Instruction: Generate impression based on findings.

Input: 2-year-old female patient with hydrocephalus status post shunt, persistent altered mental status following hypovolemic shock. Evaluate previously seen infarct on CT head. There is diffuse mild cortical restricted diffusion. Furthermore, the cortex appears mildly thickened and demonstrates mild T2 hyperintensity compatible with edema. On FLAIR images, diffuse sulcal hyperintensity is evident.The brain is dysmorphic in morphology with an apparent cleft extending from the vertex of the right parietal lobe into the ventricular system. There is severe thinning and encephalomalacia of the right parietal, temporal, and occipitals lobes. Surrounding and adjacent to the remaining right parietal, occipital, and temporal lobes, there is an intermediate T1 signal and heterogeneous hyperintense T2 signal subdural fluid collection which displaces the thin residual parenchyma medially. There also appears to be a separate, suprimposed collection of slightly different signal quality between the subdural collection and the right parietal parenchyma. The subdural collection contains thin strands of tissue which may represent fibrous material or degenerated parenchyma. Only minimal susceptibility is evident within the collection.The septum pellucidum is absent. The left half of the corpus callosum is present but thinned. The right half of the corpus callosum is deficient. The right thalamus and posterior right deep brain nuclei appear under developed/atrophic. The midbrain tectum is dysmorphic and the cerebral aqueduct is not visualized. The pituitary is unremarkable. The cerebellar tonsils are pointed in appearance and descend below the foramen magnum. The right posterior cerebral artery flow void is diminutive in its course compared to the contralateral side.There are postsurgical findings related to a right frontal approach ventriculostomy catheter which terminates within the midline anterior aspect of the dysmorphic ventricular system. The ventricular size has increased in size compared to the prior head CT with a transfrontal diameter now measuring up to 74 mm, previously 64 mm.The right eye is deviated superiorly and medially. There is scattered paranasal sinus mucosal thickening. The mastoid air cells are partially opacified.

Output: 1. Extensive parenchymal deformity and loss of volume particularly affecting the right cerebral hemisphere. Diffuse mild cortical restricted diffusion which correlates with loss of the gray-white differentiation on prior CT and is concerning for a diffuse hypoxic ischemic event.2. The dysmorphic ventricular system has increased in size compared to the prior head CT.3. An extra-axial, predominantly subdural fluid collection is evident distributed along the residual right posterior cerebrum. The nature of this fluid is not entirely clear. There is only minimal susceptibility artifact to suggest blood product, though this is still in the differential. A nonhemorrhagic proteinaceous or debris-filled hygroma can also be considered.4. Diffuse sulcal FLAIR hyperintensity is likely related to slow vascular flow or disruption of the blood brain barrier in the context of diffuse ischemic injury. Infection would be less likely given the uniform and bilateral distribution.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, s/p right partial glossectomy and neck dissection for T1 N0 SCC of the right oral tongue. A mild distortion of the tongue anatomy is seen which may reflect interval surgery. Although the fat-suppressed postcontrast images are somewhat motion degraded, no discrete or enhancing mass lesion is seen in the oral cavity.Evidence of right neck dissection is seen. The right submandibular gland has been excised. No pathologic adenopathy is detected. The remainder of the visualized aerodigestive mucosa is within normal limits. The residual salivary glands and thyroid are within normal limits. Bone marrow signal characteristics are unremarkable.

Output: Postoperative findings are seen without evidence of tumor recurrence or pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: MRI CARDIAC W/FLOW QUANT WWO, 9/14/2016 11:21 AM Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%. The LVEDV is 160 ml (normal range 109+/-23), LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), LVESV is 69 ml (normal range 31+/-10), and LV end systolic volume index is 41 ml/m2 (normal range 18+/-5). The LV mass is 76 g (normal range 114+/-24) and the LV mass index is 45 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 143 ml/m2 (normal range 69+/-14), the RVEDV is 85 ml (normal range 110+/-24), the RV end systolic volume index is 63 ml/m2 (normal range 22+/-8), and the RVESV is 37 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Normal left ventricular size and systolic function.2.Normal right ventricular size and systolic function.3.There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46-year-old male with von Hippel-Lindau disease and history of adrenal and extra adrenal pheochromocytoma. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintensities. No suspicious liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland is absent. The left adrenal gland is mildly nodular.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Punctate scattered susceptibility artifact in the right anterior abdominal wall an asymmetric abdominal rectus muscles reflective of prior surgery.OTHER: No significant abnormality noted.

Output: 1.No specific evidence of pheochromocytoma.


Instruction: Generate impression based on findings.

Input: 33-year-old female with biopsy-proven right breast cancer, suspected second lesion on MRI and right breast non-mass enhancement. Second look ultrasound for further evaluation. Targeted ultrasound of the left lower inner breast demonstrates two adjacent hypoechoic masses with microcalcifications. These masses are 1 cm apart. The more lateral and inferior of these masses (right breast 4:00 7 cm from the nipple) measures 1.0 x 0.8 x 1.2 cm and contains a biopsy clip and is consistent with the biopsy-proven malignancy. The more superior and medial of these masses (right breast 4:00 position 6 cm from the nipple) measures 1.1 x 0.8 x 1.0 cm and correlates with the additional lesion seen on MRI. Multiple cysts are present in the right inferior breast as well, but there is no definite pathologic sonographic correlate for the non-mass enhancement seen on MRI.

Output: 1. Two adjacent masses in the lower inner right breast as described above, one correlating with the patient's biopsy-proven malignancy, the other correlating with the finding on recent MRI examination. This second mass is amenable to ultrasound-guided biopsy as warranted clinically.2. No definite sonographic correlate for the additional right breast non-mass enhancement seen on MRI. If breast conservation therapy is desired, MRI biopsy is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 33 year old man with aortic root dilation on echo, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is upper limits of normal with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 296 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 138 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 154 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is upper limits of normal size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 122 ml/m2 (normal range 82+/-16), the RVEDV is 339 ml (normal range 142+/-31), the RV end systolic volume index is 60 ml/m2 (normal range 31+/-9), and the RVESV is 167 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. No evidence of mitral valve prolapse.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 (ie, sinus of Valsalva) is moderately dilated; however, there is no effacement of the ST junction. No evidence of aortic dissection or coarctation. The thoracic aortic measurements are as below:Sinus of Valsalva - 45x47mmSinotubular junction - 37x37mmAscending Aorta - 36x36mmProximal Aortic Arch - 33x33mmMid Aortic Arch - 28x30mmDescending Aorta - 27x28mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is upper limits of normal size with low normal systolic function (LVEF 54%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Right ventricle is upper limits of normal size with low normal systolic function (RVEF 51%).3. The aortic root (ie, sinus of Valsalva) is moderately dilated; however, there is no effacement of the ST junction. Beyond the Sinus of Valsalva, the thoracic aorta looks unremarkable. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for osteomyelitis of left thumb History: infection of thumb- herpetic whitlow with secondary infection, now s/p debridement with plastic surgery There are signal changes within the distal phalanx of the thumb, T1 hypointensity and T2 hyperintensity, along with marked enhancement of the bone and surrounding soft tissues, compatible with osteomyelitis. There is surrounding soft tissue edema. The rest of the hand is within normal limits.

Output: Acute osteomyelitis of the distal phalanx of the thumb.


Instruction: Generate impression based on findings.

Input: Reason: size of cyst in head of pancreas getting larger History: none ABDOMEN:LIVER, BILIARY TRACT: Numerous enhancing foci seen only on the arterial phase are likely perfusional. No suspicious enhancing lesions.SPLEEN: No significant abnormality noted.PANCREAS: There is mild increased prominence of the midportion of the main pancreatic duct measuring up to 4 mm in diameter, previously 3 mm. No obstructing lesion is evident.A 2 to 3 mm cystic lesion in the pancreatic head (801/26) is unchanged from the prior exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal T2 hyperintensities, likely cysts.RETROPERITONEUM, LYMPH NODES: Low T1 signal at the celiac origin corresponds to heavy calcification seen on the prior CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Punctate Cystic lesion in the pancreatic head is stable since 2012 examination, likely a sidebranch IPMN.2.There is minimal increased prominence of the mid main pancreatic duct measuring up to 4 mm without any other associated abnormality. No obstructing lesion is evident.


Instruction: Generate impression based on findings.

Input: 68 years Male (DOB:10/5/1947)Reason: Hx of lymphoma, new ataxia, rule out CNS involvement History: see abovePROVIDER/ATTENDING NAME: CARA ANN ROSENBAUM CARA ANN ROSENBAUM There are subdural effusions present in the posterior fossa and supratentorial brain which were also present on the prior exam and have not changed substantially.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Since the prior exam there've been a couple new periventricular white matter lesions. Specifically one in the left centrum semiovale is new. T2 hyperintense punctate lesion is also present in the subcortical white matter of the cerebellum at the level of the upper vermis. This was also present on the prior exam and is also unchanged.There are a few punctate T2 and FLAIR hyperintense foci present in the brainstem which were also present on the prior exam and do not appear to have changed significantly.There is a focus of encephalomalacia and susceptibility artifact which is redemonstrated along the medial aspect of the right occipital lobe. There is redemonstration of multiple punctate foci of signal loss and susceptibility imaging in the subcortical white matter of the supratentorial brain which were also present on the prior exam and have not changed significantly in number.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the left maxillary sinus and an asymmetrically smaller left maxillary sinus relative to the right maxillary sinus. The visualized portions of the mastoid air cells demonstrate opacities in the left mastoid air cells.. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam periventricular and subcortical white matter lesions have mildly increased in number.2.There are multiple microhemorrhages present in the subcortical white matter which are stable compared to prior exam. These are nonspecific. One possibility is that they're related to amyloid angiopathy.3.A focus of encephalomalacia and associated old blood products is redemonstrated in the right occipital lobe. This has not changed.4.Subdural effusions are likely related to atrophy.5.There is no evidence for a new enhancing lesion within the brain parenchyma to suggest CNS lymphoma.


Instruction: Generate impression based on findings.

Input: 2-year-old female status post bilateral cochlear implant placement.VIEWS: Skull AP (one view) 06/09/15, 12:50 Cochlear implants are present bilaterally. The implant leads complete the curl of the cochlea bilaterally. The skull is normal in appearance. Partially visualized ET tube and esophageal temperature probe.

Output: Bilateral cochlear implants, without evidence of complication.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB:5/9/1945)Reason: r/o mets History: severe pain -hx breast cancerReferring Attending: SUSAN HONG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There is multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There are some endplate reactive changes at this level associated with Schmorl's node. Some of the endplate reactive changes on the left side are high signal on T2 and low signal on T1 suggesting that they're subacute. There is associated contrast enhancement with this endplate reactive change.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a disc bulge at this level. There are some chronic endplate reactive changes at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and some Schmorl's nodes at this level.

Output: 1.There are degenerative changes present lumbar spine without significant compromise to the spinal canal or neural foramina.2.Abnormal enhancement adjacent to the superior endplate of L4 and suspected to represent inflammatory reaction from subacute degenerative change rather than metastatic disease. A follow-up exam with help confirm this.


Instruction: Generate impression based on findings.

Input: History of breast cancer. Now with shoulder pain. 3 views of the right shoulder reveal a vague lucency in the humeral head that is most likely a pseudotumor. There is also some vague sclerosis in the humeral head that again is probably unremarkable. Because of the patient's shoulder pain however a shoulder MRI was suggested to the clinical service

Output: Negative right shoulder radiographs


Instruction: Generate impression based on findings.

Input: Female 42 years old Reason: pancreatitis, evaluate for stones in gallbladder and pancreas History: pancreatitis and history pancreatic stones ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are multiple small T2 hyperintense lesions throughout both lobes. No definite restricted diffusion in the lesions. Have a thin enhancing wall which may represent compressed hepatic parenchyma. Given the size and number these likely represent biliary hamartomas.Gallbladder wall is mildly thickened. No evident biliary calculi. Common bile duct is normal in caliber. No filling defects to suggest stones.Intrahepatic portal vein and hepatic veins are patent.SPLEEN: Splenic vein near the splenic hilum is likely reconstituted by collaterals. Spleen is normal in size.PANCREAS: Pancreatic parenchyma in the body and tail are atrophic. There is pancreatic inflammation involving the body and tail in the setting of chronic inflammation. The pancreatic duct is dilated measuring up to 11 mm with filling defects in the head of the pancreas representing stones that are seen on the CT scan. There is a stricture in the pancreatic duct about the level of the occluding stone. The pancreatic duct in the head is dilated but to a lesser degree measuring 5 mm.There is a pancreatic tail fluid collection which may represent a blown out tail duct or pseudocyst measuring 3.1 x 2.2 cm this is in connection with the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of acute on chronic pancreatitis with a occluding stone in the pancreatic duct about the head of the pancreas.2.Pancreatic tail collection representing blown out pancreatic duct or pseudocyst.3.No specific evidence for cholelithiasis or choledocholithiasis.4.Hepatic lesions likely represent multiple biliary hamartomas.


Instruction: Generate impression based on findings.

Input: Reason: Significant pain with extra ocular movement, evaluate for optic neuritis, MS or other inflammatory conditions. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. There are several punctate foci of increased T2/FLAIR signal within the subcortical and periventricular white matter with at least one punctate focus of increased T2/FLAIR signal within the right posterior pericallosal region (series 3, image 71). No abnormal enhancement is identified within the cerebral or cerebellar hemispheres. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is nonspecific flattening of the pituitary consistent with a partially empty sella.Limited images of the orbits demonstrate suggestion of increased enhancement of the right greater than left optic nerves, though this is inadequately evaluated in the absence of dedicated orbital sequences. No gross intraorbital masses are identified. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Please note that dedicated orbital MRI images were not obtained which significantly limits evaluation of the orbits including evaluation for optic neuritis. Within this limitation, there is suggestion of increased enhancement involving the optic nerves (right greater than left) which can be seen with optic neuritis but which is incompletely assessed. No intraorbital masses are identified.2.Minimal scattered foci of increased T2/FLAIR signal which are nonspecific. There is, however, a single punctate pericallosal focus of signal abnormality suggesting the possibility of demyelinating disease. Brain parenchyma otherwise appears unremarkable.3.Suggest dedicated orbital MRI. Also suggest correlation with CSF analysis if there is clinical suspicion for demyelinating disease.Findings were relayed to the clinical service via stat consult system by radiology on-call resident at 9:07 PM on 8/5/2016.


Instruction: Generate impression based on findings.

Input: Female 55 years old s/p right partial knee replacement. Hardware components of a right medial unicompartmental knee arthroplasty device are situated in near anatomic alignment without evidence of hardware complication. There is a moderate joint effusion. A left total knee arthroplasty is situated in near-anatomic alignment as seen on the frontal view. Again seen is a calcified lesion in the proximal tibial diaphysis likely representing a large enchondroma.

Output: Right medial unicompartmental knee arthroplasty in near-anatomic alignment and other findings as above.


Instruction: Generate impression based on findings.

Input: 38-year-old male with pain. Evaluate for TFCC tear. Evaluation of the triangular fibrocartilage complex is limited due to the lack of intra-articular contrast. A skin marker is placed along the ulnar aspect of the wrist adjacent to the distal ulna.LIGAMENTS: We see no findings to suggest a tear of the scapholunate or lunotriquetral ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: The articular disc of the triangular fibrocartilage appears thinned just medial to its attachment to the distal radius with intermediate signal intensity traversing the disc likely representing a near full-thickness to full-thickness perforation. There is also increased signal intensity within the ulnar fibers of the articular disc likely reflecting a combination of degeneration/degenerative tearing and adjacent synovitis.TENDONS: The extensor carpi ulnaris tendon appears slightly thickened as it courses along the ulnar styloid with increased signal intensity suggesting mild tendinosis. The remainder of the flexor and extensor tendons are within normal limits. BONES: There is a small cyst within the trapezoid which may not be of any clinical significance.ADDITIONAL

Output: 1. Findings suggestive of degeneration and tearing of the triangular fibrocartilage as described above.2. Mild tendinosis of the extensor carpi ulnaris tendon.


Instruction: Generate impression based on findings.

Input: Pain and weakness following ulnar nerve transposition Exam limited secondary to absent prior comparison imaging as well as extensive postsurgical findings including punctate blooming artifact throughout the area in question. Within this limitation the following observations are made including focal signal abnormality in the overlying medial epicondyles with a small bone spur (circled). Overlying postsurgical scarring and soft tissue changes are observed yet the expected ulnar nerve is not distinctly observed. Specifically no abnormally enhancing nerve or abnormal signal on STIR imaging. No discrete MR findings to suggest fascial bands, abnormal soft tissue, cysts or ganglia are identified. No synovitis. The ulnar collateral ligament and retinaculum are intact.

Output: Medial epicondylar spur, see detail and pertinent negatives provided.


Instruction: Generate impression based on findings.

Input: 51-year-old female with history of rheumatoid arthritis and status post duodenal ulcer cauterization in outside hospital presenting with abdominal pain vomiting and hematemesis ABDOMEN:LUNG BASES: Small amount of bilateral pleural effusions and dependent atelectasis.LIVER, BILIARY TRACT: Pneumobilia. Two punctate air bubbles near the common bile duct best seen on image number 47 on coronal series likely represent air in the cystic duct stump, however, possibility of free air cannot be entirely excluded. SPLEEN: Wedge-shaped nonenhancing area in the superior pole of the spleen measuring 2.6 x 2.8 cm and is consistent with an infarct. Superior pole of the spleen adjacent to the infarct demonstrates heterogeneous enhancement. The etiology is unknown but may be secondary to ischemia and much less likely an infiltrating neoplastic process. Follow-up imaging can be helpful in a month for further evaluation.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys consistent with bases on history of end-stage renal disease. 12 x 12 mm hypodense lesion in the upper pole of the left kidney contains linear enhancements. This represent a thin septations, however, a solid lesion cannot be entirely excluded. There are other numerous, small hypodense lesions in both kidneys, some which contain increased density. These are too small to fairly characterize.RETROPERITONEUM, LYMPH NODES: Right retrocrural borderline enlarged lymph node measuring 10 x 7 mm or 20, series 5.BOWEL, MESENTERY: Proximal small bowel loops are minimally dilated measuring up to 2.7-cm. In the right lower quadrant, and distal small bowel loops are decompressed. Colonic loops are distended with fluid. These findings may be secondary to mild partial small bowel obstruction.The wall of the stomach and duodenum is definitive thickened.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount ascites.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes affecting the joints. Small amount of fluid around the hip joint anteriorly demonstrating possible loculations. Further evaluation with MRI may be helpful.OTHER: Decubitus ulcer with a subcutaneous abscess in the pelvis measuring 10 x 14 mm adjacent to the decubitus ulcer.

Output: Pneumobilia. The etiology is unknown. Punctate amount of air near the common bile duct may represent air in the cystic duct stump, however, although the possibility of free air is low, this cannot be entirely excluded.Splenic infarct in the upper pole of the spleen. Follow-up imaging in one month is recommended to further evaluate the splenic tissue surrounding the infarct.Bilateral small hypodense lesions in atrophic kidneys. These are incompletely evaluated with this single phase study. Follow-up imaging in 6 Maas is recommended especially for the evaluation of the left upper pole complex lesion.Mild partial small bowel obstruction. Gastroduodenal wall thickening.Decubitus ulcer with subcutaneous abscess.Left hip joint fluid demonstrating possible loculations. Further evaluation with MRI may be helpful to exclude septic arthritis.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in an appropriate position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 52-year-old male with pain ROTATOR CUFF: Best seen on the sagittal oblique sequence is a full-thickness tear through the anterior fibers of the supraspinatus tendon at its insertion. There is less than 1 cm retraction and the tear is just under 1.5 cm in AP dimension. Intermediate signal intensity within the remainder of the supraspinatus tendon may represent fraying. The supraspinatus muscle is within normal limits. There is perhaps mild tendinosis of the infraspinous tendon with no discrete tear. The infraspinatus muscle is within normal limits. The teres minor and subscapularis muscle and tendon are within normal limits.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with osteophytes resulting in mild impression of the superior fibers of the supraspinatus. No frank fluid is noted within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is within normal limits. Mild osteoarthritis affects the glenohumeral joint. Evaluation of the labrum is limited due to lack of intra-articular contrast. Given this limitation, there is no fluid-filled tear.BICEPS TENDON: Given the limitation of a nonarthrographic study, the tendon of the long head of the biceps is within normal limits. ADDITIONAL

Output: 1.Full-thickness tear of the anterior fibers of the distal supraspinatus tendon.2.Moderate osteoarthritis of the acromioclavicular joint, mild osteoarthritis of the glenohumeral joint, and other findings as above.


Instruction: Generate impression based on findings.

Input: 43-year-old female with a history of rectal cancer with bilateral groin pain. Right hip:There is a subcentimeter lucency with sclerotic margins in the right femoral neck most consistent with a benign synovial herniation pit. There is no evidence of metastatic disease. The hip joint is within normal limits for age.Left Hip:There is no evidence of metastatic disease. The hip joint is within normal limits for age.

Output: No specific findings to account for the patient's groin pain.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of elevated PSA and negative biopsy. PELVIS:PROSTATE:Prostate Size: 6.7 x 4.9 cm.Peripheral Zone: Streaky T2 hypointense area in the left base is likely a normal variant. There is right mid gland scarring. No suspicious lesions identified.Central Gland: BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: BPH, no suspicious lesion delineated.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: The lateral meniscus is normal. Examination of the medial meniscus reveals a subtle vertical tear of the posterior horn.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Vertical tear the posterior horn of the medial meniscus. Popliteal cyst.


Instruction: Generate impression based on findings.

Input: Male, 15 years old, with movement disorder s/p sugical removal of gall bladder. Evaluate for structural abnormality especially in basal ganglia. Although image quality is somewhat degraded due to artifact, no definite areas of pathologic parenchymal signal abnormality are detected. Specifically, no abnormalities are seen within or around the basal ganglia, substantia nigra or red nuclei. Likewise, no pathologic parenchymal or extra-axial enhancement is detected.Brain morphology is within normal limits. No evidence of edema or mass effect is detected. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.Multiple curvilinear and tubular enhancing structures are seen within the calvarial diploic space which likely represent prominent vessels and/or vascular spaces. Bone marrow signal is otherwise unremarkable.

Output: No definite or specific findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Note that only postcontrast T1-weighted images were obtained for this examination. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits.

Output: No areas of abnormal enhancement on postcontrast imaging.


Instruction: Generate impression based on findings.

Input: AML. Evaluate for infection Ventilation images reveals normal bone marrow throughout the tibia and fibula. There is some mild stranding in the lateral subcutaneous fat. No evidence of an abscess in the soft tissues. No evidence of a uterine soft tissues.

Output: Mild stranding of the subcutaneous fat along the lateral aspect of the leg representing mild inflammation.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: h/o metastatic breast ca to brain s/p SRS to R medial, R post-central gyrus lesions and most recently L frontal middle gyrus lesion History: eval for extent of disease There are two new enhancing nodules on this scan indicating possible metastatic nodules.One is one the at the junction of right frontomarginal gyrus and right lateral orbital gyrus (series 12, image 69/168) and another one is at the left superior parietal lobule around the cranial end of the post central sulcus (series 12, image 49/168). There is no evidence of acute ischemic lesion on this scan.The right frontal lobe precentral gyrus lesion which is close to the paracentral lobule does not show any evidence of enhancement. It does show susceptibility effects on gradient echo images but without surrounding edema or mass effects indicating hemosiderin deposition (chronic hemorrhagic lesion) which is unchanged since prior scan.The left middle frontal gyral lesion which was seen on Feb 3 2015 is not shown on today's scan.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, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Two new enhancing nodules one on the right frontal lobe and another on the left parietal lobe as detailed above indicating possible new metastatic nodules.2. Chronic hemorrhagic lesion on the right precentral gyrus close to paracentral lobule without evidence of enhancement, no change since prior scan.3. Previously seen (Feb 3 2015) left middle frontal gyral lesion is not demonstrated on today's MRI.4. No abnormal enhancement is seen.5. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Headache, new H/A and N/V, aneurysm on prior scan. There is normal gray-white matter differentiation.There is a suprasellar peripherally calcified lesion which has been characterized on prior CT and MRI examination and consistent with a right para-opthalmic aneurysm. It is most probably stable, allowing for the difference in the imaging techniques between the examinations. It measures 13.9 x 9.9 mm in the coronal plane using series 80244, image 25/59 on the current examination and 14.9 x 8.9 mm using series 80228 image 26/64. There is a 5.7 x 6.5 mm isodense lesion paramedian to the right of the foramen of Monroe (please see series 3 image 11/29) and is separate from the suprasellar lesion. This was not apparent on the prior CT examination and may have been obscured on the prior MR examination due to motion artifact as it was not demonstrated then. It is of uncertain significance and one possibility is that it may represent a tiny colloid cyst.There is no evidence of new intracranial hemorrhage, midline shift, hydrocephalus or edema. The ventricles and basal cisterns are normal in size and configuration.The calvarium and skull base appears normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized and clear.

Output: *There is no intra-axial or extra-axial hemorrhage, edema, midline shift or hydrocephalus.*Stable appearance of the known right para-opthalmic aneurysm. *There is an apparent small isodense lesion paramedian to the right of the foramen of Monroe (please see series 3 image 11/29) which was not apparent on the prior CT or MR examination and may have been obscured by motion artefact. The lesion is separate from the suprasellar lesion and is of uncertain significance. One possibility is that it may represent a tiny colloid cyst.


Instruction: Generate impression based on findings.

Input: Reason: eval for complications of Ulcerative Colitis History: bloody stools, abdominal pain, feverEXAMINATION: MR enterography without and with IV contrast 4/23/15 ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic mass is identified. No gallbladder wall thickening. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: kidneys and uretersRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Smooth, tubular appearance of descending colon, sigmoid colon, and rectum with contrast enhancement and diffusion restriction, compatible with active inflammation. Mesocolic fat stranding.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple physiologic follicles seen in bilateral adnexa. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Smooth, tubular appearance of descending colon, sigmoid colon, and rectum with contrast enhancement and diffusion restriction, compatible with active inflammation. Mesocolic fat stranding.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small pelvic free fluid.

Output: Active inflammation of the descending, sigmoid colon, and rectum compatible ulcerative colitis.


Instruction: Generate impression based on findings.

Input: Diffuse large non-Hodgkin's lymphoma status post 6 cycles chemotherapy. Given the limitations of the lack of contrast material, I see no evidence of pathologic lymphadenopathy within the neck. Visceral structures are unremarkable.Bone windows reveal no osseous abnormality

Output: No definite lymphadenopathy in the study which is limited by the lack of IV contrast.


Instruction: Generate impression based on findings.

Input: There are scattered foci of T2 hyperintensity within subcortical white matter, pons, as well as the cerebellum, without associated restricted diffusion or susceptibility abnormality. The cerebellar foci have an appearance more like tiny foci of encephalomalacia, although one contrast enhances on the current exam (although not on the recent enhanced CT scan). The ventricles and sulci are normal in size. 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. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: There are scattered foci of T2 hyperintensity within subcortical white matter, pons, as well as the cerebellum, without associated restricted diffusion or susceptibility abnormality. The cerebellar foci have an appearance more like tiny foci of encephalomalacia, although one contrast enhances on the current exam (although not on the recent enhanced CT scan). This constellation of imaging features is most suggestive of small vessel ischemic disease, with the one cerebellar lesion demonstrating enhancement likely representing a tiny focus of subacute ischemia. Other complications of HIV such as PML, primary HIV encephalopathy, infection, or metastasis are felt to be unlikely.


Instruction: Generate impression based on findings.

Input: Evaluate for lesions in hypothalamus: Progressively worsening cataplexy and sleep paralysis x 6 months. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is susceptibility effect in the bilateral globi pallidi. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are secretions within the right frontal sinus.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. In particular, the hypothalami appear unremarkable. 2. Nonspecific mineralization in the bilateral globi pallidi.


Instruction: Generate impression based on findings.

Input: 55-year-old male. Bilateral shoulder pain status post rotator cuff surgery. ROTATOR CUFF: The rotator cuff is intact without evidence of a tendon tear.SUPRASPINATUS OUTLET: Widening of the acromioclavicular joint, most likely post-operative.GLENOHUMERAL JOINT AND GLENOID LABRUM: Normal appearance of the glenoid labrum. BICEPS TENDON: Extra-articular biceps tendon is normally situated in the biceps groove.ADDITIONAL

Output: Post-surgical findings without evidence of a rotator cuff tear.


Instruction: Generate impression based on findings.

Input: History of Chiari decompression and for cervical syrinx. There are postoperative findings related to Chiari decompression. There is inferior extension of the cerebellar tonsils to the level of the dens with associated crowding of the neo-foramen magnum and diminished CSF flow anteriorly and posteriorly. The spinal cord displays normal signal and morphology, without evidence of syringohydromyelia. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression with inferior extension of the cerebellar tonsils to the level of the dens associated with crowding of the neo-foramen magnum and diminished CSF flow anteriorly and posteriorly. 2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Known prostate cancer. Biopsy 7/16/2015 reveals left lateral base, lateral mid, and lateral apex prostatic adenocarcinoma. Gleason score 7 (3+4). PELVIS:PROSTATE:Prostate Size: 3.6 x 5.0 x 4.0 cmPeripheral Zone: There is patchy T1 weighted hyperintense signal within the peripheral zone likely related to recent biopsy and limiting evaluation for a discrete lesion.In this background abnormality there are several small foci of peripheral zone T2-weighted hypointense and restricting lesions suspicious for prostatic carcinoma. The largest is a focus in the right mid gland measuring 6 mm and in the left mid gland measuring 5 mm.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suspected multifocal prostatic adenocarcinoma in the peripheral zone of the mid gland without evidence of extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: 57-year-old male with elevated PSA and negative prostate biopsy. Evaluate for discrete lesions to target on biopsy. PELVIS:PROSTATE:Prostate Size: 5.1 x 3.5 x 5.0 cm (TR X AP X CC)Peripheral Zone: There are no definitive foci of decreased T2 signal abnormality identified within the peripheral zone of the prostate. Additionally, there are no foci of restricted diffusion or abnormal enhancement on dynamic contrast enhanced sequences. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No MRI evidence to suggest prostate carcinoma.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate shoulder/axilla for local recurrence of Ewing sarcoma History: Shoulder/axillary m ass ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus and infraspinatus indicating mild to moderate tendinosis. No full-thickness tear is evident. The infraspinatus appears intact. There is undersurface fraying of the subscapularis at the level of its insertion on the lesser tuberosity. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Linear increased signal abnormality within the anterior superior glenoid labrum likely represents a normal variant sublabral foramen.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 4.5 cm right axillary mass consistent with the known history of Ewing's sarcoma. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for acetabular fx or other hip pathology History: acute on subactue left hip pain, MVA one month ago, unable to bear weight Bone marrow signal is within normal limits. There is no evidence of acute fracture. Alignment is anatomic. There is moderate osteoarthritis of left hip including moderate osteophytes and joint space narrowing.Within the limitations of a non-arthrographic study, there is abnormal T2 signal hyperintensity undercutting the anterior superior aspect of the acetabular labrum, which may reflect a tear (series 9, image 9). Additionally, there is a circumscribed, ovoid, T2 hyperintense cystic lesion anterior to the hip joint which appears to communicate with the joint capsule measuring up to 2 cm, which is nonspecific but may reflect a paralabral cyst. There is no significant joint effusion. No abnormal enhancement is identified.There is mild T2 signal hyperintensity within the gluteus musculature near the attachment on the greater trochanter, particularly the gluteus medius and minimus, compatible with mild strain. There is trace fluid in the trochanteric bursa without specific evidence of bursitis.There is no acute intrapelvic abnormality identified.Moderate to marked osteoarthritis affects the right hip and there are degenerative changes at the pubic symphysis and lower lumbar spine. There is cortical thickening and trabecular irregularity of the right hemipelvis as seen on the coronal T1, which suggests Paget's disease, as seen on previous bone scan/CT.

Output: 1.Moderate osteoarthritis of the hips without acute fracture or malalignment.2.Questioned anterior superior labral tear with possible paralabral cyst anterior to the hip joint. Consider dedicated arthrographic study as clinically indicated.3.Mild strain of the gluteus musculature.


Instruction: Generate impression based on findings.

Input: History of hydrocephalus, neurogenic bladder, neurogenic dysphagia, vocal tremor, cerebral cyst, Chiari malformation with decompression, syrinx, ataxia, headache, falls, complicated UTI, hypothyroidism, and VA shunts. Brain: There are postoperative findings related to complex Chiari decompression surgery with extensive encephalomalacia and punctate foci of susceptibility effect in the medial portions of the cerebellum and left middle cerebellar peduncle. There is interval involution of the cystic cavity in the left cerebellomedullary angle cistern, while the cystic compartment in the right cerebellomedullary angle cistern persists, measuring 9 x 12 mm in axial cross-section. There is interval decreased T2 hyperintensity and swelling of the bilateral medullary olives. There is no evidence of acute infarct. There is a left transparietal ventricular shunt catheter that terminates in the right frontal horn. The third and lateral ventricles are nearly collapsed. There is linear encephalomalacia that traverses the body of the corpus callosum into the bilateral centrum semiovale. There is also a prior left transfrontal catheter track. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable.Spine: There are postoperative findings related to complex Chiari decompression surgery with a persistent transverse low signal band that kinks the anterior aspect of the upper spinal cord at the level of the dens. There is persistent extensive central T2 hyperintensity throughout the cervical and upper thoracic spine. There is persistent lack of the usual cervical lordosis. The rest of the vertebral column alignment is otherwise anatomic. There is prominence of the epidural venous plexus in the anterior craniocervical junction region. There are scattered extramedullary intrathecal foci of low signal intensity throughout the spinal canal, particularly posteriorly. There also appears to be clumping of the lower cauda equina nerve roots. There is a small posterior disc-osteophyte complex at the C6-7 level, but no significant degenerative spondylosis in the thoracic and lumbar spine. The vertebral body heights are preserved.

Output: 1. Postoperative findings related to complex Chiari decompression surgery with persistent encephalomalacia and punctate foci of chronic hemorrhage in the medial portions of the cerebellum and left middle cerebellar peduncle and a cystic compartment in the right cerebellomedullary angle cistern, but interval involution of the cystic cavity in the left cerebellomedullary angle cistern. 2. Persistent extensive central T2 hyperintensity throughout the cervical and upper thoracic spine, which may represent a combination of edema and myelomalacia, perhaps aggravated by a persistent apparent fibrotic band that kinks the upper spinal cord at the level of the dens.3. Scattered extramedullary intrathecal foci of low signal intensity throughout the spinal canal and apparent clumping of the lower cauda equina nerve roots, which may be related to arachnoiditis incited b7 chronic hemorrhage. 4. The shunted third and lateral ventricles are nearly collapsed. 5. Interval evolution of hypertrophic olivary degeneration, which is now less conspicuous.


Instruction: Generate impression based on findings.

Input: Female 33 years old Reason: ASSESS for possible occult sesamoid bone fracture of the left foot. History: Pain and swelling There is a bipartite medial hallux sesamoid bone, the margins of which are more suggestive of a normal variant rather than a fracture. There is minimal focal increased signal intensity on fluid sensitive sequences in the proximal ossicle which may be degenerative in nature but fatty marrow signal intensity is largely preserved on T1 weighted images. The lateral hallux sesamoid appears normal. Intermediate signal intensity of the intersesamoidal ligament could represent degeneration but alignment of the sesamoid bones is normal. Sesamoid phalangeal ligaments are intact. Flexor hallucis longus tendon is normal. Small amount of fluid is in joint, not necessarily of any significance. Between the first and second metatarsal heads there is a small amount of fluid in the bursa of questionable significance. The remainder of the visualized bones and soft tissues appear normal.

Output: Bipartite medial hallux sesamoid bone with minimal degenerative signal changes in the proximal ossicle but no fracture is evident. Other findings as above.


Instruction: Generate impression based on findings.

Input: 68 year old female status post fall 2 weeks ago, headache Low-attenuation in the right frontal and parietal region consistent with prior infarct. Additional subcortical and periventricular areas of patchy low attenuation consistent with small vessel ischemic disease of indeterminant age. There is no evidence of bleed or acute infarct. If evaluation for acute ischemia is clinically warranted, MRI is recommended.There is no evidence of intracranial hemorrhage or mass.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.There is soft tissue density superficial to the right parietal bone which may represent a hematoma in the setting of acute trauma. In the absence of acute trauma, infection should be considered.

Output: Findings consistent with prior infarct in the right frontoparietal region. No evidence of acute ischemic process or hemorrhage. If evaluation for acute ischemia is clinically indicated, MRI is recommended.


Instruction: Generate impression based on findings.

Input: Patient with 8mm basilar tip aneurysm. Headaches. 37 years old female Left subclavian artery: There is no evidence for arteriovenous fistula. There is no evidence for vertebral dissection.Right subclavian artery: There is no evidence for arteriovenous fistula. No evidence for vertebral dissection.Left vertebral artery:There is opacification of both posterior cerebral arteries. The right anterior/inferior cerebellar arteries and both PICAs are large whereas the left left AICA is small. The right SCA is duplicated. The vertebral arteries are codominant. Venous and parenchymal phases are unremarkable. The PCOMAs fill in a reverse fashion. The right PCOMA is larger than the left.There is a lobulated basilar tip aneurysm present measuring approximately 5.5 mm x 5.5 x 3.5 mm dimensions which has a narrow neck. Right vertebral artery:There is opacification of both posterior cerebral arteries. The right anterior/inferior cerebellar arteries and both PICAs are large whereas the left left AICA is small. The right SCA is duplicated. The vertebral arteries are codominant. Venous and parenchymal phases are unremarkable. The PCOMAs fill in a reverse fashion. The right PCOMA is smaller than the left. There is extracranial origin of the right PICA.There is a lobulated basilar tip aneurysm present measuring approximately 5.5 mm x 5.5 x 3.5 mm dimensions which has a narrow neck. Right common carotid artery: No stenosis at the carotid bifurcation on the basis of NASCET criteria. No evidence for carotid dissection.Right internal carotid artery: There is opacification of the right anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits.The left PCOMA is small.There is a 3.5x2.5 mm aneurysm off the origin of the right anterior temporal artery of the MCA which is directed inferiorlyLeft common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. No evidence for carotid dissection.Left internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula. The left PCOMA is large.There is a 2mm broad neck aneurysm at the left MCA bifurcation.Intraprocedural angiograms:Serial arteriograms performed the during aneurysm coiling demonstrate serial occlusion of the aneurysm. At the end of the procedure there is no opacification of the aneurysm.Right common iliac artery: No contraindications to closure device.

Output: 1.5mm basilar tip aneurysm as described above.2.3.5mm right MCA aneurysm as described above.3.2 mm left MCA aneurysm as described above.4.Embolization of basilar tip aneurysm using Target coils (company Stryker). These are MRI compatible up to 3T.5.Findings were discussed with Dr Ardelt at the end of the procedure.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with pain in the neck, arms and legs, with hand weakness since car accident. A mild reversal of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. No worrisome marrow replacement or evidence of marrow edema is seen. Fusion of the right C3-4 facets is noted.The visualized spinal cord illustrates normal signal intensity and morphology throughout.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Minimal if any cord impingement. No foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Minimal if any cord impingement. Mild left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C7-T1: Unremarkable.

Output: 1.Degenerative disc disease at C4-5 and C5-6 resulting in mild spinal canal stenosis and minimal if any cord impingement. No abnormal cord signal is detected.2.No other significant findings are seen, and in particular, no evidence of any posttraumatic injury is detected.


Instruction: Generate impression based on findings.

Input: Left-sided facial weakness. Assess for stroke. The examination is moderately limited by patient motion.Brain MRI: There is no acute brain infarct or acute intracranial hemorrhage. Redemonstrated is small focus of encephalomalacia involving the left precentral gyrus, reflective of previous infarct. There are punctate foci of T2 FLAIR hyperintensity in the cerebellar hemispheres, right more than left, and the right hippocampus which probably also represent small chronic ischemia. Small CSF intensity focus in the right basal ganglia may represent dilated perivascular space or chronic infarct. There is relatively mild periventricular an subinsular T2 FLAIR hyperintensity, reflective of chronic microvascular ischemia. The ventricles and the other CSF-containing spaces are mildly enlarged, reflective of mild global parenchymal volume loss. There is no mass-effect or midline shift. The major intracranial vascular flow voids are preserved, reflecting gross patency. There is no gross orbital abnormality. Mastoid air cells are clear. There is a small retention cyst in the right maxillary sinus and trace mucosal thickening in the paranasal sinuses. The adenoids are prominent which is nonspecific most likely reactive.Cranial MRA:Flow-related signal in the major intracranial arteries is preserved as well as the vessel caliber without significant stenosis. Of note, the upper most cervical segment of the left internal carotid artery is tortuous.

Output: 1.Examination is moderately limited by patient motion.2.There is no acute infarct. Left precentral, right hippocampal and bilateral cerebellar small, chronic infarcts are present.3.No flow-limiting intracranial arterial stenosis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: assess for stenosisSigns and Symptoms: right sided weakness, speech changes MRI of the brainThere is a punctate focus of diffusion restriction present in the left pons.There is a punctate focus of susceptibility effect with low signal on susceptibility weighted imaging in the right pons.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells demonstrate that the right mastoid air cells are partially opacified. 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. The left A1 segment is larger than the right A1 segment. There is fetal origin of the right posterior communicating artery with the medium sized right P1 segment. The left posterior communicating artery is small. The vertebral arteries are similar in diameter.

Output: 1.There is an acute lacunar infarct in the left pons.2.There is an old microhemorrhage in the right pons. 3.No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. There is mild crowding of structures at the foramen magnum without tonsillar herniation or evidence of Chiari malformation. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There is mild mucosal thickening of the maxillary sinuses bilaterally. The paranasal sinuses and mastoid air cells are otherwise clear. There is no abnormal enhancement within the brain.

Output: Normal examination of the brain without evidence of intracranial hemorrhage, infarction, or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Enhancing lesion. Expressive language problem. There is no evidence of intracranial hemorrhage or acute infarct. There is increased leptomeningeal enhancement with punctate areas of restricted diffusion and possible minimal cortical involvement, as well as sulcal T2 hyperintensity and susceptibility effect in the left frontal lobe, including the precentral sulcus, and to a lesser extent the left temporal lobe. There are increased foci of cerebral white matter T2 hyperintensity, particularly in the left frontal and temporal lobes. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants.

Output: 1. Interval increased leptomeningeal enhancement with possible minimal cortical involvement and sulcal T2 hyperintensity in the left frontal lobe, and to a lesser extent the left temporal lobe. Differential considerations neoplastic, vascular, or perhaps granulomatous conditions.2. Interval increased foci of cerebral white matter T2 hyperintensity is nonspecific, but may represent a vasculitis or demyelinating process, for example.Discussed with Dr. Brorson at 4PM on 1/14/15.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (9/23/15), ultrasound images (9/23/15), breast MRI (2/29/16) performed at Northwestern Memorial Hospital. For comparison, breast MRI (6/26/15), digital mammographic images (9/29/14, 9/19/14, 9/11/14, 9/9/13), ultrasound images (9/29/14, 9/19/14) are available. History of benign right ultrasound guided biopsy at 6:00 position, and benign left stereotactic biopsy at upper outer quadrant. DIGITAL MAMMOGRAPHIC IMAGES (9/23/15):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. Stable circumscribed oval mass is present at 6:00 position in the right breast, with a marker clip from prior benign biopsy.A percutaneously placed clip is identified at middle upper outer quadrant in the left breast, from prior benign biopsy. There are new amorphous calcifications at upper outer quadrant in the left breast, located posterior and superior to the marker clip. Area of calcifications measures approximately 4 x 2 cm on ML view (AP x CC).No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES (9/23/15):There are stable benign appearing hypoechoic masses at 10:00 position (9 x 5 mm, previously 8 x 5 mm), and at 11:00 position (5 x 3 mm, previously 5 x 3 mm) in the right breast. A biopsy proven benign mass at 6:00 position in the right breast measuring 19 x 5 mm (previously 24 x 6 mm).BREAST MRI (2/29/16):Breast MRI was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a regional non-mass enhancement at 2:00 position in the left breast measuring 45 x 22 x 21 mm (AP x LR x CC). This non-mass enhancement likely corresponds to the area of developing calcifications on the mammogram.Multiple small masses and foci are present in both breasts, without significant changes from prior study.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: Developing amorphous calcifications at upper outer quadrant in the left breast, with MRI correlate. Stereotactic core needle biopsy for these calcifications is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Male, 76 years old, with memory problems, altered mental status, word finding difficulties, prolonged hypotension secondary to shock. Encephalomalacia is seen in the paramedian right frontal lobe with surrounding parenchymal T2 hyperintensity suggesting gliosis. Additional scattered foci of T2 hyperintensity are seen in the periventricular regions. No restricted diffusion is observed.No parenchymal edema or mass effect is noted. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is normal in size and morphology.Mucosal thickening and secretions are seen in the right maxillary sinus and the sphenoid sinuses.

Output: 1.No evidence of acute ischemia or any other definite acute intracranial abnormality.2.Encephalomalacia and gliosis in the right paramedian frontal lobe likely represents chronic ACA territory infarction.3.Moderate chronic microvascular ischemic disease is also seen.4.Sinus mucosal inflammation as above.


Instruction: Generate impression based on findings.

Input: 64 year old female with Wolf-Parkinson-White syndrome, and recent development of left ventricular dysfunction. Presents for cardiovascular MRI to evaluate for cardiomyopathy Left VentricleThe left ventricle is severely enlarged with severe global hypokinesis. The overall LV ejection fraction is 35%, the LV end diastolic volume index is 122 ml/m2 (normal range: 65+/-11), the LVEDV is 268 ml (normal range 109+/-23), the LV end systolic volume index is 79 ml/m2 (normal range 18+/-5), the LVESV is 174 ml (normal range 31+/-10), the LV mass index is 61 g/m2 (normal range 67+/-11), and the LV mass is 133 g (normal range 114+/-24). There is mid-myocardial late gadolinium enhancement in the basal and mid- septum. Left AtriumThe left atrium is moderately enlarged.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 177 ml (normal range 110+/-24), the RV end systolic volume index is 63 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation by visual estimation; dedicated imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. The leaflets are thickened. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no pericardial effusion.

Output: 1. The left ventricle is severely enlarged with severe global hypokinesis (LVEF 35%). There is mid-myocardial late gadolinium enhancement in the basal and mid- septum which can be seen with dilated cardiomyopathy. 2. Normal right ventricular size and systolic function (RVEF 55%).3. Trace mitral and aortic regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: VA shunt, noted at OSH to have vegetation on atrial end. Brain: There is a left transparietal catheter that terminates in the interhemispheric fissure. The ventricles have not significantly changed in size and configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged T2 hyperintensity along the prior right frontal lobe catheter tract. There are postoperative findings related to Chiari decompression surgery. There is a right cerebellar hemisphere developmental venous anomaly. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unchanged.Orbits: There is minimal residual fluid signal in the anterior left superior orbit. There is no evidence of intraorbital tumors. The right orbit is unremarkable.

Output: 1. Left transparietal catheter terminating in the interhemispheric fissure. The ventricles have not significantly changed in size and configuration. 2. Unremarkable postoperative findings related to Chiari decompression surgery.3. Minimal residual fluid or edema in the left superior orbit.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (1/8/15, 1/16/15), ultrasound images of right breast (1/13/15), breast MRI (1/29/15) performed at Christie Clinic. DIGITAL MAMMOGRAPHIC IMAGES (1/8/15, 1/16/15):The breast parenchyma is extremely dense, which limits the sensitivity of the mammogram. There is an architectural distortion at the upper outer quadrant in the right breast. A cluster of pleomorphic calcifications are present at posterior 9 o'clock position, posterior lateral from the architectural distortion in the right breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (1/13/15):An irregularly shaped, shadowing lesion, measuring 10 x 13 mm at 9:00 - 10:00 position in the right breast, likely corresponding to the architectural distortion on mammogram. Calcifications are present near this lesion. A lobulated hypoechoic mass, measuring 10 x 7 mm is detected at 8 o'clock position. At 1 o'clock position, there is a circumscribed hypoechoic mass, measuring 20 x 8 mm. A benign appearing lymph node is detected in the right axilla.BREAST MRI (1/29/15):Study was performed with a protocol outlined in the outside radiology report.RIGHT BREASTThere is an irregularly shaped mass measuring 25 x 15 x 23 mm (AP x LR x CC) at 9:00 - 10:00 position (anterior - middle), with internal marker clip artifact. This corresponds to the architectural distortion on mammogram. There is an enhancing mass with internal clip, measuring 8 x 8 x 8 mm at middle 7 o'clock position. These two lesion are likely post-biopsy because of the presence of cip. Per U of C pathology report, right 10:00 lesion was malignant; IDC 2, and right 8 o'clock lesion was benign; fibroadenoma. There are several enhancing masses around the 9:00 - 10:00 mass; the largest mass is located at middle 9:00 position, measuring 10 x 10 x 10 mm. This mass has dark internal septations, suggesting fibroadenoma. A round mass at middle 7 o'clock position, measuring 8 x 8 x 7 mm, is most distant from the 9:00 - 10:00 mass. Overall measurement of these masses is 46 x 28 x 66 mm.In addition, there is a circumscribed mass measuring 16 x 9 x 12 mm at posterior 2 o'clock position, corresponding to the mass soon on the ultrasound at 1 o'clock position. This mass is benign appearing, likely fibroadenoma. LEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal axillary lymph nodes are identified in either axillary region.

Output: Biopsy proven carcinoma in the right breast at 9:00 - 10:00 position, and biopsy proven fibroadenoma at right 8 o'clock position. Multiple additional masses in the right breast. Recommend MR directed ultrasound for right 7 o'clock mass, middle 9 o'clock mass and possible biopsy.BIRADS:6 - Known cancer. RECOMMENDATION:T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Dandy walker variant, VSD, u/s showing concern for tether, and absent left kidney: follow up, US showed tethered cord. Brain: There is hypoplasia of the inferior cerebellar vermis and prominence of the posterior fossa cerebrospinal fluid spaces. There is decreased prominence of the anterior subarachnoid spaces, now negligible. There is a cystic lesion in the midline roof of the third ventricle adjacent to the foramina of Monro, which measures up to 8 mm. The lateral and third ventricles are perhaps slightly less dilated compared to the MRI from November 2014. There has been considerable interval progression of myelination with only remaining terminal zones of myelination in the parietal and anterior frontal lobes. There is no evidence of intracranial hemorrhage or acute infarct. 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. There is partially-imaged micrognathia.Spine: There are five lumbar type vertebrae, with partial lumbarization of S1. The conus medullaris is located at the L2-3 level. There is no evidence of filum terminale fibrolipoma and the cauda equina nerve roots are unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. However, the left kidney is absent.

Output: 1. Inferior vermian hypoplasia.2. Unchanged subcentimeter probable colloid cyst.3. Slightly diminished ventricular dilatation and nearly resolved prominence of the anterior subarachnoid spaces.4. Considerable interval progression of the degree of myelination.5. The conus medullaris is located at the L2-3 level, but otherwise appears unremarkable.6. Left renal agenesis.


Instruction: Generate impression based on findings.

Input: MRI brain:Signal abnormality within bilateral parietal regions consistent with a history of previous mycotic aneurysm embolization.There are scattered punctate to small foci of T2 hyperintensity within periventricular and subcortical white matter without mass effect, restricted diffusion, or enhancement. Separately there are also punctate to small foci of susceptibility abnormality in both periventricular and subcortical white matter.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.  MRI cervical spine: Images are motion greater. Given this caveat:There is abnormal material within the extradural, epidural space extending from C4/5 inferiorly to the mid T1 level. This measures up to 7 mm in maximal depth, has a slight rightward predominant location, contains mixed signal characteristics on both T1 and T2, with minimal peripheral enhancement. The adjacent disc spaces and vertebral bodies are normal in appearance. This process effaces the anterior CSF space, however without cord compression or deformation.Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. There is no significant degenerative disease, disc pathology, or stenosis.

Output: 1.Signal abnormality within bilateral parietal regions consistent with a history of previous mycotic aneurysm embolization.2.There are scattered punctate to small foci of T2 hyperintensity within periventricular and subcortical white matter without. Separately there are also punctate to small foci of susceptibility abnormality in both periventricular and subcortical white matter. It is uncertain if these two processes are related or due to separate etiologies. The distribution of T2 hyperintensity lesions suggest a vasculitic pathology, yet is nonspecific. Susceptibility images may also be secondary to vasculitic related microhemorrhages or due to microimages from other etiologies such as cerebral cavernous malformations, although given patient age amyloid angiopathy and hemorrhagic metastases are felt to be unlikely.3.There is abnormal material within the extradural, epidural space extending from C4/5 inferiorly to the mid T1 level. This measures up to 7 mm in maximal depth, has a slight rightward predominant location, contains mixed signal characteristics on both T1 and T2, with minimal peripheral enhancement. The adjacent disc spaces and vertebral bodies are normal in appearance. This process effaces the anterior CSF space, however without cord compression or deformation. Although subtle, this is grossly stable when compared to a previous CT angiogram of the neck where these foci demonstrate mixed density. The constellation of these features are most suggestive of anterior epidural hemorrhage.


Instruction: Generate impression based on findings.

Input: 37 years Female (DOB:12/4/1979)Reason: multifocal GBM with incontinence History: incontinencePROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI 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.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There is some degenerative disc disease present but no compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Other intervertebral disc degeneration, lumbosacral region [M51.37], Reason for Study: ^Reason: assess for lumbar pathology History: low back pain with radiculopathy. Prostate cancer history. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Diffuse low signal intensities on lumbar spine indicate replacement of normal fatty marrow.Normal fatty marrow signal intensity on sacrum and bilateral ilium were seen which is consistent with prior radiation therapy related changes.The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level.The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Schmorl's node on both superior and inferior end plates. Diffuse bulging of disc with bilateral ligamentum flavum thickening results mild spinal canal stenosis. Mild left side neuroforaminal stenosis is seen. L4-L5: diffuse bulging of disc with bilateral ligamentum flavum thickening results mild spinal canal stenosis. Mild bilateral neuroforaminal stenosis are seen.L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Diffuse replacement of normal fatty marrow of lumbar vertebral bodies, this may indicate possible diffuse metastasis or conversion to red marrow.2. Multilevel various degree degenerative change of lumbar spine, in particular, L34 and L45 level shows mild spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: There is approximately 2 cm defect of the subcutaneous tissues in a left paramedian position at the vertex demonstrating some mild enhancement without MRI evidence of underlying calvarial or brain parenchymal associated abnormality.Mild flattening of the left parieto-occipital skull is most likely secondary to molding from positioning.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Myelination is appropriate. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There is approximately 2 cm defect of the subcutaneous tissues in a left paramedian position at the vertex demonstrating some mild enhancement without MRI evidence of underlying calvarial or brain parenchymal associated abnormality.2.Mild flattening of the left parieto-occipital skull is most likely secondary to molding from positioning.3.Findings were discussed with Dr. Sarah Stein on 4/25/2016 at approximately 10:20 AM.


Instruction: Generate impression based on findings.

Input: 60-year-old male with duodenal mass and liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. The gallbladder is distended measuring 5 cm in short axis. There is no pericholecystic fluid or gallbladder wall thickening. There is moderate intrahepatic biliary ductal dilatation. The common bile duct measures 11 mm at the level of the pancreas. There is no choledocholithiasis.Multiple hypoenhancing subcentimeter foci and masses are noted throughout the liver most apparent on restricted diffusion, suspicious for metastatic disease. For reference, there is a segment 5/6 lesion measuring 13 x 11 mm (series 13, image 154).SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is prominent measuring 5 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense cysts in the inferior pole of the right kidney.RETROPERITONEUM, LYMPH NODES: Mildly enlarged periportal, gastrohepatic ligament, and gastroesophageal junction lymph nodes are present. For reference, there is a gastroesophageal junction lymph node measuring 1.6 cm in short axis.BOWEL, MESENTERY: There is an enhancing mass in segment 2/3 of the duodenum measuring 3.8 x 3.3 cm, with mass effect on the ampulla of Vater. Small bowel caliber is within normal limits without evidence of obstruction. The appendix is well visualized and within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Duodenal mass with mass effect on ampulla resulting moderate intra- and extra-hepatic biliary ductal dilatation as well as pancreatic ductal dilatation.2.Numerous foci and masses throughout the liver suspicious for metastatic disease.


Instruction: Generate impression based on findings.

Input: Known left midbrain cavernoma annual follow-up. Redemonstration of left midbrain cavernoma with surrounding hemosiderin deposition, no change in terms of size, extent of hemosiderin deposition and MR signal intensity characteristics since prior scan.Associated developmental venous anomaly also do not show any significant interval change since prior scan.On FLAIR images, there are scattered bihemispheric high signal intensities indicating nonspecific small vessel disease, no change since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.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, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Redemonstration of the left midbrain cavernous malformation associated with developmental venous anomaly, no change of its size, extent of hemosiderin deposition and MR signal characteristics since prior exam.2. Nonspecific small vessel ischemic disease, no change since prior exam.


Instruction: Generate impression based on findings.

Input: Right visual blur and facial numbness, cape-like numbness and burning with gait instability MR brain: No intracranial mass or mass effect. No abnormal enhancement including the brainstem or cranial nerves. No diffusion abnormality. No intracranial hemorrhage. No evidence of hydrocephalus. Unchanged nonspecific prominence of the left occipital horn which may be developmental. Cisterns are patent. Major intracranial vasculature with normal flow voids. Scattered nonspecific periventricular white matter FLAIR/T2 hyperintensity appearing similar to prior study and compatible with mild small vessel ischemic changes. Mild downsloping of the pituitary gland which is otherwise unremarkable. No abnormal enhancement. Mild mucosal thickening of the paranasal sinuses with right maxillary sinus mucous retention cyst. Mastoid air cells are clear. Osseous structures are unremarkable.MR orbits: No mass, signal abnormality or abnormal enhancement in the orbits. Optic nerves appear normal. No periorbital or retro-orbital soft tissue swelling.MR cervical spine: Spinal cord has a smooth contour without focal atrophy, edema, or myelomalacia. No signal abnormality or mass involving the spinal canal. There is abnormal enhancement involving the right C7/T1 neural foramen which is inseparable from the right C8 dorsal root ganglion. This was suboptimally evaluated previously but appears unchanged since 9/10/2014.Vertebral body heights are maintained. Alignment is maintained. Marrow signal is benign. Multilevel degenerative changes are seen including loss of disc height at C6/7 level. Individual levels as below:C1/2: No significant spinal canal stenosis or foraminal narrowing.C2/3: No significant spinal canal stenosis or foraminal narrowing.C3/4: Uncovertebral hypertrophy with left facet arthropathy resulting in mild to moderate left foraminal narrowing. No significant spinal canal or right foraminal stenosis.C4/5: No significant spinal canal stenosis or foraminal narrowing. C5/6: Mild posterior disc osteophyte. No significant spinal canal stenosis or foraminal narrowing. C6/7: Disc osteophyte complex resulting in minimal narrowing of the spinal canal. No significant foraminal narrowing. C7/T1: Abnormal enhancement involving the right C7/T1 neural foramen as mentioned above. No significant left foraminal or spinal canal stenosis.

Output: 1.No significant intracranial abnormality. Specifically, no lesions or abnormal enhancement involving the brainstem, cranial nerves, or orbits. 2.Minimal periventricular white matter foci of FLAIR/T2 hyperintensity, which appears similar to prior study and compatible with mild chronic small vessel ischemic changes.3.There is abnormal non expansile enhancement involving the right C7/T1 neural foramen which is inseparable from the right C8 dorsal root ganglion. Finding was suboptimally evaluated on most recent study but is unchanged dating back to outside MRI from 9/10/2014 and may represent a small nerve sheath tumor. Other etiologies such as a chronic inflammatory process limited to this region seems less likely. No cord signal abnormality or lesions within the spinal canal.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder chondrosarcoma, check for recurrence History: check for recurrence We see no soft tissue mass or enhancement to indicate a recurrence of the patient's soft tissue sarcoma. There is signal abnormality within the medial clavicle and proximal humeral diaphysis which appears similar to the prior study and may represent post radiation therapy changes. Moderate osteoarthritis affects the acromioclavicular joint. Mild osteoarthritis affects the glenohumeral joint with a mild glenohumeral joint synovitis. Although this examination was not protocoled for detailed evaluation of the rotator cuff, there is thinning of the supraspinatus tendon likely reflecting chronic attritional tearing with additional more focal partial thickness undersurface tearing, distally, that is comparable to that seen on the prior examination. There is also a partial-thickness undersurface tear of the distal infraspinatus at the level of its insertion, which appears similar to the prior study. There is perhaps trace fluid and enhancement of the subacromial subdeltoid bursa.

Output: 1. No evidence of tumor recurrence. Presumed treatment-related changes of the clavicle and humerus as described above.2. Osteoarthritis of the shoulder, partial-thickness rotator cuff tears, and other findings as described above.


Instruction: Generate impression based on findings.

Input: History of PSC. Evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Stable narrowing of the distal common bile duct with mild upstream dilatation. No focal lesion or new dominant stricture visualized. Multiple prominent porta hepatis lymph nodes are nonspecific in the setting of chronic liver disease. The liver measures 20 cm in length. Partially contracted gallbladder with mild wall thickening, nonspecific.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several punctate simple-appearing cysts. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace right paracolic gutter fluid, nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Without significant change narrowing of the distal common bile duct with minimal proximal ductal prominence, unchanged. No new dominant stricture or focal lesion seen.


Instruction: Generate impression based on findings.

Input: Clinical question: CNS Nocardia, now with personality changes. Signs and symptoms: Personality changes, change in behavior. Nonenhanced brain MRI:After completion of nonenhanced portion of the exam the study was terminated due to patient's refusal to continue.Examination demonstrates no evidence of an acute or new finding since prior exam when compared with nonenhanced component of the prior brain MRI examination from 6-3-15.Well-demarcated focus of FLAIR and T2 hyperintensity in the splenium of corpus callosum believed to represent a fungus ball remains similar to prior study in signal and size. Extensive surrounding FLAIR hyperintensity consistent with vasogenic edema of the corpus callosum also remains identical to prior study in extent.Additional multiple small foci of FLAIR hyperintensity in bilateral cerebral hemisphere demonstrate no convincing evidence of change in size, extent or numbers.Mildly dilated supratentorial ventricular system without deviation of midline also remain similar to prior study in measurements. The cortical sulci and CSF cisterns remain widely patent and stable since prior exam.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Images through the orbits, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No detectable acute or convincing evidence of any new finding since prior MRI exam.2.Stable findings of presumed Nocardia infection since prior exam when compared to the prior study.3.Mild prominence of supratentorial ventricular system and generalized prominence of cortical sulci without deviation of midline or interval change since prior study.4.Examination was performed without the benefit of intravenous contrast as patient refused to continue with the exam.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Scattered areas of full-thickness loss are identified within the medial femoral condyle anteriorly. This is superimposed upon mild diffuse thinning of the articular cartilage. Similar diffuse thinning of the lateral compartment is also noted. There is full-thickness loss of the lateral patellar facet with areas of partial-thickness and full-thickness loss of the femoral trochlea. Marrow signal reflective of a hematopoietic reconversion is noted within the distal femur.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. No evidence of meniscal pathology.2. Severe articular cartilage loss with full-thickness defects involving the medial femoral condyle anteriorly. Additional areas of cartilage loss are detailed above.3. Moderate joint effusion.