Instruction: Generate impression based on findings.

Input: Other malaise and fatigueClinical question: ischemic CVASigns and Symptoms: left-sided weakness x 3 days MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The 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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The cervical spinal canal is small. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this levelAt C3-4 there is no significant compromise to the neural foramina. There is a mild disc bulge present at this level and partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis presentAt C4-5 there is no significant compromise to the neural foramina. There is a small central disc protrusion present at this level associated with mild posterior ligamentous hypertrophy and partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis present at this level.At C5-6 there is no significant compromise to the neural foramina. There is a small central disc protrusion present at this level associated with mild posterior ligamentous hypertrophy and partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are some degenerative changes present in the cervical spine superimposed on a small cervical spinal canal. There is only mild spinal stenosis present at multiple levels resulting predominantly from disc disease.2.There is no evidence for acute ischemic cerebral infarction3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Exam is mildly degraded due to some patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Left vertebral artery and proximal basilar artery occlusion. Right sided weakness. Acute brainstem stroke.IMAGE ACQUISITIONS: Precontrast head CT followed by dynamic bolus contrast enhanced CTA of the head 0.9-mm source images. Sagittal and coronal and 3-D reformats were also obtained. There is complete occlusion of the dominant left vertebral artery. Right vertebral artery is congenitally small and predominantly supplies PICA with minimal if any contribution to basilar flow. Right V4 segment is very small. There is questionably a very thin lumen along the right side of the proximal basilar artery, possibly supplied by the right V4 segment. Most of the flow to the mid and distal basilar artery appears to be from posterior communicating arteries from the carotid arteries.There is intraluminal thrombus of indeterminate age in the left vertebral artery to the level of the proximal basilar artery.There is no other evidence of intracranial arterial stenosis. There is no evidence of intracranial aneurysm or intracranial pseudoaneurysm. There is no acute intracranial hemorrhage. Brain stem and corpus callosum infarcts that were demonstrated on MRI are not yet demonstrable on CT.

Output: Complete occlusion and thrombosis of dominant left vertebral artery to the level of the proximal basilar artery, with minimal if any antegrade flow from the distal right vertebral artery and likely substantial retrograde collateral flow from posterior communicating arteries.Findings were discussed by telephone with Dr. Yallapragada on 06/06/2009 approximately 1930 hrs.


Instruction: Generate impression based on findings.

Input: 52-year-old African-American male with left-sided weakness. Possible CVA. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in the periventricular and subcortical white matter distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: There are multilevel various degree degenerative changes of the cervical spine with exaggerated cervical lordosis. Multilevel anterior osteophytes are seen. The marrow signal is heterogenous. In particular, the C6 inferior endplate and C7 superior endplate show T1 and T2 hypointensity suggestive of sclerotic changes. There is no evidence of Gad enhancement of the vertebral bodies.C2-C3: There is trace disc bulge with no neural foraminal or spinal cord compromise.C3-C4: No spinal or foraminal compromise.C4-C5: There is diffuse disc bulge with minimal to mild spinal canal stenosis and no neural foraminal compromise.C5-C6: There is diffuse disc bulge with mild spinal canal stenosis. There is right-sided mild to moderate neural foraminal stenosis and mild left-sided neural foraminal stenosis.C6-C7: There is mild disc bulge without evidence of spinal stenosis. No neural foraminal compromise.C7-T1: No neural foraminal or spinal compromise.There are multiple areas of disc bulge in the upper thoracic spine with no evidence of spinal stenosis.Note is made of bulla in the right apex.

Output: 1. No evidence of abnormal enhancement or focal abnormal signal intensity lesion on cervical vertebral bodies suggesting metastatic disease.2. Multilevel degenerative changes including mild to moderate right neural foraminal stenosis and mild left-sided neural foraminal stenosis at the level of C56 with mild spinal stenosis3. Diffuse disc bulging with minimal to mild spinal stenosis at the level of C4-C5.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE: The vertebral body heights are preserved. There is mild to moderate loss of disc height at multiple levels. There are subcentimeter cystic foci in the posterior aspects of the C3 and C7 vertebra, which are likely degenerative in nature. There is loss of the usual cervical lordosis and a congenitally narrow spinal canal. In conjunction with multilevel degenerative spondylosis, there is spinal canal stenosis with mild impingement of the spinal cord. However, the spinal cord displays normal signal. The paravertebral soft tissues are unremarkable. Additional findings by level:C2-C3: Posterior disc osteophyte complex with effacement of the ventral CSF space, flattening of the ventral cord and thickening of the ligamentum flavum contribute to moderate spinal canal stenosis, but no significant neural foramen stenosis.C3-C4: Posterior disc osteophyte complex, central to slightly asymmetric to the right, with flattening of the ventral cord and thickening of the ligamentum flavum contribute to moderate spinal canal stenosis and mild bilateral neural foramen stenosis. C4-C5: Posterior disc osteophyte complex with mild flattening of the ventral cord, bilateral uncinate spurs and thickening of the ligamentum flavum contribute to moderate spinal canal stenosis and moderate right and mild left neural foramen stenosis.C5-C6: Posterior disc osteophyte complex, bilateral uncinate spurs, thickening of the ligamentum flavum and right greater than left facet arthropathy contribute to moderate spinal canal stenosis and moderate bilateral neural foramen stenosis.C6-C7: Posterior disc osteophyte complex, bilateral uncinate spurs, and thickening of the ligamentum flavum contribute to mild spinal canal stenosis and mild bilateral neural foramen stenosis.C7-T1: No significant spinal canal or neural foramen stenosis.THORACIC SPINE: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is mild multilevel loss of disc height. The vertebral bone marrow signal is unremarkable. There are mild disc bulges of the thoracic spine. There is a small central disc protrusion at T6-T7 with mild indentation of the ventral cord. There is no associated spinal cord signal abnormality. The paravertebral soft tissues are unremarkable.LUMBAR SPINE: There is a compression fracture of the L1 vertebral body with approximately 50% loss of height centrally and mild posterior retropulsion. There is linear enhancement and high T2 signal within the vertebral body. There is no significant central spinal stenosis at this level. There is a compression fracture of the L5 vertebral body with approximately 75% loss of height centrally and 10 mm of posterior retropulsion, contributing to severe central spinal stenosis and compression of the cauda equina nerve roots. There is linear enhancement along the fracture cleft. There is also diffuse high T2 signal within the vertebral body, which extends into the posterior elements as well. There is soft tissue T2 hyperintensity and enhancement at the L4-L5 level, adjacent to the spinous processes, but no discrete fluid collection. Additional findings by level:T12-L1: L1 vertebral body fracture with mild retropulsion and moderate bilateral facet arthropathy and thickening of ligamentum flavum with minimal spinal canal and bilateral neural foramen stenosis.L1-L2: Mild disc bulge and moderate bilateral facet arthropathy, but no significant spinal canal or neural foramen stenosis.L2-L3: Mild disc bulge, thickening of the ligamentum flavum and moderate bilateral facet arthropathy, contributing to minimal bilateral neural foramen stenosis, but no significant spinal canal stenosis.L3-L4: Mild disc bulge, thickening of the ligamentum flavum and moderate bilateral facet arthropathy, contributing to mild spinal canal narrowing and mild bilateral neural foramen stenosis.L4-L5: L5 vertebral body compression fracture with moderate retropulsion. Disc bulge, thickening of the ligamentum flavum and moderate bilateral facet arthropathy, contributing to severe spinal canal stenosis, compression of the cauda equina and severe right and mild left neural foramen stenosis.L5-S1: Vacuum disc phenomenon, bilateral facet hypertrophy, and ligamentum flavum thickening with mild bilateral neural foramen stenosis, but no significant spinal canal stenosis.

Output: 1. L5 vertebral compression fracture with edema, 75% loss of height, and 10 mm of retropulsion superimposed upon underlying degenerative changes, contributing to severe spinal canal stenosis with compression of the cauda equina and severe right and moderate left foraminal stenosis at the L4-L5 level.2. L1 vertebral compression fracture with mild edema, 50% loss of height, and slight retropulsion, but no significant spinal canal stenosis.3. Multilevel degenerative cervical spondylosis and a congenitally narrow spinal canal, contributing to moderate spinal canal stenosis at C2-C3 to C5-C6 and variable degrees of multilevel foraminal stenosis.Findings discussed with Dr. Zimmerman on 12/31/2014 at 11:35 a by Dr. Wu.


Instruction: Generate impression based on findings.

Input: 45-year-old female patient with right foot and ankle pain. Right ankle: There is mild soft tissue swelling about the ankle, but we see no ankle fracture. There is mild spurring of the fibular tip, which may represent old trauma. Right foot: There is mild soft tissue swelling about the foot without acute fracture. A small ossicle along the lateral aspect of the cuboid bone may represent prior injury, however, cannot exclude retraction of an os peroneum from a peroneus longus tendon tear. If there is clinical concern for a tendon rupture, MRI can be obtained. Mild osteoarthritis affects the first metatarsophalangeal joint.

Output: 1.Mild soft tissue swelling and osteoarthritis without acute fracture seen.2.Ossicle lateral to the cuboid bone may not be of current clinical significance, however, if there is clinical concern for tendon rupture MRI can be obtained. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Provided history of recurrent endometrial cancer status post pelvic exenteration. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion. No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: The spleen is normal in size and enhancement without focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes from anterior pelvic exenteration with cystectomy and hysterectomy. BLADDER: Postsurgical changes from anterior pelvic exenteration with cystectomy and hysterectomy. Right lower quadrant ileal conduit.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right sacral insufficiency fracture, not significantly changed. OTHER: Trace free fluid.

Output: Postsurgical changes from anterior pelvic exenteration without evidence of recurrent or metastatic disease.Stable appearance of right sacral insufficiency fracture.


Instruction: Generate impression based on findings.

Input: Left low frequency sensorineural hearing loss and possible cochlear hydrops, but no vertigo . The cochleas bilaterally appear to be intact, without obvious dilation of the scala media. The bilateral vestibules and semicircular canals appear to be intact. However, the bilateral endolymphatic ducts and sacs are not conspicuous. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The bilateral mastoid air cells and middle ears appear unremarkable.

Output: The cochleas bilaterally appear to be intact, without obvious dilation of the scala media, and the bilateral vestibules and semicircular canals appear to be intact. However, the bilateral endolymphatic ducts and sacs are not conspicuous.


Instruction: Generate impression based on findings.

Input: 87 years Female (DOB:2/17/1929)Reason: 87F with h/o brain aneurysm and optic neuropathy with sudden loss of color vision left eye History: sudden loss of color vision left eyePROVIDER/ATTENDING NAME: SUSAN M KSIAZEK SUSAN M KSIAZEK MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact There is a punctate focus of enhancement present along the posterior aspect of the pons which corresponds to a microhemorrhage identified on the 9/11/2014 MRI of the brain in can be identified on the echo planar images as a signal void..No foci of diffusion restriction are appreciated within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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. The ophthalmic arteries are also identifiedThere is a 2.5 mm infundibulum present at the origin of the left posterior communicating artery. The posterior communicating arteries are very small.There appears to be obtaining infundibulum at the origin of the left ophthalmic artery. There is redemonstration of a slight bulge of the left internal carotid artery at the proximal ophthalmic segment and its lateral wall which is likely related to minor atherosclerosis.There is extracranial origin of the right posterior inferior cerebellar artery present.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The vertebral arteries are similar in size.

Output: 1.There is no evidence for an intraorbital mass or other explanation for the patient's visual loss involving the left eye.2.There is a 2.5mm infundibulum present at the origin of the left posterior communicating artery.


Instruction: Generate impression based on findings.

Input: Clinical question : Status post craniotomy for posterior fossa lesion. Signs and symptoms: As above. Nonenhanced head CT:There is expected postoperative changes of the right paramedian suboccipital craniotomy. Residual vasogenic edema in the right cerebellum is again noted. There is no evidence of parenchymal hemorrhage. Air filled surgical cavity measures approximately 17 times 12-mm in size. Fourth ventricle is in normal position and normal in size. The residual air in the subarachnoid space is also present.Focus of encephalomalacia in the left occipital lobe is likely result of an old stroke and unchanged since prior MRI exam.Prominence of cortical sulci and ventricular system for patient's stated age is similar to the preoperative study.

Output: 1.Expected postoperative changes of right paramedian suboccipital craniectomy.2.Residual vasogenic edema in the right cerebellum similar to prior study.3.Prominence of cortical sulci and ventricular system for patient's stated age of 56 similar to prior exam.4.Focus of encephalomalacia in the left occipital lobe as was seen on prior MRI study.


Instruction: Generate impression based on findings.

Input: 59 year old male with history of thyroid cancer with metastases. Status post resection, brain irradiation, chemotherapy. On clinical trial. CT of the soft tissues of the neck.Images through the skull base including cavernous sinuses are within normal limits.Images through the soft tissues of the neck demonstrate a well demarcated enhancement involving the posterior wall of nasopharynx (axial image 24 through 28). There is no evidence of an increased soft tissue mass with this finding. All of the prior studies where re-examined and demonstrated the same finding with no interval change. The exact etiology of this finding is not clear. Possibility of a tumor would be considered very low considering its stable appearance since 4 -- 28 -- 2008. An MRI may be helpful to precisely determine the etiology of this finding. This finding does not appear as a postsurgical change.An enhancing right posterior triangular lymph nodes on axial image 35 is again identified and no interval change since prior study. This node measures identical to the prior exam and is 10 mm times 11.8-mm in size.A smaller enhancing right posterior triangular lymph nodes is again also identified with no interval change. Enhancement could appearance of a central necrosis immediately medial to the right internal carotid artery is believed to represent a Trumbull was to jugular vein. This finding is also stable since prior exam (axial image 34 through 39).Extensive post therapy changes of the soft tissues of the neck with distortion of anatomy is again identified. No definitive evidence of recurrence of tumor or pathologic adenopathy. Extensive metastatic lesion two bilateral upper lung fields are noted. Please review the dictated report of CT of chest. No osseous metastatic lesion.CT of brain with infusion.Multiple small supra-and infratentorial foci of increased density (cannot be certain whether they represent small calcific post treated metastases or enhancement) are again identified and with no interval change. No evidence of new lesions is identified. No evidence of hemorrhage, edema, midline shift or hydrocephalus.

Output: 1.Stable CT examination of soft tissues of the neck and with no definitive evidence of recurrence of tumor or pathologic adenopathy. Please see above comments.2.Stable findings on CT of brain which may represent post treated metastatic lesions.


Instruction: Generate impression based on findings.

Input: 44-year-old male is status post 6-foot fall from ladder with L4 compression fracture and retrolisthesis of L4 on L5 on x-ray Advanced degenerative disk disease with significant vacuum phenomenon and sclerotic changes of the adjacent endplates at L5 -- S1 level is noted. There is grade 1 anterolisthesis at this level secondary to bilateral pars defects (spondylolysis).Less than 50% compression fracture of the superior endplate of L4 and a small loose fragment anterior to the vertebral body is noted. The alignment of the spine at this level remains normal. No evidence of any fracture of the posterior elements is noted. The facets remain aligned at this level however demonstrate degenerative changes and minimal widening of the facet space which may be secondary to degenerative changes or possibly soft tissue injury secondary to patient's fall.For better evaluation of the soft tissues and MRI would be helpful. No definitive evidence of any compromise of the spinal canal at this level is detected.

Output: 1.Compression fracture of superior endplate of L4 with no malalignment.2.Grade 1 antral listhesis at L5 -- S1 secondary to bilateral spondylolysis.


Instruction: Generate impression based on findings.

Input: 36-year-old male with recurrent Ewing's sarcoma to the right shoulder. Patient is status post radiation. Evaluate response to treatment and for disease progression. The axillary mass seen on the previous study was not imaged in its entirety on the current study. The patient has been contacted and will return for further imaging at no charge at which time an addendum will be logged.There is intermediate signal intensity within the supraspinatus tendon indicating tendinosis. There is mild edema type signal intensity and enhancement of the teres minor muscle which appears more pronounced on the current study which is nonspecific and could represent sequela of radiation therapy, myositis or early denervation atrophy.The acromioclavicular joint appears normal. No frank fluid is is present in the subacromial/subdeltoid bursa.There is linear increased signal intensity separating the anterosuperior labrum from the glenoid likely representing a normal variant sublabral foramen. There is also amorphous low signal intensity between the anterior labrum and subscapularis muscle which appears similar to prior study with no appreciable enhancement or uptake on recent PET scan and may represent scar tissue or thickened ligamentous structures from prior trauma.We see no joint effusion or synovitis.There is curvilinear intermediate signal within the extra-articular tendon of the long head of the biceps that may represent a partial thickness tear but appears similar to prior study and not necessarily of any current clinical significance.As stated previously, the axillary mass seen on the previous study is not visualized in its entirety on the current study and measurements will be provided when the patient returns for further imaging. The mass may represent confluent lymphadenopathy. There are a few additional subcentimeter enhancing lymph nodes again noted more superiorly within the axilla and beneath the clavicle which are unchanged.We see no focal bone marrow lesions.

Output: 1. Incomplete evaluation of the patient's axillary mass. Patient has been contacted and will return at which point measurements and evaluation of the patient's mass will be made. Small enhancing lymph nodes in the axilla and clavicle appear similar.2. Mild edema type signal and enhancement of the teres minor muscle which is nonspecific and could represent sequela of radiation therapy, myositis or early denervation atrophy.3. Mild supraspinatus tendinosis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 69-year-old female with drainage from groin wound and associated induration. Evaluate for bilateral groin seromas versus abscess. ABDOMEN:LUNG BASES: Bibasilar atelectasis. No acute infiltrates or effusions. Mild cardiomegaly.LIVER, BILIARY TRACT: Cholelithiasis. The multiple ill-defined hepatic hypodensities. The small at the hepatic dome on image 14 of series 3. The largest is adjacent to the hepatic hilum in the medial segment of the left lobe measuring 2 cm in greatest dimension at axial image 37 of series 3. A second lesion in the medial segment of the left hepatic lobe measures 1.6 cm in greatest dimension on axial image 36 of series 3. These hepatic lesions could be better characterized with a multiphase dedicated liver CT or MRI examination.SPLEEN: No significant abnormality noted. Splenule at the hilum. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are multiple bilateral renal cortical cysts. There is a nonobstructing punctate left upper pole renal calculus. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Aortobifemoral bypass graft is in expected position and appears widely patent. Diffuse atherosclerotic changes with vascular calcifications.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple bilateral borderline enlarged inguinal lymph nodes, probably reactive.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Bilateral groin fluid collections, largest on the left. Both fluid collections appear uniloculated with mildly thickened enhancing wall. No gas bubbles. Both of these collections lie superficial to the distal aortobifemoral bypass graft anastomotic sites. Small amount of free fluid in the pelvis. The smaller right-sided fluid collection and has a maximum diameter of approximately 2.5 cm. The left sided collection extends craniocaudally for 13 cm and has a transverse dimension of 5.5 cm.

Output: Bilateral uniloculated groin fluid collections at the distal anastomoses of aortobifemoral bypass graft. Enhancing rims suggest these are more likely abscess than seroma.. Multiple hepatic hypodensities are better characterized with dedicated liver CT or MR examination, if indicated.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of right frontotemporal craniotomy for resection of sphenoid wing meningioma. Again seen is minimal dural based thickening in the right middle cranial fossa measuring up to 7 mm in thickness extending medially into the right paraclinoid region, which is similar to prior from 2/3/2015. There has been evolution of previously seen immediate post surgical changes with resolution of previous seen parenchymal edema and associated mass effect. There has been interval development of encephalomalacia involving the right anterior temporal lobe. No evidence of mass effect on the current study. Remainder of the brain parenchyma appears unremarkable. No hydrocephalus. No extra-axial collections. Aside from aforementioned postsurgical changes, calvarium and extracranial soft tissues are unremarkable.

Output: Compared to 2/3/2015, there is evolution of postsurgical changes related to prior right sphenoid wing meningioma resection with resolution of previously seen edema and associated mass effect and development of encephalomalacia in the right anterior temporal lobe. There is minimal dural based thickening and enhancement measuring approximately 7 mm in thickness in the right middle cranial fossa extending medially into the right paraclinoid region, which is suspected to represent minimal residual meningioma and remains unchanged since prior. No evidence of mass effect on the current study.


Instruction: Generate impression based on findings.

Input: 38-year-old male with pain. Evaluate for meniscal injury. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Focus of low signal abnormality in the lateral femoral condyle likely represents a benign bone island. Otherwise no bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is thickening and increased signal abnormality within the patellar tendon at its origin suggestive of patellar tendinopathy. ADDITIONAL

Output: Findings suggestive of patellar tendinopathy "jumper's knee" as described above. No evidence of meniscal injury, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Assess interval change in hemangioma. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic posterior segment T2 hyperintense lesion measures approximately 3.0 x 2.8 cm (series 6/7), compared to 3.3 x 3.6 cm previously. Left hepatic lobe T2 hyperintense lesion measures 1.2 cm, compared to 1.0 cm previously. The lesions demonstrate peripheral discontinuous nodular enhancement which progressively fills in on delayed phase imaging compatible with hepatic hemangiomata.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild interval decrease in size of the posterior segment 3.0 cm hepatic hemangioma. 1.2 cm left hepatic lobe hemangioma also seen as above.


Instruction: Generate impression based on findings.

Input: Thigh mass, endometrial cancer Within the anteromedial soft tissues of the right thigh is an irregular lesion measuring 4.7 x 2.7 x 2 cm in the greatest transaxial and craniocaudal dimension. This lesion demonstrates predominantly low signal on both T1 and fat-suppressed T2 sequences with some areas appearing slightly more cystic in nature. Following contrast administration, there is no significant enhancement. No additional lesions or abnormal enhancement is identified within the right thigh. The marrow signal of the femur is normal. There is mild atrophy of the posterior compartment musculature.

Output: Irregular lesion within the anteromedial soft tissues of the right thigh is nonspecific but given the low signal intensity on both T1 and T2 sequences and the lack of discrete enhancement, the findings may reflect fibrosis or scarring in an area of prior hematoma (per clinical history). However given the patient's history, continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Dysphagia. Neck lump. PET/CT scan showed soft tissue mass posterior to the trachea, potentially from the known thyroid cancer. The patient has rising globulin. He received RAI 55 years ago. History of papillary thyroid cancer; status post total thyroidectomy and right modified radical neck dissection on December 19, 2014. He had two positive lymph nodes in the central neck and 0/24 nodes in the right lateral neck. He also had invasion of the middle thyroid vein on the right, and minimal extrathyroidal extension into the strap muscles on the right. Subsequently, he underwent radioactive iodide treatments but was told that he had persistence and recent thyroglobulin levels have increased. There are changes of previous thyroidectomy. There is a rightward-eccentric, infiltrative, mildly STIR-hyperintense mass located just inferior to the posterior part of the cricoid cartilage. It demonstrates diffusion restriction diffuse contrast enhancement. The mass posteriorly displaces the uppermost esophagus with no intervening fat plane. It also displaces the trachea anteriorly with high likelihood of invasion into the trachealis muscle and the right posterolateral aspect of the first tracheal ring. It causes mild tracheal narrowing. Craniocaudally, it measures 2.5 cm and abuts the posterior arch of the cricoid cartilage without grossly eroding into it. It wraps around 50% of the circumference of the upper-most trachea and measures axially 4.3 cm x 3.0 cm. Focally decreased T1 signal within the right side of the mass probably reflects susceptibility artifact. Previous PET CT showed a surgical clip in a similar location. The larynx is unremarkable without definite invasion into the cricoid or thyroid cartilages. There is also no definite invasion into the adjacent vertebral bodies of C7 and T1. There is also no vascular encasement and major neck vessels are patent.There is no discrete cervical lymph node enlargement. The major salivary glands are unremarkable.There is complete opacification of the right maxillary sinus with inspissated secretions. There is partial opacification of the ethmoid and left maxillary sinuses and fluid in the right sphenoid sinus. Both orbital lenses have been replaced.Included lung apices are notable for posterior apical pleural thickening was present on the previous PET/CT.

Output: 1.Soft tissue mass involving the upper-most part of the tracheoesophageal groove with signs of invasion into the upper-most trachea, likely representing either a local recurrence given proximity to surgical clips, or regional lymph node metastasis related to the known thyroid cancer.2.There is no separate cervical lymphadenopathy.3.Opacification of the paranasal sinuses including complete opacification of the right maxillary sinus and fluid in the right sphenoid sinus may reflect sinusitis in the proper clinical setting.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with low back pain and hyperreflexia in the upper extremities but present sensory and motor exam. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No epidural abnormalities are suspected.At C5-6 there is minimal posterior disc-osteophyte complex formation and left facet hypertrophy resulting in a mild left foraminal stenosis. Minimal posterior disc-osteophyte complex formation is seen at C6-7 as well without significant spinal canal or foraminal stenosis. Perineural root sleeve cysts are evident within the C7-T1 neural foramen, but this is a common incidental finding.Lumbar:Grade 1 anterolisthesis of L3 relative to L4 is noted. Elsewhere, sagittal alignment is unremarkable. Vertebral body heights are within normal limits. Extensive degenerative endplate signal abnormality is seen at L3-4 and L4-5 but no worrisome marrow replacement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are seen.L1-2: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy. No significant spinal canal or foraminal stenosis. L3-4: Marked facet arthropathy and ligamentum flavum thickening. Disc bulging and disc uncovering asymmetric to the left. Moderate generalized spinal canal narrowing with some crowding of the nerve roots of the cauda equina. Both lateral recesses are narrowed. The left neural foramen is significantly narrowed with possible nerve root impingement. The right neural foramen remains patent. L4-5: Marked facet arthropathy and ligamentum flavum thickening. Bulging disc asymmetric to the right with a right paracentral protrusion. Moderate generalized narrowing of the spinal canal with right greater than left lateral recess effacement. The right neural foramen is moderately to severely narrowed while the left neural foramen is patent. L5-S1: Facet arthropathy. Minimal bulging disc. No significant spinal canal stenosis. Mild right foraminal narrowing.

Output: 1.No significant abnormalities are detected in the cervical spine to account for the patient's symptoms.2.Spinal canal narrowing with nerve root crowding is seen at L3-4 and L4-5. In addition, the left L3-4 and right L4-5 neural foramina demonstrate significant narrowing.


Instruction: Generate impression based on findings.

Input: 24 year-old female with cystic mass over fifth metatarsal There is a lobulated lesion dorsal to the proximal fifth metatarsal measuring1.4 x 1.6 x 1.6 cm with heterogeneously increased T2 signal, intermediate T1 signal and heterogeneous enhancement. The lesion surrounds and appears inseparable from the extensor tendon sheath. The underlying bone marrow signal and cortex is within normal limits. There is mild edema and enhancement of the surrounding soft tissues.

Output: Heterogeneously enhancing lesion dorsal to fifth metatarsal as described above for which an underlying infectious or neoplastic process should be considered. This would be atypical for a simple ganglion cyst, although a complicated cyst with hemorrhage or infection remains on the differential. Ultrasound guided biopsy may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Lower back pain, kyphosis, tight heel cord. Evaluate for syrinx or tethered cord, history of Marfan's syndrome, and kyphosis. There is mild to moderate cervicothoracic scoliosis centered at T4-5, with the apex directed to the left and associated straightening of the cervical and thoracic spine alignment in the sagittal plane. There is mild endplate deformity of multiple lumbar vertebrae. The vertebral body and disc space heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at L1-2. There is no evidence of fibrofatty filum terminale. The paravertebral soft tissues are unremarkable. The cerebellar tonsils are not low-lying and there is intact CSF flow across the foramen of Monro.

Output: 1. Cervicothoracic scoliosis and mild endplate deformity of multiple lumbar vertebrae are likely stigmata of Marfan's syndrome. 2. No evidence of syringohydromyelia, low lying conus medullaris, or fibrofatty filum terminale.


Instruction: Generate impression based on findings.

Input: There is redemonstration in the trigone of the left lateral ventricle a cyst that measures 17 x 27 mm, not significantly changed since the previous study. The cyst is displacing the choroid plexus medially and follows spinal fluid signal on all pulse sequences.The brain parenchyma demonstrates no T2/FLAIR abnormalities. There are no diffusion or susceptibility abnormalities. Ventricular size is normal with no midline shift. There is no abnormal enhancement.Vascular flow voids are normal.There are mucous retention cysts in both maxillary sinuses, right more than the left.

Output: Left lateral intraventricular cyst, unchanged in size since the previous study.


Instruction: Generate impression based on findings.

Input: Reason: hx seroma post drainage with recurrence. Eval size and location of seroma History: back pain There is a large fluid collection containing fluid levels in the dorsal subcutaneous fat at the L3-L5 level measuring 7.8 x 7.6 x 9.6 cm which extends from the paraspinal muscular fascia to the skin. This most likely represents a postoperative seroma and was not present on the exam from 1/31/2015.Alignment is anatomic. Vertebral body heights are intact. There is disc desiccation at L4-L5 and L5-S1. Marrow signal is normal normal signal and the distal cord and conus which ends at L1-L2. Postsurgical changes of left L4-L5 hemilaminectomy. T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild facet arthropathy and ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L3-L4: Right neural foraminal disc protrusion causing moderate to severe neural foraminal narrowing. Mild facet arthropathy and ligamentum flavum thickening. No spinal canal stenosisL4-L5: Large central disc protrusion causing mild to moderate spinal canal narrowing, improved from the prior exam. Mild facet arthropathy and ligamentum flavum thickening. Mild bilateral neural foraminal stenosis.L5-S1: Large central disc protrusion causing moderate spinal canal narrowing, unchanged. Mild facet arthropathy and ligamentum flavum thickening. Mild bilateral neural foraminal stenosis, left greater than right.

Output: 1.Large chronic hematoma/seroma in the dorsal subcutaneous tissues measuring 7.8 x 7.6 x 9.6 cm.2.Right neural foraminal protrusion at L3-L4 causing moderate to severe neural foraminal narrowing.3.Postsurgical changes of left L4-L5 hemilaminectomy with persistent large central protrusion and interval improvement in mild to moderate spinal canal narrowing4.Large central protrusion at L5-S1 with moderate spinal canal narrowing, unchanged.


Instruction: Generate impression based on findings.

Input: Moya moya, f/u pial synangiosis: surveillance. MRI: There are areas of T2 hyperintensity in the subcortical and deep cerebral white matter bilaterally. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There are postoperative findings related to bilateral pial synangiosis. There is apparent focal loss of flow-related signal in the distal portion of the otherwise patent right superficial temporal artery at the microcraniotomy site, but there is abundant underlying pial vasculature. There is a small caliber left superficial temporal artery diffusely, but there is abundant underlying pial vasculature. There is severe steno-occlusive disease of the supraclinoid right internal carotid artery and proximal right middle and anterior cerebral arteries. There is also severe steno-occlusive disease throughout the length of the left internal carotid artery and proximal right middle and anterior cerebral arteries. There are numerous moyamoya collateral vessels. The posterior cerebral circulation is intact.

Output: 1. MRI: Stigmata of moyamoya disease with what may represent chronic ischemic disease, but no acute infarction. The degree of cerebrovascular steno-occlusive disease is similar to the prior exam. 2. MRA: Findings related to bilateral pial synangiosis with apparent focal loss of flow-related signal in the distal portion of the right superficial temporal artery at the microcraniotomy site, which may be due to stenosis or artifact, but there is abundant underlying pial vasculature. The left superficial temporal artery is of diffusely small caliber, but there is abundant underlying pial vasculature.


Instruction: Generate impression based on findings.

Input: Reason: T2DM with osteomyelitis, pain with WB on R ankle History: pain, NWB Patient is status post transmetatarsal amputation. Diffuse soft tissue swelling. Ulceration beneath the remaining base of the fifth metatarsal again noted. Please refer to recent prior MRI for fifth metatarsal base osteomyelitis description. We see no ankle joint effusion or ankle bone osteomyelitis. Mild deformity of the distal fibula likely represents old fracture. No acute fracture is evident.

Output: Soft tissue swelling and ulceration as above. Please refer to recent prior MRI for fifth metatarsal base osteomyelitis description. No evidence of fracture or ankle osteomyelitis.


Instruction: Generate impression based on findings.

Input: Abnormal LFTs. Clinical concern for cholangitis. Patient also has history of cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: There is poorly defined increased T2 signal surrounding the intrahepatic bile ducts, left greater than right. This is a nonspecific finding but can be seen in the setting of inflammation/cholangitis. The left hepatic ducts are moderately dilated which accounting for differences in technique appears similar to most recent CT. The common bile duct has a stent in place, and there is debris proximal to and within the stent. Again seen is poorly defined soft tissue thickening the surrounding the distal common bile duct which measures 2.5 x 1.8 cm in maximum axial dimension compatible with the patient's known tumor.SPLEEN: No significant abnormality noted.PANCREAS: Mild pancreatic atrophy. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged ablation defect in the interpolar region of the right kidney.RETROPERITONEUM, LYMPH NODES: No upper abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right lateral abdominal wall broad-based hernia containing mesenteric fat and nonobstructed ascending colon.OTHER: Basilar subsegmental atelectasis and trace right pleural effusion.

Output: 1.Soft tissue mass surrounding the common bile duct compatible with the patient's known tumor appears similar to prior. There is left greater than right intrahepatic biliary ductal dilatation also not significantly changed. These bile ducts have surrounding increased T2 signal which is nonspecific but may be seen in the setting of inflammation/infection.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other symptoms and signs involving the musculoskeletal systemClinical question: Evaluate for venous sinus thrombosisSigns and Symptoms: Acute onset L sided weakness, headache 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 mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. 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.At the clinoidal segment of the right internal carotid artery there is a medially directed 3 mm broad-based aneurysm.There is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left transverse sinus and left sigmoid sinus are larger than the right-sided counterparts.

Output: 1.No evidence for cerebrovascular occlusive disease.2.There is a right internal carotid artery clinoid segment 3 mm aneurysm present3.MR venogram of the brain is within normal limits.4.There is no evidence for acute ischemic cerebral infarction.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 54-year-old woman with history of IPMN, evaluate for stability. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal.PANCREAS: An 8 mm cystic focus in the pancreatic body/tail (series 11, image 55) is unchanged and appears to communicate with the pancreatic duct. The pancreas duct is nondilated.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable sidebranch IPMN.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Concern for CSF leak, infection. Recent resection of L1-L2 tumor. Five lumbar type vertebral bodies are presumed to be present. There is normal lumbar lordosis. Postsurgical changes of a left L1 hemi-laminectomy for tumor resection and posterior left L1-L2 fixation with pedicle screws and unilateral paraspinous rod are redemonstrated. Additionally, there appears to have been partial resection of the inferior aspect of the L1 vertebral body.There is a fluid collection extending along either side of the spinous processes from T12 to L3. The collection on the left measures 11 mm in thickness and 8 cm in its craniocaudal dimension and appears to communicate with the skin surface. While the fluid collection on the left has a relatively simple fluid appearance, the fluid collection on the right which measures approximately 9 cm in the craniocaudal dimension and 2 cm in thickness demonstrates significant heterogeneous signal, which likely reflects internal debris or blood products. There is peripheral enhancement associated with both collections. Increased enhancement of the paraspinal musculature, left greater than right, may reflect myositis. There is no evidence of epidural abscess or discitis/osteomyelitis. No residual tumor is definitively appreciated The vertebral body and disk heights are well-maintained. Disc desiccation and disc bulge with mild to moderate narrowing of the neuroforamina affects L5-S1. There is no significant spinal canal stenosis. No focal marrow signal abnormality is appreciated. The conus medullaris and cauda equina nerve roots are unremarkable.

Output: 1. Posterior paraspinous fluid collection from T11 to the L3 levels with peripheral enhancement and inflammatory changes in the adjacent musculature. Given recent surgery, differentials include seroma and pseudomeningocele with superimposed infection/abscess not excluded. The fluid collection component on the right demonstrates heterogeneous signal likely reflecting internal debris/blood products while the fluid collection on the left demonstrates signal features more compatible with simple fluid. The collection on the left appears to extend to the skin surface along the surgical tract. Fluid sampling is suggested for further evaluation.2. There is no epidural abscess or spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 46 year old with biopsy proven grade 3 IDC in the right breast with metastatic right axillary lymph node. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A heterogeneously enhancing mass, measuring 38 x 39 x 37 mm (AP x LR x CC), which is a proven carcinoma, is present at 9:00 position in the right breast. A marker clip is identified at anterior-lateral aspect within the mass. Anterior to this mass, there is a linear non-mass enhancement measuring 28 x 25 x 19 mm, suspicious for extensive disease. Overall, the enhancing lesions measure 66 mm (AP).In the right superior axilla, there is an abnormally enlarged lymph node, a proven metastatic lymph node, measuring 44 mm. Post biopsy changes are seen in the cetral aspect of the lymph node. A marker clip is present at the anterior edge of the lymph node. There are two additional abnormal nodes, both approximately 1 cm in diameter, located posterior to the proven lymph node.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in left axillary region.

Output: 1. Proven right breast cancer with possible anterior non-mass extension 2. Proven right metastatic axillary lymph node, with additional suspicious nodes.3. No MR evidence of malignancy in the left breast or left axilla BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 76 years Male (DOB:8/12/1939)Reason: hx L3-4 bilateral Lami s/p 1 month. eval for stenosis above/below. History: c/o LBP, pain down legs when standingPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation present at this level. There is some mild ligamentum flavum hypertrophy present at this level.At L4-5 there is loss of disc space height, diffuse disc bulge and endplate reactive changes with a Schmorl's node. The endplate reactive changes are mildly elevated in signal on T2 and predominantly high signal on T1. There is some ligamentum flavum hypertrophy present at this level. There is partial effacement of the fat at the right lateral recess at this level. There is some partial effacement of the fat surrounding the right-sided exiting nerve roots at this level.At L3-4 there is loss of disc space height and disc desiccation associated with a large right lateral recess disc extrusion. Disc material extends into the right neural foramen and also effaces the fat at the right lateral recess at this level. There is a superimposed disc bulge at this level. There are endplate reactive changes present at this level which are high signal on T1 and T2 associated with small Schmorl's nodes atThere is a 17 x 14 mm axial dimension T2 hyperintense focus present along the right L3 lamina which represents a laminotomy defect.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a large right lateral recess disc extrusion present at L3-4 which encroaches on the nerve roots at the right lateral recess and in the right neural foramen at this level. It also creates mild degree of spinal stenosis.2.Status post right laminotomy at L3-4.3.There is mild encroachment of the right-sided exiting nerve roots at L4-5 due to a disc disease.


Instruction: Generate impression based on findings.

Input: 74-year-old female status post fall with positive forgetfulness and headaches. Concern for subdural hematoma. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of hypoattenuation in the periventricular and subcortical white matter distribution consistent with small vessel ischemic disease common age indeterminate. If there is clinical concern for ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with headache. A 5 mm lesion is redemonstrated within the right occipital lobe showing internal T2 hyperintensity and a rim of surrounding susceptibility effect. The lesion has not changed in size. The surrounding parenchyma is free of edema. Adjacent curvilinear enhancement most likely represents a developmental venous anomaly.Several scattered small foci of nonspecific FLAIR hyperintensity are redemonstrated within the cerebral hemispheres showing no significant interval change. No edema or mass effect is detected. No abnormal extra-axial fluid collections are seen and there is no evidence to suggest acute intracranial hemorrhage. Ventricular size and morphology are within normal limits. No additional pathologic enhancement is identified intracranially.

Output: 1.Stable presumed right occipital cavernous malformation with an associated developmental venous anomaly.2.Stable scattered foci of nonspecific signal abnormality.3.No new or additional findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Right foot/ankle mass; chronic pain Ankle/hindfoot: There is slight prominence of the subcutaneous fatty tissue anterior to the lateral malleolus which could represent a lipoma but this is equivocal. There is otherwise no discrete mass identified. There is minimal edema of the subcutaneous fat about the ankle both medially and laterally. There is slight signal heterogeneity of the deep fibers of the deltoid ligament which may represent prior sprain. The remaining ligaments, tendons, and soft tissues are unremarkable.Midfoot/forefoot: Mild osteoarthritis affects the first MTP joint and there is a mild hallux valgus deformity. There is mild edema of the soft tissues at the bases of the first and second toes. A couple of small (less than 5 mm) foci of high signal intensity are seen lateral to the proximal phalanx of the second toe which are nonspecific in nature and may represent small ganglia or even nerve sheath tumors but are of questionable clinical significance. The location of these foci is slightly distal for the typical presentation of a Morton neuroma. The bone marrow signal intensity of the foot is normal.

Output: 1. Mild nonspecific soft tissue edema of the foot and ankle as described above.2. Prominence of the subcutaneous fat anterior to the lateral malleolus may represent a lipoma but this is equivocal. There is otherwise no discrete mass identified.3. Small foci of increased signal intensity lateral to the proximal phalanx of the second toe which are of uncertain clinical significance and etiology but may represent ganglia or perhaps nerve sheath tumors. Morton neuroma is considered less likely given the relatively distal location.


Instruction: Generate impression based on findings.

Input: 13-year-old male with history of juvenile angiofibroma status post surgery. Evaluate for recurrence. BRAIN: There is no evidence of intracranial hemorrhage, mass or edema. There is no abnormal postcontrast enhancement. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses demonstrate postsurgical changes of the nasopharynx without definitive soft tissue enhancement to suggest tumor recurrence. The left maxillary sinus is near completely opacified which is likely postinflammatory however residual/recurrent tumor cannot be definitively identified and follow a MRI is recommended for further characterization.The surgical cavity and right masticator space gastric postsurgical changes without evidence of abnormal enhancement.The remainder of the soft tissues of the neck are normal in appearance. The oropharynx demonstrates bilaterally enlarged tonsils which are touching however not entirely occluding the airway.

Output: 1. Normal brain CT.2. No postcontrast enhancement to suggest residual or recurrent tumor however left maxillary sinus opacification cannot definitively identify tumor recurrence. A follow-up MRI is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: Evaluate for abnormality/metastatic disease; history ovarian cancer. Brain: There is a peripherally enhancing mass in the medial left occipital lobe that measures up to 24 mm, with extensive surrounding vasogenic edema. There is also a heterogeneously enhancing mass in the right cerebellar hemisphere, which measures up to 15 mm, also with extensive surrounding vasogenic edema. The cerebellar tonsils extend up to 6 mm inferior to the foramen magnum. There is no evidence of intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Complete Spine: There is fatty bone marrow signal in the lumbosacral spine related to radiation effects. There is also irregular linear low T1 signal and enhancement that traverses the right sacral ala. There are prominent sacral perineural cysts with remodelling of the sacrum. Otherwise, there is no evidence of mass lesions in the spine. There are mild degenerative changes in the lower cervical spine and at L5-S1 without significant spinal canal stenosis. The vertebral body heights are preserved. There is no significant spondylolisthesis. The spinal cord signal and morphology is normal. There is a right pleural effusion.

Output: 1. Metastases in the right cerebellar hemisphere and left occipital lobe with associated vasogenic edema.2. Radiation effects in the lumbosacral spine bone marrow with probable right sacral insufficiency fracture versus less likely an infiltrative metastasis.3. Low-lying cerebellar tonsils may represent Chiari 1 malformation.4. Right pleural effusion.


Instruction: Generate impression based on findings.

Input: 59 years Female (DOB:10/19/1956)Reason: 3T scanner, please evaluate for Moyamoya disease, hx of TIA, recent syncopal episode, last imaging in 2014, please compare History: 3T scanner, please evaluate for Moyamoya disease, hx of TIA, recent syncopal episode, last imaging in 2014, please comparePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is diffuse marrow replacement present.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses right more than left. There is mild mucosal thickening in the right anterior ethmoid air cells. 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 mild narrowing at the origin of the left middle cerebral artery. There is mild to moderate narrowing of the proximal portion of the inferior division of the left middle cerebral artery with approximately 50% narrowing. This is stable compared to the prior exam. The inferior division of the left middle cerebral artery is the dominant division.There is approximately 25% narrowing at the proximal right middle cerebral artery present. This is stable compared to the prior exam.There is mild narrowing at the left P2 segment of the posterior cerebral artery by approximately 30%. This is stable compared to the prior exam.There is no evidence for intracranial aneurysm.The anterior communicating artery is identified. The posterior communicating arteries are intact. The vertebral arteries are similar in size.There is extracranial origin of the right posterior inferior cerebellar artery present.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. There is 50% narrowing at the origin of the left vertebral artery. This is stable compared to the prior exam.

Output: 1.Two foci of narrowing are present along the left M1 segment. One at its origin is 30% narrowed and one at the proximal portion of the inferior division is 50% narrowed by WASID criteria. This is stable compared to the prior exam.2.There is mild narrowing of the proximal right middle cerebral artery present but also the left P2 segment of the PCA. This is stable compared to the prior exam.3.There is 50% narrowing at the origin of the left vertebral artery. This is stable compared to the prior exam.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: OA, spinal stenosis Symptoms: back pain Thoracic spine:Thoracic kyphosis and dextroscoliosis of the lower thoracolumbar spine is grossly similar. Otherwise alignment is anatomic. Multilevel heterogeneous marrow signal likely reflects focal fat. Mildly increased endplate degenerative changes at T7-T8 with associated increased STIR signal. Foci of increased T2 signal in T9 may represent hemangiomas. Multilevel disc desiccation. Vertebral body heights are intact. No abnormal signal within the cord. Right neural foraminal disc protrusion at T7-T8 is unchanged. No significant neural foraminal stenosis at this level. No significant spinal or neuroforaminal stenosis at any level.Lumbar spine:Grade 1 anterolisthesis of L3 on L4, slightly worse in the prior exam. Focus of low signal in the L1 and L3 vertebral bodies are unchanged. Otherwise, heterogeneous marrow signal appears similar to the exam. Mild endplate degenerative changes at L5-S1 slightly increased STIR signal. Multilevel disc desiccation with disc space loss, most severe at L4-L5 and L5-S1. Disc space loss at T12-L1 and L3-L4 may be minimally worse since the prior exam. No abnormal signal within the distal cord or conus, which ends at L1.T12-L1: Small left neural foraminal disc protrusion is slightly increased. Mild facet arthropathy. Mild left neural foraminal stenosis, unchanged. No spinal canal stenosis.L1-L2: No disc herniation.. Mild facet arthropathy No spinal canal or neural foraminal stenosis.L2-L3: Diffuse disc bulge with small central protrusion, unchanged. Mild facet arthropathy and ligamentum flavum thickening. Minimal spinal canal narrowing is unchanged. No neural foraminal stenosis.L3-L4: Large right paracentral disc extrusion extending 1.6 cm superiorly is new from the prior exam and narrows the right lateral recess. Mild facet arthropathy. Mild left neural foraminal stenosis is unchanged.L4-L5: No disc herniation. Mild facet arthropathy. Minimal bilateral neural foraminal narrowing is unchanged. No spinal canal stenosis.L5-S1: No disc herniation. No spinal canal or neural foraminal stenosis.Mild fatty atrophy of the paraspinous muscles. Left kidney is atrophic with small cysts. Subtle deformity of the aorta at L3 may represent ectasia is unchanged since the prior exam

Output: 1.New right paracentral disc extrusion at L3-L4.2.Multilevel degenerative changes in the thoracic spine, minimally increased.


Instruction: Generate impression based on findings.

Input: History of lung cancer, evaluation for metastasis. Generalized weakness. No evidence of acute ischemic or hemorrhagic lesion.Minimal brain atrophy which is age appropriate.Multifocal scattered small high signal intensity lesions on FLAIR imaging indicating nonspecific small vessel ischemic disease. No change since prior scan.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, or abnormal contrast enhancement. 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: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 17 years Male (DOB:7/24/1998)Reason: evaluate for residual tumor History: s/p tumor and seizure focus resectionPROVIDER/ATTENDING NAME: PAULA L ZAKRZEWSKI JASON M KANE Since the prior exam patient is undergone right-sided craniotomy and right temporal lobectomy for a right temporal lobe mass. 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.There are blood products along the path of a previously placed in depth electrode as well as within the temporal lobe resection site. There are some superficial enhancement along the surface of the brain at the surgical site.A small extra-axial hemorrhagic collection is present adjacent to the depth electrode insertion site measuring about 7 mm in thickness and 38 mm in width. Another extra-axial collection of blood is present adjacent to the right frontal and parietal lobes at the surgical site measuring up to 5 mm in width.There is a scalp soft tissue swelling along the right parietal and frontal scalp as well as edema within the right temporalis muscle.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: Status post right temporal lobe surgery. There are blood products at the surgical site and along the extra-axial spaces adjacent to the craniotomy and burr hole sites. There is no convincing evidence for residual neoplasm. Please note however, that postoperative changes may mask a tiny nodule on MRI. The follow-up exam would be helpful in further evaluating for residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: 60-year-old male with effusion, left ankle neurofibromatosis, unspecified. Evaluate cause of swelling, patient with neurofibromatosis and multiple invasive neurofibromas. There is a joint effusion within the subtalar joint and sinus tarsus which demonstrates low T1 signal, intermediate T2 signal with enhancement compatible with synovitis. There is fluid and thickened synovium within the tendon sheath of the posterior tibialis tendon compatible with tenosynovitis. There is thickening and stranding of the adjacent medial subcutaneous tissues compatible with inflammatory changes. The posterior tibialis muscle appears normal. The remaining tendons and muscles of the ankle appear normal. Within the anterior calcaneus there is an area which demonstrates low T1 signal and intermediate T2 signal with mild enhancement in a tubular configuration compatible with a vascular remnant, which is a normal variant and of no clinical significance. Otherwise the bone marrow signal appears normal.The ligaments of the ankle appear normal.

Output: 1. No findings to suggest neurofibromatosis in the left ankle.2. Synovitis of the subtalar joint and sinus tarsus.3. Tenosynovitis of the posterior tibialis tendon with adjacent inflammatory changes in the medial subcutaneous soft tissues.4. Normal variant vascular remnant within the calcaneus, of no clinical significance.


Instruction: Generate impression based on findings.

Input: Right wrist/hand pain, decreased range of motion. Bone marrow signal intensity is normal. Note is made of congenital coalition of the lunate and triquetrum, a normal variant. There is perhaps mild synovitis dorsal to the proximal carpal row, but this is equivocal. The metacarpophalangeal joints appear normal. This study was not protocoled for detailed evaluation of the ligaments, but I see no gross abnormalities. Subjectively, there appears to be slight dorsal subluxation of the ulna relative to the sigmoid notch of the radius; however, using the modified radioulnar method of measurement as well as the epicenter method of measurement, distal radioulnar joint alignment is within normal limits. The visualized portions of the tendons of the hand and wrist appear normal. I see no definite abnormalities of the triangular fibrocartilage complex; apparent increase in signal intensity along the volar aspect of the volar radioulnar ligament likely simply represents interface with the ulnolunate and ulnotriquetral ligaments. The remaining soft tissue structures appear normal.

Output: There is perhaps mild synovitis dorsal to the proximal carpal row, but I otherwise see no definite findings to account for the patient's pain. Although subjectively there appears to be slight dorsal subluxation of the distal ulna relative to the sigmoid notch of the radius, measurements do not support a true subluxation. If there is clinical concern for distal radioulnar joint instability then bilateral wrist CT with neutral, supination, and pronation positioning may be considered.


Instruction: Generate impression based on findings.

Input: 48 years Male (DOB:9/18/1968)Reason: radiculopathy History: pain in back/left legPROVIDER/ATTENDING NAME: WEI WEI LEE WEI WEI LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.The patient is status post posterior fusion with pedicle screws at L5 and S1 associated with interconnecting rods. Patient is status post anterior fusion with disc spacer at L5-S1. The patient is status post laminectomy at L5. There is mild anterior subluxation of L5 on S1.At L5-S1 there is mild anterior subluxation of L5 on S1. There is increase in the AP dimension of the spinal canal at this level. There is narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots related to a diffuse disc bulge. There is someAt L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Status post lumbar spine surgery at L5-S1. There is encroachment of the exiting nerve roots within the neural foramina at this level due to disc bulge.


Instruction: Generate impression based on findings.

Input: 37-year-old male with history of cystic fibrosis related pancreatic insufficiency. Evaluate for cause of epigastric pain. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Mildly increased signal on opposed phase images in the liver diffusely, suggestive of iron deposition. Trace perihepatic ascites. No biliary ductal dilation. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Fatty replacement of the pancreas, likely secondary to known cystic fibrosis and similar to prior CT. No pancreatic duct dilation. Poor physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst and other too small to characterize T2 hyperintense lesions in both kidneys, likely additional cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis without evidence of cholecystitis.2.Fatty replacement of the pancreas with poor physiologic response to secretin.


Instruction: Generate impression based on findings.

Input: 36 years old, Female. 19 weeks gestational age. History of fetal ventriculomegaly, abnormal ultrasound. The exam is limited by fetal motion. Lack of sulcation is appropriate for reported gestational age of 19 weeks. The right ventricle measures up to 10 mm at the level of the atrium. The left ventricle measures up to 9 mm at the level of atrium. The fourth ventricle is not enlarged. No large intracranial mass or hemorrhage. No cystic lesion is evident. Although not well visualized, the corpus callosum appears present. Posterior fossa structures are normal for gestational age.

Output: 1. The right lateral ventricle is top normal in size. The left lateral ventricle is within normal limits in size.2. Given the limitations of a motion degraded exam, no significant intracranial abnormality is visualized.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is a complex tear of the lateral meniscus with intercondylar displaced component. Medial meniscus is normal in signal characteristics and morphology.ARTICULAR CARTILAGE AND BONE: The osseous alignment is anatomic. The bone marrow edema in the intercondylar region of the tibia and femur is likely degenerative. There is also a small fluid collection within the tibia at this region, likely subchondral cyst formation. LIGAMENTS: Collateral ligaments and cruciate ligaments are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Complex tear of the lateral meniscus with intercondylar displaced component. There is likely degenerative bone marrow edema of the tibia and femur. Other findings as above.


Instruction: Generate impression based on findings.

Input: History of right foot sarcoma. Assess for recurrence. Again seen are postoperative findings related to resection of myxoinflammatory fibroblastic sarcoma. Overall, skin thickening and dorsal subcutaneous edema has decreased. A nonenhancing fluid collection previously described as a seroma also has decreased in size.There is a tiny, 4 to 5 mm, lobulated enhancing nodule within the subcutaneous fat dorsal to the second/third cuneiforms. The lesion demonstrates increased T2 signal and is also slightly hyperintense to skeletal muscle on T1 images, perhaps due to volume averaging with surrounding subcutaneous fat. It was not seen on the initial postoperative study from 8/4/2014, and we therefore cannot exclude the possibility of residual or recurrent tumor. However, review of the preoperative MRI from 1/14/2014 also shows no definite tumor in this location, and therefore it is possible this may not represent malignancy (e.g., a small neuroma).Mild poorly defined enhancement of the subcutaneous fat is noted along the dorsomedial aspect of the midfoot, which corresponds to hypointense T1 and T2 signal abnormality, and may represent scarring. A small cystic lesion in the navicular bone with surrounding edema and enhancement appears similar to that seen on the prior study and may be degenerative in etiology. The bones and muscles otherwise appear within normal limits.

Output: Postoperative changes related to resection of myxoinflammatory fibroblastic sarcoma with overall decrease in dorsal soft tissue edema. New small enhancing nodule in the dorsal soft tissues of the midfoot may represent tumor recurrence.


Instruction: Generate impression based on findings.

Input: Female, 5 months old, with E. coli meningitis, cerebritis and ventriculitis. Assess size of subdural abscess and for residual ventricular abscess. Since the prior examination, a small left parietal craniotomy has been performed through which the previously seen left-sided extra-axial abscess has been evacuated. The collection is much smaller than that seen on the prior examination with only trace residual diffusion restricting material.There is air within the ventricular system and the right frontal approach EVD has been replaced. The catheter now takes a more medial course into the third ventricle. The ventricles remain markedly dilated, the severity of which is stable to minimally increased when compared to the immediate prior examination. The quantity of diffusion restricting debris within the ventricular system has slightly decreased.On postcontrast images, ependymal enhancement persists in the periatrial and temporal regions, similar to the prior examination. The previous rim-enhancing left parietal collection has collapsed into a small residual cavity with thick enhancement of the surrounding dura. No new enhancing lesions are seen.Marked parenchymal thinning is again seen. T2 hyperintensity within the anterior temporal lobes is unchanged. Mild periventricular T2 hyperintensity elsewhere, and a focus of abnormal signal within the right pons, are also unchanged.

Output: 1.Postoperative findings are seen compatible with evacuation of a left parietal extra-axial abscess. Only a small amount of residual diffusion restricting material is seen.2.Findings are seen compatible with endoscopic intervention and replacement of the right-sided EVD. Ventricular caliber is stable to very slightly increased relative to the prior exam.3.The quantity of diffusion restricting infectious debris within the ventricular system has decreased. Ependymal enhancement is unchanged.4.Generalized parenchymal thinning with areas of parenchymal signal abnormality are also unchanged.


Instruction: Generate impression based on findings.

Input: Cervicalgia. Pain with movement. Rule out DJD, bulging disc or herniation. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild straightening of the cervical spinal curvature. Alignment is otherwise maintained. Bone marrow signal is benign. Fatty endplate marrow signal changes are evident at the C5-C6 level which are on a degenerative basis. There is moderate disc height loss at the C5-C6 and C6-C7 levels.The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancement.There is mild development of narrowing of the cervical spinal canal with superimposed degenerative changes as described below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a small central/bilateral paracentral disc protrusion. No significant compromise to the spinal canal. There is mild left neural foraminal stenosis related to facet arthropathy. Right neural foramen is patentC4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex with mild to moderate degree of spinal canal stenosis. Bilateral uncovertebral hypertrophy contributes to mild to moderate bilateral, right greater than left, neural foraminal stenosis. These findings are similar to prior.C6-7: There is a disc osteophyte complex with slight interval increase in disc bulge component at this level. There is moderate spinal canal stenosis which is worse since 2/8/2016. There is also uncovertebral hypertrophy with associated moderate bilateral, left worse than right, neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.There is also mild generalized facet arthropathy throughout the cervical spine. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine, worst at the C6-C7 and to a slightly lesser degree C5-C6 levels. There is moderate spinal canal stenosis at C6-C7 which is mildly worse since 2/8/2016. There is also moderate degree of bilateral neural foraminal stenosis at C6-C7.2. Additional levels as above.


Instruction: Generate impression based on findings.

Input: 17-year-old male presents with chronic left shoulder pain, evaluate for shoulder pathology. ROTATOR CUFF: There is no complete or partial rotator cuff tear. The subscapularis constituent of the rotator cuff is intact. No bursal effusion or thickening is seen. There is no muscular tear, contusion, or atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Humeral head articulates well with the glenoid. No labral tear is identified. There is no glenohumeral joint effusion. There are no SLAP or soft tissue Bankart lesions. No paralabral cysts are seen.BICEPS TENDON: The biceps tendon is normally situated within the bicipital groove. No complete or partial biceps tendon tear is present. ADDITIONAL

Output: Normal examination. No complete tear of the rotator cuff. No Hill-Sachs, reverse Hill-Sachs, or bone Bankart lesions are seen.


Instruction: Generate impression based on findings.

Input: History of lumbar fusion: back and left leg pain. There are postoperative findings related to posterior fusion with pedicle screws and interconnecting rods at the L5-S1 level. Artifact related to the surgical hardware limits the assessment of adjacent structures. There is bilateral spondylolysis at L5 with minimal anterolisthesis of L5 upon S1, as well as mild loss of disc space height at this level. Loosening and fracture of the S1 screws is better delineated on the prior CT. There is no definite evidence of neural foraminal or spinal canal stenosis. The vertebral body heights are preserved. The imaged portions of the spinal cord and cauda equina nerve roots appear unremarkable. The vertebral bone marrow signal appears unremarkable beyond the portions obscured by surgical hardware artifact. Aside from postoperative findings in the lumbosacral region, the paraspinal soft tissues appear to be unremarkable.

Output: 1. Postoperative findings related to posterior fusion with pedicle screws and interconnecting rods at the L5-S1 level. Artifact related to the surgical hardware limits the assessment of adjacent structures and loosening and fracture of the S1 screws is better delineated on the prior CT. 2. Bilateral spondylolysis at L5 with minimal anterolisthesis of L5 upon S13. No definite evidence of neural foraminal or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Change in mental status and function. The images are degraded by patient motion. There is no evidence of intracranial hemorrhage or acute infarct. There is scattered periventricular and subcortical white matter T2 signal hyperintensity, compatible with chronic microvascular ischemic disease. More focal areas of signal abnormality in the left occipital lobe and basil ganglia suggest chronic lacunar infarcts. There is moderate global parenchymal volume loss. There is a partially empty sella. Otherwise, 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 are bilateral lens implants.

Output: 1. Findings compatible with chronic microvascular ischemic disease and chronic lacunar infarcts, without evidence of acute infarct or intracranial hemorrhage.2. Moderate cerebral volume loss.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 2 y/o with hemophilia , new onset seizures, r/o tumor vs structural cause History: new onset seizures Exam slightly limited by patient motion.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 hippocampi are symmetric bilaterally without abnormal signal or atrophy. No heterotopic gray matter or cortical abnormalities. Normal myelination for age. Midline structures are normal. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.

Output: MRI of the brain appears within normal limits without evidence of structural mass or other abnormality to suggest seizure focus. If there is continued suspicion for a structural abnormality, high-resolution imaging with epilepsy protocol may be considered.


Instruction: Generate impression based on findings.

Input: 67-year-old male with history of multiple sclerosis experiencing left-sided weakness. Brain MRI:Restricted diffusion with ADC hypointensity within the left cerebellar hemisphere correlates with previously identified increased hypoattenuation within the left cerebellar hemisphere. To a lesser extent, there are a few small foci of restricted diffusion with ADC hypointensity within the right cerebellar hemisphere and vermis. This is associated with some folio effacement on the left, T2 hyperintensity,T1 hypointensity, and a minimal degree of enhancement. This constellation of findings is consistent with subacute infarction. Previously identified supratentorial restricted diffusion in 2012 has resolved.Redemonstrated is T2 hyperintensity within the white matter, confluent in many locations, without associated mass effect correlating with previous hypodense abnormality on CT. There is no associated enhancement. Encephalomalacia in the right parietal lobe and right frontal lobe from prior remote infarct is noted. Prominence of the right sylvian fissure is again noted as identified on the recent head CT, correlating with evolution of the restricted diffusion identified on the 2012 MRI.Mucosal thickening is again noted within the left maxillary sinus. Expected vascular flow-voids are demonstrated, including the distal bilateral vertebral arteries and basilar artery.Cervical spine MRI:Numerous foci of T2 hyperintensity are noted within the cervical cord, most prominently identified at the following levels: C2, C3, C4, C5/6, C7, and T1.There are no fractures. The marrow signal is benign. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Mild posterior osteophyte disc complex, ligamentum flavum thickening, left uncinate hypertrophy, and left facet hypertrophy. There is moderate left neural foraminal stenosis.C3/4: Trace retrolisthesis C3 on C4, posterior osteophyte disc complex, uncinate hypertrophy, ligamentum flavum thickening, and left facet hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C4/5: Trace retrolisthesis C4 on C5, posterior osteophyte disc complex, uncinate hypertrophy, ligamentum flavum thickening, and minimal left facet hypertrophy. There is minimal central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, left uncinate hypertrophy, and ligamentum flavum thickening. There is moderate left neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex without significant stenosis.

Output: 1.Findings consistent with subacute infarction involving the cerebellar hemispheres (left greater than right) and vermis.2.Redemonstrated is extensive T2 abnormality within the supratentorial white matter, none of which enhances. Some of this correlates with previously identified foci of ischemia. However, the findings most likely represent a confluence of the patient's known multiple sclerosis and superimposed vascular disease.3.Numerous foci of T2 hyperintensity are noted within the cervical cord, most prominently identified at the following levels: C2, C3, C4, C5/6, C7, and T1.4.C2/3: Moderate left neural foraminal stenosis.5.C3/4: Mild central and severe bilateral neural foraminal stenosis.6.C4/5: Minimal central and severe bilateral neural foraminal stenosis.7.C5/6: Severe bilateral neural foraminal stenosis.8.C6/7: Moderate left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 64-year-old male patient with cholestasis, liver biopsy with biliary perforation with suggestion of extrahepatic biliary obstruction. Patient is status post OLT. Limited study due to the lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense lesions in the right lobe of the liver likely represent cysts. Mild intrahepatic biliary ductal dilatation. At the expected level of the anastomosis, there appears to be a focal stricture (series 5 image 82). There also may be narrowing of the common bile duct at the level of the ampulla.The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild intrahepatic biliary ductal dilatation with concern for a stricture at the expected level of the anastomosis with question of narrowing at the ampulla. Recommend an ERCP for further evaluation.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There are multiple T2 hyperintense lesions in the cerebral white matter bilaterally, which are stable to slightly progressed since 2014, although precise comparison is limited due to differences in technique. Most of the lesions demonstrate T1 hypointensity as well. There may also be a few punctate infratentorial T2 hyperintense lesions. There is no evidence of mass lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: The intracranial demyelinating lesions are stable to slightly progressed since 2014, although precise comparison is limited due to differences in technique.


Instruction: Generate impression based on findings.

Input: Reason: assess PVT History: PVT, cirrhosis ABDOMEN:LUNGS: A small right and trace left pleural effusion are new since the prior exam.LIVER, BILIARY TRACT: There is a cirrhotic liver morphology with perisplenic collaterals and perigastric and esophageal varices, similar to the prior exam. Right hepatic hypodensity without arterial enhancement appears similar to the prior exam (9/256). No suspicious hepatic lesions. There is linear hypodensity within the portal vein at the hepatic hilum branching into the right and left portal veins, likely represents a web, similar to the prior exam. The main portal vein is slightly diminutive but patent. The SMV and splenic veins are patent.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged portacaval lymph node appears similar to the prior exam.BOWEL, MESENTERY: Colonic wall thickening likely represents hepatic colopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal ascites appears to the prior exam.

Output: 1.Hepatic cirrhosis and sequela of portal hypertension without suspicious hepatic lesions.2.Linear filling defect within the main portal vein at the hepatic hilum likely represents a web from recannulization of prior thrombus, appearing similar to the prior exam. The portal vein is otherwise patent.3.Ascites and right pleural effusion suggestive of hepatic hydrothorax.