Instruction: Generate impression based on findings.

Input: There is mild worsening of cystic and solid mass in the suprasellar cistern extending into the prepontine, cerebellopontine angle cistern, right ambient and right quadrigeminal cisterns as well as the right middle cranial fossa.1.New nonenhancing cystic mass in the right suprasellar region extending along the anterior cranial fossa skull base and superiorly into the right inferior frontal lobe measuring 15 x 14 mm in oblique axial dimensions (series 501 image 15), and 16 mm CC (series 1201 image 5). 2.Mildly increased irregular nodular enhancement with concomitant increased cystic portion in the suprasellar cistern3.Slightly increased right ambient cistern cystic lesion measures 13 mm in short axis (series 601 image 15) compared to 10 mm previously. 4.Minimally increased left perimesencephalic cistern cystic mass measures 13 mm in short axis (series 601 image 17) compared to 12 mm previously. This lesion also shows mild new intrinsic T1 shortening suggesting interval bleeding or proteinaceous debris. There is slight increased craniocaudal dimension of the adjacent right ventral perimesencephalic cistern component now measuring 12 mm CC.There is persistent mass effect on the brainstem which is slightly worsened in the right ambient cistern and regional to the right inferior frontal lobe due to presence of new/worsening lesions as described above. There is persistent mass effect on the optic chiasm with superior elevation, and the right carotid terminus with superior elevation as noted before.The ventricles are not significantly changed in size and configuration. There is no acute infarct, midline shift or herniation. There are postoperative findings related to right temporal craniotomy with stable cavity in the right anterior temporal lobe, and a right transfrontal catheter terminating in the right prepontine cistern without significant change. Punctate nonspecific foci of T2 hyperintensity within the frontal lobes are unchanged and left occipital lobe. There is persistent left cerebellar volume loss.There is trace mucosal thickening in the right maxillary sinus with aerated secretions centrally. There right maxillary sinus appears somewhat diminutive in size.

Output: Mild interval worsening of the mass with new cystic component in the right anterior cranial fossa, as well as mild interval worsening of few cystic components as described above, with minimally increased mass effect at the right inferior frontal lobe and the right midbrain. The remainder of the mass is overall similar in size with similar mass effect. Please see details above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, history of melanoma with a left occipital lobe mass identified on prior imaging. An intrinsically T1 hyperintense, hemosiderin stained lesion is redemonstrated within the left occipital lobe showing no significant interval change from the prior examination. As before, this lesion measures up to 10 mm in diameter. There is no significant associated parenchymal edema.No new intracranial lesions are seen. Scattered small foci of white matter T2 hyperintensity are unchanged and nonspecific. No evidence of mass effect is seen. The ventricles are normal in size and morphology. Findings likely related to prior surgery are evident in the left calvarial scalp.

Output: 1.Stable appearing left occipital lobe lesion.2.No new intracranial lesions are seen.3.Please note that the patient experienced a mild contrast reaction following administration of gadolinium with details as above.


Instruction: Generate impression based on findings.

Input: Altered mental status, hallucinations. Visual tactile hallucinations. Significant metallic artifacts degraded nasopharynx, oropharynx and skull base area degraded image quality of these regions.There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI.Significant metallic artifacts of naso, oropharynx and skull base area.


Instruction: Generate impression based on findings.

Input: Dizziness, hearing loss, and numbness of face. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Internal auditory canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Nonspecific mild scattered cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease.3. Unremarkable internal auditory canals.


Instruction: Generate impression based on findings.

Input: Male, 67 years old. Left lower extremity pain. There is soft tissue edema about the forefoot, with skin irregularity overlying the distal aspect of the second proximal phalanx. No discrete fluid collection is identified.There is cortical thinning/irregularity of the head of the proximal phalanx of the second toe with associated marrow signal abnormality on both T1 and T2-weighted images, compatible with osteomyelitis. There is also marrow edema within the distal phalanx of the great toe, and the cortex is slightly indistinct, raising suspicion for osteomyelitis. The other visualized osseous structures have normal signal characteristics.

Output: Osteomyelitis of the proximal phalanx of the second toe and findings suspicious for additional focus of osteomyelitis of the distal phalanx of the great toe.


Instruction: Generate impression based on findings.

Input: Chiari decompression. Brain: There is artifact related to dental braces, which obscures portion of the anterior head on some sequences. There are postoperative findings related to Chiari decompression surgery with extradural fluid that measures up to 8 mm in thickness in the surgical bed. The cerebellar tonsils have a rounded morphology and extend inferiorly to the level of the tip of the dens. 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 major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology. There is a narrow column of cerebrospinal fluid flow across the anterior neo-foramen magnum and no discernible flow posteriorly. 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.

Output: 1. Interval Chiari decompression surgery with a narrow column of cerebrospinal fluid flow across the anterior neo-foramen magnum and no discernible flow posteriorly. 2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Ms. Williams is a 36-year-old female with a personal history of left breast lumpectomy in 2013 for triple negative IDC. Patient did not receive any chemotherapy or radiation therapy. Personal history of benign left MRI guided biopsy. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Few scattered enhancing foci are identified bilaterally, all of which appear stable in appearance and distribution when compared to prior examinations. Stable postsurgical changes are identified in the left upper outer breast, at site of prior lumpectomy. Susceptibility artifact from biopsy marker clip is stable in the left upper outer breast. There is no new abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.Small right pleural effusion is present.

Output: Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: History of brain metastases. Compared with prior exam. Signs and symptoms: None. Pre-and post-enhanced brain MRI:A previously measured 5.8-mm left occipital lobe medullary hemorrhagic metastatic lesion demonstrate interval decreased size and measuring at 2.7-mm. No surrounding edema however minimal or mass effect.A right posterior temporal subcortical metastatic lesion which measured 5-mm on prior exam demonstrates interval decrease size and measuring at 1.9-mm. No surrounding edema or mass effect.A right posterior temporal metastatic lesion is remeasured at 9.2-mm on prior exam demonstrate interval decreased size and measuring at 8.3-mm on current study. The minimal internal hemorrhagic changes and surrounding edema however demonstrate no significant change.The largest metastatic lesion is at the level of the trigone of left lateral ventricle and inseparable from the ventricle wall. It measures at 8-mm and post-enhanced images compared to prior study measurement of 9.8-mm areaa punctate focus of enhancement pain in right posterior parietal lobe which measured at 2.4-mm demonstrate subtle interval decrease size and measuring at 1.7-mm. Post operative changes of high convexity right lateral frontal craniotomy with expected dural thickening and enhancement demonstrates no change. Focus of encephalomalacia at the site without abnormal enhancement is also again noted without change.Stable normal size of ventricular system and maintained midline.No detectable calvarial or orbital abnormal enhancement.

Output: Redemonstration of multiple previously known brain metastatic lesion with further interval decreased size as detailed/measured above.


Instruction: Generate impression based on findings.

Input: 72 year old with history of nonischemic cardiomyopathy presenting for evaluation for fibrosis/scar and to accurately measure ejection fraction. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 151 ml/m2 (normal range: 74+/-15), the LVEDV is 326 ml (normal range 142+/-34), the LV end systolic volume index is 102 ml/m2 (normal range 25+/-9), the LVESV is 219 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 144 g (normal range 164+/-36). There is septal bounce, otherwise the LV dysfunction is global with regional variation, involving the basal LV more than the apex. There is an area of nearly transmural late gadolinium enhancement involving the basal inferolateral wall in a pattern that is typical for myocardial infarction and the involved segments are unlikely to be viable. There is additionally a mid-wall stripe of septal late gadolinium enhancement which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This second pattern of late gadolinium enhancement has been described in a variety of cardiomyopathies such as old myocarditis or dilated cardiomyopathy. There is no cardiac iron overload. No evidence of LV thrombus. Left AtriumThe left atrium is mildly enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 92 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (32 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge right renal cyst is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with moderately reduced systolic function (LVEF 33%). The etiology is potentially mixed ischemic and non-ischemic given the presence of two distinct patterns of late gadolinium enhancement.2. Nearly transmural myocardial infarction involving the basal inferolateral wall. This segment is not likely to be viable.3. Normal RV size and systolic function (RVEF 51%).


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosis Unspecified adverse effect of drug or medicament, initial encounterClinical question: MS; f/u progressionSigns and Symptoms: paresthesias.Comments: 3T DCAM, Dr Javed MS protocol version 1.1, No DTI | 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. Some of these are perpendicularly oriented to the lateral ventricles. They're stable compared to the prior exam. An additional FLAIR hyperintense lesion is present in the right cerebellar hemisphere which is also stable compared to the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are periventricular white matter lesions and subcortical white matter lesions which are stable compared to the prior exam and consistent with the patient's clinical history of demyelinating disorder.


Instruction: Generate impression based on findings.

Input: Clinical question: altered mental status. Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrate multiple foci of vasogenic edema extensively on the left side and to a lesser degree on the right. This results in effacement of adjacent cortical sulci and mass effect on the left lateral ventricle as well as 7.7-mm rightward midline shift. Within the areas of vasogenic edema there are isodense to mildly high density masses which are highly suspected for multiple metastatic foci. Images through the posterior fossa are unremarkable.Calvarium is intact. Visualized mastoid air cells and middle ear cavities as well as paranasal sinuses are unremarkable. Recommend further follow-up with a dedicated MRI of brain with enhancement.

Output: Multiple bihemispheric foci of vasogenic edema a component disease left greater than right) and suspected internal foci of isodense to slightly high density masses. Findings are highly suspected of metastatic disease. Recommend further follow-up with an MRI exam for confirmation of metastases and/or an infectious process.


Instruction: Generate impression based on findings.

Input: Reason: s/p C2-T4 fusion and C3-C7 laminectomy c/o right arm weakness r/o C5 palsy/nerve compression History: acute right arm weakness Interval postsurgical changes of laminectomy from C3 to C7 are seen. Posterior spinal fusion hardware is seen extending from the C2 to the T4 levels. Hardware can be better assessed with CT. Spinal canal is well decompressed. Susceptibility artifact limits evaluation however no obvious cord signal abnormality is appreciated. There is ossification of the posterior longitudinal ligament from C4 to C5 as seen previously. Diffuse multifocal bone marrow heterogeneity is noted related to diffuse osseous metastatic disease.Vertebral body heights and alignment are maintained. At C3-C4 there is severe left and moderate right neural foraminal stenosis. At C4-C5 there is severe left and moderate right neural foraminal stenosis. At C5-C6 there is moderate left and mild right neural foraminal stenosis. At C6-C7 there is moderate to severe right and moderate left neural foraminal stenosis. At C7-T1 there is mild to moderate right and mild left neural foraminal stenosis. These findings are much better assessed on prior CT.Expected postsurgical changes include small fluid collection in the midline posterior paraspinous soft tissues.

Output: Interval postsurgical changes of C3 to C7 laminectomy. Spinal canal is well decompressed. Posterior spinal fusion hardware is seen from C2 to T4. Hardware can be better assessed with CT. There is multilevel neural foraminal stenosis, including the right C4-C5 level, and was better assessed on prior CT from 12/22/2015. No obvious hematoma, cord signal abnormality, or evidence of nerve root avulsion within the limits of susceptibility artifact from the hardware.


Instruction: Generate impression based on findings.

Input: New onset headaches, ocular apraxia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.Orbits: The bilateral globes, optic nerves, extraocular muscles, lacrimal glands, and orbital fat are unremarkable. There is no evidence of intraorbital mass lesions.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. Mild scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease.2. No evidence of intraorbital mass lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate interval change. Signs and symptoms: Same. Unenhanced head CT:There is no evidence of intracranial hemorrhage, mass-effect, midline shift or hydrocephalus. Previously noted multiple foci of low attenuation of the cortex of bilateral posterior frontal lobes, bilateral basal ganglia are poorly visualized. There is only very subtle mass effect of the left high convexity posterior frontal area of cortical/subcortical edema. This is similar to prior MRI exam from 8 -- 4 -- 11. The ventricular system remain within normal range of size and unchanged since prior exam.

Output: 1.No evidence of an acute new findings on this nonfused portable head CT.2.Bilateral hemispheric foci of high signal intensity noted on prior MRI appear as foci of low-attenuation on CT and without any definitive appreciable interval change.


Instruction: Generate impression based on findings.

Input: Cirrhotic liver with mass. ABDOMEN: Left gastric embolization coils resulting in susceptibility artifact obscuring much of the left hemi-abdomen.LIVER, BILIARY TRACT: Mildly nodular liver contour.The faint lesion in segment IV (series 1 201/298) is not significantly changed in size measuring 2.2 x 1.5 cm. The lesion has some signal dropout on out of phase imaging indicating steatosis.Vessels appear to traverse the lesion without distortion. No significant arterial enhancement. Mild hypointensity on portal venous and delayed phases is unchanged. No discrete capsule is evident.Subcentimeter right hepatic lobe simple cyst. Transjugular intrahepatic portosystemic shunt is present and appears patent on post-contrast imaging. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal gland is not visualized. The right adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Gynecomastia. OTHER: No significant abnormality noted.

Output: Stable non-specific segment 4 lesion. Somewhat geographic appearance, steatosis and non-distorted traversing vessels raises the possibility of focal fat deposition. However, given the patient's history of cirrhosis and subtle drop-out on delayed imaging continued follow-up is recommended. Eovist with hepatobiliary phase imaging or hepatobiliary phase imaging using Multihance should be considered (requested on the order) to assess for hepatocellular function which may help differentiate the lesion.


Instruction: Generate impression based on findings.

Input: patellar instability MENISCI: The medial lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the medial and lateral compartments is intact. There is signal heterogeneity and deep fissuring of the articular cartilage of the lateral patellar facet but otherwise patellofemoral compartment is also preserved. There is a small focus of increased signal within the inferior aspect of the lateral patellar facet but otherwise the marrow signal of the patella and femoral trochlea is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Findings suggestive of remote patellar subluxation with chronic tearing of the MPFL, edema within Hoffa's fat pad, and heterogeneous signal/measuring of the underlying patellar cartilage. There is lateral patellar tilting and the TT to TG distance and Insall Salvati ratios are elevated although there is no evidence of trochlear dysplasia.


Instruction: Generate impression based on findings.

Input: 16-year-old female. Evaluate for intra-partum seizure. 16-year-old with seizure during labor. Status post C-section. The density of the brain parenchyma and subarachnoid space remains within normal limits. No evidence of parenchymal hemorrhage or subarachnoid hemorrhage is detected. Focal area of increased density at the level of the sella on axial image 7 is noted. Although this finding could represent volume averaging of bone I cannot entirely exclude possibility of hemorrhage within the pituitary gland. MRI examination is recommended for exclusion for further evaluation. This examination is essentially otherwise within normal limits.

Output: 1.Increased density within the sella as described above which would be concerning for pituitary hemorrhage and an MRI is recommended.2.Unremarkable CT of brain otherwise.


Instruction: Generate impression based on findings.

Input: Clinical question: Memory loss. Evaluate for chronic vascular changes. Non-infused head CT:Images through posterior fossa again identify a right-sided cerebellopontine angle extra axial primarily fatty density mass measuring 14.7 x 11.6-mm in size. There is no appreciable interval change in the size or morphology of this lesion. Finding likely present a lipoma however an MRI examination is recommended for more precise evaluation. Images through posterior fossa are otherwise unremarkable.Anatomical variation of partially empty sella is also again identified with no change.Images supratentorial space demonstrate diffuse patchy areas of low attenuation in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Although nonspecific these findings however are often result of small vessel ischemic strokes. These findings were present on prior exam and precise comparison is not possible.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Calvarium is intact. Visualized orbits, mastoid air cells and middle ear cavities are unremarkable.Limited images of the paranasal sinuses again demonstrate complete opacification of right chamber of the sphenoid sinus with no change since prior examination from 2008.

Output: 1.Small vessel disease of indeterminate age.2.Revisualization of complete opacification of right chamber of sphenoid sinus.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a tiny mucosal retention cyst along the floor of the left maxillary sinus.MRI CERVICAL SPINE

Output: 1. Unremarkable contrast enhanced MRI of the brain.2. Minimal cervical spondylotic changes without evidence of cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Diagnosis: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticusClinical question: eval for new infarctSigns and Symptoms: altered mental status There is redemonstration of recent bilateral transoccipital and left transfrontal electrode placement. There is soft tissue swelling adjacent ot the occipital bones and left frontal bone. There is FLAIR signal hyperintensity within the occipital lobes adjacent to the electrodes at the cortical surface. Overall there is no interval change.No foci of diffusion restriction are appreciated.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post recent left transfrontal and bilateral transoccipital electrode placement. There are associated post surgical changes redemonstrated.2.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: paresthesiasComments: 3T DCAM, Dr Javed MS protocol version 1.1, No DTI | There are multiple periventricular and subcortical white matter lesions as well as some cortically based lesions present some which are perpendicularly oriented to the lateral ventricles. Compared to the prior exam no new lesions are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Redemonstration and no change of multiple periventricular subcortical and cortical based lesions which would support the patient's diagnosis of demyelinating disorder.


Instruction: Generate impression based on findings.

Input: 50-year-old male with decreased range of motion status post VMO repair (8/12/15) complicated by infection and surgical I&D (8/24/2015). Please note that exam is slightly limited due to patient motion.MENISCI: There is attenuation of the posterior horn of the medial meniscus that may in part reflect partial meniscectomy. There is, however, an irregular, somewhat jagged contour of the femoral articular surface of the medial meniscus at the body/posterior horn junction, suspicious for tearing. Mildly increased signal intensity within the posterior horn and body of the medial meniscus likely represents additional intrasubstance degeneration. The anterior horn root appears to be attached to a subcentimeter ossicle which may reflect prior trauma, but we cannot say with certainty whether this ossicle attaches to the medial tibial plateau.There is increased signal within the inner third of the body of the lateral meniscus which appears to extend to the tibial articular surface, likely representing a tear. There is also fraying of the undersurface of the lateral meniscus posterior horn.ARTICULAR CARTILAGE AND BONE: There is patchy edema within the medial and lateral femoral condyles extending to the articular surface and to a lesser degree within the proximal tibial meta-epiphysis and medial aspect of the patella. This is nonspecific but could represent bone contusions in the correct clinical setting. There is full-thickness articular cartilage loss along the far medial aspect of the patella. There is full-thickness cartilage degeneration along the weightbearing portions of the lateral femoral condyle and lateral tibial plateau adjacent to the posterior horn of the lateral meniscus. There may be full-thickness cartilage loss along the medial femoral condyle above the posterior horn of the meniscus on coronal T2 weighted images, however this is not confirmed on sagittal sequences.LIGAMENTS: Increased signal intensity within the proximal fibers of the lateral collateral ligament proper may represent prior degeneration or tearing. The biceps femoris and iliotibial band are intact. The MCL is intact. The ACL and PCL are intact.EXTENSOR MECHANISM: There is thickening of the quadriceps tendon which likely represents a combination of prior injury, tendinosis and prior surgery including VMO repair. Heterogeneous low and intermediate signal intensity tissue deep to the distal fibers of the VMO likely represents a combination of scar tissue and perhaps chronically torn tendon. Low signal intensity scar tissue extends from beneath the VMO along the anterior aspect of the suprapatellar pouch and also along the superior margin of Hoffa's fat pad to the ACL and anterior horn of the lateral meniscus. There is an additional intermediate signal intensity within the subcutaneous fat anterior to the extensor mechanism, also likely representing scar tissue. The patellar tendon appears normal.ADDITIONAL

Output: 1.Postsurgical changes of VMO repair and scar tissue within the joint (arthrofibrosis) as well as along the anterior aspect of the extensor mechanism as described above.2.Patchy edema-type signal within the femoral diaphysis and proximal tibia is of uncertain etiology and significance. This distribution would be atypical for red marrow but could conceivably represent prior bone contusions. Marrow infection is considered less likely.3.Probable medial and lateral meniscal tears as described above.4.Cartilage degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Manning is a 38 year old female with known malignancy of the right breast with metastatic right axillary lymph node. Recent MRI detected an additional area of linear non-mass enhancement in the right lower outer breast. She presents today for MR-directed ultrasound. Targeted right breast ultrasound was performed for the MRI area of concern.In the right breast 8:00 location, approximately 6 cm from the nipple, there is an irregular hypoechoic area identified measuring approximately 1.7 x 0.6 x 0.8 cm. There is moderate associated vascularity.

Output: 1.7 cm hypoechoic area in the right lower outer breast, likely corresponding to MRI-detected area of linear non-mass enhancement. If breast conservation therapy is desired, an ultrasound guided biopsy with clip placement is recommended for further evaluation. All results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: eval rotator cuff, chronicity of tear History: shoulder pain, weakness Exam is limited by motion artifact.ROTATOR CUFF: Moderate to severe atrophy of the supraspinatus, infraspinatus, and subscapularis muscles with tendinopathy.SUPRASPINATUS OUTLET: Complete tear of the supraspinatus tendon with 2 to 3 cm retraction and large joint effusion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Globular amorphous appearance of the anterior inferior glenoid labrum suggestive of injury.BICEPS TENDON: Split tear of the long head of the biceps tendon.ADDITIONAL

Output: Exam is limited by motion artifact.1.Complete tear of the supraspinatus tendon with retraction of the muscle.2.Atrophy of the rotator cuff muscles as above.3.Split tear of the long head of the biceps tendon.4.Abnormal appearance of the anterior inferior glenoid labrum suggestive of injury.


Instruction: Generate impression based on findings.

Input: Left frontal orbital tumor with skull base extension, 3 month follow-up There is been evolution of postoperative findings related to left craniotomy and orbitotomy with reconstruction and obliteration of the left frontal sinus and reconstruction of orbital rim. There has been resolution of the previously seen postoperative fluid collection in the superior left orbit with mild soft tissue thickening compatible with postsurgical change. There is mild increase in dural thickening along the left frontotemporal convexity and above the superior orbital wall consistent with postoperative change. Focal enhancement involving the posterior aspect of the left orbital roof is noted (coronal postgad image 8/17 series 20) and may be related to postoperative change. Otherwise no discrete intraorbital or intracranial mass or nodular enhancement is appreciated to suggest tumor.Again seen is medial bowing of the lateral wall of the left orbit associated with a middle cranial fossa arachnoid cyst that measures approximately 2 x 3 cm and unchanged. The bilateral optic nerves appear to be intact. There is mild left cerebral convexity dural postoperative enhancement. There is mild edema in the left orbitofrontal gyri. The ventricles are unchanged in size and configuration, with a left choroid fissure cyst. There is no midline shift or herniation. There is moderate right maxillary sinus mucosal thickening and a left sphenoid sinus retention cyst. There is minimal fluid signal in the right mastoid air cells.

Output: 1. Evolution of postoperative findings related to left superior orbital wall reconstruction and left frontal sinus decompression. There has been resolution of previously seen fluid collection in the superior left orbit with residual thickening and enhancement compatible with granulation tissue. Focal enhancement of the posterior aspect of the left orbital roof is noted (coronal postgad image 8/17 series 20) and may be related to postoperative change. No discrete intraorbital or intracranial mass is otherwise appreciated to suggest tumor. CT of the orbits may be helpful to assess for residual osseous component of tumor.2. Unchanged left middle cranial fossa arachnoid cyst with associated medial bowing of the left lateral orbital wall.


Instruction: Generate impression based on findings.

Input: History of ileal ulcers in February 2015 while on NSAIDS. Continued right lower quadrant pain. 10/21/2015 endoscopic biopsy demonstrated minimally active enteritis of the terminal ileum. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.The terminal ileum is well seen.There is no abnormal small bowel wall thickening, post contrast enhancement or restricted diffusion. No perienteric inflammatory changes such as fibrofatty proliferation.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.The small and large bowel is normal in caliber.No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No evidence of perianal disease on the limited sequences obtained.OTHER: No significant abnormality noted.

Output: No evidence of active small bowel inflammation, fibrostenotic or fistulous disease.


Instruction: Generate impression based on findings.

Input: 90 year-old female with acute mental status changes. Diffuse periventricular and subcortical white matter hypodensity indicates diffuse small vessel ischemic disease. Prominence of the sulci and ex vacuo dilatation of the ventricles indicates moderate to severe corticomedullary volume loss.Hypodense focus in the left cerebellar hemisphere with an adjacent area of increased attenuation is nonspecific but could represent infarction, tumor, or even blood. A contrast-enhanced CT or preferably an MRI is indicated for further evaluation of this area.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Hypodense left cerebellar focus with adjacent area of increased attenuation is nonspecific. A contrast enhanced CT or preferably an MRI is indicated for further evaluation of this lesion.2. Diffuse small vessel ischemic disease and volume loss.


Instruction: Generate impression based on findings.

Input: Ms. Kelly is a 27-year-old female with recently biopsied superior left breast mass. She had a recent MRI that demonstrated two benign morphology enhancing masses in the lateral right breast. She presents today for an MR directed ultrasound of these two areas. A targeted right breast ultrasound was performed for the two MRI areas of concern. - in the right breast 9 o'clock location, approximately 5 cm from the nipple, there is a benign intramammary lymph node present. This corresponds to the MR findings and is compatible with a benign intramammary lymph node.- in the right breast 9 o'clock location, approximately 1 cm from the nipple, there is a subtle hypoechoic mass measuring 0.8 x 0.6 x 0.5 cm. This corresponds to the MRI findings and is compatible with a benign fibroadenoma.

Output: Benign intramammary lymph node and benign fibroadenoma in the right lateral breast, which corresponds with the MRI findings. No sonographic evidence of malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: rule out. Signs and symptoms: Astrocytoma with increased weakness. Unenhanced CT of brain:Examination demonstrates no evidence of hemorrhage.Lesion isointense with cortex involving the left basal ganglia and periventricular white matter of left hemisphere measures approximately 33 x 22.5-mm in transaxial dimensions. There is no evidence of surrounding edema or any associated mass effect with this finding. Considering provided clinical date out of astrocytoma this finding could represent tumor. There are no old studies and follow-up with an MRI is recommended. There is no evidence of hemorrhage, edema, significant mass effect or midline shift or hydrocephalus. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial findings.2.Isodense mass in the left hemispheric white matter which may represent patient's known astrocytoma. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with slurred speech, CT concerning for stroke. Patchy foci of restricted diffusion are seen within the left posterior frontal and parietal lobes. Small foci are also seen in the left occipital lobe. There is mild edema associated with these lesions, along with mild gyriform enhancement. Elsewhere in the brain, numerous scattered foci of white matter T2 hyperintensity are seen. No evidence of significant parenchymal edema or mass effect is detected. No abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology.The hyperattenuating lesion noted on prior CT within the left inferior frontal lobe is barely detectable on MRI as a focus of faint susceptibility and minimal if any T2 signal abnormality. The lesion does not enhance.

Output: 1.Scattered ischemic lesions within the left posterior frontal, parietal and occipital lobes which are likely subacute.2.No evidence of significant parenchymal edema or mass effect is seen.3.No intracranial hemorrhage is detected.4.A calcified lesion in the left inferior frontal lobe noted on prior CT is barely detectable on the present examination. The differential would continue to include a dystrophic calcification secondary to prior inflammation or infection, or perhaps a cavernoma.


Instruction: Generate impression based on findings.

Input: Abnormal findings on diagnostic imaging of other specified body structures [R93.8] / Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: PLEASE DO THIN CUTS POSTERIOR FOSSA AND FIESTA, Outside CTA saw an aneurysmal lesion adjacent to the right PICA. Brain MRIThere is relatively well circumscribed lesion [7.4mm (AP) x 8.1mm (RL) x 7.7mm (CC)] at the cisternal space, just inferior to the right inferior cerebellar peduncle and slightly outer aspect of the right foramen Luschka. The lesion shows iso/low signal intensity on T1, low signal intensity on T2 and homogenous enhancement. There is no mass effects and there is no evidence that the lesion is connected to vascular structure. Constellation of these findings suggest extra axial benign lesions such as calcified and prominent choroid plexus, small meningioma at or around choroid plexus. Extra axial metastatic lesion is a very remote possibility. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of other abnormal enhancement.Underlying brain shows diffuse brain atrophy with corresponding prominent ventricle enlargement.There are subtle patchy high signal intensities on periventricular white matter indicating non specific small vessel ischemic disease.The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral Pcom arteries and Acom artery are patent.There is no evidence of intracranial arterial aneurysm.No intracranial arterial luminal stenosis.

Output: 1. Extra axial enhancing lesion on the inferior aspect of the right inferior cerebellar peduncle as described above. Diagnostic possibilities include prominent calcified choroid plexus or associated small meningioma.2. No evidence of intracranial arterial aneurysm. No evidence of intracranial arterial luminal stenosis.


Instruction: Generate impression based on findings.

Input: Male, 65 years old. Reason: Prior to surgery History: Cervical stenosis and pain Severe disc space narrowing and anterior osteophyte formation at C5-6 and C6-7, with surgical clips anterior to the C5 vertebral body.Moderate facet joint degenerative changes throughout.Surgical clips overlie the jaw.

Output: Postoperative changes and severe lower cervical spine degenerative disc disease.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: 61F intubated for respiratory failure, persistently hypertensive post failed extubation attempt History: respiratory failure Multifocal high signal intensity on diffusion-weighted images on bilateral cerebellar hemisphere with the some of lesions show restricted diffusion and remained show subtle high signal intensity on T2 weighted images indicating evolving ischemic stroke lesions likely represent mixed acute and subacute ischemic stroke lesions. The left globus pallidus shows focal high signal intensity lesion on DWI but the lesions shows intermediate signal intensity on T2 images thus indicating evolving subacute ischemic stroke. There is no evidence of hemorrhagic transformation on these lesions.There are multiple susceptibility foci on bilateral hemispheres indicating possible calcifications or chronic petechial hemorrhages. Multifocal scattered FLAIR high signal intensities on bilateral hemispheres and patchy high signal intensity lesions on periventricular white matter indicating non specific small vessel ischemic disease.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mucosal thickenings on paranasal sinuses. Bilateral mastoid air cells show opacifications.

Output: 1. Mixed acute and subacute evolving ischemic stroke lesions on bilateral cerebellar hemispheres and bilateral basal ganglia as described above without evidence of hemorrhagic transformation.2. Minimal non specific small vessel ischemic disease as described above.


Instruction: Generate impression based on findings.

Input: Assess for worsening spinal pathology s/p fall: bilateral radiculopathy, lumbago. There is a persistent eccentric disc extrusion at L5-S1 with marked loss of disc space height and degenerative bone marrow signal alterations and irregular contours of the adjacent endplates. There is associated severe left lateral recess and otherwise moderate central spinal canal narrowing at this level, with compression of left-sided nerve roots. There is also a left lateral disc protrusion at L4-5, which impinges upon the left-sided exiting nerve roots and moderate left neural foraminal narrowing. There is no significant spinal canal or neural foraminal narrowing at T12 through L4. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unchanged, with diffuse T1 and T2 hypointensity. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from dependent edema in the posterior subcutaneous tissues.

Output: 1. Persistent eccentric disc extrusion at L5-S1 associated severe left lateral recess and otherwise moderate central spinal canal narrowing at this level, with compression of left-sided nerve roots. 2. Persistent left lateral disc protrusion at L4-5, which impinges upon the left-sided exiting nerve roots. 3. The vertebral bone marrow signal is unchanged, with nonspecific diffuse T1 and T2 hypointensity.


Instruction: Generate impression based on findings.

Input: Reason: Brain tumor History: Confusion. There is a large enhancing lesion centered in the splenium of the corpus callosum measuring up to 4.5 x 4.9 cm. The lesion extends into the left occipital and medial temporal lobes with significant associated edema in the left parietal, bilateral occipital and medial left temporal lobes. Non enhancing T2 hyperintensity spreads to involve the left hippocampal formation. There is local mass effect with effacement of the left occipital horn. T2 hyperintensity in the right cerebellum may represent age-indeterminate ischemia. Additional T2 hyperintensity in the left insula is nonspecific. 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: Large enhancing lesion in the splenium of the corpus callosum and left temporal and occipital lobes with associated edema and mass effect.


Instruction: Generate impression based on findings.

Input: Ms. Dazzena is a 60-year-old female with known right breast cancer. She presents today for MRI #2 per ISPY-2 protocol. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There has been an overall interval decrease in enhancement within the right superior breast, now measuring 4.1 x 6.3 x 3.3 cm (AP x ML x SI), previously measuring 4.7 x 8.2 x 3.9 cm. The overall enhancement pattern and volume of enhancement has decreased when compared to the prior examination. Susceptibility artifact from biopsy marker clip is reidentified in the medial aspect of this clumped nonmass enhancement (adjacent to the right 3:00 mass). There continues to be diffuse skin thickening present about the entire right breast, measuring up to 7 mm in thickness.There is no abnormal MR enhancement identified in the left breast.There has been an interval decrease in size of previously enlarged right axillary lymph nodes, the reference node now measuring 1.1 cm, compared to 1.9 cm. There are no abnormal axillary lymph nodes in the left axillary region.A dual-lumen Port-A-Cath is noted in the left chest wall.

Output: (1) Overall decrease in size/enhancement of multicentric disease within the right breast and decrease in size of right axillary lymph nodes.(2) No MRI evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: renal cell with brain mets, post resection and SRS 7/2014 & whole brain RT 12/2014, compare to last Brain MRI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a ring-enhancing lesion adjacent to the trigone of the left lateral ventricle which currently measures 20 x 20 mm axial dimensions. On the prior exam it measured 22 x 21 mm axial dimensions. The wall thickness of the lesion has decreased from 6 mm to approximately 4 mm. A ring-enhancing right parietal lobe lesion currently measures 7 mm and previously measured the same. These lesions are associated with susceptibility effect. Additional foci of microhemorrhage are present in the left occipital lobe which on prior exams displayed contrast enhancement.The patient is status post right frontal lobe surgery for removal of a mass. There is redemonstration of T2 signal change along the right superior frontal gyrus as well as some blood products but no abnormal enhancement. It appears stable and compared to the previous exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.

Output: 1.The findings are not old hemorrhagic metastasis of the brain which are relatively stable and compared to the prior exam. There is some indication that similar lesions are a bit smaller on the current exam but not measurably so..2.The patient is status post right frontal lobe surgery for removal of a mass.


Instruction: Generate impression based on findings.

Input: 43 years Female (DOB:5/17/1973)Reason: please do dr Javed MS protocol and compare to prior History: left-sided weaknessPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a marked degree of periventricular white matter lesions and to a lesser degree subcortical white matter lesions in the periventricular white matter lesions many of which are perpendicularly oriented to the lateral ventricles and are bright on T2 and flair MRI. Since the September exam and there is enlargement of a subcortical white matter of the left parietal lobe which now measures 16 mm previously a lesion that measured 5 mm. There is also a new lesion adjacent to the left putamen of the basal ganglia measuring 13 x 10 mm axial dimensions.There is another new lesion present in the deep white matter of the left cerebellar hemisphere measuring 13 x 9 mm axial dimensions.Additional lesions bright on T2 and flair MRI are present in the left and right cerebellar hemispheres and the left pons which are stable. Corpus callosum lesions are redemonstrated as well. Although they are similar in distribution when compared the prior exam.Postcontrast imaging demonstrates small foci of enhancement in the right frontal lobe one in the periventricular white matter measuring 5 mm and another one in the right frontal subcortical white matter measuring 3 mm. Another punctate focus of enhancement is present in the left cerebral peduncle.There is redemonstration of small T1 hypointense, FLAIR isointense and proton density hyperintense lesion in the subcortical white matter of the right superior frontal gyrus measuring 5 mm in size which has been unchanged.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 demonstrate some opacities in the right mastoid air cells which were also present on the prior exam and are unchanged. The visualized portions of the orbits are intact.

Output: There are multiple periventricular and subcortical white matter lesions as well as corpus callosum, and cerebellum and pons lesions present with some waxing and waning of some of the lesions. These are compatible the patient's diagnosis of demyelination. Many of the lesions are new compared to the exam from September. There are couple enhancing lesions present in the right frontal lobe and another one in the left cerebral peduncle which are suspected to potentially represent more acute involvement


Instruction: Generate impression based on findings.

Input: 80 years, Male, Reason: pt with a history of met renal cell cancer, please assess for disease progression History: met RCC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.Reference segment 6 lesion measures 1.0 x 0.6 cm (14/49), previously 0.9 x 0.6 cm.Reference segment two lesion measures 1.7 x 1.5 cm (14/68), previously 1.9 x 1.3 cm.Posterior segment 6 lesion measures 2.4 x 2.1 cm (14/50), previously 3.0 x 2.6 cm.Segment 5 hemangioma an adjacent cyst are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Nonenhancing cystic lesion within the pancreatic duct is unchanged in size measuring 0.3 x 0.8 cm (8/27), previously 1.9 x 1.3 cm.ADRENAL GLANDS: Right adrenal gland is absent. Left adrenal nodularity is stable.KIDNEYS, URETERS: Status post right nephrectomy. Complex cystic lesion in the left upper pole containing calcification is unchanged. Additional renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.

Output: 1.Stable reference hepatic lesions. No new lesions identified.2.Stable nonspecific pancreatic cyst.


Instruction: Generate impression based on findings.

Input: Incontinence and diplopia. Suspicion of multiple sclerosis. CERVICAL SPINE:Sagittal alignment is notable for reversal of the normal lordosis and 2 mm of anterior subluxation of C4 relative to C5. The vertebral bodies are preserved in height. In addition to multilevel disc desiccation, there is mild degenerative disc height loss and endplate irregularity at C5-C6 and C6-C7 associated with small disc-osteophyte complexes resulting in mild spinal canal stenosis. Degenerative changes are associated with minimal subjacent marrow degenerative signal but there is no suspicious bone marrow lesion. Right more than left left uncovertebral and facet arthropathy at C5-C6 and C6-C7 result in mild-to-moderate right and mild left neural foraminal stenoses. The spinal canal and neural foramina are otherwise unremarkable. The spinal cord is normal in morphology. There is no definite spinal cord signal abnormality. Following intravenous contrast injection, there is no abnormal spinal cord or leptomeningeal enhancement.The brain T2-hyperintense lesions are better assessed on the previous brain examination.THORACIC SPINE:Sagittal alignment is anatomic, the vertebral bodies are preserved in height and there is no suspicious marrow lesion. Fat intensity lesions in the left side of T2, T4 and T12 vertebral bodies compatible with hemangiomas. There is no significant degenerative disc disease and the spinal canal is preserved. The thoracic spinal cord and the conus medullaris are unremarkable. The tip of the conus medullaris lies at the lower L1 level. Following intravenous contrast injection, there is no abnormal spinal cord, leptomeningeal or nerve root contrast enhancement.Dependent pulmonary heterogeneity and contrast enhancement is probably reflective of minimal atelectasis.

Output: 1.Cervical spine: There is no appreciable signal abnormality in the cervical cord or abnormal enhancement. Relatively mild degenerative disease at C5-C6 and C6-C7 as described above.2.Thoracic spine: No appreciable cord signal abnormality or enhancement in the thoracic cord. No evidence of demyelinating disease in the cord.


Instruction: Generate impression based on findings.

Input: Pilocytic astrocytoma, posterior fossa, VP shunt, resected in 1980. There are post-treatment findings in the posterior fossa. In particular, there is an unchanged enhancing lesion along the superior aspect of the cerebellar vermis with peripheral susceptibility effect, measuring up to approximately 25 mm. There are also nonspecific scattered punctate foci of susceptibility effect in the bilateral cerebral hemispheres. There is no evidence of acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is unchanged scattered nonspecific cerebral white matter T2 hyperintensity. There is a right posterior lateral ventricular catheter. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is diffuse thickening of the calvarium. The orbits are grossly unremarkable.

Output: 1. Stable post-treatment findings in the posterior fossa with an unchanged lesion along the superior aspect of the cerebellar vermis.2. Unchanged shunted ventricular system.


Instruction: Generate impression based on findings.

Input: 79 years, Male, gait change, NPH. There are multiple patchy areas and scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate burden of chronic small vessel ischemic disease. Small foci of T2 hyperintensity in the inferior basal ganglia are likely related to perivascular spaces. Cystic foci such as the left caudate head, right pons, and left frontal corona radiata are suspected to represent chronic lacunar infarcts. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is asymmetric enlargement of the left lateral ventricle which can be a normal variant. Overall however the ventricular system is not enlarged to suggest hydrocephalus. There is a 6 mm x 11 mm focus of T2 hyperintensity involving the right aspect of the sella which is incompletely evaluated.Major flow-voids are preserved. Minimal mucosal thickening is seen involving the paranasal sinuses, which is are otherwise clear. Minimal opacification of the mastoid air cells is also noted. Calvarium and extracranial soft tissues are unremarkable.

Output: 1. Overall findings are consistent with moderate degree of chronic small vessel ischemic disease. No findings to suggest hydrocephalus/NPH.2. Incidentally noted is a small T2 hyperintense focus in the right aspect of the sella which is incompletely evaluated without contrast and may represent a Rathke's cleft cyst or cystic adenoma.


Instruction: Generate impression based on findings.

Input: Male; 68 years old. Reason: Assess extent of prostate cancer History: prostate cancer on active surveillance PELVIS:PROSTATE:Prostate Size: 5.2 x 5.7 x 6.3 cm.Peripheral Zone: 3 x 3 mm focus of low T2 signal with restricted diffusion in the left mid gland, suspicious for prostate cancer (series 704/204). This focus is slightly more prominent when compared to prior study.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small focus in the left mid gland suspicious for prostate cancer. No evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: History of right breast cancer status post bilateral mastectomy with implant reconstruction with new area of concern in right axilla Status post bilateral mastectomies.Minimal parenchymal enhancement is noted bilaterally. Bilateral implants appear intact.No abnormal enhancement is seen in either chest wall. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy especially in patient's area of concern in the right axillary region. Ultrasound can be performed to further evaluate the concern in the right axillary region if clinically needed. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: 62-year-old male with altered mental status. There is extensive bifrontal encephalomalacia and postsurgical changes of a frontal craniotomy. There is associated hyperostosis of the planum sphenoidale secondary to prior meningioma. Focal soft-tissue prominence within the surgical bed, may represent tumor recurrence. However this is a nonspecific appearance. For further clinical evaluation MRI may be considered.There is ex vacuo dilation of the frontal horns of the lateral ventricles secondary to postsurgical change. The remaining ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Expected postsurgical change with questionable focal soft-tissue prominence within the surgical bed, which may represent tumor recurrence. However, this is a nonspecific appearance. For further clinical evaluation MRI may be considered.


Instruction: Generate impression based on findings.

Input: 52 year-old female with left knee pain, possible meniscal tear MENISCI: Globular signal abnormality within the posterior horn and body of the medial meniscus without extension to the articular surface suggests intrasubstance degeneration. In addition, there is increased signal intensity within the posterior horn of the medial meniscus involving the inner fibers indicating a partial thickness radial tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The bone marrow signal is within normal limits. The articular cartilage of the medial joint compartment appears subjectively thinned relative to the lateral joint compartment, particularly along the weight-bearing portion of the medial femoral condyle. There is mild heterogeneity of the articular cartilage of the lateral tibial plateau and patellofemoral joint, suggesting mild degeneration which is not unexpected given the patient's age. LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. Partial thickness radial tear of the posterior horn of medial meniscus.2. Mild degeneration of the articular cartilage.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with gait instability, history of ovarian cancer with known brain metastases. Restaging exam. Image quality on most sequences is degraded by motion artifact. Within this limitation, the following observations are made. Multiple solidly enhancing and ring-enhancing lesions are again seen within the cerebellum, all of which have decreased in size. A lesion within the midbrain tegmentum has also significantly diminished in size, now measuring 12 x 8 mm, previously 17 x 11 mm.Supratentorially, a significant decrease in the size of multiple lesions is also seen. A ring-enhancing lesion in the left precuneus now measures 11 x 9 mm, previously 14 x 10 mm. Other previously seen lesions in the right parietal lobe are now barely detectable if at all.No new intracranial lesions are appreciated. Confluent ill-defined periventricular white matter T2 hyperintensity is unchanged from prior and possibly related to therapy. No evidence of significant parenchymal edema or mass effect is detected. No abnormal extra-axial collections are seen. The ventricles and sulci are mildly prominent compatible with underlying parenchymal volume loss.

Output: Significant interval decrease in the size of numerous infratentorial and supratentorial metastatic lesions. No new metastases are detected.


Instruction: Generate impression based on findings.

Input: Reason: r/o diverticulum or pathology causing OAB History: r/o diverticulum or pathology causing OAB PELVIS:UTERUS, ADNEXA: No significant abnormality noted.VAGINA: 7 mm likely Bartholin's gland duct cyst on the left (701:16) with fluid fluid level. A tiny contralateral likely Bartholin's gland duct cyst is also likely seen.BLADDER/URETHRA: No significant abnormality noted. No urethral or bladder diverticulum. The bladder is not located below the pubic symphysis to suggest descent. 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: 1.2 subcentimeter Bartholin's gland duct cysts as above. No urethral or bladder diverticulum.


Instruction: Generate impression based on findings.

Input: Female 65 years old left shoulder axillary lymph nodes; correlation with the left axillary ultrasound. ROTATOR CUFF: Moderate tendinosis affects the supraspinatus tendon near its distal aspect. There is a partial thickness articular surface tear at the foot plate measuring approximately 8 mm in AP dimension. There is no tendon retraction.The infraspinatus and teres minor tendons are intact. Mild tendinosis affects the subscapularis tendon.No muscle atrophy or edema.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear branching T2 signal involving the superior labrum located at and posterior to the biceps anchor suggestive of a degenerative type labral tear. T1/T2 hypointense foci at the level of the biceps anchor likely represent small calcifications.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Multiple left axillary and left chest wall lymph nodes that correlate with the sonogram 11/20/2014. 2.Partial thickness supraspinatus rotator cuff tear.3.Findings suggestive of a superior labral tear.


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with tomosynthesis were performed and reviewed with the aid of R2 CAD. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Masses in the right retroareolar region appear circumscribed with tomosynthesis and have lucent halos. These are findings compatible with cysts. Note is made that cysts were also seen on a prior MRI in this location. Biopsy clip in the left outer breast again noted with adjacent calcifications. Area of asymmetry in the left upper breast disperses with tomosynthesis.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: History of acute pancreatitis complicated by pseudocyst status post failed drainage at outside hospital. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. Normal postcontrast enhancement. Note is made of a hepatic cyst in segment 8. No intra or extrahepatic ductal dilatation. Normally distended gallbladder.SPLEEN: The spleen is normal morphology size and enhancement.PANCREAS: The pancreatic neck body and tail is replaced by a large complex loculated collection which extends superolaterally along the left pararenal space along the greater curvature of the stomach measuring 13.8 x 5.6 cm. It extends inferiorly along the right inferior anterior pararenal space into the lower abdomen adjacent to the psoas muscle where it consists of a multiloculated cystic collection measuring 6.0 x 5.3 cm. The larger left superolateral collection is markedly heterogeneous, contains layering T1 weighted hyperintense material posteriorly compatible with proteinaceous and or hemorrhagic products and centrally is very low on both T1 and T2-weighted sequences suggestive of air. The collection demonstrates peripheral thick-walled enhancement.More than 50% of the pancreatic parenchyma is replaced by this collection. The residual pancreatic head has a normal caliber main pancreatic duct and demonstrates normal postcontrast enhancement.The splenic vein is occluded.The very proximal portal vein/SMV portal vein confluence is nearly completely occluded by mass effect (series 1201/184). No arterial pseudoaneurysm is identified.Nondiagnostic secretin images.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: See discussion above regarding peripancreatic fluid collection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Very large collection replacing the majority of the pancreatic parenchyma and extending in the retroperitoneum as described above demonstrating peripheral thick-walled enhancement and internal heterogeneity compatible with walled off necrosis with possibility of superinfection given the intrinsic T1 and T2-weighted hypointense signal intensity suggestive of air (versus chronic blood products), may also be post treatment gas within the collection.Splenic vein thrombosis. Near complete occlusion of the portal vein/SMV confluence.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell cancer. History of pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal morphology and size. Decreased signal intensity on in phase imaging suggesting iron deposition. No discrete lesion is evident. No biliary ductal dilatation. Normally distended gallbladder. Small layering gallstones/sludge.SPLEEN: No significant abnormality noted.PANCREAS: The caudal aspect of the pancreatic head/uncinate process is mildly prominent. No peripancreatic inflammatory changes. The main pancreatic duct is normal in caliber without distal pancreatic atrophy. No focal pancreatic lesion is evident. Findings suggest sequela of prior acute interstitial pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. The left kidney is atrophic with cortical thinning and numerous small cysts compatible with acquired cystic disease of dialysis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval improvement in mild dilatation of the third portion of the duodenum.BONES, SOFT TISSUES: Fluid adjacent to the right ischial tuberosity may represent common hamstring attachment pathology.OTHER: No significant abnormality noted.

Output: 1.Sequela of prior acute interstitial pancreatitis involving the caudal aspect of pancreatic head/uncinate process without evidence of acute inflammation or an underlying discrete lesion.2.Cholelithiasis.3.Status post right nephrectomy without evidence of locoregional recurrence.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: please r/o structural abnormality History: MS with LE weakness and incontinence Brain MRIExtensive periventricular white matter, midbrain and right middle cerebellar peduncular FLAIR/T2 high signal lesions are redemonstrated and unchanged since prior scan.There is no evidence of new lesion on this scan.Diffuse brain parenchymal volume loss appears to be stable.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricular system appears to be enlarged likely due to secondary to volume loss, unchanged since prior scan. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings seen on bilateral maxillary, ethmoid frontal sinuses.Cervical spine MRIMotion artifact degraded exam quality. There is no evidence of abnormal spinal cord signal intensity on this scan.Vertebral body heights are preserved and craniocervical junction appear to be normal.There is focal bulging of disc at the level of C56 which abuts thecal sac.Spinal canal at the level of C56 and C67 show minimal spinal canal narrowing without neuroforaminal stenosis.Although axial T2 images were degraded due to motion artifacts, the degree of spinal canal narrowing do not show significant interval change since prior scan.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Unchanged extensive white matter lesions, diffuse volume loss and ventricular system enlargement since prior scan.3. No evidence of spinal cord abnormal signal intensity.4. Unchanged degenerative changes of cervical spine.


Instruction: Generate impression based on findings.

Input: Male, 30 years old, with brisk lower extremity reflexes. Assess high thoracic disk seen on cervical spine MRI. The upper thoracic spine is mildly scoliotic. Elsewhere, alignment is unremarkable. Vertebral body morphology is normal. No concerning marrow replacement or evidence for marrow edema is seen.The visualized spinal cord shows normal caliber and signal characteristics.At T2-3, there is a small right paracentral disk protrusion which barely contacts the ventral cord causing no significant spinal canal stenosis or foraminal narrowing.At T3-4, there is a small left paracentral protrusion which does not clearly contact the cord and causes no significant spinal canal or neuroforaminal stenosis.No other significant disk disease is seen. The spinal canal and neural foramina are patent throughout.

Output: Small disk protrusions at T2-3 and T3-4 are seen which cause no significant spinal canal or neuroforaminal stenosis.The upper thoracic spine is mildly scoliotic, but the exam is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Female, 66 years old. Reason: thyroid nodules, please assess for changes History: thyroid nodules RIGHT LOBE MEASUREMENTS: 5.7 x 2.1 x 2.9 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.6 x 2.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: A mildly heterogeneous echotexture. A cystic nodule in the upper pole of the right thyroid measures 0.6 x 0.5 x 0.5 cm. A nodule in the mid/inferior right thyroid lobe measures 1.0 x 1.0 x 0 .6 cm, spongiform consistent with colloid nodule, nonvascular.LEFT LOBE: Mildly heterogeneous echotexture. A nodule in the inferior left thyroid lobe measures 0.7 x 0.5 x 0.4 cm, spongiform consistent with a colloid nodule, with mild internal vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 4 lymph node measures 0.7 x 0.4 x 1.1 cm, with suggestion of a fatty hilum. A left level 2 lymph node measures 1.0 x 0.4 x 1 .5 cm, similar to prior.OTHER: No significant abnormality noted.

Output: 1.Bilateral subcentimeter and benign- appearing thyroid nodules as described above, stable.2.Unchanged cervical lymph nodes.


Instruction: Generate impression based on findings.

Input: Shoulder pain for months with clicking and instability. ROTATOR CUFF: No significant abnormality noted. No evidence of rotator cuff tendinopathy or tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. No evidence of labral tear or abnormality otherwise.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

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


Instruction: Generate impression based on findings.

Input: Reticular pattern of hepatic parenchyma on recent CT examination. ABDOMEN:LIVER, BILIARY TRACT: Scattered punctate T2 hyperintensities, the largest of which are consistent with simple hepatic cysts and the smallest of which are too small to characterize. There is no intrahepatic or extrahepatic biliary ductal dilatation. The liver is normal in signal, morphology and enhancement pattern. The portal vasculature is grossly patent.SPLEEN: Splenules are noted at the splenic hilumPANCREAS: The pancreas is slightly prominent and the lobulations are poorly seen, but there is no pancreatic ductal dilatation or focal mass lesions identified within the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered well-circumscribed T2 hyperintensities in both kidneys, the largest of which are consistent with simple renal cysts and the smallest of which are too small to characterize. There is no hydronephrosis.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.Scattered hepatic cysts, but otherwise normal MRI appearance of the liver, without intrahepatic or extrahepatic biliary ductal dilatation.2.Slightly prominent pancreatic parenchyma, but without focal mass lesion or pancreatic ductal dilatation. Can correlate with serum IgG4 levels for autoimmune pancreatitis.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with history of multiple sclerosis presenting with neuropathic pain, headaches, blurred vision, bilateral hand and leg numbness. Brain:Numerous T2 hyperintense lesions are demonstrated in the juxtacortical and periventricular white matter of the cerebral hemispheres, the corpus callosum, and to a lesser degree the brainstem and cerebellum. In some areas the periventricular lesions are nearly confluent. Many of the lesions demonstrate a relatively angular morphology suggesting chronicity. Most lesions demonstrate mild to moderate T1 hypointensity. A large C-shaped left frontal lesion, however, demonstrates marked T1 hypointensity. Despite the lesion burden, brain volume is relatively well preserved and the corpus callosum is only mildly thinned. No mass effect is seen. No abnormal extra-axial collections are appreciated. Ventricular size and morphology are within normal limits.Cervical spine:Numerous scattered foci of cord T2 hyperintensity are seen throughout the cervical spine distributed primarily in the dorsal and lateral aspects of the cord. Slight cord volume loss is seen in association with several of the lesions.Straightening of the cervical lordosis is seen. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement is seen. Minimal posterior disc-osteophyte complex formation is seen along with thickening of the PLL. No significant spinal canal stenosis is detected.Thoracic spine:Evaluation of the thoracic cord is compromised by motion artifact. Nevertheless, numerous scattered foci of abnormal cord signal are suspected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal. No pathologic marrow replacement is seen. The intervertebral discs are preserved. No compromise of the spinal canal or neural foramina is detected.

Output: 1.Extensive white matter disease is seen intracranially compatible with the stated history of multiple sclerosis. Many of these lesions demonstrate a relatively angular morphology which would indicate chronicity.2.Numerous scattered lesions are also seen in the cervical and thoracic spinal cord compatible with multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 29-year-old female 24 week gestation with placental lakes on ultrasound. Evaluate for placenta accreta. PELVIS:UTERUS, ADNEXA, PLACENTA: There is T2 hypointense region within the placenta measuring approximately 2.6 x 2.7 cm (series 3, image 19) without evidence of extension to the myometrial/placental junction. There are additional small scattered T2 hypointense foci within the placenta. There is no evidence of diffusion restriction within these T2 hypointense regions. No evidence of placenta previa. Additionally, there is a large T2 heterogeneous, predominantly hypointense collection posterior to the fetus extending almost the entire length of the fetus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Oligohydramnios is noted.

Output: Examination is limited given lack of T1 images. The following observations are made within this limitation. T1 images may be obtained at a later time today and addendum to this report may be made if necessary.1.Several T2 hypointense regions within the placenta with largest measuring up to 2.7 cm. Within limitation above, this may represent intra-placental hemorrhage.2.Large heterogeneous T2 hypointense collection posterior to the fetus extending almost the entire length of the fetus. Within the limitation above, this is concerning for subchorionic hemorrhage.3.No evidence of placenta accreta or percreta. 4.Oligohydramnios.Findings relayed to Dr. Garret Holcomb at 11:50 am over the phone.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for cyst. Signs and symptoms: Headache. Pre-and post-enhanced brain MRI:Diffusion weighted images are severely obscured by the calvarial metallic hardware (shunt) artifact overlapping the right side of the study. Beyond the artifact diffusion weighted images are negative.Flair and T2 weighted images also demonstrate metallic hardware artifact from patient's shunt placement which obscures part of the right hemisphere.Examination demonstrates mild enlargement of the supratentorial ventricular system with suggestion of mild interval increased size since prior head CT exam from 12 -- 9 -- 14. The transverse diameter of the third ventricle anteriorly measures of 11.2-mm compared to prior head CT examination of 8.3-mm. Combined ligaments of the frontal horns and lateral ventricles measures at 26.5-mm compared to prior CT examination measurement of 23 mm. The temporal horns of lateral ventricles also demonstrate minimal interval increased size.A right frontal approach ventricular catheter enters the right lateral ventricle and with the tip abutting the septum pellucidum in the right frontal horn lateral ventricle similar to prior exam. The cortical sulci remain patent and CSF cisterns are unremarkable.The morphology and signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. There is no detectable cyst as is questioned clinically. This signal void in the major intracranial arterial branches are identified.There is no detectable abnormal parenchymal or meningeal enhancement. On reformatted post enhanced images there is a 3.3 mm focus of hypoattenuation in the inferior midline and left paramedian pituitary gland highly suspected for a microadenoma. There is no evidence of increased size of pituitary gland, normal position and enhancement of the pituitary stalk and unremarkable adjacent cavernous sinuses.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses, mastoid air cells and bilateral middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Diffusion-weighted images are significantly obscured on the right secondary to metallic artifact and negative otherwise.2.Mildly prominent supratentorial ventricular system which measure minimally larger than prior head CT exam from 12 -- 9 -- 2014.3.Stable right frontal approach ventricular catheter with the tip in the right frontal horn of lateral ventricle.4.3.3-mm focus of hypo-enhancement in the inferior left paramedian pituitary representing a microadenoma.5.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Abnormality of gait. Evaluate for subacute stroke based on CT findings. There are scattered foci of diffusion restriction in the right frontal centrum semiovale, bilateral frontoparietal regions, and right precuneus. There is no evidence of acute intracranial hemorrhage or mass effect. There is mild global parenchymal volume loss. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There are multiple scattered foci of susceptibility artifact in the supra- and infratentorial compartments, consistent with hemosiderin deposition from chronic microhemorrhages. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is partial opacification of a right posterior ethmoid sinus.

Output: 1. Scattered foci of restriction diffusion, consistent with recent small vessel infarcts.2. Multiple scattered foci of susceptibility artifact in the supra- and infratentorial compartments, consistent with hemosiderin deposition most likely from chronic microhemorrhages. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Wrist pain Examination is limited by motion artifact.LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: There is slightly increased signal within the TFCC which is otherwise intact.TENDONS: No significant abnormality noted. BONES: Scattered areas of increased T2 signal are noted within the proximal pole of the scaphoid, the lunate, the capitate and trapezium. There is no evidence of fracture or malalignment.ADDITIONAL

Output: Mild degenerative changes within the proximal row and TFCC.


Instruction: Generate impression based on findings.

Input: Female; 32 years old. Reason: history of stage 1B1 cervical cancer, rule out recurrence. s/p trachylectomy. History: history of 1B1 cervical cancer PELVIS:UTERUS, ADNEXA: Post surgical changes from cervical trachylectomy. No evidence of residual or recurrent disease.Foley catheter tip within vagina. High T2 signal material within the vagina due to ultrasound gel.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid, likely physiologic.

Output: Status post cervical trachylectomy without evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: 35-year-old female with history of ALL in remission, concern for osteonecrosis of the sternum. Multiple reconstructions of the sternum demonstrate homogeneously low signal on T1 and T2 weighted images of the sternum and vertebral bodies, which is consistent with red marrow reconversion. There is no discrete evidence of osteonecrosis or neoplastic infiltration. Postcontrast images demonstrate very slight enhancement of the sternum, which is within normal limits. Incidental note is made of a subcentimeter vertebral body hemangioma in the lower thoracic spine.

Output: Red marrow reconversion of the sternum and vertebral bodies, which is likely post treatment related. There is no discrete evidence of osteonecrosis or neoplastic infiltration. However, bony architecture of the sternum would be better evaluated with CT.


Instruction: Generate impression based on findings.

Input: 11 months, Female. Reason: evaluate hips after spica change under anesthesia History: hip dysplasia Bilateral cartilaginous femoral heads are within the acetabula. There is mild superior and lateral displacement of the left femoral head within the left acetabulum.

Output: Bilateral cartilaginous femoral heads within the acetabula, with mild superior and lateral displacement of the left femoral head within the left acetabulum.


Instruction: Generate impression based on findings.

Input: Assess extent of PML, history of AIDS, PML and altered mental status Extensive confluent high signal intensity lesion on bilateral hemispheres in particular, right frontal lobe and left fronto-parietal lobes. The lesions involve mainly white matter and subcortical u-fibers but saving gray matter. Especially the left hemispheric lesion generates mass effects thus demonstrates midline shift toward right side with the degree of about 11mm at the level of foramen of Monroe.Gad enhanced images show minimal abnormal enhancement of the lesion especially peripheral area of the lesion. There is no evidence of acute ischemic or hemorrhagic lesion.Above described findings with considering history of AIDS and active HAART treatment indicate diagnostic possibility of Progressive Multifocal Leukoencephalopathy with Immune Reconstitution Inflammatory Syndrome (PML-IRIS). However, differential diagnosis of HIV encephalopathy, JC virus encephalitis and other opportunistic encephalitis could be considered. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Extensive confluent bihemispheric white matter lesions with mass effect of left fronto-parietal lesion creating midline shift toward right side indicate diagnostic possibility of PML with IRIS. Differential diagnosis include HIV encephalopathy, progression of JV virus encephalitis and other opportunistic infection.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Male; 21 years old. Reason: 21 y.o. with a h/o Ulcerative Colitis, but question of Crohn's disease as found to have skip lesions. Please eval for ileal disease and evidence of Crohns. History: skip lesions, diarrhea ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Pancolitis with moderate colonic wall thickening, edema, and increased enhancement extending from the cecum through the rectum. No skipped lesions. No small bowel involvement with sparing of the terminal ileum. This pattern is most consistent with the provided history of ulcerative colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: There is compression of the left common iliac vein by the overlying right common iliac artery in a configuration seen with May Thurner syndrome.OTHER: Mild pelvic ascites, likely reactive to the pancolitis.

Output: 1.Pancolitis as detailed above in a pattern most consistent with the provided history of ulcerative colitis.2.Compression of the left common iliac vein and a configuration seen with May Thurner syndrome, which can be asymptomatic, though clinical correlation for left lower extremity swelling or DVT is recommended.


Instruction: Generate impression based on findings.

Input: 51-year-old male with suspected small bowel Crohn's, bloating and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. T2 hyperintense cyst in the left lobe of the liver. 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: Mild subcentimeter lymph nodes surrounding the affect jejunum described below.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Two segments of jejunum approximately 20 cm distal to the ligament of Treitz with narrowing and concentric wall thickening. The proximal segment measures approximately 10 cm in length with an intervening non-thickened segment of bowel measuring 6 cm followed by a second segment of thickened jejunum measuring 9 cm in length. Submucosal fat deposition is noted within these affected loops of bowel. No evidence of small bowel obstruction. No abscess or fluid collection.OTHER: No significant abnormality noted.

Output: 1.Two segments of jejunal narrowing and submucosal fat deposition as described above consistent with chronic disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoClinical question: disc degenerationSigns and Symptoms: pain began after epidural for childbirth 4 y prior Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a central disk protrusion which is slightly eccentric towards the left at this level which minimally affects the nerve roots at the lateral recesses. There is a clear fat plane between the nerve root sleeves and the ligamentum flavum. There is disk dessication present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a central disk protrusion at L5-S1 which is slightly eccentric towards the left.2.No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Chiari post decompression. Brain: There are postoperative findings related to Chiari decompression with intact flow across the neo-foramen magnum. The inferior cerebellum extends nearly to the level of the inferior margin of the clivus. 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, and scalp soft tissues are grossly unremarkable. There is mild left maxillary sinus mucosal thickening.Cervical Spine: The spinal cord displays normal signal and morphology. There is no evidence of pseudomeningocele. 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.

Output: 1. Expected postoperative findings related to Chiari decompression without evidence of acute intracranial hemorrhage, mass, or acute infarction.2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Evaluate liver lesion. ABDOMEN:LIVER, BILIARY TRACT: The left hepatic segment 2 dorsal partially exophytic lesion measures 2.4 x 2.3 cm and is very homogeneously hyperintense on T2-weighted signal intensity and demonstrates peripheral nodular discontinuous enhancement which progressively fills in, compatible with a hepatic hemangioma.Otherwise the liver is normal in morphology signal intensity and enhancement.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The left hepatic 2.4 cm lesion demonstrates imaging characteristics of a hepatic hemangioma.