Instruction: Generate impression based on findings.

Input: Male, 67 years old, with history of surgery on the optic nerve in 1986, presenting with visual field alteration. Periventricular T2 hyperintensity, particularly at the level of the atria, is stable to at most minimally progressed when compared to the prior examination. Encephalomalacia of the left gyrus rectus is unchanged. T2 signal abnormality seen on the prior examination within the left anterior temporal lobe has resolved.No evidence of restricted diffusion, mass effect or significant parenchymal edema is seen. No acute intracranial hemorrhage or any new abnormal extra-axial fluid collection is observed. Postcontrast images show no pathologic parenchymal or extra-axial enhancement.Please note this examination was not tailored for the assessment of the orbits. Within this limitation, enophthalmos of the left globe is a stable finding. The left optic nerve is not visualized, nor is the left superior rectus, findings which also appear unchanged from prior.

Output: 1.Periventricular T2 hyperintensity is stable to minimally progressed. This is a nonspecific finding which may reflect chronic microvascular ischemic disease.2.Stable encephalomalacia of the left gyrus rectus. Signal abnormality seen on the prior examination within the left anterior temporal lobe has resolved.3.No new areas of parenchymal signal abnormality or pathologic enhancement are seen.4.Although not protocoled as a dedicated orbital examination, enophthalmos of the left globe, along with inability to visualize the left optic nerve and left superior rectus muscle, are stable findings.


Instruction: Generate impression based on findings.

Input: 59-year-old man with history of HCC status post TACE/RFA in 2/2016. ABDOMEN:LIVER, BILIARY TRACT: Segment 6 ablation cavity (9/163) appear similar to the prior examination measuring 35 x 34 mm, previously 36 x 35 mm. There is no abnormal arterial enhancement noted in the zone of ablation. The liver is nodular in contour and cirrhotic in morphology. Additional arterially enhancing parenchymal nodules are noted without washout, likely regenerative.There is no intra or extrahepatic biliary ductal dilatation. Cholelithiasis noted without gallbladder wall thickening.SPLEEN: The spleen measures 15.5 cm but is otherwise normal in signal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable appearance of the segment 6 of ablation cavity without evidence of recurrence or new disease.


Instruction: Generate impression based on findings.

Input: Reason: Pain in the right shoulder, concern for biceps tendinitis ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis muscles and tendons are intact without evidence of tearing.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There are multiple large subchondral cysts in the humeral head. There is a moderate amount of fluid in the AC joint with associated degenerative changes.BICEPS TENDON: The biceps tendon is intact without evidence of tearing. ADDITIONAL

Output: Acromioclavicular joint osteoarthritis and multiple subchondral cysts.


Instruction: Generate impression based on findings.

Input: Female, 74 years old. Reason: h/o thyroid nodules RIGHT LOBE MEASUREMENTS: 4.5 x 1.9 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.6 x 1.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture, with multiple nodules which appear similar to the prior exam. A dominant nodule in the mid-right lobe measures1.6 x 1.2 x 1.0 cm, predominantly solid with cystic component, noncalcified, nonvascular.LEFT LOBE: Heterogeneous echotexture, with notable nodules which appear similar to the prior exam. The dominant nodule in the mid left lobe measures 0.9 x 0.7 x 0.8 cm, spongiform and well marginated, noncalcified, without significant internal vascularity.ISTHMUS: Heterogeneous echotexture. A hypoechoic solid nodule measures 0.7 x 0.4 x 0.8 cm, similar to prior.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules, unchanged.


Instruction: Generate impression based on findings.

Input: 12 year-old male with history of astrocytoma status post resection. Yearly follow-up. Evaluate for growth or recurrence. Redemonstrated is a right frontal lobe resection cavity which is stable in size and morphology. There is no suspicious enhancement within or around the cavity. There is mild surrounding T2 hyperintensity which is stable likely representing gliosis.There is no additional concerning parenchymal signal abnormality or pathologic enhancement detected. There is no mass effect or midline shift. The ventricles are stable in size and morphology.

Output: Stable postoperative changes with no evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Fatigue, memory loss and numbness. There are multiple T2 FLAIR hyperintense lesions in the cerebral white-matter that are perpendicular to the long axis of the lateral ventricles. Some of the lesions involve the corpus callosum as well. Few of the lesions are mildly T1-hypointense. There is suggestion of contrast enhancement in a tiny lesion just anterior to the left caudate nucleus head. The other lesions are not contrast-enhancing. There is no definite brainstem or cerebellar involvement. There is no brain parenchymal volume loss. There is suggestion of 2 small lesions involving the left anterolateral periphery of the spinal cord at C3 and C3-C4 levels. A dedicated cervical spine MRI is scheduled for March 8, 2016.

Output: 1.Overall mild burden of cerebral white-matter T2 and T1 lesions that are compatible with the given diagnosis of multiple sclerosis. One of the lesions shows contrast enhancement while the others are not contrast-enhancing. There is no brain parenchymal volume loss and no definite involvement of the brainstem and cerebellum.2.Suggestion of small lesions involving the left anterolateral periphery of the spinal cord at the C3 and C3-C4 levels. A dedicated cervical spine MRI is scheduled for March 8, 2016.


Instruction: Generate impression based on findings.

Input: Reason: pain in the left shoulder ROTATOR CUFF: There is a full-thickness tear in the supraspinatus tendon (series #501/14) without tendinous retraction. The infraspinatus, teres minor, and subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There are multiple small subchondral cysts in the humeral head. There is a small amount of fluid in the joint space.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Full-thickness supraspinatus tear without retraction.


Instruction: Generate impression based on findings.

Input: 65 years, Male, transient alteration of awareness. Motion artifact limits evaluation. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. No intracranial mass or mass-effect is identified. There is no midline shift or herniation. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Motion artifact limits evaluation. However, no gross abnormality is detected.


Instruction: Generate impression based on findings.

Input: BRAIN: Again seen are findings of Chiari I malformation with pointed configuration of the cerebellar tonsils which descend approximately 6 mm below the foramen magnum similar to prior. There is mild crowding of the posterior frontal magnum. Remainder of the brain is unremarkable with no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The myelination pattern is appropriate for age. 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.CSF flow sequences demonstrate present but mildly diminished biphasic flow involving the posterior aspect of the foramen magnum. There is robust biphasic flow ventrally at the foramen magnum.CERVICAL SPINE: Please note syrinx is almost entirely in the thoracic cord with minimal prominence of the central canal at the cervicothoracic junction measuring up to 1 mm. Visualized upper thoracic cord demonstrates a syrinx measuring up to 1.8 mm at the T4 level on the axial images as well as up to 1.8 mm at the T5 level on the sagittal images. Based on a single scout survey image with T1-weighting (series 1001 image 7) of the mid and lower thoracic cord, appearance of the syrinx is very grossly similar to prior.The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. No spinal canal or neural foraminal stenosis is demonstrated. Paraspinous soft tissues are unremarkable.

Output: 1. No significant change in appearance of Chiari 1 malformation with minimally diminished but present biphasic CSF flow dorsally at the foramen magnum. There is robust biphasic flow ventrally at the foramen magnum.2. Please note the syrinx is almost entirely in the mid thoracic cord. The tiny superior component in the lower cervical cord and visualized upper thoracic cord measuring 1 to 2 mm is not significantly changed. Based on a single scout survey image with T1-weighting (series 1001 image 7) including the mid and lower thoracic cord, appearance of the syrinx is very grossly similar to prior. Dedicated thoracic study can be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: 31yo with ileo-colonic crohn's w/PSC s/p OLT in 2006. Elevated LFT's, needs imaging for further eval. Here with +cdiff History: diarrhea ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatic liver transplant. There is mild intrahepatic biliary ductal dilatation and dilatation of the common duct with short segment narrowing at the biliary enteric anastomosis (12/3). No intrahepatic biliary narrowing to suggest recurrent PSC. No suspicious hepatic lesions. The portal venous system is patent.Main portal vein is enlarged with multiple perisplenic collateral vessels.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal T2 hyperintensity, likely a cyst.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: Mild narrowing at the biliary enteric anastomosis suspicious for an anastomotic stricture with mild intrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with metastatic melanoma to the brain status post stereotactic radiosurgery. A hemorrhagic mass within the left inferior cerebellum and cerebellar tonsil is redemonstrated showing no significant interval change in size. The lesion induces strong susceptibility effect and contains pockets of internal T1 hyperintensity. Apart from this intrinsic T1 signal, little if any superimposed enhancement is seen internally. A thin uniform rim of enhancement has developed along the superior margin of the lesion. The degree of edema surrounding this lesion has slightly decreased.Chronic areas of hemosiderin staining and encephalomalacia are redemonstrated in the right parietal lobe, left occipital lobe, and within the left superior frontal gyrus showing no significant interval change. No new lesions are identified. No abnormal extra axial fluid collections are seen. A small focus of susceptibility is unchanged in the right cerebellum. Ventricular size and morphology are stable.

Output: 1.No significant change is seen in the size of a left cerebellar hemorrhagic lesion, though the associated edema has slightly improved. A thin rim of enhancement has developed along the superior margin of the lesion which is favored to be posttreatment in nature.2.Multiple additional areas of hemosiderin stained encephalomalacia are unchanged. No new intracranial lesions are detected.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness and T10 sensory level Cervical:Examination is motion degraded limiting evaluation. Again seen are postsurgical changes of anterior corpectomy at C5 with anterior fusion from C4 to C6. Compared to 1/5/2016, there is mild interval worsening of the thecal sac effacement at the C4-C5 level with worsening of epidural enhancement from the C3-C4 to the C5-C6 levels. There is narrowing of the neural foramina at C4-C5 and right worse than left C5-C6 levels related to tumor with osseous destruction, epidural extension, and degenerative disease. Abnormal enhancement at C3-C4 is also again seen. No cord signal abnormality is appreciated. Tumor extension in the right greater than left paraspinous region with encasement of the right vertebral artery again seen. Thoracic:Again seen is severe compression deformity of the T5 vertebral body with diffuse tumor infiltration and retropulsion into the spinal canal with narrowing and compression deformity of the cord, which is worsened since 1/5/2016. Severe vertebral body height loss at T5 is also worsened. There is also mild worsening of the associated kyphosis. There is prominent T1 hyperintensity associated with the tumor as seen before. Epidural tumor involving the ventral epidural space, right worse than left and extending into the right neural foramen is stable to minimally worse. There is complete obliteration of the right T5-T6 neural foramen as before. Moderate pathologic compression fracture at T8 also appears slightly worse, but without associated epidural extension or spinal canal stenosis. There appears to be worsened tumor infiltration at this level including extension into the posterior elements. Abnormal signal involving the T6 vertebral body also appears slightly worse. Aside from T5 and T8, the vertebral body heights are observed. There is increased edema in the thoracic cord at the T5 level.Abnormal signal involving the superior endplate of L3 is partially assessed and nonspecific.There is suggestion of increase in consolidation in the left upper lobe which may be related to worsened tumor but can be better assessed with chest CT.

Output: 1. Compared to MRI 1/5/2016, there is worsening of the pathologic compression fracture with retropulsion involving the T5 vertebra which is associated with worsening deformity and compression of the cord as well as increased cord edema.2. Slight worsening of tumor in the cervical spine/epidural space/paraspinous region from the C4 to C6 levels is also suspected. There is moderate spinal canal stenosis at the C4-C5 level which is slightly worse in the interval. No associated cord signal abnormality. Motion degradation and susceptibility artifact related to hardware limit optimal evaluation of the cervical spine.3. Pathologic compression fracture at T8 is also worsened but without epidural extension or spinal canal stenosis. Mild worsening of tumor involving the T6 vertebral body is also noted.4. There is suggestion of increase in consolidation in the left upper lobe which may be related to worsened tumor but can be better assessed with follow-up chest CT.


Instruction: Generate impression based on findings.

Input: 68 years Female (DOB:2/7/1948)Reason: rule out myelopathy History: spasticPROVIDER/ATTENDING NAME: RAYMOND ROOS RAYMOND ROOS Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small endplate osteophytes present this level. There is loss of disc space height and disc desiccation as well as Schmorl's nodes at this level. There are bilateral uncovertebral osteophytes at this level. There is mild narrowing of neural foramina bilaterally at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation and diffuse disc bulge at this level. There are bilateral uncovertebral osteophytes at this level. There is mild narrowing of neural foramina bilaterally at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation and a disc bulge at this level. There is associated mild narrowing of the neural foramina. There are bilateral uncovertebral osteophytes at this level. There is mild narrowing of neural foramina bilaterally at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:There is a compression fracture present at T11 with approximately 30% loss of vertebral body height and minimal retropulsion. The vertebral body at this level has high signal on T1 and mildly elevated signal on T2 STIR. There is no significant compromise to the spinal canal associated with this compression fracture.The thoracic vertebral bodies are appropriate in the overall alignment. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.There is a compression fracture at the T11 vertebral body level without significant compromise spinal canal or neural foramina. In general it has a benign appearance. It appears to be in the subacute or early chronic phase.2.There are some mild degenerative changes present in the cervical spine without significant compromise to the spinal canal or neural foramina. There is mild narrowing of neural foramina in the lower cervical spine.


Instruction: Generate impression based on findings.

Input: Multiple myeloma, without mention of having achieved remission(203.00) [203.00] / Facial weakness [781.94], Reason for Study: ^Reason: eval for brain involvement of myeloma v. Stroke History: right facial weakness There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Extensive involvement of normal bone marrow replacing lesions on skull, skull base including clivus and imaging cervical spine. The lesions show mixed signal intensity on T1 and T2 weighted images and show gadolinium enhancement. Among them, the largest lesion is about 40.8mm x 15.4mm sized slightly expansile soft tissue mass on the right posterior temporal area skull,Underlying brain shows patchy high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.The ventricles are slightly prominent likely due to associated mild brain atrophy. 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. Extensive skull, skull base including clivus and cervical spine involvement of multiple myeloma as described above.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 63-year-old male with HCV cirrhosis and chronic pancreatic ductal dilation. HCC screening. ABDOMEN: Mild cardiomegaly and left ventricular wall thickening, partially visualized and similar to prior exam.LIVER, BILIARY TRACT: Nodular contour with several subcentimeter dark T2 signal foci, similar to prior. Scattered subcentimeter T2 hyperintense lesions are too small to characterize but most likely due to cysts, similar to prior study. No suspicious hepatic lesions. No biliary ductal dilation. Gallbladder is unremarkable.SPLEEN: Unchanged bright T2 lesions may represent hemangiomas versus cysts.PANCREAS: Again seen is ductal dilation in the distal body and tail with associated side branch irregularity, compatible with chronic pancreatitis/obstruction. The degree of dilation has slightly progressed since prior study. Again seen is an abrupt truncation of the duct at the body. There is an apparent round lesion in the pancreatic body at the transition point measuring up to 2 x 3 cm (series 16/140) which demonstrates T1 and T2 hypointensity with relative hypoenhancement. The lesion also demonstrates restricted diffusion and increasing enhancement on delayed phase images. The findings are suspicious for a pancreatic neoplasm. There is focal occlusion of the splenic vein traversing posterior to this lesion.Restricted diffusion in the pancreatic tail is most likely related to chronic pancreatitis, similar to prior study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: L4 vertebral body hemangioma.OTHER: No significant abnormality noted.

Output: 1.Pancreatic ductal dilation has slightly progressed with abrupt truncation due to a 3.0cm lesion. Differential considerations include neuroendocrine neoplasm or adenocarcinoma.2. Correlation with endoscopic sampling is recommended.3.No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: 84-year-old woman with history of elevated LFTs, bilirubin, and nausea. ABDOMEN:LIVER, BILIARY TRACT: There is a septated 23 mm cyst in segment 3 (401/26), otherwise the liver is normal in signal and morphology.The gallbladder is partially decompressed with multiple folds, but otherwise normal in appearance without stones.There is diffuse, mild intrahepatic biliary ductal prominence with normal caliber, smooth contoured extrahepatic bile ducts. There is no intraluminal filling defect or extrinsic compression at the ampulla (601/61).The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: There is pancreas divisum (601/57) with the main pancreatic duct dilated up to 6 mm in the tail (601/20). Multiple cystic lesions in the uncinate process (601/44) and tail (601/27) are seen, some of which communicate with the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Prominent collecting systems without hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis and Tarlov cysts noted.OTHER: No significant abnormality noted.

Output: 1.Pancreas divisum without pancreatitis.2.Multiple cystic pancreatic lesions, likely sidebranch IPMNs.3.Prominent intrahepatic biliary ducts but normal caliber common bile duct without stone or extrinsic mass.


Instruction: Generate impression based on findings.

Input: Female, 8 years old, with diplopia and blurry vision in both eyes since 12/14, headache, articulation disorder and learning disorder. Brain parenchymal morphology is within normal limits. No pathologic parenchymal signal abnormality or abnormal enhancement is seen. No structural lesions are detected.The pituitary region is unremarkable. The corpus callosum is fully formed and normal. The brainstem, cerebellar vermis and cerebellar hemispheres are all within normal limits. White matter myelination is mature.The globes are round and symmetric. The extraocular muscles demonstrate symmetric morphology and signal characteristics. The optic nerves are normal in size and signal. No pathologic orbital enhancement is seen.Mild paranasal sinus inflammation is noted incidentally.

Output: Unremarkable examination with no findings in the brain or orbits to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Disc desiccation is present throughout with significant disc height loss at C5/6, C6/7, and C7/T1. Schmorl's nodes are present with endplate disc herniation involving C5 and T1.C1/2: Ligament thickening and arthropathy partially effaces the anterior CSF space without cord deformation or resulting stenosis.C2/3: Mild posterior osteophyte disc complex and moderate left facet hypertrophy with facet fusion. There are no stenoses.C3/4: Posterior osteophyte disc complex with a central extruded component with superimposed bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy (left greater than right). There is deformation of the anterior cord surface without intrinsic cord signal abnormality. There is moderate central and moderate bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex with a small central extruded component with superimposed bilateral uncinate hypertrophy and bilateral facet hypertrophy (left greater than right). There is trace anterolisthesis of C4 on C5 and slight flattening the anterior cord surface without intrinsic cord signal abnormality. There is mild bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and bilateral facet hypertrophy (right greater than left). There is flattening of the anterior cord surface without intrinsic cord signal abnormality. There is mild central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, slight ligamentum flavum thickening, bilateral uncinate hypertrophy, and bilateral facet hypertrophy. There is trace retrolisthesis C6 on C7 and there is mild central and severe bilateral neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and bilateral facet hypertrophy. There is mild central and moderate to severe bilateral neural foraminal stenosis.Facet hypertrophy at T1/2 and T2/3 encroach bilateral neural foramina.

Output: 1.C3/4: Moderate central and moderate bilateral neural foraminal stenosis.2.C4/5: Mild bilateral neural foraminal stenosis.3.C5/6: Mild central and severe bilateral neural foraminal stenosis.4.C6/7: Mild central and severe bilateral neural foraminal stenosis.5.C7/T1: Mild central and moderate to severe bilateral neural foraminal stenosis.6.Facet hypertrophy at T1/2 and T2/3 encroach bilateral neural foramina.


Instruction: Generate impression based on findings.

Input: 77-year-old woman with history of left lower extremity weakness, evaluate for acute stroke. Scattered areas of diffusion restriction along the medial aspect of the right superior frontal gyrus with the most conspicuous area in the right precentral gyrus. Additional scattered punctate foci are seen along the cingulate gyrus as well as along the right body of the corpus callosum. Findings are along the right anterior cerebral artery territory. There is associated increased T2 signal best seen on the FLAIR sequence. There is no significant mass effect, midline shift, or herniation.Additional foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes. The left caudate head is atrophic with decreased T2 signal suggestive of hemosiderin deposition. Increased T2 signal is seen in the genu of the left internal capsule. There is no intracranial mass or mass-effect. There is ex vacuo dilatation of the left lateral ventricle, otherwise the ventricles are within normal limits in size and configuration. The major flow-voids are preserved.The patient has had left cataract surgery. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Scattered acute right anterior cerebral artery territory punctate infarcts. 2.Chronic left caudate infarct with additional moderate chronic small vessel ischemic changes.3.Incomplete examination as the patient was unable to tolerate the entire examination. There will be attempt to obtain susceptibility weighted and MRA sequences on a repeat study today.


Instruction: Generate impression based on findings.

Input: 34 year-old female with DLBCL awaiting chemotherapy. LV dysfunction noted on echo. CMR to evaluate Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 87 ml/m2 (normal range: 65+/-11), the LVEDV is 130 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 57 g/m2 (normal range 67+/-11), and the LV mass is 84 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 52%, the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVEDV is 126 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 61 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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. PericardiumModerate-sized pericardial effusion measuring at maximum 1 cm along the lateral LV wall and inferolateral walls. No evidence of pericardial inflammation. No evidence of invasion of the pericardium by the mediastinal mass.Extracardiac FindingsPleural effusions (larger on the left). Mediastinal adenopathy. Large mediastinal mass previously characterized on CT. Maximum measurements of this mass on coronal views is 9 x 7.5 cm. 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. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%4. Moderate-sized pericardial effusion5. See extra-cardiac findings. 6. No evidence of pericarditis or myocarditis on this study.


Instruction: Generate impression based on findings.

Input: Cervical neck pain. Per Epic, patient reports neck pain since one week with decreased range of motion and difficulty swallowing since 4 days. Patient also has a history of MVA on 5/30. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C4 on C5. Alignment is otherwise maintained. Bone marrow signal is within normal limits. There is a subcentimeter focus of calcification inferior to the anterior arch of C1 which is again seen, and better appreciated on recent CT. There is edema involving the longest colli musculature and moderate-sized retropharyngeal effusion.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine with multilevel disc desiccation, individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C4-5: There is a disc bulge eccentric to the right which effaces the ventral thecal sac. There is mild to moderate narrowing of the right neural foramen. Left neural foramen is patent.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Edema involving the longus colli muscle with moderate-sized retropharyngeal effusion and focus of prevertebral calcification. Findings are most consistent with calcific tendinitis. Infection causing the retropharyngeal effusion may also be considered but given the focus of prevertebral calcification is less likely.No evidence of traumatic injury. Ligamentous structures are intact. No evidence of bone marrow edema.


Instruction: Generate impression based on findings.

Input: 10-day-old male lateral assessment of imperforate anusVIEW: Abdomen AP (one view) 01/16/15 Previously identified perineal soft tissue mass is again noted and better evaluated on the prior MRI examination. Nonobstructive bowel gas pattern. No free intraperitoneal air. The osseous structures are normal.

Output: Perineal soft tissue mass.


Instruction: Generate impression based on findings.

Input: A 35 year old male with shortness of breath on exertion and recently diagnosed biventricular systolic heart failure by echocardiography. Referred to stress cardiac MRI for further evaluationMEDICATIONS: carvedilol, furosemide First Pass PerfusionDuring hyperemia, no perfusion defects were present and a prominent "dark rim" artifact was noted.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Native myocardial T1 times are diffusely increased (~1100-1200ms). This finding suggest intersitial fibrosis.The calculated extracellular volume (ECV) was in the normal range (29%).Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 154 ml/m2 (normal range: 74+/-15), the LVEDV is 324 ml (normal range 142+/-34), the LV end systolic volume index is 122 ml/m2 (normal range 25+/-9), the LVESV is 258 ml (normal range 47+/-19), the LV mass index is 74 g/m2, and the LV mass is 156 g. There is severe global hypo/akinesis with regional variation. No intracavitary thrombus was noted.No myocardial iron overload was noted.Left AtriumThe left atrium is mildly dilated (105ml). Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 21%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 168 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (35mmmm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is trivial pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia. A dark rim artifact was noted.2. No prior myocardial infarction. The entire myocardium is viable. However, needed myocardial T1 times are diffusely increased suggestive of an abnormal infiltrative process beyond the resolution of delayed hyperenhancement MRI. The calculated ECV was in the normal range.3. The LV is severely dilated with severely reduced systolic function (LVEF 20%). There is severe global hypo/akinesis with regional variation. 4. The RV is mildly dilated with severely reduced systolic function (RVEF 21%).5. Mild biatrial dilation.6. At least moderate mitral and tricuspid regurgitation. 7. Mild aortic regurgitation.8. The main pulmonary artery is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression or epidural hematoma. Vertebral bodies are intact.

Output: No acute cord compression or epidural hematoma. Dedicated segment-specific MRI is recommended if symptomology localizes.


Instruction: Generate impression based on findings.

Input: Left shoulder pain with decreased range of motion suggesting adhesive capsulitis. Evaluate for rotator cuff tear. Some sequences are slightly limited by patient motion artifact. ROTATOR CUFF: There is a small linear focus of intermediate signal intensity within the supraspinatus tendon anteriorly at its insertion on the greater tuberosity that may represent focal insertional tendinosis or perhaps a small "rim rent" -type tear of the articular surface fibers of the tendon. There is also intermediate signal intensity along the bursal surface fibers of the distal supraspinatus tendon suggesting tendinosis and/or fraying. However, I see no fluid-filled full-thickness rotator cuff tear. The supraspinatus muscle appears normal. The infraspinatus tendon and muscle appear normal. The teres minor tendon and muscle appear normal. The subscapularis tendon and muscle appear normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa, perhaps associated with the aforementioned bursal surface rotator cuff fraying.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is a small amount of fluid in the joint, but no effusion. Intermediate signal intensity within the superior labrum likely represents degeneration/degenerative tearing, but I see no fluid-filled labral tear. The glenohumeral joint otherwise appears normal for age.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: Mild tendinosis, fraying and possibly partial-thickness tearing of the supraspinatus tendon as described above, but I see no full-thickness fluid-filled rotator cuff tear. Other findings as above.


Instruction: Generate impression based on findings.

Input: Evaluate anterior cruciate ligament. Microfracture patellar cartilage MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is marked thinning of the hyaline cartilage of the lateral facet of the patella.LIGAMENTS: The posterior cruciate ligament is intact. The medial collateral ligament and the lateral collateral complex are intact.Examination of the anterior cruciate ligament reveals abnormally increased signal on the T2-weighted images. Although some fibers may be intact there is at least partial tearing of the ACL. When compared to the previous exam this was present in January 2014 EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Tearing of the ACL with some fibers intact. Marked thinning of the patellar cartilage on the lateral facet


Instruction: Generate impression based on findings.

Input: Headache after craniotomy for tumor resection. There are interval postoperative findings related to left temporal craniotomy with areas of restricted diffusion along the margins of the resection cavity and blood products in the surgical cavity and overlying scalp swelling. There is also linear enhancement along the anterior aspect of the resection cavity and confluent areas of high T2 signal in the surrounding white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no significant midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings in the left temporal lobe with nonspecific linear enhancement along the anterior aspect of the resection cavity that may represent residual tumor or treatment effects and confluent areas of high T2 signal in the surrounding white matter that may represent edema superimposed upon mild ischemic changes along the surgical cavity margins.


Instruction: Generate impression based on findings.

Input: Pain, check for labral tear ROTATOR CUFF: Mild tendinopathy with diffuse increased signal and mild thickening of the supraspinatus, most pronounced underlying the acromion and AC joint. Specifically a definite partial and suspected full-thickness split tear is observed with supraspinatus intact fibers, given a small amount of subacromial fluid. The remainder of the rotator cuff is otherwise intactSUPRASPINATUS OUTLET: Mild narrowing with a borderline measurement of 7 mm. A downward sloping acromion is observed.GLENOHUMERAL JOINT AND GLENOID LABRUM: Liberal evaluation is limited without arthrogram augmentation. Within this limitation, the liver appears grossly intact without a definite acute focal abnormality. The superior aspect is small and demonstrates mild degenerative signal without a focal specific distinct tear. As well the inferior margin is also less discrete. Mild degenerative changes, including the AC joint, similar to the plain film evaluation. BICEPS TENDON: No significant abnormality noted and intact. ADDITIONAL

Output: 1.Supraspinatus partial and possible full-thickness split tear, see description above. 2.Mildly degenerative labor without discrete focal abnormality


Instruction: Generate impression based on findings.

Input: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus [G40.219] / Neoplasm of uncertain behavior of pituitary gland [D44.3] / Epilepsy, unspecified. Re-demonstration of non enhancing hypothalamic mass with prepontine cistern extension which shows low signal intensity on T1 and slightly high signal intensity on T2/FLAIR. The size (26mm x 30mm) and MR characteristics of the lesion do not show any interval change since prior scan in 2012.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is evidence of right side ventriculostomy tube track, again stable since prior exam.The ventricles, sulci and cisterns are unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There are subtle mucosal thickening on the left sphenoid sinus and left ethmoid sinuses.Pituitary gland MRIImage quality is degraded due to significant motion artifacts.The non enhancing hypothalamic mass is abutting the optic chiasm and indents pituitary stalk anterior and superiorly. The pituitary gland is not clearly visualized on this scan mainly due to motion artifacts but shows normal range of enhancement.

Output: 1. Stable non-enhancing hypothalamic mass since prior scan in terms of its measured size and MR characteristics.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate right knee for osteonecrosis, medial femoral condyle History: Medially sided right knee pain MENISCI: Again seen is blunting of the free edge of the medial meniscus. There is now horizontal increased signal intensity extending from the free edge to the periphery, also contacting the tibial articular surface, indicating a horizontal tear. Intrasubstance degeneration of the medial meniscal body. Anterior horn of the medial meniscus appears normal. Lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: Again seen is full-thickness cartilage loss along the weightbearing portion of the medial femoral condyle similar to the prior study with small foci of degenerative subchondral signal abnormality. Mild subjective thinning of the medial tibial plateau articular cartilage. Articular cartilage of the lateral and patellofemoral compartments is intact. No specific findings of osteonecrosis.LIGAMENTS: Anterior cruciate ligament, posterior cruciate, medial collateral ligament, and lateral collateral ligament are intact. EXTENSOR MECHANISM: Patellar and quadriceps tendons are intact. Note is made of a medial patellar plica, which does not appear thickened.ADDITIONAL

Output: Osteoarthritis of the medial tibiofemoral compartment with tear of the posterior horn of the medial meniscus as described above. 3 mm loose body in the posteromedial knee joint. Baker cyst and other findings as described above.


Instruction: Generate impression based on findings.

Input: There is no evidence of diffusion restriction. There are T2/FLAIR hyperintensities in the pons, midbrain, and in the subcortical and periventricular white matter representing chronic ischemic vascular changes.There is a low T1 and high T2 linear hyperintensity that is not seen in FLAIR in the pons representing linear encephalomalacia, likely due to prior hemorrhage.Cannot definitely exclude any chronic hemorrhage due to motion artifact in the susceptibility images.There is prominence of the ventricles and sulci due to age related volume loss. There is no midline shift. Basal cisterns are patent.Vascular flow voids are normal.

Output: 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. No acute infarct.2. Subcortical and periventricular white matter, pons, and midbrain hyperintensities on T2/FLAIR representing chronic vascular ischemic changes.3. Linear encephalomalacia in the pons, likely due to prior hemorrhage.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for ischemic change. Signs and symptoms: Comatose. Nonenhanced brain MRI:Examination demonstrate diffuse scattered varying size restricted diffusion in bilateral hemispheric cortical, subcortical white matter, basal ganglia and pontine as well as left cerebellum consistent with acute ischemic strokes.Postoperative changes of a right craniectomy for evacuation of hematoma is noted. There is a hemorrhagic surgical cavity measuring approximately at 22 x 20 mm in size and the diffuse surrounding FLAIR hyperintensity suggesting edema. No significant change in the extent of this finding when compared with prior PET/CT study.Postoperative changes of a large right-sided craniectomy with an underlying extra-axial collection is noted. It measures approximately 16 mm in thickness without significant change since prior study. There is mass effect and deviation of midline to the left of approximately 12 mm which is also nearly identical to prior exam. The ventricular system are within normal size and stable since prior exam.Diffuse subgaleal increased T2 and FLAIR signal intensity beyond the right-sided hemicraniectomy in the left high convexity posterior parietal region is noted.

Output: 1.Multiple varying sized foci of restricted diffusion involving bilateral cerebral cortex, subcortical white matter, basal ganglia and left pontine as detailed.2.Extensive postoperative changes are right sided craniectomy for evacuation of right hemispheric hematoma demonstrate no significant change since prior exam.3.Constellation of changes in the right hemisphere and including 12 mm deviation of midline to the left demonstrate no significant change.4.Stable nondilated ventricular system.5.Stable hemorrhagic postoperative surgical cavity and its surrounding edema.6.Stable extra-axial collection measuring at 16 mm in thickness in the right frontal temporal.


Instruction: Generate impression based on findings.

Input: There is redemonstration of postoperative findings related to suboccipital craniectomy for Chiari malformation, as well as resection of posterior arch of C1. Mild platybasia and retroflexion of the dens are again noted. The cerebellar tonsils are unchanged in appearance and positioning. There is stable posterior tenting of the cervicomedullary junction suggestive of adhesions. There remains moderate crowding at the level of the neoforamen magnum. Allowing for differences in technique, there is questioned interval diminished visualization of CSF signal dorsal to the cerebellar tonsils associated to the right of midline as seen on 301/30 compared to prior 401/26.There remains diminished CSF flow anteriorly at the craniocervical junction and slightly turbulent/asynchronous bidirectional flow just inferiorly at the level of the dens, appearing similar to prior exam. There is adequate CSF space posteriorly at the craniocervical junction, with stable to slightly improved biphasic flow visualized. The ventricles and sulci are stable. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures are within normal limits. CERVICAL SPINE

Output: 1. No significant interval change in MR appearance of postoperative findings relating to prior suboccipital craniectomy with suggestion of possible adhesions along the cervicomedullary junction.2. Questioned slight decreased delineation of CSF signal dorsal to the cerebellar tonsils just to the right of midline, which could suggest additional adhesions.Stable configuration of retroflexed dens and mild platybasia resulting in diminished and minimally turbulent CSF flow ventrally with stable to slightly improved visualization of dorsal biphasic flow at this level.


Instruction: Generate impression based on findings.

Input: Female 58 years old Reason: r/o growth of nodules, adenopathy. 2 year follow up study History: multinodular goiter RIGHT LOBE MEASUREMENTS: 6.0 x 2.4 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.9 x 2.4 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Background echotexture of the right thyroid lobe is normal. There is and unchanged heterogeneous nodule on the right with a mildly hypoechoic capsule measuring 1.3 x 0.9 x 0.8 cm, previously 1.2 x 0.6 x 1.1 cm. LEFT LOBE: There is an unchanged dominant left thyroid nodule with a colloid appearance measuring 2.9 x 1.7 x 1.7 cm, previously 3.1 x 1.7 x 1.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal-appearing lymph nodes.OTHER: No significant abnormality noted.

Output: Stable bilateral thyroid nodules as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: L knee meniscus tear History: Left knee pain The high definition knee coil was not utilized presumably related to the patient's body habitus. The standard knee coil was utilized instead resulting in slightly suboptimal image quality.MENISCI: There is a complex tear of the body and posterior horn of the medial meniscus which includes an abrupt contour defect of the inferior half of the body of the meniscus, posteriorly, suggesting a displaced flap fragment as well as horizontal signal abnormality within the posterior horn which extends to the tibial articular surface. The posterior horn of the medial meniscus also appears attenuated. The anterior horn appears relatively spared. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full thickness degeneration of the articular cartilage along the median eminence of the patella with additional degeneration along the medial and lateral facets. There is thinning of the articular cartilage of the medial facet of the femoral trochlea. There is full-thickness degeneration of the articular cartilage along the weightbearing surface of the medial femoral condyle and medial tibial plateau with edema type signal abnormality within the underlying bone and subchondral cyst formation. There is relatively mild degeneration of the articular cartilage of the lateral compartment with mild edema type signal within the lateral tibial spine.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the medial meniscus.2. Osteoarthritis of the knee most severely affecting the medial tibiofemoral and patellofemoral articulations.3. Moderate sized joint effusion and Baker's cyst.


Instruction: Generate impression based on findings.

Input: Evaluate left breast cancer response to neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast 12:00 position, the known cancer appears centrally necrotic and peripherally enhancing. This now measures 2.3 x 2.2 x 2.2 cm, previously 3.3 cm. The biopsy clip is along the lateral aspect of the mass, and a few foci just lateral to the biopsy clip are also noted to enhance (these are >1 cm from the clip). Previously noted prominent left axillary node is decreased in size. No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in the right axillary region.

Output: Some interval decrease in size of left breast malignancy. Interval decrease in size of a left axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 68-year-old male with metastatic lung cancer to the brain There is a hypodense area in the right occipital lobe extending into the temporal lobe but most likely represents an acute ischemic event. This area is in the region of the hyperdense focus in the right occipital region representing metastatic disease with surrounding vasogenic edema. This can be further evaluated with an MRI. No evidence of midline shift, new hemorrhage, or significant edema.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: Hypodense area in the right occipital lobe extending into the temporal lobe in the region of the hyperdense metastatic focus. Appearance most likely represents an acute ischemic event and can be further evaluate with an MRI. No evidence for new hemorrhage or mass-effect.


Instruction: Generate impression based on findings.

Input: There is interval worsening of intracranial metastases. For example:1.Worsened right postcentral gyrus enhancing irregular lesion measuring 12 x 12 mm, previously 5 mm, with susceptibility effect, and new moderate surrounding vasogenic edema.2.New right frontal lobe enhancing lesion measuring 4 mm on series 1301 image 105.3.New right basal ganglia lesion measuring 4 mm on series 1301 image 98.4.New/worsened left cerebellar hemispheric nodules measuring 6 mm and 4 mm respectively on series 1301 image 33.There is no acute infarct, midline shift or herniation. There is nonspecific bilateral mastoid high T2 signal, decreased on the left from the prior exam.

Output: Interval worsening of intracranial metastases as described above. In particular, there is a larger dominant right postcentral gyrus enhancing lesion with new moderate surrounding vasogenic edema.


Instruction: Generate impression based on findings.

Input: Evaluate liver mass. Provided history of hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: The liver morphology and contour is unremarkable. In the right hepatic lobe segment 7/8 there is a large mass measuring 12.0 x 9.1 cm x 11.8 (series 9/40) which is heterogeneously mildly T2 hyperintense with a centrally T2-weighted hyperintense stellate scar-like component. The mass is lobular in contour with avid late arterial homogeneous enhancement without significant enhancement of the central scar-like component, which may represent central necrosis. On portal venous and three-minute delayed imaging there is washout of the lesion with persistent enhancement of numerous internal septations resulting in a mosaic type appearance.Along the superior anterior aspect of the mass there appears to be a discrete 1.9 x 1.7 cm satellite nodule (series 10/36). Additionally, in the periphery of segment V (series 10/77) there is an arterial-enhancing focus measuring 1.0 cm without contrast retention or definite wash-out, non-specific.The anterior branch of the right portal vein is not well opacified and may be thrombosed without specific evidence of tumor thrombus. The hepatic veins are patent. The right hepatic vein is distorted by the mass. The hepatic artery appears patent.No biliary ductal dictation.Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. 12 cm right hepatic lobe mass with signal characteristics compatible with stated history of hepatocellular carcinoma, adjacent satellite nodule seen. Additional non-specific segment V 1.0 cm lesion. 2. Probable thrombosis of the anterior division of the right portal vein.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: 64 years Male (DOB:4/16/1952)Reason: patient with sharp pain in buttocks. Concern for neuropathic pain. Concerned for L3-L4-L5 disc disease History: patient with sharp pain in buttocks. Concern for neuropathic pain. Concerned for L3-L4-L5 disc diseasePROVIDER/ATTENDING NAME: JAMES J. CURRAN JAMES J. CURRAN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. A T1 hyperintense lesion is present at T12 measuring approximately 15 mm in diameter most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a broad-based central disc protrusion at this level associated with some facet hypertrophy of a moderate degree.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate bilateral facet hypertrophy present at this level. There is some loss of disc space height, disc desiccation and a disc bulge at this level. There is mild encroachment of the nerve roots of the right lateral recess at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is moderate facet hypertrophy at this level. There is a diffuse disc bulge present at this level associated with loss of disc space height and disc desiccation. There is some mild crowding of nerve roots within the thecal sac at this level. Overall there is a mild degree of spinal stenosis present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There are some mild ligamentum flavum thickening at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are multilevel degenerative changes present in the lower lumbar spine with a mild degree of spinal stenosis at L3-4 and some mild encroachment of the right-sided nerve roots at the right lateral recess due to degenerative changes.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, history of BRCA metastatic breast cancer with several weeks of lumbar and thoracic back pain, now with significant lower extremity weakness. No cord compression is seen. In fact, the spinal canal is not significantly compromised at any level. The cord itself demonstrates normal morphology and signal characteristics. No evidence of osseous metastatic disease is seen. A fat-containing lesion within the T6 vertebral body most likely represents a benign hemangioma. Disc degeneration is evident at L5-S1.

Output: 1.No evidence of cord compression.2.No evidence of osseous metastases on this limited examination.3.Disc degeneration at L5-S1 can be assessed with nonemergent dedicated lumbar spine imaging if clinically warranted.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: eval postop changes History: s/p crani for tumor There is evidence of right frontal craniotomy with near total resection of the right frontal lobe mass with minimal surrounding enhancement which could represent postoperative changes including resection site blood products.There still has remained mass effect of the resection site with minimal midline shift toward left side, no significant change since prior scan.The craniotomy site shows subgaleal and extra axial fluid collections which are likely to be procedure related.There is no other abnormal enhancement seen.The ventricles, sulci and cisterns are grossly symmetric and unremarkable. There is no restricted diffusion/acute ischemia, or new hemorrhagic lesion. The 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. Right frontal craniotomy postoperative changes including subgaleal and extra dural fluid collections.2. Near total excision of the right frontal mass lesion with minimal resection site enhancement.3. No acute ischemic lesion. No hemorrhagic lesion except resection site blood products.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: 42 yo M with hx of L frontal PXA s/p surgery then RT, eval for progression/recurrence History: none The examination is limited by motion artifact. Postsurgical changes with multiple left frontal bone burr holes are again demonstrated. The left frontal lobe resection cavity appears similar to prior examination with a small amount of surrounding T2/FLAIR signal. The head of the caudate is atrophic and has intrinsic high T1 signal, without significant enhancement, likely postoperative in etiology. Small area of enhancement involving the inferomedial aspect of the cavity (series 11, image 17) appears similar to prior examinations. No new or enlarging enhancing lesions are identified. No midline shift is appreciated. There is no evidence for acute ischemia. Blood degradation products are again demonstrated in the left frontal lobe subarachnoid space and surgical resection cavity. No new areas of hemorrhage are identified. Scattered areas of T2/FLAIR hyperintensity, more prominent in the left cerebral hemisphere are again seen. Prominent vascularity versus leptomeningeal enhancement involving the middle left frontal lobe gyrus appears similar to prior examination.

Output: Postsurgical changes related to left frontal lobe mass resection without evidence for tumor progression. A small nonspecific focus of enhancement at the surgical site remains similar to prior examinations.


Instruction: Generate impression based on findings.

Input: Evaluate size and character of liver masses seen on outside hospital MRI ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic lesions measuring up to 2.5 x 2.0 cm in segment 3 with ill-defined T2 hyperintensity, progressive enhancement, and no significant change in size compared to the prior exam. The hepatic vasculature is patent. No biliary ductal dilation. Status post cholecystectomy.Hemangiomas, FNH, and adenomas are considered unlikely given the signal characteristics.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Multiple hepatic lesions with ill-defined T2 hyperintensity, progressive enhancement, and no significant change in size from the prior exam. Differential considerations include inflammatory processes and metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: osteo? History: wound Marked fatty atrophy affects the musculature of the lower leg. There is loss of subcutaneous fat in a large area anteromedially within the middle third of the lower leg, consistent with stated history of large leg wound. Diffuse inflammation affects the remaining subcutaneous tissues, without evidence of discrete fluid collection/abscess. The bone marrow is within normal limits, without evidence of osteomyelitis.

Output: 1.No evidence of osteomyelitis or discrete abscess formation.2.Large anteromedial subcutaneous wound.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for labral tear History: shoulder pain with sports; running; history in 2011 of shoulder dislocation ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis tendons and muscles are intact without evidence of tearing or tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior and posterior glenoid labrum are intact without evidence of tearing or fracture. There is a small cortical defect in the posterolateral humeral head which could be secondary to prior fracture related to anterior shoulder dislocation.BICEPS TENDON: The long and short heads of the biceps tendon are intact. ADDITIONAL

Output: Small cortical irregularity of the posterior humeral head may be related to prior anterior shoulder dislocation. There is no underlying labral tear.


Instruction: Generate impression based on findings.

Input: Ms. Mayekar is a 30 -year-old female with a strong family history of breast cancer in maternal grandmother and mother. BRCA positive. Marked background parenchymal enhancement is noted bilaterally. Scattered foci of enhancement are seen in both breasts, none of which are more suspicious than the rest.There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. No MRI evidence for malignancy. 2. Marked background parenchymal enhancement which limits the sensitivity of MRI.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82]. Alcoholic cirrhosis complicated by recurrent encephalopathy. The images are degraded by patient motion. There is mild diffuse periventricular T1 hyperintensity, as well as subcentimeter areas of subcortical white matter T2 hyperintensity in the left frontal and parietal lobes. There is no evidence of acute infarct. There appears to be patchy susceptibility effect along the inferior vermis. There is diffuse cerebral and cerebellar volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant.

Output: 1. Mild diffuse periventricular T1 hyperintensity, as well as subcentimeter areas of subcortical white matter T2 hyperintensity in the left frontal and parietal lobes may represent sequela of prior ischemia, but no evidence of acute infarct.2. Patchy susceptibility effect along the inferior vermis may represent chronic hemorrhage.3. Diffuse cerebral and cerebellar volume loss may be related to alcoholism.


Instruction: Generate impression based on findings.

Input: DJD, back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is levocurvature of the lumbar spine without significant spondylolisthesis at any level. Bone marrow signal is benign. The conus medullaris is normal in position.There is prominent vacuum disc phenomena at the L1-L2 and L4-L5 levels which is new at L1-L2 since prior MRI from 2009 but was present on CT dated 7/17/2014. Additional details regarding multilevel degenerative changes as below:L1-L2: Prominent vacuum disc phenomena. There is mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is fairly mild spinal canal stenosis. There is moderate bilateral left greater than right neural foraminal stenosis.L2-L3: Minimal disc bulge and mild facet arthropathy contribute to mild right neural foraminal narrowing. No significant spinal canal or left neural foraminal stenosis.L3-L4: Minimal disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening contribute to minimal spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L4-L5: Moderate to severe disc height loss and vacuum phenomena as well as bilateral ligamentum flavum thickening and moderate bilateral facet arthropathy. There is associated moderate to severe spinal canal stenosis. There is severe right and moderate left neural foraminal stenosis. These findings are minimally worse since 1/23/2009.L5-S1: Disc height loss with vacuum phenomena and small central disc extrusion. Advanced bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis. These findings have progressed since prior MRI from 1/23/2009.

Output: 1. Multilevel degenerative changes in the lumbar spine which have progressed since prior MRI from 1/23/2009. Findings are worst at the L4-L5 level where there is moderate to severe degree of spinal canal stenosis, severe right neural foraminal stenosis, and moderate left neural foraminal stenosis.2. Facet arthropathy throughout the lumbar spine, worst at the L4-L5 and L5-S1 levels. Additional details as above.


Instruction: Generate impression based on findings.

Input: 44 years, Female, with right-sided weakness and dysarthria. Evaluate for ischemic changes. There is restricted diffusion within the mid left posterior frontal/anterior parietal lobe, consistent with acute infarction, with only subtle FLAIR abnormality. There is no evidence of hemorrhagic conversion. There is adjacent sulcal effacement, with no evidence of midline shift or herniation. There is a focus of T2 hyperintensity within the right basal ganglia, which does not restrict diffusion, probable chronic lacunar infarction. An additional punctate T2 hyperintense focus is identified within the right centrum semiovale. The ventricles are within normal limits in size and configuration. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.Restricted diffusion within the mid left posterior frontal/anterior parietal lobe, consistent with acute left MCA territory infarction. No evidence of hemorrhagic conversion. No midline shift or herniation.2.T2 hyperintensity within the right basal ganglia and right centrum semiovale, statistically most likely to represent chronic microvascular ischemic disease.Findings were discussed with Dr. Delbrutto by Dr. Brittany Dashevsky at 11:03 AM on July 18, 2015.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:10/25/1957)Reason: rule out structural lesion History: seizuresPROVIDER/ATTENDING NAME: JAMES X. TAO JAMES X. TAO The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Several periventricular and subcortical white matter lesions are nonspecific and likely of little clinical significance.2.No intracranial mass lesion is appreciated to explain the patient's seizures.


Instruction: Generate impression based on findings.

Input: 67-year-old male with newly diagnosed ascending colon cancer. Multiple liver lesions seen on CT. History of CLL. Abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense lesions in the liver. The largest of these, in segment 8, measures 2.3 x 1.7 cm (series 4, image 12), with peripheral nodular discontinuous enhancement that increases centrally with delayed imaging. In retrospect, this lesion was faintly visible though incompletely evaluated on the noncontrast CT from 10/9/2014. Additional subcentimeter foci scattered throughout the liver demonstrate minimal to no discernible enhancement, compatible with cysts or hemangiomas. Biliary sludge versus small stones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Partially imaged pelvic lymphadenopathy, seen only on large field of view coronal images. Please refer to the prior CT of the abdomen and pelvis for further characterization.BOWEL, MESENTERY: 4 cm ascending colonic mass is again seen (series 4, image 34), though incompletely imaged and incompletely evaluated on this exam. Please refer to the prior CT of the abdomen and pelvis for further characterization.BONES, SOFT TISSUES: Multiple vertebral body hemangiomas noted. Otherwise, no significant abnormality noted.

Output: 2.2 cm lesion in hepatic segment 8 compatible with a hemangioma, as suggested on the prior CT. Additional smaller liver cysts or hemangiomas noted. No hepatic masses suspicious for metastatic disease.


Instruction: Generate impression based on findings.

Input: daily headache No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.No abnormal enhancement.Normal brain MRI


Instruction: Generate impression based on findings.

Input: Diagnosis: Sarcoidosis of other sitesClinical question: Evaluate for progression of neurosarcoidosis lesion noted in prior MRI MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of volume loss associated with T2 and FLAIR signal hyperintensity involving the lateral aspect of the postcentral gyrus and precentral gyrus. This is stable since the prior exam.There is a focus of FLAIR and T2 signal hyperintensity along the medial aspect of the right temporal lobe measuring approximately 8 mm x 6 mm in axial dimensions.There is a small focus of the hypointensity on susceptibility weighted imaging within the right external capsule which is not readily identified on the T2, FLAIR or T1-weighted imaging (likely because it is too small).There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI thoracic spine:There is redemonstration of T2 signal hyperintense lesion within the spinal cord at the T2-3 level. This was also present in the 2012 exam and has not changed substantially. There is subtle contrast enhancement associated with this. There is redemonstration of mild narrowing of the spinal canal at the T2-3 level due to a disc bulge and some ligamentum flavum hypertrophy.There is redemonstration of a T2 hyperintense and T1 isointense lesion at the T4 vertebral body level is unchanged since previous exams. This lesion is also bright on inversion recovery and fat suppressed imaging.The patient is status post laminectomies in the lower cervical spine.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. There are small pleural effusions present. These were also present on the prior exam.

Output: 1.There is a stable lesion within the spinal cord at the T2-3 level.2.Small foci of encephalomalacia are present in the right medial temporal lobe as well as the right pre and postcentral gyrus. These are stable since the prior exam.3.There is a microhemorrhage present in the right external capsule which was also present on prior exams and is stable.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No abnormal enhancing lesions are identified in the brain parenchyma at this time.6.Small pleural effusions are present. These have not changed substantially since the prior exam and may be slightly smaller.


Instruction: Generate impression based on findings.

Input: Traumatic hemorrhage of right cerebrum without loss of consciousness, initial encounterClinical question: r/o malformationSigns and Symptoms: hx of ICH There is redemonstration of a hematoma centered in the right basal ganglia measuring 40 x 33 mm axial dimensions. There is associated extension of the hematoma into the right temporal horn of the lateral ventricle. There is intraventricular blood present. There is surrounding T2/FLAIR signal hyperintensity suggestion of vasogenic edema. There is T2/FLAIR signal hyperintensity extends to the right cerebral peduncle, right midbrain and pons. There is some mild mass effect with approximately 2 mm shift of the third ventricle towards the left. There is subtle uncal herniation present.There is a large (25x72mm) area of diffusion restriction involving the right inferior parietal lobule as well as some of the immediately adjacent temporal lobe and precentral gyrus with a second more intense focus of diffusion restriction (47x17mm) extending from the superior aspect of the insular cortex to the centrum semiovale. A third small (15mm) focus of diffusion restriction is present in the right middle frontal gyrus. Little FLAIR signal abnormality is associated with the diffusion restriction.There is loss of signal in the transmedullary veins on the right versus the left hemisphere centered in the MCA territory associated with loss of signal in the cortical veins. There is associated asymmetrically loser signal on SWI in the areas of diffusion restriction.There is a focus of susceptibility effect in the left orbital gyrus.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is diffuse marrow replacement present which is likely related to chronic disease.

Output: 1.There are new foci of cerebral infarction encompassing a significant proportion of the right MCA territory with a larger focus centered in the right inferior parietal lobule but extending to adjacent temporal lobe, another focus centered in the right centrum semiovale and insula, and a smaller focus centered in the right middle frontal gyrus. It is suggested that this is hyperacute and that there is hypoxia in this territory of evolving infarction.2.There is a large hematoma centered in the right basal ganglia associated with vasogenic edema extending to the brainstem and also associated with uncal herniation and midline shift.3.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. They are most likely vascular related. 4.Old small hemorrhage in the right orbital gyrus.5.Findings were discussed with Dr Kramer at around 7:30 pm on 11-4-15


Instruction: Generate impression based on findings.

Input: History of HCC status post RFA ablation. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.The segment 5 ablation cavity measures approximately 4.3 x 1.9 cm (series 13/56), compared to 4.7 x 2.2 cm previously. There is adjacent perfusional anomaly but no discrete lesion.The segment 6 ablation cavity measures 3.7 x 3.0 cm (series 13/45), compared to 4.3 x 2.9 cm previously.No evidence of residual or recurrent disease.No new suspicious liver lesion. No biliary ductal dilatation. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mildly atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhosis with two right hepatic lobe ablation cavities without evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Persistent altered mental status without clear etiology. There are multiple foci of high T2 signal and restricted diffusion scattered in the bilateral cerebral hemispheres, including the hand region of the right precentral gyrus. There is no evidence of intracranial hemorrhage or mass. There is a background of encephalomalacia in the right occipital lobe with gyriform T1 hyperintensity. There are punctate foci of encephalomalacia in the bilateral basal ganglia. There is a background of mild patchy cerebral white matter T2 hyperintensity. There is diffuse cerebral volume loss. 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 secretions within the sphenoid sinuses and bilateral tympanomastoid effusions, which may be related to intubation.

Output: 1. Multiple recent small infarcts scattered in the bilateral cerebral hemispheres.2. Chronic right posterior cerebral artery infarction and bilateral basal ganglia lacunar infarcts. Discussed with Dr. Kramer at 2PM on 2/24/16.


Instruction: Generate impression based on findings.

Input: Diagnosis: Chemotherapy follow-up examination. Malignant neoplasm of brain, unspecified siteClinical question: Glioblastoma compare to last MRI and provide bidimensional measurementsSigns and Symptoms: post 2 cycles of PDL1 antibody The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left parietal craniotomy.Since the prior exam the contrast enhancing portion of the patient's neoplasm centered in the left parietal lobe has changed. The enhancing portion of this neoplasm primarily involves the left parietal lobe but extends towards the posterior aspect of the left temporal lobe and inferiorly extends into the fusiform gyrus. This neoplasm appears to have enlarged along its more anterior aspect in the white matter adjacent to the trigone of the left lateral ventricle . Overall dimensions on the prior exam were 42 x 41 mm axial dimensions on the prior and 44 x 44 mm axial dimensions on the current. There is heterogeneous T2 signal within the tumor bed and multiple serpiginous flow-voids on the susceptibility weighted imaging within the tumor bed. This appearance was also present on the prior exam from 6/18/2015. There is T2 signal hyperintensity surrounding the enhancing component of the mass and heterogeneous component of the mass which has a vasogenic pattern. The extent of this surrounding T2 signal hyperintensity appears similar to the prior exam. There is associated midline shift with the 14 mm shift of the septum pellucidum towards the right. This is stable and compared to the prior exam. There is associated uncal herniation and associated subfalcine herniation. The temporal horn of the right lateral ventricle remains dilated.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the previous exam from June there is been some interval progression of the enhancing portion of the patient's known left parietal neoplasm. This is known to represent a glioblastoma. There is associated midline shift as well as uncal and subfalcine herniation which is stable when compared to the prior exam from 6/18/15.


Instruction: Generate impression based on findings.

Input: Heart replaced by transplant [V42.1], Reason for Study: ^Reason: 65yo F w/ hx of CNS nocardia. Monitor for interval progression. History: CNS nocardia Redemonstration of well marginated enhancing mass of the corpus callosum splenium with surrounding edema extend toward bilateral trigone areas and occipital lobes. The size of the mass was measured about 24.2mm x 17.6mm x 18.6mm. Considering slightly different scanning plane and measurement errors, there is no significant interval change of the mass in terms of size and MR characteristics.Right posterior pontine susceptibility lesion, no change since prior scan.No change of non specific small vessel ischemic disease since prior scan.No change of multiple susceptibility lesions on bilateral hemispheres suggesting chronic micro-hemorrhages, since prior scan.No change of empty sellar.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: Corpus callosum splenium mass, no change since prior exam in terms of size and MR characteristics.No change of right posterior pontine susceptibility artifacts, multiple bihemispheric susceptibility artifacts and non specific small vessel ischemic disease since prior scan.No evidence of new acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: History of metastatic adenocarcinoma, signet cell type.Omental resection 11/25/2015 showed metastatic signet renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Widening of the hepatic fissures and prominent caudate lobe compatible with chronic liver disease. Several subcentimeter hepatic cysts. No suspicious hepatic mass. No biliary ductal dilatation. The vessels are patent.SPLEEN: The spleen is normal in size.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: Postsurgical changes from transverse colectomy. Right lower quadrant end colostomy. Left lower quadrant mucocutaneous fistula. The sigmoid colon demonstrates wall thickening and hyperenhancement with mild adjacent fat stranding.BONES, SOFT TISSUES: Postsurgical changes of anterior abdominal wall and omentum. No discrete soft tissue mass.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from transverse colectomy. Right lower quadrant end colostomy. Left lower quadrant mucocutaneous fistula. The sigmoid colon demonstrates wall thickening and hyperenhancement with mild adjacent fat stranding.BONES, SOFT TISSUES: Mild presacral fluid.OTHER: No significant abnormality noted.

Output: 1. Sigmoid colon wall thickening and hyperenhancement with mild adjacent fat stranding, worrisome for a colitis of uncertain etiology. No discrete measurable sites of disease.2. Mild morphologic changes of chronic liver disease without a suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Pain and swelling check menisci MENISCI: The lateral meniscus demonstrates blunting of the body and anterior horn along with anterior horn globular signal. No discrete linear component extending to either articular surface, changes may be postsurgical representing partial revision.The medial meniscus however demonstrates increased signal in the body with complex tear in the posterior horn with discrete extension to the superior articular surface. In addition the posterior anchor is also not visualized and ghosting of the meniscus correlates with a suspected additional radial tear.ARTICULAR CARTILAGE AND BONE: Increased signal and suspected contusion involving the lateral femoral condyle and tibial plateau both medially and laterally. Mild decrease in sensitivity secondary to artifact from the ACL repair and surgical anchors. Cartilage grossly intact, specifically no discrete focal abnormalities.LIGAMENTS: ACL repair appears diffusely degenerative and torn, no discrete fibers are observed to be intact. Associated focal well-defined small cyst is also observed towards the femoral insertion. PCL and collateral ligaments are otherwise unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Loss of the ACL repair and both lateral and medial meniscal abnormalities, most pronounced involving the posterior horn of the medial meniscus, as described.


Instruction: Generate impression based on findings.

Input: Weakness. There are patchy areas of cortical and subcortical high T2 signal in the right inferior frontal gyrus, insula, superior temporal gyrus, and inferior parietal lobule without restricted diffusion, but perhaps slight volume loss. There is a background of mild scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a left lens implant. There is what may represent minimal secretions in a left ethmoid sinus.

Output: Patchy areas of cortical and subcortical high T2 signal in the right inferior frontal gyrus, insula, superior temporal gyrus, and inferior parietal lobule without restricted diffusion or definite volume loss may represent chronic infarcts, superimposed on a background of cerebral white matter chronic small vessel ischemia. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Sinonasal basaloid carcinoma that was resected. Planning for chemo/RT. There are interval postoperative findings related to interval resection of a sinonasal mass with a subcentimeter nodular lesion in the region of the olfactory recesses. There is slight extension of the tumor into the epidural space of the anterior cranial fossa via defects in portions of the ethmoid roof. There are residual secretions and mucosal thickening within the left maxillary sinus, left ethmoid cavity, and sphenoid sinuses. There is a dural based lesion along the posterior falx cerebri that measures up to 3 mm in width, which is unchanged. There is diffuse cerebral volume loss. There are bilateral lens implants and staphylomatous deformity of the globes. There is no evidence of tumor extension into the orbits.

Output: 1. Postoperative findings related to interval resection of a sinonasal mass with a subcentimeter nodular lesion in the region of the olfactory recesses that appears to have slight epidural extension along the floor of the anterior cranial fossa, which is suggestive of residual tumor.2. A dural based lesion along the posterior falx cerebri that measures up to 3 mm in width is unchanged and may represent a meningioma.


Instruction: Generate impression based on findings.

Input: 65-year-old male with history of GBM status post resection, chemotherapy, radiation therapy. Now still on chemo status post URI two weeks ago, presents with left sided weakness.IMAGE ACQUISITIONS: Brain CT without contrast There is a large cystic mass with surrounding edema in the right frontal lobe. Findings have worsened since the prior MRI study. There is 15 mm of leftward midline shift. Significant mass effect is noted on the right lateral ventricle. Findings are suggestive of tumor recurrence.

Output: Increase in the large cystic mass and surrounding edema in the right frontal lobe suggestive of tumor recurrence. A subsequent brain MRI study has been interpreted.


Instruction: Generate impression based on findings.

Input: History of breast cancer in mother diagnosed at the age of 58 and sister diagnosed at the age of 48. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A stable benign 4 mm enhancing focus is present at the 6 o'clock position of the right breast representing a benign intramammary lymph node. A few other scattered foci are also stable and not suspicious in appearance.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: 62-year-old man with intermittent right leg numbness and weakness in the right L4 or 5 distribution when sitting in a cramped position. There are five lumbar type vertebral bodies present. There is minimal anterolisthesis of L5 on S1 and loss of disc height at this level; otherwise, the vertebral body and disk heights are well-maintained. The conus medullaris terminates at L1. At L4-5, there is bilateral facet joint hypertrophy and ligamentum flavum thickening resulting in mild bilateral neural foraminal narrowing, but no significant compromise of the spinal canal. At L5-S1, there is degenerative disc disease with fatty endplate bone marrow signal alterations and mild facet arthropathy resulting in moderate right and severe left neural foraminal narrowing, but no significant compromise of the spinal canal. While the entire kidneys are not included in the field of view, the imaged portions appear extensively replaced with cysts. There is atrophy of the paraspinous muscles.

Output: 1.Degenerative disc disease at L5-S1 and mild to moderate bilateral neural foraminal narrowing at L5-5 and moderate right and severe neural foraminal narrowing at L5-S1, but no significant spinal canal stenosis.2.The imaged portions of the kidneys appear replaced by numerous cysts, which may represent polycystic kidney disease or other form or renal disease. Dedicated renal imaging is recommended for further evaluation if outside studies are unavailable for comparison.