Instruction: Generate impression based on findings.

Input: 22-year-old male with pain. Evaluate patellofemoral osteochondral defect. MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focus of intermediate to high signal intensity within the articular cartilage of the patella, centrally, indicating focal degeneration, measuring approximately 8 mm in diameter. There is a small focus of signal abnormality, with a depth of approximately 2 to 3 mm, within the underlying subchondral bone with adjacent bone marrow edema. These findings are compatible with the stated history of an osteochondral defect. There is relative 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.ADDITIONAL

Output: Central osteochondral defect of the patella and other findings as described above.


Instruction: Generate impression based on findings.

Input: History of left temporal lobe from meningioma resection, auditory and visual hallucinations, suspicious for encephalitis. No evidence of acute ischemic or hemorrhagic lesion.There is about 4mm sized intensely enhancing area (series 901, image 113/300) on the right basal ganglia, likely globus pallidus on enhancement. However, this is the only abnormal enhancement on this scan. Therefore, it is likely to be a vascular enhancement such as focal dilated venous structure. Possibility of arterial aneurysm is low.Therefore, if clinically indicated, follow up MRI with contrast enhancement can be considered.Redemonstration of left temporal lobe anterior aspect large resection cavity with the surrounding gliosis indicating postoperative changes. These are showing no interval changes since prior scan.Patch high signal intensities on FLAIR images on bilateral periventricular white matter indicating minimal to mild nonspecific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. 2. Focal intensely enhancing area on the right basal ganglia which likely represent vascular structure such as dilated venous structure. 3. Post resection status of the left temporal area meningioma with post operative changes, no interval change since prior exam.4. Non specific small vessel ischemic disease. No change since prior exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Transient alteration of awarenessClinical question: evaluate for brain metsSigns and Symptoms: altered mental status The CSF spaces are appropriate for the patient's stated age with no midline shift. No focus of diffusion restriction is identified in the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There as several punctate T2 and FLAIR hyperintense brainstem lesions present.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. To a lesser degree there are similar appearing brainstem lesions present also most likely vascular related.2.No intracranial mass lesion is identified.


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. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: Unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: History of left renal lesion seen on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The liver dome was not included in the axial images. The liver is otherwise normal in morphology signal intensity and enhancement without a suspicious lesion. No biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is located in the pelvis with punctate subcentimeter simple cysts.Orthotopic left kidney with a dorsal interpolar 1.4 cm minimally complex cyst with layering proteinaceous/hemorrhagic fluid and no suspicious postcontrast enhancement, corresponding to the cyst seen on ultrasound. Additional too small to characterize punctate probable benign cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The left renal lesion seen on ultrasound corresponds to a minimally complex benign proteinaceous/hemorrhagic cyst without suspicious postcontrast enhancement.


Instruction: Generate impression based on findings.

Input: New onset headache and dizziness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is confluent periventricular white matter T2 hyperintensity and a few scattered deep white matter T2 hyperintensity foci. There is no abnormal intracranial enhancement. There is perhaps mild diffuse cerebral volume loss. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are scattered paranasal sinus small retentions cysts, including adjacent to the left nasolacrimal duct.

Output: Perhaps mild diffuse cerebral volume loss and nonspecific areas of cerebral white matter signal abnormality may represent chronic small vessel ischemic disease, for example. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: Structural lesion causing headache. Signs and symptoms: Diffuse sharp headache with left sharp trigeminal distribution pain. Pre-and enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a few punctate foci of nonspecific flair hyperintensity in the subcortical and periventricular white matter bilateral seen hemispheres. Although nonspecific in proper clinical setting these findings could represent mild chronic small vessel ischemic strokes.The anatomical morphology as well as the signal intensity of brain parenchyma is otherwise entirely within normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement. The signal 80 the major intracranial arterial branches are identified.The signal intensity intracranial venous sinuses are within normal and with normal pattern of enhancement. Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses and bilateral mastoid air cells/middle ear cavities demonstrate normal pneumatization signal.

Output: 1.Negative diffusion weighted images.2.Few nonspecific punctate foci of flair hyperintensity the the subcortical and periventricular white matter which in proper clinical setting clips are present minimal chronic small vessel ischemic strokes.3.Unremarkable pre-and post enhanced brain MRI otherwise.4.Unremarkable images through the orbits, paranasal sinuses and well pneumatized mastoid air cells and middle ear cavities.


Instruction: Generate impression based on findings.

Input: 52 years Female (DOB:12/11/1963)Reason: eval for primary CNS lymphoma, PML, toxoplasma encephalitis, or other CNS malignancy or infection History: HIV, gait instability, cognitive impairment, recently started HART, hx "brain cancer"PROVIDER/ATTENDING NAME: GEORGE W WEYER GEORGE W WEYER There is redemonstration of abnormal signal in the right cerebellar hemisphere white matter without associated contrast enhancing lesion. It is associated with T2 and FLAIR signal hyperintensity and T1 signal hypointensity with involvement of the white matter of the right cerebellar hemisphere and the right middle cerebellar peduncle. This is stable since the prior exam.There are patchy foci of T2 and FLAIR hyperintensity in the medulla, pons and lower midbrain. This is stable since the prior exam.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a small focus of susceptibility effect present adjacent to the frontal horn of the left lateral ventricle. It is not seen on any of the other pulse sequences.No abnormal enhancing mass lesions are appreciated intracranially.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some small opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The nasopharyngeal adenoids are large which could be a manifestation of HIV.

Output: 1.There is a right cerebellar white matter lesion present. Differential considerations may include demyelinating focus including PML. Other lack of contrast enhancement makes lymphoma and toxoplasmosis less likely these diagnosis cannot be entirely excluded.2.Periventricular and subcortical white matter signal changes of a mild to moderate degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 3.There are patchy lesions present in the brainstem which are nonspecific.4.There is a microhemorrhage present adjacent to the frontal horn of the left lateral ventricle. It is of unclear significance in isolation.


Instruction: Generate impression based on findings.

Input: Right foot ulcer There is subcutaneous ulceration overlying the head of the fifth metatarsal. There is abnormal low T1 marrow signal and increased T2 marrow signal within the head of the fifth metatarsal consistent with osteomyelitis. There is overlying subcutaneous edema throughout the foot. There is no discrete focal fluid collection identified. There is moderate degenerative changes of the midfoot. The remaining marrow signal is otherwise normal.

Output: Findings consistent with osteomyelitis of the head of the fifth metatarsal.


Instruction: Generate impression based on findings.

Input: Evaluate for lateral meniscal tear. Knee pain with sports injury one month ago, with stiffness. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage deformity or bone marrow edema.LIGAMENTS: There is abnormal thickening and increased signal intensity of the anterior cruciate ligament, particularly involving the posterior and proximal fibers. This is concerning for a tear, at least involving the posterolateral bundle, but we cannot exclude a complete tear of the fibers of the proximal ligament. This may represent subacute injury given lack of bone marrow edema. Mucoid degeneration of the ligament is considered less likely. The posterior cruciate, lateral collateral and medial collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Abnormal thickening and increased signal intensity of the anterior cruciate ligament is suggestive of at least a partial thickness tear despite absence of bone contusions and joint effusion. We see no meniscal tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Right-sided weakness. Nonenhanced CT of brain:Subacute nonhemorrhagic right cerebellar and right medullary region in the distribution of right pica stroke is again identified. There is only subtle mass effect with effacement of sulci and no evidence of mass effect on the fourth ventricle.Well demarcated nonhemorrhagic lacunar infarct of right thalamus as was noted on prior MRI exam.Small vessel disease of indeterminate age is subcortical white matter of bilateral cerebral hemispheres (left greater than right). Overall this appearance also is similar to prior MRI examination. No evidence of hemorrhage.CTA of the cervical region:Right carotid, circumferential plaque at the origin of right internal carotid artery with no hemodynamically significant stenosis is noted. The right common carotid artery including its origin and the rest of the cervical portion of right internal carotid artery is unremarkable.Left carotid, circumferential complex plaque at the origin of left internal right artery with no minimal calcification is noted. This results in significant high-grade stenosis of left internal carotid artery at this site. The left common carotid artery and including its origin and the rest of the cervical portion of the left internal carotid artery is unremarkable and widely patent.Right vertebral artery is small in caliber and is believed to represent a non-dominant vertebral (and normal anatomical variation). There is no evidence of a stenotic lesion.Left vertebral artery, there is a non-calcific circumferential plaque at the origin of the dominant the left vertebral artery is noted. There appears to be more than 50% stenosis at this site. The rest of left vertebral artery is unremarkable.Limited view of lower tic origin the origin of major vessels are essentially unremarkable.CTA of intracranial circulation:Carotid system, patent bilateral supraclinoid internal carotid arteries. Minimal atherosclerotic irregularities noted.Middle cerebral arteries and their branches demonstrate mild atherosclerotic disease however but no evidence of any large vessel vascular occlusion or high-grade stenosis.Bilateral anterior cerebral arteries demonstrate multiple foci of high-grade stenosis and ectatic changes. Findings are secondary to atherosclerotic disease. Vertebral basilar system, diffuse atherosclerotic disease of the basilar artery with multi-level areas of mild vascular lumen compromise. Similar findings are noted in the intracranial component of dominant left vertebral artery in particular in its distal component.The right vertebral artery is the nondominant vessel. There is discontinuity of the distal component of the right vertebral artery. This represents occlusion of this vessel proximal to its junction with the basilar artery. The very distal portion of right vertebral artery is visualized and shows significant decrease in its caliber to its patent more proximal component.

Output: 1.Revisualization of multiple small vessel strokes, lacunar strokes and a right cerebellar -- medullary stroke in the distribution of right pica branch. No evidence of hemorrhagic transformation.2.Atherosclerotic plaque with minimal calcification however no hemodynamically significant stenosis at the origin of right internal carotid origin.3.Significant atherosclerotic disease of the left internal carotid artery origin with very high-grade stenoses.4.More than 50% stenosis at the origin of the dominant left vertebral artery and otherwise unremarkable vertebral arteries bilaterally in the neck.5.Atherosclerotic disease of supraclinoid internal carotid arteries, bilateral middle cerebral arteries with areas of mild to moderate vascular compromise. Atherosclerotic disease results in high-grade stenosis and ectatic changes of bilateral anterior cerebral arteries.6.Patent dominant left vertebral artery intracranially with minimal atherosclerotic disease.7.Patent basilar artery however but extensive atherosclerotic disease and mild vascular lumen compromise.8.Complete occlusion of the mid section of the intracranial component of the nondominant right vertebral artery. There is significant decrease in the caliber of visualized very distal right vertebral artery compared to patent a proximal component. If further evaluation is required for management a conventional angiogram would improve detection and the cause of occlusion and morphology of this vessel evaluation.


Instruction: Generate impression based on findings.

Input: 72-year-old female with decreased vision. Evaluate for etiology of retinal edema. MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild progression of the periventricular and subcortical T2/FLAIR hyperintensities which is nonspecific but likely related to small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI orbits: Motion limited exam.There is abnormal bilateral signal and thickening along the posterior aspect of the globes with T2 hyperintensity and mild T1 heterogeneity but no abnormal susceptibility to indicate hemorrhage. The bilateral nature and configuration is suggestive of bilateral retinal attachment. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1.Findings suspicious for bilateral retinal detachment. Please correlate with an ophthalmoscopic exam.2.No evidence of intracranial hemorrhage, mass, or acute infarct. 3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. This has progressed mildly since the prior exam from 12/2008


Instruction: Generate impression based on findings.

Input: Clinical question: DBS planning. Signs and symptoms: DBS planning Pre and post enhanced brain MRI:Examination is limited and performed utilizing surgical planning protocol and is not a true diagnostic exam.There are also no prior exams for comparison.Examination demonstrates uniform prominence of cortical sulci and supratentorial ventricular system without radiation of midline.There is no detectable abnormal enhancement of parenchyma or the leptomeninges.The signal void of major intracranial arterial branches are identified and there is normal enhancement of intracranial venous sinuses. There is no detectable abnormal signal intensity on T2 or susceptibility MRI sequences.

Output: Pre- and post enhanced surgical planning MRI study as detailed.


Instruction: Generate impression based on findings.

Input: Central sleep apnea with dropped breaths, hypotonia, developmental delay. Evaluate for atrophy vs mass vs other processes explaining clinical condition. There is increased crowding of the foramen magnum compared to the previous exam with pointing of the tonsils. The tonsils descend to the level of the posterior arch of C1 which is compatible with Chiari type I malformation. There is symmetric interval increase in size of the ventricles with proportionate increase in size of the sulci/subarachnoid spaces. Given that these are proportionally increased, this is favored to be secondary to parenchymal volume loss.There is normal myelination pattern for age. There are no focal lesions and no obvious structural abnormalities. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Findings compatible with Chiari Type I malformation.2.Symmetrically increased ventricular size and sulci/subarachnoid spaces suspicious for global parenchymal volume loss.3.Normal myelination pattern for age.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate interval enlargement of possible frontal meningioma. Signs and symptoms: CTH with enlarged possible meningioma. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates a dural based extra-axial mass in the anterior left middle cranial fossa along the inner table of the great wording of sphenoid. It measures at 32 x 17 mm in transaxial dimensions (axial T2 series 6 image 19). There is resultant mass effect and posterior displacement of left temporal tip however without detectable FLAIR or T2 signal abnormality to suggest vasogenic edema. The location and signal intensity of the finding is suggestive of a meningioma. No contrast was given.Additionally examination demonstrates scattered periventricular and subcortical as well as bilateral basal ganglia and minimally pontine foci of FLAIR hyperintensity which considering patient's stated age of 77 likely representing chronic nonhemorrhagic small vessel ischemic strokes of moderate degree.The signal intensity of cerebral cortex is within normal.Cortical sulci and ventricular system as well as the CSF spaces are otherwise unremarkable. The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are unremarkable.Mild mucosal thickening of all visualized paranasal sinuses are noted. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Dural based extra-axial mass in the left anterior middle cranial fossa presumed a meningioma is again noted. Subtle mass effect on the left anterior temporal tip without vasogenic edema or midline shift.2.Negative diffusion weighted images and findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes are noted.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of sarcoma. Please evaluate for recurrence and extent of disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. Punctate T2 hyperintense focus of the inferior pancreatic body (coronal series 4 image 23) is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Small simple cysts of the left kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Stable soft tissue nodule adjacent to the medial aspect of the right diaphragmatic crus measuring 2.1 x 1.3 cm (series 9 image 32) (prior 2.2 x 1.2 cm). Enhancement is most evident on the delayed series.There is a new fat signal intensity lesion of the right posterior diaphragmatic crus measuring 1.7 x 2.7 cm (series 7 image 41). This lesion is hyperintense on the T2 fat saturated sequence (series 9 image 42). Peripheral enhancement is noted on the delayed postcontrast sequence (series 13 image 463).BOWEL, MESENTERY: Status post right hemicolectomy with ileocolonic anastomosis.Adjacent to the ileal colonic anastomosis, there is a new 5.4 x 4.9 cm T2 hyperintense lesion (coronal series 4 image 23) with fat signal intensity. Hyperintense signal intensity is noted on the fat saturated T2 sequence (series 9 image 44). Mild peripheral enhancement is seen on the delayed postcontrast sequence (series 13 image 455).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable small cardiophrenic angle lymph node.

Output: 1.New 5.4 x 4.9 cm lesion adjacent to the ileocolonic anastomosis and a new 1.7 x 2.7 cm lesion of the posterior right diaphragmatic crus. These lesions demonstrate fat signal intensity and peripheral enhancement on the delayed series. These findings are concerning for liposarcoma recurrence.2.Stable right retroperitoneal soft tissue nodule adjacent to the right diaphragmatic crus medially.


Instruction: Generate impression based on findings.

Input: 68-year-old male with history of right renal cyst. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis. Scattered T2 hyperintense non-enhancing lesions compatible with benign cysts.SPLEEN: Small splenule. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole cystic lesion containing areas of intrinsic increased T1 signal without enhancement measuring 2.6 x 2.4 cm, not significantly changed dating back to 2013. Additional benign appearing exophytic subcentimeter cystic lesions are present bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Benign cyst in the right lower pole, stable in size from 2013, probably containing proteinaceous or mineral debris. Other scattered subcentimeter lesions also have a benign appearance.


Instruction: Generate impression based on findings.

Input: Male 57 years old Reason: hx of portal vein thrombosis, cirrhosis, and HCC History: eval for portal vein thrombosis LIMITED ABDOMENLIVER: Heterogeneous liver. Coarse echotexture of the liver. There is partial main portal vein thrombus. Right portal vein is not well visualized. Ill-defined masses in the right and left lobe of the liver that were seen on CT are not well seen on ultrasound. These lesions were suspicious for hepatocellular carcinoma. Further evaluation of the liver with MRI is recommended.BILIARY TRACT: No evidence of intra or extrahepatic biliary dilatation. Status post cholecystectomy.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen is enlarged measuring 16 cm. RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Cirrhotic liver. Infiltrative, ill-defined bilateral lobar liver masses detected on the previous CT were not well seen on today's study. These lesions were suspicious for hepatocellular carcinoma. Further evaluation with liver MRI is recommended.Partial thrombosis of the main portal vein.Splenomegaly.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:5/20/1957)Reason: lung mets to brain s/p SRS To L temporal and R frontal met and most recently whole brain radiation History: eval for extent of diseasePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA Since the prior exam multiple brain parenchymal lesions have increased in size. One in the posterior aspect of the left temporal lobe previously measured 7 x 7 mm now measures 12 x 12 mm axial dimensions. One in the left cerebellar hemisphere previously measured 10 mm and now measures 21 x 15 mm. One adjacent to the trigone of the left lateral ventricle was barely visible on the prior exam and now measures 9 x 12 mm. One in the right frontal lobe was not present on the prior exam measures 4 mm. One in the right middle frontal gyrus measures 12 mm and previously measured 3.5 mm. One adjacent to the the right precentral sulcus in the right precentral gyrus measures 6 mm and previously measured 2 mm. There is edema present in the posterior fossa associated with the left cerebellar lesion which partially distorts the fourth ventricle and mildly crowds the posterior fossa.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam patient's metastatic lesions have increased in size . In addition there are a couple new brain metastatic lesions.2.There is more mass effect in the posterior fossa the current exam relative to the prior exam which is related to vasogenic edema from a metastatic lesion.


Instruction: Generate impression based on findings.

Input: Left ear tinnitus and sensorineural hearing loss. . There is apparent deficiency of bone overlying the left superior semicircular canal. The rest of the inner ear structures otherwise appear unremarkable. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The bilateral mastoid air cells and middle ears also appear unremarkable. A subcentimeter focus of high T1 signal along the midline of the anterior cranial fossa may represent prominent fatty marrow within the crista galli rather than a meningioma, although this is incompletely characterized.

Output: 1. Apparent left superior semicircular canal dehiscence, which can be confirmed via a temporal bone CT, if clinically warranted. Otherwise, no evidence of vestibular schwannoma.2. A subcentimeter focus of high T1 signal along the midline of the anterior cranial fossa may represent prominent fatty marrow within the crista galli rather than a meningioma, although this is incompletely characterized.


Instruction: Generate impression based on findings.

Input: There is mild exaggeration of the lumbar lordosis without sagittal spondylolisthesis. There is mild loss of height of the T12, L1, L2, and L4 vertebral bodies overall worse compared to the 12/31/2011 MRI, but appearing similar to the more recent 11/24/2014 CT. There are additional mild endplate deformity/Schmorl's nodes nodes involving T12-L5 which also appear similar to 11/24/2014 CT. There is no significant bone marrow edema to suggest acute compression fracture. The bone marrow is mildly heterogenous including small foci of decreased T1 and T2 signal within the L2 vertebral body and within the left sacrum. The focus in the L2 vertebral body appears unchanged from the 12/31/2011 exam. These areas do not demonstrate associated increased STIR signal to suggest edema and favored to be benign, although remain nonspecific. No clearly destructive osseous lesions are identified. There is mild loss of disc height at L1-L2. The T11-L2 discs are desiccated. The conus terminates at L1-L2. The paravertebral soft tissues are unremarkable. Individual levels as below:L1-L2: Mild disc bulge without significant central canal or foraminal stenosis.L2-L3: No significant central canal or foraminal stenosis.L3-L4: Mild disc bulge without significant central canal or foraminal stenosis.L4-L5: Mild disc bulge. Mild facet hypertrophy and ligamentum flavum thickening. Mild central canal stenosis. Minimal bilateral foraminal stenosis.L5-S1: No significant central canal or foraminal stenosis.

Output: 1.Multiple chronic mild vertebral body compression deformities without bone marrow edema to suggest acute fracture.2.Mild spondylosis as described above including mild central canal stenosis at L4-L5.3.Mild facet arthropathy, relatively worse at L4-L5 which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Reason: eval mass History: R proximal humerus mass Within the superficial soft tissues overlying the right deltoid and biceps brachii muscle, there is a homogeneous 7 x 3 x 2 cm mass with well-defined margins and with signal characteristics identical to subcutaneous fat on all sequences. A thin capsule and a few thin internal septae are appreciated. The underlying muscles are uninvolved. Bone marrow signal intensity is within normal limits. No axillary lymphadenopathy.

Output: Superficial lipoma within the lateral aspect of the right shoulder.


Instruction: Generate impression based on findings.

Input: 79-year-old female with hypertension now with progressive lower extremity weakness x 1 day. Generalized weakness x 2 weeks. No objective neuro findings on exam. Question acute ischemia. Question subdural hematoma. Patient has very poor gait. Patchy areas of deep subcortical and periventricular white matter hypodensity likely represent moderate small vessel ischemic disease, age indeterminate by CT. However, if there is concern for an acute stroke, an MRI is recommended for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift. Prominence of the sulci and ventricles indicates mild to moderate corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there is concern for an acute stroke, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Left lower extremity weakness, bowel and bladder incontinence. History of metastatic breast cancer. There is extensive T2 hyperintensity involving the thoracic cord extending from the C7 to the T4 levels with mild cord expansion. There is a T2 hypointense intramedullary lesion at the T1 level measuring approximately 5 mm, previously approximately 28 mm in the craniocaudal dimension.Degenerative changes are seen in the cervical spine with disc osteophyte complexes at the C4-C5, C5-C6, and C6-C7 levels. There is minimal retrolisthesis at C5 on C6. Mild cervical spinal canal narrowing related to degenerative disease. Vertebral body heights and alignment in the cervical spine are otherwise maintained.In the thoracic spine at the T6-T7 level there is disc extrusion which appears less prominent than before. There is mild degree of spinal canal stenosis at this level. Possible T2 signal abnormality at this level, sagittal STIR image 7 but appears less severe than before. Vertebral body heights and alignment in the thoracic spine are otherwise maintained.In the lumbar spine, again seen is mild loss of height at the L2 level compatible with a chronic compression fracture. Vertebral body heights and alignment in the lumbar spine are otherwise maintained. Mild degenerative changes throughout the lumbar spine are also seen without significant spinal canal stenosis. There is severe loss of disc height at the L5-S1 level on a degenerative basis. Mild to moderate L5-S1 neural foraminal stenosis.

Output: 1. Intramedullary lesion at the T1 level highly suspicious for cord metastasis is decreased in size, currently measuring 5 mm, previously 28 mm in the craniocaudal dimension on prior study from 12/8/2014. Surrounding edema is also decreased in the interval.2. Disc extrusion at the T6-T7 level appears less prominent than 12/8/2014. There is possible T2 signal abnormality in the cord at this level but not well evaluated without axial images. There was definite cord signal abnormality at this level previously, which was presumably related to the extensive edema from the T1 metastases. There is mild degree of spinal canal stenosis at this level. 3. Please note this is a limited exam per cord compression protocol. Consider dedicated total spine MRI with gadolinium to better assess the extent of metastatic disease.Dr. Ali discussed findings with Dr. Jacobs at 1130 hrs on 8/26/2015.


Instruction: Generate impression based on findings.

Input: 58 year old female with non small cell lung cancer with new mass seen on the atrial septum on TTE. She also has shortness of breath and chest pain. MRI evaluation for atrial septal mass. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%. The LVEDV is 73 ml (normal range 109+/-23), LV end diastolic volume index is 45 ml/m2 (normal range: 65+/-11), LVESV is 18 ml (normal range 31+/-10), and LV end systolic volume index is 11 ml/m2 (normal range 18+/-5). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 62 ml/m2 (normal range 69+/-14), the RVEDV is 101 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsPulmonary veins drain normally into the left atrium, LUPV poorly visualized.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is a large right sided pleural effusion. There is also a large loculated fluid collection at the left lung base. Extensive L lung changes c/w recent CT (post surgical, radiation changes)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 sized left ventricle with normal systolic function.2.Normal sized right ventricle with normal systolic function.3.Large right sided pleural effusion. 4.Large loculated fluid collection at the left lung base. 5.No intracardiac mass to explain PET uptake at the aortic root / interatrial septum6.Posterior extracardiac mass noted on TTE is a large loculated L pleural effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: Headaches and hypertension Nonenhanced CT of brain:There is no definitive evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal. Follow-up with an MRI is recommended if clinical concern for stroke in our system. Non-infused CT can this area also the small strokes.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are unremarkable.

Output: No definitive evidence of abnormality. Follow-up with an MRI is recommended if clinical concern for stroke persists.


Instruction: Generate impression based on findings.

Input: 47 year old with known cardiac sarcoid and history of premature ventricular contraction and nonsustained ventricular tachycardia presenting with palpitations. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 145 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 54 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 75 g (normal range 114+/-24). 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 56 %, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 88 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 FindingsMediastinal lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 63%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 56%).3. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: memory impairment No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal patchy high signal intensities on bilateral periventricular white matters indicate minimal 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, 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: Minimal nonspecific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are small areas of encephalomalacia in the right cerebellar hemisphere. There are also mild scattered periventricular and subcortical white matter T2 hyperintensities, which are nonspecific, but compatible with chronic microvascular ischemic disease. There is no abnormal parenchymal or leptomeningeal 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 mild scattered paranasal sinus mucosal thickening. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is partially-imaged degenerative spondylosis at C4-5.

Output: 1. No evidence of metastatic disease.2. Chronic right cerebellar infarcts. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 44-year-old male with new onset seizure. Evaluate for stroke, edema. There is an area of hypodensity in the right frontal subcortical region that may represent edema or encephalomalacia. This could be related to old ischemic change. However, an MRI is recommended for further evaluation. The ventricles and sulci are mildly prominent, which may represent volume loss considering the patient's age. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right frontal subcortical hypodensity may represent edema or encephalomalacia. This could be related to old ischemic change. However, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 44-year-old male with shoulder pain. Evaluate for rotator cuff tendinopathy versus partial tear. ROTATOR CUFF: There is perhaps mild thickening and slight increased signal intensity of the insertional fibers of the supraspinatus tendon suggesting mild tendinosis, but we see no fluid-filled tear. The supraspinatus muscle is within normal limits. The infraspinatus tendon and muscle appear intact. The teres minor and subscapularis muscles and tendons appear intact. There is a subchondral cyst within the humeral head which is not necessarily of current clinical significance.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is mild anterior spurring of the acromion process. No fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is no joint effusion. Given the limitations of a non arthrogram study, the glenoid labrum appears normal. The articular cartilage of the shoulder appears within normal limits.BICEPS TENDON: Given the limitations of a non arthrogram study, the tendon of the long head of the biceps appears within normal limits.

Output: Possible mild supraspinatus tendinosis at its insertion and minimal osteoarthritis of the acromioclavicular joint. We see no rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: The rotator cuff is normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal and there is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is normal. There are no loose bodies within the joint. The articular cartilage is preserved.BICEPS TENDON: No significant abnormality noted.

Output: Normal appearance of the labrum with no specific findings to account for the patient's shoulder pain.


Instruction: Generate impression based on findings.

Input: 34 year old man with non-ischemic cardiomyopathy and palpitations and wide-complex tachycardia. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVEDV is 223 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 112 ml (normal range 47+/-19), the LV mass index is 66 g/m2 (normal range 85+/-15), and the LV mass is 142 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. No evidence of myocardial iron overload.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 115 ml/m2 (normal range 82+/-16), the RVEDV is 248 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 119 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 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. Normal LV size with mildly reduced systolic function (LVEF 50%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2 Normal RV size and systolic function (RVEF 52%).3. Mild left atrial dilation.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with history of spastic astrocytoma status post resection in 2012 with increasing headache. Evidence of prior tumor resection from the cerebellum is again seen. The resection cavity is stable in size and morphology. No new signal abnormality is seen. No pathologic enhancement is detected within or adjacent to the cavity. Elsewhere, there is no evidence of significant parenchymal signal abnormality or pathologic enhancement. No edema or mass effect is detected. Ventricular size and morphology are stable and within normal limits. An incidental developmental venous anomaly is evident in the right occipital lobe.

Output: Stable appearance of the cerebellar resection cavity with no evidence to suggest recurrent tumor.


Instruction: Generate impression based on findings.

Input: 51-year-old female with right foot pain status post trauma. Assess for anterior process of calcaneus fracture.IMAGE ACQUISITIONS: CT examination of the right foot was performed without IV contrast. Transverse, coronal, and sagittal reformations were performed. Soft tissue and bone windows were reviewed. There is no evidence of fracture. Specifically, the anterior process of the calcaneus appears normal. Mild osteoarthritis affects the first metatarsophalangeal joint. A bipartite medial sesamoid is identified which is a normal variant. Tiny accessory navicular bones are identified which are of doubtful clinical significance.The visualized tendons and ligamentous structures of the ankle appear normal given the limitations of CT relative to MRI. Note is made of a low-lying soleus muscle.Nonspecific subcutaneous edema along the lateral aspect of the foot and ankle.

Output: Mild lateral soft tissue swelling without evidence of fracture.


Instruction: Generate impression based on findings.

Input: Male 26 years old Reason: r/o torn meniscus History: swelling pain MENISCI: There is an obliquely orientated focus of increased signal intensity extending through the peripheral fibers of the posterior horn of the lateral meniscus to the femoral articular surface, indicating a tear that is continuous with the interface of the meniscus with the meniscofemoral ligament. Furthermore the popliteomeniscal fascicles appear distorted and torn. The body and anterior horn of the meniscus demonstrate normal signal intensity and morphology. The medial meniscus demonstrates normal signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: There is edema within the posterior aspect of the lateral tibial plateau as well as the lateral femoral condyle above the anterior horn of the lateral meniscus. The articular cartilage is intact.LIGAMENTS: The anterior cruciate ligament is abnormally thickened and of increased signal intensity indicating at least a partial thickness tear. The slope of the distal fibers is maintained but the proximal fibers are distorted. The posterior cruciate ligament demonstrates normal signal intensity and morphology. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Findings consistent with at least a partial-thickness anterior cruciate ligament tear as well as a tear of the posterior horn of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: Female 17 years old Reason: eval for djd; stiff s/p surgery pre-peroneal tendon repair History: ankle pain and stiffness for years TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is no evidence of DJD or bone compromise. T2 fluid signal on the anterior tibiotalar joint may represent a tibiotalar ganglion. Minimal narrowing of the posterior tibiotalar joint when compared with previous examination. ADDITIONAL

Output: Incidental finding of posterior tibiotalar ganglion and minimal joint narrowing of the posterior tibiotalar joint, otherwise normal examination.


Instruction: Generate impression based on findings.

Input: Adrenal mass seen on CT at outside hospital. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No significant biliary ductal dilatation. No focal liver lesion. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 2.0 x 1.4 cm right adrenal lesion demonstrates central T1 and T2-weighted hyperintensity (series 3/23; series 9/43) and a thin peripheral hypointense rim. No loss of signal on out of phase imaging or postcontrast enhancement on the subtraction images.KIDNEYS, URETERS: Atrophic right kidney. Simple left renal cysts. No suspicious renal lesion or hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine. Probable benign vertebral body hemangiomas. OTHER: No significant abnormality noted.

Output: The right adrenal lesion measures 2.0 cm, decreased from size reported. In the absence of a known primary the imaging characteristics are most suggestive of adrenal hemorrhage.


Instruction: Generate impression based on findings.

Input: Posterior tibial tendinitis TENDONS: There is a mild amount of fluid surrounding the posterior tibialis, flexor digitorum longus and flexor hallucis longus tendons however the tendons themselves appear normal in caliber and signal. The peroneal tendons and extensor tendons also appear normal.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Mild osteoarthritis affects the first MTP joint.ADDITIONAL

Output: Perhaps minimal tenosynovitis of the posterior tibialis, flexor digitorum longus, and flexor hallucis longus tendons although the tendons themselves are normal.


Instruction: Generate impression based on findings.

Input: Sarcoidosis, systemic lupus erythematosus, low back pain 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 hyperintense foci scattered within the vertebral bodies compatible with focal fat or hemangiomas. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation, mild disc bulge, and dorsal annular fissure. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: Disc desiccation. No spinal canal or neural foraminal stenosis. Moderate facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine without significant spinal canal stenosis or neural foraminal stenosis at any level. There is facet arthropathy at L5-S1 bilaterally and to a lesser degree at L4-L5, which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: 64-year-old male with confusion on Coumadin found down at bedside with no neurologic findings. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodense region within the subcortical and periventricular white matter consistent with small vessel disease, age indeterminate. Well defined hypodense region within the left MCA territory and left cerebellum consistent with previous strokes. No acute cortical stroke is seen, however, if there is clinical concern for acute ischemia, an MRI may be considered. Dense atherosclerotic calcifications noted throughout the large vessels.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Other specified health status [Z78.9], Reason for Study: ^Reason: eval for acute cerebral infarction History: acute on chronic aphasia concerning for stroke There are multifocal restricted diffusion lesions on the left MCA territory including left frontal lobe middle and inferior frontal gyri and left posterior parietal lobe indicating acute to subacute ischemic infarction.Underlying brain shows multifocal patchy FLAIR high signal intensity lesions involving bilateral frontal and parietal lobes (left more than right), as well as right occipital lobe and left temporal lobe with encephalomalacia indicating chronic ischemic infarction.Multifocal scattered FLAIR high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease.Due to patient motion, gradient-echo sequence was not applied therefore, precise evaluation regarding hemorrhagic lesion is incomplete.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, or midline shift. 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.There is a retention cyst on the right maxillary sinus.Left eye lens signal is not seen indicating prior cataract surgery.

Output: 1. Left MCA territorial acute/subacute ischemic infarctions as described above.2. Multifocal bihemispheric chronic ischemic infarctions with encephalomalacia.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 5.9 x 6.8 x 8.0 cm.Peripheral Zone: No discrete suspicious focus.Central Gland: Extensive changes of BPH.0.9 x 1.0 cm mid gland medial focus is very low signal intensity on T2-weighted imaging with restricted diffusion (series 1201/19).1.3 x 1.1 cm apex medial focus with low signal intensity on T2-weighted imaging ill-defined margins, restricted diffusion and early arterial enhancement with washout (series 1201/13).1.7 x 0.8 cm apex left lateral focus with ill-defined low signal intensity in T2-weighted sequences and restricted diffusion.Seminal Vesicles: No evidence of seminal vesicle invasion.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.Three foci in the transition zone demonstrating low signal intensity in T2-weighted imaging and restricted diffusion may reflect sites of prostatic carcinoma. Alternatively, these may reflect BPH nodules.2.After discussing the findings with the patient the patient agreed to undergo an MR guided biopsy of these lesions.


Instruction: Generate impression based on findings.

Input: 83 year-old female history of IPMN. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. No focal hepatic lesions. Mild extra hepatic biliary ductal dilatation with the common bile duct measuring up to 11 mm. No filling defects or masses are present.SPLEEN: No significant abnormality noted.PANCREAS: Unchanged uncinate process cystic lesion measures 1.7 x 1.0 cm (image 32 of series 3). Unchanged body cystic lesion measuring 1.7 x 1.0 cm (image 27 of series 3). Unchanged tail cystic lesion measuring 0.9 x 0.8 cm (image 19 of series 6).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small gastric diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Postoperative changes of right mastectomy. Ectatic ascending aorta measuring up to 4.3 cm. Trace right pleural effusion.

Output: Stable pancreatic cystic lesions as above.


Instruction: Generate impression based on findings.

Input: Six rule female with history of intracranial METs, now with right-sided headache. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse periventricular and subcortical white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Noncontrast evaluation is limited for evaluation of tumor.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute change.


Instruction: Generate impression based on findings.

Input: Headache, difficulty with potty training and constipation, family history of epilepsy and other diseases of the nervous system, evaluate for syrinx. MRI brain: There is no Chiari malformation. The CSF flow study is technically inadequate. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI spine: This is a slightly motion degraded exam. The vertebral alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. No evidence of syringohydromyelia. The spinal cord terminates at the upper L1 level. No evidence of fatty filum terminale or intraspinal mass is seen.The paravertebral soft tissues are unremarkable.

Output: 1. Unremarkable MRI brain. No evidence of Chiari malformation.2. Unremarkable MRI spine. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Asymptomatic 60 year old woman presents for routine screening mammography. Personal history of benign right breast biopsy in December 2011. Family history of breast cancer in mother, two sisters, maternal cousin, and four paternal cousins. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Previously described lobulated small mass in the right breast 9:00 position is unchanged, consistent with a benign lesion.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Female 20 years old History: seizure. Some sequences are partially degraded by artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no asymmetry of the hippocampi or evidence of volume loss. There is a nonspecific partially empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Partially visualized mild mucosal thickening of the right maxillary sinus. Evaluation of the paranasal sinuses is limited by artifact.

Output: No specific findings to account for the patient's symptoms. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA, TIA, hemorrhage. Signs and symptoms: Aphasia. Nonenhanced head CT:Examination again demonstrates as was noted on prior brain MRI of 24 hours earlier multiple foci of vasogenic edema consistent with multiple intracranial complement the study lesions. The lesion in the basal cistern demonstrate high density and likely representing known hemorrhagic component of tumor. The larger metastatic lesion in the left anterior frontal lobe demonstrates slightly higher than gray matter density also consistent with minimal internal hemorrhage. Mildly high density of vermian metastatic focus is also like lesion sulcal minimal internal hemorrhage.The rest of metastatic foci are evident only by edema without evidence of hemorrhage.There is evidence of regional mass effect at the level of metastatic lesions and without detectable mass effect on the ventricular system or midline shift.

Output: 1.Multiple foci of vasogenic edema consistent with patient's known intracranial metastatic lesions not significantly changed since prior exam from 24 hours earlier.2.Several of the lesions demonstrate slight increased density consistent with hemorrhage within the metastatic lesions as was noted on prior MRI.


Instruction: Generate impression based on findings.

Input: 75-year-old man status post adrenalectomy for a right adrenal neoplasm. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe calcifications. The liver is otherwise normal in signal and morphology. The patient is status post cholecystectomy. There is no significant intra or extrahepatic duct dilatation.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The patient is status post right adrenalectomy. In the right adrenalectomy bed (series 4, image 29) there is a peripherally T2 hyperintense lesion measuring 22 x 20 mm, previously 17 mm. There is no loss of signal on opposed phase imaging to suggest microscopic fat and this lesion does not significantly enhance until the 3 minute delayed phase of imaging (series 11, image 44). An additional, subcentimeter focus of soft tissue posterior to this lesion appears stable to prior examinations and is most likely postoperative scarring given relative stability.KIDNEYS, URETERS: A left renal cyst is unchanged. The right kidney is normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enlarging lesion in the right adrenalectomy bed suspicious for residual/recurrent tumor.


Instruction: Generate impression based on findings.

Input: 43-year-old female with multiple sclerosis. F/u progression. Again seen are new numerous T2/FLAIR hyperintense lesions predominantly within the supratentorial white matter and including the periaqueductal gray, which appear similar to the previous exam allowing for differences in technique. These lesions are T1 hypointense with some markedly T1 hypointense. There is no evidence of intracranial hemorrhage, mass, midline shift or herniation. The ventricles and basal cisterns are unchanged in size and configuration. The skull and extracranial soft tissues are unremarkable. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Allowing for differences in technique, the numerous white matter lesions in the brain compatible with multiple sclerosis are not significantly changed.


Instruction: Generate impression based on findings.

Input: Oligodendroglioma, WHO grade II, pre-treatment planning. There a postoperative findings related to left transfrontal biopsy of an infiltrative T2 hyperintense left insular mass, which measures up to approximately 3 cm. The ventricles and other cerebrospinal fluid spaces are unchanged in size and configuration, including a cystic septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There are skin fiducial markers in position.

Output: Pre-treatment planning MRI for a left insular oligodendroglioma, with skin fiducial markers present.


Instruction: Generate impression based on findings.

Input: 42 years, Male, right hemibody numbness. Evaluate for thalamic stroke. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific. There is no significant parenchymal signal abnormality. Apparent T2 hyperintensity involving the medulla is likely artifactual and demonstrates no corresponding signal abnormality on the FLAIR or diffusion sequences. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Brain parenchyma appears within normal limits for age. Specifically, no evidence of thalamic infarct.


Instruction: Generate impression based on findings.

Input: Male, 24 years old, multiple sclerosis. Recently diagnosed with MS, on October 2016 and has follow up with Dr Ciprianni at U of C. He was recently started on Tecfidera about 2 weeks ago. Over the last week he reports to be feeling progressive numbness on L hand and L toes. He was referred for admission for MS flare and treatment with IV steroids. Multiple imaging series are degraded by patient motion. Small T2/STIR hyperintense lesions are partially visualized on sagittal imaging in the right middle cerebellar peduncle and left cerebellar hemisphere white matter, which were better visualized on the outside brain MR examination. There are two small peripherally located foci of T2/STIR signal abnormality on the right at the C2 and C2-3 levels. The C2-3 level lesion may be new. A larger T2/STIR signal lesion in the spinal cord is present on the left from lower C4 level to the mid C6 level, which appears to be new. There is moderate associated expansion of the spinal cord at the C5 level. There is also enhancement of the lesion at the C4-C5 to the C5-C6 levels within the left and dorsal aspects of the spinal cord, suggesting active demyelination.There is normal alignment of the cervical spine, with normal cervical lordosis. Vertebral body and intervertebral disc heights are maintained. There is no significant disc bulge or herniation. No high-grade foraminal stenosis in the cervical spine, within the limitations of motion degradation. THORACIC SPINE

Output: 1. Interval progression of demyelinating disease in the cervical cord with a new lesion extending from the C4-C5 to C5-C6 levels involving the left and dorsal aspects of the cervical spinal cord. There is associated enhancement consistent with active demyelination.2. No abnormal signal identified in the thoracic spinal cord.3. Partially visualized demyelinating lesions within the left cerebellar hemisphere and right middle cerebellar peduncle, better visualized on outside MRI of the brain.


Instruction: Generate impression based on findings.

Input: Status post liver transplant. Known seroma with inflammation in the region of the left brachial plexus.Additional clinical history from electronic medical records: 63-year-old female with left upper extremity numbness, tingling and weakness. History of orthostatic liver transplant status on 10/5/2015 for hepatitis C/EtOH related cirrhosis with HCC. Diagnosed with CRPS type II of LUE status post liver transplant where her L arm was injured during surgery (swollen 2-3 x normal size). Had L stellate ganglion block in Marc 2016 but with only brief improvement. The surgical incision is again seen along the left upper chest. The underlying T2-hyperintensity in the left pectoris major and minor muscles remains unchanged as well as the mild distortion, probably scarring. The tiny subpectoral collection demonstrates less T2-hyperintensty and is smaller, probably a resolving seroma/hematoma. The adjacent left subclavian vein still shows slight distortion and suggestion of narrowing adjacent to a surgical clip, though looks patent upstream and downstream from this point. There is no asymmetric signal abnormality involving the left brachial plexus. There is no mass along its course but the above-described scarring findings are in the vicinity of the divisions/cords of the plexus. There are small left pectoral lymph nodes.Multilevel degenerative cervical spine disease is not significantly changed since the previous examination, most pronounced at C6-C7 where a disc extrusion with cranial migration is present minimally indenting the left ventrolateral aspect of the spinal cord. Please refer to the report of the previous cervical spine MRI from November 30, 2015 for full details.

Output: 1.There is scarring related to the previous left upper chest incision, involving the underlying muscles. There is suggestion of underlying focal stenosis/tethering of the left subclavian vein just adjacent to a surgical clip. Patency of the vein is probably better assessed by Doppler ultrasound, if clinically warranted.2.As discussed previously, though there is no definite injury to the left brachial plexus, the plexus passes reasonably close to the subclavian vein operative field where there is evidence of some scarring and tethering which may have affected the divisions/cords of the plexus. 3.The previously described small subpectoral seroma or hematoma has further regressed.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma on Temodar. The intrinsically T1 hyperintense lesions in the bilateral cerebral hemispheres are stable to slightly decreased in size. For example, a lesion in the left occipital lobe measures 4 mm in diameter, previously also 4 mm, while a lesion in the right anterior cingulate gyrus measures 3 mm in diameter, previously 5 mm. There is no appreciable vasogenic edema associated with the lesions. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Stable to slight interval decrease in size of the brain metastases.


Instruction: Generate impression based on findings.

Input: 48-year-old male with history of lumbar cracking and popping with movement Anterior vertebral body osteophytes along the lower lumbar spine with mild L4-L5 and L5-S1 disk space narrowing. Vertebral body heights are maintained. Alignment is within normal limits on flexion and extension views.

Output: Degenerative disk disease as described above.


Instruction: Generate impression based on findings.

Input: 51-year-old male with acute psychosis, history of pituitary adenoma There is redemonstration of a large sellar lesion measuring 4.1 x 3.3 x 2.2 cm in sagittal and coronal planes (sagittal image 28, coronal image 32). While the size of the sellar lesion is similar to 2004, the mass appears heterogeneously hypodense on CT which is surprising based on prior MRI appearance which was more solid appearing. This may suggest interval treatment. As before, there is remodeling of the sella by the mass, with distortion of the posterior walls of the sphenoid sinus. Relationship to the chiasm is poorly defined based on this CT.There is no acute intracranial hemorrhage with special attention to the abnormal sella turcica. There is also no focal fluid collection. Ventricles and sulci retain normal size/configuration.Gray-white matter differentiation is preserved. There is no focal parenchymal lesion or mass. There is no midline shift or basal cistern effacement.Unremarkable visualized portions of the orbits. Paranasal sinuses are clear to the extent visualized. Mastoid air cells are also clear. Probable small quantities of cerumen in the external auditory canals.

Output: 1.No acute intracranial abnormality. Specifically no acute intracranial hemorrhage or generalized mass effect.2.Redemonstration of remodeled sella consistent with previously seen pituitary adenoma. The contents of the sella are now predominately hypodense which raises possibility of interval treatment. MRI would be required to evaluate extent of remaining tumor and to define relationship to surrounding structures.


Instruction: Generate impression based on findings.

Input: 59 year old with breast pain. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal 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: Female 44 years old with right knee pain. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the cartilage along the medial facet and median ridge of the patella and trochlea. There is a 3 mm full thickness cartilage defect along the median ridge of the patella with an associated subchondral cyst. The articular cartilage of the femoral condyles and tibial plateau is otherwise within normal limits.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Mild chondromalacia patella.


Instruction: Generate impression based on findings.

Input: Female, 90 years old, with left gluteal and leg pain, worse at the posterior coccyx. A mild levocurvature of lumbar spine may be positional. Sagittal alignment is unremarkable. Vertebral body heights are preserved. Mild endplate edema is seen along the superior L2 endplate. Fatty degenerative endplate signal change is noted at L3-4 and L4-5.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below.L1-2: Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Minimal disc bulging. Small right foraminal protrusion. No significant spinal canal or foraminal stenosis L3-4: Mild facet arthropathy and ligamentum flavum thickening. Bulging disc asymmetric to the right. Narrowing of the right lateral recess but no significant generalized spinal canal stenosis. Moderate right foraminal narrowing. L4-5: Moderate facet arthropathy and ligament thickening. Bulging disc. Moderate generalized spinal canal narrowing with some crowding of the cauda equina. Severe right and mild left foraminal narrowing. L5-S1: Facet arthropathy. Central and left paracentral disc protrusion. The left lateral recess is significantly narrowed, though there is no generalized spinal canal stenosis. Severe left foraminal narrowing.

Output: Multilevel disc degeneration is seen. Most notably, at L3-4 there is a moderate generalized spinal canal stenosis and severe right foraminal narrowing; and at L5-S1, there is significant narrowing of the left lateral recess and severe left foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell carcinoma with growing destructive lesion at L1. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. There is anenhancing T1 hypointense 2.5 x 1.4 cm mass centered within the left L1-L2 neural foramen and compressing the left L1 nerve root. There is caudal epidural extension. There is loss of the adjacent L1 vertebral body cortex. There are few foci of T1 and T2 hyperintensity within the lumbar vertebral bodies, probably hemangiomas. The conus medullaris is normal in position.The sacrum and bilateral iliac bones are heterogeneous on T1, with suppression on fat saturation, probably fatty infiltration. There is disc desiccation at L5-S1 with a disc bulge and right para median-central annular fissure. The disc bulge minimally abuts the left L5 nerve root. Paraspinous soft tissues are within normal limits.

Output: Enhancing mass centered within the left L1-2 foramen, with disruption of the vertebral body cortex and extension into the epidural space, probable renal metastasis.


Instruction: Generate impression based on findings.

Input: 13-year-old female with pain and mechanical symptoms in the left knee. MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: Generalized thinning of the patellar cartilage is noted without focal defects. The articular cartilage within the lateral and medial tibiofemoral compartments is unremarkable. No bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Generalized thinning of the patellar cartilage without focal defects. Findings may represent chondromalacia patella.2.No evidence of meniscal or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Ms. Faith is a 50 year old female with recently diagnosed right breast malignancy. She presents for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.In the right upper outer breast, there is an irregular enhancing lesion identified measuring 2.0 x 1.4 x 2.2 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen centrally within this lesion, compatible with biopsy proven malignancy. There is no additional abnormal enhancement present in the right breast. There is no abnormal enhancement present in the left breast. Of note, there are several non-dilated, non-enhancing retroareolar ducts with fluid identified in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Unifocal malignancy of the right breast, measuring up to 2.2 cm. Clip is in appropriate position. If breast conservation therapy is desired, the clip can be used as targeting for preoperative surgical guidance. (2) No MRI evidence for malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other malaise and fatigueClinical question: Please evaluate for focal abnormality particularly thalamusSigns and Symptoms: Episode of transient left face, arm, and leg weakness with painComments: Please obtain without sedation if possible | The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: History of Crohn's disease. Evaluate for evidence of active inflammation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained. The terminal ileum is well seen and demonstrates no significant active inflammation. There are intermittent regions of jejunal underdistention likely related to peristalsis without specific evidence of active inflammation. No flow-limiting stricture.The descending colon is featureless. Starting at the splenic flexure the colon demonstrates mild to moderate regions of long-segment mild T2-weighted hyperintensity, restricted diffusion and post-contrast enhancement compatible with active inflammation. This is most severe at the sigmoid colon. At the level of the rectosigmoid is a short segment skip region with subsequent short segment skip lesion. The distal rectum appears spared. Proximal to the splenic flexure I suspect regions of intermittent peristaltic contraction (see dynamic images) but no flow-limiting stricture or definite evidence of active inflammation. There is engorgement of the pericolonic vasa recta and scattered small reactive lymph nodes. There is no significant upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation. No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The descending colon is featureless. Starting at the splenic flexure the colon demonstrates mild to moderate regions of long-segment mild T2-weighted hyperintensity, restricted diffusion and post-contrast enhancement compatible with active inflammation. This is most severe at the sigmoid colon. At the level of the rectosigmoid is a short segment skip region with subsequent short segment skip lesion. The distal rectum appears spared. Proximal to the splenic flexure I suspect regions of intermittent peristaltic contraction but no flow-limiting stricture or definite evidence of active inflammation. There is engorgement of the pericolonic vasa recta and scattered small reactive lymph nodes. There is no significant upstream dilatation to suggest a flow-limiting stricture.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant active inflammation of the small bowel. Moderate active inflammation of a featureless distal colon from the splenic flexure extending distally with short skip areas near the rectosigmoid and distal rectum. The inflammation is most severe of the sigmoid colon. No flow-limiting stricture or evidence of sinus tract/fistula formation.


Instruction: Generate impression based on findings.

Input: Evaluate progress of left subdural hemorrhage, assess left quadrigeminal cistern plate lipoma, calcifications: left subdural hemorrhage, lipoma, calcifications. There is a low T2 and high T1 signal subdural hematoma along the left posterior falx cerebri that measures up to 5 mm in thickness, which is not significantly changed. There is also perhaps a trace subdural hematoma along the right aspect of the posterior falx cerebri. There is lipoma within the left quadrigeminal plate cistern, which measures up to 8 mm. There is a low T2 and high T1 signal right scalp hematoma that measures up to 10 mm in thickness and a similarly low T2 and high T1 signal right scalp hematoma that measures up to 10 mm in thickness, both of which are confined by the sutures. There is no evidence of intracranial mass or acute infarct. There is no discernible abnormal intraparenchymal susceptibility effect. The degree of sulcation and myelination is likely related to prematurity. The ventricles are unchanged, accounting for differences in technique. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Unchanged small subdural hematoma along the left posterior falx cerebri and perhaps trace subdural hemorrhage along the right falx cerebri.2. Unchanged bilateral cephalohematomas, right larger than left, and superimposed caput succedaneum. 3. Small left quadrigeminal plate cistern lipoma.4. No discernible brain parenchymal calcification or hemorrhage.


Instruction: Generate impression based on findings.

Input: Pain in right hip [M25.551], Reason for Study: ^Reason: sciatica type pain - pt previously on long term steroids History: see above For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc with ligamentum flavum thickening, resulting minimal spinal canal stenosis. No neuroforaminal narrowing. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation. There is focal disc bulging toward left side lateral recess which narrows left side neural foramen. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Broad-based focal disc bulging toward left side neural foramen of L4-5.2. Minimal spinal canal stenosis at the level of L23.


Instruction: Generate impression based on findings.

Input: There is a hypoenhancing lesion in the right aspect of the pituitary gland that again measures up to 7 x 7 x 5 mm (AP x TV x CC). No evidence of macroadenoma. Infundibulum is midline. There is no suprasellar extension, mass effect upon the optic apparatus, or abnormality involving the cavernous sinuses. The carotid artery flow voids are intact.

Output: Unchanged 7 mm pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: Female 75 years old Reason: doubling of bilirubin overnight, severe abdominal pain, bladder cancer, with G tube, ileal conduit, s/p ileocolic bypass History: please evaluate for micrometastasis ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No intrahepatic biliary ductal dilatation.Gallbladder contains sludge and debris. Common bile duct is normal in caliber. There is a questionable filling defect in the distal common bile duct about the ampulla which may represent an ampulla itself or a small stone which is suboptimally evaluated. There is an adjacent duodenal diverticula.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hydronephrosis with likely papillary necrosis with some layering filling defects in the left kidney which may represent likely sludge or papillary necrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrostomy catheter terminates within the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large volume ascites.

Output: 1.Cholelithiasis without biliary ductal dilatation. Given the small size of the stones the elevated bilirubin may be due to a recently passed stone. Please see additional discussion above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for progression of GBM in the left temporal lobe. Prior history of surgery and RT. Signs and symptoms: Left temporal lobe GBM. Pre and post-enhanced brain MRI:Examination demonstrates post operative changes of a left anterior temporal and frontal craniotomy for removal of temporal lobe tumor. Expected chronic postoperative changes of a partial resection of the anterior tip of the left temporal lobe demonstrate no significant change since prior exam. Mild residual gliosis immediately posterior to the lobectomy site is again identified and without convincing evidence of change since prior study. Stable mildly expanded left temporal horn of lateral ventricle.Similar to prior exam there is no detectable abnormal enhancement to suggest residual or recurrence of tumor.A few punctate foci of flair hyperintensity remains identical to prior study. There is also a more localized periventricular white matter flair hyperintensity in the left frontal lobe which is likely post treatment/radiation change which has also remained identical to prior exam.Unremarkable and stable pre-and post-enhanced brain MRI otherwise.

Output: 1.No evidence of acute or new finding since prior exam.2.Stable post surgical/therapy changes of the left anterior temporal lobe tumor without evidence of recurrence of disease.


Instruction: Generate impression based on findings.

Input: 47-year-old man with syncope. Evaluate for hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. There are prominent calcifications of the choroid plexus in the posterior horn of the right lateral ventricle and the body of the left lateral ventricle.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT with no findings of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 32-year-old female with pain at the forefoot. Evaluate for stress injury. A marker was placed along the medial aspect of the midfoot corresponding to the patient's site of pain. Bone marrow signal is within normal limits. The cortical margins are preserved with no discontinuity or erosions. No acute fracture or malalignment. The neurovascular structures, tendons and ligaments of the foot are intact. The musculature of the foot is intact. No evidence of soft tissue defect, edema or fluid collection.

Output: Unremarkable MRI of the left foot. No evidence of stress reaction or fracture as clinically questioned.


Instruction: Generate impression based on findings.

Input: 54-year-old female with chronic diarrhea, abdominal pain. History of vaginal fistula. Exclude small bowel Crohn's disease. Oral contrast using Volumen was also administered. Motion artifact mildly limits exam quality.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion.SPLEEN: Spleen is unremarkable.PANCREAS: No focal pancreatic lesion identified.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: No focal renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There is questionable focal thickening and enhancement at the very distal terminal ileum adjacent to the ileocecal valve. There is no associated mesenteric lymphadenopathy. No fibrofatty proliferation is seen. While this enhancement may be artifactual from decompressed terminal ileal mucosal folds, superimposed acute inflammatory change in this location cannot be excluded. No other areas of abnormal enhancement, wall thickening, or other findings of acute or chronic inflammatory changes are present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Exam mildly limited by motion artifact. 2.Questionable focal enhancement of the terminal ileum adjacent to the ileocecal valve. No other findings of acute or chronic inflammation in this location or elsewhere. While this enhancement may be artifactual from decompressed terminal ileal mucosal folds, superimposed acute inflammatory change in this location cannot be excluded. Correlation with clinical, endoscopic, and pathologic findings is recommended to exclude Crohn's disease.


Instruction: Generate impression based on findings.

Input: There are multiple foci of T2/FLAIR hyperintensity throughout the white matter which are nonspecific but compatible with mild chronic small vessel ischemic disease in this age group. Cystic changes are seen in the bilateral medial thalami with mild peripheral FLAIR hyperintensity which may represent prominent perivascular spaces versus chronic lacunar infarcts. No evidence of acute infarct, hemorrhage, intracranial mass, or mass effect. Bilateral hippocampi are symmetric in size, signal intensity, and with preserved internal architecture. Ventricles are within normal limits for age.There is mild and smooth asymmetrically increased thickening and enhancement of the dura along the right convexity which is nonspecific. No discrete fluid collection. No associated nodularity or significant thickening. Otherwise no abnormal parenchymal or meningeal enhancement is appreciated. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: 1. No intracranial mass or mass effect. Nonspecific T2/FLAIR hyperintense foci are seen which are nonspecific but compatible with mild chronic small vessel ischemic disease. Cystic changes are seen in the bilateral medial thalami with mild peripheral FLAIR hyperintensity which may represent prominent perivascular spaces versus chronic infarcts.2. Mild, smooth asymmetrically increased enhancement of the dura along the right convexity which is nonspecific and may be related to a benign etiology such as prior subdural hematoma. No significant extra-axial collections, mass effect, or nodularity associated with the thickening is appreciated.