Instruction: Generate impression based on findings.

Input: 76 year old with history of left ventricular systolic dysfunction, hypertension, end stage renal disease and concern for right atrial mass presenting for evaluation of RA mass. Left VentricleThe left ventricle is moderately dilated (severely when indexed for BSA) with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 120 ml/m2 (normal range: 65+/-11), the LVEDV is 181 ml (normal range 109+/-23), the LV end systolic volume index is 66 ml/m2 (normal range 18+/-5), the LVESV is 100 ml (normal range 31+/-10), the LV mass index is 91 g/m2 (normal range 67+/-11), and the LV mass is 137 g (normal range 114+/-24). The LV systolic dysfunction is global. 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 61%, the RV end diastolic volume index is 96 ml/m2 (normal range 69+/-14), the RVEDV is 144 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. There is no clear mass seen on T1 and T2 weighted imaging. Notably imaging is limited by poor breath hold and lack of gadolinium (due to ESRD). 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 obvious pericardial disease.Extracardiac FindingsThere are large bilateral pleural effusions, left greater than right with left lower lobe atelectasis. Hepatic cysts and moderately enlarged kidneys with innumerable cysts. Small focus of T2 hyperintensity in mid-lower thoracic spine (1.1x1.3cm). 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 moderately dilated with mildly reduced systolic function (LVEF 45%)2. The right ventricle is normal in size with normal systolic function (RVEF 61%)3. The right atrium is normal in size. There is no clear mass seen on T1 and T2 weighted imaging in the right atrium. Notably imaging is limited by poor breath hold and lack of gadolinium (due to ESRD).


Instruction: Generate impression based on findings.

Input: Ms. Muzzareli is a 65 year old female with a history of right mastectomy in April 2013 for IDC and recent reduction surgery in the left breast. She received radiation chemotherapy and hormonal therapy. History of breast reduction in July 2014. Family history of breast cancer in her sister (diagnosed at age 50), maternal cousin (diagnosed at age of 40), maternal aunt and two paternal aunts. There is heterogeneous amount of fibroglandular tissue in left breast. Left breast appears smaller in size and different distribution pattern as compared to prior exam cocnsistent with recent history of reduction surgery. Mild parenchymal enhancement is noted in left breast. Patient is status post right mastectomy with reconstruction.Multiple enhancing foci in the left breast, none of them are uniquely enhancing. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region. Seroma cavity in right axillary region is smaller in size from recent MRI study.

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


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: ischemic stroke History: ischemic stroke Brain MRIMotion artifacts degraded image quality.Previously seen left thalamic hemorrhage and IVH especially on the left lateral ventricle occipital horn are again demonstrated. Restricted diffusion seen on DWI of the thalamic lesion can be considered as usual characteristics of acute hemorrhage especially in early stage. Lack of susceptibility effects on gradient echo images indicate hemorrhagic conversion from acute ischemic lesion less likely but still is a possibility.Minimal mass effect is associated with the lesion, however, there is no identifiable midline shift.There is no other acute ischemic or hemorrhagic lesion on this scan.Encephalomalacia on the left inferior parietal lobule is seen indicating chronic ischemic lesion.Underlying brain shows patch high signal intensity lesions on bilateral centrum semiovale and periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The mastoid air cells are clear.There is opacification of the right maxillary sinus the subtle mass like effects. Differential diagnosis include intra sinus mass lesion including tumorous condition such as inverted papilloma, inflammatory polyp or fungal lesion. Dedicated imaging study can be considered for further imaging evaluation if clinically necessary.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant (more than 50%) tandem stenosis of proximal basilar arteryand mid portion of the left MCA M1 segment where the left anterior temporal branch origin stenosis (about 30%). In addition, the left MCA angular branch appears to be diminutive indicating possible severe luminal stenosis or related to prior stroke.There is no evidence of intracranial arterial aneurysm.Above described findings are consistent with intracranial arterial atherosclerosis.

Output: 1. Left thalamic ICH with IVH especially in the left lateral ventricle occipital horn,2. No evidence of other acute ischemic lesion.3. Intracranial atherosclerosis involving basilar artery and the left MCA as described above.4. Mass like lesion on the right maxillary sinus, dedicated imaging study can be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Sharp head pains bilaterally for the past 7 months. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is a 3 mm diameter outpouching arising from the posteromedial aspect of the left paraclinoid internal carotid artery, with a 2 mm wide neck. There is also an small outpouching of contour deformity of the lateral aspect of the right opthalmic internal carotid artery segment. There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Incidental 3 mm diameter paraclinoid left internal carotid artery aneurysm and small aneurysm versus prominent infundibulum of the right opthalmic internal carotid artery segment.


Instruction: Generate impression based on findings.

Input: 64 year old male. Possible rotator cuff injury. ROTATOR CUFF: Mild intermediate signal abnormality in the supraspinatus and subscapularis tendons consistent with mild tendinosis. No discrete tear is evident. The rotator cuff muscles are intact without evidence of edema or atrophy.SUPRASPINATUS OUTLET: Moderate osteoarthritis of the acromioclavicular joint with inferior acromial spurring.GLENOHUMERAL JOINT AND GLENOID LABRUM: Intermediate globular signal abnormality in the superior labrum consistent with intrasubstance degeneration. No discrete tear is seen within limitations of this non-augmented exam. Bone marrow signal intensity is within normal limits. A small bone island is noted in the humeral head. No Hill-Sachs deformity is evident.BICEPS TENDON: The biceps tendon is normal in signal intensity and situated in the bicipital groove.ADDITIONAL

Output: Mild supraspinatus and subscapularis tendinosis. No rotator cuff tear is evident.


Instruction: Generate impression based on findings.

Input: 34-year-old male patient with pain, constipation, perirectal abscess. Assess rectal abscess, tracking/fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: There are prominent bilateral external iliac, internal iliac, and inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is edema type signal within the intersphincteric space. There is a tract of signal abnormality originating from the 2 to 3 o'clock position of the lower anus which tracks inferiorly within the left gluteal fold and communicates with a 4.6 x 2.7 x 3.5 cm complex, peripherally enhancing, central low intensity collection within the left gluteal soft tissues adjacent to the gluteal cleft.OTHER: There is no intrapelvic abscess.

Output: Perianal fistula with complex perianal abscess as described above.


Instruction: Generate impression based on findings.

Input: History of a liver lesion status post TACE RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Post radiofrequency ablation halos in the right hepatic dome involving segments 7/8. The more anterior older ablation defect measures 1.7 x 1.4 cm (series 10/120), compared to 2.0 x 1.5 cm previously.The more posterior lateral ablation defect measures 3.4 x 2.3 cm (series 10/122).There is persistent arterial enhancement adjacent to the anterior aspect of the new larger ablation cavity (series 10 image 17) measuring 1.4 x 1.2 cm.There are additional arterial enhancing foci throughout the liver which are not significant changed in size and demonstrate no definite washout.SPLEEN: Stable splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Subcentimeter right adrenal nodule is stable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New ablation defect in the dome of the liver. There is a persistent 1.4 cm enhancing focus with subtle washout adjacent to the anterior aspect of the new ablation defect, suspicious for residual hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: Reason: patient w/ Stage IB1 cervical cancer, please perform MRI to look for metastatic disease or Lymph node disease History: Stage IB1 cervical cancer. PELVIS:UTERUS, ADNEXA: In the right ectocervix, there is a well-defined lobulated homogeneous intermediate T2, iso-T1 signal lobulated mass with restricted diffusion, measuring 0.9 x 1.6 x 1.7 cm (AP x TR x CC; series 901 image 36, series 801 image 20). There appears to be extension into the anterior and right vaginal fornices.Follicles are present in both ovaries. In the right ovary, there is a 1.7 x 1.7 x 2.6 cm cyst with a thin septation or 2 adjacent cysts, one of which is a dominant follicle.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonenlarged bilateral pelvic sidewall and inguinal lymph nodes. No pathologically enlarged lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right 1.7 cm cervical mass compatible with history of cervical cancer with extension into the anterior and right vaginal fornix. No evidence of metastases.


Instruction: Generate impression based on findings.

Input: 47-year-old female with left knee recurrent pain and Baker's cyst. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities are identified. No near full-thickness or full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Nonspecific subcutaneous edema and small joint effusion as described above. No Baker's cyst is evident.


Instruction: Generate impression based on findings.

Input: Sudden hearing loss in left ear, history of chemoradiation for esophageal cancer. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is mild fluid signal in the bilateral mastoid air cells, left more than right. The bilateral middle ears also appear unremarkable. There are bilateral lens implants. There is scattered cerebral white matter T2 hyperintensity in the imaged portions of the brain.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. Mild nonspecific fluid signal in the bilateral mastoid air cells, left more than right, which may represent effusions.


Instruction: Generate impression based on findings.

Input: 26-year-old female patient with left lower quadrant pain, fatigue. PELVIS:UTERUS, ADNEXA: There is a focal defect in the myometrium in the lower anterior uterine body near midline measuring approximately 2 x 1.5 x 2.6 cm (sagittal x AP x transverse). Within the defect, there is T2 hyperintensity without enhancement which may represent scar tissue. The remaining overlying myometrium is significantly thinned.Blood products are noted within the endometrium which is not unexpected in a premenopausal female.The ovaries are unremarkable. No specific evidence of endometriosis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Myometrial defect within the lower anterior uterine body which is likely post-surgical in etiology.


Instruction: Generate impression based on findings.

Input: There is a left posterior approach shunt catheter that terminates in the third ventricle near the right foramen of Monro after traversing the left parietal region porencephalic cyst. The porencephalic cyst is not significantly changed in size. There is redemonstration of agenesis of the corpus callosum with associated high riding third ventricle and interhemispheric cyst, a parallel configuration of the lateral ventricles, and bilateral colpocephaly. There is unchanged disorganization of the left cerebral hemisphere with extensive left cerebral hemisphere polymicrogyria, primarily involving the left frontal lobe with what appears to be a thin schizencephalic cleft. There is an unchanged diffuse paucity of periventricular white matter. The major cerebral flow voids are grossly intact. There is mucosal thickening in the bilateral maxillary and ethmoid sinuses. The orbital contents are unremarkable.

Output: 1. No significant interval change in size of left parietal porencephalic cyst with a traversing catheter in position.2. Unchanged size of the ventricular system with an associated interhemispheric cyst and bilateral colpocephaly.3. Unchanged stigmata of agenesis of the corpus callosum, extensive left frontal hemisphere polymicrogyria, and left frontal schizencephaly.


Instruction: Generate impression based on findings.

Input: Male, 17 years old, with medically refractory epilepsy. Functional MRI requested for localization of language, motor and vision. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Of note, only left-sided foot sensorimotor activation is seen. Failure to visualize right-sided activity on the right may reflect variable patient effort or a technical artifact.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation and sentence completion paradigms. Language is left dominant.Activation corresponding to the putative Broca's area is seen within the left inferior frontal gyrus (pars opercularis and pars triangularis). Activation corresponding to the putative Wernicke's area is represented by 2-3 foci within or along the posterior aspect of the left superior temporal sulcus.Passive visual cortical stimulation results in activation as expected along the bilateral calcarine sulci.

Output: Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri.Language is left dominant. Broca's area activity is seen in its expected location of the left inferior frontal gyrus. Wernicke's area activation is seen in its expected location along the posterior aspect of the left superior temporal sulcus.Visual cortical stimulation generates cortical activation along the bilateral calcarine sulci.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of HCC and splenic cysts. Evaluate for liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Multiple bilobar subcentimeter T2 hyperintense nonenhancing lesions are present. No enhancing lesions are present. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Multiple well-defined T2 hyperintense lesions with progressive fill in after contrast administration compatible with hemangiomas..PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Benign hepatic and splenic lesions as above. No suspicious lesions identified.


Instruction: Generate impression based on findings.

Input: 61-year-old male with a history of multiple myeloma. Evaluate for bone lesions. BONE MARROW: Note is made of multiple foci of increased bone marrow signal abnormality within the bones of the pelvis suspicious for myelomatous deposits, particularly affecting the left sacral wing, left iliac bone, right iliac bone about the right sacroiliac joint, left iliac crest, right superior acetabulum, left lesser trochanter, and left pubic symphysis.SOFT TISSUES: The imaged musculature is normal in appearance. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Numerous foci of bone marrow signal abnormality within the bones of the pelvis and proximal appendicular skeleton, suspicious for myelomatous deposits as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer, prior brain metastases and RT, restaging. Signs and symptoms: Brain metastases, restaging. Pre and postcontrast enhanced brain MRI:Negative diffusion weighted images.New since prior exam is a focus of enhancement along the superior aspect of right cerebellum measuring 7 x 5 mm in transaxial dimensions and consistent with a metastatic lesion since prior scan exam.Additional tiny new focus of enhancement in the left basal ganglia measuring approximately 4 mm in transaxial dimensions as well suggestive of a new metastatic lesion.A second tiny focus of enhancement in the left basal ganglia measuring approximately at 1.7 mm size is noted.There is a punctate new focus of enhancement in the cortex of the right anterior parietal also consistent with new metastatic lesion (axial post enhanced series 1/1/2001 image 28).A tiny focus of hemorrhagic and enhancement in the right posterior frontal cortex is less conspicuous compared to prior exam and represent a small remaining metastatic focus. Few of the new and old lesions demonstrate subtle surrounding FLAIR hyperintensity/edema however none with evidence of any mass effect.Ventricular systems remain within normal size and with maintained midline and with patent cortical sulci and basal cisterns.There is no detectable abnormal enhancement of the calvarium.Unremarkable images through the orbits and including axial fat sat post enhanced series..

Output: 1.Multiple small new metastatic lesions since prior exam both in supra and infratentorial brain parenchyma as detailed/measured above.2.No significant associated mass effect with the findings and with maintained midline.3.Unremarkable calvarium and orbits without abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Reason: eval cuff History: worsening shoulder pain, acute onset Exam is mildly limited by motion artifacts.ROTATOR CUFF: There is tendinosis of the distal supraspinatus tendon with mild bursal surface fraying (series 6 image 13). Infraspinatus, subscapularis, and teres minor tendons are intact. No significant muscle atrophy.SUPRASPINATUS OUTLET: Mild to moderate degenerative changes of the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild thinning of the glenohumeral cartilage with joint space narrowing. The glenohumeral joint alignment is within normal limits. There is degenerative cyst formation in the humeral head. The glenohumeral labrum appears blunted/degenerative without definite tear on this non-arthrogram study.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Supraspinatus tendinosis with mild bursal surface fraying.2. Mild to moderate degenerative changes of the AC joint and glenohumeral joint.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other convulsionsClinical question: First time focal seizureSigns and Symptoms: focal seizureComments: Seizure 2 protocol | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is mild pneumatization of the internal capsule as well as corpus callosum on the T1-weighted imaging. This is appropriate for 6 months age. Frontal lobe and temporal lobe subcortical white matter is not yet myelinated.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Myelination appears to be age-appropriate. There is no intracranial mass lesion that would account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Reason: evaluate liver mass found on CT A/P History: abnormal liver imaging ABDOMEN:LIVER, BILIARY TRACT: Segment 4A/B lesion measuring 3.2 x 2.0 cm (1802/38) loses signal on out of phase images and is consistent with focal fat. No suspicious hepatic lesions are evident.Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of duodenal switch procedure with gastrojejunostomy and jejunojejunostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Peripheral hepatic lesion is consistent with focal fatty infiltration. No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: History of diarrhea, urgency and hematochezia. Evaluate for evidence of IBD. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild circumferential wall thickening of the descending colon, sigmoid and anorectum which appears ahaustral/featureless. There appears to be mild restricted diffusion predominantly of the mucosa and mild postcontrast enhancement. No proximal bowel dilatation. The small bowel is of normal caliber wall thickness and without adjacent inflammatory changes. The terminal ileum is unremarkable. No free or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with active on chronic ulcerative colitis to the level of the splenic flexure.


Instruction: Generate impression based on findings.

Input: 23 year-old male with tuberous sclerosis and seizures, evaluate for growth of subependymal giant cell astrocytomas. Redemonstrated are bilateral enhancing giant cell astrocytomas at the level of foramina of Monro, multilobed on the left, which appear stable in size, signal intensity and pattern of enhancement compared to the 2 prior exams. Although precise measurements of these lesions at exact same location is difficult due to lesion morphology, the overall sizes appear very similar to the prior study.Previously noted left subependymal enhancing lesion at the level of the body of the left lateral ventricle is also stable.A large irregularly shaped calcific and enhancing left occipital and posterior temporal lobe with associative parenchymal volume loss also appears unchanged in signal intensity, overall morphology and pattern of enhancement to the prior study.Multiple additional smaller subependymal enhancing lesions in bilateral ventricle are all again measured with no appreciable change since prior study.Diffuse signal abnormality of the cortex and subcortical white matter of bilateral cerebral hemispheres without enhancement and consistent with sequela of tuberous sclerosis with no new definite foci.The visualized paranasal sinuses and mastoid air cells are clear.Overall morphology of the cortical sulci and ventricular system which are mildly dilated is very similar to the prior exam however unchanged in extent.

Output: Stable extensive findings of tuberous sclerosis including bilateral subependymal giant cell astrocytomas.


Instruction: Generate impression based on findings.

Input: Angiosarcoma lesion in the right scalp with lymph node metastasis. Brain: There is an infiltrative heterogenous mass with prominent vessels in the right frontal, parietal, and temporal scalp with extension into the retroauricular, preauricular, and supraorbital regions. There appears to be infiltration of tumor into the superior right parotid gland as well. The tumor extends to the periosteum of the underlying calvarium, but there is no definite gross tumor extension into the diploic space. There are scattered areas of cerebral white matter T2 hyperintensity, as well as small foci of encephalomalacia in the posterior right external capsule, left caudate head, and left cerebellar hemisphere. There is also patchy areas of T2 hyperintensity with faint marginal enhancement in the right thalamocapsular region and left lateral thalamus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbital contents are grossly unremarkable. There is a small right mastoid effusion.Neck: There is an enlarged and hyperenhancing right level 2B lymph node that measures 17 x 23 mm. There are subcentimeter, but nevertheless abnormal appearing lower level 2B, lower parotid, and supraclavicular lymph nodes. There is no significant left cervical lymphadenopathy. The thyroid gland, left parotid, and bilateral submandibular glands appear to be unremarkable. The upper aerodigestive tract is intact. There is mild multilevel degenerative cervical spondylosis.

Output: 1. Widespread angiosarcoma of the right scalp right lateral face, with apparent infiltration of the right parotid gland, but no gross invasion of the underlying skull.2. RIght level 2B lymphadenopathy is consistent with metastatic disease, with probable metastatic involvement of smaller right lower level 2B, inferior parotid, and supraclavicular lymph nodes as well.3. No evidence of intracranial metastases. 4. Probable late subacute lacunar infarcts involving the right thalamocapsular region and left lateral thalamus superimposed upon a background of chronic lacunar infarcts involving the right external capsule, left caudate head, and left cerebellar hemisphere and chronic small vessel ischemic white matter disease.


Instruction: Generate impression based on findings.

Input: 69-year-old female with large pituitary seen on head CT, essential tremor. BRAIN: There is no evidence of intracranial hemorrhage or acute infarct. Scattered punctate T2 hyperintensities in the periventricular and subcortical white matter are nonspecific, but suggest 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.PITUITARY: Evaluation limited due to lack of IV contrast. There is an approximately 12 x 12 x 13 mm T1 isointense, slightly T2 heterogeneous mass within the sella and slightly eccentric to the left. Lack of IV contrast makes it nearly impossible to differentiate the mass from the surrounding pituitary gland; however, the pituitary stalk can be seen displaced posteriorly. The sella appears enlarged. There is no mass effect on the optic chiasm.

Output: 1. Within the limits of a noncontrast enhanced MRI, there is a mass in the sella without discrete visualization of the pituitary gland itself. Specifically this lesion most likely represents a pituitary macroadenoma. A non-pituitary mass lesion is conceivable but less likely.2. Scattered punctate T2 hyperintense foci in the periventricular and subcortical white matter are nonspecific, but suggest chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with headaches and history of sarcoidosis. Mild enhancement of the optic chiasm, pre-chiasmatic optic nerves, and the optic tracts is not significantly changed.Scattered patchy areas of previously seen leptomeningeal enhancement along the sulci of the cerebral hemispheres and cerebellum have completely or nearly completely resolved.Focal widening along the right central sulcus is unchanged and may represent the presence of a small arachnoid cyst.Minimal patchy T2 hyperintensity within the pons is unchanged and nonspecific. No significant parenchymal edema or mass effect is detected. No restricted diffusion is seen.No evidence of significant intracranial hemorrhage is seen. The ventricles are stable in size and morphology. Mild coaption of the right frontal horn is unchanged.Large mucus tension cyst remained within the maxillary sinuses, and there is patchy mucosal thickening through the ethmoid air cells.

Output: 1.Stable enhancement of the visualized portions of the optic apparatus.2.Interval complete or near complete resolution of previously seen patchy leptomeningeal enhancement.3.No new intracranial lesions.


Instruction: Generate impression based on findings.

Input: This is a limited MRI of the brain for preoperative planning. There is suggestion of mild asymmetric volume loss of the right hippocampal head. The previously seen signal abnormality is not well appreciated compared to the prior study due to limited sequences and planes. There is suggestion of left cerebellar volume loss.The ventricles and sulci are otherwise unchanged. There is a cavum septum pellucidum and vergae with convex borders and slight leftward bowing of the internal cerebral veins, favoring a cyst. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is a thin area of hypoenhancement with T2 hypointense signal in between the anterior and posterior pituitary gland, possibly representing a pars intermedia cyst. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Limited brain MRI for preoperative planning. 2. Mild asymmetric volume loss of the right hippocampal head, suggestive of mesial temporal sclerosis.3. Cavum septum pellucidum and vergae with convex borders, favoring a cyst.


Instruction: Generate impression based on findings.

Input: Male 66 years old Reason: hx of prostate cancer in focal ablation trial History: see above PELVIS:PROSTATE:Prostate Size: 5.5 x 5.5 x 3.8 cmPeripheral Zone: Focal atrophy and post-ablation changes at the left apex. No focal lesions suspicious for prostate cancer.Central Gland: Heterogenous. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: Mild circumferential bladder wall thickening with trabeculation, suggestive of chronic outlet obstruction.LYMPH NODES: No pathologically enlarged lymph nodes nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focal atrophy and post-ablation changes at the left apex of the prostate gland. No evidence of prostate cancer.


Instruction: Generate impression based on findings.

Input: Reason: hx of DM with non healing wound of Lt index finger History: non healing wound and pain of left foot, toe has been discolored with a foul odor for 2 years Toe: There is soft tissue ulceration of the tip of the first toe. Mild irregularity of the tuft of the distal phalanx is suspicious for osteomyelitis. MRI may be obtained if further imaging is clinically warranted.Finger: There is mild soft tissue swelling of the index finger. There is mild irregularity of the cortical margin of the radial aspect of the base of the middle phalanx, which was present on prior exam dated 5/8/2014. This may represent additional site of prior infection but we suspect it is chronic. Mild osteoarthritis affects the index finger.

Output: 1. Ulceration of the left first toe with irregularity of the distal tuft is suspicious for osteomyelitis.2. Soft tissue swelling of the index finger and other findings as described above with no definite features of acute osteomyelitis.3. Further evaluation with MRI may be obtained if clinically warranted.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for bleed, mass effect. Signs and symptoms: Mental status changes Non-enhanced MRI of brain:No evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray -- white matter differentiation is unremarkable.Calvarium, mastoid air cells, middle ear cavities and limited view of paranasal sinuses are negative.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: 40-year-old with strong family history of breast cancer and dense breasts. There is extreme amount of fibroglandular tissue in both breasts. Multiple high T2 signal cysts are present bilaterally. Moderate parenchymal enhancement is noted bilaterally. This includes numerous bilateral enhancing foci.In the right breast, there are a few scattered enhancing foci and small masses, several of which are similarly enhancing. This includes in the right infero- lateral retroareolar region and the right 9:00 position at mid depth.No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.Recommendations below resulted from consensus review of this study by 3 breast radiologists.

Output: Right breast foci/small masses for which a 6 month follow up MRI is recommended to evaluate stability. The 6 month follow up study would best be performed at days 7-10 of her menstrual cycle to minimize the effects of her background breast parenchyma. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Clinical question: Persistent posterior dizziness. Signs and symptoms: Dizziness. Pre and post enhanced brain MRI:Unremarkable diffusion-weighted series.There is normal anatomical development, morphology and signal intensity of brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination. The signal void of major intracranial arterial branches are identified.Post enhanced images demonstrate no abnormal enhancement of brain parenchyma or leptomeninges and no abnormal enhancement of calvarium, soft tissues of the scalp or the orbits. There is normal enhancement of the intracranial venous sinuses.Unremarkable images through the orbits.Paranasal sinuses demonstrate a large retention cyst in the right maxillary sinus measuring at least at 40 x 28 mm in transaxial dimensions and unremarkable otherwise. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Unremarkable anatomical morphology, signal intensity of brain parenchyma and without detectable abnormal enhancement.3.Unremarkable calvarium, soft tissues of the scalp, orbits and paranasal sinuses other than a large retention cyst in the right maxillary sinus.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 21-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 28 seconds.

Output: Successful right hip arthrogram for MRI study. Please refer to subsequent MRI of the right hip for additional findings.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with headache and back pain, history of spinal tumor, concern for mass recurrence. A uniformly enhancing plaque-like dural/epidural mass is evident extending along the clivus to the craniocervical junction. A small tail of this lesion also extends laterally along the skull base towards the left jugular foramen. This lesion measures up to 48 x 13 mm in the sagittal plane with encroachment upon the prepontine cistern, displacement of the vertebral arteries, and mild deformity of the brainstem. No outside examinations are available at the time of this interpretation for comparison purposes.No evidence of parenchymal edema is seen. Numerous scattered foci of white matter T2 hyperintensity are evident in the bilateral cerebral hemispheres, a nonspecific finding which may reflect chronic microvascular ischemic disease. No evidence of diffusion restriction is seen.No other areas of pathologic parenchymal or extra-axial enhancement is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is patent and normal in size.

Output: 1.A dural/epidural plaque-like mass is evident extending along the clivus down to the level of the craniocervical junction, and laterally towards the left jugular foramen. This lesion effaces the prepontine cistern and causes mild mass effect upon the adjacent brainstem, but no evidence of parenchymal invasion or parenchymal edema is seen.2.No outside examinations are available at the time of this interpretation for comparison purposes. If these can be made available, comparison will be made and an addended report will be generated.3. No other significant intracranial lesions are seen. Findings are noted likely related to chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: r/o tendon/ligament injury History: R shoulder pain. ROTATOR CUFF: There is a near complete to complete tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity with approximately 2 cm of retraction of the proximal tendon fragment. The proximal tendon fragment is thickened and demonstrates intermediate signal intensity indicating tendinosis. The supraspinatus muscle appears intact. There is a small amount of increased signal abnormality and fluid sensitive sequences within the muscle belly of the supraspinatus at the level of the myotendinous junction as well as within the teres minor muscle which is nonspecific but may represent a strain injury. There is also interstitial tearing of the supraspinatus at the level of the myotendinous junction. There is extension of the supraspinatus tearing to involve the anterior fibers of the infraspinatus. The infraspinatus muscle appears intact. The subscapularis tendon appears intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is slightly high riding. There is increased signal abnormality traversing the anterior inferior labrum indicating a tear. There is heterogeneity of the superior and anterior labrum likely representing a combination of degeneration and degenerative tearing. There is a small amount of fluid within the glenohumeral joint. There are foci of low signal intensity within the axillary recess which may reflect a mild synovitis or perhaps loose bodies within the joint. Osteoarthritis affects the glenohumeral joint.BICEPS TENDON: There is thickening and intermediate signal intensity within the intra-articular portion of the long head of the biceps tendon indicating a tendinosis. The tendon itself appears intact. There is a small amount of fluid within the tendon sheath of the long head of the biceps which likely represents fluid extension from the joint. ADDITIONAL

Output: 1. Near complete to complete tear of the supraspinatus tendon with retraction. Partial-thickness tearing of the anterior fibers of the infraspinatus.2. Osteoarthritis of the shoulder. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness, sensorineural hearing loss, unilateral right ear, with unrestricted hearing on the contralateral side. Evaluate for IAC. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: Unremarkable evaluation of the bilateral internal auditory canal.


Instruction: Generate impression based on findings.

Input: 69-year-old male with lung cancer and brain metastasis treated via SRS. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, which is not conspicuous on the T1 or T2 weighted sequences. Punctate foci of susceptibility are also present in the right thalamus and right putamen, which are unchanged. There is unchanged moderate periventricular and subcortical white matter punctate T2 hyperintense foci, compatible with chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage, new mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unchanged.

Output: Limited exam due to lack of intravenous contrast shows a punctate treated lesion in the left cerebellar hemisphere and unchanged nonspecific scattered cerebral white matter disease.


Instruction: Generate impression based on findings.

Input: 68-year-old male with upper and lower extremity weakness, lower back pain and CT findings worrisome for stenosis CERVICAL SPINE:Vertebral body heights are intact. There is multilevel disk desiccation, however disk height is preserved. No abnormal marrow signal. Signal within the cord is normal. Alignment is anatomic. No abnormal enhancement.C2-C3: No spinal or neuroforaminal stenosis.C3-C4: Mild endplate and uncovertebral osteophytes. Mild bilateral neuroforaminal stenosis. No spinal canal stenosisC4-C5: Mild endplate and uncovertebral osteophytes. Mild bilateral neuroforaminal stenosis. No spinal canal stenosis.C5-C6: Mild endplate and uncovertebral osteophytes. Mild bilateral neuroforaminal stenosis. No spinal canal stenosis.C6-C7: Mild endplate and uncovertebral osteophytes. No spinal or neuroforaminal stenosis. C7-T1: No spinal or foraminal stenosisTHORACIC SPINE:Vertebral body heights are intact. There is multilevel disk desiccation with mild loss of disk height from T7 to T11. A Schmorl's node is present within the T8 vertebral body. No abnormal marrow signal. No abnormal enhancement. No abnormal signal within the cord. Thoracic spine is mildly narrowed throughout, likely congenital. No significant spinal or neural foraminal stenosis throughout the thoracic spine.LUMBAR SPINE:Please note that there is lumbarization of S1 counting from C2. The vertebrae is labeled L1 to L6 on the present study correspond to T12 to L5 on the prior CT.Vertebral body heights are maintained. There is minimal reversal of lumbar lordosis L5 There is multilevel disk desiccation, particularly at L3-L4, L4-L5 and L5-S1. There is enhancement of the cauda equina at L3-L4 where there is moderate to severe narrowing of the canal. The conus ends at L2. Signal within the distal cord is normal. 13 rib pairs are identified with ribs at L1.L1-L2: No central or neuroforaminal stenosis.L2-L3: Mild diffuse disk bulge and ligamentum flavum thickening. Facet arthropathy. No central canal stenosis. Moderate bilateral neural foraminal stenosis.L3-L4: Diffuse disk bulge and ligamentum flavum thickening. Facet arthropathy. Ligamentum flavum cyst. Severe central canal stenosis. Moderate left and mild right neural foraminal stenosis.L4-L5: Diffuse disk bulge, ligamentum flavum thickening and facet arthropathy producing moderate central canal stenosis. Mild bilateral neuroforaminal stenosis. Mild/minimal subluxation of L4 on L5. Moderate right neuroforaminal stenosisL5-L6: Mild diffuse disk bulge, facet arthropathy and ligamentum flavum thickening. Mild/minimal subluxation of L5 on L6. Moderate right neuroforaminal stenosis. Mild to moderate central canal stenosis.

Output: 1.Please note that there are 6 lumbar type vertebra and 13 pairs of ribs present. This affects enumeration of lumbar vertebrae.2.There is moderate to severe lumbar spinal stenosis due to degenerative changes at L3-L4. The cauda equina is compressed and enhances at L3-L4.3.Moderate spinal stenosis due to degenerative changes at L4-5 associated with mild/minimal subluxation.4.Mild to moderate spinal stenosis due to degenerative changes at L5-6 associated with mild/minimal subluxation.5.There are degererative changes in the cervicla spine with mild multilevel bilateral neural foraminal encroachment of exiting nerve roots in the cervical spine but without spinal stenosis.6.There are minor degenerative changes in the thoracic spine.


Instruction: Generate impression based on findings.

Input: 43 years, Female, Reason: hifu study- fibroids History: fibroids. PELVIS: FemaleUTERUS, ADNEXA: The uterus is enlarged with multiple fibroids. The largest fibroid is decreased in size measuring 5.0 x 5.0 cm (501/17), previously 7.3 x 7.3 cm with a hypo-enhancing central component. Other additional smaller lesions are unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant fibroid is decreased in size.


Instruction: Generate impression based on findings.

Input: Angiosarcoma lesion in the right scalp with lymph node metastasis. Brain: There is an infiltrative heterogeneous mass with prominent vessels in the right frontal, parietal, and temporal scalp with extension into the retroauricular, preauricular, and supraorbital regions. There appears to be infiltration of tumor into the superior right parotid gland as well. The tumor extends to the periosteum of the underlying calvarium, but there is no definite gross tumor extension into the diploic space. There are scattered areas of cerebral white matter T2 hyperintensity, as well as small foci of encephalomalacia in the posterior right external capsule, left caudate head, and left cerebellar hemisphere. There is also patchy areas of T2 hyperintensity with faint marginal enhancement in the right thalamocapsular region and left lateral thalamus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbital contents are grossly unremarkable. There is a small right mastoid effusion.Neck: There is an enlarged and hyperenhancing right level 2B lymph node that measures 17 x 23 mm. There are subcentimeter, but nevertheless abnormal appearing lower level 2B, lower parotid, and supraclavicular lymph nodes. There is no significant left cervical lymphadenopathy. The thyroid gland, left parotid, and bilateral submandibular glands appear to be unremarkable. The upper aerodigestive tract is intact. There is mild multilevel degenerative cervical spondylosis.

Output: 1. Widespread angiosarcoma of the right scalp right lateral face, with apparent infiltration of the right parotid gland, but no gross invasion of the underlying skull.2. RIght level 2B lymphadenopathy is consistent with metastatic disease, with probable metastatic involvement of smaller right lower level 2B, inferior parotid, and supraclavicular lymph nodes as well.3. No evidence of intracranial metastases. 4. Probable late subacute lacunar infarcts involving the right thalamocapsular region and left lateral thalamus superimposed upon a background of chronic lacunar infarcts involving the right external capsule, left caudate head, and left cerebellar hemisphere and chronic small vessel ischemic white matter disease.


Instruction: Generate impression based on findings.

Input: 58-year-old male s/p dural atypical mening resection. Assess for infection There are postoperative changes related to recent meningioma resection in the right parietal region. At the site of the more superiorly resected tumor, what appears to be a fluid collection is seen which abuts the superior sagittal sinus and falx and shows rim enhancement. This collection is slightly larger than was previously seen. There is a mild restricted diffusion along the margin of the cavity, although this is decreased from prior study, and centrally within the cavity, there is no restricted diffusion. Generalized dural thickening along the right parietal and occipital lobes is similar to prior exams. Adjacent to the dura, there is a patchy pattern of ill-defined parenchymal or brain surface enhancement (see image 211, series 1301) which appears increased from the immediate prior study on 6/5/2015, but when compared to older exams in 2013 and 2014, is actually unchanged. Similar though much less extensive enhancement is seen along the left surface of the parietal lobe as well, also unchanged from prior study. The T2 signal abnormality within the brain parenchyma surrounding all of these areas is similar to prior study. There are no other intracranial lesions identified. The remaining brain parenchyma is otherwise unremarkable. No intraparenchymal hemorrhage is identified.

Output: 1. Redemonstration of postoperative findings including evidence of recent resection of two meningiomas from the right parietal region. 2. A rim-enhancing collection at the site of the superiorly resected cavity has increased in size. The margin of this cavity demonstrates some restricted diffusion which is reduced from prior study, however there is no restricted diffusion centrally within the cavity. This could simply represent a sterile postoperative collection. Although the possibility of superimposed infection cannot be excluded, the lack of any edema within the surrounding brain parenchyma argues against this. 3. Generalized dural thickening along the right parietal and occipital lobes is within expected limits given the recent meningioma resection. Ill-defined patchy surface enhancement in the right parietal and occipital lobes and the left parietal lobe as well is also stable dating back several years. This is favored to represent radiation related change or an inflammatory process.


Instruction: Generate impression based on findings.

Input: 43-year-old female patient with HCV cirrhosis, pancreatic cyst seen on prior MRI. Evaluate for HCC, pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: Mild nodularity of the hepatic contour compatible with cirrhosis. No suspicious hepatic lesion is identified. There is no intrahepatic biliary ductal dilatation. Interval mild dilatation of the common bile duct measuring up to 7 mm in diameter up to a point within the distal common bile duct where there appears to be an obstructing stone (image 9, series 901). Cholelithiasis without evidence of acute cholecystitis. Patent hepatic vasculature.SPLEEN: Splenomegaly with the spleen measuring 19 cm in the craniocaudal dimension.PANCREAS: Stable pancreatic tail cyst measuring up to 9 mm without ductal dilatation, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent retroperitoneal lymph nodes likely secondary to chronic liver disease. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval mild dilatation of the common bile duct secondary to an obstructing distal common bile duct stone.2.Cholelithiasis without evidence of acute cholecystitis.3.Cirrhotic morphology of the liver without suspicious hepatic lesion. Findings discussed with liver service prior to dictation.


Instruction: Generate impression based on findings.

Input: 71-year-old female with abdominal pain ABDOMEN:LUNG BASES: Right lower lobe calcified granuloma.LIVER, BILIARY TRACT: Moderate intra-/extrahepatic biliary ductal dilatation, not significantly changed.Enhancing lesion at the dome of the liver, most likely hemangioma, unchanged.SPLEEN: No significant abnormality notedPANCREAS: Mild pancreatic ductal dilatation is seen. The body and tail of the pancreas remain atrophic.ADRENAL GLANDS: 4.2 x 3.4 cm left adrenal nodule, increased in size and previously described as an adenoma on MRI 11/07.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Atrophic versus absent.BLADDER: A Foley catheter is looped within the bladder and can be retracted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Again noted is a linear hyperdense object in the mesentery with surrounding fat stranding/granulation tissueA metallic clip is seen adjacent to the rectosigmoid colon, unchanged.No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Linear hyperdensity within the mesentery with associated inflammatory changes, not significantly changed.Left adrenal mass, increased in size. It was previously demonstrated to contain microscopic fat on MRI from 11/07, compatible with an adenoma. However, given increase in size, biopsy can be consideredStable biliary and pancreatic ductal dilatation.No evidence of obstruction.


Instruction: Generate impression based on findings.

Input: There has been interval decrease in size and number of enhancing metastatic lesions throughout the brain. For example, a right cingulate gyrus lesion measures 7 mm in diameter, previously 14 mm, and an inferior vermis lesions measures up to 6 mm, previously 12 mm. The degree of associated vasogenic edema has also diminished. Otherwise, a small left parafalcine dural based extra-axial calcified lesion is unchanged. The ventricles and sulci are within normal limits. There is no midline shift. There is no evidence of acute infarction or hemorrhage. There is nonspecific fluid signal in the left mastoid air cells. There is also mild scattered paranasal sinus mucosal thickening. The orbits are unremarkable.

Output: 1. Interval decrease in size and number of the numerous intracranial metastases.2. An unchanged small left parafalcine mass may represent a meningioma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 52-year-old male status post cervical spine fusion, with neck pain The alignment of the cervical spine is preserved. Again noted are post surgery change statu post C1/2 fusion and stabilization change. Stabilization screws and plates runs between the occipital bone and C2 laminar are stable in position when compared to previous MRI study. The ends of both occipital screws seem crossing through the inner table of the calvarium. The cross-axial screws at C2 seems crossing through the inner table of the right lamina. No radio lucency is observed surrounding all the hardwares.Coronal images again demonstrate tilting of the dens. The joint space between the left occipital condyle and C1 arch and between the C1 and C2 have been fused by dense material. The degree of the tilting of the dens has been stable when compared to previous study dated 9/9/2011. The hardware obscures full emaculation of the cervical spine at this level, however, no apparent bony canal or neural foramina compromise is observed.Stable mild degenerative change at other level of cervical spine with no evidence of bony canal or neural foramina compromise.

Output: 1. Post C1/2 fusion and stabilization change. Stabilization screws and plates runs between the occipital bone and C2 laminar are stable in position when compared to previous MRI study. The ends of both occipital screws seem crossing through the inner table of the calvarium. The cross-axial screws at C2 seems crossing through the inner table of the right lamina. No radio lucency is observed surrounding all the hardwares.2. Stable C1/2 position. No evidence of bony canal or neural foramina compromise at any level.


Instruction: Generate impression based on findings.

Input: Reason: H/o suprasellar meningioma s/p XRT. History: H/o suprasellar meningioma s/p XRT.. A left paraclinoid/suprasellar meningioma is unchanged in size measuring 2.4 x 2.2 x 2.0 cm, previously 2.5 x 2.3 x 2.0 cm. Mass effect on the prechiasmatic left optic nerve and optic chiasm is similar to the prior exam. No edema is evident in the surrounding brain parenchyma. No new mass effect. No additional lesions or abnormal enhancement throughout the remaining parenchyma. No areas of diffusion restriction to suggest infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal mucosal thickening in the bilateral maxillary sinuses.

Output: Left paraclinoid/suprasellar meningioma is stable in size and extent.


Instruction: Generate impression based on findings.

Input: 56 year old with history of peripheral artery disease, stroke and smoking history presenting with atypical chest pain. MEDICATIONS: amlodipine, aspirin, atorvastatin, cilostozal, clopidogrel First Pass PerfusionDuring hyperemia, there is a small perfusion defect in the mid to basal septum and inferoseptal walls. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 44 ml/m2 (normal range: 74+/-15), the LVEDV is 95 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 38 ml (normal range 47+/-19), the LV mass index is 32 g/m2, and the LV mass is 69 g. There is subtle tardokinesis of the basal inferior wall. On the late gadolinium enhancement images, there is an increased signal involving the basal to mid septum, which likely represents partial volume artifact. 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 50%, the RV end diastolic volume index is 52 ml/m2 (normal range 82+/-16), the RVEDV is 112 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. There is pericardial fat present. 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. There is a mild "ischemia" / perfusion defect during hyperemia in the RCA territory. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 60%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. There is mild tardokinesis of the basal inferior wall.4. Normal RV size and systolic function (RVEF 50%).5. Mild aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is transitional spinal anatomy. Counting from C2, there are 4 lumbar appearing vertebrae. There appear to be 12 rib bearing thoracic vertebrae. For the purposes of this exam, the last fully formed disk is at the L4-S1. There is severe dextroscoliosis of the thoracic spine with apex of curvature at T9, which is worsened from the prior examination. There is compensatory mild levoscoliosis of the lumbar spine apex of curvature at L3. The vertebral body and disk heights are well-maintained except for disc narrowing along the lesser curvatures of the scoliosis. The spinal cord is of normal caliber and signal. The distal spinal cord and conus are within normal limits. The vertebral bone marrow signal is unremarkable.

Output: 1. Interval worsening of severe thoracic dextroscoliosis and mild compensatory levoscoliosis of the lumbar spine since 2013. 2. Transitional spinal anatomy, with 4 lumbar appearing vertebrae. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of head and neck cancer now with shoulder pain and decreased range of motion. Evaluation of the tendons and capsular structures is somewhat limited due to large field-of-view used to image the entire scapula.We see no foci of abnormal signal in the bone marrow to indicate metastases. A small focus of low signal intensity in the humeral head likely represents a benign bone island. Additional patchy intermediate signal intensity in the bones of the shoulder is compatible with residual red marrow. Mild osteoarthritis affects the acromioclavicular joint with small cysts in the distal clavicle.We see no gross rotator cuff tears. No frank fluid is present within the subacromial/subdeltoid bursa. Glenohumeral alignment is within normal limits. There is a small amount of fluid within the glenohumeral joint without large effusion. No gross labral abnormalities are identified. The tendon of the long head of the biceps is within normal limits.We see no abnormal enhancement on postcontrast images.

Output: Mild acromioclavicular joint osteoarthritis in otherwise normal-appearing shoulder without specific findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Brachial neuritis or radiculitis NOSClinical question: evaluate for cervical radiculopathySigns and Symptoms: L arm pain/numbness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk dessication present. There are anterior end plate osteophytes present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge present at this level assocated with partial effacement of CSF ventral to the spinal cord.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are mild degenerative changes in the cervical spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Retention of urine, unspecified [R33.9] / Full incontinence of feces [R15.9]. Renal cell carcinoma, new onset fecal incontinence with decreased rectal tone and urinary retention. There is congenital narrowing of the spinal canal. There is multilevel severe spinal stenosis in the cervical spine, most prominent at C4-5 and C6-7 levels, with indentation of the spine cord, which has progressed since 2012. There is multilevel degenerative disc disease in the thoracic and lumbar spine with multilevel neural foraminal and spinal canal stenosis, but no spinal cord compression in these regions. The spinal cord demonstrates grossly normal signal. There is mild anterolisthesis of C4 over C5. There is mild loss of T6 and L2 vertebral body heights, but no bone marrow edema. There is redemonstration of extensive endplate sclerosis at C6-7 and fusion of C5 and C6. There are multilevel thoracic and lumbar spine intravertebral disc herniations. There is mild lower lumbar and sacral lipomatosis. There is no evidence of spine tumors, within the limits of a non-contrast exam. There is a multinodular thyroid, which has increased in size since 2012. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of spine tumors, within the limits of a non-contrast exam.2. Severe cervical spinal stenosis predominantly C4-5 and C6-7 levels due to degenerative spondylosis superimposed upon congenital narrowing of the spinal canal, with associated indentation of the spine cord. These findings have progressed since 2012.3. Multilevel disc herniations in the thoracic and lumbar spine with associated multilevel neural foraminal and spinal stenosis, but no spinal cord compression in these regions.4. Mild loss of T6 and L2 vertebral body heights, but no bone marrow edema, which may represent chronic insufficiency fractures. 5. Multinodular thyroid, which has increased in size since 2012.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Status post Whipple for IPMN. Follow-up exam. This study is limited due to artifacts from surgical clips.ABDOMEN:LIVER, BILIARY TRACT: There is mild intrahepatic biliary prominence.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple surgery. Pancreatic distal body and tail enhances normally. There is mild prominence of the pancreatic duct. Due to the artifacts, postsecretin images are not obtained.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Mild prominence of the pancreatic duct in the residual body and tail with normal enhancement of the pancreas.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 47-year-old female with right hip pain. ACETABULAR LABRUM: Note is made of linear signal abnormality which traverses the anterior superior acetabular labrum which extends from the 1 o'clock position to the 2 o'clock position, and fills with intra-articular gadolinium, consistent with a tear. The alpha angle measures 46 degrees. Extravasation of contrast material along the anterior aspect of the right femoral head/neck is likely iatrogenic. ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified.SOFT TISSUES: The imaged musculature of the right hip is normal in appearance. ADDITIONAL

Output: Anterior superior acetabular labral tear.


Instruction: Generate impression based on findings.

Input: Reason: questioning status of Prostate cancer History: Prostate Cancer, no pathology reports or PSA is available at the time of this study. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.5 x 3.9 cm.Peripheral Zone: There is focus of low T2 (series 401 image 84) and ADC (series 508 image 404) signal at mid base of right peripheral zone. While this is immediately adjacent to central zone, this region is asymmetric, and is intermediate suspicion for malignancy.Central Gland: Large nodule in the transition zone of the prostate gland measuring 2.2 x 2.3 cm that is hypoattenuating on ADC (series 508 image 324) and T2 (series 401 image 70) sequences with early enhancement. There is mild displacement of the intraprostatic urethra towards the right from this lesion. However, the margins of this lesion is well-defined and may represent stromal hyperplastic nodule.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.2.3 cm early enhancing nodule in the left transition zone as above. This may represent stromal hypoplastic nodule given well-defined margins but remain PI-RADS 2.2.Tiny focus in the right peripheral zone, correlation with PSA or biopsy result is recommended. This lesion is intermediate for malignancy, PI-RADS 3. Consider targeted biopsy or follow-up MRI to ensure stability. PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: 3 month follow up from craniotomy from tumor resection for seizure focus. There are postoperative findings related to right anterior and medial temporal lob resection. There is confluent T2 hyperintensity surrounding the resection cavity and a small area of high T2 signal along the hippocampal tail. There is no evidence of acute infarct. There is no abnormal intraparenchymal enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval evolution of postoperative findings with nonspecific confluent T2 hyperintensity surrounding the resection cavity and a small area of high T2 signal along the hippocampal tail.


Instruction: Generate impression based on findings.

Input: Right parotid mass and left neck nodes in PET positive scans: history of right orbitocranial sarcoma. There are prominent bilateral upper cervical lymph nodes, measuring up to 12 x 14 mm in axial cross-section for a left level 2A lymph node. There are also several subcentimeter enhancing nodules in the superficial right inferior parotid gland. There are partially imaged postoperative findings related to right frontal craniotomy and orbitotomy for resection of a right intracranial and orbital mass with diffuse enhancement along the margins of the surgical cavity. In addition, there is decreased fluid and edema in the right superior orbit surgical bed, with associated proptosis. There is diffuse paranasal sinus mucosal thickening.

Output: 1. Prominent bilateral upper cervical lymph nodes may represent metastatic disease or a reactive process.2. Several subcentimeter enhancing nodules in the right inferior parotid gland may also represent additional lymph nodes, either reactive or affected by metastatic disease, versus Warthin tumors.3. Partially imaged postoperative findings related to right frontal craniotomy and orbitotomy for resection of a right intracranial and orbital mass with nonspecific diffuse enhancement along the margins of the surgical cavity. Please refer to the prior MRI for additional details.


Instruction: Generate impression based on findings.

Input: Possible disc herniation, right radicular pain. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment of the lumbar spine is grossly maintained with perhaps minimal anterolisthesis of L3 on L4 and L4 and L5. Bone marrow signal is benign. The conus medullaris is normal in position at the T12-L1 level.Multilevel degenerative changes are seen including disc desiccation at L3-L4 and L4-L5 and multilevel facet arthropathy which appears progressed since prior CT from 8/13/2012. Individual levels as described below: L1-L2: Small right foraminal disc protrusion with mild to moderate right neural foraminal narrowing. No spinal canal or left neural foraminal stenosis.L2-L3: Mild disc bulge without significant spinal canal or neural foraminal stenosis.L3-L4: Disc bulge eccentric to the left with annular fissure. There is also bilateral facet arthropathy which is advanced on the left. There is resulting mild to moderate right and moderate to severe left neural foraminal stenosis. There is partial effacement of the lateral recesses. Minimal central spinal canal stenosis.L4-L5: There is a diffuse disc bulge with more focal extrusion on the right effacing the right lateral recess where there may be impingement of the descending nerve root. There is also right foraminal component of the herniated disc which results in severe right foraminal stenosis and suspected impingement of the exiting right L4 nerve root. There is also mild to moderate left neural foraminal stenosis. Bilateral facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level where disc herniation results in severe right-sided neural foraminal stenosis as well as effacement of the right lateral recess. There may be associated impingement of the exiting right L4 and descending right L5 nerve roots. 2. Additional levels including moderate to severe left L3-L4 neural foraminal stenosis as above.3. No significant central canal stenosis.4. Multilevel facet arthropathy, worst at the left L3-L4 level.


Instruction: Generate impression based on findings.

Input: NF 2, status post resection of schwannoma and meningioma. Per chart, specimens sent were meningioma of C1, schwannoma of the craniocervical junction, meningioma of C5, schwannoma of the C3-4 right-sided foramen. Compared to 8/19/2015, there is interval postsurgical changes of suboccipital craniectomy and resection of the posterior arch of C1. Laminoplasties are also noted from C3 to C6. There is been resection of the previously seen extra-axial enhancing mass at the craniocervical junction dorsally, one of which appeared more rounded and one which was smaller and broad-based along the posterior aspect of the dura, best seen on 4/2/2015. There is also resection of extra-axial lesions involving the C4 and C5 levels. Again seen are multiple residual enhancing lesions throughout the cervical spine and partially imaged brain including nodular intramedullary lesions involving the cervical cord at the C1 and C2 levels which may represent ependymomas given history of NF 2. Enhancing masses seen involving the right C2 nerve root and a smaller one on the left compatible with schwannomas.C2-C3: Enhancing left nerve root with mild expansion of the neural foramina likely represents a schwannoma. There is mild intraspinal extension without significant cord deformity.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. C4-C5: Expansile lesion involving the right neural foramen again seen with intraspinal extension and mild residual mass effect on the right aspect of the cord. Partial resection as described above. T2 hyperintensity within the right aspect of the cord.C5-C6: Large, predominantly extraforaminal lesion on the right. Small enhancing extra foraminal lesion on the left is likely unchanged. No spinal canal stenosis.C6-C7: Small, predominantly extraforaminal enhancing lesions bilaterally without expansion of the foramina. No spinal canal stenosis.C7-T1: Small predominantly enhancing extraforaminal enhancing bilaterally lesions without expansion of the foramina, likely unchanged. No spinal canal stenosis.There is a relatively large lesion involving the peripheral aspect of the C6 nerve root extending to the brachial plexus. Additional smaller schwannomas partially visualized within the thoracic spine. Vertebral body heights are normal. Mild focal kyphotic angulation at the C5-C6 level is again seen. Postsurgical changes include extra-axial fluid collection in the suboccipital soft tissues which may represent a small pseudomeningocele and/or seroma. Extra-axial blood products along the dorsal spinal canal are also seen extending from the C3 to the C6-C7 levels which partially effaces the dorsal thecal sac without significant stenosis.There is abnormal T2 signal within the right hemicord at the C4 level without enhancement compatible with edema. Enhancing mass is seen on the prior images compressing the cord at this level. Mild degree of T2 hyperintensity is also noted involving the medulla and cervical cord extending to the lower C2 level and also present on preoperative study.Limited view of the oral cavity demonstrates increased T2 signal at the level of the right hemitongue raising question of denervation. However this finding is not definitively assessed due to presence of an endotracheal tube and partial visualization of the oral cavity.

Output: 1. Postsurgical changes related to resection of extra-axial enhancing masses involving the craniocervical junction/C1 level as well as in the cervical spine. There is interval increase in T2 signal noted within the right hemicord at the C4 level without enhancement compatible with edema. Enhancing mass is present compressing the cord at this level on the preoperative study. 2. Expected postsurgical changes include fluid collection at the C1-C2 level dorsal to the thecal sac which may represent a pseudomeningocele. Small extra-axial collection extending from C3 to the C6-C7 levels including the laminoplasty is also noted resulting in mild spinal canal stenosis without frank cord compression. 3. Stigmata of NF 2 with multiple enhancing lesions likely representing schwannomas, meningiomas, and tiny ependymomas.4. T2 hyperintensity and enhancement involving the right aspect of the tongue. Endotracheal tube and partial coverage makes evaluation difficult but suggests possibility of acute denervation changes.


Instruction: Generate impression based on findings.

Input: 51 year old male with a soft tissue mass on the volar aspect of the base of the proximal phalanx. Presents with pain. Note is made of a lobulated focus of fluid signal abnormality along the volar aspect of the proximal phalanx of the index finger, measuring 12 x 7 x 14 mm with minimal peripheral enhancement on postcontrast sequences, consistent with a ganglion. The flexor and extensor tendons appear intact. No bone marrow signal abnormality is identified. The alignment is anatomic. No additional enhancing mass lesions are identified.

Output: 14 mm ganglion along the volar aspect of the proximal phalanx of the index finger as described above.


Instruction: Generate impression based on findings.

Input: Male, 43 years old, with left hemiplegia. Evaluate for stroke. No evidence of restricted diffusion is seen. No focal parenchymal edema or mass effect is detected. Two or three punctate scattered foci of FLAIR hyperintensity are demonstrated within the cerebral hemispheres, a nonspecific finding. No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is observed. The ventricular system is normal in size and morphology.

Output: No evidence of acute ischemia or any other specific finding which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is no evidence for syrinx. The cerebellar tonsils are low lying and extend 5 mm below the level of the foramen magnum. There is some multilevel disc desiccation present and mild reversal of the normal cervical curvature.CSF flow at the level of the foramen magnum appears intactAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is larger than the right vertebral artery.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.No evidence for syrinx.2.There is a Chiari I malformation present.3.There is no compromise of the cervical or thoracic spinal canal.4.There are mild degenerative changes present in the cervical spine.


Instruction: Generate impression based on findings.

Input: 40 year-old female. Refractory hip pain. Evaluate for labral tear versus arthritis. ACETABULAR LABRUM: A small amount of joint fluid is seen incompletely separating the left anterior-superior labrum from the underlying acetabulum, indicating a tear. ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits with no focal worrisome signal abnormality.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Partial tear of the left anterior superior labrum.


Instruction: Generate impression based on findings.

Input: Solitary fibrous tumor of the left maxillary sinus and orbit, status post partial resection. There is no significant interval change in size of the mass centered within the left orbit with extension into the adjacent paranasal sinuses, premaxillary space, and masticator space. Overall, the tumor measures approximately 45 mm in width, 50 mm in height, and 40 mm in length. However, the tumor has grown gradually since June 2015, at which time it measured up to approximately 45 mm in greatest dimension. There is marked left proptosis and compression of the optic nerves and most of the extraocular muscles, with relative sparing of the superior rectus. There are postoperative findings in the left maxillary sinus, with moderate mucosal thickening. The right orbit is unremarkable. There is no evidence of intracranial extension of tumor. There is a subcentimeter cystic lesion in the left superficial parotid tumor.

Output: No appreciable interval change in size of the solitary fibrous tumor involving the left orbit with extension into the adjacent paranasal sinuses, premaxillary space, and masticator space. However, the tumor has grown gradually since June 2015.


Instruction: Generate impression based on findings.

Input: History of BRCA2 mutation There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are small foci of enhancement bilaterally, none of which are uniquely enhancing. There is an area of enhancement in the right lateral inferior breast, which is thought to be parenchymal. 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: 68-year-old man with history of elevated PSA of 3.7 in August 2016, 2.5 last year. PELVIS:PROSTATE:Prostate Size: 55 x 45 mmPeripheral Zone: There is a very small focus of decreased T2 signal and abnormal ADC signal in the left apex (801/6 and 508/104) which measures less than 5 mm.Central Gland: Multiple BPH nodules are noted.Seminal Vesicles: There is nonspecific low T2 signal within the seminal vesicles, however there is no mass or lesion.Extracapsular Extension: No extracapsular tumor.BLADDER: The enlarged central gland impresses upon and distorts the bladder.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Very small suspicious focus of signal abnormality in the left apical peripheral zone.2.Markedly enlarged central gland with BPH nodules.


Instruction: Generate impression based on findings.

Input: Left knee pain, no improvement with physical therapy, 6 months of pain, evaluate for medial meniscus tear. MENISCI: There is branching linear signal within the posterior horn of the medial meniscus extending to both the femoral and tibial surfaces indicating a tear. The tear also extends through the peripheral fibers of the posterior horn decompressing into small parameniscal cysts. The intrameniscal signal extends into the body of the meniscus indicating intrasubstance degeneration. The anterior horn appears normal. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the articular cartilage of the anterior aspect of the lateral femoral condyle suggesting focal degeneration. Otherwise the articular cartilage appears normal for age. Bone marrow signal intensity appears normal.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Tear of posterior horn of medial meniscus associated with parameniscal cyst formation as described above.


Instruction: Generate impression based on findings.

Input: 52 year old female with history of metastatic breast cancer and HIV status post seizure; evaluate. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are mildly increased in volume; unchanged. Patchy areas of hypoattenuation are seen in the subcortical white matter (image 22 of 36, series #6747). Increased soft tissue density seen just posterior to the right globe and within the intraconal space; see recent brain MRI for further discussion. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Patchy areas of hypoattenuation in subcortical white matter may represent progressive multifocal leukoencephalopathy versus primary HIV infection.  2. Increased soft tissue density noted just posterior to the right globe and within the intraconal space. Please see brain MRI report from 11/16/2008 for further evaluation.


Instruction: Generate impression based on findings.

Input: Hodgkin's lymphoma, prolonged symptoms of vertigo No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Few foci of T2/FLAIR hyperintensity are seen in the subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain appears within normal limits for age. No evidence of intracranial mass, infarct, or hemorrhage.


Instruction: Generate impression based on findings.

Input: 12-year-old male patient with left knee injury/pain and swelling. MENISCI: The posterior horn and body of the lateral meniscus are detached from the underlying tibial plateau and displaced superior to the anterior horn. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is patchy edema within the distal femur most predominantly on the medial and lateral aspects of the medial and lateral femoral condyles. Edema is also noted within the lateral aspect of the lateral tibial plateau and the fibular epiphysis.There is subtle curvilinear low T1 signal within the subchondral bone of the weight-bearing portion of the lateral femoral condyle and slight cortical depression with associated bone edema compatible with an impaction injury. There is low T1 signal and associated edema about the lateral aspect of the lateral tibial plateau which is suspicious for a non-displaced fracture.The articular cartilage of all three compartments is intact.LIGAMENTS: There is a complete midsubstance tear of the anterior cruciate ligament. The posterior cruciate ligament is intact. The popliteus muscle and tendon are intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Findings compatible with a pivot shift mechanism of injury with complete ACL tear, lateral meniscus tear, and associated bone injuries.


Instruction: Generate impression based on findings.

Input: Clinical question: History of craniotomy for meningioma. Evaluate for change. Signs and symptoms: Surveillance imaging. Pre and postcontrast enhanced brain MRI:No diffusion-weighted findings.Examination redemonstrates a homogeneously enhancing mass within the sella and basal cistern and with evidence of extension anteriorly along the planum sphenoidale and posteriorly along the dorsal aspect of the dorsum sella and clivus as well as bilateral cavernous sinuses. The transverse diameter of tumor at the level of cavernous sinuses measures 39 mm which is identical to prior study. The mass measures maximum of 5.5 mm along the dorsum aspect of clivus and with 17.7 mm craniocaudad size within the sella and basal cistern. The measurements are nearly identical to prior exam from 6-4-14 and consistent with patient's known meningioma. Bilateral internal carotid artery signal voids are identified and demonstrate no appreciable change since prior exam in the caliber which demonstrate no convincing evidence of decreased size.Unremarkable brain parenchyma in morphology and signal intensity on all MRI sequences and without detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits including axial fat-sat post enhanced series.Unremarkable images through the paranasal sinuses and bilateral mastoid air cells.

Output: 1.No acute intracranial process.2.Stable uniformly enhancing extra-axial mass within the sella, basal cistern, bilateral cavernous sinuses, along the dorsal aspect of clivus and minimally along the planum sphenoidale representing patient's known meningioma.3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign intracranial hypertension Arnold-Chiari syndrome without spina bifida or hydrocephalus. Other disorders of meninges, not elsewhere classifiedClinical question: Chiari malformation, 4th ventricle stent, pseudomeningocele, please do with CSF flow studySigns and Symptoms: headaches, neck pain MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post suboccipital craniotomy and resection of the posterior arch of C1. There is a fluid collection present behind the C1 arch measuring approximately 33 x 12 mm axial dimensions which are stable compared to the prior exam. There is redemonstration of stent coursing through the foramen Magendie and into the fourth ventricle with tip at the top of the fourth ventricle. It is unchanged in positionCSF flow study indicates biphasic flow without any convincing evidence for obstruction at the level of the foramen magnum. Flow is also identified through the shunt tubing.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is no evidence for syrinx.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Status post surgery for Chiari malformation with shunt placement. There is no evidence for obstruction to CSF flow. The postoperative findings including a small fluid collection overlying the dura are stable.2.There is no evidence for ventriculomegaly or syrinx.