Instruction: Generate impression based on findings.

Input: 57-year-old female with absent proven invasive ductal carcinoma with DCIS in the right breast. There are also indeterminate amorphous calcifications in the right breast. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an enhancing mass at 12:00 position in the right breast, measuring 12 x 15 x 19 mm (AP x LR x CC), which is a proven cancer. No additional enhancing lesions are seen elsewhere in right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. A biopsy proven cancer at 12:00 position in the right breast2. There are no additional enhancement in the right breast, however, stereotactic core biopsy should be considered for the most suspicious cluster of calcifications in the right breast.3. No MR evidence for malignancy in the left breast4. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a homogeneously enhancing mass filling the right internal auditory canal with extension into the cerebellopontine angle cistern. This lesion appears unchanged in size compared to both the MRIs dated 10/23/13 and 5/14/14, now measuring approximately 8 mm by 15 mm (series 8, image 74). The schwannoma extends approximately 4 mm into the cerebellopontine angle (series 8 image 74). There may be some mild bone remodeling at the meatus of the internal auditory canal secondary to schwannoma. There is no mass effect upon the brainstem. The cerebellar tonsils are in normal position. The ventricles and sulci are normal in size. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Redemonstration of a right IAC schwannoma which appears unchanged in size compared to prior studies dating back to 10/23/13. No new lesion is identified.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for changes. Signs and symptoms: Patient with migraine and paresthesias, evaluate for demyelination. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination redemonstrate very few tiny foci of FLAIR hyperintensity only in the subcortical white matter of cerebral hemispheres. The findings are nonspecific, nonhemorrhagic and demonstrate no abnormal enhancement. The signal intensity of brain parenchyma is otherwise within normal in all MRI sequences and without detectable abnormal enhancement. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces. The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No acute intracranial process and no convincing evidence of any new finding since prior exam.2.Stable very few punctate nonspecific foci of FLAIR hyperintensity as detailed.3.Unremarkable pre and post enhanced brain MRI otherwise and stable since prior study.


Instruction: Generate impression based on findings.

Input: 28-year-old female with past medical history of right hip labral tear status post arthroscopic labral repair and acetabuloplasty and cam decompression with iliopsoas release (10/1/2015). Right-sided pain has resolved. She now endorses left groin pain, particularly during flexion, for instance during upstroke while bicycling. Evaluate for labral tear. ACETABULAR LABRUM: There is slight blunting of the free edge of the anterior superior labrum, which may reflect mild degeneration/fraying, but we see no discrete tear. ARTICULAR CARTILAGE AND BONE: There is slight bony prominence along the superolateral aspect of the femoral head-neck junction indicating a cam deformity, with an alpha angle of approximately 60 degrees. There is a cystic abnormality anteriorly within the femoral head, likely representing a synovial herniation pit, which can also be associated with femoral acetabular impingement. We see no fluid filled articular cartilage defects. SOFT TISSUES: The soft tissues are unremarkable.ADDITIONAL

Output: Cam deformity of the left femoral head-neck junction and synovial herniation pit can be associated with femoral acetabular impingement in the correct clinical context. Although we see no discrete labral tear, the free edge of the anterior superior labrum appears slightly blunted, which could reflect degenerative fraying.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. A prominent benign hemangioma is evident within the T11 vertebral body. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is evident at T10/11, L4/5, and L5/S1 with mild disc height loss at L4/5.Bilateral facet hypertrophy and ligamentum flavum thickening at T10/11 (right greater than left) encroach the central canal and right neural foramen without significant resulting stenosis.T12/L1: Unremarkable.L1/2: Mild left facet hypertrophy and slight ligamentum flavum thickening without stenosis.L2/3: Mild bilateral facet hypertrophy and slight ligamentum flavum thickening without stenosis. There is an approximate 6 mm maximal diameter cystic appearing structure along the posterior aspect of the right facet joint with an MRI appearance most consistent with synovial cyst.L3/4: Asymmetric bulge to the right, mild bilateral facet hypertrophy, and slight ligamentum flavum thickening. There is an approximately 7 mm maximal diameter cystic appearing structure along the posterior aspect of the right facet joint with an MRI appearance most consistent with synovial cyst. There is mild right neural foraminal stenosis.L4/5: There is a broad-based right paracentral/foraminal disc protrusion with prominent annular tear which results in mild right lateral recess and mild right neural foraminal stenosis. There is also mild bilateral facet hypertrophy and slight ligamentum flavum thickening. There is no central or left neural foraminal stenosis.L5/S1:Diffuse annular disc bulge which abuts and slightly flattens bilateral S1 nerve root sheath origins and causes mild bilateral neural foraminal stenosis. There is also mild left facet hypertrophy. There is no central stenosis.SI Joints: There is a small bridging marginal osteophyte involving the right SI joint consistent with minimal osteoarthritic change.

Output: 1.L3/4: Mild right neural foraminal stenosis.2.L4/5: There is a broad-based right paracentral/foraminal disc protrusion with prominent annular tear which results in mild right lateral recess and mild right neural foraminal stenosis. 3.L5/S1:Diffuse annular disc bulge which abuts and slightly flattens bilateral S1 nerve root sheath origins and causes mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 61 year old man with history of hypertension and non-ischemic cardiomyopathy referred for cardiac MRI to evaluate for etiologies of CM as well as cardiac volumes. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 175 ml (normal range 142+/-34), the LV end systolic volume index is 55 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 50 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). There is global hypokinesis. There is a small focus of late gadolinium enhancement in the mid inferior wall, at the insertion point of the right ventricle. This is atypical for myocardial infarction, and can be observed in pulmonary hypertension or nonspecific cardiomyopathy. There is otherwise no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1190-1200ms. In the absence of significant late gadolinium enhancement, this elevated T1 value suggests the presence of at least mild underlying diffuse fibrosis or infiltration.There is [no evidence for]myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsT2* imaging is suggestive of iron overload in the spleen and liver (T2* decay time of <20ms) . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with moderately reduced systolic function (EF 37%). No LV thrombus noted.2. There is a small focus of late gadolinium enhancement in the mid inferior wall/inferoseptum associated with the insertion point of the RV. This is atypical for myocardial infarction and can be a nonspecific finding in cardiomyopathy. Also, there is a mild-moderate elevation in the native T1 myocardial relaxation time of the septum, which suggests the presence of at least mild diffuse underlying fibrosis or infiltration.3. Normal size right ventricle with mildly reduced systolic function (EF 46%). 4. Mild biatrial dilation.5. Low signal intensity of the liver and spleen with a significantly reduced T2* decay time; would consider iron overload if clinically appropriate. There is no evidence of intracardiac iron overload, however.


Instruction: Generate impression based on findings.

Input: C-SpineThere is central to left and slightly extended toward left side lateral recess, broad based disc protrusion which abuts thecal sac at the level of C56. The cervical spine lost normal lordosis. There is about 11mm tonsilar herniation through the foramen magnum.Spinal cord signal intensity is normal.The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. Thoracic SpineThere is normal thoracic kyphosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level.Lumbar spineThere are disc dessication at the level of L23, L45 and L5S1.Minimal bulging of disc at the level of L23 and diffuse bulging of disc associated with central to left disc protrusion at the level of L45 which abuts thecal sac. At the level of L5S1, there is broad based disc protrusion central to left which extents toward left side lateral recess and abuts left side S1 nerve root.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. About 11mm tonsilar herniation as described above.2. Multi-level various degreed intervertebral disc herniations including C56, L45 and L5S1 as described above.3. Normal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: Clinical question: rule-out acute bleed or mass. Signs and symptoms : history of metastatic cancer.? Microhemorrhage on previous MRI. Now with headaches. Nonenhanced head CT:A punctate focus of high density in the left cerebellum measuring 2.5-mm is noted on axial image 10. This finding was not detected on prior head CT from 3 -- 31 -- 11 and could represent minimal hemorrhage.A single focus of subcortical low attenuation measuring approximately 5 mm in transaxial dimension in the subcortical white matter of right frontal lobe is similar to prior exam and is a nonspecific finding. Possibility of an old small vessel stroke should be considered. This finding was present on prior MRI examination from 6 -- 5 -- 11 as well.There is no evidence of any additional foci of abnormality. The cortical sulci, ventricular system and all CSF cisterns remain within normal.

Output: 1.Small punctate focus of high density in the left cerebellum may represent minimal bleed.2.Possible minimal small vessel disease.


Instruction: Generate impression based on findings.

Input: Reason: hx of prostate cancer, evaluate for disease History: see above. PELVIS:PROSTATE:Prostate Size: 2.7 x 4.8 x 2.7 cm.Peripheral Zone: In the posterior right base, there is a focal T2 hypointense region that demonstrates restricted diffusion and early enhancement, measuring approximately 9 x 8 mm (series 1301 image 17). Additional multiple smaller T2 hypointense foci within the right mid and base.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No osseous lesions.OTHER: No significant abnormality noted.

Output: Multifocal lesions in the right mid and base with dominant tumor in the right posterior base.


Instruction: Generate impression based on findings.

Input: A 16 year old female with syncope and echocardiographic findings of suspected interatrial shunt. Also noted to have right ventricle enlargement with mildly reduced systolic function. Referred for cardiac MRI to further evaluate these findings Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 87 ml/m2 (normal range: 65+/-11), the LVEDV is 148 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 36 g/m2 (normal range 67+/-11), and the LV mass is 62 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The LA volume is 54 ml. There is a small PFO or ASD noted with predominantly left-to-right shunting with saturation band technique. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 91 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 83 ml (normal range 35+/-13). No RV wall motion abnormalities or sacculations/aneurysms noted. Indexed RVEDV meets pat of the minor criteria for ARVC.Right AtriumThe right atrium is normal in size. The RA volume is 76 ml.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Coronary arteriesThe coronary arteries have normal origin.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is 56%. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with low systolic function, the RVEF is 47%. No wall motion abnormalities noted of the RV wall in this study. Indexed RVEDV was 91 mL/m2 meeting part of the one of the minor criteria for ARVC. 3. Small PFO/ASD noted. Qp:Qs not calculated.4. Normal origins of the coronary arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 65-year-old male patient with HCC status post resection and HCV cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.No suspicious hepatic masses.Patent hepatic vasculature with normal variant replaced right hepatic artery again noted. No intra or extrahepatic biliary ductal dilatation.Small perigastric varices.SPLEEN: Mild splenomegaly, measuring up to 14 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Asymmetrically atrophic right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from median sternotomy hardware. Multilevel small perineural cysts within neuroforamina in the thoracic spine.OTHER: Left basilar atelectasis/consolidation and trace pleural effusion.

Output: Cirrhosis without evidence of recurrence or new suspicious lesion in the liver.


Instruction: Generate impression based on findings.

Input: 46 years, Male, left arm weakness, rule out structural lesion. Brain: Brain parenchyma is within normal limits for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses are clear aside from small bilateral maxillary mucus retention cysts. Mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from some straightening which may be in part positional. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild right-sided neural foraminal stenosis related to mild disc bulge, uncovertebral hypertrophy and mild facet arthropathy. No significant compromise to the spinal canal or left neural foramen.C4-5: Small right paracentral disc protrusion. No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.Scattered small bilateral perineural cysts. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Brain parenchyma appears within normal limits.2. Mild degenerative changes in the cervical spine without significant spinal canal stenosis at any level. No cord signal abnormality. No significant left neural foraminal narrowing at any level.


Instruction: Generate impression based on findings.

Input: Parkinson's preoperative planning for DBS. There is blurring of the susceptibility effect in portions of the bilateral substantia nigra. There is a nonspecific punctate focus of susceptibility effect in the right parietal lobe periventricular white matter. There are also mild nonspecific scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right lens implant and scleral band and atrophy of the right optic nerve.

Output: Findings supportive of Parkinson's disease. Otherwise, unremarkable preoperative MRI of the purposes of preoperative planning.


Instruction: Generate impression based on findings.

Input: Reason: Acute Pancreatitis on Recurrent pancreatitis History: epigastric pain, Elevated LipaseEXAMINATION: Pancreas MRI and MRCP without and with IV contrast and Secretin 1/26/2016 ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No filling defects are present within the biliary tree. The gallbladder is distended.SPLEEN: No significant abnormality noted.PANCREAS: There is mildly increased restricted diffusion and T2 signal abnormality within the pancreatic parenchyma compatible with acute pancreatitis. Small amount of peripancreatic fluid. The pancreatic duct appears normal no evidence of abnormal stricturing or dilatation. The vascular structures are intact. No pseudocysts.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate left-sided hydronephrosis and hydroureter.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: Findings compatible with acute pancreatitis without evidence of complication. Moderate left-sided hydronephrosis and hydroureter.


Instruction: Generate impression based on findings.

Input: High-resolution images of the sella demonstrate the pituitary gland to be normal in size measuring 5 mm in height. There is a 3-4 mm focal area of relative hypoenhancement within the left pituitary gland (best seen series 801, image 55/70 and series 1101 image 6/15). The pituitary infundibulum inserts on the midline of the gland. There are suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally. Limited evaluation of the brain is grossly unremarkable.

Output: MRI findings suggestive of a 3-4 microadenoma of the leftward anterior pituitary gland.


Instruction: Generate impression based on findings.

Input: Right hip pain ACETABULAR LABRUM: Note that evaluation of the acetabular labrum is limited within the lack of intra-articular contrast. Within the limits of this exam, there is no gross labral detachment.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: There is a minimal amount of increased signal at the origin of the right hamstring tendons however there is no evidence of hamstring or other tendon/muscle tear. ADDITIONAL

Output: 1. Minimal increased signal at the origin of the right hamstring which is of uncertain clinical significance but may represent very mild myotendinous strain. There is no evidence of hamstring or other muscular/tendon tear.2. Limited evaluation of the labrum secondary to lack of intra-articular contrast. Within the limits, there is no gross labral detachment although there is clinical concern, MR arthrogram can be considered.


Instruction: Generate impression based on findings.

Input: Patient with neurofibromatosis 1. Evaluate margins of the plexiform tumor. Scattered lesions within the skin and soft tissues with increased T2 signal are compatible with neurofibromas.There is moderate inflammation of the left gluteal soft tissues extending to the left labia with associated atrophy of the musculature in this region. Additionally the left inferior pubic ramus appears chronically deformed. These findings are likely postsurgical in etiology. Within the postsurgical site, there is a residual plexiform neurofibroma adjacent to the medial left ischium measuring approximately 2.8 x 1.8 x 2.7 cm. This lesion demonstrates enhancement.Additionally, along the course of the left sciatic nerve at the level of the mid femur there is a plexiform neurofibroma measuring approximately 3.5 x 2.8 x 5.7 cm. Along the course of the right sciatic nerve on the contralateral side at a level just inferior to the lesser trochanter there is an another plexiform neurofibroma measuring approximately 4.8 x 3.7 x 6.9 cm. These lesions demonstrate enhancement.There is enlargement of the lumbosacral nerve plexus along with enlargement of the foramina. Small ovarian cysts are noted bilaterally, likely physiologic in nature.

Output: 1. Small residual plexiform neurofibroma in the surgical bed.2. Additional plexiform neurofibromas along the course of the bilateral sciatic nerves as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for brain injury/insult. Signs and symptoms: 29 weeker, maternal placental percreta, low apgar, intubated. Not enhanced CT brain:Examination demonstrate a small foci of increased density at the approximately level of the body of the left caudate nucleus (axial image 16 of 28). In addition a thin linear increased density in the cortex of left posterior frontal lobe along its interhemispheric aspect (axial image 21 of 28) is also present. Neither one of these lesions can be considered definitively abnormal however considering provided clinical data and immature brain parenchyma, possibility of small hemorrhage should be considered and follow-up with ultrasound or an MRI is recommended. This examination is otherwise unremarkable for patient's stated age.Motion artifacts reduces the sensitivity of the exam significantly for detection of small possible skull fractures however no definitive evidence of fracture in this study is detected.

Output: Please see above comments.


Instruction: Generate impression based on findings.

Input: 63 year-old man status-post lung transplant on immunosuppression with an echocardiogram suspicious for constriction. MRI ordered to further evaluate. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19), the LV mass index is 77 g/m2 (normal range 85+/-15), and the LV mass is 179 g (normal range 164+/-36). There are no regional wall motion abnormalities present. No hyperenhancement noted in the myocardium on T2 stir images. Native myocardial T1 is mildly abnormal at 1055 msec. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 182 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17). There is external compression of the RV. Right AtriumThe right atrium is normal in size. Thickening along the right atrial wall.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated (43 mm) in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThickening of the pericardial sac (9 mm inferiorly in the coronal plane and up to 11 mm anteriorly in the axial plane) . There is a loculated chronic fluid collection which appears to be in the pericardial space, adjacent to the free-wall of right ventricle with prominent septations. Respirophasic septal shift noted on free-breathing sequences with evidence of tethering of the myocardium to the pericardium on tagged sequences. These findings are strongly suggestive of constriction. A collection of fat is also noted along the right ventricular free-wallExtracardiac FindingsInterstitial pattern and likely post-operative changes noted in the lungs. Dedicated chest CT would help to better assess these changes. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%2. The right ventricle is normal in size with normal systolic function. There is external compression of the RV.3. There is thickening of the pericardial sac. A loculated fluid collection which appears chronic is noted in the pericardial space. This collection sits alongside the free-wall of the right ventricle in the axial plane and contains prominent septation. A band of fat is also noted along-side the RV free-wall adjacent to this fluid collection. Respirophasic septal shift noted on free-breathing sequences with evidence of tethering of the myocardium to the pericardium on tagged sequences. 4. Due to the patient's low GFR contrast was not administered. 5. These findings are strongly suggestive of constriction.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of HCC, cirrhosis, portal venous thrombosis, now status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic morphology of the liver, with diffuse low T2 signal compatible with hemosiderin deposition. Hazy increased T2 signal about the hepatic hilum is compatible with reticular fibrosis.There is an approximately 2.2 x 2.2 cm centrally low T1/T2 signal, peripherally high T1 signal lesion in the dome the liver, in the region of prior RFA ablation. No associated abnormal enhancement is seen to suggest recurrent/residual tumor. Although the arterial phase suboptimal, no new arterially enhancing lesions are evident.There is persistent luminal attenuation of the portal vein just distal to the confluence of the SMV and splenic vein, appearing similar to the prior examinations.The gallbladder is mildly distended and there is a large lamellated gallstone.SPLEEN: Enlarged spleen, measuring up to 16 cm in length. Perisplenic varices secondary to a splenorenal shunt are again identified, and appear roughly similar to the prior exam.PANCREAS: The pancreas appears slightly atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multifocal right renal parenchymal scarring again evident, unchanged. There is no hydronephrosisRETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pericardial cyst unchanged. Small volume ascites.

Output: 1.Postprocedural changes compatible with prior RFA ablation of the right hepatic dome lesion, without evidence of residual or recurrent disease. 2.Suboptimal arterial phase, but no new arterially enhancing lesion seen to suggest new foci of hepatocellular carcinoma; however continued surveillance is recommended.3.Nodular cirrhosis with small volume ascites as well as sequelae of portal hypertension including perisplenic varices and splenomegaly.4.Persistent attenuation of the portal vein, which remains patent.5.Cholelithiasis and mild distention of the gallbladder, clinical correlation for chronic cholecystitis suggested.


Instruction: Generate impression based on findings.

Input: Again seen is a 2-3 mm aneurysm in the clinoid segment of the left internal carotid artery, not appreciably changed when compared to prior studies. The right intracranial internal carotid artery is normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis.

Output: Stable appearance of 2-3 mm left clinoid segment internal carotid artery aneurysm.


Instruction: Generate impression based on findings.

Input: Female, 62 years old. Pain and neuropathy ROTATOR CUFF: There is a full-thickness tear of the anterior fibers of the distal supraspinatus tendon at its insertion. The tear measures approximately 9 mm in AP diameter. Torn fibers are retracted approximately 1 cm. The infraspinatus, teres minor, and subscapularis tendons are intact. The rotator cuff musculature shows no significant fatty atrophy.SUPRASPINATUS OUTLET: There is mild acromioclavicular joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is increased signal within the posterior labrum, likely degenerative. There is no focal articular cartilage defect noted. Bone marrow signal is normal.BICEPS TENDON: The tendon of the long head of the biceps is normal in morphology and position. ADDITIONAL

Output: 1.Full-thickness tear of the supraspinatus tendon as described above.2.Thickening of the coracohumeral ligament and loss of the subcoracoid fat pad, raising the possibility of adhesive capsulitis.3.Increased signal within the posterior labrum, likely degenerative.


Instruction: Generate impression based on findings.

Input: History of Crohn's ileocolitis with side to side ileocolonic anastomosis. Evaluate for active Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver dome is not included on several of the image sequences. Cholelithiasis with a partially contracted gallbladder. No suspicious liver lesion. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. Otherwise, unremarkable. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from an ileocecectomy. Side to side ileocolonic anastomosis is well visualized.The small bowel is adequately distended with oral contrast.The small bowel fold pattern is maintained.There is a mild postcontrast short segment enhancement of the neoterminal ileum (series 17/6) with mild restricted diffusion.Otherwise there is no abnormal small bowel wall thickening, restricted diffusion or postcontrast enhancement. No perienteric inflammatory changes such as fibrofatty proliferation.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest a flow-limiting stricture.No sinus tract or fistula formation.No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No evidence of peri-anal disease on the limited sequences obtained.OTHER: No significant abnormality noted.

Output: Mild postcontrast enhancement and restricted diffusion of the neoterminal ileum involving approximately 4 cm. No evidence of fibrostenotic or fistulous disease.


Instruction: Generate impression based on findings.

Input: Clinical question: 45 year-old with metastatic lung cancer. Assess for acuity of compression fracture of L2. Has prior L4 vertebroplasty. Signs and symptoms: Low back pain. Pre and post enhanced Thoracic MRI:Examination demonstrates a fairly extensive osseous metastatic lesions involving vertebral bodies and the posterior elements of the thoracic spine. There is no evidence of fracture or malalignment. There is however progression of disease since prior MRI study from January of 2015. There is mild expansion of tumor into the ventral epidural space at T11 and T12 levels with resultant mild central spinal stenosis. Epidural spread of tumor at T12 also extends laterally to the left and partially into the left T11 -- T12 neural foramina. There is also mild epidural spread of tumor at T6, T7 and T9 levels and posteriorly at T3 level. There is however no appreciable compromise of the spinal canal secondary to this finding.The signal intensity and caliber of thoracic cord remains within normal without detectable abnormal in enhancement.Pre-and post enhanced lumbar MRI:Examination demonstrates very extensive marrow signal changes of the tubercle consistent with diffuse osseous metastatic lesions. There is no evidence of malalignment. There is compression deformity of the superior and inferior endplates of L2 vertebrae however without evidence of marrow space edema to suggest an acute compression. The height of L2 vertebrae at their maximum level of compression measures 14.6-mm and it 27.6-mm height along the dorsal aspect of L2 vertebrae.There is ventral epidural spread of tumor from this tube into the spinal canal and resultant spinal stenosis. No evidence of spinal stenosis at any other level.No detectable signal abnormality or abnormal enhancement of the cauda equina.

Output: 1.Pre-and post enhanced MRI of thoracic spine demonstrate extensive osseous metastatic lesions involving the vertebral bodies / posterior elements and with evidence of interval progression since prior exam 1-12-14. No fracture or malalignment. There are multiple foci of epidural spread of tumor noticeably at T11 and T12 with resultant mild central spinal stenosis as detailed above.2.Pre-and post enhanced MRI of the lumbar spine demonstrate extensive osseous metastatic lesions from patient's known lung cancer. There is mild less than 50% compression fracture of the superior and inferior endplates of L2 without detectable marrow space hyperintense signal to suggest edema and likely representing a chronic change. Epidural spread of tumor at the S2 results in central spinal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: assess for cause of L. leg tenderness, assess for soft tissue tumors History: pain in the medial L. leg, H/O Schwannoma The marrow signal intensity of the tibia and fibula is normal. The musculature appears normal and we see no soft tissue mass. Although this study was not protocoled for detailed evaluation of the knee, there appears to be mild osteoarthritis and mild synovial enhancement suggesting mild synovitis. There is a lobulated collection of fluid signal intensity with peripheral enhancement anterior to the lateral meniscus, which may represent a perimeniscal cyst or ganglion.

Output: We see no specific findings to account for the patient's leg pain. Mild osteoarthritis of the knee and possible perimeniscal cyst are not optimally evaluated on this study. If further imaging is clinically warranted, dedicated knee MRI may be considered.


Instruction: Generate impression based on findings.

Input: 51 years, Male. Reason: eval for obstruction History: worsened distention, abdominal pain; hx SBO Distended loops of small bowel measuring up to 4.0-cm. There is paucity of colonic gas. Findings are compatible with high-grade small bowel obstruction. This appears new from prior MRI study. No evidence of free air.

Output: Findings compatible with high-grade small bowel obstruction. No evidence of free air.Findings discussed with Dr. Theodore Hart on pager 8767 by phone 1/27/2015 3:14PM.


Instruction: Generate impression based on findings.

Input: Axial T2 precontrast and axial T1 postcontrast images were acquired for treatment planning purposes. Multiple fiducial markers are in place. Multiple abnormal brain lesions are identified. There is a round enhancing lesion within the right posterior frontal lobe involving the hand motor area of the precentral gyrus extending anteriorly abutting the junction with the right superior frontal gyrus measuring 16 x 17 mm in the axial plane with surrounding vasogenic edema. There is an additional enhancing lesion within the posterior right temporal lobe which measures 9 x 10 mm in the axial plane which lacks significant surrounding edema. There are additional subcentimeter foci of punctate enhancement within the left superior frontal gyrus, right putamen, and left insula. There are several punctate foci of susceptibility artifact within the right posterior temporal lobe. There are multiple foci of abnormal enhancement within the bilateral cerebellar hemispheres with associated susceptibility artifact suggesting associated microhemorrhage. Fluid is present within the right greater than left mastoid air cells. Mild mucosal thickening is present within the paranasal sinuses.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact.

Output: 1.Multiple supratentorial and infratentorial brain metastases with the largest in the right posterior frontal lobe.2.Paranasal sinus mucosal thickening and fluid within the right greater than left mastoid air cells.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: recurrent meningioma s/p RT 2013 s/p resection 2015 History: eval for extent of disease Previously seen enhancements at tumor bed appear to be decreased in extent indicating most of enhancing lesions on prior scan could represent postoperative reactive changes. There are, however, remained two enhancing foci (both about 5mm sized, one on pre central gyrus and another on post central gyrus) on today's scan. These lesions could also represent reactive changes, however, follow up scan is recommended.Previously seen right fronto-parietal convexity extra axial fluid collection appears to be stable in size and MR characteristics.Focal encephalomalacia and susceptibility artifacts on the operation site and the right precentral gyrus are redemonstrated and unchanged.Underlying brain shows scattered FLAIR high signal intensity lesions indicating non specific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Overall interval decrease in operation site enhancing lesion since prior scan. 2. Two somewhat nodular enhancing lesions at operation site as described above, follow up imaging is recommended.3. No new abnormal enhancing lesion.4. Stable extra axial operation site fluid collection since prior scan.5. Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Male 78 years old with metastatic melanoma and multiple osseous metastasis presenting with left shoulder weakness and pain. Concern for metastatic invasion, rotator cuff pathology, steroid induced myopathy. ROTATOR CUFF: There is tendinopathy of the supraspinatus tendon and a partial-thickness articular surface tear of the supraspinatus tendon at its insertion. The infraspinatus, teres minor, and subscapularis tendons are intact. There is mild fatty atrophy of the rotator cuff musculature.SUPRASPINATUS OUTLET: Cystic changes at the acromioclavicular joint indicate moderate osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact on this nonarthrogram exam. No full-thickness cartilage defects are identified.BICEPS TENDON: The tendon of the long head of the biceps is normally located within its groove and is normal in appearance. ADDITIONAL

Output: Partial thickness tear of the supraspinatus tendon at its insertion and other findings as described above.


Instruction: Generate impression based on findings.

Input: 13-year-old male with pain after fall, laxity anteriorly. Evaluate for ACL tear. MENISCI: The medial and lateral meniscus are normal.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. Articular cartilage is intact with no areas of thinning or defects.LIGAMENTS: The cruciate and collateral ligaments of the knee are normal. Specifically the anterior cruciate ligament demonstrates normal signal intensity and is intact throughout its course.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Small joint effusion with no other abnormalities evident. Specifically no evidence of anterior cruciate ligament tear as clinically questioned.


Instruction: Generate impression based on findings.

Input: Increased left-sided DT reflexes with intermittent weakness/falls. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Apparent focus of T2 hyperintensity in the partially imaged lower thoracic cord on the sagittal T2 sequence is favored to be artifactual.Individual levels described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Nonspecific focus of T1 and T2 hypointensity involving the partially imaged right iliac bone which may represent a bone island.

Output: 1. MRI of the lumbar spine is essentially unremarkable. No significant disc disease or spinal canal or neural foraminal stenosis at any level.2. Focus of T1 and T2 hypointensity involving the partially imaged right iliac bone is nonspecific but may represent a bone island.3. Apparent focus of T2 hyperintensity in the partially imaged lower thoracic cord on the sagittal T2 sequence is likely artifactual.


Instruction: Generate impression based on findings.

Input: 52-year-old male with resected pancreatic cancer with portacaval lymphadenopathy status post radiation therapy. Patient now with rising CA 19-9. Evaluate for interval change in nodes or presence of hepatic disease. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. No suspicious focal hepatic enhancing lesions. Intact hepaticojejunostomy without evidence of biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Post surgical changes from prior Whipple. The gastrointestinal tract otherwise appears normal. No free mesenteric fluid or masses.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild T2 perinephric hyperintensity consistent with nonspecific inflammatory changes, unchanged compared to the previous CT examination.RETROPERITONEUM, LYMPH NODES: Reference portacaval node is unchanged and measures 1.7 x 0.8 cm (series 8, image 30). There is an additional periaortic lymph node which measures 2.4 x 1.5 cm (series 12, image 59). This node has not significantly changed in size compared to the recent CT examination; however, this node is more prominent on the current examination and demonstrates contrast enhancement.BOWEL, MESENTERY: Postsurgical changes from multiple procedure.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable portacaval and preaortic lymph node. While the preaortic lymph node has not significantly changed in size, it is more prominent on this current MRI examination and demonstrates contrast enhancement.2.No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Medically intractable epilepsy, abnormal CT head. Left temporal seizure, right hemisphere atrophy on CT. There is marked diffuse right cerebral volume loss with ex vacuo dilatation of the right lateral and third ventricles. There is a lesser degree of diffuse left cerebral volume loss. There are mild scattered patchy cerebral white matter T2 hyperintense lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The infratentorial structures are unremarkable, aside from perhaps mild asymmetric left cerebellar volume loss, which maybe due to crosses-cerebellar diaschisis. There is no evidence of intracranial hemorrhage, abnormal intracranial enhancement, or mass. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst and the bilateral frontal sinuses are mildly prominent, right greater than left. There is marked anterior nasal septal deviation.

Output: Right greater than left cerebral atrophy may represent adult-onset Rasmussen encephalitis or sequela of periventricular leukomalacia, perhaps with superimposed volume loss.


Instruction: Generate impression based on findings.

Input: 43-year-old with history of right breast cancer status post lumpectomy axillary node dissection and reconstruction, left breast reduction. The patient had neoadjuvant chemotherapy and adjuvant radiation. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Postsurgical scar with susceptibility artifacts is seen at posterior upper inner quadrant in the right breast and right axilla. A linear scar is seen at posterior lower outer quadrant in the right breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 72-year-old female with multiple compression fractures in thoracic and lumbar spine (T4/T7/L1/L3) also with history of neurogenic claudication. Please examine for central canal stenosis. This examination has limited value for evaluation of central spinal stenosis. MRI is the modality of choice for evaluation of central spinal stenosis since he visualized the soft tissues with better advantage.Approximately 50% compression fracture of L1 with biconvex deformity is noted. There is also compression along the superior endplate of L3. Very subtle compression deformity of the superior endplate of L4 is also noted. There is minimal grade 1 anterolistheses at L4 -- L5 level. Extensive vacuum phenomenon within the intervertebral disk space at T12 -- L1 and to lesser degree at the L1 -- L2 is noted. Partially visualized intervertebral disk space at T11 -- T12 also demonstrates vacuum phenomenon.T12 -- L1. Degenerative changes are noted. Mild compromise of the left neural foramina is present. No central spinal stenosis.L1 -- L2.Minimal compromise of bilateral neuroforamina. No central spinal stenosis.L2 -- L3. No central spinal stenosis. There is subtle for broad-based bulge of disk material at this level. Minimal compromise of bilateral neural foramina.L3 -- L4. Hypertrophic changes of posterior elements and bulge of disk material causes deformity of the thecal sac all were but no central spinal stenosis. Minimal compromise of bilateral neural foramina is suspected.L4 -- L5. Extensive hypertrophic changes of posterior elements and bulge of disk material is noted. No measurable central spinal stenosis. Minimal grade 1 anterolisthesis. Minimal compromise of bilateral neural foramina.L5 -- S1.Extensive degenerative changes of posterior elements. No central spinal stenosis or definitive evidence of neural foramina compromise.

Output: 1.Multiple compression fractures as detailed.2.No measurable central spinal stenosis.3.Multi-level minimal neural foramina compromise bilaterally as detailed.4.For precise evaluation of central spinal stenosis MRI is in the modality of choice.


Instruction: Generate impression based on findings.

Input: CVA No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. No definitive evidence of an acute cortical stroke is detected. A very small punctate low density in the right external capsule is again demonstrated with no interval change. Third of admission with a dedicated MRI examination is recommended to exclude acute small strokes. This examination remains stable since prior study.

Output: Essentially unremarkable CT of brain without infusion and no interval change since prior study. If clinical concern for stroke persists an MRI is highly recommended.


Instruction: Generate impression based on findings.

Input: Left knee pain. MENISCI: The lateral meniscus appears intact. The medial meniscus appears intactARTICULAR CARTILAGE AND BONE: There is focal near full thickness cartilage degeneration along the lateral femoral condyle posteriorly with underlying degenerative subchondral signal abnormality. There is also a near full-thickness articular cartilage fissure along the lateral femoral condyle, posteriorly. There is relative sparing of the articular cartilage of the medial compartment. There is superficial fraying of the articular cartilage along the median eminence of the patella.LIGAMENTS: There is disruption of the proximal fibers of the superficial band in the MCL. The distal fibers of the meniscofemoral coronary ligament are also indistinct indicating disruption. The ACL, PCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Disruption of the proximal fibers of the MCL as described above.2. Focal articular cartilage degeneration and fissuring along the lateral femoral condyle as described. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 41 year old female with large posterior fibroids PELVIS:UTERUS, ADNEXA: Two large fibroids with additional smaller fibroids are identified. The anterior intramural fibroid measures 5.9 x 8.8 x 8.1 cm. The large posterior fibroid measures 5.8 x 5.7 x 6.4 cm exerting mass effect on the endometrial complex and likely has a submucosal component.The anterior fibroid heterogeneously enhances while the posterior fibroid demonstrates delayed enhancement. Additional smaller fibroids also demonstrate enhancement.Bilateral physiologic ovarian follicles are noted with the largest on the left measuring 2.3 x 1.8 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: 1.Two dominant uterine fibroids as described above (additional smaller fibroids also present). The large posterior fibroid exerts mass effect on the endometrial complex and likely has a submucosal component.


Instruction: Generate impression based on findings.

Input: Sickle cell patient with persistent severe headaches, evaluate for signs of increased pressure and/or lesions MRI brain:No restricted diffusion to suggest acute ischemia. The signal intensity of the brain parenchyma is within normal limits. There is no abnormal enhancement within the brain parenchyma. The ventricles, sulci, and basal cisterns are normal in size. There are no masses, mass effect or midline shift. The cerebellar tonsils are normal in position. There is no evidence of intracranial hemorrhage or extraaxial fluid collections. Polypoid mucosal thickening of the maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are grossly aerated. The orbits are unremarkable.MRA brain:MRI angiogram is somewhat motion graded yet demonstrates patent anterior and posterior intracranial circulations without evidence of flow limiting stenoses, significant atherosclerosis, or aneurysms.

Output: 1.Essentially normal MRI brain without findings to account for the patient's symptoms.2. Essentially normal MRA brain.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhosis with central fibrotic changes and iron deposition.Stigmata of portal hypertension including splenomegaly, gastroesophageal varices and recannulized periumbilical vein.No intrahepatic or extrahepatic biliary ductal dilatation.Several hepatic cysts.Stable segment 3 ablation cavity measuring 2.5 x 1.9 cm (series 10/60), compared to 2.6 x 1.6 cm previously and containing proteinaceous/hemorrhagic debris. No findings of a marginal recurrence.No new suspicious liver lesion.Cholelithiasis within a contracted gallbladder.SPLEEN: Splenomegaly, measuring 21 cm in craniocaudal dimension. No focal lesion.PANCREAS: Numerous T2 hyperintense foci within the pancreas appear to communicate with a normal caliber main pancreatic duct. The reference pancreatic body/tail lesion measures 1.4 x 1.0 cm (series 7/35), essentially unchanged. No suspicious postcontrast features.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several punctate left renal simple cysts. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace right pleural effusion with adjacent compressive atelectasis. Right lower lobe subpleural nodule is not significant change compared to 11/19/2015 CT.

Output: 1.Stable examination including segment 3 ablation cavity without evidence of marginal recurrence or new suspicious liver lesion.2.Cirrhosis with stigmata of portal hypertension.3.Numerous cystic pancreatic lesions are not significantly changed in size or number without suspicious postcontrast enhancement, likely representing side branch IPMNs.4.Right lower lobe pulmonary nodule, better characterized on 11/19/2015 chest CT.


Instruction: Generate impression based on findings.

Input: History of lymphoma in the proximal femur with prophylactic intramedullary rod fixation. Patient presents with pain in the left leg for 2 months. Metallic susceptibility artifact from an intramedullary rod and screw device within the left femur limits evaluation. No evidence of hardware complication is evident. No acute fracture is seen. Heterogeneous bone marrow signal abnormality in the right femoral diaphysis is nonspecific but likely represents residual islands of red marrow. There is a small amount of fluid within the right hip which is not necessarily of any current clinical significance. There is a lobulated focus of fluid signal intensity within the subcutaneous tissue along the lateral aspect of the greater trochanter which may represent a postoperative seroma, although this is incompletely imaged/included in the field-of-view. There is linear decreased signal abnormality within the subcutaneous tissues along the lateral aspect of the subtrochanteric region of the left thigh likely postsurgical in etiology. There is increased bone marrow signal abnormality in the subtrochanteric region of the proximal femoral diaphysis which enhances on postcontrast sequences suspicious for osseous disease which appears decreased in size when compared to the prior MRI hip examination. There is also enhancement of the surrounding soft tissues within the vastus lateralis and intermedius musculature consistent with soft tissue extension of disease which also appears decreased in size when compared to the prior MRI examination of the left hip. There is enhancing increased signal abnormality at the level of the left femoral head/neck junction which likely represents residual osseous disease seen on prior MRI examination, although this is poorly evaluated due to the extensive metallic susceptibility artifact. There is serpentine signal abnormality within the superior aspect of the femoral head consistent with avascular necrosis. Evaluation for subchondral collapse is limited due to the aforementioned metallic susceptibility artifact. Although this examination was not protocoled for detailed evaluation of the knee, there appears to be articular cartilage degeneration along the lateral facet of the patella with degenerative underlying subchondral signal abnormality. The remainder of the imaged musculature is normal in appearance

Output: 1. Limited examination demonstrating findings consistent with the patient's known history of osseous lymphoma involving the left femur which appear decreased in size and extent when compared to the prior study, within the confines of this examination.2. Postoperative changes of orthopedic fixation of the left femur without evidence of acute fracture or hardware complication.3. Findings consistent with avascular necrosis of the left femoral head. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [R40.4], Reason for Study: ^Reason: ? stroke History: see CT read There is no evidence of acute ischemic or hemorrhagic lesion.There are multifocal scattered T2/flair high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease.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: 1. No acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 67-year-old female with anorectal adenocarcinoma with fistula (invasion into vagina). Baseline scan prior to treatment. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: Note is made of linear increased T2 signal abnormality and enhancement at the 12 o'clock position of the anus, which extends anteriorly to the level of the posterior wall of the vagina, consistent with the stated history of an anovaginal fistula (36; series 1901). There is associated increased T2 signal abnormality and enhancement anterior to the anus, interposed between the anus and vagina, however, it is unclear if this represents tumor involvement or inflammatory change. Note is made of asymmetry of the external sphincter along it's left posteroinferior margin, adjacent to the aforementioned signal abnormality. Additionally, the boundaries between the internal and external sphincter are indistinct in this area and tumor involvement cannot be excluded. There is also asymmetrical wall thickening of the anus anteriorly, measuring up to 9 mm in diameter (image 11; series 701). No encapsulated fluid collection to suggest abscess formation.BONES, SOFT TISSUES: Increased T2 signal abnormality along the sacral aspect of the sacroiliac joints bilaterally, most consistent with benign osteitis condensans ilii.OTHER: No significant abnormality noted.

Output: 1.Findings consistent with a anovaginal fistula at the 12 o'clock position of the anus, as detailed above. No evidence of abscess formation.2.Wall thickening of the anus with associated enhancing signal abnormality interposed between the anus and vagina, is nonspecific but suspicious for tumor involvement, given the stated history or anorectal carcinoma. There is no evidence of pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: History of lung and breast cancer with treatment for uveitis and iriditis recently to have afferent pupil response and complaint of dizziness and headaches. Evaluate for metastases. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal enhancement. There are minimal scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific, but most consistent with minimal chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are bilateral lens implants. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of intracranial mass or abnormal enhancement.2. Nonspecific minimal scattered punctate foci of abnormal T2 signal in the white matter are most likely vascular related at this age.


Instruction: Generate impression based on findings.

Input: History of intermediate risk prostate cancer. Pathology dated 1/21/2016 showed left mid, 3+4 cancer less than 1 mm 5%, left lateral mid 3+4 4-mm 65%, left lateral base 4+ 3 0.5 mm 15%. PELVIS:PROSTATE:Prostate Size: 4.6 x 6.2 x 6.0 cmPeripheral Zone: The left peripheral zone is thinned.Right mid gland medial 6 x 5 mm lesion demonstrating T2 weighted hypointensity (series 601/12) with restricted diffusion (series 704/224).Mid-gland paramedial lesion measuring 7 mm with restricted diffusion (series 704/284). Left mid-gland medial lesion with restricted diffusion (series 704/324), measuring 1.1 x 0.4 cm. This lesion abuts the prostatic margin without frank extra capsular extension.Central Gland: BPHSeminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No definite evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: Degenerative changes of the pubic symphysis. Degenerative changes of the left sacroiliac joint.OTHER: No significant abnormality noted.

Output: Subcentimeter lesions involving the right mid gland, left mid-gland and paramedial mid-gland are suspicious for multifocal prostatic adenocarcinoma without extraprostatic extension or enlarged pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Planning for SRS treatment of a meningioma. There is a dural-based mass that involves the left cavernous sinus and petroclival regions, measuring up to approximately 20 mm in thickness. There is mild mass effect upon the medial left temporal lobe, without evidence of vasogenic edema. There is encasement of the cavernous left internal carotid artery, without significant narrowing of the flow void. 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.

Output: Preoperative planning MRI for a left cavernous sinus and petroclival region meningioma.


Instruction: Generate impression based on findings.

Input: Female, 91 years old, with left trigeminal neuralgia and left facial asymmetry, lesion noted within the left temporal lobe on prior incomplete study. As on the prior examination, an area of edema is present within the anterior left temporal lobe. There are several small foci of signal loss/susceptibility within the affected parenchyma which are favored to represent hemosiderin deposition though they could also represent foci of mineralization. In addition, hemosiderin staining is demonstrated along the ependyma of the left temporal horn.The left terminal ICA and proximal MCA within the adjacent sylvian fissure are slightly prominent. In addition, there is ill-defined parenchymal enhancement at the far anterior left temporal lobe as well as probable dural enhancement and prominent venous structures along the adjacent left greater sphenoid wing.Elsewhere, no pathologic parenchymal enhancement is detected. A moderate burden of periventricular T2 hyperintense lesions are demonstrated without edema or mass effect. No restricted diffusion is seen. The ventricular system is within normal limits.Small areas of abnormal marrow signal and ill-defined enhancement are seen within the frontal bones, right side more than left. These lesions do not breach the cortex and demonstrate a benign morphology. A small bony spur osteoma is demonstrated along the left scrotum is temporal bone which does impinge slightly on the lateral temporal lobe.

Output: Edema is seen within the left anterior temporal lobe in association with scattered foci of hemosiderin or perhaps mineralization. Hemosiderin staining is noted along the ependyma of the left temporal horn as well. Mild ill-defined enhancement is seen within the far anterior left temporal lobe parenchyma, along with dural enhancement and prominent venous structures along the left greater sphenoid wing.The differential diagnosis for this abnormality remains broad but the constellation of findings is suspicious for a vascular malformation. An inflammatory or infectious process would be less likely but are not excluded. The possibility of tumor/metastatic disease is not excluded, though this would be an unusual presentation, and in the absence of a known primary, the likelihood is low.


Instruction: Generate impression based on findings.

Input: Ms. Heinlen is a 61 year old female with a family history of breast cancer in sister (diagnosed at the age of 56 years) and paternal aunt and ovarian cancer in paternal aunt. She has a personal history of bilateral benign breast biopsies performed in 1983 and 1989. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.A few scattered enhancing foci are seen bilaterally, all of which are stable when compared back to multiple prior exams. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Glioblastoma multiforme. Status post resection followed by chemoradiotherapy. Reresection in October 2015 for relapse. On HSPPC96 vaccine trial. The resection cavity in the left temporal lobe has significantly decreased in size. In the axial plane, it now measures 2.7 cm x 2.5 cm compared to 3.8 cm x 4.8 cm previously. It contains fluid that is now greater is signal on FLAIR, suggesting the presence of blood or protein. The overlying extra-axial collection is significantly thinner.There remains enhancement in the area of the previously suspected post-operative infarct, along the posterolateral inferior surgical margin. This appears slightly less confluent on the early fat saturated postcontrast images and relatively similar in appearance to even minimally increased in confluence with decreased gyriform appearance on the more delayed postcontrast images. Persistence of contrast enhancement at this point is atypical for a bland infarct.Additionally, the contrast enhancement along the surgical margins has progressed since the previous examination with increased thickness of the rind as well as a slightly nodular appearance. This is most prominent along the superior surgical margin from which new lacelike contrast enhancement has extended to involve a significant part of the remaining left temporal lobe, including the mesial temporal lobe. In the axial plane, this new and increasingly confluent contrast enhancement measures maximally 4.0 cm x 3.0 cm (image #46 of series #1201). It is not associated with diffusion restriction or significant hyperperfusion. There is associated progression of nonenhancing T2-hyperintense signal which now spans the length of the left external capsule and most of the posterior limb of the left internal capsule, as well as extending superiorly into the frontoparietal deep white-matter. Overall, there has been only minimal increase in the mass-effect on the posterior body/trigone of the left lateral ventricle despite the progression in the contrast enhancement and associated T2 signal given the retraction of the surgical cavity. There is mild parenchymal expansion involving the remaining left temporal lobe.The remainder of the brain shows no new remote contrast enhancement. Scattered T2/FLAIR-hyperintense foci in the cerebral white-matter reflective of chronic microvascular ischemia are unchanged.The left mastoid air cell T2-hyperintense process persists, but the associated enhancement is minimally improved. The dural venous sinuses and major intracranial arteries are patent. Orbits are notable for previous right cataract surgery.

Output: 1.Progressive contrast enhancement along the surgical margins, especially superiorly where it extends into a confluent lace-like pattern into the remaining left temporal lobe but without associated diffusion restriction or hyperperfusion, is nonspecific and may reflect treatment-related effect. However, the presence of viable tumor would be difficult to exclude. Follow-up imaging may better characterize the significance of this finding.2.Enhancement persists in the area of the previously suspected infarct along the inferior posterolateral surgical margin which is atypical for a bland infarct. This is probably involved with the same process described above along the remainder of the surgical margin.3.The associated surrounding nonspecific FLAIR hyperintensity is mildly increased with mild gyral expansion and localized mass effect, and may represent a combination of vasogenic edema, post-treatment changes, and/or tumor. 4.The left temporal resection cavity is smaller but is more FLAIR hyperintense which may reflect the presence of hemorrhage or high protein content. This likely relates to a combination of cavity retraction as well as extrinsic mass effect from the surrounding parenchymal abnormality.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post cervical fusion. Signs and symptoms: Same Nonenhanced CT of cervical spine:Routine non-infused axial 3-mm CT images of the entire cervical spine were obtained. Sagittal and coronal 2-D reformatted images were also obtained.Examination demonstrates very advanced degenerative disk disease at C3 -- C4 through C6 and C7 levels.Antral listhesis of C3 in respect to C4 is again identified with no appreciable change since prior MRI exam.There is evidence of posterior fusion with placement of bilateral trans-facet fixating screws at C3 level. There is also wide bilateral laminectomy at this level.Evidence of bilateral trans-facet screws placement at C4. No evidence of laminectomy. Fixating metallic rods bilaterally at C3 there C4 levels are also present.There is no evidence of any fracture of the instruments. The appropriateness of the position of the screws should be decided by referring clinical physician.Expected postoperative changes of air in the surgical site. No evidence of intracanalicular air.

Output: 1.Expected postoperative changes of posterior fusion of C3 and C4 and wide bilateral laminectomy of C3.2.Stable anterolistheses of C3 in respect to C4 and extensive degenerative changes of cervical spine.


Instruction: Generate impression based on findings.

Input: Female 43 years old; Reason: h/o pancreatitis, now w/ abd pain, eval for pancreatic mass/inflammation History: belly pain Lack of intravenous contrast limits sensitivity for solid organ pathology. Motion artifact also limits multiple sequences.ABDOMEN:LUNG BASES: Cardiomegaly, partially visualized.LIVER, BILIARY TRACT: No focal hepatic lesions. Paradoxical loss of signal of the liver diffusely on opposed phase images, suggestive of hemosiderin deposition. No biliary ductal dilation. Gallbladder appears within normal limits.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic bilaterally with subcentimeter renal cysts, incomplete with a characterized on this exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: Mild degenerative arthritic changes of the visualized spine.OTHER: Body wall anasarca.

Output: Limited examination without evidence of pancreatic pathology, as clinically questioned. Evidence of hemosiderosis.


Instruction: Generate impression based on findings.

Input: Patient with newly diagnosed metastatic breast cancer, evaluate for brain metastasis. There is no evidence of intracranial hemorrhage, suspicious mass, or acute infarct. No abnormal enhancement is noted intracranially. Subcentimeter left frontal lobe cystic lesion is noted, demonstrating suppression on FLAIR sequence with no associated enhancement or mass effect. Differential includes enlarged perivascular space, sequela of prior injury, or other benign cystic 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Nonspecific low T1 marrow signal of the calvarium with mild associated enhancement is noted, which can be seen with marrow conversion due to conditions such as chronic anemia. No destructive focal calvarial lesions are noted.There is a T1 hypointense lesion involving the posterior aspect of the C3 vertebral body, which may represent metastasis.

Output: 1.No evidence of intracranial metastatic disease.2.T1 hypointense lesion involving the posterior aspect of the C3 vertebral body is suspicious for osseous metastasis. Suggest correlation with bone scan or PET/CT. Dedicated spine MRI may be considered as clinically warranted.3.Diffuse low signal involving the calvarium with mild enhancement. This may be related to marrow conversion such as secondary to chronic anemia; however, this is nonspecific and may also be correlated with bone scan/PET. No focal destructive osseous calvarial lesions are appreciated.


Instruction: Generate impression based on findings.

Input: Status post liver transplant evaluate nonspecific lesion seen on CT ABDOMEN: LIVER, BILIARY TRACT: Enhancing T2 hyperintense lesion in segment 7 without washout measures 1.5 x 1.1 cm (series 901, image 44). No biliary ductal dilation. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys. Complex cystic mass in the left upper pole demonstrates nodularity along its inferomedial wall without definite enhancement and measures 4.5 x 4.4 cm (series 1001, image 25). An apparent fluid/fluid level within this lesion suggests prior hemorrhage. A proteinaceous / hemorrhagic cyst is seen in the left upper pole measuring 1.6 cm. Right iliac fossa transplant kidney is incompletely visualized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lateral abdominal hernia containing bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Enhancing segment 7 hepatic lesion with signal characteristics most consistent with a flash filling hemangioma.2.Cystic mass in the left kidney without definite enhancement. Given the complexity of this mass, short term follow up with triphasic CT is recommended.


Instruction: Generate impression based on findings.

Input: Female 57 years old Reason: right ac joint osteoarthritis History: right shoulder impingement: ROTATOR CUFF: There is intermediate signal intensity and thickening of the infraspinatus tendon indicating tendinopathy with no evidence of tear. The infraspinatus muscle is normal in appearance. The supraspinatus, teres minor, and subscapularis muscles and tendons are normal in appearance.SUPRASPINATUS OUTLET: The acromioclavicular joint is unremarkable.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is no joint effusion. Within the limitations of a nonarthrogram exam, the glenoid labrum appears normal. The glenohumeral joint articular cartilage is intact.BICEPS TENDON: The tendon of the long head of the biceps is normal in appearance and normally located within the bicipital groove. ADDITIONAL

Output: Infraspinatus tendinopathy. No evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Female, 73 years old. Left shoulder pain ROTATOR CUFF: There is pronounced tendinopathy of the supraspinatus tendon, containing small foci of abnormal signal, and intrasubstance tears are not excluded. The more proximal and distal fibers are intact. The supraspinatus muscle appears normal. The infraspinatus, teres minor, and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: There is moderate acromioclavicular joint osteoarthritis. There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the joint. There is moderate osteoarthritis of the glenohumeral joint with subchondral cysts. The labrum is grossly intact on this unaugmented exam.BICEPS TENDON: The tendon of the long head of the biceps has a normal course and morphology. ADDITIONAL

Output: 1.Rotator cuff tendinosis with possible intrasubstance partial tearing of the supraspinatus but no full-thickness tear.2.Osteoarthritis.


Instruction: Generate impression based on findings.

Input: Reason: eval for labral tear History: shoulder pain for a year ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant fluid or intra-articular gadolinium is identified within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact. There are numerous foci of low signal intensity identified within the glenohumeral joint which extend into the subscapular recess likely representing a synovitis.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is low signal intensity debris within the tendon sheath of the long head of the biceps likely representing a tenosynovitis. ADDITIONAL

Output: Findings indicating a synovitis of the glenohumeral joint and tenosynovitis involving the long head of the biceps tendon. The glenoid labrum appears intact.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post focal ablation. History of right medial base Gleason 3+3 cancer from TRUS biopsy dated 5/8/2014. History of ablation of the left mid gland. PELVIS:PROSTATE:Prostate Size: 5.7 x 3.6 x 5.0 cmPeripheral Zone: Postablation changes of the left mid gland including scarring and volume loss.Again seen is a focus of T2 hypointensity with associated restricted diffusion in the right base abutting the central zone measuring approximately 1.1 x 1.4 cm (series 604/304 and series 1201/17), unchanged.Central Gland: Findings of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle lesion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small subcentimeter right external iliac lymph node, unchanged.BONES, SOFT TISSUES: Inflammatory changes adjacent to the left greater trochanter, correlate for trochanteric bursitis.OTHER: No significant abnormality noted.

Output: 1.Post ablation changes of the left mid gland peripheral zone.2.Findings consistent with prostate cancer involving the right base appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: 81-year-old female right hip pain after fall two years ago, rule out dislocation versus labral tear. ACETABULAR LABRUM: There is near complete loss of articular cartilage of the right hip.ARTICULAR CARTILAGE AND BONE: There is near complete loss of articular cartilage of the right hip with near bone-on-bone apposition.SOFT TISSUES: Multiple uterine fibroids are noted. ADDITIONAL

Output: Limited examination due to the patient's inability to tolerate the exam secondary to pain. Heterogeneous high T2 signal and low T1 signal within the right femoral head and neck with associated subchondral collapse and joint effusion, most consistent with avascular necrosis. However, if there is concern for septic arthritis, joint aspiration is recommended.


Instruction: Generate impression based on findings.

Input: Medial left elbow pain. LIGAMENTS: Within the limitations of this non-arthrographic examination, the ulnar and radial collateral ligaments appear intact without evidence of tearing.TENDONS: The biceps, brachialis, triceps, common flexor and common extensor tendons appear intact without evidence of tearing. ARTICULAR SURFACES AND BONE: The articular cartilage of the elbow appears intact. There is an oval-shaped sclerotic focus within the proximal ulna which demonstrates low T1 and T2 signal and is compatible with a normal variant bone island. Bone marrow signal intensity is otherwise within normal limits without focal lesions.SURROUNDING STRUCTURES: There is no soft tissue mass nor focal fluid collection. ADDITIONAL

Output: No specific findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: 17-year-old male with clinical concern for Crohn's disease.EXAMINATION: MR enterography without and with IV contrast 06/29/2015 ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: kidneys and uretersRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No significant areas of bowel wall thickening, mucosal hyperenhancement or aperistalsis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant areas of bowel wall thickening, mucosal hyperenhancement or aperistalsis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Altered mental status and aphasia. There is a focus of restricted diffusion in the left periventricular corona radiata, but there is also hemosiderin staining in this region raising the possibility of artifactual signal versus true restricted diffusion. There is evidence of the left thalamic hematoma with internal T1 bright signal indicating methemoglobin which overall remains unchanged in size from previous CT. There are punctate foci of hemosiderin staining in the pons indicative of prior chronic hemorrhage without any findings to suggest an acute or subacute component.There are confluent and scattered T2 hyperintensities in the periventricular and subcortical white matter, which may represent small vessel ischemic disease. In addition there are T2 hyperintense foci in the right more than left cerebellum and in the pons. The ventricles and cortical sulcal spaces are prominent compatible with global parenchymal volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the bilateral maxillary, sphenoid and ethmoid sinuses.The skull and scalp soft tissues are grossly unremarkable.

Output: 1. Punctate focus of restricted diffusion in the left periventricular coronal radiata which may reflect ischemia, but there is also strong hemosiderin staining in this area raising the possibility of artifact.2. Evolving left thalamic hematoma without significant change in size.3. Chronic appearing pontine hemorrhage in association with extensive chronic lacunar disease.3. Chronic small vessel ischemic disease elsewhere in the cerebral hemispheres.4. Prominent ventricular system and sulci compatible with global parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of distal pancreatectomy for intraductal papillary mucinous carcinoma. ABDOMEN:LIVER, BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Postoperative changes of distal pancreatectomy. Anterior to the pancreatic body, there is a thick walled, peripherally T1 hypointense enhancing lesion with intermediate to high internal T2 signal abnormality which has decreased in size now measuring 12 x 11 mm, previously 26 x 17 mm. The pancreatic duct appears normal. Left upper quadrant nonenhancing soft tissue focus, nonspecific and may be a lymph node.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter benign left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small duodenal diverticulum suggested.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in size of cystic lesion anterior to the pancreatic body, likely postoperative or inflammatory in etiology.


Instruction: Generate impression based on findings.

Input: Recent TIA with aphasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild patchy cerebral white matter T2 hyperintensity, which is nonspecific, but may represent chronic small vessel ischemic disease. 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: Probable mild chronic small vessel ischemic disease, but no evidence of acute infarction, intracranial hemorrhage, or mass.


Instruction: Generate impression based on findings.

Input: 51-year-old female with right hip pain. Evaluate for labral tear. ACETABULAR LABRUM: Note is made of linear increased signal abnormality traversing the anterior superior acetabular labrum, extending from the 1 o'clock to approximately the 3 o'clock position, consistent with a labral tear. ARTICULAR CARTILAGE AND BONE: There is prominence of the anterior right femoral head/neck junction consistent with a CAM deformity. The alpha angle measures 64 degrees (14; series 901). No articular cartilage defects are identified.SOFT TISSUES: The imaged musculature appears normal. ADDITIONAL

Output: CAM deformity with acetabular labral tear as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Unremitting headache. History of fracture 5 deficiency, on chronic anticoagulation. Signs and symptoms: Unremitting headaches and prolonged nasal congestion. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination re-demonstrates a very small focus of cortical and subcortical encephalomalacia in the left inferior frontal lobe without enhancement or interval change since prior exam. This finding is best appreciated on coronal T2-weighted series 601 on images 8 through 11 similar to prior exam.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise and without change.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Negative post infused images or abnormal parenchymal, leptomeningeal, calvarial, soft tissues of the scalp or the retro orbital enhancement.All paranasal sinuses and bilateral mastoid air cells are well pneumatized. Mild mucosal thickening of left maxillary sinus however is noted and is new since prior exam.

Output: 1.Negative diffusion weighted images.2.Stable small focus of cortical and subcortical encephalomalacia in the left inferior frontal lobe.3.Unremarkable pre-and post enhanced brain MRI otherwise and stable since prior study.4.Mild maxillary mucosal thickening is a new finding since prior study.


Instruction: Generate impression based on findings.

Input: Several sequences are motion degraded with repeat acquisition attempted. Given this caveat:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Minimal mucosal thickening is present within ethmoid and maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's new seizures.


Instruction: Generate impression based on findings.

Input: 75-year-old female hemiplegia, thrombocytopenic. May have had lead. Subtle area of low density in the left cerebellar hemisphere is suspected of possible nonhemorrhagic cerebellar stroke. Further evaluation with an MRI is recommended.Images through the supratentorial brain parenchyma are essentially unremarkable.

Output: 1.No evidence of acute hemorrhage.2.Suspected left cerebellar stroke. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Right ataxia. There is a small area of high T2 signal and restricted diffusion in the right lateral medulla. There are T2 hyperintense lesions within the left midbrain, pons, bilateral basal ganglia, as well as the bilateral cerebral hemisphere white matter, predominantly in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions in the right sphenoid sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Recent right lateral medullar infarct and bilateral basal ganglia and thalamic and right pons chronic lacunar infarcts and a background of chronic cerebral white matter small vessel ischemic disease.2. Findings suggestive of acute right sphenoid sinusitis.


Instruction: Generate impression based on findings.

Input: 62 year old female with a family history of breast cancer in her mother at age 49 and maternal aunt at age 75. History of benign right breast biopsy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Scattered enhancing foci are unchanged when compared to the images from 10/10/12.Stable non-enhancing benign masses are again seen in the lower aspect of both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 55-year-old male with a perianal fistula. Evaluate for fluid collection. ABDOMEN:LUNG BASES: No pleural or pericardial effusions.LIVER, BILIARY TRACT: Normal hepatic morphology without biliary ductal dilatation. Normal gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta. No pathologically enlarged retroperitoneal adenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lesion of the T12 or L1 vertebral body (coronal image 27) with mild vertebral body height loss, may represent a hemangioma; other etiologies such as Paget's disease should be considered. If there are symptoms or clinical concern this may be further evaluated with an MRI or bone scan. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No pelvic fluid collection.

Output: No pelvic fluid collection.Lesion of the T12 or L1 vertebral body (coronal image 27) with mild vertebral body height loss, may represent a hemangioma but other entities as noted above could have a similar appearance. If this symptomatic or there is clinical concern this may be further evaluated with an MRI or bone scan.