Instruction: Generate impression based on findings.

Input: 65 years, Female, history of brain metastases. Follow-up evaluation. Lack of contrast limits evaluation for small metastatic lesions. Postoperative changes of right parietal craniotomy and tumor resection are redemonstrated. Areas of encephalomalacia in the right parietal lobe are again seen and appear to demonstrate slight evolution with mild increase in area of cystic change involving the right superior parietal lobule. Extensive T2/FLAIR hyperintensity within this region, bilateral periventricular and subcortical white matter, and pons is largely similar to prior and reflective of posttreatment changes and/or advanced chronic small vessel ischemic disease. There is however focal interval increase in FLAIR hyperintensity involving the right inferior frontal gyrus without discrete underlying mass. No associated restricted diffusion or susceptibility to suggest acute ischemia or hemorrhage, respectively. There is no significant evidence of intracranial mass effect, midline shift, or herniation. Ventriculomegaly is not significantly changed. Remainder of the calvarium and extracranial soft tissues are grossly unremarkable.

Output: Please note lack of contrast limits evaluation for small metastatic lesions. Compared to 3/1/2015, there is focal increase in T2/FLAIR hyperintensity within the right inferior frontal gyrus. This finding may be related to interval ischemia within this region or evolution of posttreatment change; however, there is possibility that this represents a new area of edema associated with an underlying small metastatic lesion which is not discernible in the absence of contrast. Suggest postcontrast sequences for further assessment. Otherwise, remainder of the brain demonstrates extensive posttreatment changes, particularly in the right parietal region, similar to prior study and without a large intracranial mass or new mass effect. Areas of increased cystic change in the right parietal lobe are favored to represent evolution of posttreatment change, but can also can be better assessed with post gadolinium sequences.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with rheumatoid arthritis and headaches. Scattered small foci of T2 hyperintensity are again seen within the cerebral white matter, predominantly located in a subcortical distribution. The size and number of the lesions have not significantly changed. No restricted diffusion is seen. No edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.

Output: Scattered small white matter lesions are unchanged in size and number. The differential remains broad and includes gliosis from prior infection, inflammation or trauma, demyelination, ischemia/vasculitis, as well as sequelae of migraine headache.


Instruction: Generate impression based on findings.

Input: There is trace grade 1 anterolisthesis of C2 on C3 which is unchanged. The cervical spine is otherwise in normal alignment, with persistent prominent reversal of the normal cervical lordosis which may be positional in etiology. There is minimal disc narrowing at C5-C6. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.At C3-C4, there is a trace disc bulge without stenosis.At C5-C6, there is a shallow central/right paracentral disc protrusion which abuts the right ventral cord with mild contour deformity. There is mild central spinal canal stenosis.At C6-C7, there is a minimal left paracentral/foraminal disc osteophyte which results in moderate left foraminal narrowing, slightly progressed.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. There is apparent slightly ill-defined T1 isointense and mildly T2/STIR hyperintense signal in the expected location of the hypothalamus, abutting the anterior margin of the mamillary body and posterior margin of the optic chiasm. Prior MRI and concurrent CT imaging does not include this area within the field-of-view.

Output: 1.Subtle interval progression of left paracentral/foraminal disc osteophyte at C6-C7 resulting now moderate left foraminal narrowing.2.Persistent central/right paracentral disc protrusion at C5-C6 mild central spinal canal stenosis. There is abutment of the right ventral cord likely impingement upon the right ventral C6 nerve root.3.Questioned area of abnormal signal in the region of the hypothalamus, although this could be artifactual in etiology. Dedicated MRI brain with and without contrast recommended for further evaluation. This area is not included within the field-of-view on prior cervical imaging.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma, status post chemotherapy and stem cell transplant. There is no intracranial mass or abnormal parenchymal or leptomeningeal enhancement to suggest lymphoma recurrence. Previous is seen patchy T2-hyperintense signal involving the periventricular and deep cerebral white-matter as well as the left lateral cerebellar hemisphere is not significantly changed since the prior examination. The frontal horn of the right lateral ventricle remains small while the remainder of the ventricular system as well as the other CSF-containing spaces remain enlarged reflecting underlying brain volume loss. There is no acute infarct or acute intracranial hemorrhage. Bilateral lens implants. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1.No evidence of recurrent lymphoma.2.Unchanged brain white-matter signal abnormality likely representing a combination of sites of prior lymphomatous disease with superimposed posttreatment change and chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 61-year-old male with left knee pain and swelling status post quadriceps tendon repair. Injured knee in therapy. Evaluate for re-tear. MENISCI: The lateral meniscus appears intact. There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. There is linear increased signal within the posterior horn of the medial meniscus which extends to the tibial articular surface indicating a horizontal tear. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the lateral facet of the patella. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate collateral ligaments appear intact. EXTENSOR MECHANISM: Note is made of postsurgical changes consistent with the stated history of prior quadriceps tendon repair. There is a full-thickness near complete rupture of the quadriceps tendon with approximately 2.5 cm of proximal retraction. There is thickening and intermediate signal intensity within the retracted quadriceps tendon indicating moderate to severe tendinosis. The patellar tendon appears intact. There is thickening and intermediate signal intensity within the proximal fibers of the patellar tendon indicating mild tendinosis.ADDITIONAL

Output: Near complete re-tear of the quadriceps tendon with retraction as described above. Large joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Acute embolism and thrombosis of unspecified deep veins of lower extremity, bilateral [I82.403] / Slurred speech [R47.81], Reason for Study: ^Reason: Hypoattenuating lesions in brain, eval further History: brain lesions No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Multiple scattered bihemispheric periventricular and centrum semiovale T2/FLAIR high signal intensity lesions are seen, which are nonspecific. These lesions could represent nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are 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: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with acute liver injury, altered mental status. Signs and symptoms: Acute liver injury and altered mental status. Non-infused CT of brain:No evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus. The gray/white matter differentiation is preserved. The ventricular system are within normal limits and no evidence of compression or midline shift. The basal cisterns remain patent. There is slight paucity of cortical sulci which may be well within normal range for patient's stated age of 28. Calvarium, paranasal sinuses and mastoid air cells are unremarkable. If clinical concern persist follow-up with a CT or an MRI is recommended.

Output: Unremarkable non-infused CT of brain.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, history of coccygeal/sacral chordoma status post resection. Surveillance scan. There are postoperative changes involving the lower sacrum with absence of the coccyx. Mild enhancement in the surgical bed likely represents scar tissue. This region is better assessed on the accompanying pelvic MRI.Fatty signal within the S2 and S3 vertebral bodies is again seen similar to prior compatible with focal fat or hemangiomas. No evidence of suspicious T2 hyperintensity or pathologic enhancement is seen at these levels.Elsewhere in the lumbar spine, no pathologic marrow signal alteration or enhancement is seen. Vertebral body height and morphology is normal. The visualized spinal cord, conus and cauda equina are unremarkable.L1-2: No significant disk disease. No spinal canal or neural foramina stenosis.L2-3: No significant disk disease. No spinal canal or neural foramina stenosis.L3-4:Disc protrusion is again seen. No significant spinal canal stenosis. Minimal right foraminal narrowing. No left foramina narrowing.L4-5:Minimal disk bulge. Left dorsal annular fissure. No significant spinal canal stenosis.Minimal bilateral foraminal narrowing.L5-S1: New left paracentral disc protrusion with increased effacement of the left lateral recess and contact of the descending left S1 nerve root. No significant central canal stenosis or neural foraminal stenosis.Mild facet arthropathy in the lumbar spine. Paraspinous soft tissues are unremarkable.

Output: 1. Postsurgical changes in the sacrococcygeal region are only partly visualized on this examination. No evidence of residual or recurrent tumor is seen. Please see separate report from accompanying pelvic MRI.2. Mild degenerative changes in the lumbar spine as described above with interval increase in left paracentral disc protrusion at L5-S1.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Minimal disc bulge without significant mass effect or stenosis.C4/5: Asymmetric disc bulge to the left and left uncinate hypertrophy causes minimal anterior left hemicord flattening without intrinsic cord signal abnormality. There are no significant stenoses.C5/6: Asymmetric disc bulge to the left and bilateral uncinate hypertrophy (left greater than right) causes minimal anterior left hemicord flattening without intrinsic cord signal abnormality. There is mild left neural foraminal stenosis.C6/7: Disc bulge, uncinate hypertrophy, and ligamentum flavum thickening result in mild central as well as mild bilateral neural foraminal stenosis. There is minimal anterior cord flattening without intrinsic cord signal abnormality.C7/T1: Unremarkable

Output: 1.C5/6: Mild left neural foraminal stenosis.2.C6/7: Mild central as well as mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to prior right parietal craniotomies. There has been significant progression of enhancing tissue within the right frontal lobe. For example, the dominant anterior enhancing lesion now measures 41 x 59 mm, previously 17 x 19 mm. The more posterior and superior lesion currently measures 19 x 20 mm, previously 8 x 7 mm. The enhancement does however have a somewhat abnormal appearance with the superior portions respecting the gyral morphology, and the inferior margin showing a very ill-defined speckled pattern of enhancement. The more anterior dominant enhancing lesion now infiltrates inferiorly into the genu and body of the corpus callosum. There has also been a significant increase in the surrounding T2 hyperintensity that now crosses to the left side of the corpus callosum. There is a significant increase in mass effect with new 6 mm leftward midline shift and subfalcine herniation. The mass effect is however slightly less than expected given the size of the enhancing lesion. These enhancing masses demonstrate markedly elevated relative cerebral blood volume, at least along their periphery.

Output: Significant progression of right frontal enhancement is seen with corresponding increase in mass effect and new leftward subfalcine herniation. Particularly given the elevated rCBV, these findings are concerning for progressive tumor.However, considering the rapidity of progression compared with the previous slow progression of tumor from 2013, and considering the recent administration of an immune modulating drug and somewhat atypical imaging appearance of the lesion, a component of superimposed inflammation may also be contributing to this appearance.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with AML and CLL, recently receiving intrathecal and systemic chemotherapy. Reevaluate L5-S3 lesion seen on prior MRI. Bilateral lower extremity weakness and pain. A dextroscoliotic curvature of the lumbar spine is seen along with slight right lateral subluxation of the L4 vertebral body. Vertebral body heights are preserved. Diffuse T1/T2 hypointense marrow replacement is seen. Superimposed on this is patchy STIR hyperintensity and small nodules of enhancement within the L4 vertebral body and spinous process. The L3 inferior endplate is also potentially involved. These findings are not clearly appreciated on the prior examination. However, T2 hyperintense signal within the L3-4 and L4-5 disc spaces was present on the prior exam.Also noted is geographic rim enhancement involving the sacral ala and visualized iliac bones.The previously seen ventral epidural thickening involving L5 and the sacrum is no longer appreciated. No significant compromise of the spinal canal is seen. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic intrathecal enhancement is observed.Degenerative changes are again seen including disc bulging and facet hypertrophy most notably affecting L3-4 and L4-5. No high-grade spinal canal stenosis is observed. The L5-S1 neural foramina are narrowed.

Output: 1.Interval resolution of the previously demonstrated ventral epidural thickening from L5 through the sacrum. This may simply have represented an engorged venous plexus.2.New signal abnormality and foci of enhancement are demonstrated predominantly within the L4 vertebral body and spinous process. While there is disc and facet degeneration at L3-4 and L4-5 which could account for some of these findings, the possibility of leukemic involvement is also raised.3.Geographic rim-enhancing lesions within the sacral ala and visualized iliac bones are compatible with bone infarcts.


Instruction: Generate impression based on findings.

Input: 71-year-old male status post cholecystectomy now with recurrent acute pancreatitis and possible pancreatic mass ABDOMEN:LIVER, BILIARY TRACT: There is a mass at the Klatskin point, which demonstrates delayed retention of contrast and measures 1.9 x 1.8 cm (series 1305, image 45). Moderate bilobar intrahepatic biliary ductal dilation. Diffuse mild thickening of the left, right, and common hepatic bile ducts. Status post cholecystectomy. The common bile duct measures 10 mm in maximum diameter. Common bile duct stents.SPLEEN: No significant abnormality noted.PANCREAS: There is edema in the pancreatic head. No surrounding edema. Complex cystic mass at the pancreatic head / neck junction measures 2.7 x 2.6 mm (series 501, image 17) and communicates with the main pancreatic duct. The pancreatic duct is otherwise not dilated. There are small other cystic foci in the head.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple right renal cysts.RETROPERITONEUM, LYMPH NODES: Nonspecific subcentimeter cardiophrenic lymph node. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Enhancing hilar mass at the Klatskin point with associated intrahepatic bilobar biliary ductal dilation suspicious for cholangiocarcinoma. Mild thickening of the left, right, and common hepatic bile ducts; periductal tumor spread is not excluded.2.Pancreatic head edema compatible with acute pancreatitis. Complex cystic lesion at the pancreatic head/neck junction communicates with the main pancreatic duct and is most consistent with a pancreatic cystic neoplasm possibly a pseudocyst.


Instruction: Generate impression based on findings.

Input: Soft tissue mass Examination of the images reveals a soft tissue mass that measures approximately 2 x 3 x 1 cm dorsal to the fourth proximal phalanx. The soft tissue mass is of decreased signal intensity on the T1-weighted images and mixed on the T2-weighted images. It enhances with gadolinium. The lesion is adjacent to the bone but does not invade the osseous structures.

Output: Nonspecific enhancing soft tissue mass dorsal to the fourth toe suspicious for malignancy


Instruction: Generate impression based on findings.

Input: 10 year old female with Down's syndrome, s/p repair of AV canal with tetralogy of Fallot in 2006, bilateral pulmonary artery stents (2013) with differential perfusion to lungs (Left 34%). Referred for cardiac MRI for re-assessment. SitusLevocardia with normal cardiac and abdominal situs.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 44%. The LVEDV is 81 ml (normal range 55-95), LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), LVESV is 46 ml (normal range 15-35), and LV end systolic volume index is 40 ml/m2 (normal range 18+/-5). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no LV thrombus. The ventricular septal patch is intact.Left AtriumThe left atrium is normal in size. Atrial septal patch is intact.Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RVEDV is 157 ml, the RV end diastolic volume index is 139 ml/m2 (normal range 76 +/- 18), RVESV is 91 ml, and the RV end systolic volume index is 80 ml/m2 (normal range 27 +/-10).Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Left atrio-ventricular valveMild left atrio-ventricular valve regurgitation.Pulmonary arteries and pulmonary valveThere is thinning and bulging and of the RVOT suggestive of previous transannular patch type repair. The pulmonic valve leaflets are not clearly visible and there is free regurgitation through the RV outflow tract. Regurgitant fraction is 55%. The main and both proximal pulmonary arteries are focally obscured by blooming artifact from the PA stents. Right atrio-ventricular valveMild-moderate right atrio-ventricular valve regurgitation.AortaThere is a left sided aortic arch with normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLeft lower lobe subsegmental atelectasis. Suggestion of antero-posterior collapse of the left mainstem bronchus. 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.Morphologic changes of repaired AV canal and Tetralogy of Fallot. Bilateral pulmonary artery stents present.2.Severe right atrial and ventricular dilation with mildly reduced RV function. RVEF 43%, RVEDV 157 ml, RVEDVi 139 ml/m2.3.Free pulmonary regurgitation with no clearly appreciable pulmonary valve leaflets. Regurgitant fraction is 55%.4.Normal left ventricular size with mildly reduced left ventricular function. 5.No residual atrial or ventricular septal defects.6.Mild-moderate right atrio-ventricular valve regurgitation and mild left atrio-ventricular valve regurgitation.7.There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.


Instruction: Generate impression based on findings.

Input: 77 year old female status post fall. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse areas of periventricular white matter hypodensity consistent with microangiopathic changes. If there is clinical concern for stroke an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Diffuse microangiopathic changes. If there is clinical concern for stroke an MRI may be considered.


Instruction: Generate impression based on findings.

Input: New onset exertional headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Benign left breast biopsy approximately 1 year ago presents for a one year follow up to determine MRI stability. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, somewhat increased from the prior study with mostly symmetric parenchymal enhancement in each axillary tail. There are a few scattered left breast cysts. The biopsy proven benign mass in the left upper breast near 12:00 does not appear significantly changed in size, now measuring 15 x 38 x 20 mm (previously 17 x 36 x 20 mm). The benign morphology 12 mm right breast mass near 9:00 is stable, as is the small right 9:00 intramammary lymph node. No new suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No significant change in biopsy proven benign left breast mass. No MRI evidence for malignancy. Clinical follow up to ensure stability on physical exam is recommended. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ulcer due to trauma. Extensive demineralization limits sensitivity.Lower leg: Extensive atherosclerotic changes with suspected soft tissue changes representing the moderate to deep ulceration obscured by overlying lower diaphyseal gauze and bandage material. No discrete underlying osseous abnormality, specifically no evidence of bone loss/resumption, periosteal reaction or discrete soft tissue changes. Please consider serial imaging or possibly MRI suspicion remains high given the diminished sensitivity within the absence of prior examsFoot: Similar atherosclerotic changes are observed in limited due to nonstanding views. Suspected pronounced degenerative changes of the subtalar articulations and midfoot as well as more moderate changes distally. These findings include narrowing, hallux valgus deformity and bunion suspected hammertoes. No overt plain film findings to suggest osteomyelitis within this limited exam. Consider serial imaging for reasons described above

Output: Scattered moderate degenerative changes and suspected lower right leg ulceration. See details provided


Instruction: Generate impression based on findings.

Input: Ms. Denenberg is a 67-year-old female with a personal history of right breast lumpectomy in 2011 for DCIS/ADH treated with radiation and tamoxifen therapy. Personal history of benign right breast MR-guided biopsy in 6/2012 for foreign body giant cell reaction and benign left breast stereotactic guided biopsy in 11/2004 for apocrine metaplasia. Family history of breast cancer in paternal great grandmother. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable post-lumpectomy changes are noted in the right breast. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: persistent altered mental status s/p PEA w/ROSC, question of anoxic brain injury History: spont eye movements, responsive to simple commands, nonverbal, normal tone and reflexes. No evidence of acute ischemic or hemorrhagic lesion.Underlying brain shows diffuse mild brain atrophy considering patient age.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells show fluid collection. Bilateral maxillary sinus show mucosal thickening with retention cyst

Output: No evidence of acute ischemic or hemorrhagic lesion.Mild diffuse brain atrophy.


Instruction: Generate impression based on findings.

Input: Dizziness, abnormal VNG, arm weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid in the right maxillary sinus.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Rule-out acute intracranial hemorrhage. Signs and symptoms: Headaches Unenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal limits.Area of calcification within the left sylvian fissure measuring 10-mm in AP access and 7.5-mm in transverse axis on axial image 9 and approximately 15 mm in AP access and 6-mm in prandial -- cephalad access on the sagittal reformatted image 11. This finding has the appearance of a heavy vascular calcification. Recommend follow-up with an MRI.

Output: 1.No evidence of acute intracranial findings.2.Heavy calcification within the left sylvian fissure as described above likely a vascular calcification.3.Unremarkable exam otherwise for brain parenchyma and the calvarium.


Instruction: Generate impression based on findings.

Input: Headache and imbalance. There is mild prominence of the extra-axial cerebellospinal fluid spaces along the medial let temporal convexity, measuring up to 10 mm in thickness, which may represent arachnoid cyst formation. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct, and the brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Probable left middle cranial fossa arachnoid cyst. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 60-year-old male with HCV. Patient with elevated LFTs and bilirubin. Evaluate for etiology. ABDOMEN:LIVER, BILIARY TRACT: Chronic liver disease. Mild intra and extra hepatic biliary ductal dilatation without evidence of choledocholithiasis. No arterially enhancing suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of a pancreatic mass with the pancreatic duct mildly prominent. Pancreas is normal in intrinsic T1 hyperintensity.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.Mild intra and extra hepatic biliary ductal dilatation without evidence of choledocholithiasis. Pancreatic duct is mildly prominent; findings may be due to benign stricture at level of the ampulla. 2.No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Images are motion degraded. Given this caveat:There is straightening of the cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes are stenoses.

Output: 1.Although a cervical and thoracic MRI with and without contrast was requested, the patient was uncooperative and unable to hold still, even though multiple attempts were made to repeat images. Thus the study was terminated without contrast administration or thoracic spine acquisition.2.Images are motion degraded. Given this caveat, negative noncontrast MRI of the cervical spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up hydrocephalus. Signs and symptoms: Headaches, tachycardia, known to have petroclival meningioma. Non-infused CT of brain:A low density extra axial mass with some bony remodeling measures 37.4-mm x 37-mm at the level of left petroclinoid. Although the density of the lesion is not typical for meningioma on this exam this finding is believed to represent patient's known meningioma. Exclude other possibilities an MRI examination is recommended. This lesion outlines mass effect and deviates the left medial aspect of the temporal lobe laterally. The mass extends into the left cerebellopontine angle and applies mass effect on the left aspect of the pons and left middle cerebellar peduncle. There is no evidence of any edema of the brain parenchyma surrounding the tumor. There is ventriculomegaly of the supratentorial ventricles and effacement of cortical sulci. Findings are suspected for hydrocephalus. Very subtle bifrontal periventricular low attenuation of brain parenchyma is suspected for transependymal exudate of CSF.There is only minimal mass effect on the fourth ventricle however the fourth ventricle is not collapsed and is still widely patent. I see no detectable mass in the quadrigeminal cistern plate or the third ventricle by the tumor. There is no evidence of intracranial hemorrhage. Calvarium is intact.

Output: 1.Obstructive hydrocephalus with suspect that transependymal exudate of CSF.2.Low-attenuation extra-axial mass at the left petroclinoid ligament with bony remodeling and associated mass effect on the left temporal lobe and extension of mass into the left cerebellopontine angle with mass effect on the pons and left middle cerebellar peduncle.3.Follow-up with an infused MRI is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Craniosynostosis, with new headaches, evaluate for change. Signs and symptoms: New headaches. Nonenhanced brain MRI:Unremarkable diffusion weighted images.Examination demonstrates extensive minimal metallic artifact from prior craniosynostosis surgery without evidence of any intracranial associated abnormalities.There is normal anatomical development of brain parenchyma and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal voids of major intracranial arterial branches are identified and unremarkable.The signal intensity of the intracranial venous sinuses are unremarkable.Unremarkable images through the orbits.Extensive opacification of the right chamber of the sphenoid sinus consistent with sinusitis and unremarkable rest of paranasal sinuses. This finding could explain patient's new headaches.

Output: 1.Unremarkable nonenhanced brain MRI.2.Expected chronic changes of prior craniosynostosis operation without intracranial associated abnormalities.3.Extensive opacification of the right chamber of the sphenoid sinus and left posterior ethmoid and unremarkable other paranasal sinuses. This finding could explain patient's headaches. Bilateral mastoid air cells and middle ear cavities remain well pneumatized.


Instruction: Generate impression based on findings.

Input: Clinical question : CVA. Signs and symptoms: Left-sided weakness Non-infused CT of brain:No definitive evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. No detectable cortical stroke. There is subtle high density of right middle cerebral artery in the horizontal portion of sylvian fissure and considering patient provided clinical data possibility of thrombus within the right middle cerebral artery should be considered.Follow-up with a CTA and MRI examination of brain is recommended. Small area of low-attenuation in the region of the left external capsule may represent an old lacunar infarct. This examination is otherwise unremarkable. The above findings were relayed to the referring service via Stat Consult communication system.

Output: 1.Subtle high density of right middle cerebral artery in the right sylvian fissure as described above. Considering patient's provided clinical data this may represent clot within the right MCA main trunk.2.Small lacunar infarct of left basal ganglia.3.No evidence of acute cortical stroke or hemorrhage.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:6/1/1963)Reason: Metastatic breast cancer s/p SRS surveillance eval History: Metastatic breast cancer s/p SRS surveillance evalPROVIDER/ATTENDING NAME: STEVEN J. CHMURA SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a ring-enhancing lesion present in the left cerebellar hemisphere which measures 16 x 11 mm axial dimensions and previously measured 22 x 15 mm axial dimensions. It has low signal on diffusion-weighted imaging. The ring enhancement involves a very thin ring.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: A left cerebellar hemisphere cystic mass has decreased in size when compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 27-year-old female presents for evaluation of the right thigh mass. There is a large mass within the proximal thigh posteriorly that appears to arise from the sciatic nerve. It measures approximately 7 cm x 5.5 cm in the transaxial dimension and 8.5 cm in the cranial caudal dimension (measured approximately 6.5 cm x 5 cm x 8.2 cm on previous study). It is situated between the distal fibers of the gluteus maximus muscle and the hamstring musculature and extends posteriorly to just beneath the skin surface.It is isointense to skeletal muscle on isolated T1 images, heterogeneous on fat suppressed T2 images with components that are both isointense and hypointense to skeletal muscle, and there is diffuse heterogeneous enhancement following contrast administration. Small foci of signal void along the posterior margin of the mass suggest prior intervention (presumably a surgical biopsy). Additional smaller cutaneous and subcutaneous lesions in the thigh are noted. Similar to those seen on the prior study. The remainder of the musculature of the thigh appears normal and the bones appear normal. Small cutaneous neurofibromas are seen on the left thigh on the large field-of-view images.

Output: Slight enlargement of peripheral nerve sheath tumor arising from the sciatic nerve as described above. While it is impossible to exclude a malignant peripheral nerve sheath tumor, the relatively slow growth as well as the similar signal characteristics to the prior study argue against malignant transformation.


Instruction: Generate impression based on findings.

Input: 39 years Female (DOB:4/20/1977)Reason: Follow up Chirai I; s/p decompression in 8-2011. Eval for CSF flow and any scar tissue build up History: pressure like headachesPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The patient is status post suboccipital craniectomy for Chiari decompression. CSF flow demonstrates biphasic flow at the level of the foramen magnum.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: Status post Chiari decompression. There is no convincing evidence for CSF flow obstruction at the level of foramen magnum.


Instruction: Generate impression based on findings.

Input: Clinical question: Altered mental status. Signs and symptoms: Known PNET with edema. Unenhanced CT of brain:On axial image 15 there is a soft tissue density mass at the level of the cranial gland which is a new finding since prior study. This mass measures 15.5-mm x 14.5-mm. In comparison with prior examination there is further expansion of brain parenchymal through the left temporal rhinectomy site. The underlying brain parenchymal demonstrate lower density which may indicate further encephalomalacia. There is also further increase in the size of the left temporal horn secondary to ex vacuo cavitation. Diffuse low attenuation consistent with edema in the left frontal lobe with extension into the corpus callosum however is a new finding since prior exam. This results in mass effect and slight deviation of midline in the anterior frontal region. There is also extensive low-attenuation in the pattern of vasogenic edema in the right hemisphere which is also new since prior exam. There is further dilatation of the lateral ventricles. The combination of above findings results in slight effacement of cortical sulci on the right side.Above-described findings could be secondary to obstructive hydrocephalus due to presence of a new mass at the level of pineal gland. Further evaluation with an MRI is recommended.Images through posterior fossa are stable and unremarkable.

Output: 1.New mass measuring 15.5-mm x 14.5-mm and the pine needle region.2.Interval increase in the size of the supratentorial ventricular system which is concerning for obstructive hydrocephalus. Extensive edema of brain parenchyma which may represent trans- ependymal exudate of CSF. Further evaluation with an enhanced MRI is recommended to evaluate for other possible causes for extensive bilateral white matter edema.


Instruction: Generate impression based on findings.

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

Output: 1. No evidence of cochlear nerve deficiency or gross labyrinthine anomalies.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Other disorders of psychological development [F88], Reason for Study: ^Reason: re-evaluate hypoxic injury History: global developmental delay There are bilateral nearly symmetric FLAIR/T2 high signal intensity lesions on the posterior aspect of basal ganglia likely globus pallidi and bilateral thalami. There is no evidence of restricted diffusion or susceptibility artifacts indicating hemosiderin deposition. These lesions could represent prior ischemic lesions but are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Focal fluid collection on the left ethmoid sinus.

Output: 1. Bilateral nearly symmetric basal ganglia especially posterior aspect of globus pallidus and bilateral thalami as described above.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Recent tumor resection (right lateral ventricle central neurocytoma). There has been recent right posterior parietal craniotomy with re--resection of the right alteral ventricle mass and external ventricular drain insertion, with what appears to be a small amount of residual tumor or blood clot anterior to the catheter tip. There is also confluent T2 hyperintensity, restricted diffusion, linear enhancement, and susceptibility effect along the surgical tract, a small amount of extradural fluid deep to the craniotomy flap, and extensive subgaleal fluid. The catheter extends to the midline of the right lateral ventricle. There is also a right transfrontal ventricular catheter that terminates in the third ventricle and a prior left transfrontal catheter tract. The ventricular sytem is unchanged in size and there is a small amount of residual intraventricular hemorrhage and pneumocephalus. There has been interval evolution of postoperative findings related to right frontal craniotomy with right frontal lobe edema and areas of gyriform restricted diffusion and susceptibility effect. There is persistent mild scattered leptomeningeal enhancement in the right frontal region. There are scattered foci of restricted diffusion in the right centrum semiovale and medial right thalamus.

Output: 1. Postoperative findings related to recent re-resection of a right lateral ventricle central neurocytoma with what appears to be a small amount of residual tumor versus clot, as well hemorrhage, ischemia, and edema along the right parietal surgical tract. 2. Unchanged size of the shunted ventricular system with a small amount of intraventricular hemorrhage.3. Punctate foci of acute infarction in the right centrum semiovale and medial right thalamus.4. Gyriform recent infarcts and hemorrhage superimposed upon vasogenic edema in the right frontal lobe surgical bed region.


Instruction: Generate impression based on findings.

Input: Reason: c/f transverse myelitis History: LE weakness, lumbago, MRI brain: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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.There are small pleural effusions present.Lumbar spine: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. No abnormal enhancing lesions are identified in the lumbar spine.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.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is no evidence for mass lesion to explain the patient's lower extremity weakness.2.There is no evidence for spinal cord lesion in the thoracic or cervical spinal cord account for the patient's lower extremity weakness.3.There is no evidence for cauda equina or conus medullaris lesion to account for the patient's lower extremity weakness.4.To the extent of visualization, no abnormalities are appreciated in the cervical spine, thoracic spine, lumbar spine or brain. Please note that the examination is somewhat degraded due to patient motion - especially the images acquired in the lateral third of the combined exams.5.Please note that MRI of the cord may be negative in the face of transverse myelitis.


Instruction: Generate impression based on findings.

Input: Male, 11 years old, status post L5-S1 hemilaminectomy for resection of a left S1 extra dural mass. Three month follow-up examination. Postoperative findings are again seen compatible with prior left laminectomy at S1, S2 and partially at L5 for resection of the previously seen cystic lesion. Postoperative edema in the operative bed has resolved. Amorphous soft tissue thickening with low level enhancement in the operative bed is compatible with scarring.At the site of the resected lesion, along the ventral epidural space at the proximal left L5 neural foramen, a 6 x 6 mm T2 hyperintense structure with a hypointense rim is detected (see image 37 series 501). No such finding was evident on the prior exam, though the area may have been obscured by edema.Elsewhere, spinal canal contents are within normal limits. No significant canal or foraminal compromise is suspected. Vertebral body morphology and signal characteristics are within normal limits. Alignment is anatomic.

Output: 1.Redemonstration of postoperative findings reflecting prior resection of a cystic lesion from the ventral epidural space at the level of the proximal left L5 neural foramen.2.A 6 x 6 mm T2 hyperintense structure with hypointense rim is identified at the site of the prior lesion which seems to be new compared to prior, though it may have been present but obscured by edema. This could represent residual surgical distortion, but the possibility of a small residual or recurrent component of the original lesion must also be considered. Continued imaging followup is advised.


Instruction: Generate impression based on findings.

Input: Reason: please evaluate for possible soft tissue abscess located in post hip s/p revision left THA History: post hip mass with pain ARTICULAR CARTILAGE AND BONE: Metallic susceptibility artifact from the patient's left total hip arthroplasty device limits evaluation of the surrounding soft tissues of the left hip. No bone marrow signal abnormality is identified.SOFT TISSUES: Evaluation for abscess formation is limited on this noncontrast examination. Within this limitation, there is an encapsulated collection demonstrating fluid signal intensity within the subcutaneous tissues along the posterior and superior aspect of the inferior gluteal crease, measuring approximately 5.3 x 2.1 x 5.4 cm, likely representing abscess formation (image 37; series 4). Additionally, there is a moderate amount of fluid surrounding the superior and lateral aspect of the femoral component of the total hip arthroplasty device indicating an effusion. While this may be related to the patient's stated history of recent arthroplasty revision, superimposed infection cannot be excluded and clinical correlation is indicated.ADDITIONAL

Output: 1. Moderate-sized joint effusion particularly about the superolateral aspect of the femoral component. While this may be postsurgical in etiology, superimposed infection cannot be excluded and clinical correlation is indicated.2. 5.4 cm encapsulated fluid collection along the superior aspect of the inferior gluteal crease, on the right, likely representing abscess formation, within the limitations of this noncontrast examination. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female 45 years old check for progression in thyroid nodules. RIGHT LOBE MEASUREMENTS: 6.0 x 2.9 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.6 x 1.3 cmISTHMUS MEASUREMENTS: 0 2 cmRIGHT LOBE: Again seen is a large, heterogeneous partially cystic and partially solid thyroid mass with calcifications in the right superior pole measuring 3.6 x 2.6 x 2.4 cm. It is not significantly changed in size or appearance compared to the prior ultrasound. LEFT LOBE: A solid, hypoechoic nodule in the left mid pole measures 1.3 x 0.6 x 0.8 cm and contains echogenic foci. On the previous exam there was better demonstration of comet tail artifact. The nodule most compatible with a colloid nodule, unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology left level 1B and level 2 lymph nodes are noted.OTHER: No significant abnormality noted.

Output: Stable heterogeneous partially cystic and partially solid mass with calcifications in the right superior thyroid pole.No change in likely benign left lobe nodule.


Instruction: Generate impression based on findings.

Input: 91-year-old female with right hip pain. History of breast cancer. Evaluate for fracture. BONE MARROW: No bone marrow signal abnormality is identified.SOFT TISSUES: There is thickening and increased signal abnormality on the fluid sensitive sequences within the right piriformis muscle, particularly along the anterior aspect of the muscle belly along the course of the right sciatic nerve. There is also increased signal abnormality on fluid sensitive sequences within the right iliacus muscle. There is associated enhancement on postcontrast sequences. No focal masslike or nodular enhancement is identified.There is nonspecific peritrochanteric inflammation, right greater than left.JOINTS: Mild to moderate degenerative changes affect the hips bilaterally. There is a small amount of fluid within the hip joints, which is not necessarily of any current clinical significance.ADDITIONAL

Output: 1. Enlargement and increased signal abnormality within the right piriformis muscle, particularly along the course of the right sciatic nerve. This constellation of findings has been described in patient's with piriformis syndrome.2. Nonspecific increased signal abnormality within the right iliacus muscle. 3. No acute fracture is evident. Osteoarthritic changes of the hips. Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of met renal cell cancer, now with new onset double vision. The enhancing lesion in the left parietal lobe is unchanged, measuring up to 6 mm, previously also 6 mm. Likewise, the associated minimal confluent surrounding T2 hyperintensity has not significantly changed. The enhancing right inferior temporal gyrus lesion is unchanged in size, measuring up to 4 mm, previously also 4 mm. There is unchanged nonspecific mild, predominantly periventricular, cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal fluid in the mastoid air cells and retention cyst formation in the maxillary sinuses.

Output: 1. No significant interval change in size of the left parietal and right temporal lobe metastases.2. No evidence of new intracranial metastases or acute infarction.3. The orbits appear to be grossly unremarkable. However, dedicated orbital imaging may be useful for evaluating the symptomatology.


Instruction: Generate impression based on findings.

Input: Status post L3-L5 fusion, planning to extend the sacrum Five lumbar type vertebral bodies are presumed to be present. Grade 1 anterolisthesis of L5 on S1 is better seen on prior upright radiograph. Vertebral body heights and alignment are otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position. Postoperative changes of spinal fusion from L3 to L5 are again seen with hardware better assessed on recent CT. Left L5 pedicle fracture also better seen on same-day CT.Susceptibility artifact related to the hardware slightly limits assessment. Degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. Interbody fusion. No spinal canal or neural foraminal stenosis.L4-L5: Interbody fusion. Mild disc bulge eccentric to the right with mild right neural foraminal narrowing. No spinal canal or left neural foraminal stenosis. Small extradural fluid collection, likely postoperative, in the left laminectomy bed.L5-S1: Disc bulge and moderate bilateral facet arthropathy. There is mild to moderate bilateral neural foraminal stenosis with susceptibility artifact limiting evaluation.

Output: 1. Postoperative changes of L3-L5 fusion. No significant spinal canal stenosis at any level. There is mild to moderate bilateral L5-S1 and mild right L4-L5 neural foraminal stenosis.2. Left L5 pedicle fracture better seen on same-day CT. There is moderate bilateral L5-S1 facet arthropathy. Grade 1 anterolisthesis at this level is appreciated on upright radiographs.3. Please see same day CT report for additional findings.


Instruction: Generate impression based on findings.

Input: 55-year-old female. Patient had a suspected intraductal mass with associated ductal dilatation in the right breast within or immediately behind the nipple. MR directed ultrasound was recommended for further evaluation. A targeted right breast ultrasound was performed for the area of concern on MRI. In the superolateral retroareolar region, there is a 1.4 x 0.6 x 1.1 cm circumscribed parallel hypoechoic mass without significant internal vascularity. A dilated duct leads up to this mass, which corresponds to the enhancing intraductal lesion seen on MRI. The mass is inseparable from and likely within the nipple itself.

Output: The previously seen MRI intraductal mass has a sonographic correlate of a 1.4 cm circumscribed hypoechoic mass in the nipple, which may be a papilloma but is nonspecific. Further evaluation with an ultrasound guided biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Pain. Fall injury to left knee. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a subtle decreased T1 and high T2 signal within the lateral aspect of the lateral femoral condyle with minimal depression of the cortical surface compatible with an impaction injury/bone contusion. Edema is also noted within the posterior aspects of the medial and lateral tibial plateaus.There is minimal thinning of the weight-bearing portion of the articular cartilage of the medial femoral condyle. There is slight thinning of the articular cartilage of the anterior lateral femoral condyle. The extensor compartment articular cartilage is intact.LIGAMENTS: There is a complete tear of the anterior cruciate ligament. The posterior cruciate ligament is intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complete tear of the anterior cruciate ligament.2. Impaction injury/bone contusion of the lateral femoral condyle.


Instruction: Generate impression based on findings.

Input: Concern for Korsakoff syndrome. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is patchy high T1 signal within the bilateral basal ganglia and perhaps the pituitary gland. The ventricles and sulci are diffuse prominent due to cerebral volume loss. There are diffuse foci of cerebral white matter T2 hyperintensity. There are are few punctate foci of susceptibility effect in the bilateral frontal lobes. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant. The partially imaged upper cervical spine bone marrow appears mildly heterogeneous, which is nonspecific, and there are mild posterior disc-osteophyte complexes.

Output: 1. Patchy high T1 signal within the bilateral basal ganglia and perhaps the pituitary gland suggest chronic alcoholic encephalopathy. 2. Diffuse foci of cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease. 3. A few punctate foci of susceptibility effect in the bilateral frontal lobes may represent chronic microhemorrhages.4. Mild diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: please perform STROKE PROTOCOL History: L sided weakness Brain MRINew evidence of susceptibility lesions especially around the right frontal lobe where the tumor resection was performed indicate operation related blood products. There is no evidence of acute ischemic lesion on this scan.Metallic artifacts on the right middle cranial fossa due to surgical clips, unchanged. Left occipital approach catheter with left cerebellar FLAIR high signal lesion are again seen, unchanged.Bihemispheric extra axial fluid collections, subdural most likely, are seen and unchanged in terms of distribution and maximum thickness since prior scan. Right precentral gyrus and left middle frontal gyrus FLAIR high signal intensity lesions are seen, unchanged since prior scan.Scattered and somewhat patchy FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease, unchanged since prior scan. The ventricles, sulci and cisterns are unremarkable. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the right ACA, MCA and distal ICA beyond the level of the right ophthalmic artery most likely due to metallic artifacts.The left ICA, MCA and ACA appear to be normal. Vertebrobasilar system appears to be normal. Left PCA appears to be fetal origin.

Output: 1. Post right frontal tumor resection status, no unusual finding.2. Unchanged extraaxial fluid collections and multifocal FLAIR abnormalities including left cerebellar lesion since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.4. Brain MRA is unremarkable.


Instruction: Generate impression based on findings.

Input: 57 year old man with history of CAD s/p multiple PCI, referred for stress CMR for evaluation of chest pain.MEDICATIONS: amlodipine, ASA, plavix, zetia, simvastatin, irbesartan, imdur, atenolol. First Pass PerfusionDuring hyperemia, there is a perfusion defect along the inferolateral wall extending from base to apex.Viability/ Myocardial ScarThere was is a subendocardial, non-transmural myocardial infarction/ late gadolinium enhancement involving the basal to mid inferolateral wall. This territory has intermediate viability. There is additionally a second very small transmural myocardial infarction involving the apical lateral wall. This small territory is not viable. The remainder of myocardium is free of myocardial infarction and likely to be viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 217 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 42 g/m2, and the LV mass is 95 g. There is mild hypokinesis of the mid inferolateral wall. 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 66%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 203 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious 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. During hyperemia, there is a perfusion defect/ "ischemia" along the inferolateral wall extending from base to apex.2. There was is a subendocardial, non-transmural myocardial infarction involving the basal to mid inferolateral wall. This territory has intermediate viability. There is additionally a second very small transmural myocardial infarction involving the apical lateral wall. This small territory is not viable. The remainder of myocardium is free of myocardial infarction and likely to be viable.3. Normal LV size and systolic function (LVEF 65%) with mild hypokinesis of the mid inferolateral wall.4. Normal RV size and systolic function (RVEF 66%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Assess for cause for increased confusion in patient with dementia and left retro-bulbar mass. There is no evidence of intracranial hemorrhage or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease of indeterminant age. Prominence of the ventricles and sulci indicate corticomedullary volume loss. No specific findings to indicate acute ischemia. However if there is concern for an acute stroke, an MRI may be helpful for further evaluation.Limited views of the orbit shows an ill-defined soft tissue within the left orbit posterior to the globe with proptosis and deformation of the left globe is again noted. When accounting for differences in technique the size of this mass and enhancement appears decreased when compared to the prior MRI exam.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Small vessel ischemic disease of indeterminate age. No findings to indicate acute ischemia. However, if there is concern for an acute stroke an MRI is recommended for further evaluation.2. Ill-defined left orbital soft tissue mass with proptosis and deformation of the left globe. Suggestion of interval decrease in size when compared to the prior MRI exam performed 3/12/08.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with cervical myelopathy, radiculopathy, pain since 1998, numbness and tingling and burning, left upper extremity more than right upper extremity. Spinal alignment is anatomic. Vertebral body heights are preserved. Mild endplate degenerative irregularity is seen at C4-5, C5-6 and C6-7. No evidence of pathologic marrow replacement or edema is seen. The visualized spinal cord demonstrates no signal intensity. Additional details as below.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild uncovertebral hypertrophy. No spinal canal stenosis. Mild foraminal narrowing. No interval changes. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation with a central disc protrusion, progressed. Along with ligamentum flavum thickening, this causes a severe spinal canal stenosis with cord impingement. The neural foramina are significantly narrowed. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation with a central disc protrusion, progressed. This causes a severe spinal canal stenosis and cord impingement. The neural foramina are significantly narrowed.C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation with a central disc protrusion. Along with ligamentum flavum thickening, this causes a severe spinal canal stenosis and cord impingement. The neural foramina are narrowed. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Progressive degenerative disease in the cervical spine is seen. Specifically, disc osteophyte formation and central disc protrusions at C4-5, C5-6 and C6-7 have worsened resulting in significant spinal canal stenosis, cord impingement, and foraminal narrowing.


Instruction: Generate impression based on findings.

Input: There is a rim-enhancing mass measuring 5 x 6 mm within the superior frontal gyrus of the right frontal lobe which corresponds to the FLAIR signal abnormality in the previous exam. The focus of T2/FLAIR hyperintensity in the right temporal lobe does not enhance and may represent artifact on the previous exam. As suggested previously, the nonenhancing focus of T1 hypointensity in the left frontal lobe likely represents small vessel ischemic disease. Again seen is a punctate focus of susceptibility in the right frontal lobe compatible with microhemorrhage and remains nonspecific.The cortical sulci are in proportion to the cerebral ventricles. No intra-axial or extra-axial fluid collections are visualized. There is no midline shift or mass effect. The basal cisterns are visualized. No fluid collections are visualized in the paranasal sinuses and mastoid air cells.

Output: 1.A rim-enhancing mass measuring 5 x 6 mm at the right superior frontal gyrus may represent a metastasis.2.The right middle temporal gyrus abnormal FLAIR signal intensity lesion on the prior exam does not enhance thus is unlikely to represent metastatic disease.3.As suggested previously the nonenhancing focus of T1 hypointensity in the left frontal lobe likely represents small vessel ischemic disease.Comment: Since the axial 3D FSPGR was reconstructed with 2mm thickness, this sequence may need to either re-reconstructed with 1mm thickness based on 3D source images for the SRS planning or may be need to repeated.


Instruction: Generate impression based on findings.

Input: Ms. Jonikaite is a 40 year old female with a recent left breast lumpectomy for malignant phylloides tumor in 12/2015 with multiple positive margins. She initially presented with a palpable mass, first diagnosed with a fibroadenoma, then had additional surgery after continued growth of the mass revealed malignant tumor and she underwent left lumpectomy. She presents today for MR directed ultrasound for findings seen on recent MRI. On physical examination, skin scar is noted at the 12:00 location of the left breast. No mass is palpated in the left axilla or either breast.A targeted right and left breast ultrasound was performed for the MRI areas of concern and the left axilla. --Left breast: Surgical scar from recent left breast lumpectomy is identified in the left superior breast. However, no sonographic correlate is identified for the three additional enhancing masses seen extending inferomedial from the left lumpectomy bed. --Left axilla: In the left axillary region, an abnormal morphology lymph node with focal cortical thickening (4 mm) is identified, measuring approximately 1.8 x 0.7 x 1.7 cm.--Right breast: In the right breast 12:00 location, 5 cm from the nipple, there is a 8 x 6 x 12 mm clustered microcyst identified, which likely corresponds to one of the numerous cysts identified on recent MRI. No sonographic evidence of malignancy in the right breast.

Output: (1) Patient had recent left breast lumpectomy for malignant phyllodes tumor with multiple positive margins. Recent MRI demonstrated three additional enhancing masses extending inferomedial from the lumpectomy bed. No sonographic correlate was identified on today's MR directed ultrasound. If breast conservation therapy is desired, an MR guided biopsy for one of these masses (presumably the furthest enhancing mass from the lumpectomy site) is recommended. (2) Abnormal morphology left axillary lymph node, corresponding to the MR detected abnormal lymph node. An ultrasound-guided biopsy with clip placement can be performed if clinically warranted.(3) No sonographic or MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with bowel and bladder incontinence. No evidence of cord compression or significant spinal canal stenosis is seen. Relatively mild disc osteophyte formation is noted in the cervical region. In the lumbar spine, degenerative disc disease is seen at L4-5 and L5-S1. The L5-S1 neural foramina appear to be at least moderately narrowed. Vertebral body morphology is within acceptable limits. Spinal alignment is unremarkable allowing for a mild curvature in the coronal plane. Note is made of edema within and along the proximal left T8 rib.

Output: 1.No evidence of cord compression or significant spinal canal compromise.2.Edema of the proximal left T8 rib is seen. Correlation with point tenderness is suggested.


Instruction: Generate impression based on findings.

Input: Assess for progression of subchondral edema. MENISCI: Severe blunting of the body of the medial meniscus likely reflects postsurgical changes. No definite superimposed tear is present. Signal characteristics and morphology of the lateral meniscus are unremarkable without evidence of discrete tear.ARTICULAR CARTILAGE AND BONE: Full-thickness thickness cartilage defect of the weightbearing portion of the medial femoral condyle is stable to slightly larger than seen previously, measuring approximately 12 mm. There is mild thinning of the articular cartilage of the of the lateral femoral condyle without full-thickness cartilage defect. Focal near full-thickness articular cartilage degeneration of the lateral tibial plateau immediately lateral to the tibial spine is unchanged. Near full-thickness degeneration of the medial patellar facet as well as focal near full-thickness defect of the lateral patellar facet appears similar to the previous exam. Near full-thickness degeneration of the medial and lateral femoral trochlea and full-thickness defect at the central femoral trochlea are also unchanged.Bone marrow edema in the medial femoral condyle is grossly unchanged.LIGAMENTS: There is thickening and increased signal abnormality in the anterior cruciate ligament, suggestive of progressive partial chronic tearing.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Full-thickness cartilage defect of the medial femoral condyle redemonstrated.2.No significant interval change in bone marrow edema of the medial femoral condyle.3.Articular cartilage degeneration and focal defects are grossly stable, as detailed above.


Instruction: Generate impression based on findings.

Input: There is an unchanged peripherally enhancing lesion measuring up to 25 millimeters centered within the left basal ganglia with suggestion of an eccentric target sign with surrounding edema and resultant mild mass effect upon the left lateral and third ventricles. There are areas of diffusion restriction within both the lesion and the adjacent corona radiata. There is a low relative cerebral blood volume within the lesion, but mildly increased perfusion in the adjacent corona radiata, near prominent perforating lenticulostriate vessels, which therefore likely represents luxury perfusion. There is an unchanged subcentimeter focus of T2 hyperintensity in the left caudate nucleus, which is compatible with a chronic lacunar infarct. There are multiple additional unchanged subcentimeter foci of supratentorial intrinsic T1 hyperintensity and susceptibility effect that correspond to calcifications. There is mild diffuse enhancement and thickening of the dura along the left cerebral convexity that likely represents residual reaction to prior subdural hemorrhage. However, there is no evidence of acute intracranial hemorrhage. There are multiple patchy areas of T2 hypertensity throughout the cerebral white matter predominantly in a subcortical distribution, which have gradually progressed. There is gradually progressive global volume loss. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. A peripherally-enhancing lesion centered in the left basal ganglia that measures up to 25 mm has features most suggestive of toxoplasmosis and less likely lymphoma, perhaps with associated acute ischemia in the adjacent corona radiata due to vasculitis from inflammation or compression intraparenchymal vessels. Further evaluation via Thallium 201 Chloride SPECT may be useful for further characterization, if clinically warranted.2. Gradually progressive global volume loss may represent AIDS dementia.3. Multiple progressive scattered patchy areas of T2 hypertensity in the cerebral white matter may represent sequela of HIV-associated opportunistic infections, such as progressive progressive multifocal leukoencephalopathy or vasculopathy, for instance.4. Multiple unchanged intra-axial and extra-axial calcified lesions likely represent sequela of prior opportunistic infection.


Instruction: Generate impression based on findings.

Input: Ulnar nerve pain There is a small focus of increased signal intensity involving the ulnar nerve at the level of the elbow joint best appreciated on series 4 image 15. Otherwise the ulnar nerve appears normal in signal intensity and caliber throughout its visualized course. The course of the ulnar nerve is delineated on PACS and is best seen on series 4, 7, and 10. There is no abnormal enhancement following contrast administration although visualization of the nerve on the postcontrast sequences is somewhat limited. There is skin irregularity and enhancement along the posterior medial aspect of the elbow likely relating to prior surgical intervention. Enhancement of the soft tissues is thought to represent scarring and there are small foci of signal void relating to prior surgical intervention. There is no abnormal signal intensity within the musculature surrounding the elbow. Although not tailored for the evaluation of the ligamentous and tendinous structures of the elbow, the ulnar collateral ligament and origin of the common extensor tendons are poorly visualized which likely relates to chronic tearing.The marrow signal intensity of the distal humerus, proximal radius, and proximal ulna is normal.

Output: Small focus of increased signal intensity involving the ulnar nerve at the level of the elbow joint which is nonspecific but may reflect a minimal neuritis. Otherwise the ulnar nerve demonstrates normal signal intensity and caliber.


Instruction: Generate impression based on findings.

Input: 56-year-old female patient with medial right knee pain x 5 months. Evaluate for medial meniscus tear with subchondral cysts. MENISCI: There is marked attenuation of the body of the medial meniscus, likely representing extensive degenerative tearing. Although this could conceivably represent prior meniscectomy, we see no additional findings to support this. The attenuated meniscal body contains abnormal increased signal intensity that extends to the posterior horn and to a lesser degree the anterior horn, indicating a combination of degeneration and tearing. There is mild intrasubstance signal within the lateral meniscus, indicating mild intrasubstance degeneration, but we see no tear.ARTICULAR CARTILAGE AND BONE: There is a full-thickness fluid-filled defect in the articular cartilage of the weightbearing portion of the medial femoral condyle that measures approximately 2 cm in AP dimension and 5 mm in width. There is additional near full-thickness to full-thickness loss of the articular cartilage of the medial femoral condyle, particularly posteriorly, with numerous subchondral cysts and subchondral edema-like signal. There is also subjective thinning of the medial tibial plateau articular cartilage. There is degeneration of the articular cartilage of the lateral patellar facet with full-thickness fissuring and underlying subchondral cyst formation. There is less pronounced articular cartilage degeneration of the medial patellar facet. There is mild heterogeneity of the weightbearing portion of the lateral compartment articular cartilage, indicating focal degeneration.LIGAMENTS: There is mild edema along the superficial band of the medial collateral ligament, likely secondary to underlying meniscal/cartilage pathology, however, this could represent a sprain in the appropriate clinical context. The anterior cruciate alignment, posterior cruciate ligament, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Severe degeneration and tearing of the medial meniscus.2.Tricompartmental articular cartilage defects, particularly in the medial compartment with prominent subchondral cysts.


Instruction: Generate impression based on findings.

Input: Biochemical hypercortisolism. The pituitary gland enhances homogeneously and measures up to 6 mm in craniocaudal dimension, which is within normal limits. There is no discernible focal lesion within the pituitary gland. The pituitary infundibulum and neurohypophysis bright spot are intact. There is no mass effect upon the cavernous sinuses or optic apparatus. The imaged portions of the brain, brainstem, and cerebellum are unremarkable.

Output: No evidence of pituitary hypertrophy or discernible focal lesions to suggest pituitary adenoma.


Instruction: Generate impression based on findings.

Input: T8 -- T9 level mass. Possible vascular period recommended CTA for further evaluation. Examination demonstrates a dural based high density mass measuring approximately 22 mm in cranial cephalad access in 5-mm in AP access immediately anterior to the superior facet of T8 on the left. There is no evidence of increased vascularity to suggest arteriovenous malformation, dural aVF at this location. This lesion is primarily on the left side however a very small extension of the lesion across the midline to the right is noted. The finding is believed to represent a meningioma. A high density lesion on axial images is more suggestive of calcification rather than enhancement. Review of prior MRI examination demonstrates no abnormal edema of the cord. No definitive increased vascularity within the epidural dorsal fat pad is detected.

Output: Dural based intradural extra medullary high density (likely calcification and less likely enhancement) may represent an intracanalicular meningioma. No definitive evidence of increased vascularity to suggest vascular malformation and no evidence of edema of the cord on prior MRI examination from 4 -- 9 -- 2009 was noted.


Instruction: Generate impression based on findings.

Input: Female, 90 years old. Evaluate for osteomyelitis of the left 3rd toe. Chronic draining left 3rd toe ulcer (present over 1 month) with increasing pain and drainage. Plain x-rays do not show osteomyelitis. Examination of suboptimal due to motion artifact on several sequences.There is mild soft tissue swelling particularly about the dorsum of the foot. There is no abnormal signal within the bone marrow. No bone marrow edema. There is no enhancement on postcontrast imaging. No evidence of abscess. Metallic blooming artifact is present along the osteotomies of the first and second toes. Redemonstrated are ostomies of the first and second digits at the proximal phalanges present since 2012. Arthroplasties of the third and fourth toes are also noted. Moderate osteoarthritis affects the first metatarsophalangeal joint.

Output: No evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. 5/10/2015 biopsy showed 3+3 left lateral base disease. PELVIS:PROSTATE:Prostate Size: 4.3 x 5.6 x 5.9 cmPeripheral Zone: In the left mid gland there is a 8 x 8 mm focus of restricted diffusion (series 500/284) with associated T2-weighted hypointensity (series 1 601/13) and early arterial enhancement (series 1 701/1 853) suspicious for prostatic adenocarcinoma.In the left base there is a 1.1 x 0.9 cm focus of T2-weighted hyperintensity (series 1 601/19) and restricted diffusion (series 504/384) which may represent an additional site of prostatic adenocarcinoma versus asymmetric central zone.Central Gland: In the apex anteriorly there is a 1.7 x 1.0 cm focus of restricted diffusion (series 504/204 with subtle ill-defined decreased T2 weighted hypointensity. Benign prostatic hyperplasia. Median lobe hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. 8 x 8 mm focus in the left mid gland is suspicious for prostatic adenocarcinoma and is amenable to MRI/ultrasound fusion biopsy. 2. Additional 1.1 cm focus in the left base and 1.7 cm anterior apex focus may represent additional sites of prostatic adenocarcinoma and are amenable to MRI/ultrasound fusion sampling.3. No evidence of seminal vesicle invasion, extraprostatic extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified abnormalities of gait and mobilityClinical question: vascular parkinsonism, gait instability MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Some enlarged perivascular spaces are present in the deep gray nuclei and left thalamus.On susceptibility imaging there are punctate subcortical white matter signal hypointense foci present located in the left inferior frontal gyrus, right precentral gyrus, right inferior parietal lobule, left inferior parietal lobule, left posterior temporal lobe, right middle frontal gyrus, periventricular white matter adjacent to the trigone of the right lateral ventricle, adjacent to the trigone of the left lateral ventricle and in the subcortical white matter of the cerebellum.There is a punctate focus at the trigone of the right lateral ventricle which is hyperintense on diffusion-weighted imaging but does not display any diffusion restriction on the ADC maps and appears represent T2 shine through.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present. Examination is somewhat degraded by patient motion.At C2-3 there is no significant compromise to the spinal canal. There is moderate left-sided facet hypertrophy present at this level. There is mild encroachment of the left-sided exiting nerve roots at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is marked left-sided facet hypertrophy present at this level. There is encroachment of left-sided exiting nerve roots at this levelAt C4-5 there is no significant compromise to the spinal canal. There is a moderate left-sided facet hypertrophy present at this level and mild right-sided facet hypertrophy. There is a small central disc protrusion present at this level. There is some encroachment of the left-sided exiting nerve roots within the left neural foramen at this level.At C5-6 there are endplate and uncovertebral osteophytes present associated with the effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the right-sided exiting nerve roots within the neural foramina. Overall there is a moderate degree of spinal stenosis at this level.At C6-7 there are endplate and uncovertebral osteophytes present associated with the effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the exiting nerve roots within the neural foramina. Overall there is a moderate degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction. Please note that the exam is somewhat degraded by patient motion which may obscure more subtle abnormalities.3.Some enlarged perivascular spaces in the basal ganglia and left thalamus may be a result of prior ischemic events.4.There are multilevel degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is a moderate degree of spinal stenosis present. There is additional multilevel encroachment of exiting nerve roots within the neural foramina as detailed above. Please note however that the cervical spine exam is degraded by motion artifact which may obscure more subtle abnormalities.5.Multiple microhemorrhages present in the subcortical white matter. Etiology is nonspecific. One possibility is amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: 19 year-old male. Pain. Labral tear. ROTATOR CUFF: Rim rent partial tear of the undersurface of the supraspinatus tendon insertion, unchanged. The remaining rotator cuff tendons are unremarkable. No muscle edema or atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Interval resolution of previous seen edema in the humeral head. There remains a subtle depression of the posterior superior aspect of the humeral head consistent with a mild Hill-Sachs deformity. The remaining osseous structures are unremarkable. Glenoid labrum is intact without evidence of a tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Glenoid labrum is intact without evidence of tear.2. Partial undersurface tear of the supraspinatus tendon, unchanged.3. Stable mild Hill-Sachs deformity with interval resolution of humeral head edema.


Instruction: Generate impression based on findings.

Input: Low back pain with lumbar radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is straightening of the lumbar lordosis and mild levocurvature. Bone marrow signal is benign. The conus medullaris is normal in position.There is multilevel disc desiccation with disc height loss, relatively worse at the L4-L5 and L5-S1 levels. Multilevel degenerative changes are further described as below:T12-L1: Small right paracentral disc protrusion. No significant spinal canal or neural foraminal stenosis.L1-L2: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. No significant spinal canal or neural foraminal stenosis.L2-L3: Disc bulge which is eccentric to the left, ligamentum flavum thickening, and facet arthropathy contribute to moderate to severe spinal canal stenosis. There is mild left neural foraminal narrowing. Right neural foramen is patent.L3-L4: Disc bulge, ligamentum flavum thickening, and facet arthropathy contribute to mild narrowing of the spinal canal and mild narrowing of the neural foramina.L4-L5: Disc bulge, ligamentum flavum thickening, and facet arthropathy contribute to mild central spinal canal stenosis. There is also partial effacement of the lateral recesses, greater on the left. There is mild to moderate right neural foraminal stenosis as well as contact of the right L4 nerve root extra foraminally. There is mild left neural foraminal stenosis.L5-S1: Disc bulge, ligamentum flavum thickening, and facet arthropathy. Partial effacement of the left lateral recess and minimal central canal stenosis. There is mild to moderate right neural foraminal stenosis and moderate left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes throughout the lumbar spine. There is moderate to severe spinal canal stenosis at the L2-L3 level. Neural foraminal stenoses are worst at the bilateral L5-S1 level, left greater than right, as well as the right L4-L5 level. Please see additional details above.


Instruction: Generate impression based on findings.

Input: 75 year old female with metastatic breast cancer and pancreatitis status post ERCP on 10/27 with stent placement now with abdominal pain, nausea/vomiting, increasing lipase. Please evaluate for pancreatitis. ABDOMEN:LUNG BASES: Increase in bilateral pleural effusions since prior MRI, right greater than left with adjacent atelectasis/consolidation.LIVER, BILIARY TRACT: Air seen throughout the biliary tract consistent with recent biliary stent placement. Biliary stent appears patent. The portal vein is not well visualized. The SMV at the level of the confluence, confluence and the entire splenic vein are not visualized. The SMV proximal to the confluence appears patent. The gallbladder at the level of the gallbladder neck demonstrates a diffuse low attenuation lesion which enhances on arterial phase is suspicious for metastatic lesion measuring 1 cm x 1 cm best seen on image 4477, series 8.Re-identification of multiple scattered hypodense lesions throughout the liver the largest of which previously measured 1.4 x 1 cm best seen on image 64/97, series 4 now measures 1.1 cm best seen on image 16/138, series 10.SPLEEN: Splenic vein is not visualized however spleen appears unremarkable.PANCREAS: Diffuse pancreas enlargement with some posterior peripancreatic stranding out of proportion to ascites consistent with pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left-sided hydronephrosis and hydroureter with narrowing and loss of visualization of the distal ureter with resultant obstruction, best seen on image 70/138, series 10.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Re-identification of new multiple, sclerotic lesions due to metastatic disease.OTHER: Moderate intra-abdominal ascites.PELVIS:UTERUS, ADNEXAE: Calcified fibroid uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: As described above.OTHER: No significant abnormality noted

Output: 1. Worsening of bilateral pleural effusions.2. Poor visualization of the portal vein, confluence, splenic vein and distal SMV consistent with thrombosis.3. New left-sided hydronephrosis and hydroureter with lack of visualization of the distal ureter consistent with obstruction.4. Apparent worsening of intra-abdominal ascites.


Instruction: Generate impression based on findings.

Input: Low back pain, metastatic pancreatic cancer, evaluate for metastasis in the spine. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with scattered foci of T1 hyperintensity compatible with focal fat or hemangiomas. No suspicious enhancing or destructive lesions are appreciated. The conus medullaris is normal in position.Mild degenerative changes are seen with disc desiccation throughout the lumbar spine. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy with tiny synovial cyst posteriorly.L3-L4: Mild disc bulge results in minimal left greater than right neural foraminal narrowing. No significant spinal canal stenosis. Mild facet arthropathy.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.No abnormal enhancement involving the thecal sac or evidence of epidural tumor. There is mild enhancement associated with the facet arthropathy particularly at the L3-L4 level which is likely on a degenerative basis.

Output: 1. No evidence of metastatic disease to the lumbar spine. No evidence of significant spinal canal or neural foraminal stenosis.2. Mild degenerative changes including mild multilevel facet arthropathy which may be contributing to patient's low back pain.