Instruction: Generate impression based on findings.

Input: Diagnosis: Intracranial abscess and granulomaClinical question: view for residual area of lesion abscessSigns and Symptoms: s/p craniotomy for abscess The patient is status post right craniotomy and right temporal lobe surgery for removal of a ring enhancing lesion. There is no residual enhancing lesion appreciated. There are adjacent T2/FLAIR hyperintense signal changes present in the immediately adjacent brain tissue. There is scalp soft tissue swelling present. There is 2mm extra-axial collection at the craniotomy site.The patient is status post right mastoidectomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam a right temporal lobe ring enhancing lesion has been removed. There are associated postoperative changes present including a small extra-axial collection. 2.Status post right mastoidectomy and temporal bone surgery.


Instruction: Generate impression based on findings.

Input: Male 19 years old Reason: 19-year-old male with history of NK/T-Cell Lymphoma with history of R hip effusion and chronic osteomyelitis History: R hip osteomyelitis now s/p12 weeks of antibiotic therapy BONE MARROW: Right hip: Larger geographic territory of predominantly hypointense T1 and hyperintense T2 lesion of the right femoral head still extending to the femoral neck. Persistent slight irregularity of the articular surface of the femoral head with no evidence of subchondral collapse. Previous described lesions of the femoral head and neck on the right hip enhances with contrast administration. There is a focus of peripheral increased signal with loss central signal after administration of contrast of the right trochanter (image 15, series 1301).Left hip: Stable appearance of chronic appearance of avascular necrosis of the left femoral head. There is a focus of peripheral increased signal with loss central signal after administration of contrast of the left trochanter (image 18, series 1301)SOFT TISSUES: Interval resolution of changes previously described of the right iliopsoas muscle. JOINTS: Interval improvement in right-sided joint effusion.ADDITIONAL

Output: Interval resolution of right hip joint effusion and iliopsoas muscle changes.Increasing in the size of the right femoral head lesion consistent with evolving avascular necrosis.Stable appearance of left femoral head chronic avascular necrosis.Possible small focus of residual osteomyelitis in both trochanters.


Instruction: Generate impression based on findings.

Input: Lung cancer. Headache. Evaluate for metastasis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Confluent and patchy T2/4 hyperintense signal is present in both cerebral hemispheres. There is mild expansion of the CSF-containing spaces, reflecting mild global parenchymal volume loss. The brain parenchyma and pituitary gland appear unremarkable otherwise. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are preserved, accounting for hypoplastic left vertebral artery with PICA termination. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered mucosal thickening in the paranasal sinuses relatively greater involving the left frontal sinus and left anterior ethmoid air cells.

Output: 1.No evidence of intracranial metastatic disease.2.Mild-to-moderate chronic small vessel ischemic disease.3.Mild mucosal thickening in the paranasal sinuses.


Instruction: Generate impression based on findings.

Input: Clinical question: Acute stroke? Signs and symptoms: Bilateral weakness. Nonenhanced head CT:There is no detectable intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Considering normal to consecutive CT examination recommend follow-up with an MRI exam.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: Negative nonenhanced head CT. Recommend follow up with an MRI considering clinical information provided and two very recent negative head CT's.


Instruction: Generate impression based on findings.

Input: Status post stereotactic biopsy of the left breast, with a result of LCIS, presenting for high risk lesion MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.A metallic artifact from prior biopsy clip is present at middle upper inner quadrant in the left breast. No abnormal enhancement around this metallic artifact.An enhancing intramammary lymph node is present in the left upper outer quadrant.There are multiple benign appearing small enhancing masses in the left breast, the largest one (13 mm) locating posterior 10:00 position in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Follow up MRI in one year is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Pain and loss of motion. Question of scapholunate disassociation versus DJD. LIGAMENTS: No significant abnormality noted. There is no evidence of communication of the radiocarpal joint and the mid-carpal joint. TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: The trapezium is absent. There are post-surgical changes to the base of the first metacarpal bone. ADDITIONAL

Output: 1. Intact scapholunate ligament. 2. Absent trapezium and post-surgical changes of the basilar joint.


Instruction: Generate impression based on findings.

Input: History of recurrent bladder cancer. Evaluate disease status. History of vaginal bleeding. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis within a normally distended gallbladder. No focal suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous bilateral simple and minimally complex proteinaceous/hemorrhagic renal cysts and too small to characterize hyperintensities.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Incompletely characterized right lower lobe lung nodule.PELVIS:UTERUS, ADNEXA: The patient is status post hysterectomy. In the expected region of the vaginal cuff there is a lobular enhancing mass lesion measuring 5.1 x 3.7 cm (series 110/53) which demonstrates FDG avidity on same day PET/CT, compatible with tumor.BLADDER: Status post cystectomy with right lower quadrant ileal conduit.LYMPH NODES: Prominent periportal lymph nodes are nonspecific. Shotty subcentimeter retroperitoneal lymph nodes are noted. The largest is a distal left periaortic lymph node measuring approximately 8 mm (series 7/7) in short axis. Additional prominent distal aortocaval and aortic bifurcation lymph nodes.BOWEL, MESENTERY: Large right lower quadrant parastomal hernia containing bowel loops without evidence of complication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mildly prominent lower retroperitoneal lymphadenopathy. Correlate with same day PET/CT findings.2. Enhancing soft tissue in the region of the vaginal cuff is also compatible with local tumor recurrence.3. Incompletely evaluated lung nodules. Correlate with same day PET/CT findings.


Instruction: Generate impression based on findings.

Input: Male, 33 years old. Left knee pain. Concern for ACL injury. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema within the posterolateral tibial plateau and the fibular head which may be secondary to contusion. There is a bone fragment adjacent to the lateral aspect of the tibial plateau which likely represents a Segond fracture as seen on prior radiograph. The articular cartilage appears intact.LIGAMENTS: There is intermediate signal within the anterior cruciate ligament, however, some of the fibers appear intact which may indicate a partial tear. The posterior cruciate ligament appears intact. There is intermediate signal within the medial collateral ligament which may represent a sprain. The lateral collateral ligament appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings consistent with a partial tear of the anterior cruciate ligament and sprain of the medial collateral ligament.


Instruction: Generate impression based on findings.

Input: Low back pain radiating to ankles, left more than right. There is lack of the usual lumbar lordosis, but no spondylolisthesis. There are intravertebral disc herniations at L2 through L4, with surrounding endplate degenerative bone marrow signal alterations. The vertebral body heights are otherwise intact. The spinal cord is normal in appearance and the conus terminates at the mid L1 level. The paravertebral soft tissues are unremarkable. Additional findings by level:T12-L1: Minimal disc bulge without spinal canal stenosis or neuroforaminal narrowing.L1-L2: Mild diffuse disc bulge and hypertrophy of the right ligamentum flavum without significant spinal canal or neural foraminal stenosis.L2-L3: Mild diffuse disc bulge, minimal facet hypertrophy, and mild thickening of the ligamentum flavum without significant spinal canal or neural foraminal stenosis.L3-L4: Moderate disc bulge, facet hypertrophy, and hypertrophy of the ligamentum flavum results in mild bilateral neural foraminal stenosis, but no significant spinal canal stenosis.L4-L5: Moderate disc bulge, moderate to severe facet hypertrophy, and thickening of the ligamentum flavum with moderate bilateral neural foraminal narrowing and effacement of the left lateral recess with impingement upon the nerves roots in this region.L5-S1: Moderate disc bulge asymmetric to the left, severe facet arthropathy, and thickening of the ligamentum flavum with severe bilateral neural foraminal narrowing and considerable spinal canal narrowing with apparent impingement upon the nerve roots in the lateral recesses bilaterally.

Output: Multilevel degenerative spondylosis of the lumbar spine, including moderate bilateral neural foraminal narrowing at L4-5 severe bilateral neural foraminal narrowing at L5-S1, as well as compression of some of the intrathecal nerves roots at these levels, particularly on the left side at L4-5.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of HBV with lesions noted on ultrasound, evaluate for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: There is redemonstration of a T2 hyperintense 12 mm lesion within segment 5/8 which demonstrates peripheral, nodular enhancement on early postcontrast images and filling-in on more delayed images and which is compatible with a hemangioma. The lesion has minimally increased in size compared to 6/20/2013. No suspicious lesions are identified. The liver demonstrates normal morphology and signal. The hepatic vasculature appears patent. There is no biliary ductal dilatation. The gallbladder appears unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious liver lesion.2.Small lesion in the right lobe of the liver compatible with a hemangioma.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is intrasubstance degeneration of the posterior horn of the medial meniscus. Some signal abnormality extends to the tibial articular surface indicating superficial fraying. No fluid-filled tear is evident. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the median eminence of the patella. There is a linear focus of low signal intensity within the articular cartilage of the femoral trochlea, centrally, likely representing a partial-thickness articular cartilage cleft. There is relatively sparing of the articular cartilage of the medial and lateral compartments.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is increased signal abnormality within the mid substance fibers of the patellar tendon which may reflect mild tendinosis. No fluid-filled tear is evident.ADDITIONAL

Output: Large loculated fluid collection within the subcutaneous tissue along the anterior aspect of the patellar tendon which appears most consistent with a hemorrhagic subcutaneous infrapatellar bursitis, although the inferior extent of this collection is not included in its entirety on this examination. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, history of stroke with right hemiplegia and left ICA stenosis. MRI:Areas of restricted diffusion seen previously within the left centrum semiovale and insula have resolved. No new areas of restricted diffusion are demonstrated.A right frontal approach ventricular catheter is in place with its tip in the right frontal horn, approximately unchanged relative to the prior examination. Ventricular size and morphology are unchanged including ex vacuo dilatation of the right atrium.Encephalomalacia of the right parietal lobe is unchanged compatible with history of prior treated AVM. Encephalomalacia of the right frontal lobe is also unchanged. Extensive patchy periventricular and brainstem T2 hyperintensity is redemonstrated, largely unchanged with the exception of the left centrum semiovale where it has likely progressed to some degree.Susceptibility artifact is seen along the right frontal ventricular catheter likely related to chronic blood product. Susceptibility within the right parietal lobe is also seen compatible with prior treatment and chronic blood product. No evidence to suggest acute intracranial hemorrhage is seen.MRA:Scattered moderate to severe stenoses are again seen along the distal left M1 segment, the level of the MCA bifurcation and involving the left anterior temporal artery, similar to that seen on the prior examination. The basilar artery demonstrates scattered moderate stenoses also similar to prior.A 3-mm aneurysm arising from the basilar tip has likewise not significant changed in size or morphology.

Output: 1. Resolution of acute ischemia seen previously within the left centrum semiovale and insula. There is new corresponding T2 hyperintensity of the involved white matter.2. Encephalomalacia of the right parietal lobe, with evidence of prior AVM treatment, as well as encephalomalacia of the right frontal lobe and patchy white matter/brainstem signal abnormality, all unchanged.3. Stable MRA of the brain with no significant interval change in the appearance of scattered stenoses in the proximal left MCA distribution, or of a 3-mm aneurysm arising from the basilar tip.


Instruction: Generate impression based on findings.

Input: Diagnosis: Pain in limbClinical question: LE painSigns and Symptoms: LE pain 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 straightening of the normal cervical curvature. There is multilevel disc desiccation present.No abnormal enhancing lesions are appreciated 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. There is a minor disc bulge present at this level with very mild narrowing of the right neural foramenAt C4-5 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present this level associated with a disc bulge and partial effacement of spinal fluid ventral and posterior the spinal cord. There is narrowing of the neural foramina bilaterally with some encroachment of the right-sided exiting nerve roots. Overall there is a mild degree of spinal stenosis at this level. There are some endplate reactive changes present at this level.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level with some mild narrowing of the neural foramina worse on the right than the left side. There is a disc bulge at this level. There are some endplate reactive changes present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge and some endplate osteophytes 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. The right vertebral artery is very small.MRI 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 appreciated in the thoracic spine.There are some mild degenerative changes present in the cervical spine with multilevel disc desiccation and a minor disc bulge at T9-10 which affects the left neural foramen.

Output: 1.There are multilevel degenerative changes present in the cervical spine with encroachment of right-sided exiting nerve roots within the neural foramina at C4-5 and C5-6 as described above.2.There are minimal degenerative changes in the thoracic spine without compromise to spinal canal or exiting nerve roots.3.No abnormal lesion is appreciated within the cervical or thoracic spinal cords.


Instruction: Generate impression based on findings.

Input: Vertebral body heights in the lumbar spine are normal. Alignment is maintained. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. Axial images are slightly motion degraded. No significant change however is seen in degenerative changes compared to 2/5/2013. Individual levels as below:T12/L1: No significant spinal canal stenosis or neuroforaminal narrowing.L1/2: No significant spinal canal stenosis or neuroforaminal narrowing.L2/3: Minimal broad based disk bulge, facet hypertrophy, and ligamentum flavum hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing.L3/4: Mild broad based disk bulge, facet hypertrophy and ligamentum flavum hypertrophy without significant spinal canal stenosis. There is minimal bilateral foraminal narrowing. L4/5: Broad based disk bulge, ligamentum flavum hypertrophy and facet hypertrophy without significant spinal canal stenosis. Loss of disk height with disk desiccation and degenerative endplate changes. Mild bilateral neuroforaminal narrowing.L5/S1: Degenerative endplate marrow changes with mild edema. There is significant loss of disk height minimally worse compared to prior. There is a diffuse disk bulge with component of disk extrusion not significantly changed since prior. There is severe bilateral neural foraminal stenosis which may be impinging on the exiting L5 nerve roots. There is also effacement of the lateral recesses and contact of the traversing S1 nerve roots, worse on the right. No significant central canal stenosis. There is bilateral facet arthropathy similar to prior.There is mild volume loss involving the paraspinous and iliopsoas musculature similar to prior. Paraspinous soft tissues are otherwise unremarkable.

Output: Compared to 2/5/2013, minimal worsening of loss of disk height at the L5-S1 level. Otherwise no significant change in advanced degenerative changes at the L5-S1 levels with severe bilateral neural foraminal stenosis and suspected impingement of the exiting L5 nerve roots.Remainder of the levels as detailed above


Instruction: Generate impression based on findings.

Input: Right arm pain, immunocompromised There is diffusely increased signal subcutaneous tissues of the mid to distal humerus. Additionally, there is increased signal of the surrounding musculature, particularly within the distal portion of the triceps. A mild amount of fluid is noted within the elbow joint and the shoulder joint. There is similar increased signal within the musculature of the posterior chest wall including the latissimus dorsi. Within the limits of an unenhanced exam, there is no discrete focal fluid collection within the arm.The marrow signal of the humerus is normal for the patient's age.

Output: Diffuse inflammation within the subcutaneous tissues of the humerus, portions of the underlying musculature specifically the triceps, and within the musculature of the posterior chest wall. No focal fluid collection is identified within the limits of the exam.


Instruction: Generate impression based on findings.

Input: History of cervical cancer status post total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by chemotherapy. Evaluate for tumor recurrence. PELVIS:UTERUS, ADNEXA: Postsurgical changes from a total abdominal hysterectomy and bilateral salpingo-oophorectomy. No specific evidence of tumor recurrence in the surgical bed. Colonic and small bowel loops have dropped down into the dependent portion of the pelvis.BLADDER: Normal distended bladder without significant abnormality.LYMPH NODES: Subcentimeter inguinal lymph nodes. No pelvic lymph nodes measuring greater than 1 cm in short axis.BOWEL, MESENTERY: The visualized bowel in the pelvis is unremarkable.BONES, SOFT TISSUES: Tarlov cysts are noted in the sacrum. Degenerative changes at L4-5.OTHER: No significant abnormality noted.

Output: No evidence of tumor recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Brain:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position, and normal biphasic CSF flow is noted at the level of the cerebellar tonsils (as well as elsewhere). There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Note is made of scattered perivascular spaces. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present throughout the paranasal sinuses and there is a superimposed air-fluid level within the left maxillary sinus. The mastoid air cells are clear. Complete spine:The comparison study demonstrated focal, skipping, areas of uniform central dilatation, none greater than 2 mm, which on the current exam appear different. Specifically, some of the areas of "dilatation" are no longer present, and others are smaller. There are no new foci of central canal dilatation.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses.

Output: 1.Mucosal thickening is present throughout the paranasal sinuses and there is a superimposed air-fluid level within the left maxillary sinus. Otherwise negative noncontrast brain MRI. Specifically, there are no MRI findings to explain the patient's blank spells.2.The comparison study demonstrated focal, skipping, areas of uniform central dilatation, none greater than 2 mm, which on the current exam appear different. Specifically, some of the areas of "dilatation" are no longer present, and others are smaller. There are no new foci of central canal dilatation. Given the constellation of these features, this is felt to most likely represent transient enlargement of central canal and much less likely syrinx.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:4/26/1941)Reason: metastatic lung cancer History: metastatic lung cancerPROVIDER/ATTENDING NAME: EVERETT E. VOKES EVERETT E. VOKES The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for brain metastases. 2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Glioblastoma treated with RT/TMZ+TMZ. There are post-treatment findings in the left frontal lobe. There is unchanged confluent T2 hyperintensity surrounding the left frontal lobe resection cavity and elsewhere in the right cerebral white matter. A focus of enhancement along the posterior margin of the resection cavity is slightly less prominent. A punctate focus of enhancement in the anterior right superior frontal gyrus is also less conspicuous. 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 unchanged. There is a left maxillary sinus retention cyst.

Output: No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Numbness in hands. Low back pain. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Mild retrolisthesis of C3 on C4 is unchanged. Alignment is otherwise maintained. Bone marrow signal is benign. Previously seen disc extrusion at the C3-C4 level is no longer present.Patchy T2 signal abnormality is again seen throughout the cervical cord. There is a T2 hyperintense lesion at the right mid C2 level not seen previously. There is also a right dorsal C2-C3 lesion not present previously. Multiple additional lesions more inferiorly appear to be present on prior study. Focal volume loss is noted involving the right dorsal cord at the C5 level and present previously.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Previous seen disc extrusion is no longer present. No significant compromise to the spinal canal. There is moderate left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy which was present previously.C4-5: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing as before.C5-6: Mild disc bulge without significant compromise to the spinal canal. There is mild to moderate left neural foraminal narrowing which was present previously. Minimal right neural foraminal narrowing.C6-7: No significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing which was present previously.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is multilevel disc desiccation without significant disc height loss. Additional details 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: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Mild disc bulge and dorsal annular fissure. Mild facet arthropathy. No spinal canal stenosis. Mild right and minimal left neural foraminal stenosis.L5-S1: Mild disc bulge and dorsal annular fissure. Mild facet arthropathy. No spinal canal stenosis. Mild bilateral neural foraminal narrowing. Paraspinous soft tissues are within normal limits.

Output: 1. Multiple T2 hyperintense lesions throughout the cervical cord compatible with known demyelinating disease. There are at least 2 new lesions at the right C2 and C2-C3 levels not evident on prior outside MRI from 10/3/2013. More recent cervical spine MRI is not available for comparison.2. Multilevel degenerative changes in the cervical spine are again seen which are overall similar to prior, aside from the previously seen disc extrusion at C3-C4 which is no longer present. There is no significant spinal canal stenosis at any level. There is multilevel neural foraminal narrowing, left relatively worse than right, as detailed above.3. Mild degenerative changes in the lumbar spine without significant spinal canal stenosis at any level. Minimal to mild neural foraminal narrowing as described above.


Instruction: Generate impression based on findings.

Input: 36-year-old female with shooting pain down to shoulders There is straightening of the cervical spine, which may be positional, otherwise alignment is anatomic. Vertebral body heights and disc spaces are intact with tiny anterior osteophytes. No acute fracture is evident. The osseous neural foramina are patent. Borderline anterior translation of the right C3 facet relative to C4 is likely may be due to patient positioning, however MRI may be helpful to look for ligamentous injury. Possible extruded disc seen on the prior MRI would not be evident by conventional radiographs.

Output: Minimal degenerative changes. Possible extruded disc seen on prior MRI would not be evident on conventional radiographs. For further evaluation, an MRI cervical spine may be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Left unilateral SNHL, spontaneous, presented to years ago. Signs and symptoms: Left unilateral SNHL. Pre- and post enhanced MRI of IAC:Examination demonstrates normal signal intensity, size and morphology of symmetrical bilateral internal auditory canals.Normal signal intensity, morphology of symmetrical bilateral inner ears structures.Normal signal intensity and morphology of bilateral neural vascular bundles across the cerebellopontine angles and within the internal auditory canals. There is no detectable abnormal enhancement in the bilateral cerebellopontine angles, internal auditory canals or in the inner ear structures. Unremarkable signal intensity and morphology of pons and without detectable abnormal enhancement.Normal pneumatization signal pattern of bilateral mastoid air cells and middle ear cavities.Unremarkable images through the skull base without abnormal enhancement.

Output: Negative pre and post enhanced MRI of IACs.


Instruction: Generate impression based on findings.

Input: High-grade astrocytic neoplasm: interval worsening of left leg weakness. There has been increase in size of the heterogeneously enhancing right posterior frontal lobe mass and associated vasogenic edema since early December. Indeed, the mass now measures up to approximately 35 mm, previously 25 mm on 12/11/15. There are findings related to right transfrontal biopsy of the mass. There is mass effect upon the third ventricle, with slight increase in size of the lateral ventricles. There is also approximately 7 mm of midline shift to the left. There is persistent gyriform edema in the anterior temporal pole and insula without associated enhancement. There is no evidence of acute intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

Output: 1. Increase in size of the right posterior frontal lobe high-grade astrocytic neoplasm and associated vasogenic edema since early December with what appears to be incipient obstructive hydrocephalus of the lateral ventricles.2. Persistent gyriform edema in the anterior temporal pole and insula may be represent a form of encephalitis or non-enhancing infiltrative tumor.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, with intractable epilepsy. Functional MRI requested for localization of speech and sensorimotor cortex. Sensorimotor cortical activation maps as expected along the pre- and postcentral gyri.All tested language paradigms produced reliable language related cortical activation. Language is left dominant with minor task dependent contributions from the right hemisphere.Broca's area activity is identified within the inferior left frontal lobe, principally involving the pars opercularis and to a lesser degree the pars triangularis.Wernicke's area activity is identified most reliably on the sentence completion paradigm where it is visualized along the posterior aspect of the left superior temporal sulcus.

Output: Successful functional MRI for surgical planning. Sensorimotor cortical activation maps as expected along the pre- and postcentral gyri. Language is left dominant with minor contributions from the right hemisphere. Broca's and Wernicke's areas are identified in their customary locations.


Instruction: Generate impression based on findings.

Input: Neuropathy in bilateral legs Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with T1 hyperintensity at S1 compatible with focal fat or hemangioma. The conus medullaris is normal in position.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.L3-L4: Minimal disc bulge. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis. Mild to moderate facet arthropathy.Paraspinous soft tissues are unremarkable aside from prominence of subcutaneous fat.

Output: Very mild degenerative changes. No significant disc disease or spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Male, 12 years old, with headache and syringomyelia. A syrinx of the thoracic spinal cord is redemonstrated measuring up to 5 mm in diameter and extending predominantly from T5 through T8. There has been no significant interval change. Slight prominence of the central canal of the spinal cord is again observed through much of the remaining cord. The conus terminates at the L1 level which is normal. The nerve roots of cauda equina are unremarkable. No evidence of fatty filum terminale is seen.Spinal alignment is anatomic. There is a normal complement of vertebrae which demonstrate normal morphology. Marrow signal characteristics are unremarkable. The intervertebral discs are preserved. No compromise of the spinal canal or neural foramina is seen.

Output: 1.Stable syrinx of the thoracic spinal cord.2.Minimal prominence of the central canal of the spinal cord is also seen through much of the remaining cord, though this finding is not necessarily pathologic.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with brain lesion seen on prior imaging, compare to prior study. The intrinsically T1 hyperintense lesion seen within the left temporal lobe on the prior examination has significantly decreased in size now measuring 12 x 6 mm, previously 26 x 20 mm. The rim of the lesion shows strong susceptibility artifact and the internal contents are T1 and T2 hyperintense. Edema and mass effect related to this lesion seen on the prior examination have resolved. No pathologic enhancement is detected in the vicinity of this lesion or elsewhere intracranially.Patchy periventricular and pontine T2 hyperintensity is again seen, similar to the prior examination. No areas of parenchymal signal abnormality are seen. No restricted diffusion is detected. There is no evidence of any new intracranial fluid collection. The ventricular system is normal in size and morphology.

Output: 1.Interval decrease in size of a lesion in the left temporal lobe which is compatible with a parenchymal hematoma. Previously seen edema and mass effect have resolved. There is no associated pathologic enhancement or other evidence to suggest an underlying lesion.2.Evidence of chronic microvascular ischemic disease is seen with no new intracranial findings.


Instruction: Generate impression based on findings.

Input: 56-year-old male with hip pain ACETABULAR LABRUM: There is blunting of and increased signal intensity within the anterior superior labrum indicating a complex tear from the twelve o'clock to three o'clock position. Mild undersurface fraying of the posterior labrum is also noted.ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritis affects the hip. Subchondral cysts are present along the anterior aspect of the acetabular dome as well as the posterior acetabular wall. There is also subchondral cyst within the anterior medial femoral head with degeneration of the overlying articular cartilage. There is a CAM deformity involving the superior and anterior femoral head/neck junction with an alpha angle of 60 degrees.SOFT TISSUES: Increased signal is noted within the anterior soft tissues likely reflecting contrast material / lidocaine. ADDITIONAL

Output: Osteoarthritis, CAM deformity and labral tearing of the right hip as described above.


Instruction: Generate impression based on findings.

Input: 46 year old male status post aneurysm coiling. Status post suboccipital craniotomy with partially visualized fluid collection in craniotomy site not significantly changed since post recent MRI.Metallic coils are present in proximal right MCA territory, with significant metallic streak artifact obscuring adjacent structures at this level.Focal hypodensity in right parietal lobe consistent with encephalomalacia from prior hemorrhage is noted, with interval evolution since 6/2012 CT. Encephalomalacia also noted in left frontal lobe and superior left cerebellum, unchanged.There is no evidence of acute intracranial hemorrhage, mass or edema. No hydrocephalus.The ventricles and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.Postsurgical changes without evidence of acute intracranial abnormality.2.No significant change in fluid collection in suboccipital region, which may represent pseudomeningocele/CSF leak.3.Several foci of encephalomalacia again noted.


Instruction: Generate impression based on findings.

Input: Left lower extremity weakness. Evaluate for acute injury to cervical spine following laminectomy and C5 tumor resection. History of NF 2. There are interval postsurgical changes of C3-C6 laminectomies related to resection of a relatively large right sided schwannoma at C4-C5 with intraspinal extension. The intraspinal component has been resected with residual tumor within the neural foramen and lateral aspect of the spinal canal at the C4-C5 level again seen. There is T2 hyperintensity involving the right aspect of the cervical cord which has increased/become more apparent since prior study from 3/8/2016. There is an extra-axial collection in the dorsal epidural space extending from the C5-C7 levels which completely effaces the dorsal thecal sac and is associated with increased flattening of the cervical cord compared to prior. There is also associated T2 hyperintensity in the cervical cord extending from the C5-C6 to C6-C7 levels bilaterally, left greater than right, which is increased since prior.Limited images of the brain again demonstrates an enhancing lesion likely representing schwannomas at the right jugular foramen. Small extra-axial lesion along the left anterolateral surfaces of the medulla is also noted which may represent a meningioma.There is mild retrolisthesis of C3 on C4 and anterolisthesis of C4 on C5 as seen before. Focal kyphosis at the C5-C6 level is also again seen. Vertebral body heights are maintained. Bone marrow signal is benign. Enhancing mass is present at the right C1-C2 level with intraspinal extension and effacement of the right lateral thecal sac which is stable to minimally more prominent than before.. Two small enhancing intramedullary lesions are seen within the cord at the C1-C2 and mid C2 levels suspicious for tumor as before. Additional tiny nodules of enhancement are also seen inferior medulla and possibly in the mid and lower cervical cord. Individual levels as below:C2-C3: Enhancing left nerve root with mild expansion of the neural foramen. There is an extramedullary lesion involving the left anterolateral aspect of the spinal canal without significant mass effect on the cord as before and possibly contiguous with the left foraminal lesion.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. C4-C5: Partial tumor resection with residual tumor involving the right lateral aspect of the spinal canal and right neural foramen. There remains leftward displacement of the cord as well as local mass effect on the right lateral aspect of the cord, but improved since prior.C5-C6: Large, predominantly extraforaminal lesion on the right unchanged. Small enhancing extra foraminal lesion on the left is likely unchanged. No spinal canal stenosis.C6-C7: Small,predominantly extraforaminal enhancing lesions bilaterally without expansion of the foramina are likely unchanged. No spinal canal stenosis.C7-T1: Small predominantly extraforaminal enhancing lesions without expansion of the foramina, likely unchanged. No spinal canal stenosis.Additional smaller schwannomas partially visualized within the thoracic spine.

Output: 1. Interval postsurgical changes of C3-C6 laminectomies related to resection of a relatively large right sided schwannoma at C4-C5 with intraspinal extension. The intraspinal component has been resected with residual tumor within the neural foramen and lateral aspect of the spinal canal at the C4-C5 level again seen. 2. There is T2 hyperintensity involving the right aspect of the cervical cord at the C4-C5 level which has increased/become more apparent since prior study from 3/8/2016. 3. There is a fluid collection in the dorsal epidural space extending from the C5 to C7 levels which is associated with worsened effacement of the dorsal thecal sac and increased flattening of the cervical cord compared to prior. There is also associated T2 hyperintensity in the cervical cord extending from the C5-C6 to C6-C7 levels bilaterally, left greater than right, which is increased since prior.4. Stigmata of neurofibromatosis with multiple additional schwannomas, meningioma, as well as intramedullary lesions which may represent representing ependymoma similar to prior.


Instruction: Generate impression based on findings.

Input: Severe migraines and family history of cerebral aneurysm. MRI: 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.MRA: There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive lesions or cerebral aneurysms.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate right medial elbow for medial epicondylitis: tendinopathy vs. tear History: Medial right elbow pain x 2 years, s/p injections LIGAMENTS: There is increased signal intensity in the proximal fibers of the anterior bundle of the ulnar collateral ligament, which may represent mild degeneration, mild sprain, or perhaps small interstitial tear, but we see no full-thickness tear. Lateral collateral ligament is intact.TENDONS: Increased signal intensity within and around the common flexor tendon, indicating moderate tendinosis and perhaps interstitial tearing, but we see no full-thickness tendon tear. Common extender tendon is intact. Biceps, brachialis, and triceps tendons are intact.ARTICULAR SURFACES AND BONE: There appears to be cartilage loss along the radial head, but the remainder of the joint appears normal and bone marrow signal is normal.SURROUNDING STRUCTURES: There is mildly increased signal of the ulnar nerve as it passes posterior to the medial epicondyle, which may reflect mild neuritis but is of questionable clinical significance.

Output: Increased signal intensity within and surrounding the common flexor tendon representing moderate tendinosis and perhaps interstitial tearing, but we see no full-thickness tear.


Instruction: Generate impression based on findings.

Input: 16-year-old female with history of right radial styloid fracture with widening of the scapholunate interval LIGAMENTS: Contrast is noted within the radiocarpal joint and pisiform recess compatible with a tear. There is a tear of the scapholunate ligament with increased scapholunate interval as clinically suspected. The lunotriquetral ligament also appears torn.TRIANGULAR FIBROCARTILAGE COMPLEX: No clear extension of contrast into the distal radioulnar joint indicating the triangular fibrocartilage complex is intact as it appears.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: 1.Findings compatible with scapholunate and lunotriquetral ligament tears.2.Cystic lesion adjacent to the radial styloid likely represents a ganglion or cyst.


Instruction: Generate impression based on findings.

Input: Status post ACDF Again seen is an anterior plate with screws entering the C4-C7 vertebrae with interposed intervertebral bone grafts at C4-C5, C5-C6, and C6-C7. There is a new anterior spacer device at C3-C4, without evidence of acute hardware complications. There is prevertebral soft tissue swelling and an anterior drain indicating recent surgery. There are carotid calcifications bilaterally.

Output: Postoperative changes of ACDF as above.


Instruction: Generate impression based on findings.

Input: Neck pain with radiation into back and arm on the left Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis centered at the C4-C5 level. Alignment is otherwise maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowing related to small disc osteophyte complex and uncovertebral hypertrophy. C4-5: Small disc osteophyte complex and uncovertebral hypertrophy with effacement of the ventral thecal sac and mild spinal canal narrowing. There is moderate right and mild left neural foraminal narrowing related to uncovertebral hypertrophy. C5-6: Disc osteophyte complex which partially effaces the ventral thecal sac. There is mild narrowing of the spinal canal at this level. There is moderate right and mild left neural foraminal narrowing related to uncovertebral hypertrophy.C6-7: Left paracentral disc protrusion with mild narrowing of the left aspect of the spinal canal. There is moderate to severe left and mild to moderate right neural foraminal narrowing related to uncovertebral hypertrophy and disc.C7-T1: Small left paracentral disc protrusion also involving the proximal left neural foramen. There is mild to moderate narrowing of the proximal left neural foramen. Left neural foramen laterally as well as the right neural foramen are patent.Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine. There is mild spinal canal narrowing at the C4-C5, C5-C6, and C6-C7 levels. No high-grade spinal canal stenosis. There is up to moderate to severe left C6-C7 neural foraminal stenosis which may be impinging on the left C7 nerve root. Additional levels as detailed above.


Instruction: Generate impression based on findings.

Input: 43 year old man with a family history of Muscular Dystrophy referred to evaluate for cardiac damage. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 98 ml/m2 (normal range: 74+/-15), the LVEDV is 165 ml (normal range 142+/-34), the LV end systolic volume index is 45 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 93 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 170 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 79 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. There is pronounced mitral valve prolapse with elongation of the anterior mitral leaflet. There is a mild, eccentric jet of mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is 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 FindingsThe sternum is somewhat flattened. The minimum diameter in between the sternum and spine is 3.3cm. The narrowing of the chest wall is displacing the entire heart into the left thorax. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size with low normal systolic function (LVEF 54%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal right ventricular size and systolic function (RVEF 53%).3. There is pronounced mitral valve prolapse with elongation of the anterior mitral leaflet. There is a mild, eccentric jet of mitral regurgitation. 4. The sternum is somewhat flattened. The minimum diameter in between the sternum and spine is 3.3cm. The narrowing of the chest wall is displacing the entire heart into the left thorax.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, with pain in the right shoulder. Straightening of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No worrisome marrow replacement or marrow edema is detected.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.Intervertebral disc heights are preserved. No significant disc osteophyte formation is seen. The spinal canal and the neural foramina remain patent.

Output: Unremarkable evaluation with no specific findings to account for the patient's shoulder pain.


Instruction: Generate impression based on findings.

Input: Reason: Assess for meniscal tear History: Effusion, pain, + lateral mcmurray test. MENISCI: The medial and lateral menisci are intact without discrete tears.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact with no discrete focal defects.Bone marrow edema and subacute impaction fracture involving the posterior aspect of the medial tibial plateau. Small amount of bone marrow edema involving the proximal fibula. LIGAMENTS: The ACL is poorly visualized, wavy, and cannot be followed entirely to its insertion on the femur compatible with a partial thickness of full thickness tear. Small amount of pericruciate edema. The PCL and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Subacute impaction fracture involving the posterior aspect of the medial tibia plateau. Small amount of bone marrow edema with the proximal fibula as well.2.Chronic partial thickness or full thickness tear of the proximal insertion of the ACL.3.Intact menisci.


Instruction: Generate impression based on findings.

Input: 85 year-old male with metastatic lung cancer status post fall Brain: Previously seen hemorrhagic metastatic lesions in the posterior left parietal lobe and high left frontal lobe slightly smaller than the prior study. Low attenuation lesion in the right parasagittal region superior to the right lateral ventricle most likely representing metastatic disease is also decreased in size. Cerebellar metastatic lesion is not easily appreciated on this noncontrast examination. No new lesions or areas of hemorrhage are identified. The ventricles and basal cisterns are unchanged in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Cervical spine: The cervical spine demonstrates normal alignment. Well-defined lucent areas are seen within the dens and lamina of C2. Additionally, a lucent area is seen in the spinous process of C3 that is less well defined posteriorly and is worrisome for metastatic lesions given the patient's history. An MRI would provide further characterization. Degenerative changes are seen throughout the cervical spine. No evidence for fracture.Thoracic spine: Thoracic spine demonstrates normal alignment. Large left apical mass representing patient's known malignancy is seen. The mass abuts the neural foramen of T2/T3. No definite extension into the canal is seen nor is there any is displacement of the thecal sac. No lesions are seen in the vertebral bodies. No evidence of fracture. Degenerative changes are seen throughout the thoracic spine. Right posterior old rib fractures are identified.Paraseptal emphysema identified in the lungs.Lumbar spine: Lumbar spine demonstrates normal alignment. No vertebral body lesions are seen. No evidence for fracture. Degenerative changes of the lumbar spine. Thickening of the lateral limb of the left adrenal gland again seen.

Output: 1. Reidentification of multiple cerebral metastatic lesions, some of which are smaller on this exam. No new intracranial process is seen.2. Lucent lesions identified in C1- C3, with the C3 spinous process lesion being more ill-defined possibly representing metastatic disease. MRI recommended for further evaluation.3. Degenerative changes seen throughout the spine with no evidence for fracture.4. Large left apical mass abutting the neural foramina of T2/T3 with no definite extension into the spinal canal.


Instruction: Generate impression based on findings.

Input: Scaphoid fracture Note that due to the patient's cast, a wrist coil was not used resulting in suboptimal image quality.LIGAMENTS: Evaluation of the intrinsic ligaments of the wrist is limited but there is no obvious disruption.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: The flexor and extensor tendons are normal. BONES: There is a fracture through the waist of the scaphoid with minimal displacement. There is edema within the distal half of the scaphoid but the marrow signal of the proximal pole is normal. No additional fractures are identified. There is fluid and edema adjacent to the fractured scaphoid.An ovoid focus of abnormal signal intensity within the capitate likely represents a cyst and is of doubtful clinical significance.

Output: Scaphoid fracture as described above.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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. There is mucosal thickening throughout the paranasal sinuses. The skull and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: No evidence of intracranial mass.


Instruction: Generate impression based on findings.

Input: 66 year old female with history of non-ischemic cardiomyopathy, severe MR referred for pre-transplant evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 152 ml/m2 (normal range: 65+/-11), the LVEDV is 264 ml (normal range 109+/-23), the LV end systolic volume index is 126 ml/m2 (normal range 18+/-5), the LVESV is 218 ml (normal range 31+/-10), the LV mass index is 70 g/m2 (normal range 67+/-11), and the LV mass is 122 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is a midmyocardial stripe in the septum and basal to mid inferior wall which is atypical for myocardial infarction, and is consistent with dilated cardiomyopathy.The native T1 myocardial relaxation time is 1240ms, which is elevated and suggests a diffuse myocardial fibrotic or infiltrative process. There is no LV thrombus visualized on this study. There is no evidence for myocardial iron overload.Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 21%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 70 ml/m2 (normal range 22+/-8), and the RVESV is 122 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve demonstrates bileaflet tethering, and there is at least mild moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.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. The left ventricle is severely dilated with severely reduced systolic function (EF 17%). There is global hypokinesis with regional variation. 2. There is a midmyocardial stripe in the septum and basal inferior wall, which is atypical for infarction and suggests a nonischemic etiology of this patient's cardiomyopathy. Additionally, the native T1 myocardial relaxation time is moderately elevated at 1240ms, which also suggests an underlying diffuse myocardial fibrotic or infiltrative process.3. No left ventricular thrombus was visualized. 4. The right ventricle is normal in size with severely reduced systolic function (EF 21%). 5. Bileaflet tethering of the mitral valve with at least mild-moderate mitral regurgitation. 6. Biatrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 26 year old female with hip pain during weight bearing. Assess for femoral stress fracture. Focal edema is identified along the medial aspect of the proximal femoral diaphysis just below the lesser trochanter. Findings are compatible with a developing stress fracture. The remainder of the bone marrow appears normal.There is a tear of the anterosuperior labrum at the two o'clock position, best seen on series 11, image 10. The iliopsoas tendon crosses the anterior labrum at the site of this tear, suggesting the possibility of iliopsoas impingement. The hip joint is otherwise unremarkable. Foci of increased signal intensity within the right hamstring tendons at their origin suggests mild tendinopathy of questionable clinical significance. The remaining visualized bony and soft tissue structures are unremarkable.

Output: 1.Focal edema within the proximal femur, consistent with developing stress fracture.2.Anterosuperior labral tear and other findings as described above.The above findings were discussed with the referring physician, Dr. Cifu, on 2/11/2015 at 11:48 am.


Instruction: Generate impression based on findings.

Input: Dizziness. There are numerous T2 hyperintense foci in the cerebral white matter and basal ganglia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. However, there is fluid within the left mastoid air cells. There are bilateral lens implants. There is also an incompletely characterized T2 hyperintense focus in the left parapharyngeal space.

Output: 1. Chronic lacunar infarcts and small vessel ischemic disease, but no evidence of acute infarct.2. Nonspecific fluid within the left mastoid air cells may represents mastoiditis.3. Incompletely characterized T2 hyperintense focus in the left parapharyngeal space. Dedicated imaging of this region may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: There has been interval removal of the left-sided catheter with scattered areas of pneumocephalus and linear areas of susceptibility effect along the prior catheter tracts, which are likely related to blood products. There are also chronic postoperative findings related to right hemispherectomy with a persistent fluid collection in the right extradural space deep to the craniectomy flap, that measures approximately 16 mm in thickness. There is slight interval change in the configuration of the cystic components in associated with the deformed left lateral ventricle, although the overall size of these is unchanged. There is unchanged diffuse confluent T2 hyperintensity in a large portion of the left hemisphere in the periventricular region and punctate areas of encephalomalacia in the pons. There is unchanged posterior deviation and areas of encephalomalacia in the upper cervical spinal cord. However, there is no evidence of acute infarction. The right hemispheric craniotomy flap has multiple areas of deficiency that reflect bone resorption.

Output: 1. Interval removal of the left-sided catheter with no significant overall change in size of the ventricular system and associated cystic compartments, although the configuration of these appears to be slightly altered. 2. Chronic postoperative findings related to right hemispherectomy, with no significant change in the degree of the left hemisphere and pontine gliosis and/or encephalomalacia.3. Unchanged posterior deviation and encephalomalacia upper cervical spinal cord, which may be related to adhesions and chronic infarction, but no evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB:9/19/1975)Reason: evaluate for changes in white matter lesions seen on prior MRIs History: headachesPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is more than typically seen at this age. One in the right parietal lobe subcortical white matter is a low but larger on the current exam versus the prior. These are otherwise unchanged.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening.. The visualized portions of the mastoid air cells a demonstrate minor opacity in the left mastoid air cells. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. There is minor progression compared to the prior exam from 2012.


Instruction: Generate impression based on findings.

Input: 51-year-old male with pain. Evaluate lateral meniscus MENISCI: There is deformity and increased signal abnormality within the posterior horn of the medial meniscus which extends to the femoral articular surface consistent with degenerative tearing that extends to the body of the meniscus. The anterior horn appears intact. There is blunting of the free edge of the posterior horn of the lateral meniscus consistent with degeneration/tearing. No fluid-filled tear is evident. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There are tricompartmental osteophytes. There is a full-thickness articular cartilage cleft along the medial facet of the patella. There is articular cartilage degeneration along the medial facet of the femoral trochlea. There is full-thickness articular cartilage cleft along the lateral facet of the femoral trochlea, centrally. There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle. There is also full-thickness articular cartilage degeneration along the medial aspect of the medial tibial plateau with underlying subchondral cyst formation. There is focal full-thickness articular cartilage degeneration along the weightbearing surface of the lateral tibial plateau with underlying subchondral cyst formation. There is full-thickness articular cartilage degeneration along the lateral femoral condyle with underlying degenerative subchondral signal abnormality.LIGAMENTS: There is thickening of the proximal and mid substance fibers of the ACL indicating prior injury or sprain. The ACL appears intact. The PCL appears intact. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis of the left knee with full-thickness articular cartilage degeneration as described above.2. Degeneration/degenerative tearing of the medial and lateral meniscus as described above.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Fellner is a 55 year old female with a strong family history of breast cancer and BRCA2 positive. Family history of breast cancer in her sister at age 35 and in paternal aunt at age 45. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Low back pain. There is a small disc bulge at L5-S1, but no residual superimposed extrusion. There is no significant spinal canal or neural foraminal stenosis at L5-S1 or the other lumbar spine levels. There is loss of disc height and fluid signal at L5-S1. The vertebral body and disc space heights are otherwise preserved. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. The imaged portions of the spinal cord display normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Small disc bulge at L5-S1, but no residual superimposed extrusion.


Instruction: Generate impression based on findings.

Input: Clinical question: Acute stroke? Signs and symptoms: Bilateral weakness. Nonenhanced head CT:There is no detectable intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Considering normal to consecutive CT examination recommend follow-up with an MRI exam.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: Negative nonenhanced head CT. Recommend follow up with an MRI considering clinical information provided and two very recent negative head CT's.


Instruction: Generate impression based on findings.

Input: Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There are scattered bihemispheric FLAIR high signal intensities on periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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.Right ethmoid sinus shows mucosal thickening.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic leison.2. Non specific small vessel ischemic disease, unchanged since 2004.3. Normal brain MRA and neck MRA


Instruction: Generate impression based on findings.

Input: Ms. Mills is a 55-year-old woman with indeterminant left breast calcifications for which stereotactic biopsy is recommended. She presents for bilateral breast MRI as part of the Alan Penn research study. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Right breast: There is a circumscribed oval mass in the lower outer quadrant of the right breast measuring approximately 0.9 x 1.0 x 1.0 cm. Faintly visualized is a small amount of fat density centrally within the mass on the T2-weighted sequences, suggestive of an intramammary lymph node. An MR directed ultrasound is recommended for further evaluation. Additional scattered enhancing foci are scattered throughout the right breast, none of which are more suspicious than the rest. Left breast: In the 12:00 position, posterior depth, there is a 0.8 x 0.9 x 1.2 cm enhancing mass, correlating to the posterior cluster of calcifications seen on diagnostic mammogram. There is no abnormal enhancement seen elsewhere in the left breast, specifically in the distribution of the calcifications identified on diagnostic mammogram. No abnormal lymph nodes are identified in either axillary region.

Output: (1) Right Breast: Subcentimeter enhancing mass identified in the right lower outer breast. An MR directed ultrasound was performed immediately following the MRI, confirming the presence of a benign intramammary lymph node. No MRI or sonographic evidence of malignancy in the right breast.(2) Left breast: 1.2 cm enhancing mass in the left posterior central breast, corresponding to the posterior cluster of calcifications seen on the diagnostic mammogram. Please note that the patient had a two site stereotactic biopsy for the segmentally distributed calcifications identified on diagnostic mammogram (including the posterior cluster of calcifications corresponding to the MR-detected enhancing mass). The stereotactic biopsy has been reported under a separate accession.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate for left knee injury. There is swelling of the anterior soft tissue of the knee and a moderate joint effusion. There is no evidence of fracture or malalignment. The anterior soft tissue swelling limits evaluation of the quadriceps tendon. If clinically concerned about extensor mechanism injury, MRI could be considered.

Output: Anterior soft tissue swelling and joint effusion without evidence of fracture. The anterior soft tissue swelling limits evaluation of the quadriceps tendon. If there is clinical concern for extensor mechanism injury, MRI may be considered.


Instruction: Generate impression based on findings.

Input: Right knee pain not responsive to steroid injection. MENISCI: There is a full-thickness vertical tear of the posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Full-thickness tear of the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Knee pain Examination is slightly limited by motion artifact.MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted. There is a minimal amount of nonspecific edema within the inferolateral portion of Hoffa's fat pad however there is no evidence of dysplasia and the Insall Salvati ratio and TT to TG distance are normal.ADDITIONAL

Output: No evidence of internal derangement of the knee.


Instruction: Generate impression based on findings.

Input: 45-year-old male with right hip pain, history of multiple myeloma. Right hip: No specific findings seen to account for the patient's pain. No lucent lesions are seen to suggest myelomatous deposits.Pelvis: Circular lucencies within the bilateral ilium consistent with prior bone marrow biopsy. A benign enostosis is noted in the left femoral neck.No specific finding seen to account for the patient's pain, or specific radiographic features of myeloma

Output: No specific findings seen to account for the patient's pain, or specific radiographic features of myeloma.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5]. There is no significant spinal canal or neural foraminal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a probable partly atypical hemangioma in the L4 vertebral body that measures up to 9 mm. The vertebral bone marrow signal is otherwise unremarkable. The spinal cord displays normal signal and morphology and the cauda equina nerve roots appear to be intact. The paravertebral soft tissues are unremarkable.

Output: 1. No significant spinal canal or neural foraminal stenosis. 2. Small probable partly atypical hemangioma in the L4 vertebral body.


Instruction: Generate impression based on findings.

Input: No evidence of acute ischemic or hemorrhagic lesion.There are multifocal T1 high signal intensity lesions following the cortex involving left precentral gyrus right inferior frontal gyrus and right parietal operculum. These lesions do not show susceptibility artifacts nor evidence of enhancement.Constellation of above findings indicate possible laminar necrosis due to prior ischemic insult. The possibility of metastasis is unlikely.There is no evidence of abnormal enhancement on the scan.Focal susceptibility lesion is seen at right superior parietal lobule without associated surrounding edema. This is non specific and may indicate parenchymal chronic blood product or calcification. Multifocal scattered bihemispheric T2/FLAIR high signal intensity lesions involving bilateral periventricular white matter, centrum semiovale, bilateral basal ganglia and thalami are seen, unchanged.Left frontal and right posterior parietal non enhancing scalp lesion indicating inclusion cyst or pilar cyst are again seen, unchanged.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. About 2-3mm sized downward tonsilar displacement, unchanged.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Bilateral lens signals are not seen indicating post operative status.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. Multifocal cortical T1 high signal intensity lesions may indicate prior ischemic insult with cortical laminar necrosis.4. Extensive white matter FLAIR/T2 high signal intensity lesions may indicate non specific small vessel ischemic disease, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Cervicalgia. 41 years old female. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is a T1 hyperintense lesion along the right hemicord at the C7 vertebral level. This most likely represent hemangioma. There is multilevel disk dessication present.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. There is a disk bulge at this level.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.

Output: There are minor degenerative changes in the cervical spine without compromise to the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: 57M with h/o laryngeal SCC, DVT/PE, recent GI bleed with persistent AMS, eval for anatomic causes History: AMS No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.FLAIR high signal intensities on periventricular white matter and brainstem area are nonspecific which may indicate small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cyst in the left maxillary sinus.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion. 2. No evidence of abnormal enhancement.3. Nonspecific FLAIR high signal intensities, possible small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 38-year-old woman with history of primary sclerosing cholangitis and ulcerative colitis. ABDOMEN:LIVER, BILIARY TRACT: Intrahepatic biliary duct dilatation is again noted with scattered areas of narrowing and irregularity seen affecting the left, right, and common hepatic ducts.No focal hepatic lesion or abnormal parenchymal enhancement is identified.SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: The kidneys are normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy is noted.BOWEL, MESENTERY: Concentric, long segment colonic wall thickening is visualized from the hepatic flexure to the mid descending colon with enhancement, slightly decreased from the prior examination.BONES, SOFT TISSUES: L4 hemangioma noted. No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Primary sclerosing cholangitis with areas of diffuse narrowing and irregularity similar to the prior examination.2. Concentric, long segment colonic wall thickening is visualized from the hepatic flexure to the mid descending colon with enhancement, slightly decreased from the prior examination.1.Colonic inflammation compatible with ulcerative colitis, slightly decreased from the prior examination.


Instruction: Generate impression based on findings.

Input: Memory loss. Mild cognitive impairment. Visual hallucinations. There are few scattered bihemispheric small foci of subcortical and periventricular white matter abnormal FLAIR signal which is nonspecific but likely represents minimal chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Minimal chronic small vessel ischemic disease. Otherwise unremarkable MRI of the brain.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of necrotic tumor of transverse colon causing duodenal outlet obstruction. Evaluate for possible left renal vein thrombosis/invasion. ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy. No suspicious hepatic lesions. No hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable moderate left-sided hydronephrosis. The known large peripherally enhancing centrally necrotic tumor arising from the transverse colon is again seen to invade the left lower renal pole parenchyma. Nonenhancing intraluminal thrombus expanding the left renal vein (axial series 9 image 34) is in direct continuity with the colonic mass and is felt to represent tumor invasion.RETROPERITONEUM, LYMPH NODES: Stable size of mildly enlarged left retroperitoneal lymph node (axial series 9 image 21).BOWEL, MESENTERY: Large peripherally enhancing and centrally necrotic tumor arising from the transverse colon is better evaluated on the prior CT exam. No significant interval change. Interval decompression of the stomach, however there is persistent dilatation of the first and second portion duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Thrombus expanding the left renal vein is in direct continuity with the known colonic mass is favored to represent tumor invasion.2.Stable findings of a large necrotic tumor arising from the transverse colon again invading the left renal parenchyma and causing proximal dilatation of the duodenum. Stable mildly enlarged left retroperitoneal lymph node.


Instruction: Generate impression based on findings.

Input: Female 13 years old Reason: eval for loose body History: knee pain sports and history of synovial osteochondromatosis MENISCI: The lateral meniscus is intact. The medial meniscus is diminutive.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact.LIGAMENTS: Complete rupture of the ACL. Medial and lateral collateral ligaments are intact. PCL is intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Ossified loose body in the anterior joint space.2.Complete rupture of the ACL.3.Diminutive medial meniscus, raising question of chronic tearing.4.Moderate-sized joint effusion.5.Patella situated lateral to the trochlear groove suggesting patellar instability.


Instruction: Generate impression based on findings.

Input: 59-year-old man with history of prostate cancer. Additional history as per chart: Biopsy in July 2016 with 4/4 cores of the left prostate involved with Gleason 3+4 and 3+3 adenocarcinoma, 1/4 cores of the right prostate involved with Gleason 3+3 prostate adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 4.0 x 3.1 cm.Peripheral Zone: In the left prostate midgland (701/17) there is a 6 x 4 mm region in the lateral peripheral zone with decreased T2 signal and diffusion restriction. Additionally, there is more diffuse signal abnormality in the bilateral mid gland (701/14) including a 2 mm cystic focus, likely inflammatory and postbiopsy.Central Gland: BPH nodules noted.Seminal Vesicles: Seminal vesicles appear normal.Extracapsular Extension: No evidence of extracapsular 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.Focal signal abnormality in the left mid gland suspicious for adenocarcinoma.2.Diffuse signal abnormality in the mid prostate favored to represent prostatitis and postbiopsy change.


Instruction: Generate impression based on findings.

Input: 82-year-old female with metastatic cancer. Rule out brain metastases prior to anticoagulation. There is no evidence of intracranial hemorrhage, edema, or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent extensive small vessel ischemic disease, age indeterminate by CT. Calcifications are noted in the basal ganglia bilaterally. Two foci of dystrophic calcification are noted in the right cerebellar hemisphere with a surrounding area of focal low attenuation. Though this could represent microangiopathic changes with dystrophic calcification, a neoplastic lesion cannot be ruled out an MRI with intravenous contrast is recommended for further evaluation.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.These findings were communicated to the clinical service at the time of interpretation.

Output: Extensive small vessel ischemic disease, age indeterminate. An area of low attenuation with foci of calcification in the right cerebellar hemisphere may represent microangiopathic changes, but a neoplastic lesion cannot be ruled out. MRI with intravenous contrast is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other malformations of cerebral vesselsClinical question: brain lesion: preop planning for resection. Page 6876 for fiducialsSigns and Symptoms: headaches, dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a heterogeneous mass located in the right basal ganglia and right medial temporal lobe which extends to the surface of the insular cortex along its posterior aspect. It displaces the temporal horn of the right lateral ventricle inferiorly and medially and also compresses the hippocampus. It is associated with surrounding low signal intensity ring and a popcorn-like appearance. It measures 28 x 26 mm axial dimensions and is associated with a developmental venous anomaly.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 heterogeneous mass centered in the right basal ganglia and medial temporal lobe extending to the insular cortex and temporal horn of the right lateral ventricle. This most likely represents a cerebral cavernous malformation.


Instruction: Generate impression based on findings.

Input: 53-year-old male patient status post patellar dislocation. Assess MPFL. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of the articular cartilage along the lateral facet of the patella. There is also increased signal intensity in the medial facet articular cartilage indicating degeneration. There is an approximately 1.5 cm focus of intermediate signal intensity within the medial aspect of the patellofemoral articulation which likely represents a displaced cartilage fragment. There is also a 1 cm crescentic osteochondral fragment centered about the anterior aspect of the medial femoral condyle. There is a full-thickness cartilaginous defect along the lateral femoral condyle just above the anterior horn of the lateral meniscus with mild edema-type signal in the underlying bone. Increased signal intensity within the articular cartilage of the weightbearing portion of the lateral tibial plateau likely reflects degeneration. The medial compartment articular cartilage is intact.LIGAMENTS: The cruciate ligaments, medial collateral ligament, and lateral collateral ligament complex are intact.The medial patellofemoral ligament is not well visualized, likely representing a tear, with fluid and edema along the medial retinacular structures of the knee.EXTENSOR MECHANISM: There is an incomplete tear of the quadriceps tendon at the insertion on the patella. This includes a full-thickness but minimally retracted tear of the vastus intermedius, a full-thickness but minimally retracted tear of the vastus medialis, and partial thickness longitudinal tearing of the rectus femoris. The fibers of the vastus lateralis tendon can be traced to the insertion on the patella, although the medial fibers may be partially torn. Small ossicles are seen within the distal quadriceps tendon.ADDITIONAL

Output: Findings compatible with lateral patellar dislocation as described above. The medial patellofemoral ligament is not well seen and likely torn. Furthermore, there is tearing of the distal quadriceps tendon as described above and cartilage defects with fragments in the joint.


Instruction: Generate impression based on findings.

Input: 6 years, Male, complex febrile seizures, dysphasia with seizures.. Examination is slightly motion degraded. No structural lesions to suggest seizure focus are appreciated. No findings to suggest mesial temporal sclerosis with the bilateral hippocampi appearing symmetrical in size, signal intensity, and demonstrating preserved internal architecture. No findings to suggest gray matter heterotopia or cortical dysplasia. No intracranial mass or mass effect. No evidence of hemorrhage or ischemia. Ventricles are normal in size. No extra-axial collections. Major flow-voids are preserved. Calvarium and extracranial soft tissues are unremarkable.

Output: Examination is slightly motion degraded. No structural lesions to suggest seizure focus are appreciated.


Instruction: Generate impression based on findings.

Input: Other specified congenital anomalies of brain [742.4], Reason for Study: ^Reason: large 3rd ventricle History: small fontanelle. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is cavum septum pellucidum.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Female, 52 years old. Reason: hx of stroke in multiple territories, current headaches History: as above There is encephalomalacia involving the right frontal and left occipital lobes from chronic infarcts. These areas showed acute/subacute infarct on the prior study dated 11/2005. There is additional minimal scattered periventricular white matter FLAIR hyperintensity, without associated diffusion restriction. There is no evidence of acute infarct, intracranial hemorrhage, mass or edema. There is minimal ex vacuo dilatation of the frontal horn of the right lateral ventricle. Otherwise, the ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mild left maxillary sinus mucosal thickening. There is minimal scattered bilateral mastoid air cell opacification. The orbits are unremarkable.

Output: Chronic encephalomalacia involving the right frontal and left occipital lobes, without evidence of acute infarct or other acute intracranial abnormality to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Status post cardiac arrest with no movement of LUE. Focal neurological signs. Status post intubation.There is an area of focal low density in the right occipital lobe with loss of the gray-white matter differentiation and sulcal effacement consistent with an acute infarct is seen.A second area of area of focal low density in the right frontal lobe posteriorly extending to the right precentral gyrus is seen. The overlying gray matter is preserved. There is no associated ex vacuo dilatation of the anterior horn of the right lateral ventricle and the age of this lesion is indeterminate. Overlay of an acute infarct in this region cannot be excluded on CT and MRI is more sensitive at detecting acute ischemia/infarct.There is no evidence of intracranial hemorrhage, hydrocephalus or midline shift. There are background changes of periventricular low attenuation consistent with chronic small vessel ischemic change. The ventricles and basal cisterns are normal in size and configuration.There is diffuse thickening of the calvarium particularly marked over the frontal bones and sphenoid wings. The skull base appears unremarkable and the visualized paranasal sinuses and mastoid air cells are normally pneumatized and clear.

Output: *Probable acute infarct in the right occipital lobe.*There is a second area of low density in the right frontal lobe posteriorly, age is indeterminate. Overlay of an acute infarct in this region cannot be excluded on CT and MRI is more sensitive at detecting acute ischemia/infarct.*Mild chronic small vessel ischemic change is demonstrated.