Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage, fracture. Signs and symptoms: Head trauma. Nonenhanced CT brain:Diffuse area of encephalomalacia in the left frontal, temporal, parietal lobes with ex vacuo dilatation of the left lateral ventricle is consistent with an old stroke. This examination is otherwise unremarkable and in particular no evidence of acute intracranial process is detected.There is a slight widening of calvarium on the left side believed to be secondary to underlying parenchymal volume loss. Area of sclerotic change of the squamosal portion of left temporal bone may also be result of intracranial process however possibility of fibrous dysplasia should be considered. Visualized paranasal sinuses and mastoid air cells are unremarkable. There is no definitive abnormality of soft tissues of the scalp.Nonenhanced CT of cervical spine:The alignment of cervical spine remains within normal limits.There is no definitive evidence of fracture or malalignment. Advanced degenerative disk disease with large anteriorly projecting osteophytes at C3 -- C4 through C6 -- C7 levels are present. At C5 -- C6 within the anteriorly projecting osteophytes and lucent line is identified. Remote possibility of fracture of this osteophyte cannot be ruled out. There is no detectable soft tissue abnormality associated with this finding. Correlated with physical exam and direct palpation and if clinical concern persists a follow-up with an MRI is recommended.

Output: 1.No evidence of acute intracranial or calvarial pathology.2.Large area of encephalomalacia in the left frontal, temporal and parietal lobes with resultant ex vacuo dilation of left lateral ventricle.3.Calvarial changes secondary to significant left hemispheric parenchymal volume loss is evident by thickening of calvarium on the left. Focal area of fibrous dysplasia of the squamosal portion of the left temporal bone.4.No definitive evidence of fracture of the cervical spine. Lucent line traversing the anterior osteophyte at C5 -- C6 likely not a fracture. Please correlate with history and if clinical concern persists follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Reason: Hx of right breast cancer in 2008 (ER+, node+). Left breast cancer that was HER2+, node+ left breast cancer, s/p neoadjuvant therapy and lumpectomy/SLNBx \T\ XRT. Currently on exemestane History: new rib pain, now with vertebral body sclerosis at C4 concerning for metastasis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is 5 mm anterolisthesis C7 on T1. There is some loss of normal lordosis with mild reversal involving the upper cervical spine. No destructive osseous lesions or abnormal enhancement involving the vertebral bodies to suggest metastatic disease is appreciated. No suspicious enhancement within the spinal canal is definitively appreciated. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below, advanced at the C7-T1 level:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and bilateral uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is moderate right worse than left neural foraminal stenosis. C4-5: Bilateral uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis. No significant spinal canal stenosis.C5-6: Bilateral uncovertebral hypertrophy with mild to moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis.C6-7: Bilateral uncovertebral hypertrophy and small disc osteophyte complex. There is moderate to severe left and mild right neural foraminal stenosis. There is mild to moderate spinal canal stenosis.C7-T1: Advanced degenerative changes with anterolisthesis with disc uncovering and extrusion. There is moderate spinal canal stenosis at this level including mild impression on the cord without cord signal abnormality. Advanced facet arthropathy is noted bilaterally. There is abnormal enhancement surrounding the facet joints, extending into the neural foramen bilaterally, as well as the epidural space, all favored to be on a degenerative basis. There is minimal right and moderate left neural foraminal stenosis.

Output: 1. No convincing evidence of metastatic disease in the cervical spine. No suspicious lesion is seen corresponding to the C4 sclerosis seen on recent cervical radiographs and was most likely on a degenerative basis.2. Advanced degenerative changes at the C7-T1 level with grade 1 to grade 2 anterolisthesis and advanced bilateral facet arthropathy. There is abnormal paraspinous soft tissue enhancement at this level extending into the epidural space which is likely on a degenerative basis. There is moderate spinal canal stenosis at this level with mild impression on the cord, without cord signal abnormality. Additional levels as above.


Instruction: Generate impression based on findings.

Input: 19 year-old female history of hip pain. ACETABULAR LABRUM: We see no gadolinium entering the labrum, nor do we see of a full thickness tear; however there is globular increased signal abnormality within the superior labrum compatible with degeneration. This globular signal abnormality disrupts the undersurface of the labrum at the one o'clock position (posterior/superior) suggestive of undersurface fraying (image 6 of series 1501). Furthermore, there is blunting of the anterior/superior labrum at the one to two o'clock position with mild surface irregularity and intrasubstance signal suggestive of partial thickness tearing superimposed on chronic attritional degeneration. We see no displaced labral fragments.ARTICULAR CARTILAGE AND BONE: We see no focal articular cartilage defects. There is mild prominence of the anterior aspect of the femoral head/neck junction at the 3 o'clock position with an alpha angle of approximately 65 degrees. Bone marrow signal intensity is unremarkable.SOFT TISSUES: The ligamentum teres is intact. There is mild edema of the tensor fasciae latae muscle presumably related to injection. The musculature of the left hip is otherwise unremarkable.ADDITIONAL

Output: 1.Labral abnormalities as described above likely representing a combination of degenerative undersurface fraying and partial thickness tearing; however we see no displaced labral fragment.2.Mild CAM deformity and other findings as above.


Instruction: Generate impression based on findings.

Input: Redemonstrated is an approximately 6 mm craniocaudal x 3 mm AP dimension T1 hypointense, T2 hyperintense, nonenhancing focus involving the posterior aspect of the pituitary. The posterior pituitary lobe appears to be flattened posteroinferiorly. The pituitary gland anteriorly is normal in size and shape without other discrete mass lesion. There is no macroadenoma. The pituitary infundibulum inserts on the midline of the gland. There are no suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally. Limited views of the other intracranial structures are unremarkable. A 7 mm enhancing excrescence is noted of the skin just superior and anterior to the ear.

Output: 1.Redemonstrated is an approximately 6 mm craniocaudal x 3 mm AP dimension T1 hypointense, T2 hyperintense, nonenhancing focus involving the posterior aspect of the pituitary. The posterior pituitary lobe appears to be flattened posteroinferiorly. This constellation of findings is most suggestive of a Rathke's cleft cyst.2.A 7 mm enhancing excrescence is noted of the skin just superior and anterior to the ear.


Instruction: Generate impression based on findings.

Input: 8-year-old male with macrocephaly and a left arachnoid cyst. Evaluate progression of the cyst. Left middle intracranial fossa cyst without significant change in size given the differences in technique. No evidence of hydrocephalus or midline shift. No evidence of intracranial hemorrhage, edema or solid mass. The ventricles and basal cisterns are unremarkable in size and configuration.Intracranial mild scalloping and thinning of the calvarial bone is nonspecific and may be secondary to a history of chronic increased intracranial pressure or a normal variant. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Grossly stable left middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Male, 89 years old, with history of L2 deformity, history of kyphoplasty, eval for discitis. A chronic compression deformity of the L2 vertebral body, with evidence of prior kyphoplasty, is unchaged. There is no significant marrow edema at this level.A compression deformity of the L3 vertebral body has mildly progressed in severity with a slightly greater degree of retropulsion and thecal sac effacement. Marrow edema has, however, improved from the prior exam.Interval loss of disc height at L2-L3 is seen with only trace residual fluid signal present in the disc space. Stable loss of disc height is seen at L1-2, L3-4 posteriorly, and L4-5. No edema is seen in any of these discs.Post contrast images show relatively diffuse enhancement of the marrow of the compressed L2 and L3 vertebral bodies. No enhancement is seen in the L2-3 disc space, or any of the adjacent disc spaces. The dura at L2 and L3 is circumferentially enhancing, but no fluid collections are seen. The right psoas muscle is enhancing at L3, but again, no fluid collections are seen. Spinal alignment is grossly anatomic and unchanged. No other marrow space lesions are seen. The distal spinal cord and conus are within normal limits. No pathologic intrathecal enhancement is seen. L1-2: Facet arthropathy, ligamentum flavum thickening, disc bulge and slight vertebral body retropulsion contribute to a moderate spinal canal stenosis, moderate left and mild-moderate right foraminal narrowing. No interval changes. L2-3: Facet arthropathy and ligamentum flavum thickening are unchanged. Disc bulge and vertebral body retropulsion have progressed with a worsened, severe spinal canal stenosis with effacement of CSF and crowding of the cauda equina. A prior right paracentral extrusion has, however, improved. Severe right and moderate left foraminal narrowing have not changed.L3-4: Facet arthropathy, ligamentum flavum thickening, and disc bulge contribute to moderate spinal canal stenosis and moderate left foraminal narrowing. No interval changes. L4-5: Facet arthropathy, ligamentum flavum thickening, and disc bulge contribute to moderate left and mild right foraminal narrowing, unchanged. L5-S1: Facet arthropathy and disc bulging are unchanged with no significant spinal canal or foraminal stenosis.

Output: 1.No change in the L2 vertebral body compression deformity with evidence of prior kyphoplasty.2.Progressive compression of the L3 vertebral body when compared to the prior exam. However, the degree of marrow edema has improved.3.Progressive loss of height of the L2-3 disc is seen, with only trace residual fluid signal in the disc space. 4.Enhancement of the L2 and L3 marrow, the adjacent dura, and the right psoas muscle is seen. Although infection cannot be excluded with certainly on the basis of imaging alone, all these findings could potentially be reactive to the severe compressions and disc degeneration. Lack of fluid collections, and resolving L3 edema argue against infection.


Instruction: Generate impression based on findings.

Input: 37-year-old female patient with knee pain. Question of meniscus tear. Due to the patient's body habitus, a high-resolution knee coil could not be used. Alternative coils were instead used which result in suboptimal image quality. Furthermore, several sequences are rendered suboptimal due to motion artifact.MENISCI: Evaluation of the menisci is limited, however, there is blunting of the posterior horn and body of the medial meniscus with low signal intensity in the medial gutter below the peripheral fibers of the body of the medial meniscus likely representing a displaced flap of meniscal tissue. The lateral meniscus is grossly intact.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited. We see no full-thickness fluid intensity cartilaginous defects. Bone marrow signal intensity is unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. Mild edema along the patellar tendon and medial retinaculum is nonspecific.ADDITIONAL

Output: Extremely limited study showing findings compatible with a displaced flap tear of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke History: aphasia Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.There are, however, multifocal chronic ischemic lesions with encephalomalacia on bilateral cerebellar hemisphere, left parietal lobe inferior parietal lobule (series 5, image 20/32) bilateral occipital lobes and left temporal lobe posterior aspect of the middle and inferior temporal gyri. In particular, left temporal lobe, bilateral parietal lobes especially inferior parietal lobules and bilateral occipital lobe lesions show susceptibility artifacts especially on the superficial cortex on gradient echo images which indicate possible prior petechial hemorrhage of the ischemic area.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral posterior communicating arteries are patent as well as a common artery.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Multifocal chronic ischemic lesions with encephalomalacia as well as focal hemorrhagic lesions involving bilateral cerebellar and superior, bilateral occipital lobes and the right temporal lobe as described above. 3. Normal brain MR angiogram.


Instruction: Generate impression based on findings.

Input: 23 year old male with a history of Crohn's disease with prior perforation last 2/2014. Presents with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are multiple scattered mesenteric lymph nodes. BOWEL, MESENTERY: Note is made of wall thickening and increased signal abnormality with associated enhancement affecting a long segment of the terminal ileum measuring approximately 10 cm in length. No evidence of fistula formation. There is no focal fluid collection to suggest abscess formation. The appendix is normal in size and appearance. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality 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: Findings consistent with acute on chronic inflammatory bowel disease affecting a long segment of the terminal ileum. No evidence of abscess formation or fistula, as clinically questioned.


Instruction: Generate impression based on findings.

Input: History of pineal cyst: vision loss both eyes. Brain: There is no evidence of acute intracranial hemorrhage or acute infarct. There is a small amount of encephalomalacia in the right cerebellar hemisphere and bilateral basal ganglia. There is also a mild degree of cerebral white matter T2 hyperintensity. There is an unchanged 7 mm diameter pineal gland cyst. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull appears to be grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is enhancement surrounding the root of tooth number 7. There is focal thinning of the parietal scalp, which may be due to atrophy or prior surgery. There is a nonspecific small right nasolabial fold skin excrescence.Orbits: There is a right lens implant. The bilateral globes and ocular adnexa are otherwise unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. Chronic lacunar infarcts in the right cerebellar hemisphere and bilateral basal ganglia, but no evidence of acute infarct.2. Unchanged subcentimeter pineal gland cyst.3. Right lens implant. Otherwise, no evidence of gross orbital lesions.4. Periodontal disease associated with tooth number 7.


Instruction: Generate impression based on findings.

Input: Left optic nerve pallor. Orbits: There is diffuse volume loss of the left optic nerve and chiasm without evidence of signal abnormality. There are no compressive mass lesions. There is no evidence of abnormal enhancement. The globes and ocular adnexa are unremarkable.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. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. Punctate foci of susceptibility effect along the bilateral hippocampi correspond to calcifications. The major cerebral flow voids are intact. There is a 5 mm wide left frontal scalp lipoma. There is mild mucosal thickening in the maxillary sinuses.

Output: 1. Diffuse left optic nerve atrophy without evidence of inflammatory neuritis or compressive neuropathy.2. Chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or cerebral edema.


Instruction: Generate impression based on findings.

Input: History of left breast mammographic architectural distortion with sonographic correlate. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are adjacent foci of enhancement near the left breast at 10:00 in the mid to posterior depth which together measure 6 x 6 x 8 mm. These have mixed kinetics including areas of washout. This finding correlates positionally to the mammographic and sonographic finding. Elsewhere scattered non-suspicious foci are seen. No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.Hepatic cysts are noted.

Output: Enhancing adjacent left breast foci that correlate positionally to the mammographic and sonographic finding. No additional suspicious enhancing lesion. No enlarged axillary lymph node. Subsequent to this exam, the patient underwent an ultrasound guided biopsy. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Gait disorder with right upgoing toe and left leg paresthesia. There is appears to be patchy T2 hyperintensity and mild volume loss at the T6-7 level. There is also apparent T2 hyperintensity in the spinal cord at the T1-2 and T4 levels. There are small posterior disc-osteophytes in the mid thoracic spine, but the spinal canal is not significantly narrowed. There are subcentimeter neural foraminal perineural cysts at multiple levels. 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 evidence of mass lesions or abnormal enhancement in the thoracic spine. The paravertebral soft tissues are unremarkable.

Output: Apparent myelomalacia at multiple levels of the thoracic spinal cord. These may be secondary to a prior demyelinating or infectious process, for example.


Instruction: Generate impression based on findings.

Input: History of prostate cancer now with weakness and known lumbar lesions of metastatic disease. Rule out cord compression. Diffuse bone marrow changes are present compatible with the patient's known diffuse osseous metastases. There are degenerative changes in the cervical spine, including disc-osteophyte complexes and ligamentum flavum thickening at multiple levels with chronic spinal canal narrowing but there is no evidence of cord signal abnormality or acute cord compression. Similarly in the thoracic spine no cord signal abnormality or cord compression is demonstrated. Degenerative changes and osseous metastases are present in the lower lumbar spine, especially involving the L3-4 and L4-5 levels. The exam in the lumbar spine is degraded by motion artifact. Given this, and the absence of contrast, mild epidural spread of metastatic disease cannot be excluded, though a high-grade canal stenosis is not highly suspected .

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Diffuse osseous metastatic disease and degenerative changes but no distinct evidence of cord compression is identified. The exam in the lumbar spine is degraded by motion and artifact and in the absence of contrast, mild epidural spread of metastatic disease cannot be excluded. However, no high-grade acute canal stenosis is suspected.


Instruction: Generate impression based on findings.

Input: Evaluate sagittal balance, evaluate effusion. Back and right leg pain. History of lumbar fusion. Mild multilevel degenerative disc disease and anterior osteophytes are noted in the thoracolumbar spine. Posterior stabilization rods and pedicular screws entering the L4 and L5 vertebral bodies are noted, with intervertebral bone graft at L4-5. There remains approximately 7 mm in anterolisthesis of L4 on L5.There is approximately 11 degrees levoscoliosis of the thoracolumbar spine, as measured from the superior endplate of T3 to the inferior endplate of L1.Coronal balance is within normal limits. There is approximately 3.5 cm positive sagittal balance.

Output: Multilevel degenerative disc disease.Levoscoliosis and positive sagittal balance of the spine, as above.


Instruction: Generate impression based on findings.

Input: 77-year-old male with metastatic prostate cancer and history of lung cancer. CHEST:LUNGS AND PLEURA: Postsurgical changes with volume loss from prior right lower lobectomy noted.No new infiltrates, nodules, masses or effusions seen. Elevation of the right hemidiaphragm persists.MEDIASTINUM AND HILA: Calcifications from prior granulomatous disease again noted. No enlarged lymph nodes identified. No other abnormalities.CHEST WALL: Again noted are diffuse sclerotic skeletal metastases there sclerotic in nature. Previous lesions identified have increased in size and there are scattered newer foci.ABDOMEN:LIVER, BILIARY TRACT: Diffuse low-attenuation liver is present indicative of diffuse fatty infiltration. This obscures metastatic lesions on CT and if concern over metastases to liver exists, ultrasound or MRI would be recommended. No such lesions are identified. Patient is status post cholecystectomy. No intrahepatic or extrahepatic bile duct dilatation is seen.SPLEEN: No significant abnormality notedPANCREAS: Resection of the pancreatic head mass noted on 2005 CT is present. The pancreatic duct has returned to near normal diameter compared to the marked dilatation previously. No evidence of recurrent tumor is seen in surgical bed. No other abnormalities are noted.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged retroperitoneal lymph node posterior to the aorta seen inferiorly at the abdominal/pelvic junction (series 4, image 127) measuring 1.7 x 1.2 cm. This was not present on the December, 2005 examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatectomy. No evidence of tumor recurrence in surgical bed.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse sclerotic metastases seen throughout the bony skeleton. These were not present on 2005 CT examination. New since 2005 examination right inguinal hernia containing small bowel and mesenteric fat/vessels without apparent complication.OTHER: No significant abnormality noted

Output: 1. Prior right lower lobe lung resection. Diffuse thoracic skeletal metastases with slight increase number and size of sclerotic lesions noted previously. 2. Diffuse fatty infiltration of the liver. This obscures the ability to detect liver metastases as described above. 3. New lymphadenopathy in retroperitoneum of the abdomen measured above. 4. Resection of prior noted pancreatic neuroendocrine tumor without evidence of recurrence. 5. Diffuse sclerotic metastases in the abdomen and pelvis. 6. New right inguinal hernia with small bowel without complication evident.


Instruction: Generate impression based on findings.

Input: Nausea/vomiting. Evaluate pancreatic mass (found on CT A/P w). ABDOMEN:LIVER, BILIARY TRACT: Severe fatty infiltration of the liver. No biliary ductal dilatation. No focal hepatic mass. Patent hepatic vasculature.SPLEEN: Diffusely decreased T2 hypointensity of the spleen with signal loss on in phase images consistent with iron deposition.PANCREAS: The subcentimeter hypoattenuating focus in the distal pancreatic body on prior CT consistent with focal fat, best seen on opposed phase images. No pancreatic mass or IPMN is evident.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: The distal pancreatic body lesion seen on prior CT is consistent with interdigitating fat. No pancreatic mass or IPMN is evident.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for pathology for right lower extremity numbness and tingling. Signs and symptoms: RLE numbness and tingling. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.The marrow signal intensity of the vertebral column is uniformly abnormal with low T1 and low T2 and most likely secondary to long standing chronic kidney disease. No significant degenerative disease of the lumbar spine is identified.Lower most visualized thoracic spine and thoracic cord is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 demonstrate minimal ligamentum flavum hypertrophy and unremarkable otherwise.L4 -- L5 demonstrate mild bilateral symmetrical ligamentum flavum hypertrophy. There is a tiny right paramedian annular fissure at this level which is best appreciated on axial T2 series 7 image 27 and unremarkable exam at this level otherwise.L5 -- S1 is unremarkable.The paraspinal musculature remains within normal size and signal intensity. Incidental note is made symmetrical bilaterally small kidneys which was also noted on prior CT of abdomen from 12 -- 14 -- 13.

Output: 1.Tiny central and rightward annular fissure at L4 -- L5.2.Unremarkable exam otherwise and without spinal stenosis or neural foraminal compromise at any level.3.Incidental note is made of bilaterally symmetrical small kidneys.4.Uniformly abnormal marrow signal of vertebral column secondary to long standing chronic kidney disease.


Instruction: Generate impression based on findings.

Input: Status post craniotomy with worsening headache. Evaluate for bleed. The patient is status post frontal craniotomy. Pneumocephalus and subcutaneous emphysema are likely postsurgical. In the left frontal high convexity an area of hypodensity with surrounding air represents the surgical bed. Foci of high attenuation likely represent a small amount of blood within the surgical bed. No large intracranial hemorrhage is identified. No midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Expected postoperative findings of a recent craniotomy. No large intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 45-year-old male with history of EBV lymphoma proliferation in HIV. Follow-up. BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.NECK SOFT TISSUES:The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The lingual tonsils appear slightly prominent. No frontal masses are noted. There are many cervical lymph nodes at multiple levels.Small intraparotid lymph node is borderline in size measuring 12 x 8 mm (series 4, image 36). Small level 2 lymph node posterior and inferior to the right parotid gland is 11 x 8 mm (series 4, image 41). Small level 2 lymph node anterior to the sternocleidomastoid muscle anterior to the carotid artery measures 17 x 6 mm, (series 4, image 44). Additional multiple small lymph nodes are present throughout the visualized soft tissues not enlarged by CT criteria.Minimal multilevel degenerative change affects the visualized cervical spine without evidence of central canal or neuroforaminal stenosis. Vertebral body hypertrophy with posterior bridging osteophyte present at T1-T2 which is causing posterior indentation into the visualized cervical central canal. Due to CT technique and artifact in the spinal cord cannot be evaluated. There is clinical concern for cord compromise an MRI may be considered. The osseous structures are otherwise unremarkable.LUNG APICES:Lung apices are clear bilaterally.

Output: 1. Multiple lymph nodes some of which are borderline many of which are not pathologically enlarged by CT criteria, none of which demonstrate pathologic enhancement. No additional masses identified.2. Slight prominence of the lingual tonsils of uncertain etiology.3. Vertebral body hypertrophy with posterior bridging osteophyte present at T1-T2 which is causing posterior indentation into the visualized cervical central canal. Due to CT technique and artifact in the spinal cord cannot be evaluated. There is clinical concern for cord compromise an MRI may be considered.


Instruction: Generate impression based on findings.

Input: There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Osteophyte disc complex and bilateral uncinate hypertrophy. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is mild central and moderate bilateral neural foraminal stenosis.C4/5: Osteophyte disc complex somewhat asymmetric to the right and bilateral uncinate hypertrophy. There is mild anterior cord flattening, right greater than left, without intrinsic cord signal abnormality. There is mild central and mild bilateral neural foraminal stenosis.C5/6: Osteophyte disc complex and bilateral uncinate hypertrophy. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is mild central, severe left neural foraminal, and mild right neural foraminal stenosis.C6/7: Osteophyte disc complex and left-sided uncinate hypertrophy. There is moderate left neural foraminal stenosis.C7/T1: UnremarkableLeft sided facet hypertrophy encroach the left neural foramen at T1/T2 and T2/3

Output: 1.C3/4: Mild central and moderate bilateral neural foraminal stenosis.2.C4/5: Mild central and mild bilateral neural foraminal stenosis.3.C5/6: Mild central, severe left neural foraminal, and mild right neural foraminal stenosis.4.C6/7: Moderate left neural foraminal stenosis.5.Left sided facet hypertrophy encroach the left neural foramen at T1/T2 and T2/3


Instruction: Generate impression based on findings.

Input: Please obtain high res (1mm thickness) MRI T1-weighted to further characterize lesions. Differential: myeloma vs other neoplasm, inflammation, infection. History: left inferior nasal field vision blurring, 4y h/o myeloma, pt got MRI at OSH (uploaded in system) showing enhancing lesions in Lt optic n., left frontal leptomeninges, and 2 nodules in left cerebellum. There is no evidence of intracranial hemorrhage, large mass, or acute infarct. There is decreased subcortical T2 hyperintensity in the left frontal lobe. The cerebellum appears to be grossly unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild thickening diffusely along the left optic nerve sheath.

Output: No evidence of intracranial hemorrhage, large mass, or acute infarct. However, characterization of the previously demonstrated lesions is limited due to the lack of contrast. Likewise, the left optic nerve sheath abnormality is not well-characterized without intravenous contrast. Otherwise, there is decreased nonspecific subcortical T2 hyperintensity in the left frontal lobe.


Instruction: Generate impression based on findings.

Input: 30-year-old female with hyperprolactinemia and amenorrhea. Evaluate for pituitary adenoma. The pituitary gland is within normal limits in size, signal intensity and enhancement. The pituitary stalk is located at midline without deviation, and is normal in caliber, signal intensity and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable.  Limited images of the brain demonstrate no midline shift or mass effect. There are no areas of abnormal signal or pathologic enhancement. The ventricles and sulci are within normal limits. The midline structures and craniocervical junction are within normal limits.

Output: Unremarkable examination with no focal lesions identified.


Instruction: Generate impression based on findings.

Input: 57-year-old male. BMT patient on long-term steroid. Severe right hip pain. Evaluate for avascular necrosis R hip. History of metastatic melanoma and myelofibrosis. Slightly mottled appearance to the bone marrow compatible with history of myelofibrosis. We see no specific imaging features of osteonecrosis. Tubular foci of low signal within the iliac wings and right sacrum represent biopsy tracts. Mild osteoarthritis affects both hip joints. Sacroiliac joints are unremarkable. Degenerative disk disease of the lower lumbar spine with spinal canal narrowing, which can be better evaluated with dedicated MRI lumber spine if clinically warranted.Mild edema and enhancement of the lateral insertional fibers of the right gluteus minimus/medius. There is also mild edema and enhancement of the far lateral fibers of the gluteus maximus muscle at the level of the greater trochanter. The right gluteus minimus tendon is slightly thickened but otherwise intact. Mild fatty atrophy of the left inferior erector spinae muscle.Tiny subcentimeter focus of fluid signal intensity adjacent to the anterior rim of the right acetabulum. This could represent a small paralabral cyst. We see no enhancement within either hip joint to indicate synovitis.

Output: 1. Bone marrow changes may be related to patient's known history of myelofibrosis. No findings to suggest osteonecrosis.2. Mild nonspecific right peritrochanteric inflammatory changes, as described above.3. Small lobulated fluid signal collection anterior to the right acetabulum, may represent a paralabral cyst. If there is clinical concern for a labral tear, MR arthrography can be considered.


Instruction: Generate impression based on findings.

Input: Female, 6 months old, with incidental finding of hypomyelination on previous MRI. Evaluate for interval changes. The pattern of white matter myelination has progressed from the prior examination and falls in the 4 to 5-month-old range. Parenchymal morphology is otherwise unremarkable. The degree of sulcation and gyral development is appropriate. No areas of focal signal abnormality or diffusion restriction are seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. The ventricles are normal in size and morphology.

Output: Since the prior examination, white matter myelination has progressed and is appropriate for the patient's corrected gestational age. Evaluation of the brain is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post blunt head trauma.? Intracranial hemorrhage. Signs and symptoms: Fell from bed with blunt head trauma and 4 episodes of nausea and vomiting 7 hours later. Non-enhanced CT brain: There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, CSF cisterns and ventricular system are essentially unremarkable. Sagittal reformatted images demonstrate minimal ectopia of the cerebellar tonsils. Follow-up with an MRI is recommended.Limited images of orbits are negative. Calvarium is intact. No definitive abnormality of the scalp is detected. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.

Output: 1.No evidence of acute intracranial process.2.Minimally ectopic cerebellar tonsils. Followed with an MRI is recommended.3.Calvarium is intact.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for NMO or demyelinating disease. Signs and symptoms: BUE weakness. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 demonstrate moderate disk disease and loss of disk height and mild facet and moderate ligamentum flavum hypertrophy changes. Constellation of changes results in moderate to severe central spinal stenosis and no neural foraminal compromise.C3 -- C4 demonstrate moderate advanced disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is resultant significant central spinal and bilateral neural foraminal compromise.C4 -- C5 demonstrate advanced disk disease and loss of disk height, mild ligamentum flavum and moderate facet hypertrophic changes are present at this level. Constellation of changes results in moderate central spinal stenosis, significant left and moderate right neural foraminal compromise.C5 -- C6 demonstrate moderate disk disease and loss of disk height, mild facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease and mild facet and ligamentum flavum degenerative changes without spinal stenosis. Mild right neural foraminal compromise is present.C7 -- T1 demonstrate mild disk disease and moderate left facet and ligamentum flavum hypertrophy. There is resultant mild to moderate left neural foramina compromise and patent right and without spinal stenosis.The signal intensity and caliber of the cervical cord and uppermost visualized thoracic cord is within normal.Pre-and post-enhanced brain MRI:Examination demonstrates few nonspecific and non-enhancing foci of flair hyperintensity only in the subcortical white matter of bilateral cerebral hemispheres. Unremarkable signal intensity brain parenchyma otherwise on all acquired MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise. Unremarkable images through posterior fossa.Negative post enhanced images of the brain parenchyma, leptomeninges, calvarium and the orbits.Unremarkable images through the orbits.Normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: 1.Normal signal intensity of cervical and uppermost visualized thoracic cord. Extensive degenerative changes of cervical spine results in multilevel mild to severe central spinal stenosis at C2 -- C3, C3 -- C4 and C4 -- C5 levels. There are multilevel neural foraminal compromise as detailed per level above.2.Pre-and post enhanced brain MRI demonstrates few nonspecific and nonenhancing small foci of flair hyperintensity only in the subcortical white matter of cerebral hemispheres. Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Male 22 years old. Reason: r/o fx, surgical complication. History: right knee swelling, s/p patellar tendon repair. Four non-weightbearing views of the right knee demonstrate thickening of the patella tendon, particularly proximally, more so than seen on prior study. There are calcifications in the soft tissues along the inferior margin of the patella. We see no large joint effusion.

Output: Patellar tendon thickening and calcifications along the inferior margin of the patella as described above. These findings may reflect chronic tendinopathy and old post operative changes, however, we cannot exclude a superimposed "acute" partial thickness tear of the patellar tendon proximally. If further imaging is clinically warranted, MRI may be considered.


Instruction: Generate impression based on findings.

Input: Male, full-term 7-year-old infant with jerking episodes of bilateral upper extremities. A 4 mm T1 intermediate and T2 hypointense, susceptibility inducing lesion is evident along the body of the left caudate nucleus. This is located at the superior most aspect of the caudothalamic groove. No significant associated edema or mass effect is observed. There may also be a tiny focus of susceptibility overlying the right occipital horn but this is equivocal. Elsewhere, the morphology of the brain is appropriate for gestational age. No areas of edema or mass effect are detected. No large extra-axial fluid collections are observed. The ventricles are normal in size and morphology.The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The corpus callosum is fully formed and intact. The pattern of white matter myelination is appropriate for age.

Output: 1.A susceptibility inducing lesion is evident along the body of the left caudate nucleus which which could represent a small focus of hemorrhage. The age of this lesion is difficult to ascertain though it is favored to be subacute to chronic.2.A questionable focus of susceptibility overlying the right occipital horn would also support the possibility of a prior hemorrhagic event.3.Evaluation of the brain is otherwise unremarkable.Discussed with Dr. Elios at 12:00 PM on 6/3/16.


Instruction: Generate impression based on findings.

Input: 56-year-old man with history of prostate biopsy in 7/2016 demonstrating Gleason 7 adenocarcinoma in the left apex and the Gleason 6 adenocarcinoma in the left mid gland. PELVIS:PROSTATE:Prostate Size: 45 x 35 mm.Peripheral Zone: The left apical peripheral zone (401/60) there is a 9 x 5 mm area of T2 hypointensity and diffusion abnormality (708/164). This region abuts the prostatic capsule with overlying indistinctness and subtle disruption of the capsule suggested. Scattered postbiopsy change with increased T1 signal seen in the peripheral zone.Central Gland: Nodular and enlarged.Seminal Vesicles: Normal in appearance.Extracapsular Extension: Irregularity of the left posterolateral prostatic capsule suggests invasion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left apical focus of signal abnormality suspicious for adenocarcinoma with suspected focal extracapsular invasion.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with persistent abnormal smells, unilateral leg weakness, lung transplant patient. Concern for onset of temporal lobe seizures. Assess for structural lesions. Diffusion-weighted images are unremarkable. Numerous scattered foci of T2 hyperintensity are demonstrated within the bilateral cerebral white matter, unchanged from the prior exam. A few areas of cortical signal abnormality are also stable, for example involving the left parietal lobe and high right middle frontal gyrus.As on the prior examination, an oval cystic lesion is seen interposed between the substantia nigra and red nucleus on the right of the midbrain. This lesion follows CSF signal on all sequences and has not changed.There are a few scattered punctate foci of susceptibility in the brain which are of doubtful significance and may simply represent chronic microhemorrhage. No acute intracranial hemorrhage is suspected. Ventricles are stable and normal in size.A partially empty sella is unchanged. The marrow signal characteristics are unremarkable.

Output: 1. Sequelae of chronic microvascular and perhaps chronic cortical ischemia. No evidence of acute ischemia or any other acute findings.2. No change in the appearance of the temporal lobes with no specific lesions seen which would account for the patient's symptoms.3. Stable cystic lesion within the right midbrain which may represent a dilated perivascular space.


Instruction: Generate impression based on findings.

Input: 65-year-old female with slurred speech x 3 days and ataxia x 2 days on Coumadin. Rule-out intracranial hemorrhage, old stroke. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of periventricular and subcortical white matter hypodensities consistent with small vessel disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Sinus disease within the right sphenoid sinus. The remainder of the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: Female 70 years old Reason: evaluate for osteomyelitis History: wound x 3 weeks with increased drainage, increased pain. hx lymphedema. There is skin thickening and reticulation of the subcutaneous fat consistent with stated history of lymphedema. There is replacement of the subcutaneous fat along the posterolateral aspect of the calcaneus with abnormal signal intensity and enhancement, presumably representing inflammation related to the overlying wound. Focal signal abnormality within the underlying calcaneus, specifically within the inferolateral aspect of the posterior tuberosity, that demonstrates slightly decreased signal on T1-weighted images and slightly increased signal on T2 weighted images as well as contrast enhancement and is suspicious for osteomyelitis. We see no additional foci of osteomyelitis.TENDONS: The visualized tendons are intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Mild degenerative arthritic changes affect the ankle, hindfoot, and midfoot. Additionally, please refer to 'findings' above.ADDITIONAL

Output: Signal abnormality within the inferolateral aspect of the posterior tuberosity of the calcaneus suspicious for osteomyelitis.


Instruction: Generate impression based on findings.

Input: Female, 80 years old. Reason: evaluate for RA, OA History: flexion contractures at PIP's Right hand: The bones appear demineralized. Moderate osteoarthritis affects multiple interphalangeal joints. Severe osteoarthritis affects the first carpometacarpal joint. We see no specific radiographic features of rheumatoid arthritis.Left hand: The bones appear demineralized. Moderate osteoarthritis affects multiple interphalangeal joints. Moderate osteoarthritis also affects the first carpometacarpal joint. We see no specific radiographic features of rheumatoid arthritis.Right knee: Severe osteoarthritis affects the right knee, particularly the lateral and patellofemoral compartments. A cluster of calcifications in the distal femoral metaphysis likely represents a benign enchondroma. The patella appears low lying, which may simply represent artifact related to patient positioning. However, if there is clinical concern for quadriceps tendon injury, MRI can be considered for further evaluation.Left knee: Severe osteoarthritis affects the left knee, particularly the lateral and patellofemoral compartments.

Output: Osteoarthritis of both hands and both knees; other findings as above.


Instruction: Generate impression based on findings.

Input: Other headache syndrome [G44.89], Reason for Study: ^Reason: R/O venous obstruction, structural abnormality History: headaches Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV2-D and 3D MRV brain noncontrast enhanced 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.

Output: 1. Normal brain MRI.2. No evidence of dural sinus occlusion or stenosis. There is no evidence of venous congestive encephalopathy.


Instruction: Generate impression based on findings.

Input: Relapsing remitting multiple sclerosis. Not on treatment. Tingling in the hands. Brain:Since the previous examination, there has been progression of the patchy and confluent cerebral white matter (including corpus callosum) T2/FLAIR hyperintense lesions. The lesions are larger and more numerous and the overall burden is now moderate-to-severe. Some of the lesions in the frontal lobes are juxtacortical. There are lesions in the cerebellum, cerebellar peduncles, and the brainstem. Increased parenchymal volume loss is seen manifested by increased size of the sulci and other CSF-containing spaces as well as thinning of the the corpus callosum. The orbits are normal. There is minimal mucosal thickening in the inferior aspect of the left maxillary sinus and in the lateral most aspect of the left mastoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear. There is no skull destructive lesion.Cervical spine:The T2 hyperintense spinal cord lesions at C1-C2 and C4-C5 levels, as well as several smaller scattered lesion, are not significantly changed since the previous examination. The associated very subtle volume loss at C7 and T1 levels is also unchanged. There is no new cervical spinal cord lesion.Mild multilevel cervical spondylosis has minimally progressed since the previous examination at C2-C3 level and is unchanged at the other levels. There is no significant spinal canal narrowing. There is mild to moderate neural foraminal narrowing as described below.The heterogeneously T2 hyperintense right thyroid lobe nodule is still present but is not diagnostically included.C2-C3: There is mild right neural foraminal narrowing by uncovertebral arthropathy which has slightly increased since the previous examination.C3-C4: There is moderate left and mild right neural foraminal narrowing by uncovertebral and facet arthropathy.C4-C5: There is severe right and minimal left neural foraminal narrowing by uncovertebral and facet arthropathy.C5-C6: There is moderate-to-severe right and moderate left neural foraminal narrowing by uncovertebral and facet arthropathy.C6-C7 and C7-T1: There is no significant spinal canal or neural foraminal narrowing.

Output: 1.Since 2012, there has been definite progression in the involvement of the white matter by multiple sclerosis (which is now moderate-to-severe) with more obvious overall volume loss.2.The cervical spinal cord lesions are not significantly changed. 3.The relatively mild multilevel degenerative spondylosis is minimally increased at C2-C3 and is unchanged at other levels.


Instruction: Generate impression based on findings.

Input: Reason: eval hematoma vs infection of left thigh History: 4d of pain/swelling to left thigh. has liver failure w/ elevated inr... also has lactate... also has crp<3 and afebrile Complex cystic solid mass in the adductor magnus measuring approximately 10.6 x 5.0 x 20.3 cm. There is subtle peripheral enhancement. Imaging features suggestive of liquefying hematoma with or without superimposed infection. Severe compression of the superficial femoral vein anterior to the mass with abnormal signal in the vessel, which may represent DVT versus slow flow. Small joint effusion. There is interfascial and circumferential subcutaneous edema.

Output: Large complex mass centered in the abductor magnus. Imaging features most consistent with hematoma with or without superimposed infection. Recommend follow-up to resolution.


Instruction: Generate impression based on findings.

Input: Reason: renal mass History: none ABDOMEN:LIVER, BILIARY TRACT: There are 3 lesions within segments 2, 7 and 8 which are hyperintense on T2-weighted images and demonstrate peripheral nodular enhancement, consistent with hemangiomas. A segment 7 lesion measures 2.3 x 1.6 cm (5/4), previously 2.1 x 1.6 cm. A segment 2 lesion measures 1.7 x 1.2 cm (5/11), previously 1.6 x 1.2 cm. There is a lesion in within the inferior right hepatic lobe which is enhances on arterial phase and is isointense on delayed phases measuring 4.6 x 2.5 cm, unchanged in size. This lesion has previously been shown to exhibit hepatobiliary phase enhancement with central scar, suggesting focal nodular hyperplasia. .SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a lesion in the right midpole which subtly enhances on delayed phases and measures 1.2 x 1.0 cm (13/27), unchanged in size.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subtly enhancing lesion in the right midpole is stable in size and suspicious for renal cell carcinoma.2.Multiple hemangiomas are minimally increased in size.3.Lesion in the right inferior hepatic lobe is stable and likely represents focal nodular hyperplasia.


Instruction: Generate impression based on findings.

Input: Clinical question: History of tethered cord repair, x 2 by meningomyelocele, follow up. Signs and symptoms: New symptoms, back pain, and electric shock type pain feeding to lower back. Nonenhanced lumbar MRI:The examination redemonstrates a small lipoma along the dorsal aspect of conus measuring at 19.8 he previous axis and 6.4-mm in AP axis (measured on sagittal series) without interval change since prior study from 2011. Lipoma resolve since subtle flattening and forward displacement of the conus similar to prior exam and without evidence of spinal stenosis. The signal intensity of the cord and conus is otherwise within normal.The lipoma these presented at the level of the superior endplate of L2 and without evidence of any change since prior.Revisualization of stable postoperative changes of prior laminectomy for untethering of the cord and removal of meningomyelocele. There is termination of the cord at upper L2 level which is inseparable from the posterior thecal sac similar to prior exam and suspected for adhesion.Prone sagittal T2 weighted images demonstrate anterior movement of the lower cord however without movement of the tip of the conus which remains inseparable from the posterior wall of the thecal sac and likely representing adhesion. There is apparent worsening of this finding on prone sagittal series by apparent increased point of contact of the lower tip of conus to the posterior wall of thecal sac on sagittal prone T2W series compared to prior prone sagittal T2. This observation can be result of slice positioning and not a true interval change and there are no axial images on prone position for comparison.

Output: 1.Revisualization of a stable small lipoma of the dorsal aspect of conus.2.Prone sagittal T2-weighted images demonstrate anterior movement of the lower cord however without movement of the tip of the conus which remains inseparable from the posterior wall of the thecal sac and is suspected on adhesion. Please see above comments.3.Revisualization of postoperative changes of prior cord untethering and removal of the meningomyelocele.


Instruction: Generate impression based on findings.

Input: 53-year-old female with knee pain, evaluate meniscus MENISCI: There is oblique tear of posterior horn of the medial meniscus with extension to the femoral and tibial articular surfaces. There is globular signal abnormality within the body of the lateral meniscus without extension to either articular surface.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage loss along the medial patella undersurface with full-thickness degeneration and fissuring along the median eminence. Full-thickness and near full-thickness articular degeneration along the femoral trochlea with underlying reactive marrow changes. There is near full thickness loss of the articular cartilage along the medial femoral condyle with scattered foci of full-thickness degeneration and underlying reactive changes in the subchondral marrow. Mild diffuse articular cartilage thinning within the lateral tibiofemoral compartment.Tricompartmental osteophytes are noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patella tendons appear normal. There is marked prepatellar tendon soft tissue edema.ADDITIONAL

Output: 1. Severe osteoarthritis with tricompartmental articular cartilage loss as described above.2. Nondisplaced tear of the posterior horn of the medial meniscus as detailed above.3. Diffuse soft tissue swelling and fluid collection along the medial soft tissues which may reflect prior trauma/degloving injury.4. Moderate joint effusion and small Baker's cyst.


Instruction: Generate impression based on findings.

Input: Hit with baseball bat RIGHT TESTIS: No significant abnormalities noted. Normal testicular echotexture, without evidence of traumatic injury. The right testis measures 1.3 x 0.8 x 1.5 cmLEFT TESTIS: No significant abnormalities noted. Normal testicular echotexture, without evidence of traumatic injury. The left testis measures 1.5 x 0.7 x 1.0 cmRIGHT EPIDIDYMIS: No significant abnormalities noted. The right epididymis measures 0.6 x 0.3 x 0.6 cm.LEFT EPIDIDYMIS: No significant abnormalities noted. The left epididymis measures 0.6 x 0.5 x 0.7 cm.OTHER: No paratesticular collections or masses to suggest hydrocele or hematoma.DOPPLER

Output: Normal sonographic appearance of the testes and scrotum, without evidence of traumatic injury or torsion.


Instruction: Generate impression based on findings.

Input: Fall. History of agenesis of the corpus callosum and subdural hemorrhage. There is motion artifact at the convexities, however within this limitation there is stability in size (12 mm coronally) of the evolving left subdural hematoma which was first documented on the MRI performed 8/20/2013. There has been partial resolution of the previously described right parasagittal subdural hematoma. There are stable bilateral prominent CSF attenuating fluid collections. There are no new extra axial fluid collections identified.Previously described findings representing complete agenesis of the corpus callosum are stable. No new intracranial masses, mass effect including midline shift or CT evidence of acute hydrocephalus. Ethmoid air cells are aerated and maxillary sinuses are partially aerated. Sphenoid are opacified, as is appropriate for the patient's age. Mastoid air cells are unremarkable. There are no visualized bony abnormalities.

Output: 1.Stable evolving left subdural hematoma.2.Interval partial resolution of a right parasagittal subdural hematoma.3.Stable findings representing complete agenesis of the corpus callosum.4.Stable CSF attenuating extra-axial fluid collections bilaterally.


Instruction: Generate impression based on findings.

Input: 57-year-old with history of metastatic renal cell cancer, presurgical for C4 vertebrectomy. Reversal of lordosis of the cervical spine is identified. There is a significant compression fracture at C4, as well multiple metastases seen throughout the posterior elements of the cervical spine as reported on today's MRI. A posterior laminectomy from C3 to C5 is also identified.

Output: Diffuse posterior element metastases, as well as a significant compression deformity of C4. For better characterization, please see today's dedicated MRI report.


Instruction: Generate impression based on findings.

Input: Unspecified fall, initial encounter [W19.XXXA] / Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: 79F with multiple falls and RLE weakness, some incontinence too, h/o amyloidosis, ?spinal tumor, ?nerve impingement, For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-2 level.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation, with mild bilateral ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation, diffuse bulging of disc with mild bilateral ligamentum flavum thickening result minimal spinal canal stenosis. No neuroforaminal narrowing or spinal stenosis. L4-L5: There is grade 1 anterolisthesis of L4 on L5. Associated with bilateral ligamentum flavum thickening, spinal canal at this level shows moderate to severe spinal stenosis. No neuroforaminal narrowing or spinal stenosis. L5-S1: Disc desiccation, diffuse bulging of disc with bilateral ligamentum flavum thickening indicates minimal spinal canal stenosis. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Grade 1 anterolisthesis of L4 on L5 with moderate to severe spinal canal stenosis.2. Degenerative spondylosis of the lumbar spine including various degree of spinal stenosis as described above.3. No evidence of spinal cord compression.


Instruction: Generate impression based on findings.

Input: Prostate cancer. Evaluate for high risk features. PELVIS:PROSTATE:Prostate Size: 2.9 x 5.6 x 4.2 cmPeripheral Zone: In the left medial apex there is a 1.0 x 0.5 cm lesion with decreased T2/ADC signal (series 1001/11) as well as diffusion restriction (series 1104/1 84).In the right lateral mid gland there is a 9 x 7 mm focus with decreased T2/ADC signal (series 801/68) as well as associated restricted diffusion (series 1104/224).There is atrophy at the right base with ill-defined decreased T2 signal but no associated abnormal signal on ADC/DWI.Central Gland: Mild benign prostatic hyperplasia. No discrete suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small left external iliac lymph nodes are nonspecific. No additional enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant 1.0 cm left medial apex and 0.9 cm right lateral mid gland lesions, suspicious for prostatic adenocarcinoma.2.Indeterminate ill-defined lesion at the right base. 3.No evidence of extracapsular extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Left-sided sciatica with weakness in dorsiflexion For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Diffuse bulging of disc which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc with associated broad-based disc protrusion towards left side lateral recess which compress left-sided nerve root. Disc desiccation is seen.L5-S1: Diffuse bulging of disc. Disc desiccation is seen. No neuroforaminal narrowing or spinal stenosis.

Output: Central to left disc herniation at the level of L4-5 as described above.Diffuse bulging of discs at the level of L3-4 and L5-S1.


Instruction: Generate impression based on findings.

Input: Spine: Again seen are postoperative changes related to tumor resection with T7 and T8 laminectomies. Myelomalacia involving the cord from the T6 to T10 levels with associated cord deformity appears similar. The cord is again somewhat dorsally located within the thecal sac that some of these levels which may relate to adhesions. No new cord signal abnormality. Focal susceptibility at the T11 level dorsally is unchanged and consistent with postsurgical change. There is no new pathological enhancement. Again seen is enhancing nodule at the T8 level which is in the resection bed of resection from 9/2014 but smaller compared to prior pre-recent resection MRI from 7/21/2014. Lesion measures 8 mm in the craniocaudal dimension and 4 mm in the anteroposterior dimension. Axial images are motion degraded. The cervical, thoracic, and lumbar spine are in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis.Brain: The brain parenchyma appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is no abnormal intracranial enhancement.

Output: 1. Postoperative changes of tumor resection in the thoracic spine with extensive myelomalacia from T6 to T10. Again seen is an enhancing nodule at the T8 level which is in the surgical bed of recent resection from 9/2014. Although some of this enhancement may be post-surgical, residual/recurrent tumor is not excluded. Finding is slightly more prominent than prior. Suggest close follow-up.2. No new area of enhancement in the thoracic cord or leptomeningeal disease in the spine.3. MRI of the brain is unremarkable without evidence of intracranial mass or abnormal parenchymal or meningeal enhancement.


Instruction: Generate impression based on findings.

Input: 40-year-old female with pituitary lesion, assess for changes. The pituitary gland is appropriate in overall height and morphology. There is mild heterogeneous enhancement of the pituitary gland, however there are no discrete lesions identified. Dynamic images are slightly degraded by motion. No definite T2 pituitary abnormality is seen. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally. There is no diffusion abnormality.

Output: Mild heterogeneous enhancement of the pituitary gland with no discrete lesions identified.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: right knee meniscus tear History: pain and swelling MENISCI: Slight attenuation of the posterior horn of the medial meniscus that may reflect interval partial meniscectomy. A small focus of intermediate signal intensity along the undersurface of the remainder of the posterior horn of the medial meniscus may simply represent residual degenerative signal within the meniscus although we cannot completely exclude a small undersurface tear. More concerning however is replacement of the body of the medial meniscus with increased signal intensity, best seen on the coronal sequences, suggesting a large radial tear. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a new full-thickness defect of the articular cartilage on the weight-bearing surface of the medial femoral condyle measuring between 1.0 and 1.5 cm in greatest dimension. There is extensive edema within the underlying medial femoral condyle. There is also a large full thickness defect of the articular cartilage at the anterior aspect of the medial femoral condyle extending into the trochlea measuring between 1.0 and 1.5 cm in greatest dimension which is new from prior study. There is focal partial thickness degeneration of the articular cartilage of the lateral facet of the patella. The articular cartilage of the lateral joint compartment appears intact.LIGAMENTS: The anterior cruciate ligament now appears thickened and of increased signal intensity in a pattern suggestive of mucoid degeneration with small foci of signal abnormality within the adjacent tibial plateau and intracondylar notch of the femur. The posterior cruciate ligament is intact. There is edema along the superficial fibers of the medial collateral ligament that could represent a sprain in the correct clinical context. The deep fibers of the medial collateral ligament appear abnormally thickened which could represent tearing related to the aforementioned medial meniscus abnormalities. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: There is mild edema along the anterior margin of the patellar tendon but the patellar tendon and quadriceps tendon appear intact.ADDITIONAL

Output: 1. Post operative changes of the medial meniscus as described above with findings suggestive of a new large radial tear through the body of the medial meniscus.2. New full-thickness cartilage defects along the medial femoral condyle as described above with new edema in the medial femoral condyle as well.3. Thickening and increased signal intensity in the anterior cruciate ligament suggesting progression of mucoid degeneration.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Status post resection of cerebellar osteosarcoma metastasis referred for post-operative SRS to cavity. There are postoperative findings related to right suboccipital craniotomy with mild susceptibility and presumed linear enhancement along the margins of the right cerebellar hemisphere resection cavity, which measures up to 25 mm. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. A subcentimeter nodular and linear focus of presumed enhancement in the left temporal fossa may represent a vascular or inflammatory lesion versus less likely a metastasis.

Output: Pre-treatment planning MRI shows recent postoperative findings related to right suboccipital craniotomy.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cranial nerves [D33.3], Reason for Study: ^Reason: Brain tumor: Preop planning for resection History: headaches The scan was performed with multiple fiducial markers attached on the scalp.There is a large extra-axial mass on the left petrous apex with inhomogeneous enhancement.The mass is measured about 47.1mm(CC) x 35.7mm(RL) x 51.3mm(AP).The mass is centered at or around mesial skull base and eroding left petrous apex.The mass shows central non enhancing portion without evidence adjacent dural enhancement.The left cavernous sinus appears to be involved or completely pushed toward right side and the left cavernous sinus segment of the left ICA appears to be surrounded by the enhancing mass about 180-200 degree especially at the junction of petrous segment and posterior cavernous sinus segment.There is mass effects against brain stem, left cavernous sinus and left mesial temporal lobe.Differential diagnosis include left trigeminal nerve origin schwannoma or meningioma. There is no evidence of ventriculomegaly.The paranasal sinuses and mastoid air cells are clear.

Output: Left petrous apex extra axial mass with inhomogenous enhancement as described above.Differential diagnosis include Schwannoma and meningioma.


Instruction: Generate impression based on findings.

Input: Male 51 years old; Reason: Back pain. There is moderate degenerative disc disease at L4-5 and mild degenerative disease at L2-3 and L3-4. The vertebral body heights are preserved and alignment is anatomic.

Output: Degenerative disc disease as described above.


Instruction: Generate impression based on findings.

Input: 50 year-old female with generalized abdominal pain. History of ulcerative colitis. Evaluate for inflammatory bowel disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal mass measures 2 x 3 cm in axial image 30/14 series 3. This is incompletely evaluated on the postcontrast study. Further evaluation with dedicated adrenal CT or MRI examination may be helpful for further characterization, if indicated.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The colon is ahaustral and the descending colon contains small amount of fluid within mucosal enhancement. The appearance is consistent with history of ulcerative colitis. Normal appendix in the right lower quadrant. The terminal ileum appears normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: There is a central pelvic uniloculated fluid density cystic lesion which measures 7 x 8 cm in axial image 120/154 of series 3. This is most likely of adnexal origin. Bilateral adnexal cysts, larger on the left measuring more than 5 cm in diameter. If clinically indicated, transvaginal ultrasound examination may be helpful for further evaluation.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Ahaustral colon compatible with history of ulcerative colitis. No small bowel abnormality was identified. Central pelvic cystic lesion, probably adnexal measures 7 x 8 cm. Additional cystic lesions in the adnexae. Right adrenal mass.


Instruction: Generate impression based on findings.

Input: Clinical question: Please perform Dr.Javed's multiple sclerosis protocol on 3T. signs and symptoms: MS progression, please compared with prior. Pre-and post-enhanced cervical MRI:Examination redemonstrates multiple foci of T2 hyperintensity throughout the cervical cord without convincing evidence of interval change since prior study. Limited view of the posterior fossa also demonstrate multiple lesions in the pons and medulla which also appear to have remained stable since prior exam. None of the lesions demonstrate abnormal enhancement. Findings consistent with patient's known emanating disease and medulla suggestion of progression.Multilevel degenerative changes cervical spine worst at C5 -- C6 and resultant central spinal stenosis and with moderate left and mild right neural foraminal compromise remain similar to prior exam. No evidence of spinal or neural foraminal compromise/stenosis at any other level.Pre-and post-enhanced thoracic MRI:Examination demonstrate multiple small foci of T2 hyperintensity in the ,mid to lower thoracic cord which considering slight difference in technique between the exam demonstrate no definitive evidence of interval change or progression. None of the lesions demonstrate enhancement. The lesions span from T5 inferiorly and with a cluster of lesions at T10 through the conus similar to prior exam. Some of the lesions demonstrate subtle associated decreased cord caliber suggestive of volume loss. The signal intensity in the alignment of the tubercle remains within normal and without evidence of spinal canal or neuroforaminal compromise at any level. There is no detectable abnormal enhancement of the vertebral column.

Output: 1.Mild to moderate findings of chronic demyelinating disease of the cervical cord without convincing evidence of interval progression. Degenerative changes of cervical spine with resultant central spinal stenosis and bilateral neural foraminal compromise only at C5 -- C6 remains similar to prior exam. No spinal stenosis or neural foraminal compromise at other levels.2.Findings of chronic demyelinating disease of thoracic cord from T5 through the conus without enhancement or progression since prior exam.


Instruction: Generate impression based on findings.

Input: 18 years Female (DOB:7/28/1997)Reason: ? vasculitis History: confusion and h/o lupusPROVIDER/ATTENDING NAME: JAMES AHN RIMAS V LUKAS MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a well-circumscribed focus of signal loss present in the left lentiform nuclei within the putamen which is associated with some enhancement.There is a tuft of enhancing serpiginous structures posteriorly with signal loss on susceptibility imaging located in the left frontal lobe adjacent to the left middle frontal gyrus which is suspected to represent a developmental venous anomalyThere is a mild degree of subcortical and periventricular punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are predominantly identified in the left hemisphere.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is relatively small to medium sized.. The right posterior communicating artery is medium-sized whereas the left posterior communicating artery is small to medium sized. The left vertebral artery is larger than the right vertebral artery. Findings also suggest a double origin left posterior inferior cerebellar artery. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is an ill-defined lesion present in the left basal ganglia. One possibility is that this may represent capillary telangiectasia.4.There is a lesion in the left frontal lobe which is suspected represent a developmental venous anomaly, however, it may be associated with capillary telangiectasia.5.There is a mild degree of subcortical and periventricular white matter lesions present predominantly in the left hemisphere. These are unusual at this age. Differential considerations include vasculitis as well as trauma, demyelinating disorder and vascular related lesions.6.Double origin left posterior inferior cerebellar artery.


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache Cerebral aneurysm, nonrupturedClinical question: assess for thrombus developmentSigns and Symptoms: acute onset left hemiparesis MRI of the brainThere are multiple foci of subcentimeter sized diffusion restriction within the distal right MCA territory along the watershed zone adjacent ot the right superior frontal sulcus and in the right inferior parietal lobule as well as in the right with several mor scattered in the right frontal and parietal lobes. In addition, there are Periventricular and and subcortical white matter signal hyperintensities identified on FLAIR MRI without diffusion restriction some of which were not present on the 10/19/15 exam. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small air-fluid levels in the maxillary sinuses and left sphenoid sinus and scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Embolic occlusion coils are present at the patient's right anterior choroidal bilobed aneurysm (which is embedded into the medial aspect of the right temporal lobe) and the patient's basilar aneurysm. The anterior choroidal artery remains patent. There is no evidence for recanalization of either aneurysm at this time.There is redemonstration of a 2mm right ophthalmic artery aneurysm at the origin of the right ophthalmic artery. There is redemonstration of a left superior cerebellar origin 1 mm aneurysm. There is redemonstration of a 1 mm left PCOMA aneurysm.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.The anterior communicating artery is identified. The posterior communicating arteries are small. The left vertebral artery is slightly smaller than the right vertebral artery.

Output: 1.Multiple subcentimeter foci of infarction predominantly located along the right hemispheric watershed zone. These could be related to distal emboli.2.No evidence for cerebrovascular occlusion.3.Status post embolic coil occlusion of a right anterior choroidal artery aneurysm without evidence for recanalization at this time and no change since the MRA earlier in the day. This aneurysm is embedded in the right temporal lobe.4.Status post embolization of a basilar/left AICA origin aneurysm without evidence for recurrence.5.Findings were discussed with Dr Kramer at the time of the exam.6.There is redemonstration of a 2mm right ophthalmic artery aneurysm at the origin of the right ophthalmic artery. 7.There is redemonstration of a left superior cerebellar origin 1 mm aneurysm.8.There is redemonstration of a 1 mm left PCOMA aneurysm.


Instruction: Generate impression based on findings.

Input: 27-year-old female with multiple sclerosis. 3T CCD MRI Javed MS protocol no DTI Redemonstrated are multiple variable sized T2 hyperintense lesions of the periventricular and subcortical white matter, also along the corpus callosum, and within the cerebellum. There appear to be several more punctate lesions on the current exam, however this may be technical in nature given the comparison study was obtained at 1.5 Tesla and the current exam at 3 Tesla.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, or midline shift. The midline structures and cranial-cervical junction are normal. Note is again made of a partially empty sella. Normal flow voids are identified in the major intracranial vessels. Minimal mucosal thickening can be found within ethmoid air cells and the left sphenoid sinus without air-fluid levels. The remaining paranasal sinuses and mastoid air cells are clear.

Output: Redemonstrated are supratentorial and infratentorial brain lesions consistent with multiple sclerosis plaques. There appear to be several more punctate lesions, however this may be technical in nature given the comparison study was obtained at 1.5 Tesla and the current exam at 3 Tesla.


Instruction: Generate impression based on findings.

Input: Male, 15 years old, with history of recurrent juvenile angiofibroma, and two episodes of epistaxis since prior imaging, granulation tissue evident on the posterior septum. Assess and compare to prior imaging. Evidence of prior sinonasal surgery is seen for partial resection of a juvenile angiofibroma. Residual infiltrative enhancing tissue remains involving the left sphenoid bone, the pterygopalatine fossa, the left cavernous sinus, sella and clivus, and to a lesser degree the left masticator space. On comparison with the prior examination, the size and extent of this residual enhancing tissue has not convincingly changed. There is a greater degree of what likely represents sinus mucosal thickening along the residual walls of the left maxillary sinus. Mucosal thickening within the left ethmoidectomy bed has not significantly changed. No definite evidence of any new sinonasal lesion is seen.

Output: Evidence of extensive prior sinonasal surgery is seen for partial resection of the juvenile angiofibroma. Enhancing tissue centered on the left sphenoid bone with extension to the surrounding spaces is redemonstrated which most likely represents tumor. Since the prior examination, no definite increase in tumor size is seen, and no new lesions are identified.


Instruction: Generate impression based on findings.

Input: Newly diagnosed breast cancer. Hepatic lesions suspicious for metastatic disease. Back pain but neurologically nonfocal. There are 7 cervical, 12 thoracic, 4 lumbar, and 1 lumbosacral transitional vertebra. This transitional vertebra is labeled L5 for the purposes of this dictation.There is normal curvature and alignment of the spine. There is no fracture or loss of height of the vertebra. However, there is hypodensity within the right C3 vertebra and the left C5 vertebra (series 8051 images 16 and 20 respectively). Also question of focal lesion within right T1 vertebra (series 8050 image 19). These lesions are nonspecific and enhancement pattern cannot be accurately characterized by CT. However, they could represent metastatic disease in this patient who has breast cancer newly diagnosed. Bone scan may be helpful for confirming active bone remodelling and detecting occult lesions elsewhere.Detection of intracanalicular and paravertebral metastatic disease is extremely difficult based on CT. However, there is no gross intracanalicular mass lesion that can be identified based on CT. The morphology of the cord and conus medullaris appear grossly normal. In this circumstance, clinical correlation is essential.Moderate cervical spine degenerative change is present. Findings are specified level by level:C2-C3: No disk herniation, thecal sac effacement, or foraminal narrowing.C3-C4: Left sided disk osteophyte complex and uncovertebral hypertrophy. As a result, there is mild narrowing of the ventral thecal sac on the left and moderate left foraminal narrowing.C4-C5: Questionable disk protrusion with at most partial ventral thecal sac effacement. Minimal foraminal narrowing secondary to uncovertebral hypertrophy and facet hypertrophy. There is acquired fusion of the right facet articulation at this level.C5-C6: Posterior disk osteophyte complex results in partial sac effacement. There is also severe right and minimal left foraminal narrowing secondary to uncovertebral hypertrophy and facet hypertrophy.C6-C7: Minimal posterior disk osteophyte complex with at most partial ventral thecal sac effacement. Mild bilateral foraminal narrowing secondary to uncovertebral hypertrophy.C7-T1: No gross disk herniation, thecal sac effacement, or foraminal narrowing. However, streak artifact obscures detail at this level.In the thoracic spine, there is no gross disk herniation or thecal sac effacement apart from some mild dorsal thecal sac partial effacement at right T8-T9 and T10-T11 from calcified ligamentum flavum hypertrophy. There is no osseous encroachment upon the neural foramina though small disk herniations could be easily obscured given image quality. There is endplate sclerosis and anterior osteophyte seen between T3 and T12.In the lumbar spine, there is minimal degenerative change. Findings are specified level by level:L1-L2: No disk herniation, thecal sac effacement, or convincing foraminal encroachment.L2-L3: Minimal diffuse disk bulge. No central canal stenosis or foraminal narrowing.L3-L4: Mild diffuse disk bulge eccentric to the left. While there is no central canal stenosis, there is mild to moderate left foraminal narrowing from the disk herniation. Also minimal facet hypertrophy.L4-L5: Mild diffuse disk bulge with some questionable encroachment on the lateral recesses. No central canal stenosis. Probably some mild foraminal narrowing bilaterally.L5-S1: Partially fused disk space. No disk herniation, central canal stenosis, or foraminal narrowing.In the extraspinal soft tissue structures, there is elevation of the right hypopharynx from retropharyngeal carotid. No cervical lymph nodes. There is a right pleural effusion with passive atelectasis and a calcified subcarinal lymph nodes and right hilar lymph nodes, better evaluated on earlier chest CT. The nodularity of the liver is not well demonstrated on this examination which is motion degraded and has a more circumscribed field-of-view; hepatomegaly still evident. Slice intracranial contents are unremarkable apart from some mild intracranial vasculature ossification. Hypodensity seen in the middle cerebellar peduncles is felt to be most likely artifactual.

Output: 1. Areas of hypodensity/bone lysis within the right C3 and possibly left C5, right T1 vertebra. At least the C3 lesion is suspicious for metastatic disease--correlative bone scan (nuclear medicine) may be of value. No other destructive osseous lesions and no compression fractures.2. This study is poorly sensitive for intracanalicular metastatic disease and paravertebrally metastatic disease. However, no gross compression of the cord or conus is seen. If there is strong concern for leptomeningeal disease, suggest CSF puncture. 3. Mild to moderate spinal degenerative changes. Small and subtle findings are potentially obscured given poor image quality.4. Chest and abdominal findings were better seen on prior dedicated imaging. Slightly increased right pleural effusion.Findings discussed with and acknowledged by Dr. Laffin 10/27/2012 11:38 AM .


Instruction: Generate impression based on findings.

Input: Dysarthria following unspecified cerebrovascular disease [I69.922] / Essential (primary) hypertension [I10], Reason for Study: ^Reason: Concern for stroke History: As above There are new restricted diffusion lesions on the brainstem including right side of the lower midbrain, right side middle cerebellar peduncle, anterior aspect of lower pons, and right posterior aspect of medulla indicating acute ischemic infarct.Previously seen multifocal lower pontine and left middle cerebellar peduncle area restricted diffusion lesions has been decreased in signal intensity indicating normal evolution. There is no evidence of hemorrhage transformation.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: New acute ischemic infarcts on the brainstem as described above.Normal evolution of previously seen acute ischemic infarctions.No evidence of hemorrhagic transformation.


Instruction: Generate impression based on findings.

Input: 68-year-old female with right knee pain and swelling for 6 months. MENISCI: There is increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface consistent with a complex degenerative tear that extends to the body of the meniscus. There is blunting of the anterior horn of the meniscus suggestive of degeneration/tearing with a longitudinal component through the anterior horn of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral femoral condyle above the posterior horn of the meniscus as well as along the lateral tibial plateau underlying the posterior horn and body of the meniscus with underlying subchondral signal abnormality which is likely degenerative in etiology. There is a partial-thickness articular cartilage fissure along the lateral facet of the femoral trochlea.Note is made of curvilinear serpentine increased signal abnormality within the distal femoral metadiaphysis and epiphysis as well as within the proximal tibial metadiaphysis and epiphysis consistent with osteonecrosis/bone infarcts. There is apparent subchondral collapse/fracture along the weight bearing surface of the medial and lateral tibial plateau. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteonecrosis of the femur and tibia with apparent focal areas of subchondral collapse/fracture along the medial and lateral femoral condyles.2. Degenerative osteoarthritic changes of the right knee.3. Large joint effusion.4. Tearing of the lateral meniscus as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Left frontal grade 3 oligodendroglioma with 1p19q deletion. Now off all therapy. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted findings.Examination demonstrates a focus of hemorrhagic encephalomalacia along the superior aspect of the left mid to posterior frontal lobe consistent with the site of previously treated/operated tumor. There is no evidence of interval change of this finding since prior exam. Post-enhanced images demonstrate no evidence of abnormal enhancement which is a similar observation is prior to study.There is postoperative changes of left frontal -- anterior parietal craniotomy with a small extra axial CSF signal intensity collection confined to the undersurface of craniotomy flap and likely representing an epidural CSF signal intensity postoperative collection. There is expected this enhancement of dura at this level similar to prior exam. There is subtle flattening and deformity of the brain parenchyma at the site of surgery secondary to this collection which may also be as result of adhesion. This appearance remains also identical to prior exam. This collection appears to bulge into the bur hole along the medial edge of craniotomy flap. This is also similar to prior study.Residual flair hyperintensity surrounding the surgical cavity consistent with gliosis is again noted. Unremarkable and stable pre-and post enhanced brain MRI otherwise.

Output: 1.Stable post treatment/surgical changes of the left demonstrate oligodendroglioma with out evidence of residual or recurrence of tumor.2.Stable postoperative changes of left frontoparietal craniotomy and extra-axial collection under the craniotomy flap as detailed.3.Unremarkable exam otherwise and without change