Instruction: Generate impression based on findings.

Input: 52-year-old female with right knee pain and effusion MENISCI: There is disruption of the posterior horn of the medial meniscus at its root with slight medial extrusion of the body of the medial meniscus. Globular increased signal within the posterior horn and body of the medial meniscus indicates intrasubstance degeneration. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is edema within the medial aspect of the medial tibial plateau, perhaps related to the overlying extruded meniscus. There is focal thinning of the articular cartilage along the superior aspect of the patella along the median eminence with underlying edema in the subchondral bone. Blistering of the articular cartilage is seen more inferiorly.LIGAMENTS: There is mild edema along the superficial band of the MCL which could represent a sprain in the correct clinical setting, but can also be seen in the setting of medial meniscal injury. The MCL itself is intact. The lateral collateral ligament complex is intact. The ACL and PCL are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Root avulsion of the posterior horn of the medial meniscus.2.Degeneration of the articular cartilage of the patella as described above.3.Mild edema surrounding the MCL could represent a sprain in the correct clinical setting, but can also be seen in the setting of medial meniscal injury. The MCL itself is intact.4.Small joint effusion.5.Baker's cyst with findings suggesting leakage/rupture.6.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Aphasia. Nonenhanced brain MRI:Examination demonstrates a focus of cortical restricted diffusion in the right postcentral gyrus without evidence of hemorrhage and with subtle effacement of adjacent cortical sulci consistent with an acute nonhemorrhagic ischemic stroke.There is a large chronic left MCA territory ischemic stroke involving the left frontal and left basal ganglia with resultant ex vacuo dilatation of the left lateral ventricle.Minimal chronic small vessel ischemic stroke is also noted. Unremarkable images through posterior fossa.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Small acute cortical ischemic stroke in the right post central gyrus without evidence of hemorrhage.2.Large chronic left MCA territory stroke with resultant ex vacuo dilatation of left lateral ventricle.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Male 56 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: The prostate gland measures 4.8 x 3.2 x 5.0 cm.Peripheral Zone: The peripheral zone is heterogeneous. There is a dominant focus of abnormal T2 hypointense signal within the posterior right peripheral zone at the apex measuring approximately 0.9 x 0.6 cm which is dark and on the ADC map and which demonstrates early arterial enhancement and is suspicious for a focus of prostatic carcinoma.Central Gland: Mildly enlarged and heterogeneous.Seminal Vesicles: No seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic 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.Dominant subcentimeter focus of signal abnormality within the posterior right peripheral zone at the apex which is suspicious for a focus of prostatic carcinoma. There is no seminal vesicle invasion or extracapsular extension.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of breast (female), unspecified site. Encounter for long-term (current) use of other medications. Shortness of breath.Clinical question: metastatic breast cancer s/p 6 cycles of chemo please assess response to therapy and compare to previous imaging The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior examination the mass centered in the left superior frontal gyrus posteriorly and its junction with the precentral gyrus has decreased in size. There is associated susceptibility effect.There are FLAIR hyperintense lesions on the prior exam which are associated with contrast enhancement located within the cerebellar hemispheres, right temporal lobe and along the left cingulate gyrus and left middle frontal gyrus which are not readily appreciated on the current exam.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 opacified. The visualized portions of the orbits are intact.

Output: 1.The patient refused portions of the exam including postcontrast imaging. As a result many of the lesions identified on postcontrast imaging cannot be adequately evaluated. 2.Since the prior examination the left frontal lobe mass appears to decreased in size. Definitive measurements cannot be made due to lack of contrast enhancement.3. Lesions previously noted in the cerebellum, right temporal lobe, left cingulate gyrus and left middle frontal gyrus cannot be identified on the current exam and cannot be adequately evaluated on the current exam due to lack of contrast enhanced sequence. These particular lesions had FLAIR signal abnormality in the prior exam but currently are not readily identified. It is suspected that they have at least decreased in size.4.Opacification of mastoid air cells. This is a nonspecific finding but could be due to an inflammatory reaction no obstructive lesions appreciated in the nasopharynx is a potential cause. Please correlate with physical findings on clinical exam.


Instruction: Generate impression based on findings.

Input: Nontraumatic intracerebral hemorrhage in hemisphere, subcortical [I61.0], Reason for Study: ^Reason: Assess changes from prior History: Intrathalamic hemorrhage Left thalamic acute ICH (26.3mm (RL) x 23.8mm (AP) x 29.8mm (CC)) with surrounding edema with IVH is again seen, unchanged.The left lateral ventricle and 3rd ventricle show mass effects.Underlying brain shows scattered FLAIR high signal intensity lesions on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. About 26.3mm (RL) x 23.8mm (AP) x 29.8mm (CC) sized left thalamic acute ICH with surrounding edema and IVH.2. No evidence of acute ischemic lesion.3. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Reason: prior microhemorrhages, on warfarin. Please assess for new microhemorrhages. History: mild cognitive impairment No diffusion abnormality. No evidence of acute intracranial hemorrhage. Previously seen 3 foci of susceptibility artifacts appear similar on current study. Scattered T2 hyperintensity in the subcortical and periventricular white matter, nonspecific but compatible with chronic small vessel ischemic disease. The ventricles and sulci are normal in size. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is stable prominence of the left retrocerebellar CSF space.

Output: 1. No acute intracranial hemorrhage or ischemia. 2. Stable appearing scattered susceptibility artifact, presumably related to chronic microhemorrhage.3. Stable appearing small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 20 year-old male with right knee pain A moderate joint effusion is present. The knee otherwise is within normal limits. The left knee appears normal on the frontal view.

Output: Joint effusion with otherwise normal appearing knee.


Instruction: Generate impression based on findings.

Input: As seen on the outside exam, there is a large infiltrative appearing process with a thick rindof irregular heterogeneous enhancement centered in the right parietal lobe. There are numerous associated flow-voids, and the mass extends to the posterior right lateral ventricular margin. On T2-weighted images, there is central hyperintense signal, with a rind of mildly increased T2 signal, greater in signal than normal cortex. Abnormal enhancement and signal also extends in an ill-defined manner along the splenium of the corpus callosum on the right side, which is also expanded. The mass was noted to demonstrate mild hyperattenuation along the areas of MR enhancement as well as associated diffusion restriction in these areas on outside MRI consistent with hypercellularity. Susceptibility is also noted on the outside exam, most prominent in the area of focal nodular enhancement along the posterior aspect of the right lateral ventricular body. There is relatively only mild to moderate localized mass effect.In addition, there is abnormal confluent T2 hyperintensity focally within the left superior temporal lobe, without significant mass effect. Multiple oval and punctate areas of T2 hyperintensity are again seen throughout the cerebral white matter, most focal in the frontal lobes and along the corona radiata. There are some lateral left basal ganglia chronic lacunar infarcts suggested. Multiple chronic appearing lacunar infarct are also present within the brainstem, with diminutive appearance especially of the left cerebral peduncle, with evidence of previous hemosiderin deposition along the midbrain previously. There are likely a few small chronic lacunar infarcts in the cerebellum bilaterally. The ventricles and sulci are prominent, consistent with mild to moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which may represent a background of mild to moderate chronic small vessel ischemic changes. 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 grossly within normal limits. There is patchy opacification of the right posterior ethmoid air cells.

Output: 1.Redemonstration of infiltrative appearing process centered in the right parietal lobe white matter with mild to moderate localized mass effect. Associated punctate flow-voids seen throughout the areas of more solid appearing tissue, which demonstrates a lacelike pattern of enhancement, predominantly relating with the prominent vessels. Differential diagnosis includes an inflammatory abnormality, including a demyelinating process which may be fulminating and hemorrhagic, based on prior outside MRI appearance, versus infiltrative primary brain neoplasm versus less likely angiocentric lymphoma.2.Additional areas of abnormal signal throughout the white matter, most focally in the superior left temporal lobe as well as in the frontal periventricular white matter and corona radiata. Other extensive supratentorial and infratentorial white matter changes which appear to correlate with multiple chronic lacunar infarcts with even left Wallerian degeneration, much greater than expected for the patient's stated age with regard to chronic small vessel ischemic changes, although other etiologies for the white matter findings as related to the above process is not excluded.


Instruction: Generate impression based on findings.

Input: Diagnosis: Spinal stenosis, lumbar regionClinical question: chronic L5 radiculopathySigns and Symptoms: chronic low back and left pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There is multilevel disc desiccation present. The patient is status post right hemilaminectomy at L3-4. Soft tissue swelling associated with the surgical site has evolved since the prior exam and is less prominent.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L4-5 there is moderate bilateral facet and ligamentum flavum hypertrophy present associated with loss of disc space height, disc desiccation and diffuse disc bulge. There is encroachment of the exiting nerve roots within the neural foramina at this level. There is effacement of the fat at the right lateral recess and to a lesser degree left lateral recess at this level. It is crowding of the nerve roots within the thecal sac at this level. There is mild anterior subluxation of L4 and L5. Overall there is a moderate degree of spinal stenosis at this level. Compared to the previous exam there is some mild progression of the spinal stenosis but no substantial change. There is associated contrast enhancement at the endplates at this level. This appears to be new compared to the prior exam.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with moderate bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. There is a slight amount of anterior subluxation of L3 on L4 at this level. There is narrowing of the neural foramina at this level, however, the fat surrounding the exiting nerve roots within the neural foramina is preserved. There is a little bit more central disc protruding into the spinal canal at this level but otherwise there is no significant change compared to the prior exam.At L2-3 there is no significant compromise to spinal canal. There is a diffuse disc bulge present at this level, loss of disc space height and disc desiccation associated with the a left lateral disc protrusion with encroachment of the left-sided exiting nerve roots within the neural foramen. This has progressed compared to the prior exam. Endplate reactive changes are present which have high signal on T2-weighted imaging. This is also relatively new compared to prior exam. There are associated contrast enhancement at the endplates.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present this level.

Output: 1.There are multilevel degenerative changes present in the lumbar spine and there is associated status post spinal surgery who is postoperative changes have evolved since the prior exam.2.Since the prior exam the patient has progressed a left far lateral disc protrusion at L2-3 which now encroaches on the left-sided exiting nerve roots within the neural foramen. There is associated with subacute endplate reactive change.3.There is redemonstration of moderate spinal stenosis at L4-5 associated with the encroachment of the right-sided exiting nerve roots within the neural foramina at this level. This is progressed very little since the prior exam.4.Some encroachment of the nerve roots at the lateral recess bilaterally at L3-4 is also stable, however, there is a superimposed central disc protrusion present.5.There is a subacute endplate reactive change present at L4-5 predominantly on the right side.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction due to embolism of cerebral arteryClinical question: stroke vs sz, r/o malignancySigns and Symptoms: seizure MRI of the brainNo diffusion weighted abnormalities are appreciated.Foci of encephalomalacia are present in the right middle and inferior frontal gyrus as well as the right basal ganglia. Some periventricular and subcortical white matter lesions are present in the right hemisphere. These correspond to prior foci of infarction depicted on MRI from 6/24/2013.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right vertebral artery appears to be occluded proximally and reconstituted distally via the vertebrobasilar junction. Since the prior exam from 6/24/2013 right distal M1 occlusion has resolved. There is redemonstration of a narrowing of the distal left M1 segment with approximately 70% stenosis as well as a 50% stenosis along the distal ophthalmic segment of the left internal carotid artery. There is 50% stenosis at the cavernous segment of the left internal carotid artery. There is 60% stenosis at the intracranial left vertebral artery distal to the origin of the left posterior inferior cerebellar artery. There is 50% stenosis present at the distal right M1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact but small. The left A1 segment is hypoplastic. There is extracranial origin of the left posterior inferior cerebral arteryMRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is 50% stenosis at the origin of the left internal carotid artery but no stenosis at the origin of the right internal carotid artery. There is no significant stenosis along the course of the left vertebral artery. The right vertebral artery is occluded at its origin.

Output: 1.Occlusion of the right vertebral artery with distal reconstitution via the vertebrobasilar junction.2.There is 60% stenosis at the distal left vertebral artery intracranially. 3.There is a 50% stenoses are present along the distal left internal carotid artery at the ophthalmic segment and at the cavernous segment4.50% stenosis at the origin of the left internal carotid artery5.There is 70% stenosis at the left mid M1 segment6.There is 50% stenosis present at the distal right M1 segment7.Encephalomalacia involving the right middle cerebral artery territory related to prior cerebral infarction from 2013.8.There is no evidence for acute cerebral infarction.9.There is no evidence for intracranial neoplasm10.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 49-year-old woman with history of pancreatic neuroendocrine tumor status post distal pancreatectomy October 2015. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter segment 4 hepatic cyst (3/13), but otherwise the liver parenchyma is normal in signal, morphology and enhancement pattern.There is no intrahepatic or extrahepatic biliary ductal dilatation. Subcentimeter stone noted along the posterior gallbladder wall without thickening or surrounding inflammatory change.SPLEEN: Patient status post splenectomy.PANCREAS: Patient status post body and tail pancreatectomy. The head and uncinate process of the pancreas appear normal without suspicious enhancing foci. Susceptibility artifact within the pancreatectomy bed is likely postsurgical.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Left extrarenal pelvis, otherwise kidneys are normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially visualized small bowel and colon appear normal.OTHER: No significant abnormality noted.

Output: Partial pancreatectomy without evidence of tumor recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Past history of T1N2aM0 right piriform sinus status post treatment, with new left tongue base mass. There is an ulcerated mass in the left tongue base that extends into the left glossotonsillar sulcus, but not across the midline. The tumor measures up to 30 mm. There is no measurable tumor in the hypopharynx. There is no evidence of significant lymphadenopathy in the neck. There are postoperative findings in the right neck related to neck dissection. The remaining salivary glands and thyroid are unremarkable. There are retention cysts in the right maxillary and sphenoid sinuses. There is a disc-osteophyte complex at C3-4, which compresses the spinal cord.

Output: 1. An ulcerated mass in the left tongue base is compatible with squamous cell carcinoma.2. A disc-osteophyte complex at C3-4 compresses the spinal cord.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: worsening sz History: nonspecific partial sz of upper extremities Evidence of bifrontal craniotomy and maxillofacial surgery.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no abnormal intracranial enhancement.Mucosal thickening and enhancement on paranasal sinuses indicate postoperative changes.Left mastoid air cells show opacification.Bilateral hippocampi show normal and symmetric size as well as normal MR signal intensity.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels.

Output: Postoperative status, bifrontal craniotomy and maxillofacial surgery.No evidence of intracranial acute ischemic or hemorrhagic lesion.No evidence of abnormal intracranial enhancement.


Instruction: Generate impression based on findings.

Input: History of PSC, please monitor for stricture/mass ABDOMEN:LIVER, BILIARY TRACT: Unchanged hepatic subcentimeter cyst formation. Unchanged irregular intrahepatic biliary duct dilatation, most pronounced centrally, including unchanged focal stricture involving left lateral segment bile duct. No definite enhancing focal mass seen. Heterogeneous postcontrast enhancement with geographic wedge-shaped area seen in anterior segment right hepatic lobe, image 263 series 1/6/2001, most likely transient perfusional abnormality as does not persist to a significant degree on subsequent more delayed imaging.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal calyceal dilatation with multiple layering stones.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. Essentially stable exam as above. No enhancing soft tissue mass identified on current study, but evaluation with ERCP may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 58 years, Male, Reason: staging exam History: prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.2 x 2.8 x 4.3 cmPeripheral Zone: There is a lesion in the left peripheral zone extending from the left base to apex which is low signal on T2/ADC with early enhancement. There is extension to the left transitional zone, as well as adjacent extracapsular extension and extension into the left seminal vesicle.Central Gland: Suspicious lesion as above extending into central gland.Seminal Vesicles: Extension of lesion into left seminal vesicle. Right seminal vesicle is normal.Extracapsular Extension: Adjacent extracapsular extension with extension into the left seminal vesicle.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left peripheral zone lesion with features suspicious of prostatic adenocarcinoma with extracapsular and seminal vesicle extension.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is an oblique vertical tear of the medial meniscus at the junction of the posterior horn and body. Although the vertical component originates at the inner free edge of the meniscus, this does not appear to extend completely through the peripheral fibers. There is also a horizontally oriented tear of the body of the meniscus that extends from the periphery to the tibial articular surface.The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is superficial degeneration of the articular cartilage of the patella. A low signal intensity linear focus of the articular cartilage of the femoral trochlea may represent focal degeneration. There is also superficial degeneration of the articular cartilage of the medial femoral condyle above the posterior horn of the meniscus. There is also mild edema type signal of the medial tibial plateau below the body of the meniscus which is suspected to be degenerative in nature. The articular cartilage of the lateral compartment appears preserved.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Medial meniscal tears and mild articular cartilage degeneration with other findings described above.


Instruction: Generate impression based on findings.

Input: Elbow pain There is abnormal signal noted within the medial epicondyle and the growth plate likely to represent a nondisplaced fracture of the medial epicondyle. Note that there is edema in and around the ulnar collateral ligament likely to represent a partial tear. There is a small elbow joint effusion. The capitellum and trochlea are normal. The proximal radius and ulna are normal. There is minimal edema at the common flexor tendons.

Output: Abnormal signal within the medial epicondyle and growth plate likely to represent a nondisplaced fracture of the medial epicondyle with probable partial tear of the ulnar collateral ligament and the findings could be seen in Little League's elbow.


Instruction: Generate impression based on findings.

Input: Evaluate possible bony lesion, calcification at C5-6IMAGE ACQUISITIONS: Cervical spine CT without contrast Cervical spine alignment is normal. Intervertebral disk spaces and vertebral body heights are normal.At C4-5, there is a small bony growth extending from posterior element of C4 into the spinal canal.At C5-6, there is a larger bony growth extending from the posterior element of C5 to the spinal canal with mass effect on the cord at C5 on the left.Both lesions appear to have cortical and medullary continuity suggesting osteochondroma. MRI is recommended to evaluate for any cord abnormality.

Output: Bony growths extending from the posterior elements of C4 and C5 into the spinal canal. While there is mass effect on the cord at the C5 level, we cannot assess for cord injury. MRI is recommended to further evaluate.


Instruction: Generate impression based on findings.

Input: TENDONS:. There is fluid around the flexor hallucis longus which can be a normal variant. Clinical evaluation would be helpful in evaluating for tenosynovitis LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Specifically no evidence is seen of any osteochondral lesions.ADDITIONAL

Output: Possible tenosynovitis of the flexor hallucis longus. No evidence of an osteochondral lesion.


Instruction: Generate impression based on findings.

Input: Reason: rule out rotator cuff tear History: left shoulder pain, mild swelling, after lifting motion Motion artifact limits multiple sequences.ROTATOR CUFF: There is a complete tear of the supraspinatus with retraction of the tendon to the level of the glenohumeral joint. This tear extends posteriorly to involve the majority of the infraspinatus tendon, although a small portion of the tendon appears to extend to the greater tuberosity. There is moderate fatty atrophy of the supraspinatus and infraspinatus muscles. There also appear to be small ossicles within the infraspinatus tendon. The teres minor muscle and tendon appear intact. There is also a full-thickness tear of the majority of the subscapularis tendon, although a small portion of the tendon may attach to the lesser tuberosity, inferiorly. There is severe atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Severe osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint. There is fluid and intermediate signal intensity within the joint likely representing a synovitis as well as debris. Additional better defined foci of low signal intensity within the joint likely represent loose bodies. There is degenerative tearing of the glenoid labrum.BICEPS TENDON: The tendon of the long head of the biceps is not clearly identified within the bicipital groove, proximally, likely reflecting rupture. There are several loose bodies noted within the bicipital groove. ADDITIONAL

Output: Massive rotator cuff tear, arthritis, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Right vestibular schwannoma status post surgery: surveillance. There are postoperative findings related to right retrosigmoid craniotomy for resection of a right vestibular schwannoma. There is unchanged nodular enhancement within the right internal auditory canal that measures approximately 6 mm and a band of enhancing tissue along the resection margins in the right cerebellopontine angle cistern that measures up to 3 mm in thickness and is inseparable from what remains of the cranial nerve 7 and 8 complex. There is unchanged prominence of the right lateral posterior fossa cerebrospinal fluid space and flattening of the right cerebellar hemisphere. There is no evidence of acute infarct. There are a few unchanged scattered patchy foci of T2 intensity within the supratentorial white matter, which may represent chronic small vessel ischemic disease. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There are subcentimeter right middle cerebral artery bifurcation left M1 segment aneurysms.

Output: 1. Unchanged residual portions of the right vestibular schwannoma in the right internal auditory canal and cerebellopontine angle cistern and other postoperative findings. 2. Subcentimeter right middle cerebral artery bifurcation left M1 segment aneurysms.


Instruction: Generate impression based on findings.

Input: A 62 year old male with personal history of hypertension and s/p mitral valve repair (2013). Recently had an episode of syncope with positive troponin, the echocardiography showed normal functioning mitral valve and myocardial hypertrophy with suspected hypertrophic cardiomyopathy without flow acceleration. Referred to cardiac MRI for further evaluation. 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 72 ml/m2 (normal range: 74+/-15), the LVEDV is 142 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 122 g (normal range 164+/-36). There is mild to moderate left ventricular hypertrophy (maximum of 13mm at the basal anteroseptum).Despite normal left ventricular systolic function, there is decreased myocardial deformation (tagging sequences, mainly at the base to mid segments). There is late gadolinium enhancement at the superior and inferior insertion points of the right ventricle. This finding suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is also subendocardial LGE involving the basal to mid lateral wall. Although subendocardial late gadolinium enhancement could represent myocardial infarction, in this case it is within thickened myocardium suggesting that it represents an infiltrative or inflammatory process. The native myocardial T1 times are increased in the basal to mid segments (1100-1200ms), which could represent myocardial edema or fibrosis.No acceleration of the flow was noted in the left ventricular outflow tract or systolic anterior motion of the mitral leaflet.Left AtriumThe left atrium is mildly dilated (101ml). 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 74 ml/m2 (normal range 82+/-16), the RVEDV is 148 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveA ring was seen at the mitral valve annulus, the valve opens widely and there is mild 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 mildly dilated (33mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires were noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is 60%. There is mild to moderate left ventricular hypertrophy (maximum of 13mm at the basal anteroseptum). Despite normal left ventricular systolic function, there is decreased myocardial deformation (tagging sequences, mainly at the base to mid segments). There is additionally late gadolinium enhancement as described above and increased native myocardial T1 relaxation time which were both most pronounced at the base of the left ventricle. These findings most likely represent an underlying myocardial infiltrative or inflammatory process. 2. The diagnosis of hypertrophic cardiomyopathy is less likely given the absence of wall thickness 15mm or more, LVOT flow acceleration, and systolic anterior motion of the mitral leaflet; however, the possibility that these findings represent early hypertrophic cardiomyopathy can not be completely excluded. 3. Mild biatrial dilation. 4. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. 5. A ring was seen at the mitral valve annulus, with normally functioning valve. 6. The main pulmonary artery is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 51 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: The prostate gland measures 5.6 x 2.7 x 4.6 cm. Peripheral Zone: Signal abnormality throughout the peripheral zone is suspicious for tumor interspersed with hemorrhage. There is a dominant focus of signal abnormality in the left peripheral zone extending from the apex to the base. This measures approximately 2.0 x 1.6 cm in the mid gland (series 701, image 16). There is a second dominant focus of signal abnormality within the anterior prostate. This right paracentral anterior prostate lesion measures 1.6 x 1.1 cm (series 701, image 15). Additional subcentimeter foci are identified in the peripheral zone, for example the right peripheral zone (series 701, image 14).Central Gland: Heterogeneous.Seminal Vesicles: There is suspicion for seminal vesicle invasion particularly on the left side. Extracapsular Extension: At the level of the described mid gland lesion there is suspicion for extracapsular extension. This is in the region of the neurovascular bundle and neurovascular invasion is suspected.BLADDER: No significant abnormality noted.LYMPH NODES: At least two enlarged left common iliac chain lymph nodes are identified. The largest measures 1.4 x 1.2 cm (series 801, image 15). Multiple nonspecific prominent inguinal lymph nodes are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal prostatic carcinoma with dominant lesions in the left peripheral zone at the midline and within the anterior prostate as described. There is suspicion for extracapsular extension, seminal vesicle invasion and nodal involvement.


Instruction: Generate impression based on findings.

Input: Examination is slightly motion degraded. There is mild straightening of the cervical spine. Vertebral body heights are preserved. The osseous marrow signal is benign. There is disk desiccation and mild loss of disk height at C4-5, C5-6, C6-7 and C7-T1. The cord signal is within normal limits.Individual levels as below:C2-3: Mild disk and endplate degenerative changes with no significant spinal canal or neural foraminal stenosis.C3-4: Mild disk and endplate degenerative changes with no significant spinal canal or neural foraminal stenosis.C4-5: Moderate degenerative changes with disk osteophyte complex and uncovertebral hypertrophy. There is moderate spinal canal stenosis including mild flattening of the cord. There is severe right and moderate left neural foraminal stenosis.C5-6: Moderate degenerative changes with disk osteophyte complex and uncovertebral hypertrophy. There is mild to moderate spinal canal narrowing with mild flattening of the cord. There is moderate to severe bilateral neural foraminal stenosis, more so on the left.C6-7: Mild disk and endplate degenerative changes and right uncovertebral spurring. Minimal spinal canal narrowing. There is moderate right neural foraminal stenosis and minimal left neural foraminal narrowing.C7-T1: No significant spinal canal or neural foramina narrowing. Paraspinous soft tissues are unremarkable.

Output: Multilevel degenerative change in the cervical spine with up to moderate spinal canal stenosis at C4-C5 and C5-C6 related to disk osteophyte complexes with mild cord flattening. No definite cord signal abnormality. There is moderate to severe neural foraminal stenoses at multiple levels including on the left at C4-5 and C5-6 as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate etiology of recurrence lumbar pain and RLE weakness. Signs and symptoms: As above. Nonenhanced lumbar MRI:T12 -- L1 demonstrate mild degenerative changes in unremarkable otherwise and stable since prior study.L1 -- L2 demonstrate minimal degenerative changes without spinal stenosis or neural foramina compromise and stable since prior exam.L2 -- L3 similar to prior exam demonstrate minimal degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disease and loss of disk height, mild to moderate bilateral ligamentum flavum and facet hypertrophic changes without the appreciable change since prior exam. No spinal stenosis or neural foraminal compromise. There is revisualization of a stable tiny synovial cyst projecting posterior to the left articulating facet at this level.L4 -- L5 demonstrate advanced degenerative disk disease and moderate loss of disk height and with associated adjacent Modic signal changes of the endplate without convincing evidence of interval change. There is mild hypertrophic changes of posterior elements present without significant change. There is expected postoperative changes of a right-sided laminectomy similar to prior study. There is however significant decreased size of a large previously noted disk protrusion in midline and to the right since prior exam. Remaining broad based shallow disk protrusion at this level results in subtle indentation of the thecal sac without central spinal stenosis. There is however moderate to severe bilateral neural foraminal compromise (right greater than left) secondary to degenerative changes at this level. Mild right lateral recess compromise at this level is also noted without change since prior exam.L5 -- S1 demonstrate mild degenerative changes without spinal stenosis or neuroforaminal compromise.

Output: 1.Degenerative changes at L4 -- L5 without significant change since prior exam and with persistent bilateral neural foraminal compromise as detailed. There is interval significant decreased size of a disk protrusion at this level and without evidence of central spinal stenosis.2.Unremarkable lumbar MRI exam otherwise with the exception of stble mild degenerative changes without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Left knee pain, evaluate for lateral meniscal tear; history of osteochondral defect repair in August 2015 MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Linear low signals consistent with internal fixation of osteochondral defect in the lateral aspect of the medial epicondyle (series 5 image 15, series 10 image 18). The cartilage at the site of repair is thin with subchondral fluid, bone marrow edema and small cysts, likely postoperative changes. Normal patellar cartilage.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Internal fixation of the osteochondral defect with postoperative changes. No evidence of meniscal tear.


Instruction: Generate impression based on findings.

Input: cT4N1Mx left tongue squamous cell carcinoma, status post treatment. There is interval decrease in size of the infiltrative mass centered in the left tongue with extension across the midline, into the tongue base, left tonsillar fossa, and soft palate that measures up to approximately 30 mm, previously 55 mm. There also appears to be slight invasion of the left pterygoid musculature. There is interval decrease in size of the left level 2A lymph node, which now measures 10 x 11 mm, previously 13 x 17 mm. The thyroid and major salivary glands are unremarkable. The osseous structures and paranasal sinuses are unremarkable. The imaged intracranial structures are unremarkable.

Output: Interval decrease in size of the treated squamous cell carcinoma centered in the left tongue and left suprahyoid lymphadenopathy.


Instruction: Generate impression based on findings.

Input: No diffusion-weighted abnormalities are identified. There are no masses, mass effect, or midline shift. There is no abnormal enhancement within the brain. Periventricular and subcortical white matter hypoattenuation likely represents chronic small vessel ischemic disease. A focus of susceptibility artifact within the left coronary radiata and right pons are non-specific and may represent foci of microhemorrhage. There are no extra-axial fluid collections. There is a small mucous retention cyst in the right sphenoid sinus. The mastoid air cells are clear.

Output: 1. No evidence of intracranial metastases.2. Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Blunt trauma. Signs and symptoms: Loss of consciousness. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal limits. Very small focus of low-attenuation in the periventricular white matter is believed to represent a small was ischemic disease as was noted on prior MRI examcalvarium is intact. No evidence of hemorrhage or swelling of the scalp is detected.Mastoid air cells and middle ear cavities are pneumatized and unremarkable.Visualized paranasal sinuses are unremarkable.Limited images through the orbits are unremarkable.

Output: With the exception of minimal small vessel ischemic disease of indeterminate age this study is within normal limits.


Instruction: Generate impression based on findings.

Input: Tremor, cold intolerance, sensory findings. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

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


Instruction: Generate impression based on findings.

Input: Evaluate for stroke or other intracranial abnormality. Altered mental status and gaze deviation. History of endocarditis. The evaluation is limited by motion degradation. This is a punctate focus of what appears to be mildly restricted diffusion and high T2 signal within the left precentral gyrus and an additional punctate focus of what may be mildly restricted diffusion within the right cerebellum. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage or mass. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, pituitary gland, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening and secretions. There is fluid in the bilateral mastoid air cells.

Output: 1. Punctate lesions within the left precentral gyrus and within the right cerebellum, likely represent subacute ischemic infarcts related to emboli from endocarditis.2. Fluid in the bilateral mastoid air cells.Findings discussed with Dr. Khatibi at 946am on 10/19/2016.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 55 years old Reason: Hx of soft tissue sarcomas, left hip/thigh mass, please evaluate History: above A marker was placed along the medial aspect of the proximal thigh along the medial gluteal fold. Deep to the marker there is reticulation of the subcutaneous fat covering an area of approximately 5 cm in greatest dimension which is of intermediate signal intensity on T1 weighted images and predominantly low signal intensity on T2-weighted images demonstrating minimal enhancement. A similar but slightly less prominent pattern is seen on the other side. We see no discrete soft tissue mass. We see no additional soft tissue abnormalities.The bone marrow signal intensity is within normal limits. There is no significant inguinal lymphadenopathy. Both hip joints appear normal.

Output: Reticulation of the subcutaneous fat of the upper medial right thigh which is nonspecific and could represent scarring/chronic inflammation. We see no soft tissue mass.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with low back pain and L4-5 degenerative disc disease. Alignment is anatomic. Vertebral body heights are preserved. Degenerative endplate signal change is seen at L4-5. Otherwise, marrow signal characteristics are within normal limits. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal stenosis. Mild right foraminal narrowing. L3-4: Facet arthropathy. Ligamentum flavum thickening. Disc bulging. Moderate spinal canal stenosis with some crowding of the cauda equina. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy. Ligamentum flavum thickening. Loss of disc height and disc bulging. Moderate to severe spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. L5-S1: Facet arthropathy right worse than left. Ligamentum flavum thickening. No significant spinal canal stenosis. Mild left foraminal narrowing.

Output: Degenerative findings are seen at several levels, most notably at L3-4 and L4-5 where the spinal canal is narrowed.


Instruction: Generate impression based on findings.

Input: Male, 44 years old, with lung cancer. No evidence of edema, focal signal abnormality or restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is seen. A developmental venous anomaly is noted in the left temporal lobe. There are no findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation with no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 76-year-old female with low back pain and question of disc herniation or nerve impingement. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 retrolisthesis of L5 on S1 and trace anterolisthesis of L3 on L4. Bone marrow signal is benign. The conus medullaris is normal in position between L1 and L2.Multilevel degenerative changes are seen, as described below:T12-L1: Minimal right paracentral disc protrusion. No spinal canal or neural foraminal stenosis. No significant facet hypertrophy.L1-L2: Minimal right-sided disc bulge. No spinal canal or neural foraminal stenosis. Right greater than left facet hypertrophy and ligamentum flavum thickening. The right neuroforamen is narrowed.L2-L3: Right-sided disc bulge. No spinal canal stenosis. Bilateral facet hypertrophy and ligamentum flavum thickening. Mild right neuroforaminal stenosis.L3-L4: Generalized disc bulge with a superimposed right inferior paracentral disc protrusion. The cauda equina is mild to moderately crowded at this level secondary to ligamentum flavum thickening and bilateral facet hypertrophy. There is mild bilateral neural foraminal stenoses.L4-L5: Trace retrolisthesis of L4 on L5. This retrolisthesis causes some uncovering of the disc and crowding of the cauda equina. There is also an annular fissure posteriorly. There is severe left greater than right facet hypertrophy that causes moderate right neural foraminal stenosis and severe left neural foraminal stenosis. L5-S1: Grade 1 retrolisthesis of L5 on S1 causes disc uncovering and crowding of the cauda equina. There is moderate bilateral facet hypertrophy with severe bilateral neural foraminal stenoses.Apparent redundancy of the sigmoid colon within the pelvis is visualized.

Output: 1. Trace retrolisthesis of L4 on L5 and grade 1 retrolisthesis of L5 on S1.2. Extensive spondylotic changes described by level above. These include crowding of the cauda equina and neural foraminal stenoses most severe at L4-L5 and L5-S1.


Instruction: Generate impression based on findings.

Input: 52-year-old male with intermediate risk for prostate cancer status post prostatectomy in 2013 with positive left lateral anterior margin and rising PSA of 0.76. PELVIS:PROSTATE:The prostate gland is surgically absent. Between the bladder and the rectum, there is a soft tissue focus which measures 1.4 x 0.6 cm (series 901, image 7; series 1001, image 1223) with early enhancement and washout.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small soft tissue focus with early enhancement and washout concerning for recurrent disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Please evaluate patient with malignancy and recent increase intracranial pressure/hydrocephalus. Signs and symptoms: As above. Nonenhanced head CT:Diffuse low-attenuation of bilateral cerebellar hemispheres is consistent with extensive edema. There is near complete effacement of cerebellar and vermian for your, complete effacement of bilateral cerebellopontine cisterns, compressed fourth ventricle and crowding of the fragment magnum as well as effacement of the quadrigeminal plate cistern are all results of intracranial increased pressure in the posterior fossa. This appearance is not significantly different than prior head CT from 8 -- 22 -- 11. Prior MRI is suggestive of cerebellitis.Images through the supratentorial space demonstrate shunted lateral ventricles with significant interval decrease in their size since prior study. Minimal amount of blood in the dependent portion of right occipital horn is minimally larger than prior study and likely result of precipitation. There is better visualization of supratentorial cortical sulci due to reduction in the size of ventricles. No evidence of parenchymal hemorrhage with edema. No evidence of midline shift.

Output: 1.Significant interval decrease in the size of supratentorial ventricular system. Minimal blood in the dependent right occipital horn.2.Extensive cerebellar edema and resultant mass effect similar to prior study.3.No evidence of acute new findings.


Instruction: Generate impression based on findings.

Input: Clinical question: Acute abnormality. Signs and symptoms: Left hip pain, likely radiculopathy. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.There is uniform T1 and T2 hyperintense signal intensity of vertebral column from mid L4 through the sacrum. This signal pattern is suggestive of prior radiation. Please correlate with history.T12-L1 is unremarkable.L1-L2 demonstrate moderate disc disease and loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease and loss of disc height, moderate left-sided ligamentum flavum and facet hypertrophy and to a lesser degree on the left. Constellation of changes results in mild central spinal stenosis and moderate right neural foraminal compromise.L4-L5 demonstrate advanced disc disease and loss of disc height, moderate right and mild left ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in moderate central spinal stenosis and moderate right neural foraminal compromise.L5-S1 demonstrate mild disc desiccation without loss of disc height, moderate bilateral facet hypertrophy (L>R) and moderate bilateral ligamentum flavum hypertrophy. No spinal stenosis however significant left and moderate to significant right neural foraminal compromise is present.Partially visualized SI joints demonstrate no significant abnormality.No evidence of perispinal soft tissue abnormalities.

Output: 1.Degenerative changes at L3-L4 results in mild central spinal stenosis and moderate right neural foraminal compromise.2.Degenerative changes at L4-L5 with resultant moderate central spinal stenosis and moderate right neural foraminal compromise as detailed.3.Degenerative changes at L5/S1 with resultant significant left and moderate right neural foraminal compromise and no central spinal stenosis.4.Please review detailed report per level above.


Instruction: Generate impression based on findings.

Input: Female 6 years old Reason: Assess RA for possible cor triatriatum History: PFO, Murmur Left Ventricle: Normal left ventricle size. Normal wall motion. Interventricular septum is intact.Left AtriumThe left atrium is normal. 4 pulmonary veins are reaching the left atrium. 1.2 cm ASDRight Ventricle: Normal right ventricle size, normal wall motion. Interventricular septum is intact.Right Atrium: Slightly enlarged. 1.2 cm ASD. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation visualized. Dedicated through plane imaging was not performed.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation visualized. Dedicated through plane imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main, right and left pulmonary arteries are normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. The IVC reaches the right atrium somewhat in a high air position creating the diffusion of a intra-atrial septum.PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsPartial visualization of solid organ and hollow viscus of the upper abdomen is normal..

Output: 1. 1.2 cm ASD.2. Borderline right ventricle dilatation and mild dilation of the right atrium.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: 76-year-old female with shoulder pain Moderate osteoarthritis affects the AC and glenohumeral joint. There are multiple cysts in the humeral head as seen on recent MRI. The acromiohumeral interval is slightly narrowed consistent with rotator cuff tear as seen on recent MRI. Small ossicles and calcifications along the lateral aspect of the acromion likely represent enthesopathic changes at the deltoid origin.

Output: Osteoarthritis of the right shoulder and other findings as described above.


Instruction: Generate impression based on findings.

Input: Neuralgia and neuritis, unspecified [M79.2], Reason for Study: ^Reason: Patient with tingling/pain in distribution of V1 v. Facial nerve, MRI to evaluate soft tissue for inflammation with concern for tri-geminal neuralgia History: see above The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement.  The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection, hemorrhage, restricted diffusion/acute ischemia or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain and orbit MRI.


Instruction: Generate impression based on findings.

Input: 57-year-old male patient with HCV and cirrhosis, evaluate for lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour without morphologic changes to suggest cirrhosis. The hepatic parenchyma demonstrates normal signal intensity and enhancement. There is a subcentimeter T2 hyperintense focus within hepatic segment 7 (series 4, image 10) which is too small to characterize. No additional focal hepatic lesions are identified.The hepatic vasculature appears patent.No biliary ductal dilatation. The gallbladder appears within normal limits.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts, including a subcentimeter proteinaceous/hemorrhagic cyst on the left, not significantly changed and without evidence of associated enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No morphologic evidence of cirrhosis or suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB: 7/29/1953)Reason: rule out new lesion. History: increased l hand weaknessPROVIDER NAME: RAYMOND F ROOS RAYMOND F ROOS MRI brain:There is redemonstration of several subcortical and periventricular white matter lesions which are bright signal on FLAIR and T2 imaging. They have not changed since the prior exam. Additionally there is a T2 and FLAIR hyperintense punctate lesion at the left posterior lateral aspect of the pons near the middle cerebellar peduncle. This is also stable. No abnormal enhancing lesions are appreciated 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. There are multiple foci of T2 hyperintensity within the cervical spinal cord at the C1 level, C2 level at the C4 level, the C3 5 level and the C6 level which were also present on the prior exam. There is some atrophy of the cervical spinal cord present. No abnormal enhancing lesions are present in the cervical spinal cord. There is multilevel disc desiccation present. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is redemonstration of a central disc extrusion as well as some ligamentum flavum hypertrophy. There is bilateral narrowing of the neural foramina due to disc material. This is not changed since the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small right paramedian disc protrusion at this level. This is not changed since the prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level associated with narrowing of the neural foramina bilaterally and some encroachment of the exiting nerve roots. This is not changed since the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. This is not changed since the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions within the cervical spinal cord associated with some atrophy of the cervical spinal cord which were also present on the prior exam. There is not appear to be any new lesions in the cervical spinal cord when compared to the prior exam. These are compatible with patient's clinical diagnosis of multiple sclerosis.2.There are multilevel degenerative changes present in the cervical spine which are stable compared to the prior exam with encroachment of exiting nerve roots at C3-4 and to a lesser degree at other levels.3.There are several small lesions within the brain parenchyma present which are stable compared to the prior exam. Their number is too small to establish a pattern. It is quite possible they are related to demyelinating disorder but they are nonspecific.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. There is an enhancing left parietal bone lesion that measures up to 16 mm. There is also sclerotic areas in the posterior calvarium. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the anterior right temporal lobe. There are also a few scattered punctate foci of nonspecific T2 hyperintensity. 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 are grossly unremarkable.

Output: 1. Skull metastases but, no evidence of intracranial metastases. 2. Right anterior temporal lobe encephalomalacia.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left frontal lobe surgery for resection of a recurrent left frontal lobe mass. There linear enhancement along the posterior margin of the resection cavity. There is persistent confluent T2 hyperintensity surrounding the posterolateral aspect of the resection cavity and extending into the anterolateral aspect of the left lateral ventricle and corpus callosum. 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. There is mild left scalp swelling.

Output: Recent resection of recurrent glioblastoma from the left frontal lobe without evidence of gross residual enhancing tumor.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: eval for FAI History: R hip pain Minimal osteoarthritis of the right hip. Lateral center edge angle of 18 degrees, suggesting dysplasia. Coronal center edge angle of 22 degrees.

Output: Minimal osteoarthritis of the hip and findings suggesting acetabular dysplasia. Due to technologist error, modified Dunn view was not obtained. Patient will be called back for additional imaging at no additional charge.


Instruction: Generate impression based on findings.

Input: Facial myokymia [G51.4] / Anesthesia of skin [R20.0], Reason for Study: ^Reason: MS History: left facial numbness and tingling The examination is slightly limited by motion artifact. There is mild reversal of the cervical lordosis which may be positional. The vertebral body heights and intervertebral disc spaces are maintained. No worrisome focal marrow signal is identified. The spinal cord demonstrates normal caliber and signal intensity. There is no significant central spinal or neuroforaminal stenosis. Craniocervical junction appears unremarkable. The paraspinous and retropharyngeal soft tissues appear to be within normal limits. Incidentally noted is a 1.1 cm proton density hyperintense lesion within the strap muscles of the right neck just below the hyoid.

Output: 1. No specific abnormality of the cervical spine.2. Probable right thyroglossal duct cyst.


Instruction: Generate impression based on findings.

Input: 61-year-old female with lightheadedness and loss of balance. Very subtle foci of low-attenuation in the inferior aspect of the left cerebellum (image 8) is noted although it is possible this finding represent a small artifact possibly from a small stroke cannot be entirely ruled out. If clinical concern persist an MRI is recommended.Images through the supratentorial brain parenchyma demonstrate no evidence of any focal or diffuse abnormality brain parenchyma. In particular no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Calvarium, paranasal sinuses remain within normal limits. Poorly developed mastoid air cells are noted and middle ear cavities are well pneumatized.

Output: Questionable findings of possible small cerebellar stroke on the left as detailed. Please see above comments


Instruction: Generate impression based on findings.

Input: 18 years Male (DOB:8/10/1997)Reason: worsening headaches with history of mass History: headaches with waking upPROVIDER/ATTENDING NAME: CHARLES J MARCUCCILLI CHARLES J MARCUCCILLI There is redemonstration of a lesion along the medial aspect of the right temporal lobe involving the head of the hippocampus, the amygdala and the uncus which continues to regress in size compared to prior exams and is now associated with atrophy of the right hippocampal head currently there is no associated contrast enhancement.Previously noted right hemispheric leptomeningeal enhancement is no longer appreciated. The the left-sided leptomeningeal vessels are more prominent compared to the right side on the current exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening and mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Continued regression of the right medial temporal lobe lesion. This could go along with a treated encephalitis


Instruction: Generate impression based on findings.

Input: Clinical question to be answered:? Tumor. Signs and symptoms: Headaches. Prominence of cerebellar sulci and fourth ventricle is consistent with underlying cerebellar parenchymal volume loss. This finding was noted on prior MRI examination of brain. No hemorrhage is detected. Images two supratentorial space demonstrate normal density and morphology of brain parenchymal. Cortical sulci, ventricular system and all CSF cisterns remain within normal. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact. Mastoid air cells are well pneumatized and unremarkable. Very limited view of ethmoid and sphenoid sinuses demonstrate no abnormality.

Output: 1.No evidence of tumor or acute findings.2.Cerebellar volume loss.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of bladder status post cystoprostatectomy and creation of orthotopic neobladder 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: Renal cysts. Improved dilatation of renal collecting systems, no evidence of hydronephrosis, small left extrarenal pelvis.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy with orthotopic neobladder formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post cystoprostatectomy with orthotopic neobladder formation. No evidence of local tumor recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: 44M uncontrolled IDDM with recent dog scratch now presents with sepsis presumed secondary to infection of left upper due to left subscapular abscess seen on imaging status post left shoulder open anterior I&D and posterior arthroscopic I&D. Back pain. Evaluate for infection in the spine. There is mild dextro thoracic and mild levo lumbar curvature. There is straightening of the lumbar lordosis in the sagittal plane. The vertebral body heights are preserved. There is mild loss of height of the L4-L5 disc space with endplate degenerative changes. There is diffuse low signal of the bone marrow. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.T12-L1: No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: No significant disc bulge, spinal canal or foraminal stenosis.L2-L3: Mild bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L3-L4: Mild bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L4-L5: Disc bulge with superimposed large central/right paracentral disc extrusion with cranial and caudal migration and measuring approximately 20 mm, contributing to moderate spinal canal stenosis and possible impingement of the descending nerve roots, and mild bilateral foraminal stenosis. Mild bilateral facet degeneration. L5-S1: Mild bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis.

Output: 1. Central/right paracentral disc extrusion at L4-L5 with cranial and caudal migration and measuring approximately 20 mm in length. There is resulting moderate central canal stenosis as well as and right lateral recess stenosis. 2. No evidence of discitis-osteomyelitis, inflammatory changes, or fluid collections in the lumbar spine to suggest infection.3. Diffusely low marrow signal, which is nonspecific but can be seen in conditions such as chronic anemia or marrow proliferative disorders. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 41-year-old female with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Nonenhancing T2 hyperintensities compatible with benign cysts.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: Above average stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Nonspecific airspace opacity in the left lung base.PELVIS:UTERUS, ADNEXA: Nabothian cysts are present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above average stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Above average stool burden.2.No abnormal enhancement is noted in the bowel.


Instruction: Generate impression based on findings.

Input: 60-year-old woman with history of elevated transaminases. ABDOMEN:LIVER, BILIARY TRACT: The liver is unremarkable in signal and morphology. No focal hepatic lesion identified. No biliary duct dilatation is seen. The gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple simple right upper pole cysts and a small simple left midpole cyst are seen.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable study.


Instruction: Generate impression based on findings.

Input: 57-year-old with cirrhosis, evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Peripheral wedge-shaped focus of arterial enhancement in segment 8 without washout consistent with a perfusion defect. There are no suspicious arterially enhancing lesions to suggest HCC. The hepatic vasculature is patent.SPLEEN: Splenomegaly and varices. Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cirrhosis without arterially enhancing lesions to suggest HCC.


Instruction: Generate impression based on findings.

Input: Chronic vomiting concerning for increased intracranial pressure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Left-sided sensory disturbance. Evaluate for ICH or other etiology. Within the right lateral subinsular/posterior basal ganglia region is a small area of focal CSF intensity signal indicating encephalomalacia with minimal adjacent parenchymal T2/Flair hyperintensity consistent with marginal gliosis, which are consistent with the patient's previous parenchymal hemorrhage. There is ill-defined enhancement within the lateral subinsular cortex better seen on the delayed fat-saturated postcontrast imaging, with a small area of discontiguous linear enhancement just posteriorly which does not appear to be vascular in etiology. Small foci of restricted diffusion within the right subinsular region likely represent chronic blood products, with a background of significant susceptibility in the area of previous hemorrhage. Mild ex vacuo dilatation is noted about the posterior right lateral ventricle. Additional scattered punctate foci of susceptibility are also noted, including within the posterior fossa along the superior vermis and right cerebellum indicating additional probable chronic hemosiderin deposition. Moderate periventricular and subcortical white matter signal abnormality seen on T2/FLAIR is nonspecific but likely represents the sequela of chronic small vessel ischemic changes. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Interval expected evolution of area of previously seen hemorrhage in right posterior basal ganglia/subinsular region. Ill-defined and linear enhancement involving the right subinsular region in the location of the previous hemorrhage which may represent reactive sequela of the evolving area of chronic hematoma. Given the persistent enhancement at 4 months from the time of hemorrhage, follow up repeat CTA head could be obtained to exclude any underlying vascular malformation, or follow up MRI brain in 6-12 months is recommended to assess for resolution of imaging findings.


Instruction: Generate impression based on findings.

Input: Seizure and encephalopathy, history of lung and pancreatic cancer. Fall, evaluate for ligamentous injury. Brain: There are multiple foci of restricted diffusion involving the cortical surface of the right frontal, left frontal, and left parietal lobes. There is corresponding T2/FLAIR hyperintensity. Relatively larger of these areas of restricted diffusion involves the left inferior parietal lobule cortex. There are innumerable foci of susceptibility effect throughout the bilateral cerebral hemispheres, brainstem, and cerebellum compatible with chronic microhemorrhages. There is a tiny subacute subdural hematoma along the right parietal convexity as seen on recent CT. There are multiple foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic disease. Chronic lacunar infarct is noted involving the left frontal periventricular white matter.There is no evidence of intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus.Minimal mucosal thickening is seen in the paranasal sinuses. There is opacification of the bilateral mastoid air cells. There is fluid within the nasopharynx. There is edema involving the left occipital scalp which may reflect dependent edema and is nonspecific. Correlate with direct inspection to exclude possibility of associated infection.Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. There are no findings to suggest ligamentous injury. There is minimal fluid involving facet joints at multiple levels which is likely on a degenerative basis. The cervical spinal cord has normal signal characteristics and overall morphology.Some of the sequences are motion degraded slightly limiting evaluation. Multilevel degenerative changes are seen in the cervical spine with disc height loss at the C5-C6, C6-C7, and C7-T1 levels. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc bulge with small central protrusion and ligamentum flavum thickening. There is effacement of the ventral thecal sac. There is overall mild spinal canal narrowing at this level. Minimal neural foraminal narrowing bilaterally C4-5: Mild disc bulge and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C5-6: Disc osteophyte complex with effacement of the ventral thecal sac. Dorsal thecal sac is widely patent without significant spinal canal stenosis at this level. There is moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy. C6-7: Mild disc bulge and uncovertebral hypertrophy. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal. Significant loss of disc height. Mild bilateral neural foraminal narrowingThere is mild edema involving the left posterior subcutaneous soft tissues. Paraspinous soft tissue structures are otherwise grossly unremarkable.

Output: 1. Multiple small foci of acute to subacute infarct involving the cortex of the right frontal, left frontal, and left parietal lobes. These appear to be in a watershed territory suggesting hypoperfusion injury, although embolic disease remains a less likely possibility.2. Very small subacute right parietal subdural hematoma as seen on recent head CT.3. Innumerable foci of chronic microhemorrhages throughout the cerebral hemispheres, cerebellum, and brainstem. These are of nonspecific etiology, possibly related to coagulopathy.4. No intracranial mass or mass effect to suggest metastatic disease. Please note lack of contrast limits evaluation for small metastatic lesions.5. Edema involving the left parieto-occipital scalp as well as in the subcutaneous tissues of the left neck which may represent dependent edema or possibly posttraumatic. Correlate with direct inspection to exclude possibility of superficial infection in this region.6. No findings to suggest ligamentous injury in the cervical spine. Multilevel degenerative changes in the cervical spine are seen without evidence of high-grade spinal canal stenosis at any level or cord signal abnormality. There is moderate bilateral C5-C6 neural foraminal stenosis. Additional levels as above.


Instruction: Generate impression based on findings.

Input: 75 year old male patient with altered mental status and history of lymphoma. Question of lymphomatous involvement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular T2 signal abnormality and a focus of encephalomalacia within the left cerebellar hemisphere. There is mild generalized parenchymal volume loss. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement.The ventricles and basal cisterns are normal in size and configuration for the patient's age. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening of the right maxillary sinus, ethmoid air cells, and frontal sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable. Degenerative changes affect the bilateral temporomandibular joints. There are partially imaged enlarged and convex contoured left upper cervical lymph nodes.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Mild chronic small vessel ischemic disease and prior left cerebellar lacunar infarct.3. Enlarged left cervical lymph nodes.


Instruction: Generate impression based on findings.

Input: History of pelvic rhabdomyosarcoma status post radiation, chemotherapy, and surgery now with back and lower abdominal pain. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. No ovaries are visualized. No adnexal masses are seen.BLADDER: The bladder is incompletely distended. LYMPH NODES: No pelvic lymphadenopathy is identified.BOWEL, MESENTERY: The visualized bowel is normal in caliber without evidence of obstruction. No abnormal bowel wall thickening is seen.BONES, SOFT TISSUES: The bone marrow is mildly heterogeneous without focal lesions identified. Mild disc bulges are present at L3-L4, L4-L5, and L5-S1 without associated significant spinal canal stenosis. A few normal-sized inguinal lymph nodes are present bilaterally. Surgical changes are present along the lower anterior abdominal wall.OTHER: A small amount of free fluid is present in the pelvis which may be physiologic.

Output: 1.Surgical changes without specific evidence of recurrent disease.2.Mild lumbar spine disc bulges which may be a source of lower back pain.


Instruction: Generate impression based on findings.

Input: 39-year-old female with chronic pain over the left ischium. Evaluate. Note is made of a subcentimeter focus of increased signal abnormality within the proximal femoral metadiaphysis likely representing an enchondroma. Otherwise no bone marrow signal abnormality is identified. The imaged musculature is normal in appearance. Note is made of low signal intensity foci within the uterus likely representing fibroids. Although this examination was not protocoled for evaluation of the lumbosacral spine, there is moderate to severe degenerative disc disease affecting the level of L5/S1 with a disc bulge at the level of L5/ S1 resulting in apparent narrowing of the left neural foramen (image 33; series 1001).

Output: Moderate to severe degenerative disc disease affects the imaged lower lumbosacral spine with an apparent disc bulge resulting in left neural foramen narrowing at the level of L5/S1 as described above. Further evaluation with a dedicated lumbar spine MRI examination could be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: 42-year-old female with history of bilateral hip AVN presents with right hip pain. ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Curvilinear region of low T1 signal in the left femoral head with mild surrounding bone marrow edema is compatible with osteonecrosis. Similar findings are noted in the superior aspect of the right femoral head, also compatible with osteonecrosis. There has been interval core decompression of the right femoral head. No definite flattening of either femoral head is noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Persistent bilateral femoral head avascular necrosis as described above, with interval core decompression of the right femoral head. No additional findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: Ewings' sarcoma, off therapy for 2.5 years History: none Again seen is the reference pelvic mass situated between the bladder and rectosigmoid colon measuring approximately 6.2 x 5.5 cm, previously 6.2 x 5.5 cm (image 30; series 12), not significantly changed. There is no enhancement on postcontrast images. There is a peripheral rim of low signal intensity on T1 and T2-weighted images. While this is nonspecific, this may represent postsurgical change/chronic hematoma formation. No additional enhancing mass lesions are identified. There is heterogeneous bone marrow signal abnormality within the lumbar spine which may represent residual islands of red marrow. Again seen is a small nonenhancing focus of T2 signal abnormality on T1-weighted images within the left iliac bone, unchanged, which may represent a treated metastases. Again seen is an enhancing focus of signal abnormality within the anterior aspect of the left sacral wing which appears slightly decreased in size when compared to the prior study and likely represents a small focus of bone infarct.

Output: No significant interval change in post treatment changes of pelvic Ewing's sarcoma. No findings to suggest disease progression.


Instruction: Generate impression based on findings.

Input: Right frontal mass and seizures. There is a peripherally enhancing mass in the right frontal lobe that measures up to approximately 3.5 cm with extensive surrounding T2 hyperintensity. There is associated partial effacement of the right lateral ventricle, mild subfalcine herniation, and approximately 10 mm of midline shift to the left. There is also an area of encephalomalacia in the left parietal region and extensive non-enhancing cerebral white matter T2 hyperintensity. There is no evidence of acute infarct or intracranial hemorrhage. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is fluid within the left mastoid air cells and middle ear cavity.

Output: 1. A peripherally enhancing mass in the right frontal lobe that measures up to approximately 3.5 cm with extensive surrounding T2 hyperintensity may represent a primary or metastatic tumor with associated vasogenic edema, versus less likely an atypical abscess. 2. Chronic small vessel disease and left parietal lobe infarct.3. Findings suggestive of left otomastoiditis.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with paresthesias and history of multiple sclerosis. Evaluate for progression. Extensive periventricular and scattered juxtacortical T2 hyperintense lesions are redemonstrated, most of which show correlating moderate to marked T1 hypointensity. Lesions are also noted on both sides of the pons and in the right cerebellar hemisphere. On comparison with the prior examination, there has been no significant interval change in the size and distribution of these lesions, nor in their T1 or T2 signal characteristics. No new lesions are appreciated. Moderate generalized cerebral volume loss is seen. No other significant findings are noted.

Output: Scattered lesions are demonstrated both supra- and infratentorially compatible with multiple sclerosis. There has been no significant interval change in the size, number, or signal characteristics of these lesions.


Instruction: Generate impression based on findings.

Input: Male; 62 years old. Reason: abnormal ultrasound in patient with chronic hcv. tpl phase mri to ro hcc History: rule out hcc ABDOMEN:LIVER, BILIARY TRACT: Multiple small hyperechoic lesion seen on prior ultrasound correspond with subcentimeter T2 hyperintense lesions in both lobes of the liver, some of which are too small to accurately characterize, but these lesions all do not have significant restricted diffusion, arterial hyperenhancement, or washout. Some of the lesions have MR characteristics typical for benign hemangiomas. No hepatic lesions which meet the criteria for HCC.The largest hypoechoic lesion seen on prior ultrasound in the left lobe the liver does not have an MR correlate, and it may have been due to focal fat deposition or liver heterogeneity.Paradoxical increased signal of the liver diffusely on in and out of phase images, suggestive of iron deposition.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal simple 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: No hepatic lesions which meet the criteria for HCC.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer with previous metastatic lesions treated with RT. Evaluate for disease. Signs and symptoms: Lung cancer. Enhanced CT of brain:There is redemonstration of the left-sided frontal extra-axial dural based enhancing tumor measuring 18.3 millimeter in AP access (sagittal reformatted image 35) and 18.9-mm in transverse axis measured on axial postinfusion image 22 these measurements are identical to prior MRI exam. These signal characteristic and pattern of enhancement as well as its location is highly suspected for a meningioma as it was noted on prior MRI. There is subtle buckling of the adjacent brain parenchyma however no vasogenic edema is detected. There is an enhancing well-demarcated mass in the right frontal lobe with extensive surrounding vasogenic edema. This tumor measures 14.1-mm in transaxial dimension (axial postinfusion image 21). On prior exam this tumor measured 5.6-mm in its transaxial dimension. There is no evidence of an additional metastatic lesions to the brain or the leptomeninges.Calvarium is intact. Visualized mastoid air cells, middle ear cavities are unremarkable. Visualized paranasal sinuses demonstrate complete opacification of right frontal sinus this finding was noted on prior MRI and CT exam.80 cc of Omnipaque 350 is administered for the study.

Output: 1.Dural based extra axial well-demarcated enhancing mass in high convexity left frontal lobe highly suspected of a meningioma. The measurement of the tumor are similar to prior MRI exam (18.3-mm in AP access and 18.9-mm in transverse axis).2.Significant interval increase in the size of a right frontal single metastatic focus which measures 14.1 x 14.1 millimeter in transaxial dimension.


Instruction: Generate impression based on findings.

Input: History of renal cell carcinoma status post bilateral nephrectomy. Please note that evaluation is limited by lack of IV contrast.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: Status post bilateral nephrectomy. The previously seen bilateral heterogeneous retroperitoneal collections have nearly completely resolved, compatible with postsurgical hematomas. No definite soft tissue mass is identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Near-complete resolution of the bilateral retroperitoneal collections compatible with hematomas, without residual or recurrent soft tissue mass identified.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, history of right anterior clinoid meningioma status post resection. Yearly follow up exam. Evidence of a right pterional craniotomy is again seen. Minimal encephalomalacia of the anterior right temporal lobe and the inferior right frontal gyrus is unchanged. No evidence of any nodular soft tissue is seen along the right anterior clinoid process. Likewise, the right cavernous sinuses and Meckel's cave show normal morphology and enhancement without evidence of mass effect.Elsewhere in the brain, a few scattered small foci of white matter T2 hyperintensity are nonspecific and not significantly changed. No parenchymal edema or mass effect is detected. No pathologic enhancement is seen. The ventricles are normal in size and shape. A partially empty, expanded sella is redemonstrated similar to prior.

Output: No evidence of tumor recurrence.