Instruction: Generate impression based on findings.

Input: Female, 52 years old, with metastatic renal cell carcinoma status post SRS on 06/16/16 to two adjacent right basal ganglia lesions. Evaluate for response/progression. The dominant hemorrhagic right basal ganglia lesion shows further interval accumulation of blood product, particularly along its superior margin. The lesion itself is stable to slightly reduced in size when compared to the pretreatment examinations. The lesion demonstrates intrinsic T1 hyperintensity related to blood product but no clear superimposed enhancement. A smaller right basal ganglia lesion located posterior and inferior to the dominant lesion shows interval development of susceptibility effect and resolution of previously seen enhancement. The degree of edema surrounding both these lesions has significantly improved.No new intracranial lesions are identified. The previously treated right cerebellar lesion demonstrates susceptibility effect with no evidence of associated edema or enhancement. Parenchymal morphology is otherwise within normal limits. No abnormal extra axial fluid collections are seen. The ventricles are normal in size and morphology.

Output: The right basal ganglia lesions demonstrate expected post treatment findings. The dominant lesion shows progressive accumulation of blood product but stable to reduced overall size and reduced enhancement. The smaller adjacent lesion shows similar interval changes. Edema in the basal ganglia has significantly improved. The previously treated right cerebellar lesion is unchanged. No new lesions are detected.


Instruction: Generate impression based on findings.

Input: Parkinsonism. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mildly prominent susceptibility effect in the bilateral putamina, left greater than right. There may be slightly diminished susceptibility low signal in the substantia nigra. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is a 17 mm wide retrocerebellar arachnoid cyst. 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: Mildly prominent susceptibility effect in the bilateral putamina, left greater than right, may raise the possibility of MSA-P, although not conclusively so. Otherwise, no structural lesions are identified.


Instruction: Generate impression based on findings.

Input: Male 61 years old with liver lesions identified on CT from 7/2016. No symptoms at present. ABDOMEN:LIVER, BILIARY TRACT: Normal morphology for contains 4 T2 hyperintense, circumscribed, nonenhancing lesions consistent with simple cysts. The largest is in segment 4A and measures 10 x 9 mm (series 3, image 13). No enhancing liver lesion is identified. The hepatic vasculature is patent.Normally distended gallbladder with no cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or enhancing renal lesion.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: Scattered hepatic cysts correlate with the hypodense lesions seen on CT. No suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Unspecified fall, initial encounter [W19.XXXA] / Other symptoms and signs involving cognitive functions and awareness [R41.89], Reason for Study: ^Reason: eval for seizure cause History: possible seizures There is no evidence of acute ischemic or hemorrhagic lesion.There is no abnormal enhancement.Patchy scattered FLAIR/T2 high signal intensity lesions are seen on periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.Very prominent dilated perivascular spaces are seen throughout the supratentorial brain parenchyma especially around bilateral temporal lobe. These findings are nonspecific and likely to be related to normal aging phenomenon. Although remote, differential diagnosis include perivascular myelin loss, atherosclerotic change, secondary to arterial pulsation especially due to hypertension, increased permeability and etc.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Nonspecific small vessel ischemic disease.3. Prominent perivascular spaces especially around bilateral temporal lobes, most likely related to aging process.


Instruction: Generate impression based on findings.

Input: 30 year-old female with metastatic Ewing sarcoma. Evaluate for disease progression. CHEST:LUNGS AND PLEURA: Index right lower lobe pulmonary nodule measures 7-mm in diameter image number 46, series number 5. No other lung nodules. Subsegmental atelectasis in lung bases, more prominent on the right side.MEDIASTINUM AND HILA: Index right paratracheal node is slightly increased in size and now measures 15 x 8 mm image number 13, series number 3. Other mediastinal nodes are also stable to slightly increased in size.CHEST WALL: Heterogeneously changes in the right femoral head. These changes can better evaluated on a dedicated MRI.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is atrophic. Previously identified mass along the superior aspect of the pancreatic body is not visualized. Previously described small cystic lesion in the pancreas is also not well seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Lesion in the left midpole of the kidney is smaller measuring 9 x 11 mm image number 96, series number 3.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small fat containing periumbilical hernia.BONES, SOFT TISSUES: Round nodules in the anterior abdominal wall likely represent injection changes.OTHER: Small fat containing umbilical hernia.PELVIS:UTERUS, ADNEXA: Atrophic uterus.BLADDER: Significant wall thickening of the bladder persists without change and this may represent cystitis.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal appendix in the right lower quadrant.BONES, SOFT TISSUES: Laminectomy defect, stable.OTHER: No significant abnormality noted.

Output: Right lung nodule is stable.Mediastinal and lymph nodes have remained stable to minimally increased in size.Pancreatic lesions have resolved. Large left renal lesion has not changed in size. Smaller left renal lesions are larger. Diffuse wall thickening of the bladder suspicious for cystitis.Heterogeneous lytic changes in the right humerus, inadequately evaluated with this study.


Instruction: Generate impression based on findings.

Input: 68-year-old man with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 36 x 50 mm.Peripheral Zone: The peripheral zone is heterogeneous and striated in appearance with increased T1 signal, likely related to prior biopsy and slightly limiting evaluation.In the left posterior base of the prostate (series 401, image 95) there is an approximately 11 x 8 mm area of T2 hypointensity and decreased ADC which appears to cross the midline into the right lobe. Additionally, this area of signal abnormality abuts the left seminal vesicle with questionable involvement.A linear focus of decreased ADC and T2 hypointensity is seen in the right paramidline apex (series 41, image 65).An area of decreased ADC signal seen in the left apex, however there is no T2 correlate for this region (series 503, image 224).Central Gland: The central gland is heterogeneous in appearance and enlarged with impression on the midline posterior bladder wall.Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: There is no definite evidence of extracapsular extension.BLADDER: The bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Area of signal abnormality in the left base of the prostate suspicious for carcinoma abutting and possibly invading the left seminal vesicle.2.Questionable, smaller areas of signal abnormality in the left and right apex as above.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Questionable lesion on prior prostate biopsy. The patient reports an outside hospital biopsy demonstrating adenocarcinoma which was subsequently reviewed by pathology and deemed to be high-grade prostatic intraepithelial neoplasia. PELVIS:PROSTATE:Prostate Size: 5.0 x 5.8 x 6.5 cmPeripheral Zone: In the left paramedial mid gland/apex there is a 1.3 x 0.9 cm focus of T2-weighted hyperintensity restricted diffusion and arterial enhancement suspicious for prostatic adenocarcinoma. The right peripheral zone demonstrates linear T2 weighted hypointensity without a discrete lesion.Central Gland: Changes of benign prostatic hyperplasia. No suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The left paramedial mid gland lesion abuts the capsule which is mildly thinned but no definite extracapsular extension.BLADDER: Small urachal cyst or diverticulum at the dome of the bladder.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.3 cm focus in the left paramedial mid gland/apex is suspicious for prostatic adenocarcinoma. This lesion is amenable to MRI/ultrasound fusion biopsy. No seminal vesicle invasion, extracapsular extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with spinal metastases, neck pain. Signs and symptoms: Neck pain Nonenhanced CT of the cervical spine:Previously described on prior MRI of the cervical spine with the study the lesion to the vertebral body of C5 is not identified on this study. There is subtle low attenuation of C7 vertebral body consistent with patient's known metastatic lesion. There is no evidence of fracture of this vertebrae and the alignment of vertebral column is unremarkable.Nonenhanced CT of thoracic spine:The alignment the vertebral column is within normal limits. Examination identifies previously detected metastatic lesion to T1 with mild compression deformity and minimal bulge of vertebrae into the spinal canal. There is no involvement of the pedicle of T1. The alignment remains intact. Mild compression deformity of vertebral body of T5 along its superior aspect and the internal lytic changes. There is no definitive involvement of the pedicles of T5. No definitive evidence of any additional lytic changes of vertebral column is detected.No definitive metastatic lesion to the facets of the pedicles of vertebral column.Nonenhanced CT of the lumber spine:The alignment of vertebral column is unremarkable. No definitive for the study kidneys to the lumber spine is detected.No evidence of central spinal stenosis or neural foramina compromise.There is very subtle low-attenuation involving S2 vertebral body however been no distinct destruction of the cortex or any perispinal soft tissue abnormality. Possibility of metastatic disease cannot be entirely ruled out.

Output: 1.Multiple metastatic disease to the thoracic spine and a suspected metastatic lesion to as to as detailed.2.There is mild compression fracture of T1 and T5 and mid no involvement of the pedicles of T1 or T5.The alignment of the vertebral column throughout the spine remains normal.


Instruction: Generate impression based on findings.

Input: Male, 37 years old, with multiple sclerosis and worsening left leg weakness and ataxia. Brain:Image quality is degraded by motion artifact. Within this limitation, the following observations are made.A mixture of discrete and patchy confluent T2 hyperintense lesions are evident in the periventricular regions and, to a lesser extent, subcortical white matter of the bilateral cerebral hemispheres. Many of these lesions are oriented radially with respect ventricles. Most demonstrate T1 hypointensity relative to the surrounding white matter. Lesions are also evident within the basal ganglia, brainstem and the posterior fossa.At least 8 of the above-mentioned lesions demonstrate either complete or partial rim enhancement including lesions in the bilateral frontal lobes, the bilateral occipital lobes, and the right temporal lobe.No evidence of mass effect is seen. No parenchymal edema is detected. Ventricles and sulci are mildly prominent for age indicating a degree of parenchymal volume loss. The corpus callosum is mildly thinned.C-spine:A T2 hyperintense nonenhancing lesion is evident within the central cord at the C2-3 level extending approximately 20 mm in the craniocaudal dimension. A smaller T2 hyperintense nonenhancing lesion is evident in the dorsal cord at the C4 level.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No evidence of significant degenerative disc disease, spinal canal or neuroforaminal stenosis is seen.

Output: 1.Numerous supratentorial and infratentorial lesions compatible with multiple sclerosis. A number of these lesions demonstrate evidence of rim enhancement compatible with active demyelination.2.Two nonenhancing lesions are evident within the cervical spinal cord, also compatible with demyelination.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified ovary [C56.9], Reason for Study: ^Reason: patient with metastatic ovarian cancer, medullary lesion seen on MRI cervical spine concerning for new metastatic brain disease History: abnormal cervical MRI, metastatic ovarian 56 years Female (DOB:10/17/1960)Reason: patient with metastatic ovarian cancer, medullary lesion seen on MRI cervical spine concerning for new metastatic brain disease History: abnormal cervical MRI, metastatic ovarian cancerPROVIDER/ATTENDING NAME: HEDY L KINDLER There are multifocal bihemispheric supra and infratentorial enhancing nodules including right medullary lesion with some lesions are associated surrounding edema are seen, compatible with metastatic lesions.There is no evidence of acute ischemic or hemorrhagic lesion.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Multifocal various sized supra and infratentorial enhancing nodular lesions indicating multifocal metastasis.2. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Complex partial seizures starting with right face twitching, history of multiple sclerosis and ischemic stroke. There is extensive scattered periventricular and subcortical white matter T2 signal abnormality, as well as scattered posterior fossa signal abnormality, compatible with multiple sclerosis. There is no associated abnormal enhancement. There is no evidence of acute infarct or intracranial hemorrhage. There is mild global parenchymal 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.

Output: 1.Extensive white matter lesions of multiple sclerosis, without evidence of current active demyelinating lesion.2.No evidence of acute infarct or intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: A 20 year old male with tetrallogy of Fallot, repair in infancy. On 10/2014 hospitalization due to pleuritis, likely viral. Echocardiography (12/23/2014) showed mildly reduced LVEF, mild-moderate RV systolic dysfunction, mild PS, mild-mod PR, mild TR, dilated aortic root. Referred to cardiac MRI for assessment Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 110 ml/m2 (normal range: 74+/-15), the LVEDV is 188 ml (normal range 142+/-34), the LV end systolic volume index is 57 ml/m2 (normal range 25+/-9), the LVESV is 98 ml (normal range 47+/-19), the LV mass index is 50 g/m2 (normal range 85+/-15), and the LV mass is 86 g (normal range 164+/-36). There is septal hypokinesis and dyssynergy. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 35%, the RV end diastolic volume index is 139 ml/m2 (normal range 82+/-16), the RVEDV is 239 ml (normal range 142+/-31), the RV end systolic volume index is 90 ml/m2 (normal range 31+/-9), and the RVESV is 154 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.ShuntNo interatrial or interventricular shunt was noted.Aortic ValveThe aortic valve is trileaflet, opens widely and there is trace aortic regurgitation (regurgitant fraction 3%).Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild-moderate pulmonic regurgitation (regurgitant fraction 5%). No significant stenosis was noted.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 mildly dilated. Contrast 3D whole heart used for measurements.Sinus of Valsalva: Width: 45mm x 46mm x 43mmSinotubular Junction: 43 mm x 44 mmAscending Aorta (5cm from annulus): 40 mm x 40 mmMid Aortic Arch: 33 mm x 30 mmDescending Aorta: 20mm x 21 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (30 x 26mm). LPA measures 26 x 21 mm. RPA measures 15 x 17 mm.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function, the LVEF is 48%. There is septal hypokinesis with septal bounce. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is moderately dilated with moderately reduced systolic function, the RVEF is 35%. 4. The right atrium is mildly dilated. 5. No interatrial or interventricular shunt was noted.7. There is mild-moderate pulmonic regurgitation (regurgitant fraction 5%). No significant stenosis was noted.9. The aortic root is mildly dilated (see measurements above). See also main PA and branch PA measurements above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Syrinx spine, yearly eval for changes. There are stable multi-level segmentation anomalies and scoliosis involving virtually the entire spine. There is an unchanged low-lying conus medullaris, which is positioned at the L3 vertebral body level, which nevertheless demonstrates anterior translation on prone imaging. There is an unchanged syrinx in the lower spinal cord, which measures 6 x 7 mm in transverse section. There is an unchanged fibrofatty filum terminale, which measures up to 5 mm in width. There is no significant spinal canal stenosis. The vertebral bone marrow signal is unremarkable. The paraspinal soft tissues are unchanged.

Output: 1. Unchanged syrinx in the lower spinal cord.2. Unchanged low-lying conus medullaris, which is positioned at the L3 vertebral body level, which nevertheless demonstrates anterior translation on prone imaging. 3. Unchanged multi-level segmentation anomalies and scoliosis.4. Unchanged fibrofatty filum terminale.


Instruction: Generate impression based on findings.

Input: 59 years Female (DOB:1/10/1957)Reason: eval for PRES History: eval for PRESPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainNo diffusion weighted abnormalities are appreciated.The patient is status post left sided craniotomy. There is a hemorrhagic focus present in the left posterior frontal lobe measuring approximately 28 x 27 mm axial dimensions which is associated with fluid fluid levels and associated vasogenic edema. Another hemorrhagic lesion is present in the left occipital pole measuring approximately 25 x 14 mm axial dimensions which is also associated with some vasogenic edema.There is T2 hyperintensity of the gray-white interface at the occipital lobes and watershed regions of the frontal and parietal lobes associated some signal changes.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The anterior aspect of the superior sagittal sinus appears small but patent. There appears to be a filling defect at the site of change in caliber which corresponds to craniotomy site as well.

Output: 1.The pattern of hypodensities in the frontal lobes, occipital lobes and parietal lobes extending of the temporal lobes as well could be related to posterior reversible encephalopathy syndrome. RCVS is less likely given the relative lack of intracranial vasoconstriction.2.Redemonstration of hemorrhagic foci centered in the left posterior frontal lobe and left occipital pole. The patient is status post surgery for the left frontal lobe hematoma.3.No evidence for intracranial cerebrovascular occlusion or significant constriction is appreciated on this exam.4.The superior sagittal sinus appears narrowed at the craniotomy site one possibility is that this is a result of postsurgical change in appearance. Arachnoid granulation could have a similar appearance as can intraluminal thrombus. Changing caliber at this site suggests that this may have some effect on superior sagittal sinus flow.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other convulsions. Altered mental statusClinical question: r/o mass lesion or ischemiaSigns and Symptoms: seizure MRI of the brainThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the right frontal sinus. The visualized portions of the mastoid air cells demonstrate partial opacification of the left mastoid air cells and to a lesser degree right mastoid air cells. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.MRV brain:The dural venous sinuses are patent. The right transverse sinus, sigmoid sinus and jugular vein are asymmetrically smaller than their left sided counterparts. The prior CT of the head demonstrates a small right sigmoid sinus groove. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The basal veins are relatively small.

Output: 1.There is no evidence for dural sinus thrombosis.2.There is no evidence for intracranial mass lesion or hemorrhage.3.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: There is no abnormal parenchymal or meningeal enhancement. No intracranial mass or mass effect. Again seen is extensive confluent T2/FLAIR hyperintensity in the bilateral frontoparietal and to a lesser degree temporal and occipital white matter most compatible with treatment related leukoencephalopathy. There are multiple scattered foci of susceptibility effect including the bilateral temporal lobes and cerebellar hemispheres which are grossly similar to prior. There is focus of susceptibility in the left posterior frontal lobe which is not definitely seen on prior and may be due to differences in technique and the small size of the lesion. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. There is aneurysm involving the right supraclinoid internal carotid artery which measures approximately 9 mm in diameter and 11 mm in the craniocaudal dimension, similar to prior. Left maxillary mucous retention cyst again seen. The enhancing lesions that were seen in the previous study involving the left frontal calvarium at the vertex and the right parietal calvarium are grossly unchanged.

Output: 1. No evidence of intraparenchymal or leptomeningeal metastatic disease.2. Enhancing foci in the right parietal and left frontal calvarium which were seen on prior study from 5/15/2015 but not on more remote prior studies are not significantly changed. 3. No significant change in extensive supratentorial white matter abnormality most compatible with treatment-related leukoencephalopathy.4. No significant change in scattered punctate foci of chronic microhemorrhages which are nonspecific and can be seen with entities such as chronic hypertension as well as sequela of radiation treatment. 5. Right supraclinoid internal carotid artery aneurysm again seen and grossly similar in size to priors but can be better evaluated with dedicated MR or CT angiogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other malaise and fatigue. Other malaise and fatigueClinical question: Is there stenosis?Signs and Symptoms: back pain and weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is mildly degraded due to patient motionMRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are bilateral uncovertebral osteophytes present this level which are more on the left versus the right side where there is encroachment of the nerve roots of the left-sided exiting nerve root and encroachment on the left hemicord. This has progressed since the 2009 examAt C4-5 there are endplate and uncovertebral osteophytes present associated with some mild narrowing of the neural foramina bilaterally more on the left versus the right side. There is encroachment of the exiting nerve roots within the left neural foramen at this this was also present on the prior exam from 2009. It has not changed substantially since.At C5-6 there are endplate and uncovertebral osteophytes present with encroachment of the neural foramina bilaterally but more on the right and the left side where there is encroachment of the right-sided exiting nerve roots. This was also present on the prior exam and has not changed substantially.At C6-7 there are endplate and uncovertebral osteophytes present associated with disc material and mild narrowing of the neural foramina bilaterally. This was also present on the 2009 exam and not substantially changed.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with multilevel encroachment of exiting nerve roots on the left side at C3-4, and the left side at C4-5 and the right-sided C5-6. These are largely stable since the prior exam except that the encroachment of the left exiting nerve roots at C3-4 has progressed2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Examination is mildly degraded due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 72 years, Male, dysphagia and dysarthria. Evaluate for brainstem stroke. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. 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 changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild mucosal thickening involving the frontal, anterior ethmoid and maxillary sinuses. Bone marrow signal and extracranial soft tissues are within normal limits. Bilateral lens implants noted.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. The cervical spinal cord has normal signal characteristics and overall morphology. Bone marrow signal is benign with mild signal changes involving multiple endplates on a degenerative basis. There are multilevel degenerative changes with moderate disc height loss at the C5-C6 and C6-C7 levels and to a lesser degree C4-C5 level. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina. There is prominent left-sided facet arthropathy.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy on the right. There is mild right neural foraminal stenosis. There is mild spinal canal stenosis. No significant left neural foraminal narrowing.C4-5: Small disc osteophyte complex with left-sided uncovertebral hypertrophy as well as ligamentum flavum thickening. There is mild to moderate spinal canal stenosis with mild cord deformity. No cord signal abnormality. There is mild to moderate left neural foraminal stenosis. No significant right neural foraminal narrowing.C5-6: There is uncovertebral hypertrophy with mild to moderate right and mild left neural foraminal stenosis. No significant spinal canal stenosis.C6-7: No significant spinal canal stenosis. Mild to moderate neural foraminal stenosis bilaterally, right slightly worse in left, related to uncovertebral hypertrophy. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Brain MRI appears within normal limits for age. Specifically, no evidence of infarct or intracranial mass.2. Degenerative changes in the cervical spine. There is mild to moderate spinal canal stenosis at C4-C5 and to a milder degree at C3-C4. No higher-grade spinal canal stenosis or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 9-year-old female with history of pilocytic astrocytoma resection, yearly follow-up Examination is motion degraded. Redemonstrated are changes from previous left suboccipital craniotomy with left paramedian cerebellar resection tract and left cerebellar volume loss. No new FLAIR signal abnormality or significant enhancement within the resection bed is demonstrated to suggest tumor recurrence. No new parenchymal or meningeal enhancement is seen within the remainder of the brain. No evidence of acute infarct or hemorrhage. No intracranial mass effect. No hydrocephalus. No extra-axial collections. Mild mucosal thickening is seen within the left maxillary sinus. Visualized extracranial soft tissues are otherwise unremarkable.

Output: Examination is mildly motion degraded but demonstrates no appreciable evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:2/8/1944)Reason: L4 Lytic lesion, h/o breast ca History: back painPROVIDER/ATTENDING NAME: DIANE B CHANEY DIANE B CHANEY There are multiple marrow replacing lesions throughout the visualized lumbar and thoracic spine as well as the lower cervical spine. There is a large spinous process lesion at T4 and some of the larger lesions are located at C6, C7, T5, L5, L4, L2, L1, T12 with smaller lesions elsewhere. Additional lesions are present in the sacrum.There is no convincing evidence for cord compression. There are multilevel degenerative changes in the thoracic spine with the disc bulges at multiple thoracic levels but without any spinal stenosis. There are also degenerative changes present in the lumbar spine with diffuse disc bulges at L4-5 and L5-S1 associated with narrowing of the neural foramina at L5-S1. T2 signal hyperintensity within the L5-S1 disc is present.The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2.There are multiple marrow replacing lesions throughout the visualized spine compatible with metastatic disease.3.There are degenerative changes present in the thoracic and lumbar spine without significant compromise to the spinal canal.


Instruction: Generate impression based on findings.

Input: 27 years Female (DOB:8/26/1988)Reason: evaluate for lumbar pathology - please view full SI joints History: refractory lower back painReferring Attending: REEM H JAN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Reason: r/o osteomyelitis, extent of infection to wound in foot History: purulent drainage with foul odor several months There is minimal soft tissue irregularity along the plantar aspect of the base of the proximal phalanx of the great toe consistent with the stated history of ulceration. There is increased signal abnormality within the surrounding subcutaneous and soft tissues which demonstrates enhancement on postcontrast sequences likely representing a cellulitis in the correct clinical context. There is minimal increased signal abnormality and fluid sensitive sequences within the proximal phalanx and to a greater extent the distal phalanx of the great toe. There is no corresponding decreased signal abnormality on T1-weighted images to confirm osteomyelitis. These findings are most consistent with reactive osteitis. There is increased signal abnormality on fluid sensitive sequences within the plantar musculature of the foot which is nonspecific but can be seen in myositis. Minimal degenerative changes affect the tarsometatarsal joints. The flexor and extensor tendons appear intact. There is no focal fluid collection to suggest abscess formation. There is no frank osteolysis to suggest osteomyelitis.

Output: Soft tissue ulceration along the plantar aspect of the great toe with findings suggestive of a cellulitis as described above. Bone marrow signal abnormality within the proximal and distal phalanx of the great toe in a pattern most consistent with reactive osteitis. There are no findings to suggest osteomyelitis. No focal fluid collection is identified to suggest abscess formation. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 39-year-old man with history of acute pancreatitis, please evaluate pancreatic anatomy. ABDOMEN:LIVER, BILIARY TRACT: Diffuse loss of parenchymal signal on out-of-phase images indicates steatosis. Additionally, there is hepatomegaly. 2 round, focal T1 mildly hyperintense lesions are seen in segment 2 (14/107) of the liver and segment 6 (14/125) measuring approximately 1 x 1 cm. These foci subtlely enhance and do not washout on delayed phases of perfusion imaging and are T2 hypointense.Additional, geographic area of relative isointense T1 signal adjacent to the gallbladder fossa (14/47) is favored to represent focal fatty sparing.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a single pancreatic duct without dilatation. The pancreatic parenchyma appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Simple right renal cysts are noted. The left kidney appears normal.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Partially visualized small bowel colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatomegaly with steatosis.2.Focal subtly enhancing lesions in the liver which are nonspecific but are favored to be benign and may represent regenerative nodules.3.Normal pancreatic anatomy without focal lesion.


Instruction: Generate impression based on findings.

Input: 73-year-old male status post liver transplant with abnormal CT findings ABDOMEN:LUNG BASES: Trace bilateral pleural effusions. Cardiomegaly.LIVER, BILIARY TRACT: The liver is heterogeneous in signal and enhancement with lobular contours suggestive of periportal fibrosis. There is mild diffuse biliary ductal prominence, similar to the prior CT. No mass is seen in the inferior right hepatic lobe, in the region of suspicion on the prior CT.SPLEEN: Subcentimeter T2 hyperintense foci, likely representing cysts. No significant abnormality noted.PANCREAS: 11 x 9 mm cystic lesion in the pancreatic head (series 6, image 59), which does not appear to communicate with the main pancreatic duct, likely representing a side branch IPMN. The main pancreatic duct is not dilated. No focal lesions are otherwise identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 20 x 11 mm retrocrural lymph node is similar to the prior CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of abdominal ascites.

Output: 1.Peri-portal hepatic fibrosis, without mass seen.2.11 x 9 mm cystic lesion in the pancreatic head likely representing a side branch IPMN.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for infection and hematoma. Signs and symptoms: Weakness. Enhanced thoracic MRI:Examination is performed without the benefit of intravenous contrast due to patient's severe pain and claustrophobia.There are diffuse patchy foci of T2/T2 stir hyperintensity throughout the thoracic cord highly suggestive of demyelinating disease. There is normal anatomical alignment the vertebral column.There is unremarkable signal intensity of vertebral column.C7 -- T1 is unremarkable.T1 -- T2 is unremarkable.T3 -- T4 demonstrate minimal degenerative changes with resultant mild right neural foraminal compromise.T4 -- T5 demonstrate mild degenerative disk disease and a tiny right paramedian disk protrusion resulting in subtle indentation of the ventral aspect of the cord without cord signal abnormality. No spinal stenosis or neural foraminal compromise.T5 -- T6 is unremarkable.T6 -- T7 is unremarkable.T7 -- T8 demonstrate a tiny linear focus of T2 hyperintensity in the annulus of the disk on the right highly suspected of an annular fissure. The finding is best appreciated on sagittal T2 and T2 stir image 8. No spinal stenosis or neural foraminal compromise.T8 -- T9 also demonstrate a tiny T2 hyperintensity in the annulus of the disk on the right suggestive of a smaller annular fissure. Unremarkable exam otherwise.T9 -- T10 is unremarkable.T10 -- T11 is unremarkable.T11 -- T12 and T 12 -- L1 levels are unremarkable.There is no detectable paraspinal soft tissue abnormalities.Although examination is performed without the benefit of intravenous contrast there is a normal finding on this exam to suggest presence of an infectious or inflammatory process.

Output: 1.Examination is performed without the benefit of intravenous contrast due to patient's severe pain and claustrophobia.2.Diffuse patchy foci of T2/T2stir hyperintensity throughout the cord consistent with demyelinating disease.3.Within the limitation of a nonenhanced study there is no finding to suggest presence of an infectious or inflammatory process.4.Tiny right lateral disk protrusion at T4 -- T5 results in subtle flattening deformity of the cord however without central spinal stenosis or cord signal abnormality.5.Tiny annular fissure on the right at T7 -- T8 and T8 -- T9 levels as detailed.6.No evidence of spinal stenosis or neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: Ataxia, unspecified [R27.0], Reason for Study: ^Reason: Eval L frontal lesion w/ contrast (T1 w only needed, brain wo already done) History: RLE apraxia Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Patchy and somewhat confluent FLAIR/T2 high signal intensities on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRIThe cranial cervical junction is normal.The spinal cord signal intensity is normal.There is no abnormal enhancement.There is subtle kyphotic angulation of the cervical spine at C45.Degenerative changes are follows;C23: Minimal focal bulging of disc central to right which abuts thecal sac. No neuroforaminal stenosis.C34: Diffuse bulging of disc which abuts thecal sac results minimal spinal stenosis. No neuroforaminal stenosis.C45: There is broad based disc protrusion central and slightly eccentric toward right which abuts thecal sac and narrows right side lateral recess. Mild to moderate spinal canal stenosis and moderate neuroforaminal stenosis on the right side are seen.C56: Diffuse broad based disc protrusion which abuts thecal sac, mild to moderate spinal canal stenosis.C67: Diffuse bulging of disc, otherwise unremarkable.C7T1: Diffuse bulging of disc, otherwise unremarkable.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Non specific small vessel ischemic disease, unchanged.3. Multilevel various degree degenerative changes of cervical spine as described above.


Instruction: Generate impression based on findings.

Input: Reason: Neuro MRI of left elbow - evaluate nerves around elbow, 3T MRI History: Neuro MRI of left elbow - evaluate nerves around elbow, 3T MRI LIGAMENTS: Although this examination was not protocoled for detailed evaluation of the intrinsic ligaments of the elbow. The ulnar collateral ligament appears intact. The lateral ulnar collateral ligament appears intact. The radial collateral ligament appears intact within the limitations of this non arthrogram study.TENDONS: There is thickening and intermediate signal intensity within the biceps tendon indicating a severe tendinosis. Note is made of postsurgical changes of prior biceps tendon repair including surgical screws within the proximal radius at the level of the bicipital tuberosity. The biceps tendon appears intact. The brachialis tendon appears intact. The flexor and extensor tendons appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormalities are identified. The imaged musculature of the left elbow is unremarkable. SURROUNDING STRUCTURES: No large effusion is evident.ADDITIONAL

Output: 1. Postsurgical change of prior biceps tendon repair. The biceps tendon appears intact. Severe tendinosis affects the biceps tendon.2. Minimal increased signal abnormality within the ulnar nerve as it courses along the medial epicondyle of the distal humerus indicating a mild neuritis. Presumed surgical changes of prior cubital tunnel release. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: 1.2 cm right lateral temporal lobe ring-enhancing lesion s/p SRS History: follow up ill-defined T2 hyperintensity involving the mesial left temporal w/o pathologic enhancement on last MRI. This exam is for treatment planning purposes and is limited. There is a ring-enhancing lesion in the lateral right temporal lobe measuring 8 x 9 mm in greatest axial dimensions (series 401, image 80) by 7 mm in the craniocaudal dimension (series 403, image 152), previously 12 x 12 x 10 mm. The lesion remains T1 hypointense internally, and the previously seen internal enhancing septations are less prominent. There is minimal associated local sulcal effacement, slightly improved. There is now a slightly increased rim of susceptibility artifact surrounding the lesion compatible with treatment effect.Previously described T2 signal abnormalities are not evaluated on this limited treatment planning examination.The ventricles and sulci are otherwise within normal limits for age. The cisterns remain patent. There is no midline shift. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits.

Output: Limited examination for treatment planning demonstrating interval decrease in size of right lateral temporal lobe ring-enhancing lesion.


Instruction: Generate impression based on findings.

Input: Male; 80 years old. Reason: History of bilateral iliac aneurysms seen on MRI in May 2014. Repeat MRI to evaluate interval change. Abdomen:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: This study is not optimized for characterization of renal lesions, although the previously noted cystic lesion in the upper pole of the left kidney contains thin septations and measures 3.6 x 3.4 cm, previously 3.7 x 3.2 cm (series 601, image 24). Small T1 hyperintense focus located posteriorly within the lesion may represent an area of hemorrhage as discussed on the prior MRI (series 503, image 74). Subcentimeter simple cysts are also noted within the left kidney. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Marked aneurysmal dilatation of the bilateral common iliac arteries is again noted, measuring 4.1 cm on the right (series 1801, image 23) and 3.5 cm on the left (series 1801, image 34). Previously, measurements were 4.2 cm on the right and 3.6 cm on the left. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate cardiomegaly.Pelvis:PROSTATE/SEMINAL VESICLES: Heterogeneous appearance of the prostate, which may be related to patient age. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in size of bilateral common iliac artery aneurysms. Please see reference measurements above. 2.Complex cyst in the upper pole of the left kidney does not appear grossly changed, although it should be noted that this exam is not optimized for complete evaluation of renal lesions.


Instruction: Generate impression based on findings.

Input: 16-year-old female with fever and left hip pain, evaluate for septic arthritis. BONE MARROW: Bone marrow signal is within normal limits.SOFT TISSUES: Slightly prominent pelvic lymph nodes measuring up to 1.1 cm identified, likely reactive in etiology. The musculature is normal in appearance. No abnormal enhancement is identified.JOINTS: No joint effusion is identified in bilateral hips. No evidence of septic arthritis are identified. No abnormal enhancement is present.ADDITIONAL

Output: Slightly prominent pelvic lymph nodes, likely reactive in etiology. Otherwise, normal examination without evidence of septic arthritis of the right or the left hip.


Instruction: Generate impression based on findings.

Input: 68-year-old female with HCC, status post TACE RFA. Follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense nonenhancing focus of the lateral right hepatic lobe likely representing a benign cyst.The known hepatic segment 4A lesion demonstrates residual contrast enhancement measuring 2.3 x 2.5 cm (axial series 11 image 55). Adjacent T1 and T2 hypointense signal intensity compatible with posttreatment effect. Resistant restricted diffusion is also noted. The portal and hepatic veins are patent. No new lesions are identified. T1 hyperintense bile within the gallbladder is noted along with stable small gallbladder polyps.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Stable small simple cyst of the left lower renal pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate size hiatal hernia, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Residual enhancement of the known hepatic segment 4A HCC lesion measuring 2.3 x 2.5 cm.


Instruction: Generate impression based on findings.

Input: Known left breast malignancy present for I-Spy research MRI. Two areas positive for malignancy in the breast, and additional malignant axillary biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Bilateral retropectoral silicone implants are present.In the left inner breast, the index enhancing mass near 8:00 measures 2.0 x 2.7 x 2.8 cm (LM x CC x AP). Adjacent to this mass are small foci/areas of non-mass enhancement measuring up to 7 mm and extend up to 1.4 cm from the mass. This index mass extends posteriorly close to the thin pectoralis muscle overlying the implant. But there is no definite abnormal pectoralis enhancement. Additionally, there is abnormal non-mass enhancement surrounding a cyst in the lower outer left breast which measures 2.7 x 3.2 x 5.7 cm. These areas together measure 5.2 x 6.5 cm in the axial plane.No abnormal enhancement is seen in the right breast. There are at least 4 enlarged left axillary lymph nodes, including a subpectoral node. A representative node adjacent to the pectoralis minor measures 1.1 x 1.1 cm in the axial plane. A focus of low T1 signal in one of these nodes suggests biopsy clip artifact. No abnormal axillary lymph nodes are identified in the right axillary region.A port-a-cath is present in the right upper chest wall. A high T2 signal hepatic lesion is likely a benign cyst.

Output: Know left breast cancer with left axillary metastasis with pre-treatment measurements as above. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: pelvic fluid collection History: peri rectal pain PELVIS: UTERUS, ADNEXA: Normal ovaries and uterus.BLADDER: No significant abnormality noted. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A complex network of fistulae are redemonstrated in the right perianal region, now with seton. Again seen is a 2.9 x 1.9 cm collection in the right ischioanal space (5:66), unchanged. The tract extends approximately 6.6cm caudally from this collection, courses along the right gluteal fold and connects with the anus in the 6:00 position, not significantly changed from prior study.A separate thin tract that extends from the collection above in a caudal direction and crosses the external sphincter previously into a 1.4 x 0.7cm intersphinteric/perirectal collection which is not seen today. However, the tract does still appear to terminate along the posterior wall of the vagina, not significantly changed (5:44). Also, as before, a tract extends from the location of the previously seen 1.4cm collection in a cranial direction and appears to communicate with the anus at the 6/7 oclock position (5:37).Few prominent bilateral internal nodes are enlarged by size criteria.OTHER: No significant abnormality noted.

Output: 1.Essentially unchanged/slightly improved complex fistulae, some with setons, as above, including an unchanged 2.9 cm right ischioanal collection. Previously seen 1.4 cm intersphincteric/perirectal collection is not visualized today.


Instruction: Generate impression based on findings.

Input: Female 67 years old with bilateral renal cell carcinoma status post nephrectomy and partial nephrectomy. Evaluate for renal recurrence or distant metastasis. ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts are unchanged. Normally distended gallbladder without gallstones. No intra or extrahepatic biliary ductal dilatation. No ascites.SPLEEN: No significant abnormality noted.PANCREAS: Fatty infiltration of the pancreatic head is again noted. The pancreatic duct is normal in diameter.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence in the nephrectomy bed.Status post partial left nephrectomy. A subcentimeter cystic focus in the inferior pole of the left kidney is likely a benign cyst and is unchanged.RETROPERITONEUM, LYMPH NODES: No regional lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post right nephrectomy and partial left nephrectomy with no evidence of disease recurrence or metastasis.


Instruction: Generate impression based on findings.

Input: 80 year old female with new neuropathy, possible relapse. History of multiple myeloma; recurrence of M protein. CERVICAL SPINE: There is grade 1 retrolisthesis of C5 on C6. There is grade 1 anterolisthesis of C4 on C5 which is slightly increased in prior MR study, as well as stable grade 1 anterolisthesis of C7 on T1. Marrow signal is benign. Focal lesion along the posterior aspect of C7 vertebral body which demonstrates increased T1 and T2 signal which is stable dating back to 2012 and most likely represents a benign hemangioma or area of focal fat.The craniocervical junction and ligamentous structures are maintained. There is abnormal signal intensity of the spinal cord. Multilevel degenerative changes including uncovertebral hypertrophy, mild disc osteophyte complexes with uncovering of the disc at levels of subluxation, ligamentum flavum and facet hypertrophy appear similar. There is up to mild to moderate central spinal canal stenosis at C4-C5. There is moderate left and mild right neural foraminal stenosis at C6-C7 and C7-T1.THORACIC SPINE:Alignment is maintained. There is chronic compression deformity of T8 vertebral body with near complete loss of vertebral body height present at least since 2014 with mild associated enhancement and associated retropulsion of the vertebral body by approximately 4 to 5 mm. There is acute kyphosis of the thoracic spine at this level. There is increased signal and enhancement along the anterosuperior aspect of T9 which is likely degenerative, related to the aforementioned kyphosis. There is stable anterior wedging and persistent focal concavity along the superior endplate of T7 relating to a Schmorl's node. Other than the T8 vertebral body fracture related enhancement, there are no other areas of abnormal marrow enhancement elsewhere. Cord signal is unremarkable.There are multilevel degenerative changes including facet and ligamentum flavum hypertrophy. At T7-T8 there is uncovering of disc with superimposed disc bulge accentuated by the retropulsion of T8; there is associated bilateral moderate neural foraminal stenosis as well as mild to moderate spinal canal stenosis at this level. There is bilateral moderate to severe neural foraminal stenosis and at least moderate spinal canal stenosis at T8-T9. There is moderate to severe left-sided neural foraminal stenosis at T11-T12 which is stable.LUMBAR SPINE:Re-demonstration of extensive hardware artifact related to posterior spinal fusion spanning L2-L5. Cord signal intensity is unremarkable, specifically the conus medullaris on sagittal imaging is grossly intact. Five lumbar type vertebral bodies are presumed to be present. There are multilevel compression deformities and associated Modic type endplate changes, specifically involving L2, L3 and L4 with slightly progressed vertebral body height loss at L4 measuring 9 mm on the current study, previously 16 mm at the thinnest portion of the vertebral body. There is associated mild retropulsion of the L4 vertebral body fracture fragments. There is stable grade 1 anterolisthesis of L4 on L5. Besides the aforementioned endplate Modic typic changes, there is no abnormal marrow signal elsewhere.There are multilevel degenerative changes including disc osteophyte complexes, ligamentum flavum and facet hypertrophy.At L1-L2, there is moderate bulging of the disc with a foraminal component on the right associated with moderate right-sided neural foraminal stenosis. There is moderate to severe spinal canal stenosis at this level which has progressed from prior study.At L2-L3, there is mild spinal canal stenosis related to postoperative decompression.At L3-L4, there is mild to moderate bilateral neural foraminal stenosis, left greater than right.At L4-L5, there is uncovering of the disc with superimposed disc bulge and focal disc material within the left foramen resulting in associated moderate to severe left foraminal stenosis. There is also mild to moderate right-sided neural foraminal stenosis.At L5-S1, there is mild bilateral neural foraminal stenosis.Evaluation of the spinal canal from L3 to S1 is obscured by hardware artifact.There is a focal cystic lesion within the right kidney measuring up to 9 mm.

Output: 1. There is no definite evidence of active myelomatous disease.2. Chronic moderate-severe compression deformity of T8 with retropulsion of fracture fragments intervening to overall moderate central spinal canal stenosis at T8-T9. Slight interval progression of moderate chronic compression deformity of L4 with mild retropulsion.3. Multilevel degenerative changes which overall appear progressed in the lumbar spine as described above. Up to moderate to severe left foraminal stenosis at L4-L5 and moderate-severe central spinal canal stenosis at L1-L2. Bilateral moderate to severe foraminal stenosis at T8-T9, as well as moderate to severe left foraminal narrowing at T11-T12.


Instruction: Generate impression based on findings.

Input: 56-year-old female with pain with abduction. Evaluate for rotator cuff tear. ROTATOR CUFF: There is thickening and increased signal abnormality of the supraspinatus tendon consistent with moderate tendinosis. There is thickening and increased signal abnormality within the infraspinatus tendon consistent with moderate tendinosis. The infraspinatus and supraspinatus muscles and tendons appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Degenerative changes affect the glenohumeral joint including subchondral cyst formation. The glenohumeral joint alignment is anatomic.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Rotator cuff tendinosis as described above without evidence of a full thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 15 year old woman with pulmonic stenosis s/p angioplasty who now has significant pulmonic valve regurgitation. She is referred for assessment of her RV size and function as part of a clinical study. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 50 ml/m2 (normal range: 65+/-11), the LVEDV is 107 ml (normal range 109+/-23), the LV end systolic volume index is 16 ml/m2 (normal range 18+/-5), the LVESV is 35 ml (normal range 31+/-10), the LV mass index is 33 g/m2 (normal range 67+/-11), and the LV mass is 70 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is upper-normal size when adjusted for body surface area; however, when compared to the LV it is nearly twice as large. There is normal RV systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 96 ml/m2 (normal range 69+/-14), the RVEDV is 205 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 94 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. 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 is bicuspid and opens widely. There is moderate to severe pulmonary regurgitation. Regurgitant fraction is 37% and regurgitant volume 42ml.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe distal main pulmonary artery is mildly dilated and very distensible. During diastole it is mildly dilated (28mm) and during systole it is 38mm.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPossible thyroid enlargement, recommend correlation with physical exam. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 67%).2. The right ventricle is upper-normal size when adjusted for body surface area; however, when compared to the LV it is nearly twice as large. There is normal RV systolic function (RVEF 54%).3. Bicuspid pulmonic valve with normal leaflet excursion but moderate to severe pulmonic regurgitation.4. Mild dilation of the distal main pulmonary artery.5. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Focal seizure with secondary generalization. Abnormal EEG because of an active T8 spike focus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The hippocampi appear to be grossly intact and there is no evidence of heterotopia. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No discernible seizure foci.


Instruction: Generate impression based on findings.

Input: 47-year-old male. Left knee pain and swelling with mechanical symptoms. Evaluate for meniscus tear. Due to the patient's body habitus, a high-resolution knee coil could not be used. An alternative coil was used instead which results in slightly suboptimal image quality.MENISCI: There is marked attenuation of the posterior horn of the medial meniscus compared to that on the prior study, which may reflect either partial meniscectomy or interval tearing. The root of the posterior horn of the medial meniscus is not well visualized, likely reflecting a chronic tear, as the root was not visualized on the prior study. Increased signal intensity along the undersurface of the remaining posterior horn could either represent additional tearing or residual degenerative signal in the meniscus following meniscectomy. There is extrusion of the body of the medial meniscus more so than that seen on the prior study with intrasubstance signal suggesting mucoid degeneration. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Moderate degeneration of the articular cartilage of the weight-bearing portion of the medial tibiofemoral compartment with foci of near full thickness to full-thickness degeneration. Small foci of low signal intensity within the articular cartilage may reflect prior microfracture. There is degeneration of the articular cartilage of the lateral femoral condyle just anterior to the anterior horn of the lateral meniscus with small osteophytes. Small foci of signal abnormality within the articular cartilage of the patella and femoral trochlea suggests focal degeneration/tearing, similar to the prior study. The bone marrow signal intensity appears normal. Tricompartmental osteophytes have progressed slightly compared to the prior study.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Limited study, as described above.2. Medial meniscus abnormality, as described above, that may simply reflect a combination of old tearing and interval partial meniscectomy but we cannot exclude the possibility of a new tear on the basis of this study.3. Progression of osteoarthritic changes particularly affecting the medial tibiofemoral compartment.


Instruction: Generate impression based on findings.

Input: CERVICAL: There is mild motion artifact degrading image quality. There has been progressive interval volume loss and myomalacia centered at C5-6 through C6-7 levels measuring up to 21 x 4 mm on series 501 image 8, previously 12 x 4 mm. The cord at this level is flattened and is eccentric to the right with focal adhesion suspected along the right lateral aspect of the thecal sac (series 601 image 26).There is minimal subtle flattening of the ventral pons is compared to the prior examination, as well as mild prominence of the CSF space around the cervical cord which are suspected to represent interval mild diffuse/uniform volume loss as a result of progressive myelomalacia described above. There is prominent CSF pulsation artifact secondary to prominent CSF space around the cervical cord.There is straightening. The osseous marrow signal is within normal limits. There is interval loss of T2 disk signal and C6-7. The intravertebral disk heights and signal are otherwise within normal limits.There is no significant disk/endplate degenerative change or spinal stenosis in the cervical spine.The right V2 vertebral artery flow void remains indistinct, similar to prior examination. The remaining imaged flow-voids in the neck are preserved.THORACIC: There is mild thoracic levoscoliosis centered in the upper thoracic spine. There are the usual complement of 12 thoracic and 5 lumbar vertebral bodies. The osseous marrow signal is within normal limits. The thoracic thecal sac to cord caliber appears somewhat increased with prominent CSF space around the thoracic cord; this can be due to congenitally/developmentally larger thecal sac or due to mild uniform volume loss of the thoracic cord. However, given the focal myelomalacia in the cervical spine, this appearance is suspected to represent mild uniform volume loss as opposed to a developmental/congenital finding. Cord signal is within normal limits. There is no significant disk herniation or spinal stenosis the thoracic spine.LUMBAR: There is usual complement of 5 lumbar vertebral bodies with the last well formed disk space referred to as L5-S1. The osseous marrow signal is within normal limits. The conus terminates at L1-2, and has a normal signal characteristics and caliber. The conus is mobile and settles anteriorly in the spinal canal upon prone positioning. There is no fatty filum or lipoma. There is no dysraphism.L1-2: Minimal disk bulge with no significant spinal stenosis.L2-3: Minimal disk bulge with no significant spinal stenosis.L3-4: Minimal disk bulge with no spinal stenosis.L4-5: Minimal disk bulge. No significant spinal stenosis.L5-S1: Minimal disk bulge with no spinal stenosis.

Output: 1.Mild progressive myelomalacia centered at C5-6 through C6-7 as described above. There is subtle/mild uniform volume loss also suspected in the pons, cervical and thoracic cord as a result of progressive myelomalacia mentioned above.2.No new or separate areas of cord signal abnormality, syrinx or evidence of cord tethering.3.Mild thoracic levoscoliosis.


Instruction: Generate impression based on findings.

Input: 71-year-old male with NASH cirrhosis, status post RFA for HCC and known IPMN. Please evaluate with cirrhosis protocol MR and MRCP. Exam is limited by extensive motion artifact and lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology is large volume abdominal ascites. A TIPS connects the right portal vein and hepatic vein. There is a wedge shaped area of T2 hyperintensity within hepatic segment 7/8 measures 6.1 x 5.0 cm (series 5, image 28) corresponding to the ablation zone as seen on prior CT, previously 7.3 x 4.6 cm. The round segment 7/8 lesion is unchanged in size 2.3 x 2.2 cm (series 1401, image 38) compared to prior 7/7/16 CT study accounting for differences in technique, it is intrinsically bright on T1 and demonstrates loss of signal on out of phase images compatible with microscopic fat content. There is characterize on CT is a slight decrease in lesion size. Post contrast images were not obtained so enhancements patterns cannot be evaluated.No biliary ductal dilatation.SPLEEN: The spleen measures 20 cm in craniocaudal dimension. Multiple collateral vessels are present in the splenic hilum.PANCREAS: Bilobed cystic lesion in the uncinate process measures 21 x 15 mm (series 7, image 14), previously measured as 2 lesions and not significantly changed in size when measured similarly.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple bilateral renal cysts are unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Enlarged periaortic lymph nodes are again seen.BOWEL, MESENTERY: Esophageal and gastric varices are redemonstrated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Minor contrast extravasation as described in the technique section.2.Limited exam due to lack of IV contrast. Mild decrease in size of post treatment ablation zone and stable right hepatic lesion (when compared to 7/7/16 CT study). Given difficulties with breath-holding and large volume of ascites CT should be considered for future follow-up.3.Findings of splenomegaly, cirrhosis and portal hypertension.


Instruction: Generate impression based on findings.

Input: There is a small focus of T2 hyperintensity and enhancement in the anterior aspect of the C7 vertebral body. The spinal cord is of normal caliber and signal. At C3-4 through C6-7 there are central to left foraminal base disc bulges with mild to moderate narrowing of the spinal canal and moderate left neural foraminal stenosis. The vertebral body heights are preserved and there is no spondylolisthesis. The paravertebral soft tissues are unremarkable.THORACIC SPINE

Output: 1.Numerous myelomatous lesions are present in the axial skeleton, without associated spinal cord compression of pathological fracture.2.Degenerative spondylosis in the cervical and lumbar spine, without associated spinal cord compression either.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: Headaches, neck pain C3 -- C4. Clinical question: Is there evidence of fracture/dislocation. Non-enhanced CT of brain:M. there is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray -- white matter differentiation remains to be normal.Calvarium is intact.CT of the cervical spine:There is no evidence of fracture or subluxation. Very minimal degenerative changes of cervical spine is noted. Reformatted images demonstrate normal alignment the vertebral column. No definitive neural foramina compromise or central spinal stenosis. Limited images through the apices of the lungs demonstrate emphysematous pole I bilaterally. Multi-level subtle bulge of disk material is present. This is more pronounced at C3 -- C4 and apparent subtle mass effect on the cord. This findings can be better evaluated with an MRI exam.

Output: 1.Unremarkable nonenhanced CT of brain.2.No evidence of fracture or subluxation of cervical spine. Minimal degenerative disk disease.


Instruction: Generate impression based on findings.

Input: Brain:There are multiple nonenhancing foci of T2 hyperintensity within the supratentorial white matter, a majority of which are subcortical in location, with a few periventricular. There are no posterior fossa lesions. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. A small amount of mucosal thickening is present within a single anterior right ethmoid air cell. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Cervical spine:There are nonenhancing T2 hyperintense foci within the cervical cord at the following locations: C2/3 left lateral cord, C3/4 posterior central cord, and C4 right posterolateral cord. There are other suspicious T2 hyperintense foci, however are small and subtle and may reflect artifact.There is reversal of normal upper cervical curvature. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: Mild disc bulge causing slight anterior cord flattening without stenosis.C5/6: There is a right paracentral disc extrusion which extends below the disc level, causing anterior right hemicord flattening. There is no significant stenosis.C6/7: UnremarkableC7/T1: UnremarkableThoracic spine:Axial T2 images demonstrate what appears to be T2 hyperintense lesion within the posterior midline thoracic cord, not confirmed on sagittal imaging. A T2 hyperintense lesion is noted within the left hemicord T11. A subtle more diffuse T2 hyperintense lesion is noted at the T12 level. None demonstrate contrast enhancement.There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy. There are no masses. There is no abnormal enhancement.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.

Output: 1.There are multiple nonenhancing foci of T2 hyperintensity within the supratentorial white matter, a majority of which are subcortical in location, with a few periventricular. There are no posterior fossa lesions.2.There are nonenhancing T2 hyperintense foci within the cervical cord at the following locations: C2/3 left lateral cord, C3/4 posterior central cord, and C4 right posterolateral cord. There are other suspicious T2 hyperintense foci, however are small and subtle and may reflect artifact.3.C5/6: There is a right paracentral disc extrusion which extends below the disc level, causing anterior right hemicord flattening. There is no significant stenosis.4.Axial T2 images demonstrate what appears to be T2 hyperintense lesion within the posterior midline thoracic cord, not confirmed on sagittal imaging. A T2 hyperintense lesion is noted within the left hemicord T11. A subtle more diffuse T2 hyperintense lesion is noted at the T12 level. None demonstrate contrast enhancement.


Instruction: Generate impression based on findings.

Input: 54 years, Male, meningioma, MRI for radiation treatment planning. Examination is limited to sequences per radiation treatment planning MRI protocol. Again seen is an enhancing lesion along the left planum sphenoidale measuring approximately 14 mm x 14 mm x 7 mm. There is mild local mass effect on the adjacent left gyrus rectus. There is evidence of mild gradual enlargement when compared to prior studies from 1/20/2014. No other intracranial mass or mass effect within the remainder of the brain. No hydrocephalus. No extra-axial collections. Patchy signal abnormalities involving the white matter are better assessed on prior complete brain MRI.

Output: Examination for treatment planning again demonstrating a left planum sphenoidale meningioma.


Instruction: Generate impression based on findings.

Input: Female, 34 years old. SLE, dermatomyositis, reactive arthritis. Now with R ankle ulcer with cellulitis. There is ulceration of the skin and subcutaneous fat lateral to the distal fibula with inflammation of the adjacent soft tissues. However, we see no well-defined or rim-enhancing fluid collection to indicate an abscess. The inflammation extends to the peroneal musculature, but the peroneal muscles and tendons appear intact, as do the remaining tendons. We see no marrow signal abnormality to indicate osteomyelitis. Additional edema and mild diffuse enhancement is noted within the medial subcutaneous fat of the ankle as well as along the dorsum of the ankle. A small amount of fluid is noted in the tibiotalar, talonavicular, and subtalar joints, not necessarily of any clinical significance. The visualized ligaments are within normal limits. There is a small amount of fluid at the knot of Henry, also of doubtful clinical significance.

Output: Soft tissue ulceration and inflammation without osteomyelitis.


Instruction: Generate impression based on findings.

Input: 30 year-old male with left flank pain. Rule out renal stone. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: There is a 2.6 x 4 cm mass which appears contiguous with the left adrenal at axial image 50/175. Numerous punctate calcifications are present in this mass. The mass attenuation measures 36 Hounsfield units average. Further characterization with dedicated adrenal MRI or CT examination would be helpful, if indicated.KIDNEYS, URETERS: No nephrolithiasis. Mild fat stranding surrounding the left kidney may be due to pyelonephritis or recent passage of stone. Right kidney is normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: L5 vertebral segment is sacralized on the left.OTHER: No significant abnormality noted

Output: Left adrenal mass with punctate calcifications. See above.No nephrolithiasis. Mild fat stranding surrounding the left kidney may be due to pyelonephritis or recent passage of stone. Right kidney is normal.L5 vertebral segment articulates with the sacrum on the left side and may be a source of back pain.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post radical prostatectomy. Evaluate for recurrence. Pathology states left seminal vesicle invasion. 3+ for disease in both the right and left peripheral and transition zone. Multifocal extraprostatic extension. Positive margin at the right base. No pelvic lymphadenopathy. PELVIS:PROSTATE: Status post radical prostatectomy. No evidence of residual or recurrent tumor in the prostatectomy bed or vesicourethral anastomosis.BLADDER: Unremarkable vesicourethral anastomosis.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: 39-year-old female. Follow-up lesion from 11/20/2015. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. There are multiple small well-defined T1-weighted hypointense lesions demonstrating peripheral nodular discontinuous enhancement, which progresses centrally compatible with multiple cavernous hemangiomas. The hepatic segment 7, there are 2 subcentimeter flash-filling hemangiomas (axial series 10 image 37) only seen in the arterial phase. In the peripheral right hepatic lobe, there is a stable septated cyst (axial series 7 image 8).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal fossa lesion is similar in size measuring 2.6 x 1.9 cm (axial series 11 image 41). The lesion again appears separate from the adrenal gland, pancreas, kidney and spleen. The lesion demonstrates peripheral thick enhancement (axial series 10 image 38), which appears to progress centrally. This enhancement pattern is unchanged.KIDNEYS, URETERS: Few simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. The left retroperitoneal mass is stable in size and again demonstrates peripheral thick enhancement which progresses centrally. The differential is unchanged.2. Multiple typical hepatic hemangiomas. Additionally, there are 2 subcentimeter presumably flash-filling hemangiomas in hepatic segment 7. Attention on follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with ptosis and decreased depth perception. Patient status post resection of a left maxillary sinus solitary fibrous tumor with orbital extension. Findings are demonstrated compatible with prior surgeries including endoscopic surgery of the left maxillary sinus and evidence of prior left orbital surgery. A defect is seen within the anterior wall of the left maxillary sinus which may reflect prior surgery as well.A lobular, mildly but homogeneously enhancing tumor is evident occupying the inferior and medial portions of the left orbit. In the axial plane, the major component of this lesion measures 35 x 31 mm, and in the craniocaudal dimension, the lesion measures up to 30 mm. As there does not appear to be an immediate postoperative examination subsequent to the patient's 10-2015 resection, it is unclear how much of this tumor represents residual disease and how much represents interval growth. The tumor on today's examination is, however, smaller than that seen on the preoperative examination of 9/10/2015.The lesion displaces the orbital contents superiorly. The optic nerve is stretched along the superior surface of the tumor, but the tumor does not appear to encase the nerve. The inferior rectus muscle is not well seen, and at some points, there is difficulty in distinguishing the medial and lateral recti muscles from the tumor which could indicate invasion. The left globe is proptotic. Tumor appears to extend medially into the left ethmoid air cells, as well as laterally and inferiorly, through a deficiency of the maxilla, into the premaxillary and retromaxillary spaces. The pterygopalatine fossa does not appear to be invaded.

Output: A large tumor is evident occupying the inferior aspect of the left orbit with extension medially into the ethmoid region, and inferolaterally into the premaxillary and retromaxillary spaces. On comparison with the prior preoperative examination, the lesion is smaller. Given that a surgical resection was performed in the interval, it is unclear to what extent this lesion represents residual versus growing tumor.


Instruction: Generate impression based on findings.

Input: compression fx. f/u on fractures/stenosis hx lumbar fusion History: Thoracic back Thoracic spine MRIThere is about 10% of compression fracture with bone marrow edema of T7 vertebrae indicating acute/subacute compression fracture. There is no retropulsion of fractured fragment at this level.There are multifocal compression fractures without evidence of bone marrow edema at the level of T10 and T12.Thoracic spine alignment is normal with normal kyphosis.Spinal cord signal intensity is normal.No evidence of spinal canal stenosis.L spine MRIThere is scoliosis of the lumbar spine.Multifocal degenerative changes of lumbar spine and intervertebral discs are seen. In addition, there are evidence of intra-discal interbody spacers at the level of L23, L34, and L45.There is no evidence of bone marrow edema.Spinal cord signal intensity is normal and the conus is terminated at the level of T12-L1 level.Degenerative changes are seen as follows;T12-L1: disc dessication, mild left neuroforaminal stenosis.L1-L2: disc dessication, diffuse bulge with left side eccentric disc bulge toward left neural foramen.No spinal canal stenosis. L2-L3: disc dessication. Moderate bilateral neuroforaminal stenosis. No spinal canal stenosis. L3-L4: disc dessication, no neuroforaminal narrowing or spinal stenosis. L4-L5: disc dessication, diffuse bulging of disc with bilateral ligamentum flavum hypertrophy results mild to moderate bilateral neuroforaminal stenosis. Minimal spinal canal stenosis.L5-S1: mild disc dessication, bilateral ligamentum flavum minimal thickening, no neuroforaminal or spinal canal stenosis.

Output: 1. New acute/subacute compression fracture of T7 vertebral body.2. Multifocal chronic compression fractures T10 and 12.3. Degenerative spondylosis of lumbar spine with multilevel various degree neuroforaminal and spinal canal stenosis as described above.4. Inter body spacers at the level of L23, L34 and L45.5. Scoliosis of thoracolumbar spine.


Instruction: Generate impression based on findings.

Input: Brain: There are postoperative findings related to suboccipital craniotomy for Chiari decompression. There is expected biphasic cerebrospinal fluid flow anteriorly and posteriorly across the neo-foramen magnum. The ventricles are unchanged in size and configuration. There is no evidence of acute infarction or hemorrhage. There is no evidence of pseudomeningocele.Cervical Spine: The cerebellar tonsils extend to the level of C1. At the C1-C2 level, there is unchanged focal syringohydromyelia, which measures up to 6 in width and 12 mm in length. There is minimal retroflexion of the dens and loss of the usual cervical lordosis. There is no evidence of vertebral subluxation. The vertebral body heights are preserved. There is no significant spinal canal or neural foraminal stenosis.

Output: 1.Postoperative findings related to Chiari decompression surgery with a patent neo-foramen magnum. 2.Persistent focal syringohydromyelia at the C1-C2 level.


Instruction: Generate impression based on findings.

Input: 54 years, Male, Reason: f/u brain lesions History: brain lesions. History of leukemia and intracranial abscess. Compared to 6/18/2015, there is been marked improvement/resolution of the previously seen peripherally enhancing lesion with restricted diffusion within the left cerebellar hemisphere. Again seen is leptomeningeal enhancement involving the cerebellar surfaces as well as prominent enhancement involving the right greater than left ependymal surfaces of the bilateral, right greater than left occipital horns, not significantly changed compared to 6/18/2015. No new enhancing lesion. No new focus of restricted diffusion to suggest infarct. Unchanged caliber of the ventricular system without evidence of hydrocephalus. Major flow-voids are preserved. Trace mucosal thickening involving the paranasal sinuses. Paranasal sinuses otherwise clear. Mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Previously seen left cerebellar abscess has resolved.2. Leptomeningeal enhancement involving the cerebellar surfaces as well as along the ependymal surface of the lateral ventricles is not significantly changed and compatible with leptomeningeal infection and ventriculitis. Leukemic involvement however can not be entirely excluded and continued follow-up is suggested as clinically indicated. 3. No new enhancing lesion, edema, mass effect, or hydrocephalus.


Instruction: Generate impression based on findings.

Input: 69-year-old male with right pain. MENISCI: There is heterogeneity and increased signal abnormality within the posterior horn of the medial meniscus which extends to the tibial and femoral articular surfaces consistent with complex degenerative tearing that extends to the body and anterior horn of the meniscus. There is globular increased signal abnormality within the posterior horn indicating intrasubstance degeneration. There is globular increased signal abnormality within the posterior horn of the lateral meniscus indicating intrasubstance degeneration. Some of the signal extends to the tibial articular surface consistent with degenerative tearing. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus. There is near full-thickness to full-thickness articular cartilage degeneration along the medial tibial plateau with underlying degenerative subchondral signal abnormality There is superficial fraying of the articular cartilage along the medial facet of the patella. There are tricompartmental osteophytes. There is subchondral cyst formation within the anterior tibial plateau.LIGAMENTS: The cruciate ligaments appear intact. The LCL appears intact. The superficial band of the MCL appears intact. The meniscal femoral coronary ligament appears thickened which may reflect prior injury or sprain. There is a small amount of edema type signal abnormality along the medial aspect of the MCL which may reflect a sprain.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial and lateral meniscus as described above.2. Osteoarthritis of the right knee with full-thickness articular cartilage degeneration as described above.3. Small joint effusion.4. Findings consistent with a MCL sprain.


Instruction: Generate impression based on findings.

Input: 55-year-old female with lupus status post CVA x 2, hypotensive and unresponsive with distended abdomen. Concern for intracranial process and acute abdomen. There is no evidence of intracranial hemorrhage, mass or edema. No evidence of acute cortical stroke, however, if there is clinical concern for acute stroke an MRI may be considered. Increased density within the left globe may be due to hemorrhage.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: 1. No evidence of acute cortical stroke, however, if there is clinical concern for acute stroke an MRI may be considered.2. Increased density within the left globe may be due to hemorrhage.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (10/1/14), ultrasound images of left breast (10/1/14) performed at Regenstein Breast Imaging Center. DIGITAL MAMMOGRAPHIC IMAGES (10/1/14):The breast parenchyma is extremely dense, which limits the sensitivity of the mammogram . A scar marker overlays anterior upper outer right breast. Two marker clips are present in the left breast, from prior benign biopsy.There are two large circumscribed masses are seen in the left breast, which correspond to the benign cysts on MRI (4/21/15). Scattered benign calcifications are noted in left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. On MRI (4/21/15), a suspicious lesion was present in the right breast and subsequent MRI guided biopsy revealed the lesion to be malignant. On retrospect, no abnormal findings are seen in the right breast on the mammogram dated 10/1/14.ULTRASOUND IMAGES OF LEFT BREAST (10/1/14):Three simple cysts are visualized in the left breast, at 3:00, 6:00 and 9:00 position.

Output: No mammographic and sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.