Instruction: Generate impression based on findings.

Input: Reason: Evaluation of soft tissues of the pelvis and lumbar spine. Please extend scan proximally to lumbar spine to eval soft tissue for involvement of infection History: Osteomyelitis of L lumbar spine in pt with spinal hardware Extensive metallic susceptibility artifact from the patient's lumbosacral fixation device limits evaluation of the lumbar spine and sacrum as well as the surrounding soft tissues. Again seen is a postoperative deformity of the right hip. There is increased bone marrow signal abnormality within the right femoral head which is likely degenerative in etiology. There is a small amount of fluid within the right hip which is likely of no current clinical significance. There is fatty atrophy of the imaged musculature of the right hip and iliacus muscles bilaterally.There is increased signal abnormality within the subcutaneous tissue along the posterior aspect of the sacrum on the left, best seen on coronal STIR sequences indicating nonspecific inflammatory change. There is increased signal abnormality within the paraspinal musculature as well which is nonspecific but may be postsurgical in etiology. Extensive metallic susceptibility artifact severely limits our ability to evaluate for hardware complication. Please see the dedicated MRI lumbar spine report for additional details.

Output: Extensive metallic susceptibility artifact severely limits evaluation, particularly in the area of the orthopedic hardware and surrounding soft tissues. Nonspecific subcutaneous inflammatory change along the posterior aspect of the sacrum, on the left, with other findings as described above. Please see the dedicated MRI lumbar spine report for additional details.


Instruction: Generate impression based on findings.

Input: 29-year-old male with knee pain evaluate for ACL or meniscus injury MENISCI: There is a tear/fraying of the inner margin of the posterior horn of the lateral meniscus with an overlying articular cartilage defect described below. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness defect of the articular cartilage of the posterior lateral femoral condyle overlying the posterior horn of the lateral meniscus which measures approximately 4 mm in AP dimension and 8 mm in transverse dimension with underlying marrow signal changes. There is a lateral notch along the anterior femoral condyle likely from prior injury and minimal edema in the posterolateral tibial plateau.LIGAMENTS: The ACL is fully disrupted. The PCL is intact. The medial and lateral collateral ligaments appear intact.EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: 1. ACL tear, likely subacute to chronic.2. Inner margin tear/fraying of the posterior horn of the lateral meniscus with overlying focal articular cartilage defect along the posterior lateral femoral as described above.


Instruction: Generate impression based on findings.

Input: Left hip pain. Left lower extremity weakness. Evaluate for fracture/dislocation. The bones appear demineralized suggesting osteopenia. Mild osteoarthritis affects the left hip. The left femur is held in external rotation, limiting evaluation of the femoral neck. I see no fracture line. There is mild irregularity of the cortex along the lateral aspect of the femoral neck that I suspect represents osteophyte formation, as the underlying trabeculae do not appear disrupted; however, if there is strong clinical concern for femoral neck fracture, then MRI is recommended. Mild osteoarthritis affects the right hip. Osteoarthritis also affects both sacroiliac joints and the lower lumbar spine.

Output: Mild irregularity of the cortex along the lateral aspect of the femoral neck is favored to represent osteophyte formation, as the underlying trabeculae do not appear disrupted; however, if there is strong clinical concern for femoral neck fracture, then MRI is recommended.


Instruction: Generate impression based on findings.

Input: 55 year old female. Evaluate for bleeding/trauma. Prominent cerebral sulci and cerebellar folia consistent with volume loss, unchanged.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Cerebral volume loss with no acute intracranial abnormality seen.


Instruction: Generate impression based on findings.

Input: 55-year-old female with hx of aneurysm clipping, 1yr follow up There is redemonstration of postsurgical changes consistent with right pterional craniotomy. Parasellar and intrahemispheric susceptibility artifact from aneurysm coil/clipping material is demonstrated. There is diffuse prominence of the cortical sulci in proportion to the cerebral ventricles consistent with diffuse cerebral atrophy. T2/FLAIR abnormalities involving the right frontal lobe, right frontal and temporal operculum, occipital lobe and right inferior parietal lobule are seen consistent with chronic infarction. Additional small lacunar infarcts are demonstrated in the right centrum semiovale. Subtle T2/FLAIR abnormality involving the left frontal lobe white matter may be related to chronic microvascular ischemic change. There is no evidence for diffusion restriction to suggest acute or subacute ischemia. No intra-axial or extra-axial fluid collections are visualized. No midline shift or mass effect is appreciated. There is no abnormal postcontrast enhancement demonstrated.The visualized paranasal sinuses and mastoid air cells are negative for fluid collections. The visualized orbits appear grossly unremarkable.3-D time-of-flight MRA demonstrates suspicious small (about 2mm) filling of the bottom of coil mass of the right Pcom aneurysm indicating possible minimal aneurysm recanalization. However, this could represent tortuous nature of the proximal right fetal PCA. Comparing to prior MRA (Apr-5 2015) this lesions appears to be slightly prominent.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. The bilateral internal carotid arteries and middle cerebral arteries demonstrate normal caliber without evidence for aneurysm. Susceptibility artifact from coiling material involving the Acom artery limits evaluation of the bilateral A1 and A2 segments. However, no new aneurysm is visualized. Fetal origins of the bilateral posterior cerebral arteries are again visualized.

Output: 1. Tortuosity of the right fetal PCA vs possible minimal aneurysm neck recanalization of previously coiled right Pcom aneurysm as described above.2. Postsurgical changes consistent with left frontal craniotomy and Acom aneurysm clipping as well as right P-comm aneurysm coiling are again seen. Susceptibility artifact limits evaluation of the surrounding vasculature.3. No evidence of new intracranial arterial aneurysm.4. Chronic infarction of the right frontal and parietal lobes is again seen.


Instruction: Generate impression based on findings.

Input: Altered mental status. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity. There are also small areas of encephalomalacia in the bilateral basal ganglia and corona radiata. There is prominent low T2 signal in the bilateral basal ganglia. The ventricles and basal cisterns are unchanged in size and configuration. There is diffuse cerebellar volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal fluid signal in the left mastoid air cells. There is diffuse paranasal sinus mucosal thickening. There is leftward nasal septal deviation with spur.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Probable chronic small vessel white matter ischemic disease and chronic bilateral basal ganglia and corona radiata lacunar infarcts. 3. Nonspecific diffuse cerebellar volume loss.


Instruction: Generate impression based on findings.

Input: 49-year-old female presents for routine follow-up of prior parotid cancer status post resection. MRI Brain:No abnormal parenchymal or meningeal enhancement is identified. There is no evidence mass or edema. Again demonstrated are numerous foci of punctate susceptibility artifact predominantly within the right temporal lobe, brainstem, and cerebellum, which are compatible with tiny microhemorrhages and presumably sequela from prior radiation therapy. The ventricles and basal cisterns are normal in size and configuration. No evidence of infarct. The expected intracranial vascular flow voids are present. Stable partial opacification of the right mastoid air cells. The orbits are unremarkable.MRI ST Neck:Posttreatment changes in the neck including resection of the right parotid gland as well as atrophy of the right submandibular gland. Stable appearance of the tongue with volume loss of the right hemitongue and posterior ptosis of the left tongue base. No enhancing soft tissue mass to indicate a recurrence. There are scattered subcentimeter neck lymph nodes which are not pathologically enlarged. No significant lymphadenopathy. The thyroid, left parotid, and left submandibular glands are unremarkable. The cervical spine demonstrates mild multilevel degenerative changes without suspicious osseous lesions.

Output: 1. No evidence of metastatic disease in the brain.2. Stable posttreatment changes in the neck related to prior right parotid tumor without evidence of locoregional tumor recurrence.3. Multiple tiny foci of susceptibility in the brain are again seen and may represent tiny cavernous malformations related to prior radiation therapy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62 year old man with angina and multivessel coronary disease is referred to evaluate for ischemic territory prior to possible revascularization.MEDICATIONS: allopurinol, aspirin, atorvastatin, colchicine, ezetimibe, isosorbide mononitrate and levothyroxine. First Pass PerfusionDuring hyperemia, there is are 2 distinct perfusion defects. The first involves the basal anteroseptum, mid anteroseptum & inferoseptum, and apical septum. The second involves the mid inferolateral wall. The overall ischemia score is 5 out of 32. Approximately, 15% of the myocardium is ischemic.Viability/ Myocardial ScarThere are two separate areas of late gadolinium enhancement in a pattern consistent with prior myocardial infarction. The first is non-transmural and involves the basal to mid inferolateral wall. These segments have an intermediate probability of viability. The second is small involves the apical inferior wall. It is transmural and that small myocardial segment is not likely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 60 ml (normal range 47+/-19), the LV mass index is 64 g/m2, and the LV mass is 135 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57 %, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is 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. There is a large burden of ischemia involving the usual territory of the LAD and LCx.2. The LAD territory has a small transmural myocardial infarction in the distal most territory; however, the majority of the LAD territory is viable. 3. The LCx territory has a non-transmural myocardial infarction and has an intermediate probability of viability. 3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 57%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for evidence of wernicke or other encephalopathy: reported cirrhosis (EtOH &/or Hepatitis C) and EtOH abuse with concern for high grade Hepatic Encephalopathy likely due to acute alcoholic hepatitis There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of cerebral white matter T2 hyperintensity, which are non-specific. There is also foci T2 hyperintensity in the bilateral globi pallidi as well as susceptibility effect and patchy T1 hyperintensity. However, the thalami and mammillary bodies appear to be intact. There is diffuse mild cerebral and cerebellar volume loss. 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. However, there appears to be a submucosal T2 hyperintense lesion in the left hard palate that measures up to 12 mm.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Abnormality in the bilateral globi pallidi may represent sequela of prior ischemic injury and/or chronic alcoholic encephalopathy, but there are no findings specific for Wernicke encephalopathy or acute hyperammonemic encephalopathy. 3. Diffuse mild cerebral and cerebellar volume loss.4. An apparent submucosal T2 hyperintense lesion in the left hard palate is incompletely characterized, but may represent a reactive or neoplastic process. Further evaluation via an MRI with contrast and otolaryngological examination may be useful.


Instruction: Generate impression based on findings.

Input: 15-year-old male with history of knee trauma and mechanical symptoms. Evaluate for cruciate/meniscal injury. MENISCI: There is a large complete longitudinal tear of the periphery of the body and posterior horn of the lateral meniscus, seen on multiple sequential sagittal and coronal images. The anterior horn appears intact. There is a complex tear of the posterior horn of the medial meniscus, consisting of a complete longitudinal tear through the periphery of the horn and a more oblique component, extending from the periphery to the femoral articular surface. The periphery of the body of the medial meniscus is indistinct and we cannot exclude meniscocapsular separation.ARTICULAR CARTILAGE AND BONE: There is a small bony fragment along the lateral aspect of the proximal tibial epiphysis representing a Segond-type fracture and/or an iliotibial band avulsion fracture. There is edema within the underlying marrow of the tibial plateau. There is also an impaction fracture along the lateral femoral condyle along the anterior horn of the meniscus which is associated with underlying bone marrow edema consistent with a "lateral notch sign". There is mild edema within the far medial aspect of the tibial plateau as well. There are no fluid-filled articular cartilage defects.LIGAMENTS: There is a full-thickness rupture of the ACL. The PCL appears intact. There is a partial thickness tear of the anterior fibers of the proximal half of the MCL. The femoral attachment of the medial patellofemoral ligament is not well visualized amidst this edema. The lateral collateral ligament proper and biceps femoris tendon appear intact. The anterior fibers of the iliotibial band can be traced to their insertion onto Gerdy's tubercle. The posterior fibers appear to attach to the aforementioned Segond type avulsion fracture.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Rupture of the ACL with a Segond type fracture and other associated findings as described above.2. Medial and lateral meniscus tears as described above with possible medial meniscocapsular separation.3. Joint effusion and other findings as described above.


Instruction: Generate impression based on findings.

Input: 66-year-old female status post heart transplant and partial gastrectomy. Presenting with right upper quadrant pain anemia ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Ill-defined hypodense lesion in the left lobe of the liver measuring 10 x 9 mm on image number 14, series number 3, nonspecific. This lesion is not well seen on previous CT and MRI. Follow-up imaging with liver MR 6-month helpful. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Enhancing mass in the anterior aspect of the left kidney measuring 16 x 13 mm image number 47, series number 3 has slightly increased in size compared to previous CT and MRI. Simple appearing left renal cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes involving the abdominal aorta predominantly SMA. Celiac trunk and IMA are patent.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Transplant kidney in the right iliac fossa without evidence of hydronephrosis, focal lesions.

Output: Right adrenal mass suspicious for renal cell carcinoma slightly increased in size compared to previous studies.Liver MRI may be helpful in 6 months for further evaluation of the nonspecific, but new lesion in the left lobe of the liver.


Instruction: Generate impression based on findings.

Input: History of ovarian cancer. Patient has new onset cloudy vision involving the left eye. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. Incidental note is made of partial empty sella with mild expansion of the sella.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: MRI of the brain and orbits is within normal limits. Nio evidence for brain or orbital metastases.


Instruction: Generate impression based on findings.

Input: Reason: PANCREATIC CYSTIC NEOPLASM IN HEAD OF PANCREAS. ANY CHANGE? History: PANCREATIC CYSTIC NEOPLASM IN HEAD OF PANCREAS. ANY CHANGE?. ABDOMEN:LIVER, BILIARY TRACT: Hepatic cysts, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic cystic lesions in the uncinate process that appear to communicate with the pancreatic duct are not significantly changed. The largest measures 7 mm, unchanged (series 601 image 69). New punctate uncinate process cystic lesion measuring 2 mm (series 601 image 64). No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable uncinate process side branch IPMN's. New punctate 2 mm uncinate process cystic lesion, also likely a side branch IPMN.


Instruction: Generate impression based on findings.

Input: Left hip pain. Please rule out for labral tear. ACETABULAR LABRUM: Linear signal abnormality traversing the labrum the 2:00 position.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Findings compatible with a labral tear at the 2:00 position. Borderline cam type femoral acetabular impingement deformity with an alpha angle measuring approximately 56 degrees.


Instruction: Generate impression based on findings.

Input: Seizure. Altered mental status and weakness. The residual subcortical T2 hyperintensity within the occipital lobes bilaterally remain unchanged as well as the overlying cortical thinning. The few punctate foci of susceptibility effect in the parietal and occipital lobes as well. There are also unchanged scattered punctate cerebral white matter T2 hyperintensities and a focal defect in the right aspect of the body of the corpus callosum. There is an unchanged configuration of the ventricular system, with prominence of the lateral ventricles, particularly posteriorly, with associated diminished periventricular white matter volume. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The hippocampi are symmetric without abnormal signal. There is no midline shift. There are unchanged minimally low-lying cerebellar tonsils. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the ethmoid sinuses.

Output: 1. Residual stigmata of previous posterior reversible encephalopathy syndrome are unchanged.2. Mild probable chronic small vessel ischemic disease without evidence of acute infarction.3. Unchanged ventriculomegaly with what appears to be colpocephaly.


Instruction: Generate impression based on findings.

Input: Diagnosis: Acute lymphoblastic leukemia not having achieved remission. Acute lymphoblastic leukemia not having achieved remissionClinical question: patient with lytic lesions in T spine seen on CT scan There are multiple foci of marrow replacement and contrast and enhancement scattered throughout the thoracic spine and in general throughout the visualized spine. There is partial compression of T11. Involving the left half of the T11 vertebra more than the right with approximately 30% loss of vertebral body height there is no evidence for retropulsion or compromise to spinal canal.Multiple marrow replacing lesions are also identified in the other visualized skeletal structures including the ribs and scapula.There is no compromise of thoracic spinal canal or exiting nerve roots.There is a large left-sided pleural effusion associated with airspace disease. There are multiple nodules present in the visualized portion of the right lung. There is a small right pleural effusion present.

Output: 1.Findings are compatible with diffuse skeletal metastases involving the visualized portions of the spine with mild compression fracture at T11 without significant compromise to the spinal canal at this time. Skeletal metastases are also suspected in the ribs and scapula.2.There are multiple nodules identified in the visualized portions of the right and left lung. Please refer to chest CT from 10/13/2015 for further comments.3.Bilateral pleural effusions-the left pleural effusion is larger and associated with airspace disease whereas the right pleural effusion is much smaller.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer to brain status post right frontal tumor resection: evaluation of cavity and presence of additional lesions, referred for radiosurgery planning. There are postoperative findings related to right frontal lobe tumor with diffuse presumed marginal enhancement that is more nodular along the anterior and inferior aspects of the surgical cavity. There is susceptibility effect within the resection cavity, which likely represents blood products. There is also circumferential confluent high T2 signal surrounding the surgical cavity, which may represent vasogenic edema, and mild mass effect upon the anterior portions of the lateral ventricles. There are a few scattered punctate foci of cerebral white matter T2 hyperintensity. There is a 10 mm diameter cystic pineal gland. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is fluid and mucosal thickening in the left maxillary sinus.

Output: 1. Postoperative findings related to right frontal lobe tumor with diffuse presumed enhancement that is more nodular along the anterior and inferior aspects of the surgical cavity, which may represent residual tumor. However, assessment is limited due to the lack of non-contrast T1-weighted sequences for comparison.2. Findings suggestive of acute left maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: Male, 33 years old, with worsening quadriparesis and spasms. Cervical:Patchy T2 hyperintensity persists within the cervical spinal cord without significant cord expansion and no definite associated cord enhancement. Findings are similar to the prior exam. However, on postcontrast images, all of the dorsal and ventral nerve roots arising from the cervical region are enhancing. This finding was not clearly present on the prior study.No marrow signal abnormality is detected. Vertebral body morphology and alignment are normal. No evidence of significant spinal canal or neuroforaminal stenosis is seen.Thoracic:Patchy T2 hyperintensity is redemonstrated throughout the thoracic spinal cord. This is most conspicuous at the T7 through T9 levels. The degree of this signal abnormality may be mildly increased compared to that seen on the prior study, although this appearance could in part be due to technical differences. No definite pathologic cord enhancement is seen.Although not as clearly seen as in the cervical region, most of the thoracic nerve roots are enhancing, particularly those giving rise to the cauda equina. Again, this finding was not as well visualized on the prior study.The thoracic kyphosis is mildly exaggerated. In addition, there are Schmorl's node deformities and end plate undulation from T6 through T9 along with mild anterior wedging. No pathologic marrow signal abnormality is seen.At T8-9, there is a central disk protrusion which mildly impinges upon the ventral spinal cord. Elsewhere, no significant disk disease, spinal canal or neuroforaminal stenosis is detected.

Output: Patchy cord signal abnormality is again seen, without significant change from the prior examination.Diffuse enhancement of the cervical and thoracic nerve roots is new or progressed from the prior study.The differential diagnosis would include a post infectious autoimmune phenomenon as the most likely etiology. Noninfectious inflammatory etiologies may also be considered, with ongoing atypical or viral infection a less likely possibility. Findings in the thoracic spine suggestive of Scheuerman's disease. Also noted is a central disk protrusion at T8-9 which impinges the spinal cord.


Instruction: Generate impression based on findings.

Input: Male 61 years old with HCV cirrhosis status post TACE/ RFA. Assess for liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic pathology with reticular T2 hyperintensity consistent with fibrosis and multiple regenerative nodules.The segment 6 ablation cavity is unchanged in appearance with no evidence of recurrent or residual tumor.There is a new 11 x 11 mm lesion in hepatic segment 5 that demonstrates arterial enhancement and washout suspicious for hepatocellular carcinoma. Additional small enhancing foci in segment 5 are too small to characterize.Stable mild dilation of the common bile duct.SPLEEN: Marked splenomegaly and extensive perisplenic collateral vasculature are stable.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.New segment 5 lesion is suspicious for hepatocellular carcinoma.2.Stable appearance of the segment 6 ablation cavity.3.Stable splenomegaly, perisplenic collateral vessels and mild common bile duct dilatation.


Instruction: Generate impression based on findings.

Input: Reason: eval rotator cuff. History: she has 2 mo acute worsening of chronic symptoms. Had prior rtc repair in the past. ROTATOR CUFF: Note is made of postsurgical changes of prior rotator cuff repair. There is near complete to complete rupture of the supraspinatus tendon with approximately 4 cm of retraction. The tear extends posteriorly to involve the anterior fibers of the infraspinatus. There is marked fatty atrophy of the supraspinatus and infraspinatus muscles. The teres minor muscle and tendon appear intact. There is mild fatty infiltration of the teres minor muscle. There is thickening and intermediate signal intensity within the subscapularis which may reflect tendinosis.SUPRASPINATUS OUTLET: There is a moderate amount of fluid within the subacromial subdeltoid bursa. Degenerative changes of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Note is made of a high riding humeral head. The glenohumeral joint alignment is otherwise anatomic. There is a near full-thickness to full-thickness articular cartilage fissure affecting the glenoid articular cartilage, centrally with delamination. There is heterogeneity and intermediate signal intensity within the anterior and inferior glenoid labrum indicating degeneration/degenerative tearing.BICEPS TENDON: There is thickening and intermediate signal intensity within the intra-articular portion of the long head of the biceps tendon indicating tendinosis. There is linear fluid signal intensity traversing the tendon of the long head of the biceps at the level of its transition from the bicipital groove to the rotator interval indicating a longitudinal split tear. There is extensive circumferential fluid within the tendon sheath of the long head of the biceps indicating a tenosynovitis.ADDITIONAL

Output: 1. Near complete to complete rupture of the supraspinatus with extension of the tear to involve the anterior fibers of the infraspinatus. Fissuring of the articular cartilage of the glenoid with delamination as described above. Longitudinal split tear of the tendon of the long head of the biceps. 2. Glenohumeral joint effusion with findings indicating a synovitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Newly diagnosed prostate cancer. 3+4 disease right middle lobe PELVIS:PROSTATE:Prostate Size: 2.4 x 4.2 x 2.0 cmPeripheral Zone: Mild patchy increased T1-weighted signal intensity of the peripheral zone likely represents recent biopsy. This limits evaluation.There is an approximately 8 x 6 mm focus of restricted diffusion (series 703/184) associated with T2 weighted hypointensity (series 501/10) in the right lateral base/mid gland, suspicious for prostatic adenocarcinoma.Additional smaller foci of T2 weighted hypointensity are noted without definite associated restricted diffusion or abnormal enhancement.Central Gland: Mild 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: 8 mm focus in the right base/mid gland is suspicious for prostatic adenocarcinoma.No evidence of extraprostatic extension or enlarged pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Other specified types of non-hodgkin lymphoma, unspecified site [C85.80] / Diffuse large b-cell lymphoma, lymph nodes of multiple sites [C83.38], Reason for Study: ^Reason: new dx large B-cell lymphoma -- evaluate for CNS disease There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is no abnormal enhancement.Scattered focal FLAIR/T2 high signal intensities on centrum semiovale and pathy FLAIR/T2 high signal intensities on periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cysts in the left maxillary sinus and right side of sphenoid sinus. And focal minimal fluid collection on the right maxillary sinus.

Output: 1. Non specific small vessel ischemic disease.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 5 day old 39 weeks male with poor responsiveness at birth status post cooling for perinatal depression. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The pattern of myelination is appropriate for age. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull is unremarkable. There is a right parietal scalp soft tissue swelling.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Right parietal scalp soft tissue swelling, which likely represents a caput succedaneum.


Instruction: Generate impression based on findings.

Input: History of cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size measuring 17.8 cm in the craniocaudal dimension. There is mild fissural widening and an undulating liver contour compatible with cirrhosis. There is heterogeneous intrinsic T1 and T2-weighted signal intensity of the liver as well as diffusely heterogeneous post-contrast enhancement, including several peripheral wedge-shaped arterially-enhancing and subsequently iso-intense foci suggestive of perfusional anomalies in the setting of fibrosis. The hepatic veins are normal in caliber and the vessels appear patent.No discrete suspicious arterial enhancing lesion with associated wash-out on portal venous, equilibrium and/or delayed imaging phases.Gallstones within a normally distended gallbladder. Minimal gallbladder wall thickening/pericholecystic fluid is nonspecific in the setting of cirrhosis. Minimal perihepatic fluid. No intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is mildly enlarged measuring 13.7 cm in craniocaudal dimension without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter simple appearing bilateral renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneous bone marrow signal intensity. Mild right sided gynecomastia. OTHER: No significant abnormality noted.

Output: 1.Cirrhotic hepatic morphology with stigmata of mild portal hypertension. No focal suspicious liver lesion. 2.Heterogeneous liver parenchyma on pre- and post-contrast imaging may represent underlying fibrosis and perfusional anomalies.


Instruction: Generate impression based on findings.

Input: Clinical question: Indeterminate/dementia. Signs and symptoms: Memory decline, visual spatial impairment and cognitive dysfunction. Nonenhanced brain MRI:No diffusion weighted abnormalities. Examination redemonstrate periventricular and subcortical foci of nonspecific flair hyperintensity only in bilateral cerebral hemispheres without associated susceptibility signal changes. Although nonspecific this appearance is often result of microvascular ischemic changes. Findings remain very similar to prior exam and with only questionable minute interval progression. The overall anatomical morphology and signal intensity of brain parenchyma otherwise remains within normal patient's stated age. The cerebral cortex demonstrate no signal abnormality. The ventricular system remain within normal size and with maintained midline.The signal voids of major intracranial arterial branches are identified and unremarkable.The signal intensity of the intracranial venous sinuses are also normal.Calvarium and soft tissues of the scalp are unremarkable. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process and negative diffusion weighted images.2.Findings suggestive of mild chronic small vessel ischemic strokes without convincing evidence of any significant interval change since prior exam. Findings are entirely confined in the periventricular and subcortical white matter of cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: Reason: Breast cancer: Pain in right shoulder: has metastasis in shoulder; looking for fracture/ tear. History: Breast cancer: Pain in right shoulder: has metastasis in shoulder; looking for fracture/tear Note is made of a lesion within the right humeral head and neck which extends to the level of the proximal humeral diaphysis and demonstrates increased signal abnormality on fluid sensitive sequences with enhancement on postcontrast sequences consistent with the findings of a lytic lesion seen on recent radiographs, likely representing osseous metastatic disease. This lesion spans the entire medullary space of the proximal humerus with associated multifocal cortical disruption along the inferomedial aspect of the humeral head as well as along the posterior and lateral aspect of the surgical neck of the humerus. There is enhancing soft tissue extension in the surrounding area. There is also a focus of enhancing bone marrow signal abnormality within the coracoid process indicating an additional focus of osseous metastatic disease. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. No full-thickness rotator cuff tear is evident. There is a small amount of fluid within the subcoracoid bursa which may reflect a mild bursitis. There is a small amount of fluid within the glenohumeral joint which extends into the subscapular recess with associated enhancement on postcontrast sequences likely representing a synovitis.

Output: Large focus of enhancing bone marrow signal abnormality in the proximal humerus consistent with the patient's known history of osseous metastatic disease. There is associated multifocal cortical destruction at the level of the surgical neck of the humerus as well as along the inferomedial aspect of the humeral head. An additional osseous metastatic deposit is identified within the coracoid.


Instruction: Generate impression based on findings.

Input: Reason: Hx of relapsed Ewings in past, now with T10 vertebral body lesion History: above Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. following biopsy no hmatoma or complication was identified.

Output: T10 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis in two formalin jars.


Instruction: Generate impression based on findings.

Input: 89-year-old female with osteomyelitis. TENDONS: The extensor and flexor tendons appear intact. The peroneal tendons appear intact.LIGAMENTS: The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified to suggest osteomyelitis. There is a small amount of fluid within the tibiotalar joint.ADDITIONAL

Output: Findings suggestive of inflammation/subcutaneous edema along the posteromedial aspect of the ankle as described above without evidence of osteomyelitis or abscess formation.


Instruction: Generate impression based on findings.

Input: There is no diffusion abnormality. No intracranial mass or mass effect. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Small infarct involving the left cerebral hemisphere is noted and present on prior limited MRI from 2011. There is focus of susceptibility effect in the right cerebellar hemisphere consistent with chronic microhemorrhage and nonspecific. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits.MRA HEAD

Output: 1. No evidence of acute infarct. No intracranial mass or mass effect. Mild chronic small vessel ischemic disease. Small chronic infarct in the left cerebellar hemisphere which appears grossly unchanged. Focus of chronic microhemorrhage in the right cerebellar hemisphere which is nonspecific.2. MRA again demonstrates severe multifocal disease involving the posterior circulation in the head and neck as described above. Bilateral posterior cerebral arteries and superior cerebellar arteries appear to fill from the anterior circulation via large posterior communicating arteries. There is stable to mild worsening involving the multifocal high-grade stenosis and occlusion involving the vertebral arteries in the head and neck as well as the proximal basilar artery. CTA may be helpful for more accurate comparison.3. There is mild to moderate stenosis involving the right petrous internal carotid artery. The distal internal carotid, anterior, middle, and posterior cerebral arteries demonstrate no significant stenosis. 4. No significant stenosis involving the internal carotid artery origins in the neck.


Instruction: Generate impression based on findings.

Input: Reason: staging exam History: new prostate cancer PELVIS:PROSTATE:Prostate Size: 5.0 x 4.0 x 4.5 cmPeripheral Zone: There is hemorrhage in the left base peripheral zone and right mid gland and apex peripheral zone. In the nonhemorrhagic regions, there is a large area of low T2/ADC signal with early enhancement extending throughout the right base, mid gland and apex. In the right mid gland, this lesion measures 3.1 x 2.3 cm (401/10).Central Gland: BPH nodules.Seminal Vesicles: Large right-sided lesion abuts the seminal vesicles.Extracapsular Extension: There is irregularity of the capsule in the right mid gland (401/9), likely representing extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small right external iliac node measuring 11 x 8 mm (1301/90). Small pelvic sidewall node measures 1.0 x 0.9 cm (1301/90).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat-containing inguinal hernias.

Output: 1.Large right-sided lesion throughout the base, mid gland and apex is suspicious for prostatic adenocarcinoma with findings suggesting extracapsular extension.2.Mildly enlarged pelvic lymph nodes are suspicious for nodal metastases.


Instruction: Generate impression based on findings.

Input: 58-year-old female patient with open wound in the right lower leg. Evaluate for osteomyelitis. There is an ulcer on the lateral aspect of the lower leg with thickening of the adjacent skin and edema within the underlying subcutaneous fat. Although the edema becomes confluent, we see no discrete fluid collection to suggest abscess formation. There is a small amount of edema adjacent to the peroneus longus tendon, but we see no intramuscular abscess. No bone marrow signal abnormality to suggest osteomyelitis. Additional mild subcutaneous edema is noted in the proximal leg and at the ankle. There is a small knee joint effusion and a small amount of edema posterior to the femur. Note is made of mild subcutaneous edema in the left leg on large field coronal images.

Output: Soft tissue ulceration and adjacent cellulitis without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 34-year-old male with posterior hamstring pain for 2 years. Evaluate for proximal hamstring tendon tear and evaluate atrophy of the distal hamstring and possible denervation. As seen on the recent knee MRI examination, there is fatty infiltration of the semimembranosus muscle. The distal tendinous insertion is not included in the field-of-view of this study, but was unremarkable on the prior knee MRI exam. The proximal tendon can be followed to its origin from the ischium and does not appear to be thickened or scarred. There is perhaps minimal fatty infiltration of the distal biceps femoris muscle, but otherwise the biceps femoris and semitendinous muscles appear normal. The remaining musculature of the thigh is normal. On the large field-of-view coronal images, there appears to be fatty infiltration of the right semimembranosus muscle as well. The bone marrow signal intensity is normal.

Output: Idiopathic fatty atrophy of the semimembranosus muscle without findings to confirm a hamstring tendon tear. Of note, this appears to be a bilateral process.


Instruction: Generate impression based on findings.

Input: Male, 4 months old, with history of anterior fontanelle hemangioma. A lobular scalp lesion is evident overlying the anterior fontanelle which measures 37 x 29 mm in the axial plane and 12 mm in thickness. The lesion involves the scalp only with no clear involvement of the underlying bone and no invasion of the intracranial space. The lesion is mildly T2 hyperintense and heterogeneously T1 hypointense. There are vessels coursing adjacent to and within the lesion.On limited MRI sequences, the brain itself demonstrates normal morphology and signal characteristics. The pattern of white matter myelination is appropriate for age. No focal parenchymal signal abnormality is seen. No abnormal extra axial fluid collections are detected. The ventricles are normal in size and morphology.

Output: A vascular scalp lesion is evident overlying the anterior fontanelle which does not clearly involve the underlying bone or the intracranial space. As on the prior ultrasound, this lesion would be compatible with a hemangioma.


Instruction: Generate impression based on findings.

Input: HIV on HART, polysubstance abuse, reported h/o brain tumor, multiple falls, slurred speech, dysmetria although confounded by admitting to opiate intoxication. There aer multiple scattered foci of predominantly subcortical white matter T2 hyperintensity without restricted diffusion. There is also patchy T2 hyperintensity and swelling within the central pons and within the medial cerebellar hemisphere white matter, right greater than left. The cerebellar tonsils are mildly low-lying. There is a punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle, with what appears to be adjacent linear susceptibility effect. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. The calvarial bone marrow is diffusely heterogenous. The adenoids are prominent. There is mild diffuse paranasal sinus mucosal thickening.

Output: 1. Multiple supratentorial and infratentorial white matter lesions may represent progressive multifocal leukoencephalopathy or other opportunistic infection, the primary effects of HIV, neoplasm, such as CNS lymphoma, and/or the effects of opiate intoxication, with what may represent mild tonsillar herniation versus baseline low-lying tonsils. However, assessment is limited due to the lack of intravenous contrast. Otherwise, no evidence of acute intracranial hemorrhage or acute infarct.2. A punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle may represent a cavernous malformation associated with a developmental venous anomaly. 3. Nonspecific prominence of the adenoids may be related to HIV, for example.4. The appearance of the calvarial bone marrow may also be attributable to HIV.


Instruction: Generate impression based on findings.

Input: 64-year-old male with uncinate process lesion. Evaluate for changes. Artifact limits evaluation.ABDOMEN:LIVER, BILIARY TRACT: Stable segment 8 cyst. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Stable cystic lesion of the uncinate process measuring 15 x 15 mm (series 3, image 28).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cysts. Postsurgical changes of partial right nephrectomy with evidence of fat necrosis.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: Stable uncinate process pancreatic cystic lesion.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB: 3/10/1972)Reason: Multiple Sclerosis History: follow up progressionPROVIDER NAME: BARRY G. ARNASON BARRY G. ARNASON MRI brain:There are periventricular white matter lesions present some which are perpendicularly oriented to the lateral ventricles. There is some involvement of the corpus callosum. Additional lesions are present along the right posterior lateral aspect of the midbrain and right cerebral peduncle as well as the right middle cerebellar peduncle and the cervical medullary junction.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is T2 hyperintense lesions present throughout much of the cervical spinal cord. One extends from C1 to down to C2-3 and is centered anteriorly. Another from extends from C3 vertebral level down to C4 and is centered along the right hemicord. Another one extends from the C4-5 disc space level to the C6 vertebral body level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a T2 hyperintense lesion present along the anterior aspect of the thoracic spinal cord at the T11-T12 level which is centered in the left anterolateral aspect of the spinal cord.

Output: 1.There are multiple white matter lesions present in the brain as well as the cervical and thoracic spinal cord which are suspicious for demyelinating disorder. None of these enhance following gadolinium administration suggesting that they're more likely in the chronic phase. There are no comparison studies available.


Instruction: Generate impression based on findings.

Input: Chronic headache with photophobia and rash. There are numerous, greater than 10, punctate cerebral white matter T2 hyperintense lesions without abnormal enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There may be enhancement of the canalicular portion of the left optic nerve versus artifact. There are no meningeal lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst and fluid.

Output: 1. Multiple scattered punctate cerebral white matter lesions are nonspecific, but may represent demyelinating or chronic vasculitic lesions for example. 2. Possible enhancement of the canalicular portion of the left optic nerve versus artifact, although the sequences are not optimized for assessment of this anatomy and a dedicated orbit MRI may be useful. If it is an actual abnormality, this could also be related to a demyelinating or vasculitic process.3. Findings suggestive of acute left maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: 42 year old female with hypertension. Woke up this a.m. with togue and lip laceration and sore left shoulder. Concern for new onset of seizure Images at the level from a magnum demonstrate increased soft tissue density and is believed to represent Chiari malformation.This examination is otherwise unremarkable. No evidence of hydrocephalus, hemorrhage, midline sure or any edema is detected.Follow up exam and MRI is recommended.

Output: Chiari malformation and otherwise unremarkable CT of brain.


Instruction: Generate impression based on findings.

Input: Facial numbness. Eval for syrinx extension into the brainstem. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered T2 signal changes within the subcortical and periventricular white matter, likely related to chronic ischemic small vessel changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a small right maxillary sinus retention cyst including scattered mucosal sinus disease. There is interval opacification of left mastoid air cells. The skull and extracranial soft tissues are unremarkable. MRI Cervical Spine:There are post surgical changes related to posterior decompression with a drainage catheter in the cord syrinx. There is reversal of the normal cervical lordosis and exaggerated kyphosis of the cervical spine centered around C7, unchanged from previous. The C7 vertebral body is densely sclerotic and demonstrates a severe compression deformity with retropulsion of the remainder of C7, that results in central canal stenosis at this level. However, no T2 STIR signal abnormality to suggest bone marrow edema. There is also anterior wedging of the left aspect of the T1 vertebral body without edematous changes.Redemonstrated is a large multiloculated syrinx which extends from C1 level. The lower aspect of the syrinx is obscured by motion artifact, however there does not appear to be significant change from previous with likely termination of the syrinx at the T3 level. There is significant thinning of the cord distally.There is multilevel disc dessication. There is complete loss of disc height and fusion of the C6 vertebral body and remaining portion of the C7 vertebral body. There is severe multilevel facet and uncovertebral hypertrophy that results in multilevel neural foraminal narrowing. At C5-C6, there is uncovertebral hypertrophy resulting in mild to moderate narrowing of the left neural foramen. At C6-C7, there is bilateral facet and uncovertebral hypertrophy with resulting moderate to severe narrowing of left neural foramen. At C7-T1, there is retropulsion of the C7 vertebra along with bilateral facet and uncovertebral hypertrophy resulting in severe left neural foraminal narrowing, where there is a bony spur and moderate right neural foraminal narrowing. These findings remain unchanged from previous exam.

Output: 1. No acute intracranial abnormality.2. Periventricular and subcortical white matter hyperintensities compatible with chronic small vessel ischemic disease.3. Very large multiloculated syrinx that extends from C1 to T3 with significant thinning of the cord distally, with associated postsurgical changes from posterior decompression, similar to prior exam.4. Chronic compression fractures of C7 and T1 and retropulsion of C7, unchanged.5. There is severe left neural foraminal narrowing and moderate right neural foraminal narrowing at C7-T1, similar to previous. Additional neural foraminal narrowing at multiple levels as detailed.


Instruction: Generate impression based on findings.

Input: Hepatitis C virus infection and liver cirrhosis. Hepatocellular carcinoma. Back pain. Cervical Spine:Cervicothoracic and craniocervical articulations are anatomic. Alignment throughout the remainder of the cervical spine is notable for minimal reversal of the lordosis which may reflect patient position or muscle spasm. Vertebral body heights are preserved. Marrow signal shows no suspicious focality. The spinal cord shows normal morphology and signal. Following contrast injection, there is no abnormal spinal cord or the image of contrast enhancement.C2-C3: No spinal canal or foraminal stenosis.C3-C4: Shallow disc-osteophyte complex. No spinal canal or foraminal stenosis.C4-C5: Disc-osteophyte complex indents the anterior aspect of thecal sac but with preservation of the CSF surrounding the cord. There is mild, right more than left, uncovertebral preoperative change causing minimal, probably insignificant right foraminal stenosis.C5-C6: Disc-osteophyte complex also causes small anterior indentation of the thecal sac without significant narrowing of the spinal canal. Uncovertebral and facet proliferative changes cause mild bilateral foraminal narrowing.C6-C7: No spinal canal or foraminal stenosis.C7-T1: No spinal canal or foraminal stenosis.Thoracic Spine:Alignment of the thoracic spine is normal. The vertebral bodies are present in height. Marrow signal is notable for fat signal intensity in the T7 vertebral body, most compatible with a hemangioma. The thoracic spinal cord shows normal morphology and signal characteristics.T7-T8 and T8-T9: Degenerative dens as more pronounced on the left causing mild left anterolateral indentation of the thecal sac but no significant narrowing.There is no significant degenerative disease or spinal canal/foraminal stenosis at the other levels.There is dependent atelectasis in the lungs which is minimal.Lumbar Spine:Alignment is notable for straightening which may reflect patient positioning muscle spasm. Vertebral body heights are preserved. Marrow signal shows no suspicious focality. The lumbar spinal canal is narrowed by congenitally short pedicles and superimposed degenerative disease as described below. This is most pronounced at L4-5. The conus medullaris shows normal morphology and signal characteristics. T12-L1 and L1-L2: No significant degenerative disease. No spinal canal or foraminal stenosis.L2-L3: Disc bulge is associated with a small right paracentral extrusion that migrates cranially for a short distance. The disc mildly to moderately narrows the right subarticular recess and spinal canal. There is minimal right foraminal narrowing.L3-L4: Disc bulge is associated with bilateral subarticular recess narrowing and mild bilateral foraminal narrowing. Ligamenta flava thickening contributes to mild to moderate central canal narrowing.L4-L5: Disc bulge along with severe ligamenta flava thickening result in severe central spinal canal narrowing. There is also bilateral mild foraminal narrowing of the disc and mild facet proliferative change.L5-S1: No significant degenerative disease. No spinal canal or foraminal stenosis.There is free fluid in the pelvis. Small T2 hypointense focus in the ventral upper uterine body/fundus may represent an incidental leiomyoma.

Output: 1.Lumbar spondylosis is most pronounced at the L4-L5 where there is severe central spinal canal narrowing (caused by the disc, congenitally short pedicles as well as ligamenta flava thickening).2.Mild cervical and thoracic spondylosis without significant narrowings.3.There is no suspicious osseous lesion to indicate metastasis.4.Fluid in the peritoneal cavity may related to liver dysfunction. Other findings are described above.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with history of acinic cell parotid cancer status post CRT. Findings are demonstrated compatible with prior right mastoidectomy and parotidectomy, without significant interval change.Again seen is marrow replacement with corresponding patchy heterogeneous enhancement involving the right basiocciput, petrous ridge, condylar and squamous portions of the occipital bone, and the right lateral mass of C1. Findings have not significantly changed, and no new skull base osseous lesions are suspected. As on prior examinations, abnormal enhancing tissue abuts the right ICA and appears to encase the jugular foramen.Intracranially, no new or suspicious lesions are seen. Two or three small foci of enhancement within the right lateral cerebellum, immediately adjacent to the lesional bone, are seen with associated FLAIR hyperintensity. These findings are not significantly changed when compared to numerous prior examinations dating back several years and are favored to represent treatment effect.Supratentorially, several scattered foci of nonspecific FLAIR hyperintensity are redemonstrated without significant interval change. No new enhancing lesions are seen. No significant edema or mass effect is detected. The ventricles remain normal in size and morphology.

Output: Stable findings are seen related to metastatic involvement of the right central and posterior skull base and the right craniocervical junction. No new lesions are detected.


Instruction: Generate impression based on findings.

Input: Female 30 years old Reason: ileocolic Crohn's disease off therapy for 3 years, re-staging disease for stricture or inflammation History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Probable small hepatic cysts.SPLEEN: There is normal in size. There is a small splenule near the hilum.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber. There is severe bowel wall thickening and inflammation involving the terminal ileum. The segment of inflamed bowel measures at least 12 to 15-cm in length and involves the ileocecal valve. The area appears slightly patulous although there are certain points in the inflamed bowel pattern narrowed. Ileocecal valve is narrowed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The right ovary is adjacent to the inflamed bowel. There is some adjacent peritoneal thickening.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No pelvic abscess is evident. There is a small amount of pelvic free fluid.OTHER: No significant abnormality noted.

Output: 1.Findings of active inflammatory bowel disease involving the terminal ileum as detailed above.


Instruction: Generate impression based on findings.

Input: Lightheadedness, evaluate for CVA and compare meningioma There is no evidence of intracranial hemorrhage or acute infarct. There is a homogeneously enhancing dural based mass in the left middle cranial fossa with dense calcifications which are better appreciated on CT. Mass involves the left cavernous sinus and extends posteriorly along the left tentorium. There is mild displacement of the left internal carotid artery and PCA medially. Mass measures 2.9 x 2.3 cm (image 75, series 1101) and grossly unchanged compared to prior CT study. There is adjacent T2/FLAIR hyperintensity suggesting mild edema.Subcortical and periventricular T2/FLAIR hyperintense foci are compatible with moderate small vessel ischemic disease. The pituitary gland 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, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Moderate small vessel ischemic disease without evidence of acute infarct.2.Left middle cranial fossa mass consistent with meningioma involving the left cavernous sinus and extending posteriorly along the left tentorium. There is no prior MRI for comparison, however it is grossly unchanged in size and configuration from the prior CT. There is mild associated parenchymal FLAIR hyperintensity in the left temporal lobe which may represent mild edema and/or gliosis.


Instruction: Generate impression based on findings.

Input: malaise and fatigueClinical question: tumor recurrence, edemaSigns and Symptoms: left sided weakness The patient is status post right-sided parietal craniotomy. There is a cystic lesion with surrounding enhancement and surrounding T2 and FLAIR signal hyperintensity centered in the right parietal lobe and extending into the right posterior temporal lobe which is suspected to represent prior area of tumor resection possibly with some residual recurrent tumor. There is associated susceptibility effect at the margins of the cystic lesion. T2 and FLAIR signal hyperintensity extends into the external capsule and posterior limb of the right internal capsule.There are high signal foci present along the thalami bilaterally and some mild signal hyperintensities in the pons. Signal changes extending down the right cerebral peduncle into the pons is present.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A cystic and partially solid mass located in the right parietal lobe and extending into the right posterior temporal lobe is suspected to represent prior area of tumor resection possibly with some residual recurrent tumor, though radiation change status post surgery may have a similar appearance. Please correlate with clinical history. If clinically appropriate, comparison with the prior exams may be of benefit.2.Signal change tracking along the right external peduncle and into the pons is suspected to represent a layering degeneration3.Small lesions in the thalami bilaterally are suspected to represent lacunar infarcts age-indeterminate.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Examination is somewhat limited by patient motion


Instruction: Generate impression based on findings.

Input: Female 68 years old Reason: please evaluate rt knee swelling s/p fall and direct knee injury, soft tissue mass adjacent to rt knee medially There is a large fluid collection measuring approximately 8.8 x 3.0 x 8.8 cm (axial by craniocaudal) which is located within the subcutaneous fat in the medial aspect of the knee, is T2 bright with a few septations, most consistent with Morel-Lavalle injury. Minimal peripheral enhancement. No large hematoma. No significant pathologic enhancement.MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Generalized thinning of the trochlear, medial compartment, and lateral compartment cartilage. No focal full-thickness cartilage defect.LIGAMENTS: Ligaments, including the ACL, PCL, MCL, and lateral collateral complex are intact. EXTENSOR MECHANISM: Mild soft tissue swelling anterior to the patellar tendon. Extensor mechanism is intact.ADDITIONAL

Output: 1.Morel-Lavalle injury within the medial subcutaneous soft tissues of the knee. 2.Generalized cartilage thinning without focal full-thickness defect.


Instruction: Generate impression based on findings.

Input: Progressive supranuclear palsy clinical trial, principal investigator Dr Tao Xie. The FLAIR images are degraded by motion. There is atrophy of the midbrain. There also appears to be mild atrophy of the cerebellar vermis. There is no evidence of intracranial hemorrhage. There are minimal confluent and punctate foci of T2 hyperintensity within the supratentorial white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There appears to be congenital narrowing of the imaged portions of the cervical spinal canal.

Output: 1.Atrophy of the midbrain is compatible with progressive supranuclear palsy.2.Nonspecific supratentorial white matter signal abnormality is nonspecific, but may represent chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Other complicated headache syndrome [G44.59] / Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: brain mets History: severe headache, nausea, NSCLC w brain mets There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Previously recognized right central sulcus leptomeningeal enhancement is not as conspicuous as before, but still demonstrated especially on sagittal scan (series 11, image #8/29).There are diffuse leptomeningeal enhancement involving bilateral occipital lobes, bilateral cerebellar hemispheres, vermis and the anterior aspect of pons indicating possible leptomeningeal metastatic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickening on ethmoid sinuses and sphenoid sinus indicating sinusitis.In addition, there are some exaggerated leptomeningeal enhancement around cervical cord. This could represent extension of leptomeningeal metastatic lesion, thus, if clinically indicated, spinal MRI with and without contrast can be considered for further imaging evaluation.

Output: 1. Decreased but still remained right central sulcus leptomeningeal enhancement since prior scan.2. Extensive leptomeningeal enhancement involving bilateral occipital lobes, and posterior fossa as described above indicating leptomeningeal metastatic lesions.3. No acute hemorrhagic or ischemic lesion on the scan.4. Possible extension of leptomeningeal metastasis toward cervical spinal cord, if indicated, spinal MRI with and without contrast can be considered for further evaluation..


Instruction: Generate impression based on findings.

Input: 67-year-old female with worsening right-sided weakness and adenocarcinoma of the lung with brain metastases. MRI BRAIN:The wedge-shaped left parietal lobe MCA territory restricted diffusion has expanded since the prior exam, now extending into the left temporal lobe and to a smaller extent the left insula. No new separate areas of restricted diffusion are seen to indicate other areas of ischemia. Within the left parietal MCA territory, there is a pattern of intrinsic, gyriform T1 hyperintensity with minimal, if any, superimposed enhancement. This pattern likely represents laminar necrosis. There is some visualization of the previous gyriform pattern of susceptibility artifact on 11/4/2015, however imaging at 1.5 T likely results in decreased conspiuity of this finding when compared to prior. There has been interval increase in surrounding FLAIR abnormality, consistent with increasing edema. This results in effacement of the adjacent sulci and of the posterior horn of the left lateral ventricle. No midline shift and the basal cisterns appear intact. The enhancing, known metastases appear stable to slightly improved given changes in technique. There are no new foci of metastatic disease seen.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. There are no new areas of hemorrhage nor large extraaxial collections. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.MRA NECK:Common origin of the brachiocephalic artery and the left carotid artery without evidence for stenosis of the great vessels. Small caliber of the right vertebral artery is likely secondary to atherosclerotic disease, though suboptimal image quality limits examination.There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified. MRA BRAIN:There is narrowing of a long segment of the inferior division of the left MCA that appears worsened allowing for differences in technique. In fact, the there is loss of flow signal completely at the distally aspect of this branch which is new from prior examination. Maderate narrowing in the left A2 ACA and in the left P3 PCA branches are unchanged.

Output: 1. Slowly progressive ischemic injury in the posterior left MCA territory is worsened and correlates with MRA findings of worsening inferior branch left MCA long segment stenosis and distal occlusion.2. The left vertebral artery is small in caliber. Otherwise, MRA of the neck is unremarkable.3. No new hemorrhage or metastatic disease is visualized. The previously seen metastatic disease is stable to improved from prior exam.


Instruction: Generate impression based on findings.

Input: 60 years, Female, with headache and questionable right hemianopsia. Multiple series are degraded by motion, as on prior examination.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are stable in size with mild diffuse parenchymal atrophy. There is no evidence of hydrocephalus.Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes. No significant change since 3/5/2012. Major flow-voids are preserved.There is no obvious orbital mass or mass effect on the optic chiasm. The sella is partially empty, which can be a normal variant. The orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Motion degraded examination demonstrates no evidence of intracranial hemorrhage, mass or acute infarct.2. Grossly similar appearance of moderate chronic small vessel ischemic disease, within the limits of motion degradation.


Instruction: Generate impression based on findings.

Input: Clinical question: Back pain. Signs and symptoms: Back pain Nonenhanced lumbar MRI:The alignment of which column is clinical.Unremarkable lower most visualized thoracic spine and thoracic cord.T12 -- L1 is unremarkable.L1 -- L2 demonstrates mild disk desiccation without spinal canal or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy and mild (left greater than right) facet degenerative changes. Constellation of changes results in mild central spinal stenosis and mild left neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, asymmetric moderate left facet and ligamentum hypertrophy and to a lesser degree on the right is present. There is a large central disk extrusion at this level with resultant significant mass effect on the thecal sac and result in significant central spinal stenosis. Moderate left and mild to moderate right neural foraminal compromise is also present.There is more than 50% compression deformity of the superior endplate of L3 vertebrae. There is increased T2 and decreased T1 signal intensity compressed vertebrae which could represent edema. Please correlate with history regarding recent trauma/fall since the signal changes of marrow space may indicate edema secondary to recent fracture.L4 -- L5 demonstrate moderate disk disease and loss of disk height, asymmetric (left greater than right) moderate ligamentum flavum hypertrophy and facet disease. There is a small centrally located disk protrusion projecting into the ventral epidural space and without significant mass effect on the thecal sac. There is no spinal stenosis, however significant right and moderate left neural foraminal compromise is present.L5 -- S1 demonstrate moderate (left greater than right) facet hypertrophic changes and ligamentum flavum hypertrophy. No central spinal stenosis. Moderate to severe bilateral neural foraminal compromise is present.

Output: 1.L3 -- L4 there is advanced degenerative disk disease, large central disk extrusion with resultant significant central spinal stenosis. Bilateral neural foraminal compromise at this level is also present as detailed. More than 50% compression fracture of L4 vertebrae is noted without malalignment. T2/T2 stir hyperintensity of L4 vertebrae although could represent degenerative Modic signal changes, possibility of edema as result of recent fracture cannot be excluded. Correlate with history for recent fall or trauma to the back.2.Mild central spinal stenosis at L2 -- L3 is also noted and unremarkable at all other levels.3.Multilevel neural foraminal compromise (some significantly) as detailed per level above.


Instruction: Generate impression based on findings.

Input: 59 year old male with atrial fibrillation status post cardioversion x 4, LV dysfunction with improved LVEF. Left VentricleThe left ventricle is normal in size with mildly decreased systolic function. The overall LV ejection fraction is 53%. The LVEDV is 183 ml (normal range 142+/-34), the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVESV is 86 ml (normal range 47+/-19) and the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9). The LV mass is 129 g (normal range 164+/-36) and the LV mass index is 64 g/m2 (normal range 85+/-15). 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 LV thrombus. Left AtriumThe left atrium is mildly dilated (100ml). All four pulmonary veins drain normally into the left atrium. The pulmonary vein measurements are:LSPV: 18x12mmLIPV: 10x16mmRSPV: 20x17mmRIPV: 16x13mmRight VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%. The RVEDV is 221 ml (normal range 142+/-31), RV end diastolic volume index is 108 ml/m2 (normal range 82+/-16), the RVESV is 94 ml (normal range 54+/-17), and the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9).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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.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 sized LV with mildly reduced systolic function (LVEF 53%)2. Normal sized RV with normal systolic function (RVEF 58%).3. Mild tricuspid insufficiency.4. Mild left atrial dilation with normal pulmonary vein anatomy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are scattered foci of T2 hyperintensity within periventricular and subcortical white matter without restricted diffusion, mass effect, susceptibility abnormality, or enhancement.There is a stable 4 x 4 mm transaxial dimension lesion (as measured on axial T2 images) within the right frontal lobe which is primarily T2 hypointense demonstrating susceptibility effect. There is no perilesional edema or associated developmental venous anomaly. Foci of susceptibility effect are also noted along the edge of the rightward tentorium as well as anterior falx which are felt to represent calcifications.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute 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 left mastoid air cells are clear. Note is made of post procedural changes involving lateral right temporal bone including retained fluid signal material within mastoid air cells. There is no abnormal enhancement within the brain.

Output: 1.Stable right frontal lobe cavernous reformation.2.Chronic small vessel ischemic disease.3.Note is made of post procedural changes involving lateral right temporal bone including retained fluid signal material within mastoid air cells.


Instruction: Generate impression based on findings.

Input: Seizures and falls and possible breakthrough seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is nonspecific mild patchy cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Mild patchy cerebral white matter T2 hyperintensity, but no discernible seizure foci otherwise.


Instruction: Generate impression based on findings.

Input: Resected pancreatic mass in 2013, found to be a benign IPMN. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Several subcentimeter nonenhancing T2 hyperintense lesions are again seen in the pancreatic body, likely representing sidebranch AP dimension. The largest of these, in the pancreatic body, is stable at 1.6 x 0.9 cm (series 3, image 58), previously 1.7 x 1.0 cm. The main pancreatic duct is mildly dilated at 3 mm, also stable. Postsurgical changes are noted in the pancreatic tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Otherwise no significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 5.7 x 1.9 cm non-enhancing T1 and T2 hyperintense ovoid lesion in the epigastric anterior abdominal wall at midline, possibly representing a hematoma.

Output: 1. Stable nonenhancing T2 hyperintense lesions in the pancreatic body, likely representing sidebranch IPMNs.2. 5.7 x 1.9 cm non-enhancing T1 and T2 hyperintense ovoid lesion in the epigastric anterior abdominal wall at midline, possibly representing a hematoma. Correlation with any relevant clinical history may be helpful.


Instruction: Generate impression based on findings.

Input: Anaplastic astrocytoma status post chemotherapy and radiation treatment. Headache and increasing weakness. Again seen are areas of intrinsic T1 shortening as well as heterogeneous nodular enhancement in the right frontal, parietal, and temporal lobes predominantly in the periventricular regions related to known tumor. Enhancement extending across the corpus callosum is again seen including at the levels of genu, body, and splenium. Enhancing nodules in the left frontal lobe are stable to minimally larger. For example the more anterior enhancing left frontal lobe nodule measures up to 6 x 9 x 10 mm, previously previously 6 x 7 x 9 mm. Subtle differences in measurement may relate to contrast timing and technique with the current study performed at 3 Tesla and previously at 1.5 Tesla. Restricted diffusion is again noted in these areas. Extensive masslike FLAIR signal abnormality in the right cerebral hemisphere extending across the corpus callosum into the left cerebral hemisphere as well as extending inferiorly into the brainstem is again seen and not significantly changed since 10/7/2016. Mass effect with partial effacement of the lateral ventricles is not significantly changed. No significant change in size of the ventricles. There is no significant midline shift or uncal herniation. Compared to 7/29/2016, areas of enhancement and masslike FLAIR signal abnormality are clearly progressed however.Prior postsurgical changes including right temporoparietal craniotomy and right anterior parietal burr hole again seen. A focus of susceptibility along the right precentral gyrus likely represents a biopsy marker. Hemosiderin deposition the surgical bed is similar to prior examination. No findings to suggest acute ischemia, new hemorrhage or new mass effect. Mild to moderate mucosal thickening involving the anterior ethmoid air cells and frontal sinuses is similar to prior.

Output: Allowing for slight differences in technique, there is no significant change since 10/7/2016. Compared to 7/29/2016, however, there appears to have been significant progression with increased tumor involvement of the right frontal lobe, corpus callosum, and extension into the left cerebral hemisphere.


Instruction: Generate impression based on findings.

Input: 45-year-old man with history of ileal carcinoid and hepatic lesion seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: There is a 22 x 16 mm lesion in the dome of the liver (series 15, image 18) which is mildly hyperintense on T2-weighted images and enhances. No additional hepatic lesions are identified. The gallbladder is normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal.PANCREAS: The patient is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a subcentimeter cyst in the inferior pole of the left kidney (series 5, image 13). The kidneys are otherwise normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Single lesion in the hepatic dome which is suspicious for metastasis.


Instruction: Generate impression based on findings.

Input: Right knee pain. Evaluate for lateral meniscus tear. MENISCI: The posterior anchor of the lateral meniscus is indistinct with increased signal, which may represent degeneration though tearing cannot be excluded. Focal punctate increased signal at the anterior apex of the lateral meniscus seen on a single slice and may represent a small cleft, of uncertain clinical significance. The medial meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: Bone contusions are present in the bilateral femoral condyles and tibial plateaus, lateral greater than medial. No fracture is present.LIGAMENTS: The anterior cruciate ligament is thickened and indistinct, with increased signal. No distinct fibers are visualized, suspicious for partial tearing. However, no retraction is evident. The posterior cruciate ligament is intact. The collateral ligaments are intact. Minimal signal adjacent to the MCL likely represents a mild sprain. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings suspicious for partial tearing of the anterior cruciate ligament, with associated bone contusions and mild MCL sprain.2. Degeneration of the posterior horn of the lateral meniscus, with possible tearing.


Instruction: Generate impression based on findings.

Input: 39-year-old female with personal history of triple negative left breast cancer, status post neoadjuvant chemotherapy, lumpectomy and radiation in 2012, and benign MRI guided biopsy in right breast in 2015. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted in the right breast, and minimal parenchymal enhancement in the left breast.There are 2 marker clips in the right breast, and multiple metallic artifacts in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Lumbar spinal stenosis. Signs and symptoms: Back pain with radiculopathy. Nonenhanced lumbar MRI:Unremarkable lower most visualized thoracic spine and thoracic cord.The alignment of vertebral column is anatomical. The signal intensity of vertebral column is unremarkable.T12 -- L1 demonstrate minimal degenerative changes and unremarkable otherwise.L1 -- L2 demonstrate mild degenerative changes and unremarkable otherwise.L2 -- L3 demonstrate mild disk disease, moderate asymmetric left facet hypertrophy and mild bilateral ligamentum flavum hypertrophy. No spinal stenosis. Mild right neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes result in mild central spinal stenosis and moderate (right greater than left) bilateral neural foraminal compromise. There is no significant change of the findings at this level since prior exam.L4 -- L5 demonstrate moderate disk disease and loss of disk height, moderate bilateral (left greater than right) facet and ligamentum flavum hypertrophic changes. There is interval decreased T2 hyperintensity of the facets at space on the left since prior exam suggestive of synovitis. There is revisualization of a small central disk protrusion at this level which in combination with broad base bulging disk results in moderate central spinal stenosis without convincing evidence of interval change. Moderate bilateral neural foraminal compromise is noted.L5 -- S1 re-demonstrate mild disk disease and loss of disk height, small central and left paramedian annular fissure, mild bilateral facet and ligamentum flavum hypertrophic changes. No spinal stenosis or neural foraminal compromise.

Output: 1.Degenerative changes at L4 -- L5 results in moderate central spinal stenosis and bilateral neural foraminal compromise. No significant change since prior exam. There is however interval resolution of previously noted facet space widening and fluid signal intensity.2.Degenerative changes at L3 -- 4 with resultant mild central spinal stenosis and bilateral neuroforaminal compromise without significant change.3.Incidental note is made of a partially visualized right renal cyst.


Instruction: Generate impression based on findings.

Input: History of index finger mass. A marker was placed along the volar and ulnar aspect of the index finger at the level of the middle phalanx. Deep to the marker is a lobular mass replacing the subcutaneous fat of the index finger centered within the volar and ulnar soft tissues at the level of the DIP joint. The mass extends from the skin surface to the underlying phalanges. It also contacts the volar surface of the flexor tendon apparatus. Smaller lobular components of the mass extend along the radial aspect of the base of the distal phalanx as well as dorsal to the head of the middle phalanx deep to the extensor tendon apparatus such that there is essentially circumferential involvement. There is no clear bone or joint involvement, however. Due to the circumferential involvement of the mass, it is somewhat difficult to measure. However, it measures approximately just under 3 cm in the longitudinal dimension extending from the level of the mid diaphysis of the middle phalanx to the midportion of the distal phalanx. Overall, the mass measures approximately 2 cm in the greatest transverse dimension (medial-lateral). The mass is isointense to skeletal muscle on T1-weighted images and is heterogenous but predominantly of low signal on T2-weighted images. The mass enhances diffusely following contrast administration.

Output: 1.Minor contrast reaction as described above. Reaction documented in EPIC, and patient provided with discharge instructions.2.Soft tissue mass of index finger which circumferentially surrounds the phalanges with signal characteristics suggestive of giant cell tumor of tendon sheath.