Instruction: Generate impression based on findings.

Input: Chronic right knee pain, cutaneous amyloidosis The marrow signal intensity of the distal femur and proximal tibia/fibula is normal.There is no abnormal enhancement or evidence of a mass lesion following administration of contrast. The soft tissues of the knee including the subcutaneous fat and musculature demonstrate no signal abnormalities. Branching signal intensity within the posterior horn of the medial meniscus is thought to represent vascularity as opposed to true tearing. The menisci otherwise appear intact. The cruciate and collateral ligaments are intact. A linear focus of low signal intensity is identified within the femoral trochlea centrally appearing similar to the prior examination. There is otherwise no evidence of a full-thickness articular cartilage defect. There is a small joint effusion. Low signal intensity scarring within Hoffa's fat and scattered foci of signal void within the joint space reflect prior arthroscopic.

Output: Unchanged MRI exam of the knee compared to 3/16/2016 with no evidence of abnormal enhancement or mass.


Instruction: Generate impression based on findings.

Input: History of anal fistula with persistent fistulous drainage. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a low T1 signal tract extending from the 12:00 position of the external sphincter and traveling through the subcutaneous fat of the left perineum corresponding to the patient's previously noted perianal fistula. There is a very trace residual T2 bright tract lumen, but no significant inflammation in the adjacent soft tissues. There is mild postcontrast enhancement of the tract compatible with granulation tissue. No associated abscess.Partially visualized colonic diverticulosis and a giant sigmoid diverticulum.OTHER: Trace bilateral hydroceles.

Output: 1.Healing. No fistula with granulation tissue and minimal fluid along the tract as described. There is no significant adjacent edema or associated abscess formation.


Instruction: Generate impression based on findings.

Input: History of chordoma. Lethargy and vomiting There is a redemonstration of a large calcified mass within the right middle cranial fossa with involvement of the skull base, which remains unchanged from prior brain MRI exam. Postoperative change of the right middle cranial fossa and skull base is present.The cerebral and cerebellar hemispheres are normal in attenuation and morphology. There is no intracranial hemorrhage, edema, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in volume and symmetric.Mucosal thickening is noted in the ethmoid and right frontal sinuses. Opacification of the right mastoid is noted.

Output: 1.No intracranial hemorrhage.2.A calcified mass and postoperative change at the right middle cranial fossa.3.Right mastoid and ethmoid and frontal sinus inflammatory disease.


Instruction: Generate impression based on findings.

Input: 42 years Male (DOB:12/18/1973)Reason: 42 yo with hx of brain aneurysm s/p clipping and coils, admitted for w/u for retinal artery occlusion History: decreased visual acuity in R visualPROVIDER/ATTENDING NAME: VENKATESAN RAM KRISHNAMOORTHI VENKATESAN RAM KRISHNAMOORTHI MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a small focus of of encephalomalacia in the left precuneus. The previous noted punctate focus of diffusion restriction in the left thalamus has disappeared.On susceptibility images are multiple punctate foci of signal loss in the left hemisphere more than the right but also in the cerebellum and vermis.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The distal right internal carotid artery and proximal right middle cerebral artery and posterior cerebral artery are obscured by metal artifact from an aneurysm clip.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. The left P1 segment is slightly larger than the left posterior communicating artery. There is extracranial origin of the right posterior inferior cerebellar artery.

Output: 1.No evidence for cerebrovascular occlusive disease to the extent of visualization. The distal right internal carotid artery, proximal right middle cerebral artery and proximal right anterior cerebral artery as well as the proximal right posterior cerebral artery are obscured by artifact. Please note that the exam was performed on 1.5 T MR which is less sensitive than the 3 Tesla MRI.2.No evidence for intracranial aneurysm recurrence.3.No evidence for acute ischemic cerebral infarction.4.Small focus of encephalomalacia in the left precuneus. 5.Multiple microhemorrhages in the posterior circulation as well as the left subcortical and periventricular white matter and to a lesser degree right subcortical and periventricular white matter. This was also present on the 2014 exam.6.Please note the ophthalmic arteries are not well evaluated on this exam predominantly because this is a 1.5 Tesla MR unit rather than a 3 Tesla MR.


Instruction: Generate impression based on findings.

Input: Clinical question: 87 year-old female with altered mental status, posturing. Signs and symptoms: Altered mental status. Non-enhanced CT of brain:There is no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns remain within normal. Very subtle small vessel disease is suspected.Follow-up with an MRI is recommended.Calvarium, visualized orbits, mastoid air cells and middle air cavities are unremarkable.Paranasal sinuses are unremarkable with the exception of minimal sphenoid sinusitis.

Output: No evidence of acute intracranial findings.


Instruction: Generate impression based on findings.

Input: Please IT12 with thin slices to determine/quantitate compression and retropulsion. A or or Again noted is an approximate 50 to 75% compression deformity of the T12 vertebral body. There is retropulsion of bone fragments into the spinal canal. Bone fragments extend approximately 9 mm posterior to the posterior vertebral line. As noted on the recent MRI, there is no evidence of spinal canal stenosis. The adjacent intervertebral disk spaces are maintained. Few foci of air density are seen in the adjacent intervertebral disks and within the compressed T12 vertebral body. Remaining thoracic vertebral bodies are normal in height and slightly heterogenous in density consistent with osteopenia. Degenerative osteophytes and intervertebral disk space narrowing is seen involving the visualized lower cervical spine.

Output: Compression deformity of the T12 vertebral body with retropulsion of bone fragments, as described above.


Instruction: Generate impression based on findings.

Input: Reason: stage IV melanoma involving the left leg History: assess for disease burden Note is made of multiple enhancing masses situated within the subcutaneous tissues along the posterior aspect of the calf, with the largest measuring 2.2 x 1.3 cm, consistent with the patient's history of metastatic melanoma. These masses abut the posterior margin of the medial and lateral heads of the gastrocnemius and appear grossly similar to the CT examination from 4/1/2016, when allowing for differences in technique. The imaged musculature of the left leg is otherwise unremarkable. No bone marrow signal abnormality is identified.

Output: Multiple enhancing masses along the posterior aspect of the left calf consistent with the stated history of metastatic melanoma with reference measurements provided above..


Instruction: Generate impression based on findings.

Input: Low back pain. Thoracic Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a probable hemangioma in the C6 vertebral body. The vertebral bone marrow signal is otherwise unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are subcentimeter perineural cysts bilaterally at multiple levels.Lumbar Spine: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small disc bulge and loss of disc space height at L5-S1, as well as facet hypertrophy, with mild bilateral neural foraminal narrowing, However, there is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are sacral perineural cysts, measuring up to 19 mm.

Output: 1.Degenerative spondylosis at L5-S1, with mild bilateral neural foraminal narrowing, However, there is no significant thoracic or lumbar spinal canal stenosis.2.Multiple perineural cysts in the thoracic spine and sacrum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 13-year-old female with knee pain. MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: Normal bone marrow signal intensity. Normal thickness of the articular cartilage without evidence of degeneration.LIGAMENTS: The cruciate and collateral ligaments are normal. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Small joint effusion about the knee with mild edema within the infrapatellar fat inferior to the lateral articular facet of the patella; this may represent mild bursitis.


Instruction: Generate impression based on findings.

Input: 48-year-old female with bleeding and discharge. History of cervical cancer with persistent disease on cervix despite chemoradiation therapy. Evaluate for parametrium and bladder/rectal proximity of tumor for surgical planning. PELVIS:UTERUS, ADNEXA: Enhancing soft tissue mass of the cervix measuring 6.1 x 3.5 cm (series 8 image 327). This lesion again extends into the mesorectal fascia posteriorly and parametrium bilaterally. Prior measurement was 4.6 x 2.3 cm. Upper vaginal thickening is again seen.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free fluid in the dependent pelvis.

Output: Increased size of the known cervical soft tissue mass with extension into the mesorectal fascia and parametrium bilaterally.


Instruction: Generate impression based on findings.

Input: 51-year-old woman with biopsy-proven right upper-outer quadrant breast cancer presents for second look ultrasound for indeterminate right mass and left focus identified on staging MRI. A targeted right ultrasound was performed area of clinical concern. In the right breast 3:00 position 3 cm from the nipple, there is a mixed echogenicity mass with mild internal and apical vascularity, correlating to the mass seen on MRI. This mass measures 1.0 x 0.5 x 1.0 cm and is indeterminate. An ultrasound core biopsy is recommended.A targeted left ultrasound was performed for the area of the focus deep to the nipple. In the left breast periareolar region, unremarkable fibroglandular tissue is seen. No discrete solid or cystic masses are identified to correlate with the finding on MRI.

Output: (1) Indeterminate right breast 3:00 position mass measuring up to 1.0 cm, correlating to the area of clinical concern identified on MRI. An ultrasound-guided core biopsy is recommended. This will be performed today and reported under a different accession.(2) No sonographic correlate to enhancing focus identified in the left periareolar region on MRI.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 23-year-old male with a history of meningitis. Evaluate for structural abnormality. There is no restricted diffusion to indicate acute infarct or susceptibility abnormalities to indicate hemorrhage. There is no mass, mass effect, midline shift, herniation or extra-axial fluid collection. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Normal MRI of the brain.


Instruction: Generate impression based on findings.

Input: Tethered cord, please do tethered cord protocol, status post surgical repair. Muscle spasms. Five lumbar type vertebral bodies are presumed to be present. Again seen are postsurgical changes in the lumbar spine with laminoplasties related to cord detethering. Vertebral body heights are within normal limits. Again seen is dextrocurvature at the thoracolumbar junction and levocurvature of the lower lumbar spine. Evidence of prior spinal hardware with transpedicular screw tracts noted at the L1, L2, and lower thoracic levels. Bone marrow signal is benign. Again seen is a low lying conus with the tip L2-L3 level. Prone images demonstrate no significant ventral motion of the conus and cauda equina nerve roots although scoliosis limits significance of this finding. There is trace increased CSF fluid measuring 2 mm in the AP dimension dorsal to the L1 level (sag prone T2 image 13) as compared to the supine images. Fatty infiltration of the filum terminale is again seen.There is no significant spinal canal or neural foraminal stenosis at any level. Incidentally noted is malformation of the S2 vertebral body with midline cleft.

Output: Postsurgical changes in the lumbar spine related to cord detethering. Again seen is a low-lying conus with tip at the L2-L3 level and fatty filum terminale. Prone images demonstrate minimal if any ventral motion of the conus and cauda equina nerve roots, although patient's scoliosis limits evaluation. Please see details above. Cord re-tethering cannot be excluded and can be considered in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: New breast cancer in the right breast. Status post two outside hospital biopsies of the right breast (10:00 pathology is mucinous IDC, 12:00 pathology is benign). MRI for extent of disease and for surgery planning. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is biopsy clip artifact in the right lateral breast at mid depth. This corresponds to the site of the recent right breast 10:00 malignant biopsy. There is a faint enhancement around the clip, though the degree of enhancement near the clip is very similar to the rest of the background breast enhancement. A definite artifact from the 12:00 benign biopsy clip cannot be seen. There is a faintly enhancing 8 mm mass at the 12:00 position that may be a correlate to the biopsied mass. This finding is benign in appearance. No abnormal enhancement is seen in the left breast. Typical benign edge parenchymal enhancement pattern is noted along the anterior/superior aspect of her breast tissue on the left.No abnormal lymph nodes are identified in either axillary region.

Output: Right outer breast biopsy clip artifact represents the site of the recent 10:00 malignant biopsy. Only mild enhancement is seen around the clip.Faintly enhancing right breast 12:00 mass is typically benign in appearance and may correspond to the finding shown at this location on ultrasound.  BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female 45 years old Reason: composition of right 1st MTP mass History: right bunion with overlying painful mass/cyst Small osteophytes are present at the MTP and interphalangeal joints indicating moderate osteoarthritis. Bone marrow signal is normal. Lis franc ligament is intact. No abnormal tendinous tears or thickening.Along the medial aspect of the first MTP there is an oval well-circumscribed fluid attenuation lesion measuring approximately 8 x 6 mm (series 8, image 17). This cystic lesion demonstrates homogeneous T2 hyperintense signal without internal septation. On postcontrast imaging, there is a thin wall of enhancement. This cyst does not involve the extensor tendon but closely associated with the collateral ligament. This likely represents a ganglion cyst which appears to be arising adjacent to the collateral ligament, likely extending from the joint space. Minimal subcutaneous soft tissue edema is present surrounding this cyst.

Output: Ganglion cyst medial to the MTP adjacent to the collateral ligament likely extending from the joint space.


Instruction: Generate impression based on findings.

Input: Reason: Hx: met breast cancer History: pain Exam is mildly limited by metal artifact from right hip intramedullary rod. There are numerous enhancing lesions throughout the pelvis and imaged proximal femurs compatible with metastatic lesions. Of note, there is 2.1 x 1.9 cm lesion at the femoral head and neck junction of the left hip, concerning for future pathologic fracture. There is also proximal diaphyseal lesion of the left femur measuring approximately 3.3 x 2.2 cm with marked cortical thinning, also concerning for future pathologic fracture.

Output: Numerous enhancing lesions throughout the pelvis and imaged proximal femurs compatible with metastatic lesions. Of note, there are femoral head and neck junction lesion and proximal diaphyseal lesion of the left femur concerning for future pathologic fracture as above.


Instruction: Generate impression based on findings.

Input: 57-year-old female with abnormal LFTs. Evaluate for PSC. ABDOMEN:LIVER, BILIARY TRACT: Small right hepatic lobe cyst. No suspicious hepatic lesions. No cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilation. Findings are suggestive of low insertion of the cystic duct into the common bile duct.SPLEEN: No significant abnormality noted.PANCREAS: Small T2 hyperintense lesion measuring up to 7 mm (series 5/44) at the posterior aspect of the pancreatic body, most likely due to a small side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst.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. No biliary ductal dilation or specific evidence of PSC. Findings suggestive of low insertion of the cystic duct into the common bile duct.2. Probable small pancreatic body side branch IPMN.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with neck pain, cervical spondylosis and myelopathy. Since the prior examination, anterior instrumented fusion has been performed from C4 through C7.Spinal alignment is anatomic. Where not obscured by the presence of orthopedic instruments, the morphology and signal characteristics of the vertebral bodies are within normal limits.The visualized spinal cord demonstrates normal signal intensity and morphology.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Progression of right facet hypertrophy. Progression of posterior disc osteophyte and right uncovertebral hypertrophy. The right lateral aspect of the spinal canal is effaced to a greater degree than on the prior examination. The right neural foramen is also narrowed to a greater degree. C4-5: Improvement in the previously seen right paracentral disc protrusion. No significant spinal canal stenosis. No significant neuroforaminal narrowing.C5-6: Mild disc osteophyte formation/uncovertebral hypertrophy appearing similar to prior. Mild lateral recess encroachment but no significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing is unchanged. C6-7: Mild disc osteophyte and uncovertebral hypertrophy more so on the right, unchanged. No significant generalized spinal canal stenosis. Mild right foraminal narrowing is unchanged. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. A small disc protrusion at T2-3 appears similar to priorA 12 mm T2 hyperintense lesion within the right thyroid lobe is unchanged.

Output: 1.Interval anterior instrumented fusion from C4 through C7.2.Improvement in the previously seen right paracentral disc protrusion at C4-5.3.Progression of right-sided uncovertebral and facet hypertrophy at C3-4 with slightly progressed narrowing of the right lateral recess and right neural foramen.4.No significant change in degenerative findings at other levels as above.


Instruction: Generate impression based on findings.

Input: Lung cancer. 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 or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 69-year-old male with asymptomatic biliary dilatation seen on HCC screening US. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with numerous punctate T2 hyperintense foci scattered throughout. Significant degree peribiliary cysts are noted adjacent to the fissure. The gallbladder is dilated with edematous wall which may be seen in hepatic patients. The common bile duct is dilated measuring up to 10 mm appearing similar to that seen on multiple prior examinations dating back to 5/23/2013, within normal limits for age.The portal veins and hepatic veins are patent.At least three arterial enhancing subcentimeter foci are seen in the right lobe of liver, segment 5/6, without definite washout.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 hyperintense cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Spinal fusion hardware in the lumbar spine is present.OTHER: No significant abnormality noted.

Output: 1.Significant degree peribiliary cysts noted adjacent to the fissure correlated with left sided biliary ductal dilation seen on prior ultrasound.2.At least 3 arterial enhancing subcentimeter foci in the right lobe of the liver without definite washout are nonspecific. Attention on subsequent imaging is suggested.


Instruction: Generate impression based on findings.

Input: History of B-cell lymphoma. Evaluate pelvic cysts and/or abscesses. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free pelvic fluid.BONES, SOFT TISSUES: Demonstrated again is diffuse nonspecific subcutaneous edema. No discrete loculated fluid collection with interval resolution of the previously seen lobulated collections in the posterior aspect of the right hemipelvis.OTHER: No significant abnormality noted.

Output: Diffuse nonspecific subcutaneous edema with interval resolution of the previously described lobulated collections in the subcutaneous soft tissues of the dorsal right hemi-pelvis.


Instruction: Generate impression based on findings.

Input: Male, 30 years old, with flaccid paraplegia, HIV positive, evaluate for lesions in the brain or cord. Brain:Scattered irregular T2 hyperintense lesions are evident in the cerebral hemispheres, predominantly in the subcortical white matter with some preference for the frontal lobes. These lesions range in size from punctate to 1 or 2 cm in size, but they exert no significant mass effect. The largest lesion, in the left superior frontal gyrus, appears to demonstrate associated volume loss. None of these lesions demonstrates evidence of enhancement. None is associated with evidence of blood product.Morphology of the brain is otherwise unremarkable. No abnormal extra-axial fluid collections are seen. No pathologic parenchymal or extra-axial enhancement is detected. The ventricles are normal in size and morphology.Spine:The distal spinal cord and conus are edematous. Beginning at the T11 and T12 level, the emerging cauda equina nerve roots show diffuse enhancement and thickening. Beginning at the L2 level, the thecal sac is filled with solidly enhancing tissue which may represent compacted thickened nerve roots or nerve roots intermixed with some other pathologic tissue. Extensive enhancement and nerve root clumping persists into the sacral region where CSF becomes evident again.In the cervical and thoracic region, minimal if any nerve root enhancement is detected and the spinal cord itself shows normal morphology and signal intensity.Reversal of the cervical lordosis is seen. There is a moderate loss of vertebral body height at C4 with evidence of marrow edema at this level. A moderate to severe loss of vertebral body height is seen at T10 and at L5, both of which show edematous marrow signal. Right-sided pedicle screws are in place at L5 and S1.Multiple enlarged left periaortic lymph nodes are seen in the lumbar region. In addition, the iliopsoas muscle complex shows evidence of ill-defined enhancement suggesting inflammation.

Output: 1.Extensive enhancement is seen along the distal spinal cord and within the thecal sac of the lumbar spine. This is favored to represent either thickened and enhancing nerve roots or nerve roots mixed with some other pathologic enhancing soft tissue process. There may be at most minimal nerve root enhancement in the cervical and thoracic spine, but those regions of the spinal cord are otherwise unremarkable. The differential diagnosis for this finding includes infection, particularly opportunistic and atypical agents as well as tuberculosis. The possibility of a malignant process should also be considered including lymphoma. The possibility that this represents a postinfectious or autoimmune phenomenon such as Guillain-Barre syndrome is considered less likely given the severity of the soft tissue thickening.2.Multiple mild to moderate compression deformities are also seen with evidence of marrow edema suggesting a relatively recent onset. The etiology for these compressions is uncertain. These could simply represent compressions related to osteopenia, though superimposed infection or some other marrow infiltrating process can also be considered. Tuberculous osteomyelitis could be considered, though in most cases, there is evidence of adjacent soft tissue thickening which is not seen in this case.3.Left periaortic lymphadenopathy is noted along with inflammation of the left iliopsoas muscle complex.4.Intracranially, scattered foci of white matter signal abnormality are seen, predominantly in the subcortical white matter and with some preference for the frontal lobes. These lesions appear to be chronic as they do not enhance and exert no mass effect. The differential would include sequelae of demyelinating or infectious processes including the direct action of HIV on the CNS. Vasculitis or a small vessel vascular process can also be considered.


Instruction: Generate impression based on findings.

Input: Male, 70 years old. Shoulder pain Several sequences are limited by patient motion artifact.ROTATOR CUFF: There is a small linear focus of increased signal intensity within the insertional fibers of the rotator cuff at the junction of the supraspinatus and infraspinatus tendons, indicating a concealed insertional tear. The tear involves approximately 50% of the tendon thickness and measures just under 1 cm in AP diameter. Mild tendinosis is noted within the supraspinous and infraspinatus tendons more proximally. The supraspinatus and infraspinatus muscles appear normal. The teres minor tendon and muscle appear normal. There is perhaps mild tendinosis of the subscapularis which otherwise appears intact. There is a small lipoma within the subscapularis muscle, unchanged from the prior study. The subscapularis muscle otherwise appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is trace fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. Evaluation of the labrum is limited due to lack of intra-articular contrast and motion artifact, but deformity and increased signal within the superior labrum likely represents degenerative tearing appearing similar to that seen on the prior study. There is a small amount of fluid within the glenohumeral joint, but there is no large effusion.BICEPS TENDON: Given the limitations of a nonarthrogram study, the tendon of the long head of the biceps appears normal.

Output: Osteoarthritis of the left shoulder with a new concealed insertional tear of the supraspinatus and infraspinatus tendons as described above.


Instruction: Generate impression based on findings.

Input: 25-year-old male with knee pain for weeks MENISCI: The medial and lateral menisci are intact. Minimal increased signal within the posterior horn of the medial meniscus likely represents vascularity.ARTICULAR CARTILAGE AND BONE: The patellofemoral and tibiofemoral articular cartilage is intact. The bone marrow signal is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: No specific findings to account for the patient's knee pain. Intact menisci, cruciate and collateral ligaments.


Instruction: Generate impression based on findings.

Input: Reason: Patellar Tendonitis / Tear History: Pain, Weakness MENISCI: There is a small focus of increased signal intensity within the periphery of the posterior horn of the medial meniscus extending to the tibial articular surface compatible with a tear, although we cannot determine if this is acute or chronic on the basis of this single study. There is mild deformity of the periphery of the posterior horn of the medial meniscus which may likewise represent an old tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is increased signal intensity within the articular cartilage along the medial facet and median eminence of the patella with focal near full-thickness to full-thickness articular cartilage defects as well as surface delamination. There is also a high signal intensity cleft centrally within the femoral trochlea indicating a focal defect. The tibiofemoral articular cartilage appears intact. There are small tricompartmental osteophytes. The bone marrow signal intensity is otherwise normal.LIGAMENTS: The patient has undergone ACL reconstruction. The graft appears intact. The PCL appears intact. The MCL and LCL appear intact.EXTENSOR MECHANISM: There is thickening of the proximal patellar tendon, particularly laterally, with fluid signal intensity within its lateral fibers at its insertion on the patella indicating a partial thickness undersurface tear. The quadriceps tendon appears intact.ADDITIONAL

Output: 1. Proximal patellar tendinosis and partial-thickness tearing as described above.2. Intact anterior cruciate ligament reconstruction.3. Degeneration of the articular cartilage of the patellofemoral joint as described above.4. Medial meniscus tear as described above that may be chronic and perhaps healed.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is blunting of the inner free edge of the medial meniscus with some increased signal of the posterior horn thought to represent a small vertical tear. There is no evidence of an unstable meniscal fragment. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is mild diffuse thinning of the articular cartilage of the medial femoral condyle. There is a mild amount of degenerative marrow signal noted within the medial tibial plateau and femoral condyle. The articular cartilage of the lateral compartment is maintained. There is partial-thickness loss of the articular cartilage of the medial patellar facet with heterogeneous signal and a small focus of partial loss in the lateral patellar facet as well. There is diffuse thinning of the articular cartilage of the femoral trochlea.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Vertical tear of the posterior horn of the medial meniscus.2. Mild articular cartilage thinning of the medial condyle and femoral trochlea with areas of partial-thickness loss involving the patellar facets.


Instruction: Generate impression based on findings.

Input: 50 year-old female with abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Punctate hypodensity in the dome of the liver and hemangioma in the right lobe are unchanged. Nearly isodense lesion in the segment two of the liver is difficult to impression from the surrounding liver but is also unchanged. (Image number 20, series number 3 measuring 2.4 x 2.1 cm.MRI may be helpful to determine the exact etiology of this lesion.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific mild dilatation of the presumably jejunal segment in the mid abdomen of unknown etiology and significance.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Multiple uterine fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Benign-appearing liver lesions are unchanged.Nonspecific focally and minimally dilated jejunal segment. Clinical etiology is uncertain and of indeterminate significance.Multiple uterine fibroids.


Instruction: Generate impression based on findings.

Input: There is global volume loss with superimposed progressive diffuse increase of ventricular caliber which is out of proportion to the degree of sulcal prominence. Although the ventricles are stable to minimally larger compared to 4/10/2015, they have been significantly enlarging from 12/6/2014 exams. There is no evidence of transependymal CSF resorption. There are multiple scattered new punctate foci of restricted diffusion within the cerebral hemispheres representing acute/subacute small vessel ischemic strokes. There is unchanged T2 hyperintense signal in the globus pallidus bilaterally which is nonspecific. There are nonspecific periventricular and subcortical white matter T2 hyperintensities likely representing chronic microvascular ischemic changes. There are small scattered microhemorrhages in the cerebellum in the also in the cerebral hemispheres which were felt to be present on the prior degraded exam. There is no extra-axial fluid collection with resolution of remote bilateral hemispheric subdural collections as noted on recent CTs. There is no mass effect or midline shift.

Output: 1.Progressive diffuse ventriculomegaly out of proportion to sulcal prominence, consistent with worsening, favored to represent hydrocephalus/NPH in the appropriate clinical setting. Also underlying progressive volume loss which may related to Alzheimer's.2.Scattered bilateral acute punctate nonhemorrhagic infarcts upon background of probable chronic small vessel ischemic changes.3.Stable nonspecific T2 hyperintensity associated with the globus pallidi, which could relate to a metabolic etiology. No other deep grey abnormal signal or diffusion restriction to suggest findings specific to CJD.


Instruction: Generate impression based on findings.

Input: Severe pain with eye movement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are minimal secretions within the ethmoid sinuses.

Output: 1. No evidence of intracranial demyelinating lesions. 2. No gross evidence orbital lesions, although the study is otherwise not optimized for the evaluation of the orbits.


Instruction: Generate impression based on findings.

Input: Neck pain, right arm numbness/tingling. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from straightening of the cervical curvature. Bone marrow signal is benign. There is abnormal T2 hyperintensity involving the left aspect of the cervical cord at the C3-C4 level with suggestion of volume loss likely representing myelomalacia.There is developmental narrowing of the cervical spinal canal with superimposed degenerative changes as described below:C2-3: Small right paracentral disc protrusion which mildly indents the right ventral aspect of the cord. There is overall mild to moderate spinal canal stenosis at this level. Neural foramina are patent. C3-4: Left paracentral and foraminal disc osteophyte complex with moderate degree of spinal canal stenosis, particularly involving the left aspect of the spinal canal. There is also moderate left and mild right neural foraminal stenosis.C4-5: Small disc osteophyte complex with mild to moderate spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.C5-6: Disc osteophyte complex with moderate spinal canal stenosis. There is mild bilateral neural foraminal stenosis.C6-7: There is a right paracentral disc osteophyte complex with moderate spinal canal stenosis, particularly involving the right aspect of the spinal canal where there is also partial flattening of the cervical cord. There is mild to moderate proximal right neural foraminal stenosis. Left neural foramen is patent.C7-T1: Small disc osteophyte complex without significant spinal canal stenosis. There is mild to moderate right neural foraminal stenosis. Mild narrowing of the left neural foramen.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine with moderate spinal canal stenosis at the C3-C4, C5-C6, and C6-C7 levels and to a milder degree at the C4-C5 and C2-C3 levels.2. There is small focus of T2 signal abnormality involving the left aspect of the cervical cord at the C3-C4 level with volume loss consistent with myelomalacia.3. Multilevel neural foraminal stenoses as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Ischemic stroke workup. Left lower extremity weakness with acute on chronic worsening of RUE and RLE weakness. Signs and symptoms: As above. Nonenhanced brain MRI:Diffusion weighted images demonstrate an acute nonhemorrhagic ischemic stroke in the distribution of the left lenticulostriate artery measuring approximately up to 5.5 x 13.5-mm.Additionally flair and T2-weighted images demonstrate moderate chronic small vessel ischemic strokes of bilateral subcortical and periventricular white matter as well as left bilateral basal ganglia, the thalamus and extensively of the pons. No evidence cerebral cortical chronic ischemic stroke is detected. Punctate foci of T2 hyperintensity in the right cerebellum is suspicious for a tiny chronic cerebellar stroke. Slight prominence of cortical sulci for age.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Acute nonhemorrhagic ischemic stroke in the distribution of left lenticulostriate artery measuring at 5.5 x 13.5-mm.2.Moderate chronic minimally small vessel ischemic strokes as detailed.


Instruction: Generate impression based on findings.

Input: There is slightly decreased diffusion within the bilateral occipital cortical regions that is likely artifactual. There is otherwise no evidence of acute ischemia. There is minimal susceptibility effect along the left tentorial leaflet compatible with subdural blood products, likely birth related. 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 midline structures and craniocervical junction are within normal limits. There is 1 cm thick caput succedaneum overlying the parietal and occipital bones that contains some blood products.

Output: 1.Slightly decreased diffusion within the bilateral occipital cortical regions is likely artifactual. Otherwise, no evidence of acute ischemia. A follow-up MRI is suggested.2.Caput succedaneum.


Instruction: Generate impression based on findings.

Input: Known multiple sclerosis with recent numbness of right arm and leg: decreased vibration and joint sense on the right. There are multiple T2 hyperintense cerebral white matter lesions. There appears to be a new subcentimeter lesion in the left inferior frontal gyrus deep white matter since 2011. However, a left temporal stem lesion appears to be smaller. The other lesions appears to be unchanged. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There are several scalp nodules, which have increased in size since 2011 and likely represent inclusion or pilar cysts. The largest of these is in the right frontal scalp, which measures up to 20 mm.

Output: Stigmata of multiple sclerosis with a newly apparent subcentimeter lesion in the left inferior frontal gyrus deep white matter since 2011. However, a left temporal stem lesion appears to be smaller. The other lesions appears to be unchanged.


Instruction: Generate impression based on findings.

Input: Ao aneurysm Left VentricleThe left ventricle is normal. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 71 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9), the LVESV is 41 ml (normal range 47+/-19). 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 mildly enlarged. Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 145 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve opens widely and there is at least mild aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.SOV commissure to sinus 36 -37 mmSOV sinus to sinus 41-41 mmMid asc Ao 38 x 42 mmMid arch Ao 34 x 33 mm2014Mid desc thoracic Ao 25 x 24 mmPulmonary 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 Findings . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV and RV systolic function2. Mild Ao dilation with mild AR - no significant change from 2014


Instruction: Generate impression based on findings.

Input: Reason: evaluation soft tissue and muscle inflammation around R hip and upper thigh. History: pain, swelling, inflammation There are foci of signal void within the soft tissues of the right hip likely reflecting metallic susceptibility artifact from prior surgery. There is mild deformity of the anterior femoral head/neck junction likely reflecting prior osteoplasty. There is a small amount of edema and enhancement within the lateral aspect of the femoral head which is nonspecific but not clearly evident on the prior study. There is a small amount of fluid within the right hip joint, but we see no frank synovitis. Please note that this study was not protocoled for detailed evaluation of the acetabular labrum. There is enhancement of the soft tissues along the lateral margin of the greater trochanter as well as within the soft tissues anterior and superior to the femoral neck as well as a small amount of enhancement within the direct head of the rectus femoris, at its origin There are also linear foci of enhancement within the tensor fascia lata muscle that we presume reflect postoperative scarring. There is moderate atrophy of the right gluteus minimus muscle. Portions of the gluteus minimus tendon are indistinct at the insertion on the anterior facet of the greater trochanter indicating at least partial thickness tearing. The remaining musculature of the right hip is unremarkable. The remaining musculature of the pelvis is unremarkable. There is avascular necrosis of the left femoral head without evidence of subchondral fracture or collapse. There is minimal peritrochanteric enhancement on the left, which is not necessarily of any clinical significance. There is a small amount of fluid within the left hip joint with no evidence of a synovitis. The sacroiliac joints are within normal limits. Mild degenerative disc disease affects the imaged lower lumbar spine.

Output: Surgical changes involving the right hip, as described above, with enhancement of the adjacent soft tissues likely reflecting a combination of scarring and mild inflammation. There is also atrophy of the right gluteus minimus muscle and at least partial-thickness tearing of the gluteus minimus tendon at its insertion on the anterior facet of the greater trochanter. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is poorly defined intermediate signal in the body of the lateral meniscus suggesting degeneration and perhaps undersurface fraying, but we see no discrete tear. There is no discrete tear in the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is moderate to severe degeneration of the articular cartilage of the lateral facet of the patella with underlying subchondral cysts. There is also focal degeneration and perhaps delamination of the articular cartilage of the medial facet of the patella. There is a focal defect of the articular cartilage of the medial facet of the femoral trochlea inferiorly with underlying subchondral cyst formation. There is mild degeneration of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus with underlying degenerative signal abnormality. Mild heterogeneity of the articular cartilage of the lateral femoral condyle posteriorly suggests mild degeneration. There is moderate degeneration of the articular cartilage of the medial femoral condyle posteriorly with underlying subchondral cysts and signal abnormality. There are small osteophytes about the knee.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Tricompartmental cartilage degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: patient has a cutaneous neurofibroma just above the right inguinal area. It is unusually painful. Is there any evidence of deep extension or deep tumor? History: boy with NF1 and painful right inguinal area Thickening and diffuse signal abnormality is noted in the left gluteus musculature extending into the deep soft tissues and extending to the left perirectal soft tissues and displacing the rectum to the right, as best visualized on image 30 of series 3, appearing slightly more extensive as compared to prior exam. Additional more focal area of signal abnormality in the right superior anterior thigh region measuring 2.4 x 0.6 cm on image 27 of series 3 compatible with neurofibroma and is increased in size. Additional neurofibroma noted along the deep fascial planes of the left thigh seen on image 30 of series 3 is unchanged. Scattered diffuse cutaneous neurofibromas are noted in bilateral lateral and posterior aspects of the pelvis and are increased in number and size.

Output: 1.Diffuse signal abnormality in the left gluteus musculature extending into the the perirectal soft tissues and mildly displacing the rectum, increased in size as compared to prior exam.2.Numerous scattered cutaneous neurofibromas, increased in size and number, as above.


Instruction: Generate impression based on findings.

Input: History of cervical schwannoma. Annual follow-up. The examination is significantly limited by patient motion.The contrast-enhancing soft tissue mass expanding the left C2-C3 neural foramen has not significantly changed since the prior examinations, measuring transaxially 15 mm x 10 mm. Postoperative findings involving the left C2 lamina and the overlying soft tissues remain unchanged. The mild deformity including rotation of the upper cervical spinal cord at the C1-C2 level which is unchanged, and may be related to the adhesion. The cervical spinal cord shows normal signal. Multilevel degenerative changes, most pronounced at C4-C5, C5-C6 and C6-C7 related to small disc osteophyte complexes and uncovertebral hypertrophy remain unchanged since the prior examination, resulting mild spinal canal stenosis. Mild right C3-C4, left more than right C4-C5, moderate left and mild right C5-C6, and moderate left C6-C7 neural foraminal stenoses are present.

Output: 1.The contrast-enhancing, expansile soft tissue in the left C2-C3 neural foramen, compatible with the known schwannoma, remains unchanged compared to prior examinations from June 2015 and June 2014.2.Mild cord deformity and rotation at C1-C2 level is unchanged and may relate to adhesions.3.Multilevel degenerative disease resulting in variable mild-to-moderate spinal canal and neural foraminal stenoses, also remains not significantly changed.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Other than scattered sporadic foci of mucosal thickening, the paranasal sinuses and mastoid air cells are clear. Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis.

Output: 1.Negative MRI of the brain including gadolinium enhancement.2.Negative MRA of the brain.3.Specifically, there are no MRI/MRA findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Unspecified congenital anomaly of circulatory system [747.9] / Swelling, mass, or lump in head and neck [784.2], Reason for Study: ^Reason: eval for vascular malformation History: mass along submandibular There is a lobulated large mass measured about 31.4 mm x 49.7 mm x 31.8 mm on the left sublingual space.The lesion shows intermediate signal intensity on T1 and high signal intensity on T2 with restricted diffusion.There is no evidence of contrast enhancement on post Gad T1 weighted image.The mass is mainly located on the left side floor of mouth and appears to be extended toward submandibular space. There is no evidence of sizable neck lymphadenopathy.Above described finding suggest possibility of plunging ranula with complicated or high protein content. Differential diagnosis include minor salivary gland epidermoid, tumorous condition or inflammatory condition.Covered brain and orbit appear to be normal.The paranasal sinuses and mastoid air cells are clear.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. Prominent bilateral supraophthalmic veins without other imaging evidence of cavernous sinus congestion, thus this indicate normal range of prominency.

Output: 1. Left mouth floor cystic mass extending toward left submandibular space indicating plunging ranula. Differential diagnosis include epidermoid, tumorous condition or inflammatory condition.2. Normal neck MR angiography.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [R40.4], Reason for Study: ^Reason: evaluate L temporal lobe, ? Encephalitis History: focal exam, L temporal slowing Motion artifact significantly degraded image quality, so the interpretation is very limited.There is no evidence of abnormal enhancement seen on the scan.Mild to moderate brain atrophy is again seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, or abnormal contrast enhancement.

Output: Poor quality exam due to motion artifacts.No evidence of abnormal enhancement.Comment: repeat examination is recommended.


Instruction: Generate impression based on findings.

Input: 66-year-old man with history of PSA of 7.2 in June 2016, subsequent prostate biopsies with Gleason 7 and Gleason 6 adenocarcinoma in the right lobe. PELVIS:PROSTATE:Prostate Size: 43 x 25 mm.Peripheral Zone: There is an 8 x 5 mm area of T2 hypointensity in the right lateral mid gland (301/82) with corresponding diffusion restriction (408/304). The remainder of the peripheral zone appears normal.Central Gland: Central gland appears normal.Seminal Vesicles: Seminal vesicles are normal.Extracapsular Extension: The right lateral mid gland focus abuts the prostate capsule which appears irregular at this site.BLADDER: No significant abnormality noted.LYMPH NODES: No significantly enlarged lymph nodes are identified.BONES, SOFT TISSUES: Normal marrow signal in the pelvis.OTHER: No significant abnormality noted.

Output: 1.Focus of signal abnormality in the right lateral mid gland suspicious for adenocarcinoma. Irregularity of the adjacent capsule, minimal extracapsular extension not excluded.


Instruction: Generate impression based on findings.

Input: Female 29 years old with a history of 3 prior cesarean sections. Placental lakes seen on ultrasound. Evaluate placentation. PELVIS:UTERUS, ADNEXA: Gravid uterus. The myometrium is thinned along the right lower anterior uterine body compatible with scarring from prior cesarean section. There is disruption of the normal hypoechoic myometrium stripe by intermediate signal intensity placental soft tissue in this region. The placenta is heterogeneous with areas of bandlike low T2 signal intensity and foci of T1 hyperintensity.BLADDER: The urinary bladder is decompressed.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No hydronephrosis.

Output: 1.Focal area of myometrial thinning and abnormal signal intensity along the right anterior lower uterine body is suspicious for placenta accreta. More deeper invasion is not excluded as the myometrium is thinned in this area.2.Please note that this exam was not tailored to provide detailed evaluation of fetal anatomy.


Instruction: Generate impression based on findings.

Input: 28-year-old man with history of cystic fibrosis status post lung transplant, now with elevated LFTs and alkaline phosphatase. Please note that this examination is limited by patient motion and noncontrast technique.ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. There is no intra or extrahepatic biliary duct dilatation. There are small layering stones in the gallbladder, but no evidence of cholecystitis.SPLEEN: There is an 8 mm splenic cyst (series 6, image 30). The spleen is at the upper limits of normal size.PANCREAS: The pancreas is atrophic. A subcentimeter cystic focus near the ampulla is thought to represent a pancreatic duct remnant or very small IPMN.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There are subcentimeter renal cyst, otherwise the kidneys appear normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Surgical clip is noted near the greater curvature of the stomach. The pulmonary veins are prominent, probably related to prior lung transplant.

Output: 1.Cholelithiasis without cholecystitis. 2.No intra or extrahepatic biliary duct dilatation.3.Atrophic pancreas compatible with history of cystic fibrosis.


Instruction: Generate impression based on findings.

Input: Note only sagittal T1 and T2-weighted sequences of the cervical spine were obtained, which are also motion degraded. Thoracic and lumbar spine images were not obtained.Motion degraded images of the cervical spine demonstrate straightening of the cervical spine curvature. Vertebral body heights and alignment are otherwise maintained. There is developmental narrowing of the cervical spinal canal. There are degenerative changes with disc osteophyte complex at the C3-C4 level with up to moderate degree of spinal canal stenosis suspected at this level on a degenerative basis. No large destructive osseous lesion the cervical spine is evident.

Output: Patient was claustrophobic and could not tolerate the study despite medications. Examination is limited to sagittal sequences of cervical spine, which are significantly motion degraded. No pathologic fracture in the cervical spine or large destructive osseous lesion is evident. There are degenerative changes with suspected up to moderate spinal canal stenosis at the C3-C4 level related to disc osteophyte complex. Examination under anesthesia can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: History of pilocytic astrocytoma for surveillance. There are postoperative findings related to right transfrontal biopsy. There is no significant interval change in size of the non-enhancing T2 hyperintense exophytic right parahippocampal gyrus mass. There is no evidence of acute cerebral infarction or hemorrhage. The ventricles and basal cisterns are unchanged in in size and configuration. There is no midline shift or herniation.

Output: No significant interval change in size of the right medial temporal lobe glial tumor.


Instruction: Generate impression based on findings.

Input: Proximal muscle weakness, polymyositis Left thigh: There are varying degrees of abnormal increased signal and enhancement involving nearly all of the musculature of the thigh with the short head of the biceps femoris appearing relatively spared. These changes are more evident within the proximal musculature compared to distally. There is no fatty atrophy of the musculature. The bone marrow signal of the femur is normal.Right thigh: There are varying degrees of abnormal increased signal and enhancement involving nearly all of the musculature of the thigh with the short head of the biceps femoris appearing relatively spared. These changes are more evident within the proximal musculature compared to distally. There is no fatty atrophy of the musculature. The bone marrow signal of the femur is normal.

Output: Bilateral and symmetric inflammation of the thigh muscles indicating polymyositis.


Instruction: Generate impression based on findings.

Input: Precocious puberty and headaches, abnormal pituitary on MRI, back pain, gait changes: 6month follow up. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Pituitary: The pituitary gland is not enlarged and enhances appropriately. The posterior pituitary bright spot and infundibulum are intact. The cavernous sinuses and optic apparatus are unremarkable. There is no evidence of sella or parasellar mass lesions.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is situated at the L1-2 level. The cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or hydrocephalus. 2. No evidence of pituitary lesions3. No evidence of spine lesions.


Instruction: Generate impression based on findings.

Input: SLE and seizure-like events. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific periventricular white matter T2 hyperintensity. The brain parenchyma, including the hippocampi otherwise appears unremarkable. There is no evidence of hamartomas, heterotopia, or 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: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: The patient was not able to tolerate the full exam and for this reason sagittal and oblique images were not obtained. In addition, multiple sequences are limited due to motion artifact. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The paravertebral soft tissues are unremarkable. There is multilevel degenerative spondylosis, which is most pronounced at C5-6, where there is mild spinal stenosis and endplate degenerative bone marrow signal alterations. The evaluation of the neural foramina is otherwise limited.

Output: 1.Normal signal throughout the cervical cord with no evidence of cervical spinal cord lesions.2.Multilevel degenerative changes with mild spinal canal stenosis at C5-6. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Low back pain Mild osteoarthritis affects the sacroiliac joints. A small focus of increased signal intensity is seen within the left ilium. Following contrast administration, there is a mild amount of increased enhancement of the left SI joint but the pattern is not suggestive of sacroiliitis and is most likely degenerative in nature. There is otherwise no abnormal enhancement of the visualized SI joints.

Output: Mild osteoarthritis of the sacroiliac joints without evidence of sacroiliitis.


Instruction: Generate impression based on findings.

Input: Low back pain with radiation into the legs. History of epidural injections. There has been prior posterior fixation between L4 and L5 using screws and posterior rods, as well as interbody fusion. There is minimal anterior subluxation at L4-L5 as well as C2-C3. There is straightening of the cervical vertebrae, but no spondylolisthesis. The vertebral bodies heights are preserved. The spinal cord is not compressed and shows no definite signal abnormality. The tip of the conus medullaris lies at the upper L1 level. At the L2-3 and L3-L4 levels, there are disc bulges, facet hypertrophy, and ligamenta flava thickening, which appear to indent the cauda equina nerve roots. There is also neural foraminal stenosis bilaterally at the L2 through L5 neural foramina, perhaps most pronounced at the left L3-4 level. Multilevel cervical and thoracic disc-osteophyte complexes result in slight ventral indentation of the thecal sac, but no spinal cord compression. There is atrophy of the lower paraspinal muscles. There is an incompletely imaged, well-circumscribed, homogeneously T1-hypointense and T2-hyperintense left paraspinal mass at the T4 and T5 levels, which measures up to 3.8 cm craniocaudally. This is associated with remodeling of the vertebral bodies, but does not impinge on the spinal canal or neural foramina. A large, presumably cystic mass in the abdomen measures up to 15 cm craniocaudally. A smaller, perhaps also cystic lesion is present in the left side of the pelvis, measuring up to 4.1 cm.

Output: 1.Prior fusion at L4-L5 and degenerative disease at L2-3 and L3-L4, resulting in spinal canal and bilateral neural foraminal stenosis. 2.Multilevel degenerative spondylosis in the cervical and thoracic spine is not associated with spinal cord compression.3.A left upper thoracic paraspinal lesion may represent a developmental cyst or neoplasm. However, assessment is limited by the lack of intravenous contrast. 4.Large presumably cystic abdominal mass and presumably cystic pelvic lesions may represent renal and adnexal cysts or neoplasms, respectively. However, assessment is limited by the lack of intravenous contrast. These can be further assessed by renal and pelvic ultrasound or abdominopelvic CT, if clinically indicated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain and spinal cord [198.3], Reason for Study: ^Reason: hx of metastatic SCLC to brain s/p WBRT, eval L frontal lesion History: none Previously seen right middle frontal gyrus enhancing nodule with surrounding edema appears to be significantly reduced in size and the degree of enhancement as well as the extent of surrounding edema comparing to prior scan.There is no other enhancing lesion seen on this scan.There is no evidence of acute ischemic or hemorrhagic lesion on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable. 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. Interval significant reduction of the size of right middle frontal gyrus enhancing nodule as well as the extent of surrounding edema since prior scan.2. No evidence of new ischemic or hemorrhagic lesion.3. No evidence of new enhancing lesion.


Instruction: Generate impression based on findings.

Input: 22-year-old male. Pain and swelling status post hyperextension injury for 2 to 3 months. MENISCI: The medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Mild edema type signal within the anterior aspect of the medial femoral condyle and the anterior aspect of the lateral tibial plateau, perhaps representing bone contusions sustained at the time of injury. The articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. The ligament of Wrisberg appears abnormally thickened with increased signal intensity, which may reflect prior injury.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Bone contusions, as described above. We see no chondral injury.2. Thickening and increased signal intensity of the ligament of Wrisberg may indicate prior injury but the remaining ligamentous structures appear intact.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer. Need adequate staging. Signs and symptoms: None Enhanced head CT: 100 cc of Omnipaque 350 is administered for this exam.Examination demonstrates a small extra-axial enhancing mass along the inner table of the skull in the left frontal region measuring 10 mm in length and 5.4-mm in thickness. This finding is best appreciated on axial image 20 of series 4 and coronal reformatted image 61 on series 80328. There is no associated mass effect on the parenchyma by this lesion and there is no detectable edema of brain parenchyma. There is also no evidence of any associated bony changes with this finding. This finding is believed to represent a meningioma. Recommend follow-up with an MRI exam to entirely exclude a very remote possibility of metastatic lesion.There is no detectable parenchymal enhancement or enhancement of the leptomeninges to suggest metastatic disease. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact. Limited view of paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. Limited images through the orbits are unremarkable.

Output: 1.Small extra-axial dural based enhancing mass measuring 10 times 5.4-mm in height suspect for a small meningioma. To entirely exclude the remote possibility of metastatic disease recommend a follow with an enhanced MRI examination.2.Negative enhanced CT of brain and calvarium otherwise.


Instruction: Generate impression based on findings.

Input: History of soft tissue sarcoma of the left thigh, rule-out recurrence. Again seen is a surgical scar through the posterior subcutaneous fat of the thigh. An elongated collection of fluid signal intensity in the posterior aspect of the thigh is slightly smaller on the current study than on the prior study now measuring approximately 1.5 cm in diameter with thin peripheral enhancement, likely representing a seroma. Additional post-operative changes appear similar to the prior study. There is edema and mild enhancement of the adductor muscle which is slightly less pronounced on the current study than on the prior study. We see no findings to suggest tumor recurrence. We see no lesions in the bone marrow. Metal susceptibility artifact of a right hip arthroplasty device.

Output: Post-operative changes as described above. We see no evidence of recurrence.


Instruction: Generate impression based on findings.

Input: 72-year-old man with possible pancreatic tail lesion on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extra hepatic ductal dilatation.SPLEEN: The spleen is normal.PANCREAS: There is a subcentimeter focus of T2 hyperintensity which appears to communicate with the main pancreatic duct in the pancreatic body (series 12, image 16). The pancreas is otherwise normal without focal lesion identified. Specifically, there is no lesion in the pancreatic tail.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Multiple renal cysts are noted bilaterally, otherwise the kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No focal lesion in the pancreatic tail. Subcentimeter sidebranch IPMN in the pancreatic body.


Instruction: Generate impression based on findings.

Input: Left knee locking MENISCI: There is globular signal abnormality within the posterior horn of the medial meniscus suggesting intrasubstance degeneration although there is no discrete signal abnormality extending to either articular surface to suggest focal tear. The lateral meniscus also appears intact.ARTICULAR CARTILAGE AND BONE: There is heterogeneity and thinning of the articular cartilage of the medial compartment, particularly of the femoral condyle anteriorly. There is no discrete full-thickness defect. Similar changes are noted in the lateral compartment although to a lesser degree. There is severe articular cartilage loss of the patellofemoral compartment particularly of the lateral patellar facet. There is associated underlying degenerative marrow signal abnormality and these changes have progressed from the prior exam.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Mild intrasubstance degeneration of the posterior horn of the medial meniscus with no evidence of discrete medial or lateral meniscal tear.2.Worsening articular cartilage loss of the patellofemoral compartment.3.Small foci of low T1/T2 signal are identified in the posterior joint space which may represent small calcified bodies however these are similar in size and location to the prior exam and may be fixed in nature.


Instruction: Generate impression based on findings.

Input: 62-year-old male. History of prostate cancer on active surveillance. Evaluate for disease. PELVIS:PROSTATE:Prostate Size: 3.7 x 4.8 x 5.1 cm.Peripheral Zone: 2 mm T2 hypointense focus in the left medial mid-prostate, indeterminate (series 801, image 13).Central Gland: Benign hyperplastic nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 2 mm T2 hypointense focus in the left medial mid-prostate, indeterminate. No evidence of local metastatic disease.


Instruction: Generate impression based on findings.

Input: New right arm shooting burning constant pain. Brain: There are multiple supratentorial and infratentorial high T2 signal lesions within affected the white matter, which have not significantly changed in size. There is no evidence of enhancement associated with these lesions. There is an unchanged small right occipital developmental venous anomaly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Cervical Spine: There are multiple faint patchy areas of high T2 signal within the imaged portions of the spinal cord, which have not appreciably changed. There is no evidence of associated enhancement. There is unchanged multilevel degenerative spondylosis with associated neural foramen narrowing as previously described, but no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No significant change in the intracranial demyelinating lesions.2. No significant change in the demyelinating lesions involving the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: 56-year-old male with syncope evaluate for hemorrhage. High attenuation, well-defined lesion within the left thalamus measuring approximately 8 mm x 8 mm without surrounding edema is suspicious for hemorrhage however cavernoma may have a similar appearance. MRI is recommended for further characterization.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and right mastoid air cells are normally pneumatized with left mastoid air cell opacification.

Output: Left thalamic high attenuation lesion is suspicious for hemorrhage, however, cavernoma may have a similar appearance and MRI is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is abnormal increased linear signal intensity within the body of the lateral meniscus indicating tearing which extends from the tibial articular surface through the peripheral fibers. There is a small associated parameniscal cyst and lateral extrusion of the body of the meniscus. The tear also propagates into the anterior horn where it appears to contact the femoral articular surface. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage of the lateral tibial plateau along the intercondylar eminence. There is also superficial degeneration of the articular cartilage of the adjacent lateral femoral condyle. The articular cartilage of the medial compartment is intact. There is mild heterogeneous signal of the articular cartilage of the medial patellar facet which may reflect mild focal degeneration. The articular cartilage of the lateral patellar facet and femoral trochlear is intact. Residual red marrow is noted within the distal femur, proximal tibia, and proximal fibula. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Lateral meniscal tear as detailed above. The medial meniscus is intact.2. Cartilage loss of the lateral compartment with additional findings described above.


Instruction: Generate impression based on findings.

Input: Right arm and leg weakness. Evaluate for acute infarct. There are multiple foci of restricted diffusion within the left frontal lobe, left frontoparietal corona radiata and centrum semiovale and left parieto-occipital lobe with associated T2 signal abnormality. There is loss of normal flow void of the cervical, petrous and cavernous left internal carotid artery. There is no evidence of intracranial hemorrhage or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is moderate mucosal thickening of the right sphenoid sinus. There is partial opacification of the left mastoid air cells. The skull and extracranial soft tissues are unremarkable.

Output: 1. Multiple foci of restricted diffusion consistent with acute infarcts within the left cerebral hemisphere in a watershed distribution.2. Loss of normal flow void of the cervical, petrous and cavernous left internal carotid artery, likely representing high-grade stenosis or occlusion. Recommend further evaluation with CTA or MRA.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 37-year-old female with abdominal pain and history of Crohn's disease status post bowel resection. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. High T1 signal sludge within the gallbladder 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: Postsurgical changes from ileocecectomy with neoterminal ileum. No significant bowel wall thickening or enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Physiologic changes with small amount of endometrial fluid and small simple cysts in both ovaries.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Subcentimeter T2 hyperintense right perineal lesion (series 4/37), most likely a Bartholin's gland cyst.OTHER: Mild pelvic free fluid, likely physiologic.

Output: No MRI evidence of active inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Brain metastases s/p SRS and laser beam. There is no significant interval change of a partially enhancing lesion in the right superior frontal gyrus that measures up to 16 mm, which was previously treated via laser ablation. There is also no significant interval change in the enhancing nodules within the right occipital lobe at the grey-white matter junction, which measures up to 5 mm. There is interval decrease in size of the left occipital lobe lesion, which measures up to 7 mm, previously 9 mm. There is an unchanged punctate right precentral gyrus lesion. There is no midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unchanged.

Output: The treated cerebral metastases are stable to slightly smaller overall.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for lumbar spine pain. Signs and symptoms: Back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.T11-T12 is unremarkable.T12/L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild disc desiccation and mild ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate moderate degenerative disc disease and loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. No evidence of spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc disease, mild bilateral facet disease and ligamentum flavum hypertrophy. There is a shallow broad-based left lateral and far lateral disc protrusion with resultant left lateral recess compromise however without spinal stenosis or neural foraminal compromise.L5-S1 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. There is a linear focus of T2/T2 STIR hyperintensity within the annulus of the disc in the midline and to the right suggestive of an annular fissure. No spinal stenosis or neural foraminal compromise.

Output: 1.At L4-L5 there is evidence of mild degenerative changes, a shallow broad-based left lateral and far lateral disc protrusion with resultant left lateral recess compromise.2.At L5-S1 there is moderate disc disease and a central and rightward annular fissure as detailed.3.There is no evidence of spinal stenosis or neural foraminal compromise at any level.4.Mild degenerative changes of lumbar spine as detailed per level above.


Instruction: Generate impression based on findings.

Input: Male 41 years old Reason: 41 y/o man w/ narrowing of the portal vein who p/w abdominal pain and elevated Bilirubin History: CBD dilation on US. ABDOMEN:LIVER, BILIARY TRACT: There is progressive intrahepatic and extrahepatic biliary duct dilatation as well as gallbladder distention. The common duct measures 1.1 cm in maximum transverse dimension and demonstrates diffuse wall thickening and enhancement. There is a focal segment of nonvisualization of the duct at the level of the pancreatic head and this is presumably secondary to the below described pancreatic head/neck abnormality.Patent hepatic vasculature. There is progressive portal vein narrowing with almost complete occlusion at the confluence. Gastrohepatic and perihepatic varices are noted.SPLEEN: No significant abnormality noted.PANCREAS: There is progressive pancreatic duct dilatation in the pancreatic body and tail. There is a tiny filling defect within the pancreatic duct which may represent a small calculus. There is abrupt termination of the pancreatic duct in the region of the pancreatic head/neck where there is masslike enlargement of the pancreatic head and neck. This demonstrates diffuse T2 hypointense signal suggestive of fibrosis and there are infiltrative changes within the peripancreatic fat. Cystogastrostomy tube in situ. There is no fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left upper pole renal cyst.RETROPERITONEUM, LYMPH NODES: There are multiple enlarged peripancreatic and portacaval lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Masslike enlargement of the pancreatic head and neck as described above. The differential considerations include focal autoimmune pancreatitis or evolution of pancreatitis with fibrotic changes in the pancreatic head and neck. Pancreatic neoplasm is not excluded however is felt much less likely.2.There is progressive intra and extra hepatic biliary duct and pancreatic duct dilatation secondary to the aforementioned infiltrative pancreatic abnormality.3.Marked attenuation of the portal vein with almost complete occlusion of the confluence.


Instruction: Generate impression based on findings.

Input: Female, 46 years old. Reason: secondary hyperparathyroidism, please evaluate for thyroid nodules and abnormal parathyroids Study is limited by body habitus.RIGHT LOBE MEASUREMENTS: 4.3 x 1.8 x 2.4 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.9 x 1.4 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture. A nodule at the posterior aspect of the mid right thyroid measures approximately 0.5 x 0.3 x 0.9 cm, hypoechoic, noncalcified, nonvascular.LEFT LOBE: Heterogeneous echotexture. A left lower pole nodule measures 0.7 x 0.5 x 0 .6 cm, heterogeneous and hypoechoic, noncalcified, nonvascular.ISTHMUS: Heterogeneous echotexture, without focal lesion..PARATHYROID GLANDS: A a, hypoechoic structure posterior to the inferior pole of the right thyroid measures 1.0 x 0.6 x 1 .2 cm, nonvascular, and may represent a parathyroid gland. However, this is not adequately visualized for further evaluation.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A right level 3 lymph node measures 1.5 x 0.6 x 1.2 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: 1. Bilateral subcentimeter thyroid nodules as detailed above, with benign-appearing cervical lymph nodes. 2. A hypoechoic structure posterior to the inferior pole of the right thyroid may represent a parathyroid gland, although evaluation is limitedI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 22 years old Reason: knee pain and instability There is a 1.5 cm faint nodular opacity in the subcutaneous fat medial to the proximal tibia. The knee otherwise appears normal. Sclerotic focus in the distal left femur likely represents a bone island.

Output: Nonspecific nodular mass in the medial soft tissues of the knee better seen on recent MRI. Contrast enhanced MR of the knee, and/or referral to orthopedic oncology should be considered.


Instruction: Generate impression based on findings.

Input: Reason: right knee pain History: pain Normal appearing right knee without findings to account for the patient's pain.

Output: Normal appearing right knee without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Baseline assessment of CCM lesions. There are numerous, perhaps greater than 50, supratentorial and infratentorial lesions with susceptibility effect. The largest of these measures up to 13 mm in the left parietal lobe. There is no evidence of associated developmental venous anomalies or vasogenic edema. There is also no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is right paranasal sinus mucosal thickening.

Output: Numerous supratentorial and infratentorial cavernous malformations.


Instruction: Generate impression based on findings.

Input: 61 years, Female, Reason: elevated lipase, non specific abdominal symptoms History: pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse loss of signal in phase images suggests hepatic steatosis. No focal hepatic lesions. Cholecystectomy clips. Common bile duct is normal without stones.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum. No peripancreatic fat stranding or abnormal signal to suggest pancreatitis. No suspicious pancreatic lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst.RETROPERITONEUM, LYMPH NODES: Enlarged periportal node measuring 1.4 x 1.0 cm (6/22).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of pancreatitis or other findings to explain abnormal lipase. 2.Hepatic steatosis with enlarged periportal lymph nodes.3.Pancreatic divisum.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate meniscus. MENISCI: There is a complete vertical tear through the red/white zone of the medial aspect of the posterior horn of the medial meniscus that contains fluid signal intensity. This tear appears similar to that seen on the MRI study from 2005. I suspect that this tear extends into the body of the medial meniscus, which has undergone further medial extrusion compared with the prior study. The morphology of the extruded meniscal body suggests the possibility of an adherent flap of displaced meniscal tissue, but this is equivocal. The posterior horn of the medial meniscus lateral to the aforementioned vertical tear is abnormally small which may reflect chronic attritional tearing. The anterior horn of the medial meniscus appears intact. There is perhaps mild surface fraying of the lateral meniscus, but I see no findings to suggest an unstable tear of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There has been progression of osteoarthritis of the knee were compared with the prior MRI study. There is diffuse degeneration of the articular cartilage of the medial compartment, most severe medially where there is near-full-thickness to full-thickness cartilage loss (see image 25 of series 5). Small subchondral cysts and degenerative edema-type signal are noted within the far medial aspect of the medial femoral condyle and medial tibial plateau. There is more focal degeneration of the articular cartilage of the weight-bearing surfaces of the lateral tibiofemoral compartment, with focal full-thickness degeneration along the lateral femoral condyle above the posterior horn of the lateral meniscus and near full-thickness degeneration of the articular cartilage of the lateral tibial plateau just lateral to the lateral tibial spine. There is moderate degeneration of the articular cartilage of the patella with small foci of degenerative marrow abnormality in the subchondral bone. Similar findings affect the femoral trochlea. There are tricompartment osteophytes. I see no fracture. LIGAMENTS: The anterior cruciate ligament appears normal. The posterior cruciate ligament appears normal; the findings seen on the previous examination suggestive of a partial thickness tear are no longer evident. The medial collateral ligament is slightly bowed by the aforementioned extruded medial meniscus, but otherwise intact. The lateral collateral ligament complex components are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: 2.3.Progression of osteoarthritis as described above.4.Complex tear of the posterior horn and body of the medial meniscus, with progression of medial extrusion of the body of the medial meniscus. Fluid signal intensity within the vertical component of the tear may indicate an unstable flap.5.Slight enlargement of lobulated fluid signal intensity structure within the posterolateral aspect of the knee as described that I suspect represents a ganglion or less likely a venous malformation.6.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no stenoses. There is no abnormal enhancement.

Output: Negative contrast enhanced cervical spine MRI. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: 74 yo M with metastatic SCC to brain s/p SRS to L cerebellum, eval for new lesions The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is redemonstration of 2 foci of susceptibility effect in the left cerebellar hemisphere laterally and one in the left cerebellar hemisphere medially which are only seen on the susceptibility weighted images. The one located on the lateral aspect has been identified as an enhancing nodule on the 8/12/2014 exam and could also be seen on the recent 3/21/2015 exam. On the current exam there is no associated contrast enhancement. It can be identified as far back as 10/22/2014 on susceptibility weighted images.A couple punctate foci of susceptibility weighted image signal loss in the periventricular white matter were also present on the prior exam. In isolation these are of uncertain significance.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 some mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Findings suggest hemorrhagic lesions in the left cerebellar hemisphere which have been identified on prior exams and are stable since the July 2015 exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Ex 24 weeker near drowning with cognitive disabilities. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: 36 year old with known right breast cancer, undergoing neoadjuvant chemotherapy. MR for evaluation of chemo effect. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A catheter port is present at left medial chest wall.An irregularly shaped enhancing mass mass, which is a proven carcinoma, at middle 3:00 position in the right breast measures 18 x 20 x 21 mm (AP x LR x CC, previously 55 x 35 x 25 mm). A marker clip is present at the medial aspect of this mass.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: Significant imaging response of right breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 82-year-old female status post fall and hit right forehead. There is no evidence of intracranial hemorrhage, mass or edema. Periventricular and deep white matter diffuse hypodensities consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Diffuse white matter hypodensities consistent with ischemic disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.