Instruction: Generate impression based on findings.

Input: 61 year old woman with history of HTN, DM, HL, TIA, CAD with previous LAD stents (2005 and 2015), with ongoing atypical chest pain and shortness of breath, now referred for vasodilator cardiac MRI perfusion study.MEDICATIONS: aspirin, ticagrelor, fish oil, metformin, glyburide, crestor, HCTz-triamterene First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 74 ml/m2 (normal range: 65+/-11), the LVEDV is 164 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10), the LV mass index is 46 g/m2, and the LV mass is 102 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. 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 79 ml/m2 (normal range 69+/-14), the RVEDV is 174 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 86 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. 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 trivial tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no significant pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 51%).5. Mild mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Benign intracranial hypertension [G93.2], Reason for Study: ^Reason: assess for subarachnoid hemorrhage, pituitary abnormality History: CT concerning for pituitary hemorrhage, headache and neck pain 26 years Female (DOB:6/20/1990)Reason: assess for subarachnoid hemorrhage, pituitary abnormality History: CT concerning for pituitary hemorrhage, headache and neck painPROVIDER/ATTENDING NAME: NAVNEET CHEEMA There is no evidence of acute ischemic or hemorrhagic lesion.Smooth linear enhancement of thickenings on post gadolinium enhancement without associated with small ventricle size or sagging of brainstem. These findings indicate either pachymeningeal irritation such as post lumbar puncture status, pachymeningitis or intracranial hypotension. Considering the patient recent history of a lumbar puncture with CSF drainage, this finding is not unexpected.The pituitary gland is measured about 11.1mm (right to left) x 10.3 mm (craniocaudal) with a homogeneous enhancement. There is no MRI evidence of pituitary gland hemorrhage. At this age female, these findings are within normal limits.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Diffuse pachymeningeal enhancement is seen most likely reflect recent lumbar puncture with CSF drainage.2. No evidence of acute ischemic or hemorrhagic lesion.3. No evidence of pituitary hemorrhage.


Instruction: Generate impression based on findings.

Input: Chiari, syrinx, and fatty filum: 6 month follow up with worsening back pain. Cervical Spine: The cerebellar tonsils have a pointed morphology and extend up to approximately 15 mm inferior to the foramen magnum. There is an intact, albeit slightly narrowed column of biphasic cerebrospinal fluid flow across the anterior aspect of the foramen magnum, while there is blunted cerebrospinal fluid flow across the posterior aspect of the foramen magnum. There is interval increase in size of the caliber of the septated syrinx at the C5 through C7 level, measuring up to 8 mm in the anteroposterior dimension, previously 4 mm. Lumbar Spine: There is no evidence of fibrofatty filum terminale or other mass lesions in the spine. There is partially-imaged syringohydromyelia in portions of the thoracic spinal cord. The conus medullaris is situated at the L1 level. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Findings compatible with Chiari type 1 malformation with pointed cerebellar tonsils that extend up to approximately 15 mm inferior to the foramen magnum. 2. Interval increase in size of the cervical syrinx. The thoracic syringohydromyelia is otherwise only partially-imaged.3. No evidence of fibrofatty filum terminale.


Instruction: Generate impression based on findings.

Input: 9-year-old male with history of right lateral ventricular tumor (low grade astrocytoma) complains of occipital head pain more to touch and not headache. Evaluate for infection or abnormality. CSF-density cyst is again seen in the right parietal lobe. It measures approximately 4.7 x 5 cm in greatest axial dimension; measuring approximately 4.4 x 4 cm on prior MRI from 2008. The size and configuration of the ventricles and basal cisterns are unchanged. There is no evidence of intracranial hemorrhage, mass or edema. Right intracranial catheter is again seen in the extra-axial space on the right with tip at the level of the right sylvian fissure. Thinning of the right parietal skull reflects old craniotomy. The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Slight enlargement of CSF-density cyst in the right parietal lobe. Otherwise, stable postsurgical changes as above. Please note that lack of IV contrast limits evaluation for infection.


Instruction: Generate impression based on findings.

Input: Reason: eval for labral pathology History: pain ACETABULAR LABRUM: Linear defect in the anterior superior labrum likely represents a small tear.ARTICULAR CARTILAGE AND BONE: Focus of low T1 and T2 signal within the femoral head likely represents bone island. Otherwise, no abnormal marrow signal. Small osteophytes are again seen and likely indicate mild osteoarthritis.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small anterior superior labral tear with mild osteoarthritis.


Instruction: Generate impression based on findings.

Input: Male, 21 years old, with right upper extremity plegia. Evaluate C1-C5 intramedullary lesion. An expansile, heterogeneously T2 hyperintense lesion is present within the spinal cord. This lesion expands the cord such that it fills the spinal canal. The lesion appears to extend from the C1-C5 level and measures at least 68 mm in craniocaudal length and 17 x 12 mm in maximal transaxial dimension. Less intense tapering T2 signal abnormality extending superiorly and inferiorly from the lesion may represent edema.The internal texture of the lesion suggests areas of heterogeneous tissue potentially with some foci of liquefaction or cyst formation. On postcontrast images, faint rim enhancement is seen along the lesion's superior aspect. On gradient echo images, there is the suggestion of susceptibility effect at the inferior pole of the lesion which may represent a hemosiderin cap.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow signal or enhancement is seen. The intervertebral discs are preserved. No areas of extrinsic spinal canal or neuroforaminal encroachment are seen.

Output: An expansile masslike lesion is evident within the cervical spinal cord. The core of the lesion appears to extend from C1 down to C5, with tapering signal abnormality above and below the lesion potentially representing edema.The differential diagnosis would include a primary tumor of the spinal cord. The imaging features of the lesion and the age of the patient favor ependymoma, though astrocytoma would still be in the differential diagnosis. An inflammatory or demyelinating process is considered unlikely. However, imaging of the brain and the remainder of the spine may provide additional information.


Instruction: Generate impression based on findings.

Input: Clinical question: Possible. Signs and symptoms: Fall Nonenhanced CT of brain:There is no evidence of acute post traumatic intracranial findings.Findings consistent with minimal small vessel disease of indeterminate age is noted.Cortical sulci, ventricular system and CSF cisterns remain within normal for patient of stated age of 87. Large vessel intracranial calcification of carotid and vertebral arteries are noted.Limited view of paranasal sinuses and mastoid air cells are unremarkable.Gadolinium demonstrate a large area of low attenuation within the marrow space in the right frontal lobe with suspected area also thinning of the inner cortex of right frontal bone. There is no associated epidural component with this finding. Findings could represent fibrous dysplasia however less likely possibility of a metastatic lesion cannot be entirely ruled out. There are no additional foci of abnormality of calvarium. This finding can be further evaluated either by a nuclear medicine study or a dedicated MRI of brain with enhancement.

Output: 1. No evidence of post traumatic findings of intracranial space or the calvarium.2.Findings consistent with minimal small vessel disease of indeterminate age.3.Large area of lytic change involving the right frontal bone which may represent fibrous dysplasia and less likely possibility of a metastatic lesion cannot be entirely ruled out. Follow up with neck medicine bone scan or an MRI of brain with enhancement is recommended.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: stroke, Demyelinating disease.Signs and Symptoms: complicated neuro symptoms x 1 month, right sided weakness, vertiginous symptoms, R pronator drift The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 66-year-old male with a 4 cm firm nodule distal to the medial malleolus. Differentiate between a ganglion cyst versus epidermoid cyst. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The deltoid ligament appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormalities identified. ADDITIONAL

Output: Nonspecific 3.4 cm heterogeneous mass with thick nodular and septal enhancement as described above, which does not have the appearance of a simple cyst or ganglion, as clinically questioned. Neoplasm cannot be excluded by this examination.


Instruction: Generate impression based on findings.

Input: Reason: shoulder pain, stiffness History: shoulder pain, stiffness ROTATOR CUFF: There is intermediate signal intensity within the distal supraspinatus indicating mild tendinosis. There is superficial fraying of the bursal surface fibers of the supraspinatus. No fluid-filled tear is identified. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No intra-articular gadolinium or fluid is identified within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is slight posterior translation of the humeral head relative to the glenoid. There is heterogeneity and intermediate signal intensity within the superior and anterior glenoid labrum likely representing a combination of postsurgical change and degeneration/degenerative tearing. Multiple foci of signal void are identified in the surrounding area which are presumably postsurgical in etiology. Intra-articular gadolinium enters the anterior superior labrum at the 2 o'clock position in a branching configuration indicating a re-tear. There is also intra-articular gadolinium identified entering the superior labrum indicating a re-tear. There is a full-thickness articular cartilage fissure affecting the cartilage of the glenoid, centrally. There is cyst formation in the superolateral humeral head.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Postsurgical changes of prior glenoid labrum repair with findings indicating a re-tear of the anterior and superior glenoid labrum as described above. 2. Mild tendinosis of the rotator cuff without evidence of a full-thickness rotator cuff tear or retraction.


Instruction: Generate impression based on findings.

Input: 67-year-old male with a right forearm mass in the lateral part of the arm. BONE MARROW: No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: The imaged musculature of the forearm is normal in appearance.ADDITIONAL

Output: Prominence of the subcutaneous fat along the anterior aspect of the right forearm most consistent with a benign lipoma. Otherwise, no focal mass lesion is identified.


Instruction: Generate impression based on findings.

Input: The ventricles, sulci, and cisterns are maintained and unremarkable. There is no mass, mass effect, midline shift, or abnormal focus of enhancement. Expected vascular flow voids are demonstrated. The paranasal sinuses and mastoid air cells are clear.

Output: Negative brain MRI with and without contrast utilizing preoperative DBS protocol.


Instruction: Generate impression based on findings.

Input: Assess aneurysm for stability: nasopharyngeal cancer, microhemorrhage versus mets. MRI: There are numerous unchanged subcentimeter non-enhancing lesions with associated susceptibility effect. There is no associated edema with the lesions. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small amount of fluid in the right mastoid air cells. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is no evidence of tumor in the nasopharyngeal region, although the imaging is not optimized for assessment of that region.MRA: There is an unchanged 3 mm diameter posteromedially directed right aneurysm arising from the anterior genu of the internal carotid artery. There is no evidence of significant steno-occlusive lesions.

Output: 1. Numerous unchanged subcentimeter non-enhancing lesions with associated susceptibility effect likely represent cavernous malformations or chronic microhemorrhages.2. Unchanged 3 mm diameter posteromedially directed right aneurysm arising from the anterior genu of the internal carotid artery.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: Headache in the setting of immunosuppressor use History: as above 46 years Female (DOB:2/17/1970)Reason: Headache in the setting of immunosuppressor use History: as abovePROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY There is no evidence of acute ischemic or hemorrhagic lesion. There is no evidence of abnormal enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids of major intracranial vasculature are present.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. Prosthetic eye on the left side.

Output: MRI of the brain is within normal limits.Specifically, there is no evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with history of metastatic breast cancer. Multiple, at least seven, enhancing masses are evident along the surface of the bilateral cerebral hemispheres. These lesions range in size from 5 mm up to 20 mm in diameter. They induce minimal if any edema in the surrounding parenchyma. On comparison with prior examination from 2013, these lesions are all new.No evidence of any suspicious parenchymal signal abnormality or pathologic enhancement is seen in the supratentorial brain. No pathologic enhancement of the cranial nerves is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is patent and normal in size.

Output: Multiple, at least seven, metastatic lesions are evident along the surface of the cerebellum, all of which are new when compared to the prior examination from 2013.


Instruction: Generate impression based on findings.

Input: Female, 31 years old, with worsening headaches and visual disturbances. Family history of aneurysm. Patient is a surgical candidate if a lesion is detected. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.MRA images demonstrate normal flow related signal within the intracranial vessels. No significant vascular stenosis or occlusion is seen. No aneurysms are detected within the limitations of technique.The ACOM artery is moderately sized and normal. A small right PCOM artery and a moderately sized left PCOM artery are present.

Output: 1.Unremarkable MRI evaluation of the brain with no specific findings to account for the patient's symptoms.2.Unremarkable MRA evaluation of the brain. No aneurysm or other vascular malformation is detected.


Instruction: Generate impression based on findings.

Input: Left breast lumpectomy for an ADC. Now presents with recurrent right chest wall moderately differentiated adenocarcinoma. Pay particular attention to right anterior lateral chest wall mass and metastatic workup. CHEST:LUNGS AND PLEURA: One mild interstitial opacity in the right apex and in the subpleural left anterior chest consistent with scarring.MEDIASTINUM AND HILA: Small thyroid cyst in the left lobe.Moderately enlarged lower right paratracheal lymph node with a short axis measurement of 18 mm.Extensive and severe coronary artery calcification.CHEST WALL: Focal enhancing nodular lesion in the subcutaneous tissues of the right anterior chest wall at the level of the clavicle on image 17/140 measuring 10 x 18 mm, consistent with a metastasis.Low density, probably necrotic lymph node, best seen on the coronal sections on image 59/119, measuring 14 x 26 mm.Right Mammoplasty.Surgical clips in the left breast and skin thickening.Kyphosis with associated degenerative disease but no visible skeletal metastases.ABDOMEN:LIVER, BILIARY TRACT: Multiple well-defined hypodense hepatic lesions compatible with cysts, and a large partially loculated lesion with slightly ill-defined margins measuring 27 x 37 mm on image 73/40.. This may represent an atypical cyst but further imaging with PET or MRI would be necessary to exclude a metastasis with confidence.Moderate dilation of intrahepatic ducts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nodular enlargement of the right adrenal gland measuring 16 x 18 mm on image 84/140.KIDNEYS, URETERS: Multiple bilateral renal cysts.PANCREAS: Multiple large cysts in the head, body and tail of the pancreas of uncertain etiology, possibly due to intraductal capillary mucinous neoplasms , though probably benign.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. Enhancing subcutaneous lesion in the right anterior chest wall with a locally necrotic enlarged lymph node, consistent with metastases.2. Additional indeterminate abnormalities in the abdomen as detailed above.


Instruction: Generate impression based on findings.

Input: Parkinson's disease with tremor. Preoperative planning MRI. There is an anterior left frontal lobe developmental venous anomaly. There is a punctate focus of high signal on the post-contrast T1-weighted image with associated susceptibility effect in the inferior left pons. There is mild scattered cerebral white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the right sphenoid sinus. The skull and scalp soft tissues are grossly unremarkable. There is a right lens implant. There is a large retrodental pannus with compression of the upper spinal cord. There is apparent fluid within the inferior left mastoid air cells.

Output: 1. Mild scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent small vessel ischemia.2. A punctate focus of high signal on the post-contrast T1-weighted image in the inferior left pons may represent a telangiectasia, for example. 3. Anterior left frontal lobe developmental venous anomaly.4. Large retrodental pannus with compression of the upper spinal cord. 5. Fluid within the right sphenoid sinus may represent acute sinusitis.


Instruction: Generate impression based on findings.

Input: 37-year-old male patient with left knee pain status post injury two weeks ago. Assess for medial meniscal tear. MENISCI: The medial and lateral menisci appear grossly intact.ARTICULAR CARTILAGE AND BONE: There is marked thinning of the lateral patellar facet articular cartilage, with mild underlying bone edema, and fraying of the adjacent medial patellar facet. There is fraying/thinning of the femoral trochlear articular cartilage. There is heterogeneous signal within the anterior weightbearing portion of the lateral femoral condyle articular cartilage indicating degeneration with generalized thinning.Bone marrow edema is present within the posterior aspect of the medial femoral condyle and to a lesser degree the posterior aspect of the medial tibial plateau. Small tricompartmental osteophytes are noted.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. Popliteus muscle and tendon are intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Bone contusion of the medial compartment.2. Chondromalacia predominately affecting the patellofemoral compartment.3. Possible loose body.4. Intact ligamentous and meniscal structures.


Instruction: Generate impression based on findings.

Input: Incidental right adrenal mass. History of Barrett's esophagus and Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule measuring 1.9 x 1.2 cm has intrinsic T1 weighted signal hyperintensity on precontrast imaging. No loss of signal on out of phase imaging, macroscopic fat or significant postcontrast enhancement. The enhancement peripheral to the lesion is felt to represent normal adrenal parenchyma. On the outside hospital study 2/18/2015 there was no right adrenal lesion. On 3/6/2016 the nodule appeared mildly heterogenous and hyperattenuating measuring 2.5 cm.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lower thoracic vertebral body hemangioma. OTHER: No significant abnormality noted.

Output: Nonenhancing intrinsically T1 weighted hyperintense right adrenal nodule now measures 1.9 cm, decreased from prior, findings favoring adrenal hemorrhage. Consider follow-up CT or MRI in 3-6 months to document resolution/reduction.


Instruction: Generate impression based on findings.

Input: 86-year-old male with history of renal cell carcinoma ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintensities are unchanged and likely benign. Cholelithiasis without MR evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy and partial left nephrectomy. T2 hyperintense cysts are noted in the left kidney, unchanged. No evidence of recurrent disease in the surgical beds. Examination is mildly limited due to susceptibility artifact in the right paravertebral surgical bed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes from right nephrectomy and partial left nephrectomy without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Female 56 years old Reason: evaluate bilary ducts History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology but slightly enlarged. No suspicious hepatic lesions. Hepatic and portal veins are patent. Status post cholecystectomy. Common bile duct is dilated measuring 14 mm.SPLEEN: No significant abnormality noted.PANCREAS: Findings of severe chronic pancreatitis which distorts the underlying pancreatic duct. The pancreatic duct is dilated and multiple segments measuring up to 8 mm in the head of the pancreas. There are multiple calculi within the pancreatic parenchyma. There is a small collection in the pancreatic tail likely representing a pseudocyst measuring 2.1 cm. There is moderate inflammation involving the pancreas and its surroundings.The splenic vein is thrombosed. The superior mesenteric vein is thrombosed at the porta splenic confluence but is reconstituted by collaterals.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophy of the upper pole of the left kidney with mild hydronephrosis. The left renal vein is narrowed as it passes underneath the SMA due to pancreatic inflammation.RETROPERITONEUM, LYMPH NODES: IVC filter is in place.Multiple small peripancreatic lymph nodes.BOWEL, MESENTERY: No bowel obstruction is evident. There are mildly dilated upper abdominal loops of bowel with mild wall thickening possibly due to pancreatitis. No drainable fluid collections.BONES, SOFT TISSUES: Postsurgical changes in anterior abdominal wall.OTHER: Trace upper abdominal ascites.

Output: 1.Findings of a acute on chronic pancreatitis with a small pseudocyst in the pancreatic tail.2.Given the edema and enlargement of the pancreatic parenchyma a more focal neoplasm is not entirely excluded on this exam.3.Occlusion of the splenic vein and superior mesenteric vein near the porta splenic confluence.4.Common bile duct is mildly dilated.


Instruction: Generate impression based on findings.

Input: 64-year-old male with confusion, HPV + SCC of right BOT. There are two small foci of restricted diffusion within the left frontal and left posterior temporal lobe with associated T2/FLAIR hyperintensity and punctate enhancement (series 6, images 13 and 15). There are scattered T2/FLAIR hyperintense foci within the subcortical and periventricular white matter with no associated restricted diffusion or enhancement most consistent with chronic small vessel ischemic disease. Additional punctate focus of T2/FLAIR hyperintensity within the left cerebral hemisphere likely represents prior chronic infarct. No acute intracranial hemorrhage. The CSF spaces are appropriate for patient age without mass effect or midline shift.The imaged orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Two small foci of restricted diffusion with associated T2/FLAIR hyperintensity and punctate enhancement are nonspecific and could represent small metastases, although small ischemic lesions could potentially also enhance in the subacute phase. Close interval follow-up is recommended. 2. Chronic small vessel ischemic disease within the subcortical and periventricular white matter without evidence of acute ischemic infarction. Focus of T2/FLAIR hyperintensity within the left cerebellar hemisphere likely sequelae of chronic infarct.


Instruction: Generate impression based on findings.

Input: pt with bladder cancer; possible metastatic lesion to T12 that requires a biopsy for definitive result . Benign compression fracture versus malignancy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: T12 vertebral bone biopsy under CT guidance. A total of five samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: 37 year old female with autoimmune hepatitis. Status post liver transplant in 1988. Prolonged hospital stay with EGD on 1/15 showing multiple ulcers in the duodenum and jejunum. Evaluate for bowel ischemia. Also with laboratory findings suggestive of pancreatitis. ABDOMEN: It should be noted that enterography examinations are not tailored for evaluation of the abdominopelvic vasculature.LIVER, BILIARY TRACT: There is no evidence of intra-or extrahepatic biliary ductal dilation. There is diffuse abdominopelvic ascites. Anasarca.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple simple cysts are identified bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening of multiple loops of jejunum in the left upper quadrant is non specific but may be related to hypoalbuminemia or portal hypertension.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: It should be noted that enterography examinations are not tailored for evaluation of the abdominopelvic vasculature.UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening of the multiple loops of jejunum in the left upper quadrant is non specific but may be related to hypoalbuminemia or portal hypertension.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Wall thickening of multiple loops of small bowel in the left upper quadrant is nonspecific but may be related to hypoalbuminemia or portal hypertension, however, it should be noted that this enterography examination is not tailored for the evaluation of abdominopelvic vasculature.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with history of stroke. Concern for movement disorder. Assess for lesions. No evidence of restricted diffusion is seen. Scattered small foci of parenchymal FLAIR hyperintensity are seen, along with more confluent hyperintensity at the ventricular atria. No edema or mass effect is detected. A small slitlike focus of encephalomalacia is seen within the right cerebellum. The ventricles and sulci are slightly prominent compatible with parenchymal volume loss. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: 1.No evidence of acute ischemia or any other acute lesions.2.Findings are seen compatible with chronic microvascular ischemia, and a small chronic stroke in the right cerebellum.


Instruction: Generate impression based on findings.

Input: As seen on CT from earlier the same date, there are diffuse osseous metastatic lesions throughout the spine with signal abnormalities most consistent with a sclerotic foci identified previously. In the cervical spine, there are multiple posterior disc osteophyte complexes and scattered metastatic lesions, which partially efface the spinal canal, but do not cause direct mass effect on the cord and there is no signal abnormality in the cervical spine. In the thoracic spine there are multilevel metastatic lesions, most notably at T3 and T8 where there is significant marrow infiltration and cortical expansion. There is collapse of the T3 vertebral body with extrusion of the T2-3 disc as well as cortical retropulsion, causing mass effect on the ventral cord and cord T2 hyperintensity at this level. There is involvement of the posterior elements at T3. CSF is effaced at this level resulting in central stenosis, however sagittal STIR technique demonstrates a tiny amount of residual CSF posteriorly.There is also direct extension of metastatic disease via cortical expansion into the posterior elements at the T8 level with direct extradural metastatic invasion into the ventral spinal canal resulting in mass effect on the cord and resultant cord T2 hyperintensity. Overall the cord is displaced posteriorly by this mass effect and is compressed against the posterior epidural fat, which is maintained, without compression against osseous elements. Additional metastatic lesions and resultant canal narrowing are also seen at L1-2 L3-4 and L4-5. Multiple renal cysts are better evaluated on same-day CT.

Output: 1.Multilevel osseous metastatic disease.2.There is collapse of the T3 vertebral body with extrusion of the T2-3 disc as well as cortical retropulsion, causing mass effect on the ventral cord and cord T2 hyperintensity at this level. CSF is effaced at this level resulting in central stenosis, however sagittal STIR technique demonstrates a tiny amount of residual CSF posteriorly.3.There is direct extension of metastatic disease via cortical expansion into the posterior elements at the T8 level with direct extradural metastatic invasion into the ventral spinal canal resulting in mass effect on the cord and resultant cord T2 hyperintensity. Overall the cord is displaced posteriorly by this mass effect and is compressed against the posterior epidural fat, which is maintained, without compression against osseous elements. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old male with history of lung and larynx cancer. Had resection of lung and larynx, XRT. Recurred in the larynx and had salvage laryngectomy with free flap. Assess for possible recurrence versus new cancer. He CT of the soft tissues of the neck without contrast:Images through the skull base and including the region of cavernous sinuses, all paranasal sinuses and mastoid air cells remain unremarkable.Images through the neck demonstrate heavy calcification of the carotid bifurcations bilaterally. Post operative changes on the right side of the neck with multiple clips are noted. Extensive postoperative changes of laryngectomy is noted. Postoperative changes of midline free flap placement.No evidence of a mass or pathologic adenopathy neck.Limited images of the apices of the lungs and mediastinum demonstrate minimal apical scarring and emphysematous changes. Please review the dictated report of CT of chest which demonstrates both these regions with better advantage. Bony structures of the area of the exam are negative for metastatic lesions.CT of brain without the infusion:Large vessel intracranial vascular calcification is noted. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal for patient stated age. Calvarium demonstrates multiple areas of sclerotic change which were present on the prior examination from T. -- 6/2009 and read no interval change. To exclude metastatic lesion and MRI or bone scan is recommended.

Output: 1.Negative non-a diffuse CT of soft tissues of the neck for recurrence of disease.2.Negative CT of brain without infusion.3.Multiple patchy areas of the sclerotic changes of calvarium is stable since prior multiple studies. To exclude metastases nuclear medicine study or MRI is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stroke, edema. Signs and symptoms: Worsened hypertension and bradycardia. Nonenhanced brain MRI:There is no detectable acute intracranial process and diffusion weighted images are negative.Extensive confluent periventricular and mildly subcortical nonspecific FLAIR hyperintensity of the white matter is noted. There is resultant mild ex vacuo dilatation of the lateral ventricles.Minimal similar signal changes in bilateral basal ganglia and pons is also noted. Findings are nonspecific however at this age group off and represent microvascular ischemic changes.No detectable cortical signal abnormality and unremarkable bilateral cerebellum and vermis.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process and negative diffusion-weighted images.2.Extensive periventricular and to a lesser degree bilateral basal ganglia and pontine FLAIR hyperintensity suggestive of advanced chronic nonhemorrhagic small vessel ischemic strokes as detailed.


Instruction: Generate impression based on findings.

Input: Pelvic pain. Negative ultrasound. PELVIS:UTERUS, ADNEXA: Anteverted anteflexed uterus measuring 5.8 x 3.1 cm in the sagittal plane.The myometrium is normal in thickness measuring 2 mm.The endometrial and inner myometrial/junctional zone interface is unremarkable. The inner myometrium/junctional zone measures 8 mm (normal is < 8 mm; indeterminate 8-12 mm), non-specific and of doubtful significance. No T2 hyperintense foci or focal lesion is noted.The outer myometrium is unremarkable.No uterine mass is present.The cervical signal intensity is unremarkable. The vaginal canal is unremarkable.The parametrial soft tissues are unremarkable.The ovaries are atrophic and difficult to visualize, appropriate for the patient's age without an adnexal mass lesion evident. The left ovary measures approximately 2.1 x 1.0 cm.BLADDER: Partially distended urinary bladder without a focal abnormality evident.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Nonspecific junctional zone thickness of 8 mm does not meet criteria for adenomyosis. No uterine or adnexal mass.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma Again seen are multiple enhancing masses within the subcutaneous tissues overlying the posterior calf. When compared to the prior exam, these have increased in size and has become somewhat confluent in nature and as a result, direct comparison/measurement is difficult. However, the medial-most lesion now measures 1.5 x 1.8 cm as compared to 1.2 x 1.2 cm, the middle lesion measures 2.8 x 3.4 cm as compared to 1.4 x 1.6 cm, and the lateral-most mass measures approximately 2 x 2.8 cm as compared to 2.2 x 1.3 cm. An area of skin thickening and enhancement slightly superior to these masses also appears larger. No new discrete foci of enhancement are identified. There is mild subcutaneous edema in the region of the masses.Marrow edema involving the medial tibial plateau appears improved from the prior exam and is likely degenerative in nature. The remaining marrow signal of the tibia and fibula is otherwise normal.

Output: Interval increase in size of multiple enhancing masses within the subcutaneous tissues of the posterior calf consistent with progression of disease.


Instruction: Generate impression based on findings.

Input: Knee pain and swelling MENISCI: Again seen is abnormal intrasubstance signal intensity within the posterior horn and body of the medial meniscus that appears to contact the tibial articular surface, perhaps representing a chronic tear. This appears similar to the prior exam. There is attenuation/deformity and increased signal intensity involving much of the lateral meniscus which has progressed from the prior exam, and there now appears to be a large, radially oriented gap involving the body of the meniscus. These findings may reflect progression of tearing, interval partial meniscectomy changes, or combination of the two. ARTICULAR CARTILAGE AND BONE: There has been progression of cartilage loss in the lateral compartment with much of the weightbearing surface of both the lateral tibial plateau and lateral femoral condyle now devoid of cartilage. Although the articular cartilage of the medial tibiofemoral compartment is relatively spared, there is at least one new small focal full-thickness defect along the medial femoral condyle. There are tricompartmental osteophytes with progression of osteophyte formation along the medial femoral trochlea and loss of the overlying articular cartilage. Subchondral cysts within the tibial plateau appear similar to the prior exam.LIGAMENTS: The ACL is thickened and poorly defined which is suspected to represent progression of mucoid degeneration with associated cyst formation in the intercondylar eminence of the tibia. The PCL, MCL, and LCL appear intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Progression of tricompartmental osteoarthritis.2. Lateral meniscus abnormalities suggesting progression of tearing, partial meniscectomy changes, or a combination of both.3. Medial meniscal abnormalities suggesting chronic undersurface tearing which appears unchanged from the prior exam.4. Progressive mucoid degeneration of the ACL.5. Joint effusion with findings indicative of prior hemarthrosis.6. Other findings as above.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits without spondylolisthesis. Vertebral body heights are preserved. A few scattered foci of increased T1 and T2 signal within the bone marrow are compatible with small hemangiomas and/or focal fat deposition without suspicious focal lesions. There is mild-moderate loss of disc height at L1-L2 with small anterior osteophytes at this level. Multiple discs are desiccated. The visualized spinal cord displays normal signal and morphology. The tip of the conus is at L1-L2. The paravertebral soft tissues are grossly unremarkable.T12-L1: No significant central canal or foraminal stenosis.L1-L2: Mild disc bulge without significant central canal or foraminal stenosis.L2-L3: Minimal disc bulge without significant central canal or foraminal stenosis.L3-L4: Minimal disc bulge without significant central canal or foraminal stenosis.L4-L5: Mild disc bulge. Mild ligamentum flavum and facet hypertrophy. Mild bilateral foraminal stenosis. No significant central canal stenosis.L5-S1: Mild disc bulge which causes partial effacement of the bilateral lateral recesses and abuts the bilateral S1 nerve roots. Mild facet hypertrophy. No significant central canal stenosis. Minimal bilateral foraminal stenosis.Incidental note is made of conjoined S2-3 nerve roots on the right.

Output: Mild degenerative changes as described above including mild disc bulge at L5-S1 which abuts the bilateral S1 nerve roots in the lateral recess, and mild bilateral L4-L5 neural foraminal stenosis. Otherwise no significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Cervical spine:Alignment is normal. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes and there are no stenoses.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There is no abnormal enhancement. There are no significant degenerative changes and there are no stenoses.

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


Instruction: Generate impression based on findings.

Input: Mass in left side of hard palate. History of neurofibromatosis type 1. There is a nodular, enhancing, exophytic lesion in the left hard palate region that measures up to 23 mm in width and 8 mm in thickness. There are numerous, generally subcentimeter skin lesions, which likely represent neurofibromas. A cluster of T2 hyperintense enhancing nodules in the left supraclavicular region also likely represent neurofibromas. There are partially-imaged postoperative findings in the upper back dermal tissues. There is no significant cervical lymphadenopathy. The major salivary glands are unremarkable. There is a subcentimeter left thyroid cyst. There is mild multilevel degenerative cervical spondylosis. There appear to be multiple dental caries and periodontal inflammation. The imaged portions of the orbits and intracranial structures are unremarkable.

Output: A left hard palate region mass may represent a peripheral nerve sheath tumor in the setting of neurofibromatosis type 1. Alternative potential differential considerations include a pyogenic granuloma and minor salivary gland neoplasm.


Instruction: Generate impression based on findings.

Input: Reason: Possible AVN 4th metatarsal History: TTP about 4th metatarsal Note is made of a linear focus of decreased signal abnormality traversing the tuberosity of the base of the fifth metatarsal indicating a nondisplaced fracture. There is a small amount of bone marrow edema in the surrounding area. Additionally, note is made of a lesion within the proximal fourth metatarsal which demonstrates increased signal abnormality on T2-weighted images and decreased signal abnormality on T1-weighted images likely representing an enchondroma, although this is incompletely characterized on this noncontrast examination. A skin marker is identified and the overlying area, presumably corresponding to the patient's area of concern. There is minimal associated endosteal scalloping. No definite cortical destruction is identified. No definite fracture is identified within the fourth metatarsal. The imaged musculature of the right foot is within normal limits. The flexor and extensor tendons appear intact. Mild osteoarthritis affects the imaged midfoot articulations.

Output: 1. Nondisplaced fracture through the base of the fifth metatarsal as described above.2. Lesion within the base of the fourth metatarsal likely represents a benign enchondroma. However, CT examination is recommended for further characterization, particularly given the stated history of fourth metatarsal pain. 3. Osteoarthritis of the midfoot.


Instruction: Generate impression based on findings.

Input: 29-year-old with history of radical prostatectomy with persistently elevated PSA. Positive bladder neck surgical margin and positive lymph node. PELVIS:PROSTATE:Status post prostatectomy. There are small foci of susceptibility in the resection bed which is an expected postoperative finding. No definite residual enhancing soft tissue to indicate local recurrence.Seminal Vesicles: Surgically absent.BLADDER: Moderate bladder distention without bladder wall thickening or trabeculation.LYMPH NODES: There is a mildly prominent enhancing left common iliac lymph node which measures 7 x 10 mm, (series 1501 image 114). There are scattered normally sized inguinal and low pelvic lymph nodes.BONES, SOFT TISSUES: No focal suspicious lesion.OTHER: No significant abnormality noted.

Output: 1.Postoperative changes from radical prostatectomy without evidence of residual enhancing tumor to indicate local recurrence.2.Enhancing left common iliac lymph node as described above. This is nonspecific, but additional follow-up is warranted.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of elevated PSA and prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 2.6 x 4.0 x 3.7 cmPeripheral Zone: In the left peripheral mid gland there is a T2 hypointense lesion with corresponding restricted diffusion measuring 10 x 7 mm (image 16 of series 801).Central Gland: BPHSeminal Vesicles: No significant abnormality noted.Extracapsular Extension: Lesion touches capsule.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suspicious focus in the left peripheral midgland as above.


Instruction: Generate impression based on findings.

Input: Female, 44 years old, with low back pain and bilateral leg pain. Alignment is anatomic. Vertebral body morphology is within normal limits. A mildly transitional morphology of the L5 vertebral body is seen. No concerning marrow replacement or marrow edema is detected.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. The conus tip terminates at the lower L2 level which is within normal limits. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L3-4: Moderate facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L4-5: Moderate to severe facet arthropathy and ligamentum flavum thickening. Small cystic structures are evident adjacent to the left facet joint which may be synovial in nature. Disc height is preserved but there is some loss of disc T2 signal. A mild disc bulge is seen with a small superimposed left foraminal protrusion and annular fissure. No significant spinal canal stenosis. The left neural foramen is mildly narrowed. L5-S1: Advanced facet arthropathy and ligamentum flavum thickening. Disc height is preserved but there is some loss of disc T2 signal. A mild bulging disc is seen with small superimposed central protrusion. No significant spinal canal stenosis is seen. The neural foramina are mildly narrowed.

Output: 1.At L4-5, there is a mild disc bulge with small superimposed left foraminal protrusion. The left neural foramen is mildly narrowed at this level but there is no significant spinal canal stenosis.2.At L5-S1, there is a mildly bulging disc with small superimposed central protrusion. No significant spinal canal stenosis is seen at this level but the neural foramina are mildly narrowed.3.Facet arthropathy is seen, becoming progressively worse at lower lumbar levels.


Instruction: Generate impression based on findings.

Input: Velo-cardio-facial syndrome and hypopituitarism (growth hormone deficiency). 22q11 deletion syndrome. Brain MRI without contrast:Craniofacial ratio suggests microcephaly. Otherwise, the brain shows no acute infarct or hemorrhage and the myelination is appropriate for age. The ventricles and other CSF-containing spaces are normal in size. There is no mass-effect or midline shift. The major intracranial vascular flow voids are preserved.The adenoids are enlarged, as well as the palatine tonsils. In addition, there are prominent lymph nodes in the upper neck, including the retropharyngeal region. These are probably reactive. There is no gross orbital abnormality. There is mild mucosal thickening in the paranasal sinuses, which is nonspecific.Pituitary MRI without and with contrast:The pituitary bright spot is preserved. The pituitary gland has a maximum height of 4 mm and a concave superior border, which is slightly, focally more concave to the left of the pituitary infundibulum insertion. While this may represent a normal variation, mild extrinsic compression by a small arachnoid cyst can also give a similar appearance. The pituitary tissue is homogenous without focal lesion. The pituitary infundibulum is of normal thickness and midline. The cavernous sinuses are unremarkable as well as the Meckel's caves. The optic canal is normal.

Output: 1.Normal brain MRI apart from suggestion of small head size, which is better assessed clinically.2.The pituitary gland shows subtle focal asymmetric concavity to its superior border, to the left of the infundibulum, which may reflect a normal variation but could possibly reflect extrinsic compression by a small arachnoid cyst. The pituitary gland is otherwise unremarkable in signal characteristics, pattern of contrast enhancement as well as overall volume.


Instruction: Generate impression based on findings.

Input: 71-year-old female with incidental finding of thyroid calcification on MRI neck exam. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 2.3 x 5.8 x 2.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 2.1 x 5.7 x 2.1 cm.ISTHMUS MEASUREMENTS: The isthmus measures 3.5 cm in thickness.RIGHT LOBE: Multinodular heterogenous appearance of the right thyroid lobe. The dominant nodule is located in the right lower pole measuring 3.2 x 2.5 x 2.5 cm and contains a internal focal calcification. Additional nodules are also noted including a posterior mid pole isoechoic nodule measuring 1.3 x 1.2 x 1.1 cm.LEFT LOBE: Multinodular heterogenous appearance of the left thyroid lobe. The dominant nodule on the left has a heterogenous solid and cystic appearance measuring 2.3 x 1.8 x 1.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy.OTHER: No significant abnormality noted.

Output: Multinodular thyroid goiter. The dominant nodule is in the right lower pole measuring at least 3 cm in size and contains internal hyperechoic focus compatible with calcification. This nodule is amenable to percutaneous biopsy.


Instruction: Generate impression based on findings.

Input: Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified [R93.0] / Migraine with aura, not intractable, without status migrainosus [G43.109], Reason for Study: ^Reason: please compare to prior, please do Dr. Javed MS protocol, c Motion artifacts degraded exam quality.There are multifocal bihemispheric scattered high signa intensity white matter lesions on FLAIR images including bilateral frontal lobe, parietal lobe and corpus callosum, overall no change since prior scan in terms of size, number and signal intensity level.There is 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, 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: Multifocal scattered bihemispheric and corpus callosum high FLAIR high signal intensity lesions indicating demyelinating disease, no change in terms of size, number of lesions and MR signal characteristics since prior scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, bilateral lower extremity neuropathy. History of spinal stenosis and DJD. Cervical:The cervical adenosis is exaggerated. Vertebral body alignment is otherwise unremarkable. No evidence of worrisome marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology.C2-3: Unremarkable. C3-4: Mild posterior disc osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing. C4-5: Mild posterior disc osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing. C5-6: Posterior disc osteophyte formation resulting in a mild narrowing of the spinal canal and at least moderate bilateral foraminal narrowing. C6-7: Facet hypertrophy. Mild posterior disc osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing. C7-T1: Unremarkable. Thoracic:The thoracic kyphosis is mildly exaggerated. Alignment is unremarkable. Vertebral body height and morphology are normal. No concerning marrow replacement or evidence of marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology throughout.Small disc protrusions are evident at T1-2, T2-3 and T7-8. These result in no significant spinal canal or neuroforaminal stenosis.Lumbar:The lumbar lordosis is straightened and there is a mild scoliotic curvature to the lower lumbar spine. Vertebral body heights are preserved. Marrow signal characteristics are diffusely heterogeneous but benign in appearance. No evidence of significant marrow edema is seen.The visualized conus is unremarkable. Details of the cauda equina will be discussed below.Loss of disc height is evident from L2-3 through L4-5. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Facet hypertrophy and ligamentum flavum thickening. Moderate bulging disk. Moderate spinal canal narrowing with slight crowding of the cauda equina nerve roots. Mild bilateral foraminal narrowing. L3-4: Postoperative findings perhaps representing prior laminectomy. Facet hypertrophy. Mild bulging disk. Mild generalized spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. L4-5: Facet hypertrophy, worse on the left. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening with perhaps a small ligamentum cyst on the left. Mild bulging disk. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. Atherosclerotic irregularity and some ectasia of the distal aorta is seen.

Output: 1.Relatively mild degenerative findings in the cervical and thoracic spine with no areas of significant spinal canal or neuroforaminal stenosis.2.More significant degenerative disease in the lumbar spine with scattered mild-to-moderate spinal canal stenosis, most severely affecting L2-3, and mild to moderate foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Reason: 66 year old female with VHL and history of renal cysts; evaluate for size and growth ABDOMEN:LIVER, BILIARY TRACT: The hepatic parenchyma demonstrates geographic areas of decreased signal intensity on out of phase images compatible with hepatic steatosis. A 7 mm simple cyst is present within segment 7 of the liver. No additional focal hepatic lesions are identified. There is no biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in appearance. No masses or cystic lesions are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 5 mm round lesion arising from the cortex of the midpole of the left kidney (series 1002, image 227) which demonstrates isointense signal on T1, decreased signal on T2, and mild enhancement. This lesion may represent a small papillary renal cell carcinoma. Multiple simple cysts are present in both kidneys. The largest in the right kidney is in the lower pole (series 801, image 13) and measures 4.9 x 5.4 cm. Additional subcentimeter simple cysts are present within the right kidney. The largest simple cyst in the left kidney is in the upper pole (series 801, image 7) and measures approximately 1.0 x 1.4 cm. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine including degenerative endplate changes and disc bulges at L2-L3, L3-L4, and L5-S1.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter lesion within the left kidney with features suggestive of papillary renal cell carcinoma.2.Multiple simple renal cysts the largest of which is in the right kidney measuring up to 5.4 cm.3.Hepatic steatosis.Findings discussed with NIELSEN, SARAH at 4:30 PM on 11/17/2015.


Instruction: Generate impression based on findings.

Input: Acute onset left upper extremity and lower extremity weakness. Clinical suspicion of internal capsule/pontine infarct. There are 2 small diffusion restriction lesions along the right frontal corona radiata, which correlates with T1-hypointense, T2-hyperintense signal. The largest measures up to 1.3 cm and extends toward the external capsule. These are compatible with acute/recent infarcts. There is a ring shaped diffusion weighted hyperintensity in the left frontal white-matter with no definite associated ADC abnormality which is equivocal for recent ischemia.In addition, there are multiple small chronic infarcts in the cerebral and brainstem white-matter, deep gray nuclei, and cerebellum as well as confluent and patchy T2-hyperintense signal in the cerebral and brainstem white-matter, which is nonspecific but likely chronic microvascular ischemia. There is no significant mass-effect, midline shift, or brain herniation. There is no acute hemorrhage. Punctate susceptibility effect in the superior aspect of the right thalamus may represent mineralization or chronic blood products. The ventricles and other CSF-containing spaces are mildly enlarged, reflective of mild global brain volume loss. The major vascular flow voids are preserved. The skull, scalp and orbits are grossly unremarkable. There is mild ethmoid mucosal thickening.

Output: 1.Two areas of diffusion restriction along the right corona radiata are compatible with acute/recent white-matter infarcts. A third lesions in the left frontal lobe is associated with ring-shaped diffusion weighted hyperintensity no remarkable ADC restriction and is equivocal for recent ischemia, versus chronic ischemia.2.Otherwise, findings of chronic microvascular ischemia and small chronic infarcts are present throughout the brain.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: pre-op planning. Patient needs fiducials History: brain tumor Multiple fiducial markers attached on scalp for the preparation of image guided operation.There is a 23.8 mm x 28. 7 mm sized thick irregular wall enhancing mass located on the floor of the fourth ventricle with surrounding edema. There is also a small enhancing nodule adjacent to the main mass which imply possible daughter lesion. Ventricular system appears to be slightly enlarged but no evidence of acute hydrocephalus.No other enhancing lesion is seen.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Irregular thick wall enhancing mass on the 4th ventricle wall as described above indicating possible malignant nature of the lesion such as metastasis.Mild ventriculomegaly was seen.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:10/6/1970)Reason: Bilateral buttock pain with radiation down the posterior legs bilaterally to the feet. Evaluate for neural foraminal stenosis vs HNP vs spinal stenosis. History: As abovePROVIDER/ATTENDING NAME: SUSAN B GLICK SUSAN B GLICK 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. There is mild disc desiccation present at L4-5 and L5-S1.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level.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.There is a 20 x 22 mm axial dimension cystic lesion in the right pelvis which could represent an ovarian cyst.

Output: 1.No compromise to lumbar spinal canal or neural foramina. There are mild degenerative changes present in the lumbar spine.2.A cystic appearing lesion along the right adnexa is present. The possibility this represents an ovarian cyst is raised. If clinically appropriate additional imaging of the right ovary may be of further benefit in evaluating this. Please correlate the patient's ultrasound from 6/24/2014.


Instruction: Generate impression based on findings.

Input: Reason: Follow up chronic pancreatitis, rule out new necrotic areas. History: h/o abd pain with chronic pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Stable appearance of fatty liver. No intra-or extrahepatic biliary ductal dilatation. No cholelithiasis or choledocholithiasis. Common bile duct is non-dilated measuring 6 mm and terminates in the second portion of the duodenum.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is irregular and beaded with innumerable mildly dilated sidebranches. The main pancreatic duct is dilated measuring up to 6 mm. After secretin administration, there is no significant increase in the size of the pancreatic duct. However, there is increased fluid signal in the duodenum after secretin administration. Uniform enhancement of the pancreatic parenchyma. No peripancreatic fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right upper pole renal cyst. There is symmetric enhancement of the renal parenchyma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTRY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Dilated, irregular, and beaded appearance of the pancreatic duct with mildly dilated sidebranches. The diseased pancreatic duct did not significantly respond to secretin administration, but there was increased fluid in the duodenum with secretin administration suggestive of responsive exocrine function.2. Normal appearing common bile duct. No cholelithiasis or choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Evaluate for encephalopathy: meningitis, former 24 weeker. There is T1 hyperintensity in portions of the brainstem and bilateral posterior limbs of the internal capsules, but not in the rest of the cerebral hemisphere white matter. There are small foci of susceptibility effect in the left posterior fossa, without associated mass-effect. There is no evidence of acute infarct. 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: 1. Delayed myelination, even accounting for prematurity.2. No evidence of acute infarct. Non-contrast MRI is otherwise insensitive for the detection of meningitis.3. A small amount of chronic hemorrhage in the left posterior fossa without mass-effect is likely birth related.


Instruction: Generate impression based on findings.

Input: Lower lip squamous cell carcinoma status post resection and local flap reconstruction. There are postoperative findings in the right lower lip. There is mild amorphous enhancement and high T2 signal in the surgical bed, but no measurable tumor. There is no significant regional lymphadenopathy. The orbits, salivary glands, oral cavity contents, and imaged intracranial structures are unremarkable. There is degenerative cervical spondylosis with a prominent disc-osteophyte complex at C5-6.

Output: Postoperative findings in the right lower lip without measurable tumor.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with neck pain and bilateral arm pain associated with numbness. Straightening of the cervical lordosis is seen. Sagittal alignment is otherwise unremarkable. Vertebral body heights are preserved. Mild endplate edema is seen at C3-4, likely degenerative in nature. No pathologic marrow replacement is seen. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac. No significant spinal canal stenosis. No foraminal narrowing. C4-5: Left uncovertebral hypertrophy. No spinal canal stenosis. Mild left foraminal narrowing.C5-6: Posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac and slight flattening of the ventral cord. No spinal canal stenosis. Moderate left and mild right foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Disc degeneration is seen most notably at C3-4 and C5-6. However, only mild effacement of ventral thecal sac is noted at these levels. At C3-4, mild foraminal narrowing is evident on the left. At C5-6, moderate left and mild right foraminal narrowing are seen.


Instruction: Generate impression based on findings.

Input: There is diffuse prominence of the cortical sulci in proportion to the cerebral ventricles consistent with mild diffuse cerebral atrophy. There is an approximately 1.3 cm septated subdural fluid collection anterior to the left frontal lobe. A 7 mm superficial component of this fluid collection adjacent to the calvarium demonstrates small amount of intrinsic T1 signal and T2/FLAIR hyperintensity with respect to the CSF, while the remainder of the collection demonstrates CSF intensity. Additionally, there is prominence of the subarachnoid space overlying the somewhat flattened anterolateral left frontal lobe, possibly related to posttraumatic arachnoid cyst formation, with a prominent vessel coursing anteriorly. Scattered superficial siderosis is demonstrated along the paramedian frontal lobes near the vertex, as well as along the left anterolateral frontal lobe and minimally along the anterior right frontal lobe. There are also a few foci of susceptibility along the mesial left temporal lobe inferiorly. There is no diffusion restriction to suggest acute ischemia. The basal cisterns are visualized.

Output: 1. Chronic appearing septated 1.3 cm left frontal subdural collection may be related to prior hematoma. A 7 mm component of this collection demonstrates signal intensity slightly different from CSF.2. There is prominence of the subarachnoid space anterior to the left frontal lobe with hemosiderin deposition within the left frontal cortical sulci suggestive of possible posttraumatic arachnoid cyst formation.3. There is superficial siderosis along the left greater than right frontal lobes. This is favored to relate to prior trauma. Recommend correlation with history. If there is no history of prior trauma, further imaging of the spine may be considered as a potential source of subarachnoid hemorrhage.


Instruction: Generate impression based on findings.

Input: Fever, unspecified [R50.9] / Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: New area of hypoattenuation in left frontal lobe concerning for ischemia. History: LOC, AMS. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The left frontal lobe lesion seen on prior CT scan shows focal encephalomalacia with high signal intensity on FLAIR images indicating chronic ischemic lesion.However, there are multiple patchy FLAIR/T2 high signal intensity lesions at bilateral periventricular white matter, splenium of corpus callosum and right temporo-occipital lobe deep white matter including periventricular white matter. Differential diagnosis of these lesion include post transplantation changes/disease related, post-chemotheraphy related lesions, or recurrent Lymphoma/ALL.Other scattered T2/FLAIR high signal intensity lesions at bilateral frontoparietal white matter and left anterior aspect of putamen indicating non specific chronic ischemic disease do not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric except slightly effaced right lateral ventricle occipital horn. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening on bilateral maxillary sinuses and sphenoid sinus.

Output: 1. Multifocal T2/FALIR high signal intensity lesions involving right posterior temporal and occipital white matter and splenium of corpus callosum suggest differential diagnosis of post transplantation changes/disease related, post-chemotheraphy related lesions, or lymphoma/ALL.2. No evidence of new acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 63-year-old male with HCC, status post TACE/RFA. Assess liver lesion. Exam limitations related to marked respiratory motion artifact. There is a lack of an arterial phase due to patient intolerance in the scanner.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Segment 8 ablation cavity is again demonstrates T1 precontrast hyperintense signal, and there is no suspicious enhancing components on the postcontrast series. The previously described small focus of washout in the anterior hepatic segment 8 is again visualized and is stable in size measuring 1.5 x 1.4 cm (series 4 image 19). Small stone in the gallbladder fundus.SPLEEN: Splenomegaly measuring 15.7 cm in length.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: 1.Stable segment 8 ablation cavity without evidence of recurrent disease.2.Previously described satellite lesion anterior to the ablation cavity is again identified with suspected washout and stable in size measuring 1.5 x 1.4 cm. Further evaluation is limited due to the lack of an arterial phase.


Instruction: Generate impression based on findings.

Input: 78-year-old female with possible seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered foci of T2 hyperintensity are found within the periventricular and subcortical white matter consistent with chronic small vessel ischemic disease. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. The ventricles and sulci are prominent, consistent with diffuse volume loss. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No specific findings to explain seizure.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Developmental delay. There is encephalomalacia and hemosiderin staining in the anterior right superior frontal gyrus at the site of prior hemorrhage. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There are prominent perivascular spaces in the bilateral basal ganglia. 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. There is high T2 signal within the bilateral middle ears and mastoid air cells.

Output: Encephalomalacia in the anterior right superior frontal gyrus at the site of prior hemorrhage. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: There is enlargement of the adenoids, which measures up to approximately 15 mm. In addition, the usual adenoidal striations are not clearly evident, at least on the right side. There is no significant lymphadenopathy in the upper neck and retropharyngeal region. The skull base appears to be intact. The imaged intracranial structures are unremarkable. There are postoperative findings related to right mastoidectomy with as trace amount of fluid in this region. There is also a trace amount of fluid in the left mastoid region. There is scattered paranasal sinus mucosal thickening and leftward nasal septal deviation. The orbits, salivary glands, and superficial facial soft tissues appear unremarkable.

Output: 1. Enlargement of the adenoids up to approximately 15 mm, which may represent a neoplastic process. 2. Diffuse paranasal sinus disease.3. Right mastoidectomy and trace nonspecific bilateral mastoid region fluid, although the images are not optimized for dedicated assessment of pathology in this region. Therefore, a temporal bone CT may be useful for further evaluation, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Metastatic pancreatic cancer to liver status post biliary stent now with increasing jaundice, assess for biliary obstruction versus worsening liver metastases Suboptimal study secondary to absence of IV contrast, not given due to low GFR.ABDOMEN:LIVER, BILIARY TRACT: Marked hepatomegaly with liver measuring up to 26 cm in longitudinal dimension. New from earlier CT study is moderate perihepatic ascites.Accounting for differences in technique, positioning and modality, enlarging hepatic metastases noted. Left hepatic dome lesion measuring 8 x 7.4 cm on image 21 series 5 previously measured 6.2 x 6.1 cm. Heterogeneous debris-containing lobulated cystic structure in right hepatic lobe is much larger with greater extension seen anteriorly and superiorly, structure appears contiguous with aforementioned metastatic liver lesion, component measuring 8.7 x 7.2 cm on image 25 series 5 previously measured approximately 6.7 x 4.7 cm. Minimal increased T1 signal seen relating to the cystic structure, likely reflecting underlying hemorrhage or proteinaceous material. Evaluation for associated wall enhancement as in the setting of an abscess not possible on this noncontrast study but no definite restricted diffusion identified. Worsening of intrahepatic biliary duct dilatation, primarily in right lobe, seen to level of previously described hepatic cystic lesion and also likely due in part to infiltrative soft tissue and nodal metastatic disease at porta hepatis. CBD stent. Portal venous thrombosis better delineated on prior contrast-enhanced CT imaging.Layering sludge in distended gallbladder, measures 4.7 cm.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreatic body and tail, pancreatic ductal dilatation seen to level of heterogeneous ill-defined soft tissue masslesion centered in pancreatic head/extending into uncinate process, stable to slightly increased in size (measures up to 5.1 cm across, previously measured 4.9 cm). Adjacent mild thickening of duodenum seen. Encasement of common hepatic artery visualized, but better assessed on prior contrast-enhanced imaging. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Thick-walled right-sided colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New from prior CT exam is large right pleural effusion. Tiny fat containing umbilical hernia. Mild anasarca. MRI is not ideal for evaluation of the lung parenchyma; however, pulmonary micronodularity suggested (see image 44 series 13, left lower lobe), suspicious for pulmonary metastatic disease.

Output: 1. Enlarging debris-containing cystic structure in right hepatic lobe that appears to originate from dominant left hepatic dome metastasis (also increased in size), appearance suspicious for collection containing necrotic pus from necrotic liver metastasis and/or an enlarging biloma. Increasing size of other hepatic metastases.2. Increasing intrahepatic biliary duct dilatation, primarily in right hepatic lobe, seen to level of aforementioned enlarging cystic structure, also likely due in part to infiltrative soft tissue and nodal metastatic disease extending from porta hepatis.3. New large right pleural effusion. While MRI is not ideal for evaluation of the lung parenchyma, pulmonary micronodularity is suggested, suspicious for lung metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with confusion, left-sided weakness and vision changes. Assess for right occipital hemorrhage of unclear etiology in the setting of ALL. A hematoma is evident within the right occipital lobe measuring 27 x 18 x 16 mm. Internal signal characteristics are compatible with acute blood product (predominantly deoxyhemoglobin). Moderate vasogenic edema is seen surrounding the hematoma, which mildly effaces the right ventricular atrium, but without significant generalized mass effect. Trace subdural blood product is also seen along the right occipital and temporal lobes and along the right tentorium.Within the limits of this noncontrast examination, no definite underlying lesion can be seen in the vicinity of the hematoma. Elsewhere, patchy predominantly periventricular white matter T2 hyperintensity is seen without significant mass effect. No additional areas of intracranial hemorrhage are suspected. The ventricular system is otherwise within normal limits.On MRA imaging, no evidence of any vascular lesion is seen in the vicinity of the occipital lobe hematoma. No significant vascular stenosis or occlusion is suspected. No aneurysms are detected within the limitations of technique. Although a dedicated MRV could not be performed due to patient tolerance, the T2 flow voids of the dural venous sinuses appear to be preserved compatible with patency.

Output: 1.An acute hematoma is evident within the right occipital lobe inducing moderate vasogenic edema but without significant generalized mass effect.2.No clear underlying etiology for the hematoma is identified on this examination, including no evidence of any vascular lesion on MRA imaging.3.The differential diagnosis would include hemorrhage related to coagulopathy. Less common etiologies would include vasculitis or intravascular involvement by leukemia which can produce vessel rupture. A leukemic parenchymal chloroma can also present with hemorrhage. Parenchymal hemorrhage has been reported as a rare complication of therapy. Finally, an invasive fungal infection such as aspergillus could produce a parenchymal hemorrhage.


Instruction: Generate impression based on findings.

Input: Altered mental status, visual hallucination. Evaluate for stroke. Nonenhanced head CT:CT is insensitive for detection of early acute strokes.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci and ventricular system as well as CSF cisterns are within normal limits.Very subtle periventricular and subcortical low attenuation of cerebral white matter is suspected of small vessel ischemic disease. These findings are significantly less noticeable on this study compared to prior MRI exam.Calvarium is intact. Visualized paranasal sinuses, mastoid air cells and orbits are unremarkable.

Output: Very subtle findings of small vessel ischemic strokes of indeterminate age. Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 68-year-old male with history of prostate cancer. Pathology from 4/23/2015 showed high-grade prostatic intraepithelial neoplasia in the right apex medial, left mid medial, left mid lateral, and left apex lateral. Prostatic adenocarcinoma, Gleason score 6 (3+3), 5 mm from left apex medial. PSA was 1.88 on 4/22/2015. Patient is status post MRI prostate laser ablation of the right apex peripheral zone on 4/9/2014. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.4 cm in transverse, 2.6 cm in AP, and 3.5 cm in critical length.Peripheral Zone: Slight interval increase in size of the known T2 and ADC hypointense lesion of the right mid gland measuring 6 x 7 mm (axial series 2208 image 244, axial series 601 image 59) (prior 5 x 3 mm). The additional T2 and ADC hypointense focus of the left apex measuring 5 x 4 mm is similar in size and appearance (axial series 601 image 45, axial 2208 image 164).Central Gland: The T2 hypointense focus of the midline central gland (axial series 601 image 50) does not show and ADC correlate and is felt to represent anterior hypervascular stroma. Nodular changes of BPH are again seen.Seminal Vesicles: No significant abnormality.Extracapsular Extension: Not present.BLADDER: Left anterior urinary bladder wall diverticulum extending into a left inguinal hernia (coronal series 602 image 10).LYMPH NODES: Stable small external iliac lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slight interval increased size of a right mid gland suspicious lesion.2.Stable small left apex suspicious lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cerebellar brain metastases, concern for CNS progression of disease. Signs and symptoms: Vertigo. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a thick irregular rim enhancing mass in the left cerebellum measuring approximately a 29 x 20.5-mm and consistent with patient's previously known metastatic lesion.This lesion demonstrated no significant enhancement on prior study. On nonenhanced exam there is no significant change in the size of this lesion. There is slight interval decreased surrounding vasogenic edema. The fourth ventricle remains reading normal and in midline similar to prior study. There is no detectable additional foci of enhancement in the posterior fossa.Images through supratentorial space remains negative for parenchymal or leptomeningeal metastases.Ventricle are patent the lesser degree subcortical foci of there and T2 hyperintensity is less conspicuous on current exam compared to prior which may be due to technique difference of 3T scan on prior exam and 1.5 on current. Examination also mildly degraded due to motion artifact on flair sequence. Focus of encephalomalacia in the left occipital lobe without abnormal enhancement remains similar to prior exam. Prominence of cortical sulci similar to prior study. Stable normal size of ventricular system and without deviation of midline.

Output: 1.No significant change in the size of a previously known metastatic lesion in the left cerebellum. In comparison to prior exam however this lesion demonstrate intense irregular rim enhancement which was not present on prior study and could be as result of change in treatment regimen/medication. Subtle regional mass effect of this lesion remains identical to prior study.2.No detectable additional metastatic lesions.3.Stable focus of encephalomalacia without enhancement in the left occipital lobe since prior study.


Instruction: Generate impression based on findings.

Input: Right distal lower extremity cellulitis. Question of osteomyelitis. There is isolated proximal fibular fracture which appears chronic. Bone marrow signal is otherwise within normal limits and there is no specific evidence of osteomyelitis.There is age related muscle atrophy. There is a moderate amount of muscle edema involving the posterior compartment muscles including the gastrocnemius, soleus, and flexor tendons.A small knee joint effusion is seen.

Output: 1. No specific evidence of osteomyelitis.2. Isolated chronic proximal fibular fracture.


Instruction: Generate impression based on findings.

Input: 16-year-old male patient with OCD lesion on radiograph and knee pain. MENISCI: There is tearing of the free edge of the body and posterior horn of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is a full-thickness chondral defect and cortical defect in the lateral tibial plateau that measures 5 mm in AP dimension with underlying reactive marrow changes and subchondral cyst formation.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex and patellar retinacula are intact. EXTENSOR MECHANISM: There is mild lateral subluxation of the patella relative to the femur. Patella alta with Insall-Salvati ratio of 1.5. There is signal abnormality in the central patellar tendon fibers (5 mm in mediolateral dimension), compatible with a partial tear.ADDITIONAL

Output: 1.Probable combination of osteochondral defect and subchondral cyst formation in the lateral tibial plateau.2.Partial patellar tendon tear with patella alta.3.Tearing of the free edge of the body and posterior horn of the lateral meniscus.4.Mild lateral subluxation of the patella.


Instruction: Generate impression based on findings.

Input: 80 year old man with history of coronary disease, history of melanoma with left lung recurrence s/p resection in February 2016, and persistent atrial fibrillation, now referred for pre-ablation cardiac MRI to delineate atrial volumes and pulmonary vein dimensions. Left VentricleThe left ventricle is normal in size with mild-moderately reduced systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 104 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 105 g (normal range 164+/-36). There is global hypokinesis . There is subtle patchy late gadolinium enhancement in the basal inferior, inferolateral and lateral wall which is atypical for prior myocardial infarction and may represent an underlying inflammatory, infiltrative or fibrotic process. In addition there appears to be basal inferolateral mid-myocardial late gadolinium enhancement also diffuse and possibly representative of underlying inflammatory, infiltrative or fibrotic process. Native T1 myocardial relaxation time is elevated (1170-1243ms) which is abnormal. Left AtriumThe left atrium is severely dilated, with a maximal volume of 163mL. The interatrial septum is intact. There is no evidence for left atrial appendage thrombus.Right VentricleThe right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 214 ml (normal range 142+/-31), the RV end systolic volume index is 64 ml/m2 (normal range 31+/-9), and the RVESV is 128 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated with a maximal volume of 215mL.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is at least mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta is upper normal in size (41mm x 39mm)Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. The individual pulmonary vein dimensions are as listed below:LUPV: 17 x 15mmLLPV: 17 x 14mmRUPV: 17 x 16mmRLPV: 19 x 18mmPulmonary ArteryThe main pulmonary artery is mild to moderately dilated (36mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsExtensive post surgical changes and fluid collection in the left lung consistent with patient's recent pulmonary resection. There is a trivial right pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with mild-moderately reduced systolic function (LVEF 41%).2. Abnormal native T1 myocardial relaxation time with patchy subtle late gadolinium enhancement in the basal segments of the left ventricle; taken together, a possible infiltrative, inflammatory or fibrotic underlying process should be considered.3. Normal size right ventricle with mild-moderately reduced systolic function (RVEF 40%). 4. Biatrial enlargement. 5. Moderately dilated main pulmonary artery. 6. Post surgical changes of the left lung with associated volume loss and fluid collection, consistent with history of recent lung resection. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: r/o bony metastases or muscle inflammation - hx of prostate cancer s/p prostatectomy History: right hip pain, please include iliac crest Note is made of postsurgical changes of prior prostatectomy. There is a focus of decreased signal abnormality along the superior aspect of the left acetabulum on all pulse sequences which does not enhance on postcontrast images, this could represent a benign bone island or perhaps a treated metastasis. Otherwise no bone marrow signal abnormalities are identified. No enhancing mass lesions are seen. Mild osteoarthritis affects the hips. There is a small amount of fluid within the hips which is not necessarily of any clinical significance. Note is made of a penile prosthesis. The imaged musculature of the pelvis is unremarkable. Although this examination was not protocol for detailed evaluation of the pelvic viscera, no acute abnormalities identified.

Output: Postsurgical changes of prior prostatectomy without evidence of osseous metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with seizures. Assess for prior brain damage. Scattered foci of nonspecific T2 hyperintensity are seen within the periventricular white matter, predominantly in the frontal lobes. No edema or mass effect is seen. Diffusion-weighted images are unremarkable. No pathologic parenchymal or extra-axial enhancement is observed. There are no abnormal extra-axial fluid collections nor is there evidence of acute or chronic intracranial hemorrhage. The ventricular system is normal in size and morphology.

Output: Scattered nonspecific foci of white matter T2 hyperintensity are seen. Otherwise, no obvious parenchymal lesions or structural abnormalities are seen, and there are no specific findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: 19 year-old female, with pain along third, fourth, and fifth metatarsals, evaluate for fracture Foot: There is mild soft tissue swelling and edema along the dorsum of the foot underlying the skin marker at the patient's site of symptoms. There is no significant bone marrow edema within the metatarsals to indicate a stress fracture. The bone marrow signal is normal throughout the foot.Ankle: Moderate tibiotalar joint effusion. The ATFL is not visualized and likely torn. The PTFL and calcaneofibular ligaments are intact. The inferior tibiofibular ligaments appear intact. There is edema within the medial talus and medial malleolus without discrete fracture line. There is also edema within the soft tissues along the medial and lateral aspect of the ankle beneath skin markers presumably placed at the site of patient's symptoms without underlying osseous abnormality. The extensor and flexor tendons including the Achilles tendon appear normal.

Output: 1. ATFL tear with marrow edema in the medial talus and medial malleolus, which may represent contusions as well as soft tissue swelling about the ankle.2. Soft tissue edema along the dorsum of the foot without evidence of fracture/bone marrow edema.