. Multilevel degenerative changes are seen multilevel disc desiccation and up to moderate disc height loss at the C4-C5 and C5-C6 levels. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small right paracentral disc protrusion. No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex including uncovertebral hypertrophy. No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing, right relatively worse in left.C5-6: Small disc osteophyte complex. No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing, right relatively worse than left.C6-7: Small disc osteophyte complex including a right paracentral disc protrusion and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There appears to be a 1 cm nodule along the posterior aspect of the right thyroid gland, which is not well assessed but also appears to enhance.Partially imaged parotid glands demonstrate mild heterogeneity including multiple T2 hyperintense foci.Thoracic: There is a T2 hyperintense lesion involving the left aspect of the cord at the T4 level, best seen on axial image 8 of series 2401. This lesion appears to mildly enhance, axial series 3201 images 10-12 and sagittal series 2901 image 8. No additional thoracic cord signal abnormality is definitively appreciated. The thoracic spine is in normal alignment. The vertebral body heights are well maintained. Bone marrow signal is benign with a T1 T1 hyperintense focus involving the posterior aspect of the T2 vertebral body compatible with a small hemangioma or focus of fat. Mild degenerative changes include minimal scattered disc bulges and protrusions without significant spinal canal or neural foraminal stenosis at any level.

Output: 1. T2 hyperintense nonenhancing lesion in the right ventral cord at the upper C2 level. There is also a left T4 thoracic cord lesion which appears to enhance. Differentials include demyelinating disease as well as other inflammatory myelopathies.2. Mild heterogeneity of the parotid glands with T2 hyperintense foci which can be seen with Sjogren's and other connective tissue diseases. Unclear if this finding is related to the above mentioned cord lesions.3. Mild degenerative changes in the cervical and thoracic spine as described above, but without significant spinal canal stenosis at any level.4. Probable 1 cm nodule which appears to enhance in the posterior aspect of the right thyroid lobe. This lesion is not well imaged and may represent a thyroid nodule or a parathyroid adenoma. Ultrasound can be considered for better assessment as clinically indicated.


Instruction: Generate impression based on findings.

Input: Evaluate for periventricular leukomalacia: Right arm spasticity. Brain: There is diffuse deficiency of bilateral cerebral white matter with associated mild periventricular signal abnormality, thinning of the corpus callosum, and prominence of the lateral ventricles. The degree of myelination is otherwise age-appropriate. The pituitary gland and infratentorial structures are unremarkable. There is no evidence of acute infarction, hemorrhage, or mass lesions. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: 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 and cauda equina nerve roots display normal signal and morphology. The conus medullaris terminates at the L1-L2 level. The paravertebral soft tissues are unremarkable.

Output: 1. Findings compatible with periventricular leukomalacia.2. The spine appears to be unremarkable.


Instruction: Generate impression based on findings.

Input: Frequent ankle sprains TENDONS: Achilles tendon is unremarkable. Fluid is noted within the tendon sheath of the posterior tibialis tendon which may reflect mild tenosynovitis. Fluid is also noted within the tendon sheath of the flexor hallucis longus which could represent additional mild tenosynovitis or extension of fluid from the tibiotalar joint. A small amount of fluid is seen along the peroneal tendons which is of unlikely clinical significance.LIGAMENTS: The anterior talofibular ligament is not seen, presumably from prior tearing. Although the fibular attachment of the calcaneofibular ligament is indistinct, distally the ligament is visualized and we suspect that it is intact. The posterior talofibular ligament is perhaps slightly attenuated but otherwise appears intact. The distal tibiofibular syndesmotic complex is intact. There is loss of the normal fatty striations of the deep tibiotalar fibers of the deltoid ligament which may reflect prior sprain. The spring ligament appears intact.ARTICULAR SURFACES AND BONE: There is focal full-thickness articular cartilage loss along the talar dome laterally with mild edema in the underlying talus and additional mild articular cartilage degeneration along the talar dome posteromedially. There is a small tibiotalar joint effusion. Additional foci of edema type signal is noted medially within the talus which is nonspecific but could represent contusions given the patient's history. A small amount of fluid is noted within the anterior and posterior recesses of the subtalar joint which is nonspecific in nature.

Output: 1. Nonvisualization of the anterior talofibular ligament likely reflecting chronic tear given the patient's history.2. Tibiotalar cartilage defects with other findings as described above.


Instruction: Generate impression based on findings.

Input: Seizures and chronic gait disturbance. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is mild cerebral volume loss. 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 a mild left maxillary sinus mucosal thickening.Cervical Spine: There is multilevel degenerative spondylosis and posterior longitudinal ligament ossification that results in spinal cord compression from C3-4 to C4-5 and substantial bilateral neural foraminal stenosis at these levels. There is also high T2 signal and volume loss in the spinal cord at C4-5. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Mild scattered cerebral white matter T2 hyperintensity is non-specific, but may represent chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Multilevel degenerative spondylosis and posterior longitudinal ligament ossification that results in spinal cord compression from C3-4 to C4-5 and substantial bilateral neural foraminal stenosis at these levels, as well as myelomalacia at C4-5.


Instruction: Generate impression based on findings.

Input: Worsening weakness to foot, has stenosis progressed? Please note there is transitional anatomy and for the purposes of numbering, the sixth lumbarized vertebral body segment is labeled S1 to be consistent with prior MRI report. There is grade 2 anterolisthesis of L5 on S1 similar to prior and can be correlated with upright radiographs. There is also trace retrolisthesis of L1 on L2. Alignment is otherwise preserved. Vertebral body heights are normal. Bone marrow signal is benign with edematous endplate changes again seen at the L5-S1 level. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: There is a right paracentral disc protrusion which is slightly progressed in the interval but is not associated with spinal canal or neural foraminal stenosis. L2-L3: Small left foraminal protrusion and left-sided facet arthropathy. No significant spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge and mild facet arthropathy. No significant spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge and left greater than right facet arthropathy without significant spinal canal or neural foraminal stenosis.L5-S1: Grade 2 anterolisthesis as mentioned above with near complete loss of disc height. There is disc uncovering with mild cephalad extension, advanced bilateral facet arthropathy, and ligamentum flavum thickening. There is resulting severe spinal canal stenosis which appears similar to prior. There is also severe bilateral neural foraminal stenosis which is also similar to prior.S1-S2: No significant spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy.Resection involving the lower sacrum is better seen on prior study. No abnormal enhancement or mass in the visualized lumbar spine or upper sacrum to suggest tumor.

Output: 1. Please note transitional lumbosacral junction anatomy. To be consistent with prior report, the most inferior well-defined disc space is labeled S1-S2. 2. Again seen is grade 2 anterolisthesis of L5 on S1 similar to prior with severe spinal canal stenosis and severe bilateral neural foraminal stenoses, not significantly changed since prior.3. Milder degenerative changes at additional levels as described above.


Instruction: Generate impression based on findings.

Input: Dysarthria. Please evaluate brain stem for infarct/lesion/other that may be causing difficulty with speaking. There is patchy T2 hyperintensity in the pons and cerebral white matter. There is no evidence of acute infarction in the brainstem, however. There are right thyroid nodules, which measure up to 11 mm. There is scattered mild to moderate mucosal thickening within the imaged paranasal sinuses. There is no evidence of significant lymphadenopathy in the neck. There is multilevel degenerative spondylosis with associated mild spinal canal stenosis. The orbits and salivary glands appear unremarkable.

Output: 1. Probable chronic small vessel ischemic disease in the pone, but no evidence of acute brainstem infarct. 2. Nonspecific thyroid nodules measuring up to 11 mm. 3. Multilevel degenerative spondylosis with associated mild spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 67-year-old man with history of rectal mass. ABDOMEN:LIVER, BILIARY TRACT: No discrete liver lesions identified. The gallbladder appears normal. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No focal renal lesion identified. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral pleural effusions noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large rectal mass, not adequately characterized on the pelvic portion of the study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Please note that due to poor quality of images, patient will be recalled for repeat pre and postcontrast imaging at no charge.2.Large rectal mass, not adequately characterized on this exam.3.No gross evidence of metastases, however this examination is limited without intravenous contrast.


Instruction: Generate impression based on findings.

Input: Female, 27 years old, 37 weeks GA, with ventriculomegaly on prenatal ultrasound. Image quality is degraded by fetal and respiratory motion. Within these limitations, the following observations are made.The lateral ventricles are dilated, measuring up to 19 mm diameter at the left atrium, and up to 14 mm diameter at the right atrium. Thinning of the brain parenchyma is seen in the peri-atrial regions.No obvious underlying etiology for the enlarged ventricles is seen. Specifically, no intracranial mass is suspected and the cerebral aqueduct appears to be patent. The third and fourth ventricles are normal in size.The cerebral hemispheres are otherwise normally formed. The corpus callosum is present. The brainstem and cerebellum are unremarkable.Fetal presentation is breech. Bilateral fetal hydroceles are evident. The fetal gallbladder is not clearly visualized.

Output: 1.Fetal ventriculomegaly with atrial diameters of 19 mm on the left and 14 mm on the right. No obvious underlying etiology is identified.2.No other definite intracranial abnormalities are detected within the limits of motion degredation.3.Incidental note is made of bilateral fetal hydroceles, which are of uncertain clinical significance. In addition, the fetal gallbladder is not visualized, which may be technical. Dedicated post-natal imaging is suggested to excluded biliary atresia.


Instruction: Generate impression based on findings.

Input: 71 year old with known left breast cancer on neoadjuvant chemotherapy. Evaluate response. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The known index cancer with an associated Hydromark biopsy clip is decreasing in size now measuring 14 x 11 x 17 mm in total, previously the mass measured 29 x 33 x 27 mm (AP x LR x CC), and overall measurement was 50 x 38 x 33 mm with non-mass enhancement. The two reference left axillary lymph nodes are also smaller. The biopsied node now measures 14 x 6 mm, previously 33 x 24 mm, and has normalized in morphology. The level 2 node now measures 13 x 6 mm, previously 28 x 13 mm.No additional suspicious or new enhancement is seen in either breast. No abnormal lymph nodes are identified in the right axillary region.A port-a-cath is noted in the right upper chest wall.

Output: Significant response to therapy in the left breast and axilla with measurements given above.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Left arm and leg weakness, aphasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mucosal thickening and secretions in the frontal and anterior ethmoid sinuses, as well as a small bilateral maxillary retention cysts. There are also small retention cysts in the nasopharynx. There is a small defect in the cartilaginous nasal septum.

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


Instruction: Generate impression based on findings.

Input: Female 38 years old; Reason: Achilles tear? Ankle instability. History: Ankle instability. Pain and swelling of achilles TENDONS: The anterior fibers of the distal Achilles tendon appear minimally convex with minimal streaky increased signal, which may represent minimal tendinosis, however this is equivocal and appears similar to that seen on the prior study. No Achilles tendon tear is seen. There is mild edema in the pre-Achilles fat which may reflect mild inflammation or bursitis, though this also appears similar to the prior study. There is mild edema in the superior aspect of the posterior calcaneus, which is likely reactive and related to the aforementioned soft tissue inflammation. There is perhaps a minimal Haglund deformity of the calcaneus. The remaining tendons are within normal limits. LIGAMENTS: The anterior talofibular ligament is attenuated, perhaps reflecting prior injury though appearing similar to the prior study. The calcaneofibular and posterior talofibular ligaments are intact. The distal tibiofibular syndesmosis is intact. Loss of the normal fatty striations of the deltoid ligament may reflect prior injury, however this appears similar to the prior study. ARTICULAR SURFACES AND BONE: Again seen is the small focus of increased T2 signal in the medial aspect of the talar dome, which may represent a degenerative cyst or old osteochondral defect and appears similar to that seen on the prior study. Other than the aforementioned calcaneal edema, no additional bone abnormality is seen.ADDITIONAL

Output: 1. Mild inflammatory changes in the pre-Achilles fat in the approximate location of the retrocalcaneal bursa, with mild reactive edema in the underlying calcaneus. There is perhaps minimal tendinosis of the distal Achilles tendon, however this is equivocal and is unchanged from the prior study.2. Other findings as described above, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: 63-year-old female with liver lesion seen on prior CT. Further characterized by MRI. Please note multiple sequences are limited due to motion artifact.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions including in the region of interest near the falciform ligament. Though fat-sensitive sequences of this region are limited due to motion, the finding on prior CT may have been due to focal fat deposition or perfusional change.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No focal hepatic lesions.


Instruction: Generate impression based on findings.

Input: NSCLC. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered cerebral white matter T2 hyperintense foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases. A few scattered cerebral white matter T2 hyperintense foci are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Low back pain after lifting heavy object with radiation down the right leg. History of MS, lumbar discectomy in 2009. 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.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a new right foraminal disc extrusion with mild cranial migration. There is moderate degree of right-sided neural foraminal stenosis and suspected impingement of the right exiting L3 nerve root. No significant spinal canal or left neural foraminal stenosis.L4-L5: Small right foraminal disc protrusion is also new since prior and contacts the right L4 nerve root. There is mild right-sided neural foraminal stenosis. Minimal left neural foraminal narrowing. No significant spinal canal stenosis.L5-S1: Prior right-sided laminotomy. There is a dorsal annular fissure and right paracentral protrusion. Minimal right neural foraminal stenosis. No significant spinal canal stenosis or left neural foraminal stenosis. There is bilateral facet arthropathy.

Output: 1. New right foraminal disc extrusion at the L3-L4 level where there may be impingement of the right L3 nerve root.2. Smaller, new right foraminal disc protrusion at the L4-L5 level which contacts the right L4 nerve root.3. Postoperative changes related to remote right L5-S1 discectomy.


Instruction: Generate impression based on findings.

Input: 33 year old with proven left breast cancer presents for I-SPY 2 study #2. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted in the right breast.The left breast again shows diffuse abnormal enhancement of known cancer, measuring 57 x 86 x 117 mm (AP x LR x CC, previously 65 x 97 x 126 mm). Diffuse edema and skin thickening is slightly decreased. A Hydromark clip is again identified at anterior 12 o'clock position within the tumor in the left breast.A known metastatic left axillary lymph node with Hydromark clip, measures 17 mm in maximum diameter (previously 26 mm). Multiple small cysts are present in the right breast.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in right axillary region.

Output: Known left breast cancer with metastatic left axillary lymph node, slight decrease in size.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female 16 years old Reason: evaluation of left dorsal midfoot pain History: same A vitamin E skin marker was placed along the medial aspect of the first metatarsal cuboid joint indicating the site of patient's pain, about which the field of view was centered. TENDONS: The tendons of the midfoot are unremarkable.LIGAMENTS: The ligaments of the midfoot are unremarkable.ARTICULAR SURFACES AND BONE: There is diffuse patchy high T2 signal with associated low T1 signal, particularly within the distal tibia, talar dome, distal navicular and within the distal cuboid and proximal first metatarsal. Although this most likely represents residual red marrow, stress related marrow changes related to altered biomechanics of ballet dancing is not excluded.ADDITIONAL

Output: 1.Patchy increased high T2 signal likely most consistent with residual red marrow; however, marrow changes related to altered biomechanics from ballet dancing is not entirely excluded.2.The tendons and ligaments of the foot are unremarkable.


Instruction: Generate impression based on findings.

Input: Clinical question: Clinical question: Rule out right frontal lesion. Signs and symptoms: LLE numbness/weakness and anosmia. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse scattered nonspecific foci of FLAIR and T2 hyperintensity along in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the right basal ganglia. Findings are nonhemorrhagic and demonstrate no abnormal enhancement. Although nonspecific this appearance is often result of microvascular ischemic changes considering patient's stated age.The anatomical morphology and the signal intensity of brain is otherwise within normal on all MRI sequences for patient's stated age and without detectable abnormal enhancement.The signal void in major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses remain within normal and with normal pattern of enhancement.Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.Paranasal sinuses demonstrate acute on chronic right maxillary sinus disease and mild (L>R) chronic ethmoid sinus disease and unremarkable otherwise. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No acute intracranial process.2.Findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter of cerebral hemispheres.3.Unremarkable pre and post enhanced brain MRI otherwise.4.Acute on chronic sinusitis as detailed.


Instruction: Generate impression based on findings.

Input: Occipital headaches. The images are partly degraded by dental brace artifacts. There is no definite evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate foci of subcortical white mater T2 hyperintensity in the right parietal lobe. The brain, brainstem, and cerebellum otherwise appear unremarkable. The pituitary gland is not enlarged. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of posterior fossa mass or Chiari malformation. A punctate foci of subcortical white mater T2 hyperintensity in the right parietal lobe is nonspecific.


Instruction: Generate impression based on findings.

Input: 57 years, Female, Reason: 57F with dilated pancreatic duct and side branches. Please evaluate for nodules, masses using secretin protocol History: dilated duct. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Right hepatic lobe T2 hyperintensity likely represents cysts. There is a 8mm lesion in the left hepatic lobe which is dark on all sequences and likely represents calcification. Bile duct is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: No suspicious pancreatic lesions.Pancreatic duct is ectatic and dilated within the body and tail to 1.7 cm, consistent with a main duct IPMN. No enhancing component is evident. No obstructing lesions are present. There is a blunted response to secretin. Attenuation within the pancreatic parenchyma is normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Debris within the bladder.

Output: Findings consistent with a main duct IPMN.


Instruction: Generate impression based on findings.

Input: There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Unremarkable MRI of the brain with no evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Multiple lacunar infarcts as well as a left posterior thalamic hematoma are again visualized and appear grossly similar to prior brain MRI although evaluation is limited on the provided sequences which are optimized for the vasculature. There is evidence of intracranial atherosclerotic disease with scattered areas of narrowing. The intracranial internal carotid arteries demonstrate no significant stenosis, with dense vascular calcifications involving the right cavernous ICA demonstrated on recent CT. There is mild to moderate multifocal narrowing involving the right middle cerebral artery M2 segments and minimal irregularity involving the right M1 segment. There is also at least moderate multifocal involving the right anterior cerebral artery in its distal A2 and A3 segments. Otherwise no high-grade stenosis in the anterior circulation. There is also mild irregularity involving the distal P1 as well as P2 segments of the right posterior cerebral artery as well as moderate to severe focal stenosis involving the left posterior cerebral artery at the left P2 segment. Bilateral vertebral and basilar arteries are patent. No evidence of aneurysm.

Output: Multifocal narrowing involving the intracranial vasculature likely due to atherosclerotic disease. There is moderate to severe focal stenosis involving the left P2 segment. Additional stenoses as above. No high-grade stenosis involving the more proximal intracranial vasculature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68 years, Male, Reason: hx of penile mass, evaluate local extent of invasion and inguinal/pelvic lymphadenopathy History: penile mass. PELVIS: MalePROSTATE, SEMINAL VESICLES: Large lesion of the distal penis measures 6.9 x 7.7 x 5.0 cm (401/10 and 501/13). The distal corpus and urethra are not well delineated and likely replaced with tumor. The lesion extends within the subcutaneous fat of the left scrotum and abuts the left testicle (401/9 and 807/198), however no definite invasion within the testicle is evident. The base of the penis is normal appearing.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral inguinal lymphadenopathy with a right inguinal node measuring at 1.9 x 1.6 m (802/547). There are several small subcentimeter pelvic nodes. For example, a left external iliac node measures 1.5 x 0.6 cm (401/44). There is a subcentimeter node within a right fat containing inguinal hernia (401/32) which is nonspecific.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Distal penile mass. further described above, abuts and extends along the left scrotum, and underlying invasion into the scrotum is not excluded. 2.Bilateral inguinal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: History of recurrent Rhabdomyosarcoma. On therapy. Comparison. Status post resection. Examination redemonstrates extensive postoperative changes of tumor removal via bifrontal craniotomy. CSF filled cavity within the right frontal lobe is believed to be the site of previous tumor invagination into the brain parenchyma. This is associated with surrounding vasogenic edema. Enhancement around the posterior edge of surgical cavity is believed to represent leptomeningeal scarring. No distinct tumor is identified however follow-up with an infused MRI is recommended. Expected postoperative changes of epidural thickening with minimal enhancement in bifrontal region is noted.In comparison to the prior non-infused CT of brain dated 6 -- 2 -- 2009 there is a slight increase in the soft tissue/fluid density within the paranasal sinuses.

Output: Findings are believed to represent post operative change and not residual tumor. Follow-up with an infused MRI however is recommended for better assessment.


Instruction: Generate impression based on findings.

Input: 53-year-old male with a past history of CVA, tobacco abuse, possible alcoholic cirrhosis who presented with chest pain and shortness of breath, elevated troponin and BNP, ECG changes consistent with NSTEMI. Referred for a cardiac MRI to evaluate etiology of regional hypokinesis of the left ventricle in the setting of no significant coronary artery disease on cardiac catheterization. Left VentricleThe left ventricle is normal in size with moderate to severely depressed function. The overall LV ejection fraction is 30%. The LVEDV is 177 ml (normal range 142+/-34), the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVESV is 125 ml (normal range 47+/-19) and the LV end systolic volume index is 74 ml/m2 (normal range 25+/-9). The LV mass is 122 g (normal range 164+/-36) and the LV mass index is 73 g/m2 (normal range 85+/-15). There are wall motion abnormalities noted in the inferior, inferolateral and lateral walls (mid ventricular segments). There is a increased signal noted on T2 STIR imaging in the mid inferolateral, lateral walls suggestive of inflammation or edema in this area of the myocardium. There is mostly transmural late gadolinium enhancement in the mid inferior, base to mid inferolateral and lateral walls. This pattern of late gadolinium enhancement is consistent with myocardial infarction. There are also areas of microvascular obstruction noted in the inferolateral wall. Left AtriumThe left atrium is mild-moderately enlarged. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%. The RVEDV is 113 ml (normal range 142+/-31), RV end diastolic volume index is 67 ml/m2 (normal range 82+/-16), the RVESV is 57 ml (normal range 54+/-17), and the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate left-sided pleural effusion. 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-sized left ventricle with moderate to severely depressed function. LVEF 30%. 2.There are wall motion abnormalities noted in the inferior, inferolateral and lateral walls (mid ventricular segments). 3.There is a increased signal noted on T2 STIR imaging in the mid inferolateral, lateral walls suggestive of inflammation or edema in this area of the myocardium. 4.There is mostly transmural late gadolinium enhancement in the mid inferior, base to mid inferolateral and lateral walls. This pattern of late gadolinium enhancement is consistent with myocardial infarction. 5.There are areas of microvascular obstruction noted in the inferolateral wall. 6.Normal sized right ventricle with mildly depressed function. RVEF is 49%.7.Mild to moderate tricuspid regurgitation.8.These constellation of findings are suggestive of recent myocardial infarction. Given the normal coronary angiogram these findings could be consistent with an embolic event. Clinical correlation required.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 47-year-old female with shin pain, evaluate for stress fractures Left: There is thinned poorly defined intermediate signal along the posterior and medial aspect of the tibial diaphysis that may represent a very mild (grade 1) stress reaction, but this is equivocal, and we see no stress fracture. Bone marrow signal is within normal limits in the tibia and fibula. Mild edema within the subcutaneous tissue anterior to the tibia is present. Slight prominence of the left anterior tibial tubercle. Subjectively, the anterior tibial tubercle appears lateralized but this study was not protocoled for detailed evaluation of the knee.Right: There is faint intermediate signal along the posterior and medial aspect of the mid tibial diaphysis which may represent a very mild (grade 1) stress reaction, although this is equivocal and no stress fracture is seen. Bone marrow signal is within normal limits in the tibia and fibula. Subjectively, the anterior tibial tubercle appears lateralized but this study was not protocoled for evaluation of the knee. Minimal edema is noted within the subcutaneous tissue along the anterior and medial tibia.

Output: Minimal intermediate signal along the posterior and medial aspect of the tibia bilaterally may conceivably represent grade 1 stress reaction although this is equivocal. No stress fracture is seen.


Instruction: Generate impression based on findings.

Input: 57-year-old female with intermittent headaches. Small cell lung cancer. Evaluate for metastases. Enhanced CT of brain:There is no evidence of normal enhancement of brain parenchymal or leptomeninges to suggest metastatic lesion. The cortical sulci, ventricular system and all CSF cisterns remain within normal limits for patient's stated age. There is heavy vascular calcification of intracranial vertebral arteries and bilateral cavernous carotid. I suspect subtle low-attenuation in the subcortical white matter of bilateral cerebral hemispheres. This findings are nonspecific however considering patients provided clinical data and heavy intracranial vascular calcification, the above findings may represent small vessel disease of indeterminate age. Follow-up with an MRI examination is recommended.Calvarium is intact. Mastoid air cells and middle ear cavities and limited view of paranasal sinuses are negative.

Output: 1.No evidence of metastatic disease to brain, leptomeninges or of the calvarium.2.Vascular calcification of bilateral intracranial vertebrals and cavernous carotids consistent with atherosclerotic disease.3.Minimal small vessel disease of indeterminate age is suspected.


Instruction: Generate impression based on findings.

Input: 32 years, Male. Reason: stricture due to Crohn's disease that is active. Is there evidence of free air? History: right shoulder pain Small amount of pneumoperitoneum seen on lateral decubitus view, and in the subhepatic space on the supine view. Prominent, gaseous colon is noted in the right upper quadrant, relative paucity of gas in left-sided colon, finding suspicious for underlying colonic stricture particularly given patient's clinical history and prior MRI exam.

Output: Pneumoperitoneum, additional findings as above.Findings discussed with Dr. Rubin via phone at 1:50 PM on 7/14/2015.


Instruction: Generate impression based on findings.

Input: L1 metastasis status post radiation therapy. Increased lower back pain. History of polymyalgia rheumatica and degenerative joint disease. Evaluate for compression fracture. Status post bilateral total hip arthroplasty. Normal lumbar alignment is preserved. Vertebral body height is maintained, with no compression fracture identified. Multilevel disc narrowing is most severe at L1-L2. There is vacuum disc phenomenon at L3-4. The known left L1 pedicle metastasis is not identified on radiographic imaging, please see MRI 9/30/2015.

Output: No evidence of acute fracture or malalignment. Moderate degenerative disc disease, most severe at L1-2.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: Again seen are complete tears of the supraspinatus and infraspinatus tendons with retraction to the level of the glenohumeral joint. There is mild fatty atrophy of the supraspinatus muscle with marked fatty atrophy of the infraspinatus muscle. The teres minor tendon and muscle are intact. There is high-grade partial-thickness tearing of the insertional fibers of the subscapularis tendon. The subscapularis muscle appears relatively preserved.SUPRASPINATUS OUTLET: Severe osteoarthritis affects the glenohumeral joint. There is a small amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding and there is degenerative cystic change at the insertion of the rotator cuff. There is mild articular cartilage loss of the humeral head and osteoarthritis of the glenohumeral joint. There is degenerative tearing of the anterior labrum both superiorly and inferiorly. There is a small amount of joint fluid present.BICEPS TENDON: Evaluation of the biceps tendon is limited given the internally rotated nature of the patient however the intra-articular portion of the biceps tendon is not well seen likely the result of tearing. There is a small amount of fluid surrounding the biceps tendon which may reflect mild tenosynovitis.ADDITIONAL

Output: 1. Full-thickness tears of the supraspinatus and infraspinatus tendon and high-grade partial-thickness tearing of the subscapularis tendon.2. Severe osteoarthritis of the glenohumeral joint.3. Degenerative tearing of the labrum.4. Probable partial tearing of the long head of the biceps tendon.


Instruction: Generate impression based on findings.

Input: Sickle cell disease and left P1 segment small aneurysm or infundibulum: surveillance imaging. MRI: There is an area of encephalomalacia and susceptibility effect in the anterior right frontal lobe. There is no evidence of acute infarct. There are unchanged mild scattered foci of non-specific T2 hyperintensity elsewhere in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is an unchanged 2 to 3mm wide conical outpouching involving the P1 segment of the left posterior cerebral artery. The rest of the major cerebral arteries are unremarkable, without evidence of significant steno-occlusive lesions.

Output: 1. Unchanged right frontal lobe encephalomalacia related to a prior hemorrhagic infarct.2. Unchanged 2 to 3mm wide conical outpouching involving the P1 segment of the left posterior cerebral artery.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with von Hippel-Lindau and pre-existing hemangioblastoma of the cerebellum. Evaluate for growth and new lesions. Brain:A punctate focus of enhancement within the left cerebellar tonsil may be slightly more conspicuous than on the prior examination, though it still measures no more than 2 mm in size and does not produce any edema in the surrounding parenchyma. No additional enhancing lesions are seen. No areas of focal signal abnormality or restricted diffusion are detected. There is no edema or mass effect. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.Spine:The spinal cord, conus and nerve roots of the cauda equina demonstrate normal morphology and signal characteristics. Small foci of enhancement along the cauda equina are nonspecific and may simply represent normal vessels. No definite masslike lesions are seen.Mild reversal of the cervical lordosis is seen. Otherwise, spinal alignment is anatomic. Vertebral body heights are preserved. Spinal numbering reflects the presence of 13 thoracic and 5 lumbar type vertebrae. Evidence of prior posterior element surgery, perhaps reflecting partial laminectomy, is seen at L3-4 and L4-5. No pathologic marrow replacement is noted. Mild degenerative endplate signal changes are seen in the cervical spine at multiple levels and in the lumbar spine at L4-5.Mild posterior disc-osteophyte complex formation is seen at C4-5 through C7-T1 without high-grade spinal stenosis, similar to the prior examination. Mild foraminal narrowing is seen on the left at C5-6 and bilaterally at C6-7. Scattered small disc protrusions are evident in the thoracic spine without significant spinal canal or foraminal compromise. The lumbar intervertebral discs are fairly well preserved with the exception of L4-5 where there is loss of disc height and disc bulging with osteophyte formation. No significant spinal canal stenosis is seen. However, the L4-5 neural foramina are mildly narrowed, similar to prior.

Output: 1.A punctate focus of enhancement within the left cerebellar tonsil is slightly more conspicuous though still only measures 2 mm in size. This perceived difference could potentially be technical in nature. The finding is nonspecific, but given the patient's history, a small hemangioblastoma remains in the differential.2.No definite additional hemangioblastomas are seen in the brain or spine. Scattered tiny foci of enhancement within the cauda equina are nonspecific and could simply represent vascular structures.3.Mild degenerative findings in the spine show no significant interval change.


Instruction: Generate impression based on findings.

Input: Fetal MRI, evaluate for changes in fetal lymphangioma of pelvis and left thigh PELVIS:UTERUS, ADNEXA: Gravid uterus consistent with 34 week gestation. Posterior thigh T2 hyperintense mass involves the sacrum and left pelvis /retroperitoneum proximally and extends distally to the knee with subtle involvement of the lower leg. Internal heterogeneity may be be due in part to septations or flow voids. The mass measures up to 24 mm in maximal thickness at the buttock. Otherwise, no fetal abnormalities are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: T2 hyperintense mass involving the sacrum, left retroperitoneum / pelvis / buttock, posterior left thigh, and lower leg suggestive of lymphangioma or hemangioma.


Instruction: Generate impression based on findings.

Input: Melanoma and right arm weakness, concern for metastases. MRI brain:There is no evidence of intracranial mass or acute infarct. No abnormal intracranial enhancement is evident. There is cystic encephalomalacia in the bilateral frontal lobes in the periventricular region. A 5 mm focus of susceptibility artifact is noted in the anterior paramedian right frontal lobe (series 1701 image 109), which may be related to prior hemorrhage or mineralization. Confluent and scattered foci of T2/FLAIR hyperintensity in the periventricular and cortical white matter are nonspecific, but compatible with chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major intracranial vascular flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained. The cervical vertebral bodies and disc spaces are appropriate in height. There is a focus of T1 and T2 hyperintensity in the right side of the T1 vertebral body, compatible with intraosseous hemangioma. No focal worrisome bone marrow signal abnormality is identified. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There are mild multilevel degenerative changes, most prominent at C5-6. At C5-6, there is right greater than left uncinate hypertrophy contributing to mild right neural foraminal narrowing. There is also mild spinal canal narrowing at this level, predominantly on the developmental basis. No high-grade spinal canal stenosis or neural foraminal narrowing is identified in the cervical spine.

Output: 1. No evidence of intracranial or cervical spine metastatic disease.2. 5 mm focus of susceptibility in the anterior paramedian right frontal lobe which may be related to chronic hemorrhage or mineralization. No associated enhancement.3. Cystic encephalomalacia in the bilateral frontal lobes may be related to remote ischemia or other injury. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific and may represent chronic small vessel ischemic disease, prior inflammation, or less likely demyelination.4. Degenerative changes in the cervical spine without high-grade spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Possible myelopathy. Signs and symptoms: Numbness and tingling. Nonenhanced cervical MRI:Examination demonstrates multiple small foci of T2/T2 STIR hyperintensity in the cervical and upper most visualized thoracic cord summed with suggestion of subtle underlying cord volume loss. Distribution of the findings are highly suggestive of demyelinating disease. Findings are best appreciated on sagittal T2 STIR series 4 image 7 as well as axial T2 series 5 and images 16, 19, 20, 23 and 25.There are no prior exams for comparison and this examination is performed without intravenous contrast.There is normal signal intensity of vertebral column. There is straightening of cervical lordosis which may be positional.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate subtle wasting at the level disc level which could indicate attempted congenital partial fusion. No spinal stenosis or neural foraminal compromise.C4-C5 demonstrate mild degenerative disc disease and shallow central disc protrusion without spinal stenosis or neural foraminal compromise.C5-C6 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromiseC6-C7 demonstrate mild degenerative disc and mild bilateral ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.

Output: 1.Multiple small foci of T2/T2 STIR hyperintensity in the cervical spine and upper most visualized thoracic cord with morphology and distribution highly suspicious for demyelinating disease.2.Mild degenerative changes of cervical spine however without central spinal stenosis or neural foraminal compromise. Please see above comments.


Instruction: Generate impression based on findings.

Input: Reason: r/o medial meniscus History: left knee pain MENISCI: There is mild increased signal within the posterior horn of the medial meniscus which suggests intrasubstance degeneration, but we see no medial meniscal tear. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: Minimal signal heterogeneity of the patellofemoral articular cartilage suggests minimal degeneration but we see no fluid-filled defects. Bone marrow signal intensity is normal. LIGAMENTS: The cruciate and collateral ligaments appear normal. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal. There is mild edema of the quadriceps fat pad, which is of questionable clinical significance.ADDITIONAL

Output: Minimal signal heterogeneity of the cartilage of the patellofemoral articulation. Mild edema of the quadriceps fat pad, which is of questionable clinical significance. We see no meniscal tear or other finding to account for the patient’s pain.


Instruction: Generate impression based on findings.

Input: Bilateral basal ganglia abnormal signal intensity on MR and CT scans. The route deep venous thrombosis. 3D MRV brain pre and post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.Due to limitation of resolution, localized cortical venous thrombosis or localized deep venous thrombosis cannot be evaluated with MR venogram alone.

Output: No evidence of venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for rotator cuff repair, underwent previous single-row rotator cuff repair and AC resection History: Pain with overhead activities Suboptimal evaluation secondary to patient motion artifact.ROTATOR CUFF: Multiple foci of signal void are identified within the superior soft tissues of the shoulder indicating prior surgery. There is a tubular focus of signal void within the greater tuberosity presumably representing a suture anchor. There is increased signal intensity within the distal fibers of the supraspinatus tendon at its insertion on the greater tuberosity at the 12 o'clock position that is nonspecific and could represent insertional tendinosis or granulation tissue from prior tearing/surgery. This measures approximately 1 cm in the AP dimension. The distal fibers of the supraspinatus also appear thinned. There is a more focal fluid signal intensity defect within the bursal surface fibers of the supraspinatus tendon which may represent a small 2 to 3 mm tear, but we see no full-thickness fluid-filled tear. There is perhaps mild tendinosis of the infraspinatus, but otherwise the tendon and muscle appear intact. There is mild insertional tendinosis of the subscapularis. The tendon and muscle appear intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: A small anterior spur seen previously arising from the acromion process is no longer evident which may represent prior surgery. There is a small amount of fluid within the subacromial/subdeltoid bursa which is not necessarily of any clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. No effusion is evident. The superior labrum appears attenuated which may represent a combination of degeneration and prior surgery.BICEPS TENDON: The tendon of the long head of the biceps is noted within the bicipital groove. The intra-articular portion of the tendon of the long head of the biceps appears thinned which may reflect attritional tearing or prior surgery.

Output: Signal intensity within the distal fibers of the supraspinatus likely reflects a combination of tendinosis and undersurface fraying, but we see no full-thickness rotator cuff tear. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 68-year-old male with neck pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild retrolisthesis of C5 on C6 and minimally of C6 on C7. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine including prominent facet arthropathy on the left at C3-C4. Individual levels as below: C2-3: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C3-4: Small disc osteophyte complex and ligamentum flavum thickening resulting in effacement of the ventral and dorsal thecal sac and mild to moderate spinal canal stenosis. There is moderate to severe left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. Mild left facet joint distention. No significant right neural foraminal narrowing.C4-5: No significant compromise to the spinal canal or left neural foramen. Mild right neural foraminal narrowing.C5-6: Disc osteophyte complex without significant compromise to the spinal canal. There is moderate to severe right and moderate left neural foraminal stenosis primarily related to uncovertebral hypertrophy.C6-7: Disc osteophyte complex and ligamentum flavum thickening result in mild spinal canal narrowing. There is minimal right and moderate to severe left neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or left neural foramina. Minimal right neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Moderate degenerative changes throughout the cervical spine without evidence of high-grade spinal canal stenosis. Spinal canal narrowing is relatively worse at C3-C4 with mild to moderate stenosis. No cord signal abnormality is definitively appreciated.2. Neural foraminal narrowing at multiple levels as detailed above, particularly on the left at C3-C4, bilaterally at C5-C6, and on the left at C6-C7.3. Left C3-C4 facet arthropathy with mild joint distention which may be contributing to patient's neck pain.


Instruction: Generate impression based on findings.

Input: 58 years, Female, non-small cell lung cancer. Evaluate for restaging. There is no restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. There is increased size and number of intraparenchymal metastases scattered throughout the brain parenchyma. The largest lesion is located within the left cerebellum and measures 0.9 x 0.7 cm, previously 0.6 x 0.6 cm. There are sequela of previously treated metastases identified on MRI June 6, 2014, now visible as punctate T1 iso- to subtly hypointense lesions.There is new gyriform enhancement along left greater than right temporal lobes (series 1101, image 13; series 1101, image 72), and along the temporal horn of the right lateral ventricle (series 9, image 13). Additional foci of enhancement are identified within the right hippocampus (series 1101, image 89). There are a few punctate foci of susceptibility, with no associated lesion, probably microhemorrhages. There is new curvilinear susceptibility along left posterior parietal sulci (series 7, image 43), probably hemosiderin deposition consistent with superficial siderosis.There is no midline shift or herniation. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but probably secondary to chronic small vessel ischemic changes. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Increased size and number of multiple brain metastases. However, comparison is limited due to absence of intravenous contrast on the prior study. In comparison to earlier contrast-enhanced study June 6, 2014, there is decreased size of previously identified enhancing metastases, probably secondary to treatment-related change, but multiple new metastases and increased size of dominant cerebellar metastasis.2.New gyriform enhancement along the bilateral temporal lobes and temporal horn of right lateral ventricle, most likely due to metastatic disease.3.New curvilinear area of susceptibility along the left posterior parietal sulci, consistent with interval microhemorrhage possibly from metastases or prior trauma.


Instruction: Generate impression based on findings.

Input: Shoulder pain with limited activities, evaluate for rotator cuff tear or AC spur ROTATOR CUFF: Mildly increased signal and thickening of the supraspinatus tendon. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild supraspinatus tendinopathy. No evidence of rotator cuff tear or AC spur.


Instruction: Generate impression based on findings.

Input: There is no suspicious intracranial enhancement, acute infarct, mass effect or midline shift. There are numerous nonspecific periventricular and subcortical punctate white matter T2 signal abnormalities with additional lesions in the right thalamus and questionable ill-defined foci in the central pons (series 501 image 6). There is no suspicious enhancement of the cisternal portions of the trigeminal nerves. Incidental note is made of a small focus of enhancement in the fundus of the left and auditory canal which measures partially 4 x 5 mm in greatest axial dimensions at 1801/47.There is minimal scattered ethmoid sinus mucosal thickening.

Output: 1. No acute intracranial abnormality. 2. Small enhancing nodule in the left internal auditory canal fundus, which could represent a small vestibular schwannoma. Dedicated MRI of the internal auditory canals could be obtained for more detailed evaluation, and clinical correlation is recommended. No definite abnormality involving Meckel's caves, although dedicated trigeminal protocol was not obtained.3. Multiple nonspecific nonenhancing white matter lesions, with differential diagnosis including infectious and inflammatory processes, demyelinating disease, chronic small vessel ischemic changes.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-year-old male with possible elbow MCL tear status post fall. Evaluate for pain and swelling. LIGAMENTS: There is disruption of the proximal fibers of the radial collateral ligament. The ulnar collateral ligament appears intact. The lateral ulnar collateral ligament is poorly visualized and may be disrupted.TENDONS: There is discontinuity of the proximal fibers of the extensor digitorum tendon just distal to its origin off of the lateral epicondyle indicating a tear. There is increased signal abnormality and deformity of the remainder of the common extensor tendon indicating at least partial thickness tearing. Some of the fibers of the common extensor tendon to be traced to their insertion on the lateral epicondyle. The common flexor tendon appears intact. The biceps and brachialis tendons appear intact. The triceps tendon appears intact. ARTICULAR SURFACES AND BONE: There is a minimally displaced fracture of the coronoid process with slight inferior displacement of the volar fracture fragment. There is increased bone marrow signal abnormality on fluid sensitive sequences about the sublime tubercle and in the surrounding area likely representing a minimally depressed (2 mm) impaction fracture. There is increased bone marrow signal abnormality within the lateral aspect of the radial head likely representing a direct bone contusion.SURROUNDING STRUCTURES: There is increased signal abnormality on fluid sensitive sequences within the ulnar nerve within and proximal to the level of the cubital tunnel which likely represents a mild neuritis perhaps related to the patient's history of trauma. There is mild increased signal abnormality within the flexor digitorum profundus and flexor carpi ulnaris which may be related to the patient's history of trauma/inflammation, although subacute denervation cannot be excluded. There is subcutaneous edema in the overlying area.ADDITIONAL

Output: 1. Disruption of the radial collateral ligament, lateral ulnar collateral ligament, and extensor digitorum tendon with additional partial thickness tearing of the remainder of the common extensor tendon as described above.2. Fracture of the coronoid process as well as a minimally depressed impaction fracture about the sublime tubercle of the ulna.3. Bone contusion of the radial head.4. Moderate size elbow joint hemarthrosis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: H/o brain tumor. S/p biopsy. Examination demonstrates postsurgical change including a Burr hole in the right frontal bone. Again, a hypoattenuating mass is seen in the right frontal lobe with extension into the genu of corpus callosum and left anterior frontal lobe and mass effect on the right frontal horn. Please refer to the previous MRI for the measurements. No evidence of intracranial hemorrhage is identified. The ventricular size has been stable.

Output: Frontal tumor. Interval postsurgical change with no intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: DLBCL status post R-CHOP and neuropathy. There are postoperative findings related to left lateral neck dissection. There is no significant lymphadenopathy by size criteria. Indeed, the largest lymph nodes in the neck measure up to 8 mm in short axis in the right level 2 region. The Waldeyer ring structures are not significantly enlarged. No mass lesions are identified. The thyroid gland and major salivary glands are unremarkable. The major cervical flow voids are grossly intact. There is mild degenerative cervical spondylosis. The imaged portions of the orbits and intracranial structures are grossly unremarkable.

Output: No evidence of neuromas or significant cervical lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Male 16 years old with sacral decubitus ulcer and concern for sacral osteomyelitis. PROSTATE, SEMINAL VESICLES: No significant abnormality.BLADDER: Distended and normal.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction. A small amount of free fluid in the pelvis is nonspecific but most likely related to the patient's ventriculoperitoneal shunt.BONES, SOFT TISSUES: There is a decubitus ulcer just to the left of midline overlying the coccyx. It measures 2.7 cm transverse and 5.3 cm in craniocaudal dimension. There is mild surrounding inflammatory change and moderate contrast enhancement but no discrete fluid collection. The bone marrow signal in the sacrum and coccyx is unremarkable.OTHER: No significant abnormality.

Output: 2.7 x 5.3 cm decubitus ulcer without associated abscess or underlying osteomyelitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 43-year-old male with left-sided weakness and numbness; evaluate for stroke There is no evidence of acute intracranial hemorrhage, significant mass effect/midline shift, hydrocephalus or edema. Gray-white matter differentiation is preserved.The ventricles and basal cisterns are normal in size and configuration. There is mild ectopia of the cerebellar tonsils. Recommend MRI with CSF flow study for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses, middle ear cavities and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial hemorrhage, cortical infarct, mass-effect or edema. 2. Mild ectopia of the cerebellar tonsils. Recommend MRI with CSF flow study for further evaluation.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged small patchy foci of T2 hyperintensity within the subcortical, deep, and periatrial white matter compatible with chronic small vessel ischemic disease. 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. There is an unchnaged deformity of the left medial orbital wall. The skull, paranasal sinuses, and scalp soft tissues are otherwise unremarkable.

Output: Unremarkable MRI with the exception of mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Seizure-like activity. Signs and symptoms: As above. Nonenhanced brain MRI:Examination demonstrate normal anatomical development of brain and a normal pattern of myelination for age.There is no detectable cortical abnormality. The cortical sulci remain within normal. The ventricular system remain within normal size and morphology for age and with maintained midline.Signal void of all major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses appear normal. Unremarkable images through the orbits.The signal intensity calvarium demonstrate no abnormalities.Images through the paranasal sinuses and bilateral mastoid air cells demonstrate diffuse increased T2 signal intensity.

Output: 1.Unremarkable nonenhanced brain MRI for age.2.Diffuse patchy opacification of mastoid air cells and paranasal sinuses.