Instruction: Generate impression based on findings.

Input: Diagnosis: Other disturbances of skin sensationClinical question: StrokeSigns and Symptoms: Stroke MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a punctate focus of signal loss present in the right pons on SWI.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. There is fetal origin of the posterior cerebral arteries present bilaterally. The right P1 segment is fairly large. The left P1 segment is small. The left vertebral artery functionally ends in the left posterior inferior cerebellar artery and is hypoplastic distally. MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is an apparent weblike narrowing at the origin of the left internal carotid artery which is suspected to be artifactual. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery is smaller than the right vertebral artery. The origins of the vertebral arteries are tortuous.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is a levocurvature to the thoracic spine centered at the T12-L1 level and a compensatory dextrocurvature to the upper lumbar spine and upper thoracic spine.. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. There is facet degeneration in the visualized upper lumbar spine and lower thoracic spine. No spinal stenosis is appreciated.There is retroperitoneal fat that extends into the posterior aspect of the left pleural cavity. To lesser degree the same is true in the posterior aspect of the right lower pleural cavity.A small amount of pleural fluid is present.A small cortical renal cystic lesion is partially included on this exam. It is also identified on the CT from 3/28/2015. Appeared to represent a more complex cyst

Output: 1.There is an apparent weblike narrowing at the origin of the left internal carotid artery which is suspected to be artifactual. This can be confirmed by duplex ultrasonography.2.There is retroperitoneal fat which extends into the posterior and inferior aspects of the pleural cavities. This is more prominent on the left compared to the right side.3.There is a scoliotic curvature to the lumbar spine which is centered at the T12-L1 without associated spinal stenosis or neural foraminal encroachment.4.There is no evidence for acute ischemic cerebral infarction.5.There is no evidence for intracranial cerebrovascular occlusive disease.6.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 7.There is a complex cortically based cyst on the right kidney which is about 1 cm in size


Instruction: Generate impression based on findings.

Input: Reason: previous infection and GSW to the hand-sensitivity of hand-palm and unable to move index finger. History: pain and swelling and stiffness There is near complete to complete interval resolution of the previously described fluid collection along the volar aspect of the palm. The previously seen bullet fragment is also not well-visualized on today's examination and may have been removed. There is linear decreased signal abnormality in the surrounding area which likely represents scarring or postsurgical change. The palmaris longus tendon is indistinct in the adjacent area and may be disrupted.Again seen is bone marrow signal abnormality within the second metacarpal head, neck, and diaphysis consistent with the patient's known history of a nondisplaced fracture. Again seen is heterogeneity and increased signal abnormality within the volar plate of the second MCP joint indicating disruption. The A1 pulley of the index finger is again noted to be indistinct likely indicating disruption. The flexor digitorum superficialis tendon appears intact. However, the flexor digitorum profundus tendon of the index finger is again noted to deviate laterally and appears to terminate at the level of the MCP joint indicating a tear. The remaining visualized tendons of the hand appear intact.

Output: 1. Interval resolution of the previously described fluid collection within the volar soft tissues of the mid palm.2. Nondisplaced fracture of the second metacarpal.3. Disruption of the volar plate of the MCP joint and A1 pulley of the index finger, appearing similar to the prior study.4. Findings suggestive of disruption of the flexor digitorum profundus at the level of the MCP joint of the index finger, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: 73-year-old female. Evaluate for neoplasm and/or metastasis status post Whipple. ABDOMEN:LUNG BASES: No significant abnormality noted. Bilateral breast implants present.LIVER, BILIARY TRACT: There is a small amount of pneumobilia which is a normal finding status post Whipple. No focal hepatic lesions are identified. Patient status post cholecystectomy.SPLEEN: Multiple subcentimeter hypodense lesions within the spleen are nonspecific in appearance, but given the lack of lesions within the liver are more likely to represent benign lesions rather than metastatic disease. Calcified granuloma present in the spleen.PANCREAS: Patient is status post Whipple procedure. No mass is identified in the surgical bed. The remnant pancreatic duct is mildly dilated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesion in both kidneys likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is some infiltration of mesenteric fat anterior to the surgical bed. This likely represents postsurgical changes but attention should be paid to this area on subsequent examinations.BONES, SOFT TISSUES: Postsurgical change are identified in the anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: An exophytic mass arising from the uterus likely represents a fibroid uterus. However, this is nonspecific by CT and could be further evaluated with gynecologic ultrasound or MRI as clinically indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine. A sclerotic focus is in the right iliac wing may represent a large bone island but is nonspecific. A smaller sclerotic focus in the left iliac wing adjacent to the SI joint is also nonspecific.OTHER: No significant abnormality noted

Output: 1. No definite evidence of metastatic disease. 2. Postsurgical changes from the Whipple procedure including some infiltrative changes near the resection site. This should be followed on subsequent exams.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Relapsed DLBC lymphoma to the brain, now status post 4 cycles of chemotherapy in need of restaging. There has been interval decrease in size of the patchy enhancement and associated T2 hyperintensity in the right peritrigonal region, which now measures up to 14 mm, previously 17 mm. There is unchanged background of nonspecific cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Interval decrease in size of the CNS lymphoma in the right peritrigonal region.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with history of carotid stenosis and stroke presenting with near syncope. Moderately extensive scattered FLAIR hyperintense lesions are seen within the periventricular and subcortical white matter of the cerebral hemispheres, and to a lesser degree within the brainstem. These findings have not significantly changed. No restricted diffusion, edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. Scattered mucosal thickening is seen in the paranasal sinuses.

Output: 1.Moderately extensive chronic small vessel and lacunar ischemic disease.2.No evidence of acute ischemia or any other definite acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Dysarthria [784.51], Reason for Study: ^Reason: CVA History: Right sided weakness No evidence of acute ischemic or hemorrhagic lesion on the scan.Encephalomalacia of the left occipital lobe as well as left lingual gyrus with corresponding ex vacuo changes of the left lateral ventricle occipital horn.There are punctate susceptibility artifacts on the left cerebellar hemisphere and bilateral thalamus as well as left occipital lobe indicating possible chronic hemorrhagic foci.Multifocal scattered high signal intensities on periventricular white matter on FLAIR images indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic ischemic infarction with encephalomalacia on the left occipital lobe (left PCA territory) as described above.3. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Evaluate for Chiari and tethered cord status post spinal cord untethering, now with incontinence. Brain: The right cerebellar tonsil extends up to 5 mm inferior to the foramen magnum with associated reduced CSF flow. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Spine: There are postoperative findings in the lumbar spine. The spinal cord displays normal signal and morphology. The conus medullaris is situated at the L1 level. The cauda equina nerve roots appear to be intact. There is no evidence of a filar fibrolipoma. There is reduced lumbar lordosis and thoracic kyphosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is partially-imaged dilatation of the urinary bladder.

Output: 1. The right cerebellar tonsil extend up to 5 mm inferior to the foramen magnum with associated reduced CSF flow, but no evidence of syringohydromyelia.2. Postoperative findings related to cord untethering with a conus medullaris is situated at the L1 level and unremarkable cauda equina nerve roots.


Instruction: Generate impression based on findings.

Input: Female 66 years old Reason: eval for cirrhosis and HCC History: right-sided heart failure, portal hypertension The study is limited by diffuse abdominal ascites with resultant artifact.ABDOMEN:LUNG BASES: The right atrium is severely enlarged consistent with tricuspid regurgitation. There is reflux into the hepatic veins consistent with congestive cardiac failure.LIVER, BILIARY TRACT: The liver is diffusely fibrotic and cirrhotic. No arterially enhancing lesion is identified. No areas of delayed washout are identified.SPLEEN: No significant abnormality noted. No significant splenomegaly.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: Diffuse abdominal ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER:

Output: 1 .No lesion suspicious for HCC within the limitations of this study. 2. Diffuse abdominal ascites. Consideration should be given to diuresis prior to additional MR imaging.


Instruction: Generate impression based on findings.

Input: Neck pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C5 on C6 and mild straightening of the cervical spinal curvature. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge associated with the mild retrolisthesis with small annular fissure. There is also minimal ligamentum flavum thickening at this level. There is no significant spinal canal or neural foraminal stenosis. C6-7: Minimal disc bulge and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Minimal degenerative changes in the cervical spine as described above without significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Left parietal brain tumor, operative planning. Examination is limited to sequences for operative planning and intraoperative guidance. Fiducial markers are in place. Again seen is an infiltrative, enhancing mass within the left parietal calvarium that measures up to 50 mm with mild epidural extension. There is minimal associated mass effect upon the underlying left parietal lobe. No intraparenchymal lesions are seen.There is an additional more nonspecific punctate focus of enhancement in the left frontal calvarium, which appears to be present on prior and may represent an additional lesion (axial post gadolinium series 401 133/196).

Output: Examination obtained for operative planning again demonstrating enhancing mass involving the left parietal calvarium with mild epidural extension and consistent with metastatic disease. There is a punctate additional focus of enhancement in the left frontal calvarium, which may represent an additional lesion.


Instruction: Generate impression based on findings.

Input: Patient with right total knee arthroplasty with but with substantial pain/dysfunction at level of patellar tendon insertion. Has either scar or other substance irritating patellar tendon or intrasubstance tendinitis of tendon. Total knee arthroplasty was implanted in 2013, is made of chrome-cobalt allow, and x-rays indicate it is well fixed. Evaluation of the bones and soft tissues of the knee is limited due to metallic susceptibility artifact arising from the patient's total knee arthroplasty. The extensor mechanism is best seen on the MAVRIC sequences: series 7, 9, and 11. The patellar tendon appears intact. There is minimal increased signal intensity within the proximal fibers of the patellar tendon at its attachment to the patella which could conceivably represent mild tendinosis, but the true clinical significance of this is uncertain. I see no frank edema within the adjacent patella or the anterior tibial tubercle. There is bandlike low signal intensity along the posterior margin of Hoffa's fat pad, extending from the undersurface of the patella to the anterior aspect of the proximal tibial component, likely representing postoperative scarring, but this not does not appear to directly involve the patellar tendon. Minimal, thin bandlike intermediate signal intensity extends from the anterior margin of the tibial component to the patellar tendon (image 14 of series 9) which may reflect mild scarring, but this is of questionable clinical significance. The visualized components of the quadriceps tendon appear normal. There is a small amount of fluid in the joint. There are foci of metallic stability artifact anterior to the distal quadriceps tendon and patellar tendon likely representing suture material. The remaining visualized soft tissue structures are unremarkable. Visualized bone marrow signal intensity is likewise within normal limits. The susceptibility artifact from the patient's total knee arthroplasty precludes evaluation of enhancement along the patellar tendon and in the soft tissues adjacent to the prosthesis; no abnormal enhancement is noted in the tissues proximal and distal to the prosthesis.

Output: There is perhaps minimal proximal patellar tendinosis and subjacent scarring, but I see otherwise see no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 64-year-old female history of OA and RA now with right groin pain. ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the hip with flattening of the femoral head superiorly, bulky osteophytes, and subchondral cysts. There is asymmetric edema type signal within the right femoral head and neck which is nonspecific. While we see no evidence of a discrete fracture, a subchondral stress fracture can have this appearance. Severe osteoarthritis also affects the left hip as seen on the large field-of-view images.ACETABULAR LABRUM: There is diffuse degeneration of the acetabular labrum.SOFT TISSUES: There is fat signal abnormality within the anterior aspect of the right gluteus minimus which may represent focal atrophy or less likely an intramuscular lipoma.ADDITIONAL

Output: Asymmetric edema type signal within the right femoral head/neck may simply be degenerative in etiology, although with the presence of an effusion and mild flattening of the superior aspect of the femoral head, a subchondral stress fracture cannot be entirely excluded; if an acute concern remains suspected.


Instruction: Generate impression based on findings.

Input: TI thickening on colonoscopy, evaluate for enterovesicular fistula and disease activity. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening and enhancement involving the distal 20 cm of the distal / terminal ileum (series 23, image 99). There is stricturing of the most proximal portion of this bowel segment with prestenotic dilatation of the small bowel (series 6, image 36). Fibrofatty proliferation surrounds these distal small bowel loops. No evidence of fistula or abscess. Suboptimal distention of proximal small bowel loops. Mildly prominent ileocolic lymph nodes. BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Acute on chronic inflammatory changes in the distal / terminal ileum as described above compatible with inflammatory bowel disease.2.No evidence of fistula or abscess.


Instruction: Generate impression based on findings.

Input: History of acute pancreatitis with pseudocyst formation. Evaluate for underlying mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal lesions evident. There is mild intrahepatic and moderate extrahepatic biliary ductal dilatation. The common bile duct measures 16 mm in diameter.SPLEEN: No significant abnormality noted.PANCREAS: Findings of acute pancreatitis poorly defined edema involving the pancreatic head and proximal body as well as the peripancreatic soft tissues. The pseudocyst within the pancreatic head is decreased compared to prior. There is mild prominence of the main pancreatic duct extending to the level of the pseudocyst. No definite mass lesion, however the exam is limited by the ongoing inflammatory changes of pancreatitis and the lack of intravenous contrast.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys bilaterally within numerable small cysts compatible with acquired cystic disease. No hydronephrosis. No definite mass within the limits of a noncontrast exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New perihepatic ascites extending into the right paracolic gutter.

Output: 1.Findings of acute pancreatitis involving the head and proximal body of the pancreas. The patient's known pseudocyst in pancreatic head is decreased in size compared to prior. There is an increasing amount of perihepatic ascites.2.Persistent prominence of the pancreatic duct extending to the level of the patient's pseudocyst. No definite underlying mass lesion, however exam is limited by the extensive inflammatory changes of ongoing pancreatitis and the lack of intravenous contrast. Consider a repeat exam after the pancreatitis has resolved for further evaluation.3.Persistent mild intrahepatic and moderate extrahepatic biliary ductal dilatation extending to the level of the ampulla.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of pancreatic cystic lesion. ABDOMEN:LIVER, BILIARY TRACT: Bilobar subcentimeter nonenhancing simple cysts. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a multilobulated cystic lesion located in the pancreatic head measuring 2.0 x 1.1 cm (image 35 of series 4). An additional cystic lesion is present in the pancreatic body measuring 8 x 6 mm (image 25 of series 4). Multiple other tiny simple cystic lesions are seen around the main pancreatic duct. All these lesions appear similar to prior.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right inferior pole simple cyst. Mild bilateral perinephric stranding, likely chronic in etiology.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: Limited exam as detailed above. Stable pancreatic cystic lesions, likely IPMN.


Instruction: Generate impression based on findings.

Input: 15-year-old female, evaluate Q-angle for patellar instability There is minimal, approximately 4 degrees varus angulation of the knee relative to the neutral mechanical axis. Four views of the knee are unremarkable for the patient's age.

Output: Minimal varus angulation.


Instruction: Generate impression based on findings.

Input: Question of cavernomas versus metstases. Mild cognitive impairment. Past medical history of an aortic dissection and thoracic aortic aneurysm s/p bioprosthetic aortic valve replacement and bladder/prostate cancer. There are multiple unchanged supratentorial and infratentorial punctate foci of susceptibility. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Multiple unchanged supratentorial and infratentorial punctate foci of susceptibility may represent amyloid angiopathy, microemboli, cavernous malformations, treated metastases, or chronic microhemorrhages that may be related to hypertension. Otherwise, no evidence of intracranial hemorrhage, mass, or cerebral edema.


Instruction: Generate impression based on findings.

Input: Left calf pain The muscles and tendons of the calf appear normal. The marrow signal of the tibia and fibula is also normal. A small Baker's cyst is present which is incompletely imaged.

Output: Small Baker's cyst which is incompletely imaged but otherwise no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Male; 48 years old. Reason: eval biliary system for strictures, f/u of fluid collections, s/p OLT x 2 History: elevated AP ABDOMEN:LIVER, BILIARY TRACT: Status post hepatic transplant. No focal hepatic lesions. Posteriorly located perihepatic hematoma has decreased in size with minimal residual blood products seen tracking along the posterior hepatic lobe, much of the area is seen as mild adjacent stranding.Gallbladder is absent. Mild central intrahepatic biliary ductal prominence, left greater than right, with slight irregularity seen of some of the intrahepatic bile ducts. The common hepatic duct is also prominent with widely patent choledochojejunostomy. SPLEEN: Splenomegaly with the spleen measuring up to 17-cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts, including a hemorrhagic or proteinaceous cyst in the right mid pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild dilation of right upper quadrant small bowel loops likely due to ileus with no abrupt transition point to suggest obstruction. Nonspecific colonic wall thickening is similar to prior study. Interval removal of G-tube.BONES, SOFT TISSUES: Body wall anasarca. Previously seen anteriorly located elongated anterior bowel wall fluid collection is a stable to slightly decreased, measuring up to 7.8 x 1.7 cm (series of 401/12), previously 8.3 x 1.5 cm.OTHER: Moderate to large right pleural effusion, increased since prior study. Unchanged trace left pleural effusion.Mild abdominal ascites. Stable to slightly decreased size in small, scattered intraabdominal postsurgical hematomas at the splenic hilum and posterior to the stomach.

Output: 1. Mild prominence of the biliary tree with widely patent choledochojejunostomy as detailed above.2. Stable to slightly decreased anterior abdominal wall fluid collection and intraabdominal postsurgical hematomas.3. Moderate to large right pleural effusion, increased since prior study.4. Stable nonspecific colonic wall thickening.


Instruction: Generate impression based on findings.

Input: 21 year old man referred for evaluation of pulmonic regurgitation and RV volume/function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 181 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19), the LV mass index is 68 g/m2 (normal range 85+/-15), and the LV mass is 121 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 179 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 76 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation. Regurgitation fraction is 2%.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsResidual thymus tissue. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 179 ml (normal range 142+/-31).3. The pulmonic valve opens widely. There is only mild pulmonic regurgitation based on qualitative visualization of the pulmonic valve, quantitative velocity encoded imaging, and also based on absence of left ventricular and right ventricular stroke volume differences. Additionally RV volumes and ejection fraction are within normal limits.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: New persistent dizziness with subtle cerebellar signs. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and cerebellum 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 are grossly unremarkable. There are a few small retention cysts in the paranasal sinuses. There is a dome-shaped lesion in the left parietal scalp that measures up to 15 mm.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. In particular, there cerebellum appears to be unremarkable. 2. Nonspecific lesion in the left parietal scalp.


Instruction: Generate impression based on findings.

Input: 52-year-old female with right hip pain. History of SLE and AVN, evaluate for AVN. Evaluation of the left hip is slightly limited due to artifact related to vascular coil placement in the pelvisACETABULAR LABRUM: There is degenerative tearing of the anterior labrum of the right hip.ARTICULAR CARTILAGE AND BONE: Mild degenerative changes of the hips bilaterally with narrowing of the joint space. Bone marrow signal is normal with no evidence of avascular necrosis. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Mild osteoarthritic changes of the hips. No evidence of avascular necrosis.2. Degenerative anterior labral tear of the right hip.


Instruction: Generate impression based on findings.

Input: There is a confluent area of encephalomalacia and gliosis in the right paramedian parietal lobe, cingulate gyrus, medial temporal lobe, and occipital lobe. There is associated ex vacuo dilatation of the right lateral ventricle. There are also small areas of encephalomalacia in the left basal ganglia and corona radiata with ex vacuo dilatation of the frontal horn. There is a background of scattered cerebral white matter T2 hyperintensity. There is no evidence of acute ischemia. There are no masses, mass effect or midline shift. The skull, paranasal sinuses, and mastoid air cells are unremarkable. There is mild staphylomatous deformity of the bilateral globes.

Output: Large chronic infarction in the right posterior cerebral artery territory and chronic lacunar infarctions in the left basal ganglia and corona radiata, superimposed on a background of scattered cerebral white matter chronic small vessel ischemic disease, but no evidence of acute ischemia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 60 years, Male, episodic word finding difficulty. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are a few scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal small vessel ischemic changes. There is mild parenchymal volume loss which appears age-appropriate. Brain parenchyma is otherwise unremarkable. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Mild mucosal thickening involving the ethmoid air cells and small amount of layering fluid is seen within the left maxillary sinus. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Examination is essentially within normal limits for patient's age. There are minimal chronic small vessel ischemic changes. No evidence of recent infarct.


Instruction: Generate impression based on findings.

Input: Pain with weightbearing TENDONS: There is a minimal amount of fluid in the peroneus longus tendon sheath as it courses along the anterior calcaneus and cuboid but this is within normal limits. The remaining tendons are unremarkable.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There are no findings to suggest a cuboid fracture. A small rounded focus of mildly increased signal intensity is seen on fluid sensitive sequences within the proximal medial cuboid beneath the anterior process of the calcaneus. This may represent an early degenerative cyst but is of questionable clinical significance. The bone marrow signal of the ankle and hindfoot is otherwise unremarkable. ADDITIONAL

Output: Tiny focus of signal abnormality within the proximal medial cuboid proximal to the anterior calcaneus may represent an early degenerative cyst but there is no evidence of cuboid fracture. Other findings are described above.


Instruction: Generate impression based on findings.

Input: 63 year-old female history of enlarged right bile duct seen incidentally on lumbar spine MRI. ABDOMEN:LIVER, BILIARY TRACT: No intrahepatic biliary ductal dilatation. Common bile duct measures 7 mm. There is a low insertion of the cystic duct.Tiny scattered nonenhancing cysts.The gallbladder appears unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable exam with no evidence of biliary ductal abnormality.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified epilepsy without mention of intractable epilepsyClinical question: h/o seizures since childhood. R/O structural lesionSigns and Symptoms: Seizure disorder The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally there are a couple punctate hyperintense T2 and FLAIR sequences lesions present in the brainstem and the right external capsule.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 in the left ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is diffuse calvarial thickening.

Output: 1.Periventricular and subcortical white matter changes of a mild (several) degree are nonspecific. They are most likely vascular related. Additionally there is a mild (several) degree of punctate lesions in the brainstem and right external capsule which similarly are nonspecific but most likely vascular related.2.Calvarial thickening is a nonspecific finding


Instruction: Generate impression based on findings.

Input: 72-year-old male patient with left knee pain. Question of medial meniscus tear. MENISCI: There is a horizontal cleavage tear of the posterior horn of the medial meniscus. The anterior horn of the medial meniscus appears extruded. There is increased internal signal within the body of the lateral meniscus suggestive of mucoid degeneration though no discrete tear.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the lateral tibiofemoral articular cartilage. There is marked generalized thinning of the patellofemoral articular cartilage with a partial-thickness defect within the lateral facet. There is complete loss of the articular cartilage of the weightbearing portion and anterior medial femoral condyle and medial tibial plateau articular cartilage with underlying bone edema; this has progressed compared to the prior study.There are tricompartmental osteophytes. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. ADDITIONAL

Output: 1. Osteoarthritis of the knee with marked medial compartment articular cartilage loss and underlying bone edema.2. Tearing of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of meninges, unspecified [D32.9], Reason for Study: ^Reason: RIght temp meningioma post resection. f/u for changes or recurrence History: none- surveillance Postoperative findings related to resection of a right middle cranial fossa meningioma are again seen. There is thin enhancement along the floor of the middle cranial fossa in the operative bed, not significantly changed since prior examination. A small area of encephalomalacia is again seen in the surgical bed. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a branching developmental venous anomaly in the left paramedian pons with perhaps an associated telangiectasia. The major cerebral artery flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to resection of a right middle cranial fossa meningioma with minimal persistent adjacent dural thickening. No evidence of residual or recurrent tumor is seen.


Instruction: Generate impression based on findings.

Input: history of breast cancer, stroke on the right hemisphere. There are restricted diffusion lesion on the right pre central gyrus extending to the level of frontal operculum indicating acute ischemic infarction. There is no evidence of hemorrhagic conversion.On post gadolinium scan, those involved right frontal lesions show cortical and subcortical enhancement indicating subacute ischemic infarction.There is no other abnormal enhancement on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. 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 relatively sparse right MCA branches especially frontal lobe area, however, no definitive evidence of large vessel occlusion or stenosis.Left MCA and bilateral ACAs appear to be normal.Vertebrobasilar system appears to be normal.There is no evidence of intracranial arterial aneurysm.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Acute ischemic infarction on the right frontal lobe pre central gyrus as described above. No hemorrhagic conversion.2. Sparse right MCA branches on the right frontal lobe area, otherwise unremarkable brain MRA3. Normal neck MRA4. No abnormal enhancement except acute/subacute ischemic infarction area enhancement.


Instruction: Generate impression based on findings.

Input: Loss of patellar reflex on left leg and weakness and pain of left lower extremity. Evaluate for compression of L4. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Severe loss of disc space at the L3-L4 level as well as grade 1 retrolisthesis which appears slightly worse since 6/23/2014. Associated endplate marrow edema however has slightly decreased. Previously seen disc extrusion at this level is no longer present. Conus is in normal position. No suspicious osseous lesions. Multilevel degenerative changes are described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Severe loss of disc height and mild retrolisthesis which has slightly progressed. There is interval resolution of previously seen disc extrusion. There is mild narrowing of the left lateral aspect of the spinal canal related to facet arthropathy, otherwise no significant spinal canal stenosis at this level. There is minimal right neural foraminal narrowing and mild left neural foraminal narrowing. Previously seen right lateral recess effacement has resolved related to surgical removal of disc material.L4-L5: There is moderate to severe spinal canal stenosis at this level which appears progressed, and related to combination of facet arthropathy, ligamentum flavum thickening, and mild disc bulge. There is also lobulated soft tissue measuring approximately 6 mm in the AP dimension along the dorsal aspect of the spinal canal which may be related to postoperative scar tissue, chronic blood products, or possibly synovial cyst. There is moderate narrowing of the left neural foramen and mild narrowing of the right neural foramen which appear worse. There is effacement of the left lateral recess partially related to disc material. There is mild interval in distention of the bilateral facetsL5-S1: Disc height loss and mild bulge. Mild facet arthropathy. No significant spinal canal stenosis. There is mild bilateral neural foraminal narrowing.

Output: Multilevel degenerative changes in the lumbar spine are again seen. Compared to 6/4/2014, interval removal of disc extrusion at the right L3-L4 level is seen with marked improvement in the previously seen spinal canal stenosis at this level. There is slight interval worsening of disc height loss and retrolisthesis at this level.At the L4-L5 level, there is moderate to severe spinal canal stenosis which is worse in the interval as well as worsened neural foraminal stenosis, particularly on the left, where there may be impingement of the left L4 nerve root. There may also be impingement of the left L5 nerve root in the left lateral recess. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Reason: Follow up after UFE History: Fibroid uterus PELVIS:UTERUS, ADNEXA: There are multiple large uterine fibroids. A left sided subserosal fibroid along the fundus with heterogeneous enhancement measures 6.7 x 6.5 x 7.5 cm (series 12 image 27, series 8 image 29), previously 9.8 x 8.7 x 10.9 cm. A right-sided intramural fibroid measures 3.5 x 2.7 cm (series 12 image 35), previously 4.3 x 3.8 cm. Multiple additional subserosal and intramural fibroids are present. Majority of the large fibroids are significantly decreased in enhancement. Nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple intramural and subserosal fibroids; the largest lesions are decreased in size and enhancement.


Instruction: Generate impression based on findings.

Input: 35 year old female with pain and weakness with a sense of instability of the left knee for 2 weeks. Due to the patient's body habitus, the dedicated knee coil was not able to be used. A cardiac coil was utilized for this examination.MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal signal heterogeneity along the medial facet of the patella indicating near full-thickness to full-thickness articular cartilage degeneration. The articular cartilage of the medial and lateral tibiofemoral compartments is within normal limits.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Mild focal degeneration of the articular cartilage of the medial facet of the patella. Otherwise, no specific findings to account for the patient's knee pain.


Instruction: Generate impression based on findings.

Input: BRAIN AND ORBITS: There is interval enlargement of heterogeneously enhancing lobulated sinonasal mass that extends into the bilateral pterygopalatine fossae, as well as the medial right masticator space, with further posterior extension toward the nasopharynx and inferior spread into the superior oropharynx/palate. There is further invasion into the right maxillary ostium, new extension into the left maxillary ostium, as well as more mass effect with bowing into the right medial orbit. There is subtle increased mass effect with convexity into the left medial orbit. There is increased ill-defined enhancement of the right pterygoid muscles which may be reactive, although this is nonspecific. There is more nodular enhancement suspected to be tumor in the right masticator space/right retro-maxillary fat region.Overall, the confluent mass measures up to 33 x 34 mm at the level of the orbits, previously 28 x 28 mm. At the level of the nasal cavity, the mass measures up to 35 mm wide compared to 28 mm by previously. There is new restricted diffusion consistent with cellular tumor present along the right lateral portion of the mass. Previously seen intrinsic high T1 signal secretions at the periphery of the mass have now been replaced by enhancing soft tissue tumor. There is more extensive mass opacifying the left nasal cavity as compared to prior exam, with increased extension into the inferior meati. The enhancement characteristics have changed with more internal enhancement in numerous areas of internal necrosis. There is persistent opacification of the bilateral maxillary and sphenoid sinuses with proteinaceous material likely secondary to obstruction at the sinus outflow tracts. There is stable hyperintense central skull base osseous marrow signal involving the sphenoid wings and pterygoids.Again seen is dural enhancement along the anterior cranial fossa floor as seen on series 17 image 15 with cortical loss, which likely represents tumor invading through the floor of the anterior cranial fossa.There are unchanged postsurgical findings related to frontal craniectomy with mesh cranioplasty. There is subjacent dural thickening and enhancement as noted before. There is no acute infarct, suspicious enhancement, or cerebral edema. There is an unchanged small focus of susceptibility effect in the right parietal lobe. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is nonspecific high T2 signal in the mastoids on the right as noted before.

Output: 1.Marked interval enlargement of bulky mass in the nasal cavity with bulging into the bilateral medial orbits, invading the bilateral maxillary ostia (right greater than left), invading the bilateral pterygopalatine fossae, with further posterior and inferior extension along the nasal cavity toward the posterior nasopharynx, and along the palate into the oropharynx.2.Findings suggesting possible tumor invasion of the anterior cranial fossa floor with cortical loss, although this is similar to the prior exam.3.No brain parenchymal enhancing lesions.


Instruction: Generate impression based on findings.

Input: 64 years Male (DOB:5/29/1952)Reason: GBM s/p chemo XRT. Please eval History: headache.PROVIDER/ATTENDING NAME: STEVEN J. CHMURA RIMAS V. LUKAS There is redemonstration of a T2 and FLAIR hyperintense lesion involving gray and white matter located the anterior aspect of the left temporal lobe which currently measures 52 x 33 mm axial dimensions and on the prior exam the same location measured the same dimensions. The patient is status post left-sided temporal lobe surgery with a hemosiderin tract in the middle of the patient's left temporal lobe lesion. There is some associated mass effect with some mild uncal herniation.Is a cystic lesion present in the right pharyngeal mucosal space measuring 10 x 17 mm in axial dimensionsNormal 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.There is a left temporal lobe mass present which is stable compared to the prior exam. This is known to represent a glioblastoma. No contrast enhanced imaging was performed due to the patient's inability to cooperate further with the exam. The mass associated with mass effect and mild uncal herniation.2.Motion artifact is present which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Loss of rectal tone and incontinence. Evaluate for cord compression. Numbering is performed as per prior studies. There is chronic compression deformity involving the anterior T11 vertebral body similar to prior, without associated edema, retropulsion or spinal canal stenosis. There is mild anterolisthesis of C6 on C7 as seen previously. There is mild dextrocurvature at the thoracolumbar junction. The remainder of the vertebral bodies are appropriate in the overall alignment and height. There is moderate spinal canal stenosis noted at the C3-C4, C4-C5, and C5-C6 levels related to disc osteophyte complexes and ligamentum flavum thickening. There is apparent T2/STIR hyperintensity which is not well evaluated and can be better assessed on dedicated cervical spine MRI. Mild degenerative changes in the lower lumbar spine with small disc bulges again seen without significant spinal canal stenosis. There is mild right-sided neural foraminal narrowing at the L4-L5 and L5-S1 levels.

Output: Examination is performed per limited cord compression protocol. There is moderate spinal canal stenosis in the cervical spine at the C3-C4, C4-C5, and C5-C6 levels related to degenerative changes. There is apparent STIR hyperintensity in the cervical cord at the C3 level which may be artifactual but can be better assessed with dedicated cervical spine study. There is otherwise no evidence of cord compression or cauda equina compression.Chronic T11 compression deformity appears similar to prior without associated osseous retropulsion or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Follow-up of thyroid nodules RIGHT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.1 x 0.9 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Markedly heterogeneity with no focal lesion.LEFT LOBE: Marked heterogeneity with single 7 mm hypoechoic nodule at the lower poleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Possible enlarged parathyroid gland posterior to the right lobe measuring 2.0 x 0.5 x 1.1 cmLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid with 7 mm nodule in the left lobe. Possible enlarged parathyroid gland posterior to the right lobe.


Instruction: Generate impression based on findings.

Input: Anaplastic oligodendroglioma, WHO grade III, status post treatment. There are postoperative findings related to left craniotomy with a resection cavity in the left frontal and temporal lobes and a persistent overlying extra-axial fluid collection. There is intrinsic T1 hyperintensity and susceptibility effect along the posterior margins of the surgical cavity, without definite nodular enhancement. There is unchanged confluent T2 hyperintensity in the surrounding brain parenchyma. There is no evidence of acute infarct. The ventricular system appears unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Post-treatment findings in the left the left frontal and temporal lobes without evidence interval tumor progression.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to right frontal craniotomy with no significant change in the area of confluent T2 hyperintensity within the right superior frontal gyrus surrounding the surgical cavity. However, there is no evidence of associated abnormal intraparenchymal enhancement. The ventricles and sulci are stable. There is no midline shift or mass effect. There is no evidence of acute infarct. The skull and extracranial soft tissues appear to be unchanged.

Output: Post-treatment findings involving the right frontal lobe without evidence of interval tumor progression.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, history of lung cancer with unsteady ambulation. At least 10 enhancing parenchymal lesions are identified in the brain, most of which are supratentorial. They range in size from punctate up to 15 mm in diameter. Most are solidly enhancing but several show a centrally cystic morphology. The lesions are surrounded by mild edema and they induce mild local mass effect. These lesions are new when compared to the prior examination.No significant generalized mass-effect is seen. No evidence of intra-cranial hemorrhage or any abnormal extra-axial collection is identified. The ventricles are normal in size and morphology. Apart from the above-mentioned lesions, there are a few scattered punctate foci of T2 hyperintensity within the cerebral white matter which are nonspecific and unchanged.Marrow replacement and pathologic enhancement is seen at the right skull base involving the right occipital condyle and right mastoid temporal bone.

Output: 1. Numerous, at least 10, parenchymal metastatic lesions are seen, predominantly affecting the cerebral hemispheres. These lesions induce only mild local edema and mass effect. These are new when compared to the prior examination.2. Metastatic disease to the right skull base is seen involving the occipital condyle and the mastoid portion of the temporal bone.


Instruction: Generate impression based on findings.

Input: Reason: eval for fx, malalignment History: s/p R patellar dislocation Note is made of a NOF within the distal femoral metaphysis. No evidence of patella alta. There is a small joint effusion. Linear ossific density along the posterior aspect of the knee only seen on the lateral projection is suspicious for an avulsion fracture, although no donor site is evident. Further evaluation with MRI could be considered if clinically warranted. Soft tissue swelling limits evaluation of the extensor mechanism.

Output: Probable avulsion fracture along the posterior aspect of the distal femur and small joint effusion as described above.


Instruction: Generate impression based on findings.

Input: History of right ear cholesteatoma and surgery in 2000 and 2013: right ear fullness, right tympanic membrane retraction. There are postoperative findings related to right mastoidectomy, which contains fluid. There is diffuse mucosal enhancement along the walls of the mastoid bowl. However, there is no corresponding restricted diffusion in this region. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is scattered mucosal enhancement and fluid within the left mastoid air cells and middle ears also appear unremarkable. There is a retention cyst in the right sphenoid sinus.

Output: 1. Postoperative findings related to right mastoidectomy with associated effusion and perhaps inflammation, including granulation tissue perhaps, but no evidence of cholesteatoma.2. Findings suggestive of left otomastoiditis.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with small cell lung cancer and brain metastases status post whole brain radiation in 2014. Two adjacent cystic masses in the left parietal lobe have decreased substantially in size since the prior examination. The degree of surrounding parenchymal T2 hyperintensity is also significantly improved.One of the lesions contained blood fluid levels on the prior examination, and this lesion now shows evidence of peripheral hemosiderin staining. A round focus of FLAIR hyperintensity and apparent restricted diffusion is seen central to this region of hemosiderin staining. On T1 weighted images, there appears to be some intermediate signal debris adherent within this region. Otherwise, the remainder of the cystic spaces are largely FLAIR hypointense.Scattered small foci of white matter T2 hyperintensity seen elsewhere within the brain are not significantly changed. No evidence of new parenchymal edema or mass effect is detected. The ventricular system is normal in size and morphology.

Output: 1. Significant interval decrease in the size of two adjacent cystic masses in the left parietal lobe. The degree of surrounding parenchymal edema has also improved.2. One of the cystic lesions contains evidence of chronic blood product. FLAIR hyperintensity and apparent restricted diffusion along the inferior aspect of this lesion seem to correlate with a small quantity of adherent debris. The signal characteristics of this debris may reflect blood product or very viscous material. Infectious material, however, can present similarly, and as such, correlation with clinical and laboratory findings is recommended.3. Without the benefit of IV contrast, no definite evidence of any new parenchymal metastases is seen.


Instruction: Generate impression based on findings.

Input: 10-month-old female with left lower extremities edema, cellulitis, abscess, concern for osteomyelitis. Diffuse subcutaneous edema extends from the knee to the forefoot. No bone marrow edema in the tibia-fibula or in the bones of the foot to suggest osteomyelitis. No abnormal enhancement is present. An area of increased signal intensity on T2 weighted images within the subcutaneous tissues superior to the left lateral malleolus may represent an empty abscess cavity. The visualized ligaments of the ankle are intact without evidence of infection.

Output: Diffuse cellulitis extending from the knee to the forefoot. No osteomyelitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Dizziness; evaluate for structural lesions. Signs and symptoms: Dizziness. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates scattered foci of FLAIR hyperintensity in the periventricular and to a lesser degree subcortical white matter of bilateral cerebral hemispheres, bilateral basal ganglia, bilateral thalami (R>L) and bilateral paramedian pons. Findings are nonspecific and demonstrate no evidence of susceptibility signal changes. A few of the lesions demonstrate perpendicular access to the ventricular wall in their orientation. In this age group this appearance is often result of microvascular ischemic changes however less likely possibility of demyelinating disease considering and also be consideredThere is no detectable signal abnormality of the cortex or the cerebellum/vermis. This signal void in major intracranial arterial branches are identified. Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Findings highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild to moderate degree both in supra and infratentorial brain parenchyma. Remote possibility of demyelinating disease cannot be entirely excluded.3.Unremarkable nonenhanced brain MRI otherwise for patient's stated age of 68.


Instruction: Generate impression based on findings.

Input: Neck mass. There is marked diffuse and heterogeneous enlargement of the thyroid gland, measuring up to approximately 8 cm craniocaudally and up to nearly 10 cm in transverse width. There is associated severe narrowing of the trachea, measuring a minimum of 3 mm in width. There is lateral displacement of the bilateral internal jugular and carotid arteries by the thyroid. There is no significant cervical lymphadenopathy. The salivary glands are unremarkable. The osseous structures appear to be grossly intact. The orbits and imaged intracranial structures are unremarkable. There appears to be a carious tooth number 14.

Output: 1. Marked thyromegaly with severe tracheal narrowing.2. Apparently carious tooth number 14.Discussed with Dr. Fatunde at 2:30 PM on 9/16/16.


Instruction: Generate impression based on findings.

Input: 64 year old male. CT abdomen describing bilateral renal lesions indeterminate. Recommended MRI of kidneys. No symptoms. Post-contrast sequences are degraded by motion artifact (patient was feeling nauseated), somewhat limiting evaluation.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild diffuse thickening of the right adrenal gland with no focal lesion.KIDNEYS, URETERS: 2.1 x 1.5 cm complex T2 hyperintense lesion with multiple thick enhancing septations and a questionable small mural nodule posteriorly (series 10, image 18) in the midpole of the left kidney. Additional subcentimeter simple appearing cysts in both kidneys.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: Complex cystic lesion with enhancing thick septations in the left midpole kidney, suspicious for a cystic renal cell carcinoma. No evidence of local metastatic disease.


Instruction: Generate impression based on findings.

Input: 75 male with right foot drop. Evaluate for compressive lesion around the peroneal nerve. No bone marrow signal abnormality is identified. Although this examination was not protocoled for detailed evaluation of the knee, there is full-thickness articular cartilage degeneration along the medial and lateral facets of the patella with underlying degenerative subchondral signal abnormality. There is also apparent near full-thickness to full-thickness articular cartilage degeneration affecting the femoral trochlea.There is increased signal abnormality within the tibialis anterior, extensor digitorum, and peroneal muscles just proximal to the level of the myotendinous junction which is nonspecific but can be seen in subacute denervation injury. The imaged portions of the peroneal nerve are unremarkable. No focal mass lesions are identified in the surrounding area, as clinically questioned. There is also increased signal abnormality on fluid sensitive sequences within the vastus medialis musculature, which is nonspecific. There is fatty infiltration of the gastrocnemius and soleus musculature, particularly affecting the medial head of the gastrocnemius. There is a lobulated focus of fluid signal intensity along the posterior and medial aspect of the proximal tibia, likely representing ganglion formation.

Output: 1. Increased signal abnormality within the tibialis anterior, extensor digitorum, and peroneal muscles just proximal to the level of the myotendinous junction which is nonspecific but can be seen in subacute denervation injury. No focal mass lesion is identified in the vicinity of the peroneal nerve as clinically questioned.2. Moderate fatty atrophy of the gastrocnemius and soleus musculature. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 19 years old, with elevated prolactin and irregular menses. The pituitary gland is well within normal limits for size. However, the sella is very shallow which puts the gland in contact with the optic apparatus and the inferior frontal lobes. There is essentially no suprasellar cistern. Rather than descending from the hypothalamus, the pituitary infundibulum takes a relatively horizontal course to its insertion point at the midline superior gland. In addition, it appears that the dorsum sellae projects into the posterior aspect of the gland at midline (see image 7 series 1400). The enhancement of the gland is very mildly heterogeneous, but no clear discrete lesions are identified. Enhancement of the infundibulum is normal.

Output: Mildly heterogeneous pituitary enhancement is seen. White the possibility of a tiny focal lesion such as an adenoma cannot be excluded, this possibility is not highly suspected as there is no clear focal lesion identified. The pituitary gland is not enlarged. However, due to a very shallow sella, there is essentially no suprasellar cistern which allows the pituitary gland to contact the optic apparatus and the inferior frontal lobes. There may also be some impingement of the gland by the dorsum sellae. The infundibulum is forced to take a relatively horizontal course from the hypothalamus to its insertion point on the gland. It is unclear if these findings may be related to the patient's presenting symptoms.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease. Evaluate ileal disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is above average stool throughout the colon. Portions of the small bowel are suboptimally distended. Small bowel feces sign in the terminal ileum which is minimally prominent. The ileocecal valve is patent. There is no bowel wall thickening, abnormal enhancement or restricted diffusion to suggest acute inflammation. No fluid collections or fibrofatty proliferation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above discussion.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Above average stool burden throughout the colon. Small bowel feces sign in the terminal ileum which may reflect ileocecal valve incompetence without specific evidence of acute bowel inflammation.


Instruction: Generate impression based on findings.

Input: Female 71 years old history of multiple pancreas cysts on surveillance yearly for changes. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Hepatic and portal veins are patent. No biliary ductal dilatation. There is focal minimal nonspecific ductal dilatation in the left hepatic lobe which is unchanged from prior. No focal hepatic lesion in the area is identified.SPLEEN: Spleen is normal in size. Enhancing nodule near the splenic flexure likely represents a small splenule.PANCREAS: There is a cystic lesion in the pancreatic head that measures 0.8 x 0.8 cm (image 4/series 23) previously, 0.8 x 0.7 cm.Small cystic lesion in the pancreatic body located posteriorly measures 5 mm (image 16/series 3), unchanged. Initially, there is a subcentimeter cystic focus in the pancreatic tail.The small size of these lesions limits evaluation for nodularity however, within this limitations, no definite nodularity is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic pancreatic lesions, unchanged in size.


Instruction: Generate impression based on findings.

Input: 56-year-old male with right lower extremity swelling and muscular mass visualized on right lower extremity vascular Doppler examination. There is a large mass in the posterior compartment of the calf which is predominantly situated between the gastrocnemius and soleus muscles. There is an additional component extending anteriorly between the tibia and fibula along the lateral aspect of the posterior tibialis muscle. The maximum transverse dimensions measure 8.5 x 9.0 cm and 13.5 cm in the craniocaudal dimension. The mass displaces the popliteal neurovascular bundle and its branches anteriorly. The signal intensity is predominantly fat signal intensity on all pulse sequences. There are thin minimally enhancing septa and/or vessels within the mass. We see no additional masses. There is nonenhancing reticulation of the subcutaneous fat of the lower leg suggestive of edema. Moderate osteoarthritis affects the knee. Slight focal nonenhancing heterogeneity of the bone marrow of the proximal tibial diaphysis may represent an island of residual red marrow.

Output: Large calf lipoma, as described above.


Instruction: Generate impression based on findings.

Input: 57 year old with strong family history of breast cancer. BRCA mutation carrier. History of right lumpectomy with adjuvant radiation therapy for DCIS in 2005. History of a benign MRI guided biopsy for a lesion at the 3 o'clock position in the left breast, performed in July 2012. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Multiple enhancing foci in the left breast are similar to prior studies, most similar to the 8/21/14 and 8/12/13 studies. Right breast surgical scar and artifact from the left breast biopsy clip near the 3:00 position are again noted. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 68 years, Male, Reason: 68M with low risk prostate cancer. Evaluate with MRI prostate History: Prostate cancer. Left base, right transitional zone PELVIS:PROSTATE:Prostate Size: 4.7 x 2.8 x 4.1 cm.Peripheral Zone: Lesion in the left base peripheral zone with low ADC/questionable low T2 signal (704/284) suspicious for prostatic adenocarcinoma. This lesion measures 0.8 x 0.6 cm (704/304). T2 hypointense irregular signal in region of right base peripheral zone without definite corresponding abnormal ADC hypointense signal, nonspecific, may reflect underlying scarring. Central Gland: Well-defined heterogeneous nodules in the central gland suggest BPH.Seminal Vesicles: No involvement.Extracapsular Extension: No extracapsular extension.BLADDER: There is a left sided ureterocele measuring 1.6 x 1.6 cm.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Lesion in the left base suspicious for prostatic adenocarcinoma.2.Left-sided ureterocele.


Instruction: Generate impression based on findings.

Input: Sacral dimple with ultrasound showing possible tethered cord when she was a newborn. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved and there is no gross dysraphism. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There may be trace fluid within the inferior central canal of the spinal cord. The imaged portion of the spinal cord otherwise appears unremarkable and appears to shift anteriorly in the prone position. The conus medullaris is situated at the L1-2 level. There is no evidence of filar fibrolipoma. The paravertebral soft tissues are unremarkable.

Output: Possible trace partially imaged ventriculus terminalis. Otherwise, no evidence of gross lumbosacral spine anomalies.


Instruction: Generate impression based on findings.

Input: 16-year-old female with history of chronic lymphocytic thyroiditis and thyromegaly, evaluate.EXAMINATION: Sonogram thyroid 11/1/2016, 3:35 PM. RIGHT LOBE MEASUREMENTS: 3.7 x 1.2 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.1 x 1.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Right lobe of the thyroid is normal in echotexture and echogenicity.LEFT LOBE: The left lobe of the thyroid is normal in echotexture and echogenicity.ISTHMUS: Isthmus is normal in echogenicity and echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is persistent right level 2 lymphadenopathy measuring up to 3.4 x 1.1 x 2.1 cm and left level 3 lymphadenopathy measuring 2.7 x 0.4 x 1 cm.OTHER: None.

Output: 1.Normal echogenicity and echotexture of the thyroid gland.2.Persistent bilateral cervical lymphadenopathy, which maybe secondary to viral infection.


Instruction: Generate impression based on findings.

Input: 15 year-old male. Pain in joint, lower leg. MENISCI: Medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Normal signal intensity and morphology of the articular cartilage. Bone marrow signal intensity is within normal limits.LIGAMENTS: ACL and PCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal menisci and ligaments. No specific findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female 46 years old Reason: previous mri shows cerebellar edema with mass affect, reassess for interval improvement History: cerebellar edema with mass affect . There is improved edema in the posterior fossa with decreased T2 signal as well as decreased mass effect on the fourth ventricle and brainstem. The fourth ventricle and prepontine cistern are now essentially normal in size. The size of the lateral ventricles are minimally decreased compared to the prior exam, indicating likely resolution of obstructive component. Enhancement pattern of the resection cavity has also improved compared to the prior exam, now appearing more thin and smooth, previously thick and irregular.Enhancing lesions in the right anterior aspect of the pons and right occipital lobe are again seen and not significantly changed compared to the prior exam. Nonspecific enhancement in the right corona radiata is also unchanged. No new metastatic lesions are seen. Unchanged left frontal encephalomalacia. Unchanged postoperative findings of a occipital craniotomy and left frontal craniotomy. There is minimal unchanged cerebellar ectopia, with borderline low lying tonsils. The major cerebral flow voids are intact.

Output: 1.Improved edema in the posterior fossa with decreased mass effect on the fourth ventricle, which is now essentially normal in size. Previous mild increase in ventricular size has resolved. The enhancement pattern of the resection cavity has also improved.2.Right pontine lesion and right occipital lesion are unchanged compared to the prior exam. No new metastatic lesions are seen.


Instruction: Generate impression based on findings.

Input: Memory difficulty. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of high T2 signal in the cerebral white matter. There are also scattered prominent perivascular spaces, including within the left basal ganglia. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A few scattered cerebral white matter lesions are nonspecific, but there is no evidence of acute inflammatory process.


Instruction: Generate impression based on findings.

Input: 81 year old man with multiple myeloma, referred for evaluation of cardiac amyloid. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 109 ml/m2 (normal range: 74+/-15), the LVEDV is 202 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 108 g (normal range 164+/-36). There are no regional wall motion abnormalities present. The native myocardial T1 relaxation time is 1007ms, which is in the normal range. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is mildly dilated. There is lipomatous hypertrophy of the interatrial septum. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 163 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is moderate aortic regurgitation.Mitral ValveThe mitral 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.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsDiffuse interstitial disease is noted in the bilateral lung fields . Small T2 hyperintense splenic lesions, possibly sarcoid-related. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%.2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 relaxation time is 1007ms, which is in the normal range. Given these findings, there is currently no imaging evidence suggestive of cardiac amyloid.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%


Instruction: Generate impression based on findings.

Input: There is multilevel degenerative spondylosis with mild indentation upon the spinal cord at C3-4 through C5-6, as well as considerable neural foraminal stenoses bilaterally at these levels. There is also marked bilateral neural foraminal stenosis at C6-7. There is a small intravertebral disc herniation in the inferior C4 endplate. The vertebral body heights are intact and there is no spondylolisthesis. There is no evidence of mass lesions. There is a heterogeneous mass in the right tracheoesophageal groove that is partly imaged, but measures up to at least 25 mm. The imaged intracranial structures are unremarkable.

Output: 1. No evidence of cervical spine metastases.2. Multilevel degenerative spondylosis with mild indentation upon the spinal cord at C3-4 through C5-6, as well as considerable neural foraminal stenoses bilaterally at these levels. 3. A heterogeneous mass in the right tracheoesophageal groove is partly imaged, but measures up to at least 25 mm may represent an intrinsic thyroid nodule or metastasis. Dedicated imaging of this region is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Wound infection, evaluate for treatment response. Signs and symptoms:Wound infection, evaluate for treatment response. Pre-and post-enhanced lumbar MRI:Examination redemonstrates postoperative changes of lower lumber spine posteriorly and including placement of metallic hardware at L3 -- L4 level.New since prior exam is a large loculated focus of T2 hyperintensity likely representing fluid surrounding the cluster of metallic hardware which measures approximately at 30 x 41-mm in transaxial dimensions and we craniocephalad extension of approximately 47 millimeter.Additionally there is evidence of a knee large focus of fluid collection in the soft tissues of lower back involving the cutaneous and subcutaneous fat. This fluid accumulation measures at least at the 40 x 41 mm in transaxial dimensions and 74.4-mm in craniocephalad axis. There is also evidence of significant soft tissue thickening/increased volume with T2/T2 stir hyperintensity of the soft tissues in the subcutaneous fat of the lower back which includes the musculature and partial planes.On post enhanced images there is diffuse enhancement of posterior soft tissues of the lower back and the surgical site and in enhancement of the new foci of fluid accumulation. The extent of this finding has increased since prior exam and suspected of progression of inflammatory/infectious process.Previously noted mild posterior dural thickening and enhancement and with resultant subtle mass effect on the dorsal aspect of thecal sac demonstrate however no significant change since prior study. There is no detectable new foci of signal abnormality of vertebral bodies, disk spaces or the epidural space since prior study. Mild central spinal stenosis at L4 -- 5 demonstrate no evidence of change since prior study.

Output: 1.New loculated fluid collection surrounding the cluster of metallic hardware posteriorly at L3 -- L4 level as detailed/measured above.2.New loculated irregular fluid collection in the soft tissues of posterior lower back and including the cutaneous tissues without convincing detectable communication with the above mentioned fluid collection surrounding metallic hardware.3.Interval increased T2 hyperintensity and volume of all soft tissues of posterior lower back at the surgical site and with diffuse enhancement which surrounds the above mentioned fluid collections. Constellation of above findings are highly suggestive of progression of inflammatory and possibly infectious process.4.Post operative dural thickening and mass effect along the dorsal aspect of thecal sac at the L4 and L5 levels demonstrate no evidence of interval change in thickness, extent and pattern of enhancement. This findings similar to prior exam demonstrate subtle mass effect on the thecal sac.5.Mild central spinal stenosis at L4 -- L5 without interval change since prior exam.6.No detectable intracanalicular inflammatory/infectious/ abscess formation.


Instruction: Generate impression based on findings.

Input: Clinical question: Dizziness. Signs and symptoms: Dizziness. Nonenhanced head CT:No detectable activity intracranial process.There is evidence of ectopia of cerebellar tonsils through the foramen magnum of approximately 3 mm. There is resultant partial effacement of subarachnoid space at the level of foramen magnumRecommend follow-up with MRI exam.Unremarkable cerebral cortex, cortical sulci, ventricular system and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits mastoid air cells and paranasal sinuses.

Output: Mild ectopia of cerebellar tonsils and unremarkable study otherwise. Follow-up with MRI and CSF flow study is recommended


Instruction: Generate impression based on findings.

Input: Diagnosis: Closed fracture of cervical vertebra, unspecified level without mention of spinal cord injuryClinical question: looking for soft tissue foraminaSigns and Symptoms: weakness of right arm extension The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord demonstrates signal hyperintensity along the anterior aspect of the spinal cord at the C6 and C7 levels. Overall the patient's spinal canal is relatively smaller on a congenital basis.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There are right-sided uncovertebral osteophytes present at this level associated with disc material encroaching right-sided exiting nerve roots at this level. This is stable compared to the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal. There are some uncovertebral osteophytes present bilaterally at this level which are worse on the left versus the right side. There is encroachment of the left-sided exiting nerve roots. There is mild narrowing of the right neural foramen at this level. There is some adjacent signal hyperintensity within the C6 and C7 vertebral bodies which was also present on the prior exam and has mildly subsided but not resolved. The narrowing of the left neural foramen is slightly more on the current exam when compared to the priorAt 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 multilevel degenerative changes present in the cervical spine worse at C6-7 where there is encroachment of the left-sided exiting nerve roots within the neural foramina due to disc material and endplate osteophytes which narrowing has slightly progressed when compared to the prior exam. Signal changes within the C7 and C6 vertebral bodies adjacent to the disc protrusion signify subacute stage of an inflammatory change. 2.There is encroachment of right-sided exiting nerve roots at C3-4 related to uncovertebral osteophytes and disc material. This is stable when compared to the prior exam and not associated with acute inflammatory changes.3.There is some myelomalacia present within the spinal cord at the C6-7 level which remains stable compared to the previous exam


Instruction: Generate impression based on findings.

Input: Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: Pt with expressive aphasia, hx of seizures and question of previous stroke History: expressive aphasia, history of seizures There is mild left greater than right cerebral volume loss. There are a few scattered foci of T2/FLAIR signal intensity involving the subcortical and periventricular white matter, not significantly changed from the prior examination. There is no evidence of intracranial hemorrhage, mass or edema The ventricles and basal cisterns are normal in size and configuration. The basal cisterns are visualized.

Output: 1. Mild right greater than left cerebral hemispheric volume loss and a few punctate scattered foci of T2/FLAIR hyperintensity which are nonspecific however likely related to chronic microvascular ischemic change.2. Otherwise unremarkable MRI of the brain.


Instruction: Generate impression based on findings.

Input: Prostate cancer status post prostatectomy. PSA 0.2. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. There is an approximately 0.9 x 0.6 cm focus of asymmetric abnormal signal at the vesicourethral anastomosis which demonstrates diffusion restriction, suspicious for recurrent or residual tumor (series 701, image 73).Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Surgically removed.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Subcentimeter focus of abnormal signal at the vesicourethral anastomosis suspicious for recurrent or residual tumor.


Instruction: Generate impression based on findings.

Input: Reason: 77 y/o M with history of October 2016 small bowel obstruction. MRE requested to rule out small bowel pathology as etiology of the prior SBO. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Indeterminant left adrenal nodule, too small to characterize accurately.KIDNEYS, URETERS: Right superior pole T1 hypointense and T2 isointense lesion with possible enhancing septation. Bilateral T2 hyperintense lesions, likely cyst.RETROPERITONEUM, LYMPH NODES: Mildly prominent left retroperitoneal lymph nodes are stable from prior CT.BOWEL, MESENTERY: Evaluation of the small bowel is somewhat limited due to underdistention. Mild jejunal thickening is likely due to underdistention. Previously seen small bowel obstruction has resolved. No specific findings to suggest inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific findings to suggest inflammatory bowel disease. 2.Indeterminant right renal lesion with enhancing septation. Ultrasound follow-up is recommended.3.Findings discussed with Dr. Kavitt at the time of dictation.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression. Cervical spine degenerative changes are grossly stable and better demonstrated on the previous diagnostic cervical spine MRI dated 8/1/2015

Output: No acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes.


Instruction: Generate impression based on findings.

Input: Female, 49 years old. Shoulder pain ROTATOR CUFF: There is a full-thickness, near complete tear of the supraspinatus tendon at its insertion with just under 1 cm of retraction. The tear also appears to involve the anteriormost fibers of the infraspinatus tendon and measures approximately 1.5 cm in AP dimension. The remainder of the supraspinatus tendon appears slightly thickened, likely representing a combination of mild tendinosis and retraction. The supraspinatus muscle itself appears normal. There is perhaps a small interstitial tear at the myotendinous junction of the infraspinatus muscle, but the remainder of the infraspinatus muscle appears normal. The teres minor tendon and muscle are normal. The subscapularis tendon and muscle appear normal for age.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is no joint effusion. Focal intermediate signal intensity in the superior labrum suggests degeneration, but we see no fluid-filled labral tear.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1.Full-thickness rotator cuff tear predominantly involving the distal supraspinatus tendon.2.Acromioclavicular joint osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of left bronchus or lung [C34.92] / Secondary malignant neoplasm of unspecified site [C79.9], Reason for Study: ^Reason: location and extent of spinal mets from met lung CA and any cord compression History: severe p Brain MRIThere are multiple scattered abnormal signal intensity lesions on skull including right parietotemporal area (series #1001, image #19/32) and left frontal area (series #1001, image #21/32), slightly increased in size of the lesions since prior scan.Since there was no post contrast images, intraparenchymal nodular enhancement cannot be evaluated, however, there is no evidence of space-occupying lesion or abnormal edema. Right C2 lesion is again seen, appears to be slightly increased since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.No change of right maxillary sinus retention cyst.Cervical Spine MRIThere is signal change of the C2 dens indicating infiltrative process. In addition, the right side body of the C2 shows 19.5mm x19.9mm x 25.6mm soft tissue mass. The lateral margin of the mass abuts right C2 neural foramen.At the level of T1-2, there are upper mediastinal right side paratracheal lymph nodes and left pleural effusion. Comparing to prior Chest CT scan, no significant interval change since prior scan.Spinal cord signal intensity is normal.Vertebral body alignment is normal with normal lordosis.Thoracic Spine MRIThere is about 10% compression fracture T11 vertebral body with disruption of anterior cortical margin. There is another small vertebral body lesion at T9 vertebral body close to its superior endplate.Spinal cord signal intensity is normal.There is no evidence of spinal canal stenosis.Thoracic neural foramen appear to be normal.

Output: 1. Interval increase in size of multiple skull metastasis and possibly C2 lesion since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. No evidence of brain parenchymal metastasis.4. C2 body right side metastatic mass as well as about 10% compression fracture of T11 metastasis lesion. 5. Focal metastatic lesion at T9 vertebral body superior endplate.6. No evidence of spinal cord compression, no spinal canal stenosis. 7. No abnormal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: 59-year-old male with newly diagnosed oral cancer, evaluate for lung metastases LUNGS AND PLEURA: Mild right basilar pleural parenchymal scarring is redemonstrated without interval change. No new pulmonary, pleural nodules or masses. No pleural effusion identified.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy is identified. Cardiac size is normal. Small pericardial effusion is stable however, is new from the exam dated 6/17/10.Central venous catheter with its tip in the RA.CHEST WALL: Extensive postsurgical changes in the thoracic spine. See recent MRI of the thoracic spine.UPPER ABDOMEN: Status post cholecystectomy.

Output: No evidence of metastatic disease.