Instruction: Generate impression based on findings.

Input: Reason: ovarian remnant History: pain, h/o breast cancer (estrogen receptor positive)Additional history per electronic medical record:Here for consultation for ovarian remnant syndrome. History of breast ca (triple +) s/p b/l mastectomy, and endometriosis. Prior hysterectomy for stage IV endometriosis and extensive lysis of adhesions in 2008 (Ingalls) (pathology adenomyosis, focal endometriosis). She needed a second laparotomy, lysis of adhesions, BSO in 2009 for a 10 cm left ovarian cyst and endometriosis. Noted improved pain relief with both surgeries until ~ 9 months ago. Pain has returned, left side greater than right that is similar to before surgery. Ultrasound done shows a right ~ 1 cm right ovarian remnant. Metallic susceptibility artifact from lumbosacral fusion device obscures the paraspinal and upper presacral regions.ABDOMEN:LUNG BASES: There is a nonspecific 8 mm subpleural pulmonary nodule (series 1800, image 1).LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Several small, T2 hyperintense structures within the spleen are nonspecific but most likely benign.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.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.PELVIS:UTERUS, ADNEXA: Postsurgical changes of hysterectomy and bilateral salpingo-oophorectomy. No evidence of ovarian remnant in the expected location of the bilateral adnexa.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of hysterectomy and bilateral salpingo-oophorectomy. No ovarian remnant is visualized in the expected location of the adnexa as clinically questioned, within the limitations described above.2.Nonspecific 8 mm right subpleural pulmonary nodule. Given history of breast cancer, recommend correlation with prior outside imaging to ensure stability. Otherwise, dedicated chest CT can be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 73-year-old male with mixed cholangio-/HCC histology on chemotherapy for evaluation of response. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with trace ascites.Interval enlargement of a segment five liver lesion measuring 6.2 x 4.5 cm, previously 4.3 x 3.4 cm. Interval enlargement of a segment eight peripheral lesion with capsular retraction measuring 5.3 x 3.1 cm, previously 4.2 x 2.7 cm. There is a small amount of ascites overlying this lesion. There is a new arterially enhancing focus without definite washout in hepatic segment seven that is favored to represent a perfusion defect (series 10, image 17). Attention on subsequent imaging is suggested.There is some centimeter T2 hyperintense foci that are nonenhancing compatible with cysts, unchanged.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: Interval enlargement of a porta hepatis lymph node measuring 4.6 x 2.5 cm, previously 3.1 x 2.0 cm. Additional prominent porta hepatis and gastrohepatic ligament lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval increase in size of segment eight and segment five lesions as detailed above. Increased porta hepatis lymphadenopathy.2.There is a new arterially enhancing focus in segment seven without definite washout favored to represent a perfusion defect. Attention on subsequent imaging is suggested.


Instruction: Generate impression based on findings.

Input: 41-year-old female with right knee pain and question of patellofemoral syndrome. MENISCI: There is fraying of the inner edge of the lateral meniscus. There is a horizontal, complex tear of the posterior horn of the medial meniscus with extension to both the superior and inferior surfaces and questionable extension to the posterior anchor. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There are mild degenerative changes of the undersurface of the patella. There is thinning of the medial compartment with focal defect measuring about 7 mm on the anterior aspect of the medial femoral condyle articular cartilage. Bone marrow edema is visualized at the origin and insertional sites of the ACL.LIGAMENTS: There is mild MCL thickening with minimal adjacent fluid without evidence of tearing. Further, there is thickening of the ACL with inflammatory change and partial tearing.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Degenerative changes of the articular cartilage and meniscal tear specifically described above. 2. ACL and MCL thickening as outlined above.3. Moderate to large joint effusion with questionable synovitis.


Instruction: Generate impression based on findings.

Input: 51 year-old female.Fibromatosis. ABDOMEN:LIVER, BILIARY TRACT: The faintly T2 hyperintense, enhancing lesion in segment 6 of the liver is unchanged at 1.6 x 2.4 cm (series 13, image 200). The second enhancing lesion more superiorly in the right hepatic lobe is unchanged at 1.1 x 1.1 cm (series 13, image 53). No biliary ductal dilatation is present. Scattered small hepatic cysts are also noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes noted in the duodenum and jejunum from the prior mass resection. Colonic diverticulosis.BONES, SOFT TISSUES: Midline small incisional hernia containing mesenteric fat and a loop of small bowel, without evidence of complication.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: 1.5 cm right-sided Bartholin cyst (series 24, image 35). Otherwise, no significant abnormality noted.

Output: 1. No evidence of recurrent fibromatosis. 2. Stable appearance of the right hepatic lobe enhancing lesions, with appearances favoring benign etiologies such as focal nodular hyperplasia or adenoma.


Instruction: Generate impression based on findings.

Input: Male 57 years old with cirrhosis, HCC and IPMN. Assess for HCC recurrence and side branch IPMN. ABDOMEN:LIVER, BILIARY TRACT: Nodular, cirrhotic liver morphology. Hepatic steatosis.The segment 8 ablation cavity measures 1.8 x 1.1 cm (series 13, image 422), previously 1.8 x 1.3 cm. There is no enhancement within the ablation cavity and no evidence of residual tumor. A subcentimeter T2 hyperintense focus within hepatic segment 3 is likely a cyst. No new enhancing or suspicious liver lesion. A plaque-like enhancing focus in the gallbladder fundus measures 4 x 8 mm, stable compared to 1/6/2015. Cholelithiasis but no evidence of cholecystitis. No biliary ductal dilatation.Recanalized umbilical vein. The hepatic vasculature appears patent.SPLEEN: The spleen measures 14 cm in length, unchanged.PANCREAS: A lobular, cystic focus in the pancreatic head measures 13 mm, unchanged. The pancreas enhances homogeneously and is without suspicious lesion. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Healed right posterior rib fractures are again noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with evidence of portal hypertension.2.Segment 8 and ablation cavity with no evidence of residual tumor.3.No new suspicious liver lesion.4.Stable cystic pancreatic head lesion suggestive of sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: History of left-sided testicular cancer. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Punctate subcentimeter left peri-aortic lymph nodes are not pathologically enlarged by size criteria and are unchanged from priors.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No retroperitoneal lymphadenopathy or evidence of metastatic disease in the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: Clinical question: History of meningioma resection, evaluate site for residual or recurrence. Signs and symptoms: None surveillance scan. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates a large focus of hemorrhagic cystic encephalomalacia in the right posterior parietal lobe at the site of previously resected tumor. There is abnormal signal intensity with mild enlargement of the superior sagittal sinus at the surgical site which is in continuity with a dural base right posterior parietal loculated isointense T2 signal mass. The finding within the superior sagittal sinus and adjacent dura demonstrate uniform intense enhancement and consistent with residual meningioma. The combination of findings measures approximately 12 x 19.5 mm in transaxial dimensions (axial T1 series 901 image 27) and at least 37 mm intracranial cephalad axis on sagittal post enhanced images.There is also a tiny focus of residual tumor to the left of superior sagittal sinus in the left parietal measuring approximately 9 x 6 mm in transaxial dimensions measured on axial post enhanced series 1001 image 27.Combination of findings in the superior sagittal sinus and bilateral posterior parietal measure approximately at 32 mm along the inner table of the skull and 14 mm in AP axis.Multiple small foci of FLAIR hyperintensity and a confluent foci in the left posterior parietal white matter grossly similar to prior exam and suggestive of chronic small vessel ischemic strokes as well as possible post radiation change overlap. Similar to prior exam there is complete opacification of left frontal sinus demonstrating isointense signal on T1 and T2 and hyperintense FLAIR with rim enhancement consistent with chronic long-standing sinus disease without change since prior exam from February 2015. The rest of the paranasal sinuses remain well pneumatized and with intravenous and mild bilateral ethmoid disease.

Output: 1.Signal abnormality and dural based enhancement in bilateral paramedian posterior parietal and continuous through the superior sagittal sinus consistent with residual meningioma as detailed and measuring at 12 x 19.5 x 37 mm.2.Extensive cystic and minimally hemorrhagic encephalomalacia at the site of previously resected meningioma in the right posterior parietal as detailed.3.Stable diffuse punctate and patchy white matter FLAIR hyperintensity since prior exam and likely representing chronic small vessel ischemic strokes with possible overlapping post radiation changes.


Instruction: Generate impression based on findings.

Input: 77 year old female with a personal history of right lumpectomy and radiation therapy for invasive lobular carcinoma in 1999. Prior benign left breast biopsy in 1985, and surgical removal of scar tissue from the left breast in July 2010. No current breast complaints. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.Volume loss of the right breast with stable postoperative deformity and scarring is unchanged.A few small metallic artifacts are seen in the right breast and right axilla, from the surgical clips of the prior surgery.Stable duct ectasia is present in the left retroareolar area.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 25 year-old woman with history of pain and catching of the right knee. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the tibiofemoral and patellofemoral compartments is intact. Marrow and cortical signal is normal.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No finding to explain the patient's pain.


Instruction: Generate impression based on findings.

Input: 42 year old female. Status post vaginal hysterectomy. Now has bandemia and abdominal pain. Right CVA TTP, fever and rigors. DM. Evaluate for perinephric abscess. ABDOMEN:LUNG BASES: Mild bibasilar dependent atelectasis. LIVER, BILIARY TRACT: Hepatomegaly. The liver measures 22 cm overall. Periportal edema seen previously has resolved. There are hepatic hypodensities which are subcentimeter in size and unchanged since prior examination, probably benign. SPLEEN: No significant abnormality noted. Splenules at the hilum and lower pole. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The previous examination found left hydronephrosis and hydroureter which has resolved. No specific renal abnormality was identified.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged pericaval and paraaortic lymph nodes inferior to the kidneys. BOWEL, MESENTERY: No significant abnormality noted. Normal appendix in the right lower quadrant. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No abscess or ascites. The celiac and superior mesenteric arteries share a common origin, a normal anatomic variant. This is seen best on midline sagittal view.Umbilical Richter's hernia contains nonobstructed bowel.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Large central pelvic multiloculated cystic mass with wall enhancement was seen on the prior exam and is much smaller. The mass measures 8.7 x 12 cm. No gas bubbles. May be further evaluated with transvaginal ultrasound and/or MRI, if indicated. BLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged left iliac lymph nodes.BOWEL, MESENTERY: No significant abnormality notedqBONES, SOFT TISSUES: Intramuscular cystic lesion at right rectus femoris muscle image 101 of series 3) is stable since the prior exam and does not have characteristics of an abscess. OTHER: No significant abnormality noted

Output: The multiloculated central pelvic mass seen on the prior exam of 2/21/2010 is much smaller. Interval resolution of left hydroureter and hydronephrosis. Pelvic ultrasound exam may be helpful for further evaluation.


Instruction: Generate impression based on findings.

Input: 44-year-old woman with history of aqueduct stenosis and hydrocephalus. The lateral and third ventricles are enlarged measuring 54 and 14 mm respectively, stable in size compared to examination from November 2015. A focal stenosis of the cerebral aqueduct is again seen inferiorly (801/56). There is no visualized CSF flow through the cerebral aqueduct. There is CSF flow through the third ventriculostomy. There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. A few foci of T2/FLAIR hyperintensity are seen in the periventricular white matter, which are nonspecific, but probably related to chronic small vessel ischemic changes. Punctate foci of susceptibility artifact in the lateral ventricular wall likely represent hemosiderin deposition from prior procedures.Sella and orbits are grossly within normal limits. There are left maxillary mucosal retention cyst, otherwise the paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Patent third ventriculostomy. 2.Findings compatible with cerebral aqueduct stenosis with no CSF flow visualized across the aqueduct.3.Stable lateral and third ventricular size.


Instruction: Generate impression based on findings.

Input: 72-year-old female with shoulder pain. ROTATOR CUFF: There is thickening and intermediate signal abnormality within the supraspinatus tendon indicating moderate tendinosis. There is a small partial-thickness tear of the undersurface fibers of the supraspinatus tendon at the level of the humeral head with minimal retraction of approximately 7 mm. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. The infraspinatus muscle appears intact. There is thickening and intermediate signal intensity within the subscapularis tendon indicating moderate tendinosis, although this may in part be related to redundancy of the tendon related to lack of external rotation of the humeral head. The teres minor and subscapularis muscles and tendons otherwise appear intact.SUPRASPINATUS OUTLET: There is a moderate to large amount of fluid within the subacromial subdeltoid bursa suggestive of a bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the glenoid labrum suggestive of degeneration/tearing. There is articular cartilage fraying affecting the glenohumeral joint. There is subchondral cyst formation within the humeral head. BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the glenohumeral joint versus a tenosynovitis. ADDITIONAL

Output: 1. Findings suggestive of a synovitis affecting the glenohumeral joint as well as a subacromial subdeltoid bursitis.2. Partial-thickness tearing of the rotator cuff without evidence of a full-thickness rotator cuff tear. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 72-year-old female patient with hypoattenuating lesion of the inferior pole of the right kidney. Patient diagnosed with colonic adenocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. No intra or extrahepatic biliary ductal dilatation. No suspicious hepatic lesion is identified.SPLEEN: There is an accessory splenule.PANCREAS: There appears to be a stricture of the pancreatic duct within the body with focal dilatation of the duct up to 6 mm just distal to this point and generalized mild ductal dilatation otherwise. No pancreatic mass is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 1.6 cm lesion within the right upper pole which demonstrates T2 hyperintensity and does not enhance; this is compatible with a cyst. A 1.4 cm right lower pole lesion with T2 hyperintensity, mild internal heterogeneity, and no significant enhancement is not significantly changed in size since a MRI from 8/21/2015. A subcentimeter T2 hyperintense lesion within the right lower pole and left mid pole are too small to characterize but likely represent cysts. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A lesion within the right aspect of the L4 vertebral body with internal fat is compatible with a hemangioma.OTHER: No significant abnormality noted.

Output: 1.Mildly complex cystic lesion without significant enhancement in the right lower pole is stable from prior MRI in 8/2015; this is likely benign in etiology. Simple renal cysts noted elsewhere.2.Focal stricture of the pancreatic duct without definite obstructing mass.3.Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: Right buttock pain and right heel numbness, evaluate for nerve root impingement Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Small disk bulge is seen at the T12-L1 level without significant stenosis. Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L5-S1: Disk dessication and minimal bulge. Mild endplate degenerative changes. There is minimal right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing. There is mild facet arthropathy throughout the lumbar spine. Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the lumbar spine with minimal right sided neural foraminal narrowing at L5-S1. No obvious impingement of the exiting right L5 nerve root. Spinal canal and neural foramina in the lumbar spine are otherwise patent.2. Mild multilevel facet arthropathy.


Instruction: Generate impression based on findings.

Input: Clinical question: History of gunshot wound thoracic spine 12-2014, T7 fracture, paraplegic, follow-up TLSO brace. Signs and symptoms: Follow-up TLSO brace, T7 fracture. Nonenhanced thoracic MRI:Examination demonstrates significant interval decreased bone marrow T2/T2 STIR hyperintensity consistent with edema secondary to fracture of the T7 and T8 vertebral bodies and the posterior elements since prior exam. Only trace residual edema ( T1 hypointense and T2 STIR hyperintense) remains in the superior left articulating facet of T8.There is normal signal intensity and the alignment of vertebral column otherwise.Examination demonstrate significant interval myelomalacia of the cord at T8-T10 with significant decreased cord caliber and to a lesser degree of the rest the of the thoracic cord.There is no detectable paraspinal soft tissue abnormalities.

Output: 1.Significant interval myelomalacia of the thoracic cord most severe at T8 to T10 levels as detailed.2.Near complete resolution of bone marrow edema secondary to prior fracture at T7 and T8 levels with only trace residual T2 hyperintensity in the left superior articulating facet of T8.3.Normal signal intensity and alignment of vertebral column otherwise.4.No spinal stenosis or neural foraminal compromise and no paraspinal soft tissue abnormalities.


Instruction: Generate impression based on findings.

Input: 80 year old with history of nonischemic cardiomyopathy, paroxysmal atrial fibrillation and PVCs s/p ablation presenting prior to planned AF ablation. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 35%, the LV end diastolic volume index is 114 ml/m2 (normal range: 65+/-11), the LVEDV is 199 ml (normal range 109+/-23), the LV end systolic volume index is 74 ml/m2 (normal range 18+/-5), the LVESV is 129 ml (normal range 31+/-10). There are left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. The indexed LA volume is 66 ml.RUPV: 17 x 14 mmRLPV: 15 x 12 mmLUPV: 25 x 25 mmLLPV: 25 x 18 mmRight VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 26%, the RV end diastolic volume index is 104 ml/m2 (normal range 69+/-14), the RVEDV is 181 ml (normal range 110+/-24), the RV end systolic volume index is 77 ml/m2 (normal range 22+/-8), and the RVESV is 134 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 mildly dilated (30 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 35%. There are left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 26%.3. Biatrial enlargement, left atrial measurements above.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: There is mild restricted diffusion predominantly involving the inferior cerebellar vermis on the right with also a punctate focus in the right inferior cerebellar hemisphere with slight evolution since outside MRI. No findings to suggest new infarct. There is T2/FLAIR hyperintensity associated with the cerebellar infarcts consistent with mild edema. There is a punctate focus of susceptibility in the right inferior cerebellum which may represent a microhemorrhage versus thrombus within a branch vessel, and also present on outside study.Remainder of the brain parenchyma is unremarkable. No intracranial mass or mass effect. No midline shift or herniation. Ventricles and sulci are within normal limits. Calvarium and intracranial soft tissue is unremarkable.MRA HEAD

Output: 1. Slight interval evolution of recent infarcts involving the right inferior cerebellar vermis and right cerebellar hemisphere. No new infarct.2. Dissection of the right vertebral artery primarily involving the V2 segment with near occlusion and milder irregularity and narrowing involving the right V3 segment. The intracranial right vertebral artery is small but this is nonspecific and favored to be developmental. Dominant left vertebral artery, basilar artery and remainder of the intracranial circulation appear patent.3. Punctate focus of susceptibility in the right inferior cerebellum which may represent a microhemorrhage or perhaps thrombosis within a branch vessel but unchanged.


Instruction: Generate impression based on findings.

Input: 53-year-old female with medial elbow pain after tendon debridement. Look at the ulnar collateral ligament. LIGAMENTS: Evaluation of the ulnar collateral ligament is limited on this non-arthrogram study, however, no intra-articular fluid extends beyond the sublime tubercle to suggest a tear. The ulnar collateral ligament appears intact within the limitations of this examination. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: Note is made of multiple foci of signal void within the common flexor tendon which are presumably representing a combination of postsurgical change and calcification. The common flexor and extensor tendons appear intact. The biceps and brachialis tendons appear intact. The triceps tendon is normal in appearance. A marker overlies the soft tissues of the antecubital fossa presumably corresponding to the patient's area of concern.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified.SURROUNDING STRUCTURES: The imaged musculature of the right elbow is normal.ADDITIONAL

Output: Postsurgical changes as described above without evidence of ulnar collateral ligament disruption. If further characterization is clinically warranted, MRI arthrogram examination could be considered.


Instruction: Generate impression based on findings.

Input: Lymphoma with recent PET showing a new neck lesion. There is an enhancing nodule in the left prestyloid parapharyngeal space that measures 8 x 12 mm in axial cross-section. There is no significant lymphadenopathy in the neck otherwise. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are intact. The osseous structures are unremarkable, aside from mild lower cervical spine degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: A left parapharyngeal lesion may represent a manifestation of lymphoma.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: Patient with AMS; concern for acute CVA, PRES, any enhancement suggestive of meningitis/encephalitis History: as above No evidence of acute ischemic or hemorrhagic lesion on the scan.Few scattered patchy T2/FLAIR high signal intensities suggest minimal non specific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening on the right maxillary sinus.

Output: Minimal non specific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 34-year-old female with a history of bilateral mastectomy and reconstruction in May 2002 for right breast cancer (prophylactic left mastectomy) and subsequent FNA positive right axillary metastatic disease and lymph node dissection in April 2003. Itching and pain in the right breast near the nipple areola complex. Status post bilateral mastectomy and reconstruction with no remaining visible glandular tissue.No parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either reconstructed breast. The bilateral silicone breast implants are intact. There is susceptibility artifact from clips and right axillary scar tissue in the lymph node dissection bed. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Other malformations of cerebral vessels [Q28.3] / Other nontraumatic intracerebral hemorrhage [I61.8], Reason for Study: ^Reason: CCM brain with recent hemorrhage, 6 month follow up to eval for changes History: hemorrhage CCM Previously seen 3rd ventricular hemorrhagic lesion has been continuously evolving in its shape and MR characteristics. In terms of its size, the maximum diameter appears to be stable around 9mm but the configuration has been slightly elongated toward craniocaudal direction since prior scan.In addition, the superior aspect of the lesion is now showing typical multi compartmentalized appearance with fluid fluid level within those compartments (arrows). There is no evidence of Gad enhancement of the lesion. There is no other susceptibility lesion seen on this scan.Constellation of above findings suggest the diagnosis of cavernous malformation. The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings on bilateral maxillary sinuses and ethmoid sinuses.

Output: 1. Continuously evolving 3rd ventricle hemorrhagic mass lesion with more conspicuous multi compartmentalization with intra compartmental fluid-fluid level indicating the diagnosis of cavernous malformation.2. No significant interval change of the size of the lesion since prior scan. No new susceptibility lesion is seen.


Instruction: Generate impression based on findings.

Input: 42 year-old female with history of pain. LEFT KNEE: MENISCI: There is blunting of the free edge of the body of the lateral meniscus, however we see no fluid filled tears. The medial meniscus is slightly attenuated which may reflect chronic attritional tearing, but again we see no discrete fluid-filled tear.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the patella and femoral trochlea indicating osteoarthritis. There is near full thickness degeneration of the articular cartilage of the lateral tibial plateau with relative sparing of the lateral femoral condyle and medial tibial femoral compartment. There is edema within the lateral tibial plateau extending into the intercondylar eminence of the tibia as well as the proximal tibial metaphysis. This is nonspecific, but we suspect this may be degenerative in etiology or the result of an occult subchondral fracture which is not well visualized on this study.The superior aspect of the femoral trochlea appears shallow along with prominence of the lateral facet suggesting femoral trochlear dysplasia. The tibial tuberosity to trochlear groove distance measures 14 mm, which is at the upper limits of normal. The Insall-Salvati ratio is 1.2, borderline.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Left Knee:1. Osteoarthritis predominantly affecting the patellofemoral and lateral tibiofemoral compartments with anatomic findings suggestive of femoral trochlear dysplasia.2. Edema within the proximal tibia is nonspecific and may be degenerative in etiology, although a small subchondral fracture is also a diagnostic consideration.Right knee:1. Osteoarthritis as above particular affecting the patellofemoral joint with anatomic findings which may predispose to patellofemoral instability.


Instruction: Generate impression based on findings.

Input: 61-year-old female with recurrent left thigh pain and back pain, history of L4/5 left foraminal herniation Redemonstrated is mild generalized narrowing of the spinal canal which is believed to be at least partially secondary to congenital anatomical variation of the short pedicles. A left simple renal cyst is stable.T10/11 demonstrates bilateral ligamentum flavum hypertrophy which results in mild bilateral neural foraminal stenosis.T11/12 demonstrates significant asymmetric left-sided ligamentum flavum hypertrophy which results in mass-effect and forward displacement of the cord and central spinal stenosis. Moderate to significant right neural foraminal compromise is also detected. These findings are unchanged. Previously demonstrated mild increased T2 signal intensity of the cord is not well demonstrated on the current exam given the lack of axial T2 imaging.T12/L1 demonstrates asymmetric right-sided ligamentum flavum hypertrophy and mild bilateral facet disease. There is significant right neural foraminal compromise, no central spinal stenosis and patent the left neural foramina. These findings are unchanged.L1/2 demonstrates moderate bilateral (right greater than left) ligamentum flavum hypertrophy and mild right facet hypertrophy. There is significant right neural foraminal compromise, no central spinal stenosis and patent the left neural foramina. These findings are unchanged.L2/3 demonstrates mild disk disease and loss of disk height, mild left and moderate right facet and ligamentum flavum hypertrophy. There is a linear T2 hyperintensity in the annulus of the disk laterally on the left consistent with an annular fissure. There is moderate bilateral neural foraminal compromise. These findings are unchanged. Secondary to slight increase in posteriorly located epidural fat, there is now moderate central stenosis (previously mild to moderate). L3/4 demonstrates mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy, mild degenerative facet disease and evidence of bilateral facet effusion. There is mild to moderate bilateral neural foramina compromise. These findings are unchanged. Secondary to increasing posteriorly located epidural fat, there is now moderate central spinal stenosis (previously mild).L4/5 demonstrates postoperative changes with resection of a left foraminal/lateral disc herniation. Enhancement is noted within the operative approach, surrounding the L4 nerve roots, however without associated mass effect. Redemonstrated is mild degenerative disk disease and loss of disk height, mild to moderate bilateral facet and ligamentum flavum hypertrophy. Moderate left neural foraminal and moderate to severe right neural foraminal stenosis are unchanged. Secondary to increasing posteriorly located epidural fat, there is now mild central stenosis (previously no stenosis).L5/S1 demonstrates mild disc disease and loss of disk height, moderate bilateral facet hypertrophy and mild ligamentum flavum. No central spinal stenosis. Moderate (left greater than right) neural foraminal compromise is present. These findings are unchanged.Unremarkable paraspinal soft tissues other than above mentioned left renal cyst.

Output: 1.T10/11: mild bilateral neural foraminal stenosis.2.T11/12: Moderate to significant right neural foraminal compromise and central stenosis is unchanged. Previously demonstrated mild increased T2 signal intensity of the cord is not well demonstrated on the current exam given the lack of axial T2 imaging.3.T12/L1: Right neural foraminal compromise is unchanged.4.L1/2: Right neural foraminal compromise is unchanged.5.L2/3: Moderate bilateral neural foraminal compromise is unchanged. Secondary to slight increase in posteriorly located epidural fat, there is now moderate central stenosis (previously mild to moderate). 6.L3/4: Mild to moderate bilateral neural foramina compromise is unchanged. Secondary to increasing posteriorly located epidural fat, there is now moderate central spinal stenosis (previously mild).7.L4/5: Postoperative changes with resection of a left foraminal/lateral disc herniation. Enhancement is noted within the operative approach, surrounding the L4 nerve roots, however without associated mass effect. Redemonstrated is moderate left neural foraminal and moderate to severe right neural foraminal stenosis, unchanged. Secondary to increasing posteriorly located epidural fat, there is now mild central stenosis (previously no stenosis).8.L5/S1: Moderate (left greater than right) neural foraminal compromise is unchanged.


Instruction: Generate impression based on findings.

Input: 84 year old with fall. Diffuse decreased periventricular white matter attenuation, representing age -- indeterminate small vessel disease. The ventricles are midline and normal in size, and there is no intracranial hemorrhage or abnormal extra-axial fluid.A calcified mass is again seen projecting from the left side of the falx anteriorly (image 19/30 bone windows), representing the patient's known meningioma. No CT is available for comparison, however when compared to the MRI dated 2004, this is likely stable.The calvarium is normal and the mastoid air cells and visualized paranasal sinuses are normally pneumatized. Diffuse calcifications of the vertebrobasilar system and circle of Willis are present.

Output: Diffuse periventricular small vessel white matter ischemic disease, age-indeterminate, and a stable left frontal meningioma. No intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: thyroid nodule seen on routine CT for GIST History: none RIGHT LOBE MEASUREMENTS: 6.0 x 2.1 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.9 x 1.8 x 1.5 cmISTHMUS MEASUREMENTS: 0.22 cmRIGHT LOBE: Within the right lobe there is a heterogeneous thyroid nodule with internal cystic and solid components measuring 2.1 x 1.3 x 1.6 cm. There is some internal vascularity. No calcifications, no ringdown, and no pseudocapsule is present.LEFT LOBE: Within the left thyroid lobe there is a small hypoechoic nodule measuring 1.3 x 1.1 x 0.9 cm. The remainder of the left thyroid lobe is normal in appearance.ISTHMUS: There is a nodular focus measuring 1.4 x 1.4 x 1.4 cm. The remainder of isthmus is normal in appearance.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small benign appearing lymph nodes are present.OTHER: No significant abnormality noted.

Output: Dominant mixed solid and cystic nodule in the right thyroid lobe. Small left thyroid and isthmus nodules.


Instruction: Generate impression based on findings.

Input: Diagnosis: Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticusClinical question: structural abnormalitiesSigns and Symptoms: epilepsy, abnormal EEG The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No intracranial lesions are identified which could explain the patient's epilepsy


Instruction: Generate impression based on findings.

Input: NECK: There are extensive postoperative findings related to right orbital and sinonasal exenteration with myocutaneous flap reconstruction. There has been marked interval decrease in size of the enhancing lesion in the roof of the left posterior nasopharynx along the surgical margin, now measuring up to approximately 5 mm, previously 15 mm. In addition, the previously demonstrated punctate right temporal scalp subcutaneous tissues nodule is no longer apparent. The right temporal fossa enhancing lesion with an adjacent underlying calvarial defect has decreased in size, measuring up to 5 mm, previously 9 mm. Likewise, the right squamosal temporal bone calvarial lesion with extension into the overlying scalp has decreased in size, now measuring up to approximately 4 mm, previously 6 mm. The right mandibular body lesion is also smaller, measuring 14 mm in the anteroposterior dimension, previously 16 mm, such that the lesion no longer protrudes through the anterior cortical defect. There is unchanged asymmetric enhancement in the right foramen rotundum. There are persistent obstructed secretions in the frontal and sphenoid sinuses with new mucosal thickening and fluid level in the left maxillary sinus. There is nonspecific high T2 signal in the right mastoid air cells. There is no evidence of significant lymphadenopathy in the neck. The thyroid and salivary glands appear unchanged.BRAIN: There is no abnormal intraparenchymal enhancement, acute infarct, mass, herniation, or midline shift. There are unchanged scattered T2 hyperintensities in the subcortical and periventricular white matter, which are nonspecific. The ventricles and sulci are unchanged.

Output: 1.Interval decrease in size of the metastases in the skull and mandible, left posterior nasopharynx along the surgical margin, and in the right scalp have decreased in size, consistent with response to therapy.2.Persistent mild asymmetric enhancement in the right foramen rotundum may be post-treatment in nature.3.No evidence of intraparenchymal brain metastases.4.Findings suggestive of acute left maxillary sinusitis with otherwise persistent obstructed secretions associated with the exenteration flap.


Instruction: Generate impression based on findings.

Input: Possible visual deficit, increased headaches. There is a small subdural hematoma along the right cerebral convexity which measures up to 5 mm in thickness, previously approximately 3 mm. There is no significant mass effect. The ventricles and sulci are slightly larger compared to 5/15/2015 likely indicating resolution of previously seen mild cerebral edema. Blood products are noted within the left inferior frontal lobe and medial cerebellar hemispheres on the susceptibility sensitive sequence.Subtle T2/FLAIR hyperintensity again seen along the lateral orbital frontal gyrus, slightly less prominent than before. Previously seen subtle T2 signal involving the medial cerebellar hemispheres also less prominent. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable. Major flow-voids are preserved. Diffuse paranasal sinus opacification is again seen but appears improved since 5/15/2015. Please note left orbital fractures are better seen on prior CT.Postcontrast demonstrate diffuse dural enhancement which may be reactive to the subdural blood products.Dedicated images of the orbits demonstrate no abnormal signal within the optic nerves or evidence of mass effect. No retrobulbar hematoma. Minimal edema is seen involving the left periorbital soft tissues. There is subtle asymmetrically increased T2 signal and enhancement involving the left superior and lateral recti musculature which may represent minimal intraorbital soft tissue edema (for example coronal STIR image 14). No discrete intraorbital hematoma is appreciated.

Output: 1. Compared to 5/15/2015, there is mild increase in size of small subdural hematoma along the right cerebral convexity measuring up to 5 mm, previously 3mm, but without significant mass effect. Finding is at least in part related to decreased tamponade effect from previously seen mild cerebral edema which has since improved. Diffuse dural enhancement is noted which may be reactive to the subdural collection.2. Evolution of small foci of hemorrhagic contusions involving the left orbitofrontal gyri with decrease in mild associated edema. Minimal blood products are also noted involving the medial bilateral cerebellar hemispheres with decrease in associated edema seen previously. 3. Left orbital fractures are better seen on prior CT. No appreciable T2 signal/edema or enhancement involving the optic nerves or chiasm is appreciated. Minimal left intra-orbital soft tissue edema as described above. No discrete intra-orbital hematoma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Spinal stenosis, lumbar region CervicalgiaClinical question: eval for stenosis.Signs and Symptoms: Left > right hand numbness. Neck pain Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is heterogeneous marrow replacement throughout the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a disc bulge present at this level associated with mild narrowing of the neural foramina bilaterally. There are associated uncovertebral osteophytes at this level.At C4-5 there is no significant compromise to the spinal canal. There are small endplate and uncovertebral osteophytes present with narrowing of the neural foramina.At C5-6 there are endplate and uncovertebral osteophytes present associated with partial effacement of spinal fluid ventral to the spinal cord and encroachment of the neural foramina bilaterally more on the left than the right side where there is encroachment of the left-sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are uncovertebral osteophytes present bilaterally associated with disc material and mild narrowing of the neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is straightening of the normal cervical curvature. There is diffuse marrow replacement throughout the area vertebral musculatureAt L5-S1 there is loss of disc space height, disc desiccation and endplate reactive changes associated with a diffuse disc bulge. Endplate reactive changes are high signal on T1 indicating that they are chronic. There is right-sided facet hypertrophy more than left-sided facet hypertrophy at this level. There is narrowing of the neural foramina bilaterally with mild encroachment of the right-sided exiting nerve roots within the neural foramen. There is a left far lateral disc protrusion present at this level which abuts and displaces the left-sided exiting nerve roots after they exit the neural foramina.At L4-5 there is loss of disc space height, disc desiccation and endplate reactive changes associated with a diffuse disc bulge. Endplate reactive changes are high signal on T1 indicating that they are chronic. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height, disc desiccation and a mild disc bulge at this level. There is mild ligamentum flavum and facet hypertrophy at this level. There is crowding of the nerve roots within the thecal sac at this level. This crowding in part is related to epidural lipomatosis.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level. There is some crowding of nerve roots within the thecal sac at this disc space level. This crowding in part is related to epidural lipomatosisAt L1-2 there is no significant compromise to spinal canal or neural foramina.At T11-T12 on sagittal imaging there is a disc bulge present which mildly effaces spinal fluid ventral to the spinal cord.

Output: 1.There are multilevel degenerative changes present in the cervical spine worse at C5-6 where there is encroachment of the left-sided exiting nerve roots. There are mild degrees of encroachment of exiting nerve roots at C4-5 and C5-6 and on the right-sided C5-6.2.Heterogeneous marrow replacement in the spine is a nonspecific finding. It could be related to anemia, lymphoproliferative sarcoma myeloproliferative disorder or chronic disease. It is nonspecific.3.There are multilevel degenerative changes present in the lumbar spine. There are some superimposed epidural lipomatosis. This leads to narrowing of the thecal sac with spinal stenosis at L3-4 and L2-3.4.There is encroachment of the exiting nerve roots within the right neural foramen at L5-S1 related to disc disease.5.There is some displacement of the left-sided exiting nerve roots at L5-S1 after exiting the neural foramen related to a left far lateral disc protrusion.


Instruction: Generate impression based on findings.

Input: T1N2 EBV-associated poorly differentiated nasopharyngeal squamous cell carcinoma status post treatment. There are post-treatment findings in the nasopharyngeal region without evidence of measurable tumor in the treatment bed. There is no significant region lymphadenopathy. There appears to be mild patchy edema in the right aspect of the clivus, which may be treatment-related. The skull base otherwise appears to be intact. The imaged intracranial structures and orbits are unremarkable. There is scattered nonspecific bilateral mastoid fluid signal. There is scattered paranasal sinus mucosal thickening.

Output: No evidence of measurable residual or recurrent nasopharyngeal tumor.


Instruction: Generate impression based on findings.

Input: Female, 44 years old. Reason: Hx of thyroid nodules- monitoring RIGHT LOBE MEASUREMENTS: 2.0 x 1.5 x 4.1 cmLEFT LOBE MEASUREMENTS: 2.0 x 1.5 x 4.4 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Mildly heterogeneous echotexture. An upper pole nodule measures are 0.7 x 0 .4 x 0 .6 cm, stable from prior, spongiform and well marginated, nonvascular. A midpole nodule measures 0.3 x 0.1 x 0.2 cm, stable from prior, homogeneous and hypoechoic, nonvascular.LEFT LOBE: Mildly heterogeneous echotexture. A mid to lower pole nodule measures 0.3 x 0.2 x 0.3 cm, partially visualized on the prior exam, well marginated, hypoechoic, nonvascular.ISTHMUS: Mildly heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 2 lymph node measures 0.9 x 0.7 x 1 .8 cm, with a fatty hilum. A left level 2/3 lymph node measures 0.8 x 0.5 x 1 .0 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: Stable examination. Unchanged subcentimeter thyroid nodules.


Instruction: Generate impression based on findings.

Input: Cervical stenosis. There is extensive ossification of the posterior longitudinal ligament from C4 to T1 with mild compression of the spinal cord at C3-4 to C4-5, but there is no discernible spinal cord signal abnormality. There is also mild indentation of the anterior aspect od the spinal cord at the C6-7 level, but the posterior thecal sac cerebrospinal fluid space is maintained at this level. There are lesser degrees of spinal canal narrowing at the other levels. There is an anterior osteophyte that bridges the C5-6 disc space, which suggests a limited manifestation of DISH. There are small disc-osteophyte complexes at C6-7, C7-T1, and T1-2, with up to mild neural foraminal narrowing at these levels. There is no evidence of bone marrow edema. There is no spondylolisthesis. The vertebral body heights are preserved. The imaged paraspinal soft tissues and intracranial structures are unremarkable.

Output: Extensive ossification of the posterior longitudinal ligament from C4 to T1 with mild compression of the spinal cord at C3-4 to C4-5.


Instruction: Generate impression based on findings.

Input: An area of restricted diffusion is seen in the right deep frontal white matter with somewhat more extensive high T2/FLAIR signal, representing acute ischemia but with probable underlying T2 shine through from more chronic changes. A punctate focus of restricted diffusion in the left superior frontal gyrus demonstrates corresponding high signal on T2 and FLAIR. There is a prominent somewhat linear are of restricted diffusion in the right temporal lobe with T2/FLAIR hyperintensity representing acute ischemia. A focus of mild diffusion hyperintensity and ADC isointensity is also visualized in the left parietal lobe. These findings are consistent with areas of recent ischemia, likely of slightly varying age.In addition, the T2/FLAIR hyperintensities are seen in the basal ganglia, midbrain, pons, cerebellar white matter bilaterally, as well as more extensively in the subcortical and periventricular white matter are consistent with chronic small vessel ischemic changes. There are multiple scattered CSF irregular foci in the white matter consistent with chronic lacunar infarcts.There are multiple scattered foci of susceptibility likely relating to chronic blood products from previous microhemorrhages.Ventricular size is normal with no evidence of midline shift. Basal cisterns are patent. No evidence of herniation. Vascular flow voids are normal.There is opacification of the left sphenoid sinus with inspissated secretions extending to the left ethmoid sinus.

Output: 1. Scattered foci of bilateral acute to likely subacute supratentorial infarcts which may be embolic.2. Multiple chronic lacunar infarcts with extensive chronic white matter chronic ischemic changes especially for patient age.3. Multiple foci of susceptibility likely relating to chronic microhemorrhages.


Instruction: Generate impression based on findings.

Input: Vascular and nutrition access needed, evaluate vasculature in the neck and chest CHEST: LUNGS AND PLEURA: Large left pleural effusion with collapse of the left lung. Small right pleural effusion.MEDIASTINUM AND HILA: NG tube in the stomach.VASCULATURE: The left internal jugular vein is patent with a focus of ectasia just superior to its confluence with the subclavian vein (series 601, image 17). The right internal jugular vein is not visualized. The SVC appears small in caliber but patent proximally on postcontrast imaging. The distal SVC is not well visualized on postcontrast imaging, but appears patent on the coronal FIESTA sequence. There is a three-vessel aortic arch with a typical configuration of the major branch vessels. CHEST WALL: No significant abnormality noted.

Output: 1. Small caliber SVC with findings suggestive of patency on this limited exam.2. Patent left internal jugular vein. Nonvisualization of the right internal jugular vein.3. Large left pleural effusion with collapse of the left lung. Small right pleural effusion.


Instruction: Generate impression based on findings.

Input: Dizziness, abnormal CT No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is moderate degree of T2/FLAIR hyperintensity involving the right greater than left frontal and parietal subcortical and periventricular white matter. There are focal areas of cystic change in the left frontal and left parietal white matter which may represent small areas of cystic encephalomalacia or prominent perivascular spaces. No large vascular distribution infarcts are evident. Major flow-voids are preserved with incidental note of variant anatomy with occipital sinus on the left. There is mild volume loss involving the left parietal lobe without underlying large infarcts. No abnormal parenchymal or meningeal enhancement.There is slight prominence of the vascularity in the right cerebral hemisphere. Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits. There is extensive opacification involving the right maxillary sinus with polypoid soft tissue extending into the right nasal cavity. There is also moderate opacification of the right greater the left frontal and ethmoid sinuses.

Output: 1. Extensive areas of T2/FLAIR hyperintensity in the periventricular and subcortical white matter in the frontal and parietal lobes. Finding may be related to vasculopathy. Entities such as CADASIL could be considered although the relatively characteristic anterior temporal pole lesions are not present. Demyelinating disease is also in the differential although the morphology and distribution of these lesions is not typical for multiple sclerosis. 2. There is asymmetric volume loss involving the left parietal lobe and apparent relative increased vascularity in the right cerebral hemisphere. These findings may also be related to a chronic vasculopathy. Leukomalacia related to remote perinatal injury is also a possibility. 3. No evidence of acute infarct or intracranial mass effect. No abnormal parenchymal or meningeal enhancement.4. Moderate paranasal sinus opacification as detailed above.


Instruction: Generate impression based on findings.

Input: Left hip pain There is severe osteoarthritis of the left knee as evidenced by subchondral sclerosis, subchondral cystic change, and joint space narrowing. Moderate to severe osteoarthritis of the right hip also noted. There is no malalignment. Moderate multilevel degenerative changes of the lower lumbar spine also noted.

Output: Severe osteoarthritis of the hip.


Instruction: Generate impression based on findings.

Input: Female 18 months old Reason: MRV of hepatic vasculature to evaluate patency of portal venous system in pt with abnormal vasculature around gall bladder. History: portal hypertension ABDOMEN:Motion artifact limits evaluation.LIVER, BILIARY TRACT: Portal vein is patent. Multiple portosystemic collateral vessels adjacent to the gallbladder again noted. No biliary ductal dilatation. No focal hepatic mass.SPLEEN: The spleen is enlarged.PANCREAS: Pancreas is normal in appearance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Syringohydromyelia in the distal spinal cord is again noted, please refer to moderate lumbar spine 1/21/2015.

Output: 1.Gallbladder varices. Patent portal vein.


Instruction: Generate impression based on findings.

Input: TAPVR repair. 15q11.2 deletion, 2p25.1 duplication, and 16q11.2 duplication. There is no evidence of acute infarct or gross structural abnormalities of the brain. There is a punctate focus of susceptibility effect in th right temporal lobe. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. There is mild asymmetry of the temporal horns. The ventricles and basal cisterns are otherwise 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: A punctate focus of susceptibility effect in the right temporal lobe may represent previous hemorrhage. Otherwise, no gross structural abnormalities of the brain are evident.


Instruction: Generate impression based on findings.

Input: 74 years, Male, Reason: 74M with hx of pancreatic pseudocyst History: Pancreatic pseudocyst. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis. Mild hepatic steatosis.There is narrowing of the distal common bile duct, however the proximal common bile duct itself is normal in caliber. There is mild intrahepatic biliary ductal dilatation.SPLEEN: Splenic vein thrombosis is unchanged.PANCREAS: Fluid collection along the body of the stomach has resolved. There is normal enhancement of the head, neck and proximal body of the pancreas with atrophy of the distal body and tail.There is a blunted response to secretin administration with multiple dilated side branches along the course of the main pancreatic duct. The main pancreatic duct has areas of narrowing and irregularity.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.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.Resolution of peripancreatic fluid collection.2.Findings of chronic pancreatitis with irregularity and dilated side branches along the pancreatic duct.3.Stenosis of the distal common bile duct with mild intrahepatic biliary ductal dilatation.4.Stable splenic vein thrombosis.5.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Unspecified fall, initial encounter [W19.XXXA], Reason for Study: ^Reason: r/o cord compression History: s/p fall, profound weakness. There is about 10% compression fracture of T12 vertebral body with the vertebral body bone marrow edema.In addition, there is high signal intensity on T 11-12 inter-spinous process ligament as well as subcutaneous tissues overlying T 11-12 spinous process indicating soft tissue contusion and possible T 11-12 intraspinous ligament injury.However, alignment of thoracic vertebral bodies appears to be maintained.There is normal cervical lordosis. The cranial-cervical junction appears to be normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1. There is no evidence of cord compression or mass.

Output: 1. Compression fracture of T12 vertebral body with about 10% height loss with possible associated T11-12 interspinous process injury and soft tissues overlying T11-12 spinous process contusion.2. No evidence of spinal cord compression or abnormal MR signal intensity.


Instruction: Generate impression based on findings.

Input: Right asymmetrical sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is fluid in the right mastoid air cells. The left mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. Fluid in the right mastoid air cells may represent acute mastoiditis.


Instruction: Generate impression based on findings.

Input: Reason: 5yo F with new onset seizures, possible left basal ganglia hypoattenuation on OSH head CT History: New onset seizure, possible left basal ganglia hypoattenuation on OSH head CT There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a solitary punctate focus in the left subinsular white matter which is hyperintense on T2 and FLAIR and hypointense on T1. This is notably not in the basal ganglia, which appear normal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.

Output: 1.No basal ganglia lesion or other finding to account for patient's seizures.2.Solitary punctate foci of increased T2 signal in the left subinsular white matter appears chronic and is nonspecific but may reflect a remote insult.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact. There is a focus of decreased diffusion and T2 hyperintensity centered within the right hemi-pons. There are scattered additional foci of T2 hyperintensity throughout the supratentorial white matter. There is a fluid signal intensity well-defined lesion within the pineal cistern that measures up to 18 mm. There is no midline shift or herniation. The vertebrobasilar flow voids are relatively inconspicuous. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is a left lens implant.

Output: 1. Acute right brainstem infarct without evidence of hemorrhagic transformation, but the vertebrobasilar flow voids are relatively inconspicuous. Dedicated vascular imaging is recommended.2. Mild chronic small vessel ischemic disease. 3. Pineal cyst.


Instruction: Generate impression based on findings.

Input: Osteoarthritis, severe back pain Thoracic: Thoracic vertebral body heights are maintained. Alignment is maintained. No significant spinal canal or neural foraminal stenosis is seen. Thoracic cord is normal in signal and contour. Bone marrow signal is benign with no suspicious lesions. Mild degenerative changes are seen with minimal disk bulges at T2-T3, T3-T4, T4-T5, T5-T6, T6-T7, T7-T8, and T8-T9. Overall appearance is not significantly changed since 4/9/2011.Lumbar: Numbering is performed as per prior studies with the most inferior well-defined disc space labeled L5-S1. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is no significant disk disease at any level. There is no significant spinal canal or neural foramina stenosis at any level in the lumbar spine. There is facet arthropathy in the lumbar spine, particularly at the L5-S1 level, and is not significantly changed. Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the thoracic spine and lumbar spine without significant spinal canal stenosis or neural foramina stenosis at any level in the thoracic or lumbar spine. No compression fractures.2. There is facet arthropathy in the lumbar spine, particularly at L5-S1, which may be contributing to patient's low back pain. Appearance is similar to prior study from 2005.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness. Lumbar spine from September 29, 2015 indicated foraminal stenosis. History of bladder cancer treated with neoadjuvant chemotherapy and then radical cystectomy/ileal conduit in Feb 2015. This is a limited examination performed only in the sagittal plane with T1 and STIR sequences to rule out spinal cord compression. The alignment is anatomic. The vertebral bodies are preserved in height. There is a focus of T1-hypointense, T2 hyperintense signal in the inferior aspect of T9 vertebral body. This was not included on the recent lumbar spine MRI examination. Other than degenerative mild to moderate narrowing of the spinal canal at C5-C6, the spinal canal is preserved. Apparent high T2 signal along the cervical spinal cord extending from C3 through C6 is likely artifactual. The spinal cord otherwise displays normal morphology and signal. There is multilevel lumbar spondylosis, including bilateral L5-S1 neural foraminal narrowing caused by a disc-osteophyte complex and facet arthropathy. There is a partially-imaged heterogeneous and lobulated mass in the right side of the pelvis. There is presacral edema.

Output: 1.No evidence of spinal cord compression. 2. Partially-imaged large pelvic mass likely represents recurrent tumor. Please refer to the separate pelvis and abdomen CT report for additional details.3. A lesion in the T9 vertebral body is nonspecific, but may represent a metastasis.4. Multilevel degenerative spondylosis in the lumbar spine and cervical spine is otherwise incompletely assessed on this examination.


Instruction: Generate impression based on findings.

Input: 39-year-old female with history of gastric cancer status post total gastrectomy. ABDOMEN:LIVER, BILIARY TRACT: There is a right percutaneous biliary drainage catheter with distal tip in the duodenum. There is persistent significant bilateral intrahepatic biliary ductal dilatation with shouldering and sharp cut off of the left hepatic duct near Klatskin's point. There is long segment narrowing of the common bile duct. No focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: There is soft tissue fullness of the pancreatic head and porta hepatis which significantly narrows the proximal main portal vein (image 17-18 of series 5). Additionally, there is sharp cutoff of the pancreatic duct at the pancreatic head/neck with atrophy of the remaining pancreas and ductal dilatation measuring up to 7 mm. There is mildly increased restricted diffusion within this area without appreciable differences in enhancement when compared to the background atrophied pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post Roux-en-Y gastrectomy. No drainable fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Fullness at the pancreatic head extending into the porta hepatis with associated sharp attenuation and narrowing of the main portal vein, dilated pancreatic duct with abrupt cutoff seen at level of head, intrahepatic biliary duct dilatation (more pronounced on left side; right side decompressed by biliary drainage catheter) and long segment narrowing of the common bile duct suggested. Although it is difficult to delineate a measurable obstructing lesion, constellation of findings are suspicious for an infiltrative neoplasm, such as an extrahepatic cholangiocarcinoma or pancreatic head carcinoma. Extrinsic lymphadenopathy and benign stricturing is considered less likely.2. Postoperative changes as above.


Instruction: Generate impression based on findings.

Input: 59-year-old female with metastatic neuroendocrine tumor of liver and jejunum, status post resection. Complains of right upper quadrant pain since surgery of liver on 10/2015. ABDOMEN:LIVER, BILIARY TRACT: Multiple subcentimeter hepatic cysts versus hamartomas. There is a 3 x 3.2 cm well-circumscribed hepatic cyst in hepatic segment 5. In the lateral hepatic dome, there is a 3.2 x 2.5 cm lobulated T2 hyperintense lesion (axial series 10 image 7). This lesion is hyperintense on T1 (axial series 11 image 23), and anteriorly there is a small focus of susceptibility artifact (axial series 11 image 24). Restricted diffusion is also noted. The lack of intravenous contrast limits further evaluation.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: Suspected osseous hemangioma at L2 (coronal series 8 image 23).OTHER: No significant abnormality noted.

Output: 1.Lobulated 3.2 x 2.5 cm lesion of the anterolateral hepatic dome. The hyperintense signal on T2 and diffusion-weighted imaging could represent residual disease. The precontrast increased T1 signal intensity and small focus of adjacent susceptibility artifact could be related to hemorrhage or posttreatment effect. The lack of intravenous contrast markedly limits the evaluation, and correlation with procedural history and prior imaging is suggested.2. Suspected osseous hemangioma of the L2 vertebral body.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with history of T-cell lymphoma and spinal metastases, status post extensive thoracic and lumbar spinal surgery, with chronic right lower extremity weakness. Dependent on walker/wheelchair, but able to ambulate at baseline. Now with worsened right lower extremity weakness and inability to ambulate. Cervical:There may be a mild curvature of the cervical spine in the coronal plane, but this could be positional. Sagittal alignment is unremarkable.Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic cord or leptomeningeal enhancement is observed.Minimal disc degeneration is seen without significant compromise of the spinal canal or neural foramina.Thoracic:Evidence of instrumented posterior fusion is again seen beginning at T4 and continuing down to T11. The T8 vertebral body shows complete loss of height with artifact related to a spacer device within the right aspect of the vertebral body. These findings are unchanged from prior.The T10 vertebral body remains partially compressed with heterogeneous marrow signal, similar to prior. The remaining vertebral bodies demonstrate relatively unremarkable or only mildly heterogeneous marrow signal characteristics. No pathologic enhancement is suspected.A mild focal kyphosis is evident at the T3-4 level. A focal kyphosis is also evident at the T8 level. Anterior subluxation of T7 relative to T9 is unchanged.The spinal canal remains mildly narrowed at the T8 level due to vertebral body subluxation and and the compression deformity, but there is evidence of posterior decompression and the overall appearance is unchanged. Artifact from orthopedic instrumentation prevents accurate assessment for subtle cord signal abnormality, but no significant interval changes are suspected.No significant disc bulging or disc herniation is seen. The spinal canal is otherwise patent. The T8-9 neural foramina are not well visualized but are presumably significantly narrowed.Opacification possibly representing atelectasis is seen in the lung bases.Lumbar:Based on vertebral body counting from above, and the location of the last set of ribs, there are four lumbar type vertebral bodies.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic intraspinal enhancement is suspected.The intervertebral disc spaces are preserved with no significant disc bulge or disc herniation identified. Facet hypertrophy develops at lower lumbar levels. The spinal canal and neural foramina remain patent.

Output: 1.Demonstration of findings related to extensive posterior instrumented fusion in the thoracic spine with a complete compression of the T8 vertebral body. The spinal canal may be mildly narrowed at this level, but has been decompressed posteriorly and the appearance is unchanged.2.Mild compression of the T10 vertebral body along with heterogeneous marrow signal characteristics suggesting treated disease are unchanged. No new compression deformity or pathologic marrow process is suspected.3.Relatively unremarkable evaluations of the cervical and lumbar spine with no new or significant findings to account for the patient's worsening symptoms.


Instruction: Generate impression based on findings.

Input: T1 axial anatomic images again demonstrate mild asymmetric enlargement right temporal horn. The hand, foot, and tongue sensory and motor activation centers map to their expected locations along the pre- and post central gyri. Language is left dominant with Broca's area mapping to the left pars triangularis and pars operculararis while two regions of activation within the posterior left superior temporal gyrus are compatible with Wernicke's area.

Output: 1.Left dominant language activation.2.Hand, foot, and tongue motor and sensory activation is found in their expected locations along the pre- and post-central gyri.


Instruction: Generate impression based on findings.

Input: 18 year-old male with chronic shoulder pain The muscles and tendons of the rotator cuff are intact. Contrast outlines a Bankart lesion of the anterior/inferior glenoid with avulsed labrum, cartilage and small osseous component involving nearly the entire anteroinferior glenoid (image 21, series 6). Contrast also extends superiorly within the superior labrum from anterior to posterior (image 9, series 2) consistent with a SLAP tear. There are small cysts within the lateral humeral head. The bone marrow signal is otherwise normal for age. The AC joint is normal. Glenohumeral alignment is within normal limits. Muscle bulk is within normal limits.

Output: Complex Bankhart lesion and SLAP tear as described above.


Instruction: Generate impression based on findings.

Input: Left knee pain following injury MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a nondisplaced fracture of the lateral tibial plateau without definite intra-articular extension or articular collapse. An additional nondisplaced fracture through the fibular head is also seen. No full-thickness articular cartilage defects are identified within the medial, lateral, or patellofemoral compartments.LIGAMENTS: The cruciate ligaments are intact. There is edema type signal within the posterolateral corner of the knee raising the concern for posterolateral corner injury. The popliteal fibular ligament is not seen concerning for rupture and there is additional edema type signal near the attachment of the biceps femoris which may through the result of partial tearing or secondary to the bony changes described above. The popliteus tendon is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Nondisplaced fractures of the lateral tibial plateau and fibular head.2. Extensive edema within the posterolateral corner of the knee suggesting posterolateral corner injury. There is absence of the popliteal fibular ligament with additional edema near the attachment of the biceps femoris which may be the result of partial tearing or secondary to the adjacent bony changes.


Instruction: Generate impression based on findings.

Input: 22-year-old male with left knee pain and swelling. MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow signal abnormality in the lateral femoral condyle and lateral tibial plateau consistent with bone contusions. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: There is disruption of the superficial fibers of the medial collateral ligament. There is increased signal abnormality within the deep fibers of the medial collateral ligament with possible disruption at the level of its insertion on the medial femoral condyle. There is a small amount of fluid within the MCL bursa. The cruciate ligaments appear intact. The lateral collateral ligament complex appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Disruption of the MCL with associated bone contusions along the lateral tibiofemoral compartment and other findings as described above.


Instruction: Generate impression based on findings.

Input: There is an extra-axial mass in the left posterior frontal convexity that measures 5.2 x 4.5 cm in anteroposterior and transverse dimensions and 4.5 cm in craniocaudal dimension. The tumor infiltrates the overlying calvarium with associated hyperostosis. There is mass effect upon the left superior frontal gyrus and approximately 3 mm of midline shift to the right. There is infiltration of tumor into the superior sagittal sinus and compression of underlying cortical vein. There are areas of susceptibility effect within the mass related to calcifications and hemorrhage. In addition, there is susceptibility effect within adjacent sulci, which is suggestive of prior subarachnoid hemorrhage or superficial siderosis. There is no evidence of intraparenchymal edema or acute infarct. The ventricles are normal in size and configuration. However, there is a partially-empty sella. The adenoids are prominent and contain several retention cysts.

Output: 1. An extra-axial parasagittal mass that measures up to 5.2 cm along the left frontal convexity with invasion of the superior sagittal sinus and infiltration of the overlying calvarium likely represents a meningioma. 2. Susceptibility effect within left frontal lobe sulci is suggestive of prior subarachnoid hemorrhage or superficial siderosis associated with the tumor.


Instruction: Generate impression based on findings.

Input: Diagnosis: AphasiaClinical question: TIA strokeSigns and Symptoms: Left sided sensory deficits and resolved slurred speech MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are small. The left vertebral artery is slightly larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is mild narrowing of the vertebral arteries at their origins but no significant stenosis..

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease


Instruction: Generate impression based on findings.

Input: 63 year old female with breast cancer and brain METs presents after having a focal seizure in her right arm. There is no evidence of intracranial hemorrhage. Exam is limited for metastatic disease due to lack of post contrast enhancement. Focal area of well-defined hypodensity in the left posterior parietal region along the high convexity is consistent with vasogenic edema. There is mild effacement of the sulci within this region and may be further evaluated with MRI with contrast as clinically indicated. No acute cortical ischemia is seen.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses cells are normally pneumatized.The left mastoid air cells appear opacified. The internal auditory canals are patent bilaterally.

Output: Left posterior parietal region of vasogenic edema may be further evaluated with contrast enhanced MRI as clinically indicated.


Instruction: Generate impression based on findings.

Input: There are moderate new periventricular and subcortical white matter T2 hyperintense lesions, many of which are perpendicular in orientation to the lateral ventricles, and ovoid in shape. There are tiny signal abnormalities in the corpus callosum body and splenium on the coronal T2 images suggesting possible small T2 hyperintense lesions (for example series 8 images 25, 27 and 29). There is no suspicious enhancement or intracranial mass. There is no acute infarct, mass effect or midline shift. The hippocampi show symmetric volume and signal. There is diffuse low T1 signal of the osseous marrow without discrete lesion, nonspecific and may be related to predominance of red marrow in a patient of this age, or due to marrow-replacing process. Clinical correlation is advised.

Output: 1.Interval development of numerous nonenhancing (greater than 15) periventricular and subcortical white matter T2 hyperintense lesions, many of which are perpendicular to the lateral ventricles, nonspecific but favored to represent demyelinating lesions versus chronic small vessel ischemic changes. Differential diagnosis however includes infectious/inflammatory and vascular etiologies.2.No intracranial mass or evidence of mesial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: Postoperative changes in the posterior fossa are partially imaged without evidence of a discrete mass in the field-of-view. There is kyphotic angulation of the cervical spine with apex at the C5 level, which may be in part positional. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Minimal disc bulges are evident from the C3-C4 to the C7-T1 levels. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: No evidence of metastatic disease in the spine.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, history of esophageal cancer and brain metastases, status post resection/drainage of cystic lesion, status post SRS in 7/14. There is an enhancing lesion involving the left parieto-occipital lobe measuring approximately 4.2 x 2.3 x 3.4 cm in the AP, transverse, and craniocaudal dimensions, respectively. Most recent MRI was obtained without gadolinium. Compared to earlier MRI brain with gadolinium dated 1/19/2015, there is been marked interval increase in size of this enhancing lesion, at which time it measured 17 x 20 x 18 mm. There is gradually increasing associated edema compared to 1/19/2015 and 4/16/2015. Enhancement extends to the left lateral ventricular surface. Again seen is susceptibility compatible with chronic blood products within this lesion. Restricted diffusion is noted along the inferior aspect of the lesion which may related to blood products.There is increased associated mass effect with effacement of the left parieto-occipital sulci as well as increased effacement of the left lateral ventricle. 6 x 7 x 8 mm mm enhancing lesion in the right cerebellar hemisphere is not significantly changed in size compared to 1/19/2015. There is relatively mild associated FLAIR hyperintensity which is slightly increased since 1/19/2015 and may be related to treatment changes.No new enhancing lesions are seen within the brain to definitively indicate progression of intracranial metastatic disease. There is no midline shift or evidence of downward herniation. Parenchymal volume loss is again seen including in the cerebellum. Left posterior parietal burr hole again seen related to prior drainage/resection.

Output: 1. Please note most recent MRI brain dated 4/16/2015 was obtained without gadolinium. Compared to MRI brain with gadolinium from 1/19/2015, there has been marked increase in size of the left parieto-occipital enhancing lesion as well as gradually worsening associated edema and mass effect compared to 4/16/2015 and 1/19/2015. Findings may represent radiation necrosis although recurrent tumor is not entirely excluded. Consider follow-up PET or MRI with perfusion and spectroscopy sequences for differentiation. Of note, prior PET dated to 2/12/2015 did not demonstrate significant uptake within this region, favoring radiation necrosis.2. Small right cerebellar enhancing lesion is not significantly changed in size.3. No new lesions are seen to definitively indicated metastatic disease progression.


Instruction: Generate impression based on findings.

Input: Seizure. History of neurofibromatosis type I. Assess for seizure focus. Small foci of subtle T2-hyperintensity are present in the globi pallidi, posterior thalami, brainstem and cerebellar white-matter, compatible with the diagnosis of neurofibromatosis type I. The corpus callosum is diffusely, but mildly thickened without a focal lesion. There is no space-occupying or contrast-enhancing brain lesion. There is no intracranial hemorrhage or acute infarct. The ventricles, sulci and basal cisterns are normal in size. The major intracranial vascular flow voids are preserved.The optic nerves and the other orbital structures are grossly unremarkable. The mastoid air cells and middle ear cavities are clear. There is no skull destructive lesion.

Output: 1.Stigmata of neurofibromatosis type I including multiple small focal T2-hyperintense lesions without mass-effect or contrast enhancement in the brain (FASI) as well as mildly thickened corpus callosum. 2.No appreciable intracranial neoplasm or other focal lesion to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: Brain MRI:There is a small, linear focus of hyperintensity on DWI images involving the right posterolateral pons near the brachium pontis, with hypointensity noted on corresponding ADC. However, this is an area of frequent artifact on diffusion imaging, although this may represent a small focus of acute ischemia, thus correlation with the patient's neurologic exam could determine whether this represents a real finding versus that of artifact.There is mild diffuse volume loss without findings of ventricular obstruction. Confluent T2 hyperintensity is noted within the white matter, as well as within the pons, without associated mass effect, restricted diffusion, or susceptibility of pneumonia. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of a partially empty sella. There is no evidence for intracranial hemorrhage, There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.

Output: 1.There is a small, linear focus of hyperintensity on DWI images involving the right posterolateral pons near the brachium pontis, with hypointensity noted on corresponding ADC. However, this is an area of frequent artifact on diffusion imaging, although this may represent a small focus of acute ischemia, thus correlation with the patient's neurologic exam could determine whether this represents a real finding versus that of artifact.2.Mild diffuse volume loss.3.Advanced chronic small vessel ischemic disease.4.Negative MRA of the brain.5.Negative MRA of the neck.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with history of bilateral arm and leg paresis and sensory changes. Evaluate for spinal cord abnormality. Cervical:Slight retroflexion of the dens is noted, likely an anatomic variation. Cervical spinal alignment is otherwise unremarkable. Vertebral body height and morphology are normal. No concerning marrow signal replacement or edema is seen.The spinal cord shows normal morphology and is free of any concerning signal abnormality. No evidence of any pathologic epidural soft tissue or fluid is demonstrated.The intervertebral discs are normal. No spinal canal or neuroforaminal stenosis is evident.Thoracic:Thoracic alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal replacement or edema is seen.The spinal cord shows normal morphology and is free of any concerning signal abnormality. The position of the conus tip is not visualized on this examination. No evidence of any pathologic epidural soft tissue or fluid is demonstrated.The intervertebral discs are normal. No spinal canal or neuroforaminal stenosis is evident.

Output: No abnormalities of the spinal cord or bony spine are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Proximal muscle weakness, atrophy, concern for autoimmune etiology/myositis. Evaluate for abnormality. Limited images of the bilateral femurs demonstrate no abnormal T1 or T2 signal within the musculature to suggest atrophy or inflammation/edema. The muscles are bilaterally symmetric. Bone marrow signal is within normal limits.

Output: No specific evidence of abnormality of the thigh musculature.