Instruction: Generate impression based on findings.

Input: There is slight interval decrease in size of right perirolandic enhancing lesion with susceptibility, now measuring 14 mm x 8 mm (series 10 and image 5), previously measuring 17 mm x 10 mm. The surrounding vasogenic edema is minimally diminished compared to the prior exam. Previously noted left occipital lobe lesion is no longer definitely visible. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Slight interval decrease in size of intracranial metastasis.


Instruction: Generate impression based on findings.

Input: 68-year-old female with altered mental status There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality


Instruction: Generate impression based on findings.

Input: Hepatitis C cirrhosis. Screening. Status post partial left nephrectomy in 2011 for clear cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. No suspicious hepatic lesion is identified. Layering cholelithiasis, without evidence of cholecystitis. No intra or extrahepatic biliary ductal dilatation is identified. Multiple small enhancing arterial foci (series 1003, image 78), without washout on delayed imaging, compatible with perfusion abnormalities, unchanged from prior.SPLEEN: Splenomegaly measuring 13.1 cm in the coronal plane.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post partial left nephrectomy. No discrete mass or area of abnormal enhancement. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal adenopathy measures 1.2 x 1.0 cm (series 1003, image 263), similar to prior.BOWEL, MESENTERY: Periumbilical hernia with adjacent fluid collection measuring 3.3 x 2.4 cm, unchanged. No evidence of bowel obstruction. Trace ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Gynecomastia.

Output: 1.Cirrhotic liver, without evidence of hepatocellular carcinoma. 2.Status post partial left nephrectomy, without evidence of recurrent disease. 3.Borderline retroperitoneal adenopathy, similar to prior.4.Mild ascites. 5.Cholelithiasis, without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Metastatic ovarian cancer needs evaluation for screening on trial IRB 15-0396. Scattered foci of increased T2/FLAIR signal in the subcortical and periventricular white matter. Given the patient's age, this statistically most likely represents chronic small vessel ischemic changes. No acute ischemic infarct.There is no evidence of intracranial hemorrhage, mass or edema. 3-D T1 post contrast images are somewhat limited by wrap around artifact. No definite intracranial foci of abnormal enhancement are identified. The apparent punctate focus of enhancement along the right cerebellum adjacent to the posterior lateral fourth ventricular margin appears vascular in etiology when correlated with multiplane 3-D T1 post contrast imaging. Incidental note is also made of a developmental venous anomaly in the left cerebellum.The ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Small focus of increased intrinsic T1 and T2 signal in the right parietal bone adjacent to the lambda with perhaps minimal enhancement, likely representing a small hemangioma.

Output: 1. No evidence of metastatic disease in the brain.2. Mild chronic small vessel ischemic changes.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: Low back pain Other chronic painClinical question: source of chronic midline LBP (L5-S1), no radiculopathySigns and Symptoms: intermittent LBP since childhood, L5-S1 Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and a small central disk protrusion at this level.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: There is a small central disk protrusion at L5-S1. There is no compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Evaluate for meniscal injury versus chondral injury, right knee pain. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The MCL, LCL, PCL, and ACL are in tact. EXTENSOR MECHANISM: There is a small joint effusion.ADDITIONAL

Output: Small joint effusion without meniscal or ligamentous injury or other findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 65F with right-sided neck pain radiating up to ear/down to shoulder, no specific injury, no muscle spasms on exam, fails to respond to muscle relaxants and exercises, flex-ex imaging negative for instability, ?facet pathology, ?nerve impingement Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex with uncovertebral hypertrophy. There is also mild ligamentum flavum thickening. There is mild spinal canal stenosis. There is mild to moderate right and minimal left neural foraminal stenosis.C5-6: Small central disc protrusion and mild ligamentum flavum thickening. There is minimal narrowing of the spinal canal. No significant neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.There is fairly mild generalized facet arthropathy affecting the cervical spine. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild multilevel degenerative changes in the cervical spine, relatively worse at the C4-C5 level where there is mild spinal canal stenosis and mild to moderate right-sided neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 3-year-old male with macrocephaly, speech delay, hypotonia; reported history of head injury in infancy and positive maternal syphilis. Assess myelination and reported history of cyst. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, including what may represent faint terminal zones of myelination in the parietal regions bilaterally. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The cranial vault appears to be larger than usual, consistent with the reported macrocephaly.

Output: No evidence of structural or myelination abnormalities. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right knee stiffness MENISCI: There is abnormal signal intensity and morphology of the posterior horn of the medial meniscus which extends into the body and is consistent with complex tearing. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of the articular cartilage of the weightbearing portion of the medial femoral condyle particularly posteriorly with areas of less severe diffuse loss. There is diffuse thinning of the articular cartilage of the lateral femoral condyle but without discrete full-thickness defect. There is severe articular cartilage loss of the patellofemoral compartment with areas of full-thickness loss particularly affecting the medial compartment. Areas of full-thickness degeneration are also evident within the femoral trochlea, particularly laterally. There are small tricompartmental osteophytes and associated degenerative marrow changes within the femoral condyles bilaterally. A 2 cm ovoid focus is identified within the intercondylar notch best seen on series 5 image 18 which may represent a displaced chondral fragment.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tearing of the medial meniscus.2. Tricompartmental osteoarthritis with areas of full-thickness articular cartilage loss affecting the medial and patellofemoral compartments. A 2 cm ovoid focus within the intercondylar notch may represent a displaced chondral fragment.3. Nonaggressive appearing chondroid lesion within the head of the fibula with possible adjacent ganglion cyst at the tibiofibular articulation.


Instruction: Generate impression based on findings.

Input: Pain in the right elbow. LIGAMENTS: Evaluation of the intrinsic ligaments of the elbow is limited on this non arthrogram study. The ulnar collateral ligament, lateral ulnar collateral ligament and radial collateral ligaments appear grossly intact.TENDONS: There is thickening and intermediate signal intensity within the common extensor tendon indicating moderate tendinosis. There is linear fluid signal intensity within the common extensor tendon at the level of its insertion indicating interstitial tearing. The common flexor tendon appears intact. The biceps and brachialis tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: The imaged musculature of the right elbow appears intact.ADDITIONAL

Output: 1. Moderate tendinosis of the common extensor tendon with interstitial tearing as described above.2. Small amount of nonspecific subcutaneous edema along the posterior aspect of the olecranon which may reflect an early olecranon bursitis.


Instruction: Generate impression based on findings.

Input: Brain MRI:There is a small oval nonenhancing peripherally FLAIR hyperintense appearing lesion in the anterior body the right lateral ventricle, best visualized on sagittal reformatted images, spanning the ventricular lumen at this level. The center of the finding is not clearly of CSF signal, appearing slightly greater than CSF on T1-weighted images. It measures up to 6 mm AP, with minimal adjacent marginal FLAIR hyperintensity along the ventricular margin itself, with slight distortion of the adjacent callosal margin.There are a few scattered foci of FLAIR hyperintensities in the periventricular and subcortical white matter, with slight interval increased conspicuity of the left superior anterior temporal lobe focus of abnormal signal. Again noted is a developmental venous anomaly in the right middle frontal gyrus. There is no evidence of acute infarct, hemorrhage, edema, midline shift, herniation, hydrocephalus or extra-axial fluid collection. Unchanged polypoid lesion within the right maxillary sinus, which likely represents a mucous retention cyst. T-spine MRI:Images are somewhat limited by patient motion. The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. There is diffuse heterogeneous appearance of the marrow signal which is nonspecific but may relate to patient's underlying malignancy. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. The counting survey image demonstrates mild mid to lower cervical spondylotic changes without high-grade stenosis.

Output: 1.No MR imaging abnormality involving the cerebellum.2.Scattered foci of FLAIR hyperintensities in the white matter which are nonspecific finding, with slight increased conspicuity in the left anterior temporal lobe. 3.Benign-appearing cystic lesion, perhaps subependymal in origin, along the anterior body the right lateral ventricle which is doubtful to be related to the patient's symptoms or underlying disease.4.Thoracic spine within normal limits.


Instruction: Generate impression based on findings.

Input: 39 year old female with proven right breast IDC grade 2 with DCIS, intermediate grade There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.In the right breast, a segmental non-mass enhancement is present at posterior 6:00 - 9:00 position, measuring 49 x 35 x 40 mm (AP x LR x CC). Within the non-mass enhancement, there are two clip artifacts from recent biopsy of malignant pathology, separating 22 mm, at the posterior-lateral aspect and middle-medial aspect. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Non-mass enhancement in the right 6:00 - 9:00 position corresponding to the known cancer.2. No MRI evidence of malignancy of left breast.3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 19 years, Female, with syncope and collapse along with dizziness. Vertiginous migraines with 3 episodes of loss of consciousness which are clinically concerning for seizure.. Evaluate for masses, vascular abnormalities, demyelinating lesions. Brain parenchyma is unremarkable for age. No parenchymal signal abnormality. No findings to suggest a seizure focus. Bilateral hippocampi appear unremarkable. 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. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is within normal limits. Specifically, no evidence of mass, demyelinating lesion, or seizures focus. Dedicated MR angiogram was not obtained however the vasculature also appears grossly unremarkable.


Instruction: Generate impression based on findings.

Input: Assess adrenal mass seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. No suspicious hepatic lesion is identified. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is normal in appearance. SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule measures 1.4 x 0.8 cm (series 10, image 28), with partial dropout consistent with fat, probable adenoma.KIDNEYS, URETERS: Right lower pole subcentimeter nodule, too small to characterize.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: Right adrenal lesion containing fat, probable adenoma.


Instruction: Generate impression based on findings.

Input: Left renal mass/cyst on prior abdominal CT. Evaluation is limited by lack of IV contrast.ABDOMEN:LUNGS BASES: Small pericardial effusion.LIVER, BILIARY TRACT: Diffusely low T2 signal throughout the liver is suggestive of iron deposition.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic kidneys. The 2.2 x 1.9 cm round lesion in the left kidney midpole is again seen. This lesion is hypointense to renal parenchyma on T2-weighted sequences and heterogeneously hypointense on T1-weighted sequences. No internal microscopic or macroscopic fat signal is evident.Right lower quadrant transplant kidney.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: 2.2 cm lesion in the left native kidney, which remains indeterminate in appearance. The mass does not definitely meet criteria for a hemorrhagic cyst, and biopsy is recommended to exclude renal cell carcinoma.


Instruction: Generate impression based on findings.

Input: 64 year old woman with CREST variant scleroderma and smoldering myeloma with evidence of left ventricular hypertrophy referred to evaluate for infiltrative heart disease. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The interventricular septum is mildly thickened (12mm). The overall LV ejection fraction is 68%, the LV end diastolic volume index is 104 ml/m2 (normal range: 65+/-11), the LVEDV is 171 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 55 ml (normal range 31+/-10), the LV mass index is 38 g/m2 (normal range 67+/-11), and the LV mass is 63 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native myocardial T1 relaxation time, extracellular volume fraction, global relative enhancement ratio, and T2-ratio are all within normal limits. Left AtriumThe left atrium is mildly dilated. The LA volume is 104 ml.Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 134 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is at least moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (36mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (27mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion (previously present but not mentioned).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. Moderate left ventricular dilation with normal systolic function (LVEF 68%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal right ventricular size and systolic function (RVEF 64%).3. Mild left atrial dilation.4. At least moderate aortic regurgitation.5. Mild pericardial effusion.6. Compared to the CMR study from 2/22/2011, the LV is now moderately dilated and there is more aortic regurgitation.


Instruction: Generate impression based on findings.

Input: History of triple negative left breast cancer status post neoadjuvant chemotherapy, breast conservation surgery (October 2013) and adjuvant radiation therapy. History of 2 benign left breast percutaneous biopsies. Known BRCA 2 mutation carrier. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Two stable lobulated masses are present in the left breast, compatible with biopsy proven fibroadenomata. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Arachnoid cyst fenestration followup. There are postoperative findings from prior suboccipital craniectomy for fenestration of an arachnoid cyst just superior to the cerebellar vermis. The lesion has increased in size, measuring up to 16 mm, previously 12 mm. There is associated mild mass effect on the tectum and superior cerebellum, without underlying signal abnormality. There is no restricted diffusion to suggest acute ischemia. There is no evidence of acute intracranial hemorrhage. The ventricles are within normal limits in size and configuration. There is no abnormal intracranial enhancement. The major flow-voids are preserved. There are mucosal retention cysts in the left maxillary sinus. The orbits, paranasal sinuses, calvarium, and overlying scalp are otherwise unremarkable.

Output: Interval increase in size of posterior fossa arachnoid cyst without evidence of complication.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: NMO flare: left eye pain, blurry vision. There is mild residual T2 hyperintensity throughout much of the left optic nerve, which now appears mildly atrophic. There may be mild enhancement versus artifact in the canalicular portion of the left optic nerve. There is also mild diffuse atrophy of the right optic nerve. Furthermore, the optic chiasm appears to be atrophic and displays high T2 signal. The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital mass lesions. The imaged portions of the brain parenchyma are unremarkable. There are small retention cysts in the bilateral maxillary sinuses and mild mucosal thickening in the ethmoid sinuses.

Output: 1. Sequela of prior optic neuritis involving the left optic nerve, with possible mild enhancement versus artifact in the canalicular portion of the left optic nerve. 2. Mild right optic nerve atrophy.


Instruction: Generate impression based on findings.

Input: HPV positive metastatic adenocarcinoma of the cervix, status post resection and currently on chemotherapy. Last dose of chemotherapy was July 1, 2015 (cycle 4). Interval development of nausea and vomiting. Evaluate for abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarction. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are patchy opacities within the mastoid air cells. The remaining visualized paranasal sinuses are unremarkable.

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


Instruction: Generate impression based on findings.

Input: Male 42 years old Reason: Small bowel thickening? Pancreas findings? History: Abdmominal pain, diarrhea, nausea, vomiting, episodic. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal T1 hyperintense signal and abnormal enhancement postcontrast.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel wall thickening and hyperenhancement. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel wall thickening and hyperenhancement. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of bowel wall thickening or other findings to suggest active inflammation. 2.Unremarkable appearance of the pancreas. No specific findings to explain patient's symptoms.


Instruction: Generate impression based on findings.

Input: Clinical question: 73-year-old female with memory loss in the last 6 months. History of hypertension, diabetes, intubation in fall. Evaluate for CVA, mass or others. Signs and symptoms: Memory loss. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted images.Examination demonstrates few tiny foci of FLAIR hyperintensity only in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Findings are nonspecific and demonstrate no evidence of hemorrhagic changes or abnormal enhancement. Considering patient's age findings likely representing chronic minimal microvascular ischemic changes.There is slight prominence of cortical sulci and mild prominence of lateral ventricles which could still be within normal range for patient's stated age of 73. The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are within normal angles with normal pattern of enhancement.Post enhanced images demonstrate no detectable abnormal parenchymal, meningeal or calvarial enhancement.Paranasal sinuses demonstrate partial opacification of left frontal sinus with mucosal enhancement suggestive of sinus disease. The rest of paranasal sinuses and bilateral mastoid air cells are unremarkable.

Output: 1.No acute intracranial process and negative diffusion-weighted images.2.Few tiny foci of FLAIR hyperintensity only in the subcortical and periventricular white matter could represent minute chronic small vessel ischemic strokes.3.Mild prominence of cerebral cortical sulci and supratentorial ventricular system which could be still within normal for patient's stated age of 73.4.No abnormal parenchymal, leptomeningeal or calvarial/retro-orbital enhancement.


Instruction: Generate impression based on findings.

Input: The previous large left-sided retroperitoneal mass has markedly decreased in size and the intraspinal portion is no longer apparent. The residual tissue centered along the left anterolateral aspect of the L1-L2 disc space measures approximately 11 x 12 mm, previously approximately 34 x 49 mm. There is small focus of enhancement and T2 hyperintensity within the central T12 vertebral body compatible with basivertebral venous plexus. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is diffuse loss of normal bone marrow signal intensity most compatible with treatment effect and conversion to red marrow. The imaged spinal cord displays normal signal and morphology and the conus terminates at L1-L2. The left-sided hydronephrosis is no longer apparent and the partially imaged hepatic lesions have decreased in number.

Output: 1.Marked treatment response with decrease in size of the retroperitoneal mass and resolution of the intraspinal portion.2.Apparent resolution of the left-sided hydronephrosis and improvement in the partially imaged hepatic lesions.3.Diffuse bone marrow treatment response with conversion to red marrow.


Instruction: Generate impression based on findings.

Input: 39-year-old female with persistent pain status post sprain TENDONS: There is perhaps mild tendinosis of the peroneus brevis as it courses below the fibular tip, although this is equivocal. Otherwise the peroneus tendons are intact. The tendons of the achilles, tibialis posterior, flexor digitorum longus, flexor hallucis longus, tibialis anterior, extensor hallucis longus, and extensor digitorum longus are grossly intact. LIGAMENTS: A marker was placed along the lateral aspect of the ankle. The anterior talofibular ligament is thickened and poorly defined compatible with prior tear. Its attachment to the talus is also poorly defined. The calcaneofibular ligament is also thickened indicating a sprain. The posterior talofibular ligament is grossly intact. The distal tibiofibular ligament complex is grossly intact. The deep fibers of the deltoid ligament have lost some of their normal striations suggesting prior sprain. ARTICULAR SURFACES AND BONE: Small amount of fluid in the tibiotalar joint which is probably within normal limits. We see no osteochondral defect. Small amount of fluid within the recesses of the subtalar joint is also within normal limits. Tiny osteophytes at the talonavicular joint suggesting mild osteoarthritis.

Output: Findings compatible with prior tear of the anterior talofibular ligament and sprain of the calcaneofibular ligament.


Instruction: Generate impression based on findings.

Input: 48-year-old female patient with history of left breast invasive ductal carcinoma in 2013 status post left mastectomy and reconstruction. Patient received radiation, chemotherapy, and hormonal therapy. Status post left mastectomy and reconstruction. There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast. Multiple subcentimeter cysts in the right breast are smaller compared to the prior study.No abnormal enhancement is seen in right breast and left reconstructed breast . Normal morphology lymph nodes are noted in the right axilla.There is a stable subcentimeter cyst in the liver. An additional region of T2 hyperintensity overlying the hepatic dome may represent fluid.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Back pain, bowel incontinence. There is no evidence of spinal cord compression.Cervical, thoracic and lumbar spinal cord signal intensity appear to be normal.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of T12.

Output: No evidence of abnormal signal intensity of spinal cord.No evidence of spinal cord compression


Instruction: Generate impression based on findings.

Input: Female 72 years old with nonalcoholic steatohepatitis, cirrhosis and ascites. Hepatocellular carcinoma surveillance. Hepatocellular carcinoma surveillance. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour with widened fissures and a moderate amount of upper abdominal ascites. No focal liver lesion. The vasculature is patent.The common bile duct is dilated up to 17 mm in diameter and tapers distally similar to improved compared to the prior ultrasound. There is mild intrahepatic biliary ductal dilatation. No biliary stone is identified. These findings are likely due in part to combination of post cholecystectomy state and age related ectasia.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with moderate ascites. No focal liver lesion.2.Interval improvement in mild intra and extrahepatic biliary dilatation without evidence of obstructing stone. Findings are likely related to age-related ectasia and postcholecystectomy change.


Instruction: Generate impression based on findings.

Input: Evaluate for change in mass, edema. Posterior fossa meningioma which worsening drowsiness and headaches. No evidence of intracranial bleed. Again seen is a left-sided posterior fossa lesion exerting mass effect upon the left cerebellar hemisphere with effacement of the extra-axial space and fissure. It is not as well bowel weighted on the noncontrast CT as in recent contrast-enhanced brain MRI. No hydrocephalus. There is minimal mass effect upon the fourth ventricle. The supratentorial compartment demonstrates stable appearance with no evidence of intracranial bleed, stable mild to moderate diffuse bilateral periventricular and subcortical white matter hypodensities.

Output: No interval change in the appearance of the head CT when compared to 12/31 2008. The evaluation of the posterior fossa meningioma is not well achieved by this noncontrast CT alone. A more adequate/accurate evaluation can be achieved with an MRI of the brain with contrast, if clinically indicated. There is no evidence of intracranial bleed or hydrocephalus.


Instruction: Generate impression based on findings.

Input: 33 years Female (DOB: 3/11/1982)Reason: Right side numbness History: AbovePROVIDER NAME: THOMAS J. KELLY THOMAS J. KELLY MRI brain: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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There are right sided uncovertebral osteophytes at this level associated with disk material resulting in some mild encroachment of right sided exiting nerve roots. There are smaller left sided uncovertebral osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal. There are right sided uncovertebral osteophytes at this level associated with disk material resulting in some mild encroachment of right sided exiting nerve roots. There are smaller left sided uncovertebral osteophytes at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: 1.There are degenerative changes in the cervical spine with some encroachment of right sided exiting nerve roots at C4-5 and C5-6.2.There is no evidence for intracranial, cervical or thoracic spine mass lesion.3.There is no evidence for cerebral or spinal cord demyelinating lesion.


Instruction: Generate impression based on findings.

Input: 41-year-old female with Chiari malformation, decompressed, experiencing headache for one month with neck pain. Brain: Redemonstrated are stable postoperative findings related to Chiari decompression. There is persistent prominence of the retrocerebellar cerebrospinal fluid space. Redemonstrated is biphasic cerebrospinal fluid flow at the level of the cerebellar tonsils, unchanged in extent. As before, there are multiple cerebral white matter T2 hyperintense lesions, primarily in a periventricular distribution, without new lesions identified. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. Paranasal sinus mucosal thickening has improved.Cervical Spine: Redemonstrated are numerous patchy as well as more focal areas of T2 hyperintensity in the cervical and imaged portions of the upper thoracic spinal cord, stable in appearance, without new lesions identified. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is unchanged multilevel degenerative cervical spondylosis, but no significant spinal canal stenosis, stable in appearance. The paravertebral soft tissues are unremarkable.

Output: 1. Stable postoperative findings related to Chiari decompression.2. Numerous stable intracranial and upper spinal cord white matter lesions likely represent multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 56-year-old female with bilateral breast cancers just diagnosed: right sided mass at 10:00 position, (Grade II IDC, ER-, PR-, Her2-, Ki67 40-50%, in the setting of DCIS, coil clip placed), as well as the left breast upper inner quadrant calcifications (Grade I IDC). There is a heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The enhancing mass and associated clip artifact in the right breast at the 10:00 position, posterior depth, has now nearly completely resolved, now measuring 5 x 6 x 7 mm (AP X ML X CC), previously 24 x 14 x 15. The second lesion of non mass enhancement anteromedial to this mass at the 2:00 position has also decreased in size, now measuring 9 x 7 x 16 mm (AP X ML X CC), previously 19 x 15 x 22 mm.The previously identified left breast mass at the 9:00 position now measures 9 x 10 x 9 mm (AP X ML X CC), previously 14 x 12 x 18 mm. There is persistent but improved posterior, inferior, and slight anterior nonmass enhancement, the total extent of which measures approximately 31 x 19 x 14 mm (AP X ML X CC), previously 47 x 16 x 30 mm.Multiple subcentimeter nonenhancing cysts are noted in the right breast.No internal mammary lymphadenopathy is noted. Stable benign-appearing axillary lymph nodes are present bilaterally.

Output: 1.Near complete resolution of the right posterior breast mass.2.Moderate decrease in size of the left breast mass and anterior right breast lesion, as well as the associated nonmass enhancement.3.No significant axillary lymphadenopathy is evident.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: spinal stenosis History: pain and weakness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation and a disk bulge present at this level. There is loss of disk space height. There is ligamentum flavum hypertrophy and facet hypertrophy at this level there at the lateral recess and is is not effaced. There is mild narrowing of the neural foramina with mild encroachment of the exiting nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some ligamentum flavum hypertrophy associated with some mild facet hypertrophy. There is mild disk desiccation present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Incidental note is made of gallstones in the gallbladder

Output: 1.There are degenerative changes present in the lower lumbar spine without significant compromise to lumbar spinal canal or neural foramina.2.Gallstones


Instruction: Generate impression based on findings.

Input: 78-year-old male with history of muscle invasive bladder cancer status post cystectomy. Patient presents for routine surveillance. ABDOMEN:LIVER, BILIARY TRACT: Punctate left hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: Stable 5 mm cystic focus at the junction of pancreatic head/uncinate process compatible with sidebranch IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right nephrectomy. No suspicious left renal lesion. Stable left T1 hyperintense nonenhancing lesions compatible with a proteinaceous/hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left-sided ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality.

Output: Stable examination with postoperative changes without evidence for recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Female 46 years old with a diagnosis of cervical cancer. Evaluate lymph node involvement. History: post coital bleeding, + colonoscopy. PELVIS:UTERUS, ADNEXA: A large, heterogenously enhancing mass within the cervix measures 3.1 x 1.6 cm (series 501, image 36). The mass extends into the internal os as well as the anterior fornix. The posterior fornix is involved to a lesser degree. Parametrial extension is seen anterolaterally on the left (series 501, image 35) and possibly on the right.There is a well defined, bulging myometrial mass on the right which is not contiguous with the cervical mass. It is isointense to muscle on T1 and intermediate intensity in T2-weighted images. BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No hydroureter.

Output: 1.3.1 x 1.6 cm cervical mass with parametrial invasion on the left and possibly on the right.2.Given that the right myometrial lesion is not contiguous with the cervical mass it more likely represents a degenerating fibroid however, myometrial invasion cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: Right sciatic pain s/p L4-5 transforaminal lumbar interbody fusion and facetectomy and laminotomy for lumbar radiculopathy and synovial cyst on 7/7/15. There are interval postoperative findings related to posterior spinal fusion at L4 and L5 level with intervertebral spacer, with decreased right spinal canal stenosis, but persistent left lateral recess narrowing at this level. There is confluent low T1 and T2 signal material along the right surgical approach, extending into the right lateral recess and medial aspect of the neural foramen at L4-5. This tissue appears to impinge upon the exiting nerve roots. The more lateral aspect of the right neural foramen appears wider than before. Likewise, there is decreased left L4-5 neural foraminal narrowing. Bilateral L3-4 and L5-S1 neural foraminal and L5-S1 spinal canal stenoses are not significantly changed. Furthermore, mild degenerative spondylosis at L1 through L3 is unchanged. The alignment is unchanged. The vertebral body heights are maintained. The conus is normal in signal and morphology and terminates at an appropriate level. There is fatty atrophy of the paraspinal muscles.

Output: Interval postoperative findings related to posterior spinal fusion at L4 and L5 level with intervertebral spacer, with decreased right spinal canal stenosis, but persistent left lateral recess narrowing at this level. Confluent low T1 and T2 signal material along the right surgical approach, extending into the right lateral recess and medial aspect of the neural foramen at L4-5 may represent scar tissue, but is incompletely characterized without contrast. Nevertheless, this tissue appears to impinge upon the exiting nerve roots. Otherwise, the more lateral aspect of the right neural foramen appears wider than before. Likewise, there is decreased left L4-5 neural foraminal narrowing. Bilateral L3-4 and L5-S1 neural foraminal and L5-S1 spinal canal stenoses are not significantly changed. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Meningioma: headaches. There is a smoothly contoured T2 hyperintense avidly enhancing mass in the right cavernous sinus that measures up to approximately 15 mm and partially encircles the cavernous right internal carotid artery. The pituitary gland and infundibulum are intact. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings suggestive of a right cavernous sinus hemangioma versus less likely a meningioma.


Instruction: Generate impression based on findings.

Input: Age: 83 yearsSex: MaleReason for study: Evaluation for abdominal aortic aneurysm. Follow-up examination.IMAGE ACQUISITION:Transverse and longitudinal grayscale and color sonographic evaluation of the abdominal aorta was performed. Measurements as follows with AP dimension given first:Proximal aorta: 3.4 x 3.4 x 3.3 cmMid aorta: 3.2 x 4 x 2.6 cmDistal aorta: 2.5 x 2.8 x 2.2 cmRight common iliac artery: 1.3 cmLeft common iliac artery: 1.4 cmColor Doppler and spectral analysis are within normal limits with normal waveforms.

Output: Although today's measurements differ from the 2014 exam, there was under-measurement at that time. However, measurements are virtually unchanged from 5/11/2012 exam demonstrating stability.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are prominent, consistent with mild age-related volume loss, commensurate with age. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild, right greater than left, opacification of the mastoid air cells.

Output: No evidence of acute infarct. Moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 44-year-old female with osteomyelitis presents with fever and discharge. Evaluate for osteomyelitis extension. Again seen is T1 and T2 prolongation involving the left ischium consistent with the history of osteomyelitis, appearing increased when compared to the prior study. There is soft tissue irregularity/ulceration along the posterior aspect of the left hemipelvis which extends to the level of the left inferior pubic ramus overlying the aforementioned area of bone marrow signal abnormality. There is extensive increased signal abnormality on fluid sensitive sequences in the surrounding soft tissue, consistent with inflammatory changes, which extend to the level of the posterolateral aspect of the anus and a enterocutaneous fistula cannot be completely excluded. No focal fluid collection is identified to suggest abscess formation. There is linear increased signal abnormality traversing the left inferior pubic ramus suspicious for a nondisplaced stress fracture. There is mild periosteal reaction in the surrounding area. There is nonspecific subcutaneous edema type signal abnormality involving the left mons pubis, left perineum, left anterolateral thigh and right lateral thigh. There is diffuse fatty atrophy of the musculature of the hips. Again seen are changes consistent with bilateral hip dysplasia with deformity of both femoral heads and the acetabuli. There is a nonspecific lobulated focus of fluid signal intensity along the anterior aspect of the sacrum which may represent inflammatory or postsurgical change, appearing similar to the prior studies. Again seen is a posterior myelomeningocele. Foley catheter in place.

Output: Slight interval increase in findings consistent with acute on chronic osteomyelitis involving the left ischium. Probable nondisplaced stress fracture of the left inferior pubic ramus. No drainable fluid collection is identified. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 18-year-old man with history of metastatic lung cancer. No substantial change in right paramediastinal and parahilar fibrosis consistent with radiation changes. No new pulmonary nodules, masses, or consolidation.Small apparent focus of restricted diffusion noted in the posterior aspect of the focal area of right paramediastinal radiation fibrosis in the right upper lobe (image 480 of the B800 images, series 1006).Please see same-day MRI abdomen dictation for pertinent findings in the abdomen.

Output: No substantial change in right paramediastinal and parahilar fibrosis.Nonspecific small apparent focus of restricted diffusion in the posterior aspect of the focal area of right paramediastinal radiation fibrosis in the right upper lobe. MRI follow-up in 3 months is suggested to reassess this area.


Instruction: Generate impression based on findings.

Input: Status post prostatectomy with rising PSA. Evaluate lymph node status and assess for local recurrence. Per Epic: Adenocarcinoma of the prostate, preop PSA 20.2, s/p radical prostatectomy in 4/2015, pT3bN0, Gleason 4+5, positive surgical margin with detectable post-operative PSA, maximum 0.21. PELVIS:PROSTATE:Prostate Size: Surgically removed.There is no enhancing soft tissue or nodularity within the resection bed.Seminal Vesicles: Surgically removed.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy identified.BONES, SOFT TISSUES: Left hip arthroplasty results in artifact along the left pelvic sidewall, limiting evaluation.OTHER: No significant abnormality noted.

Output: Status post prostatectomy, with no evidence of recurrence.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with pure sensory syndrome. Evaluate for cord mass. Thoracic:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Signal related to a benign hemangioma or focal fat is seen in the T3 vertebral body. Otherwise, vertebral body signal characteristics are within normal limits. The visualized spinal cord shows normal signal intensity and morphology throughout. However, prominent vascularity is seen along the surface of the conus and there is enhancement of the cauda equina nerve roots. A small central disc protrusion is present at T8-9 but this causes no significant spinal canal or foraminal compromise. Elsewhere, the intervertebral discs are preserved.Lumbar:As above, the nerve roots of the cauda equina demonstrate diffuse subtle enhancement. They do not appear to be thickened or clumped. No epidural abnormalities are suspected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement are seen. Minimal disc bulging is present at L4-5 and L5-S1. No significant spinal canal or foraminal compromise is detected.

Output: Diffuse enhancement of the cauda equina nerve roots is seen. The differential diagnosis is broad and would include infectious or postinfectious/autoimmune phenomenon, as well as nonimmune demyelinating syndromes. Certain collagen vascular disorders such as lupus can also produce similar findings. Although leptomeningeal metastatic disease would technically be in the differential as well, this is considered less likely, particularly if there is no known primary cancer history.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with history of metastatic thyroid cancer. Evaluate for treatment. Brain:No evidence of mass, mass effect, edema, or pathologic enhancement is seen to suggest intracranial metastatic disease.Diffusion-weighted images are unremarkable. Brain parenchymal morphology is within normal limits. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is detected. Ventricles are normal in size and morphology.Neck:Thyroid tissue is not clearly recognized compatible with thyroidectomy. No obvious tumor like lesions are seen within the thyroid bed.T2 hyperintensity and enhancement are seen within the proximal right clavicle, the right aspect of the manubrium and in the surrounding soft tissues. A prominent sternomanubrial joint effusion is also seen.No definite pathologic adenopathy is seen in the neck. The salivary glands are unremarkable. Note is made of medialization of the vocal folds on the right which may reflect dysfunction of the recurrent laryngeal nerve.Multiple marrow replacing lesions are demonstrated within the visualized spine including C6, C7 and T2.Brachial plexus:The nerves of the brachial plexus demonstrate normal morphology and course. No evidence of thickening, pathologic enhancement or impingement is seen.Note is made of atrophy and mild T2 signal abnormality affecting the right trapezius muscle which may reflect a denervation effect. Degenerative joint disease is also seen at the right acromioclavicular joint.

Output: 1.Unremarkable evaluation of the brain with no evidence of metastatic disease.2.Evidence of thyroidectomy in the neck with no definite tumor like lesions in the thyroid bed or pathologic adenopathy in the neck. Findings are seen suggestive of right recurrent laryngeal nerve dysfunction.3.Marrow edema and enhancement affects the proximal right clavicle and the right aspect of the manubrium. This region is hypermetabolic on a recent PET scan, the CT portion of which also demonstrates some mild associated bony erosion. Findings are concerning for a site of metastatic disease, though an inflammatory process or severe osteoarthritic degeneration can also be considered.4.Multiple metastatic lesions are suspected within the cervical vertebrae as above.5.No specific abnormalities of the brachial plexi are suspected. Note is made of atrophy and abnormal signal affecting the right trapezius muscle which may represent an effect of denervation.


Instruction: Generate impression based on findings.

Input: Reason: eval for labral tear History: shoulder pain for 10 months posterior and football injury ROTATOR CUFF: Intermediate signal within the distal aspect of the supraspinatus tendon suggests tendinopathy. The remainder of the musculature and tendons of the rotator cuff are within normal limits. There is no communication with the subacromial-subdeltoid bursa to suggest rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Contrast is seen extending into the superior labrum, likely representing a superior labral anterior posterior tear (series 2, image 13).BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Contrast extends into the superior labrum, consistent with a SLAP tear.2.Intermediate signal intensity in the supraspinatus tendon likely reflects tendinopathy. No rotator cuff tear is identified.


Instruction: Generate impression based on findings.

Input: Low back pain and fever. History of endocarditis. The study is limited by patient motion, at least moderately.Sagittal alignment is notable for 7 mm of anterior subluxation of L5 relative to S1, likely spondylolytic and degenerative. There is moderate-to-severe lumbar disc height loss, sparing L1-L2. There is T2-hyperintensity in the L4-L5 disc and to a lesser extent L5-S1, while the other discs show desiccation. There is also abnormal signal in the posterior aspect of L5 vertebral body associated suggestion of erosion of the posterior cortex and possibly mild posterior height loss (versus physiologic wedging). Milder marrow edema is also present in the posterior part of L4 vertebral body and perhaps L3 as well. There is inflammatory change in the adjacent anterior epidural fat and the L3-L4, L4-L5 and L5-S1 neural foramina bilaterally. There is an abnormal anterior epidural fluid collection with rim enhancement that extends from the upper L3 level to the second sacral segment level. The collection is largest at the mid L4 level, where it has an anterior-posterior diameter of 1.3 cm and does posteriorly displace and severely compress the thecal sac. It measures in transverse 2 cm. There is inflammatory change also in the paraspinal soft tissues including the medial aspect of the left iliacus and psoas muscles. This is most pronounced at L5 level, where there multiple small fluid locules medial to the psoas muscle. The largest discrete locule measures up to 2 cm.Faint contrast enhancement within the thecal sac extending from mid L2 through mid S1 level may relate to venous congestion from the severe spinal canal stenosis or may reflect associated arachnoiditis. This is associated with circumferential tumoral contrast enhancement and thickening that is most pronounced at L5 and S1 levels.L1-L2: No spinal canal or neural foraminal stenosis.L2-L3: Disc bulge and mild ligamentum flavum thickening and facet arthropathy cause moderate spinal canal and bilateral neuroforaminal stenoses.L3-S1: Severe thecal sac compression by the epidural abscess. The neural foramina are involved by the inflammatory.

Output: 1.Limited examination, because of patient motion.2.Osteomyelitis involving L5 vertebral body and perhaps L4 and L3 vertebral bodies in addition to discitis involving L4-L5 and perhaps L5-S1 discs. Relatively large epidural abscess extending from L3 through S2 level which severely compresses the thecal sac and involve the respective neural foramina bilaterally.3.There is also paravertebral soft tissue involvement with small left paraspinal abscesses at L5 level.4.Associated intrathecal contrast enhancement may reflect reaction to the epidural inflammatory process and the severe canal stenosis or may represent associated arachnoiditis.Dr. Monther Qandeel discussed the above findings and recommendations with Neuro ICU Fellow Dr. Mojumder over the phone on 3/4/2016 11:42 AM. The epidural abscess has significantly increased in size compared to the limited noncontrast-enhanced lumbar spine MRI from Methodist SouthLake dated February 29, 2016 and March 1, 2016 and CT scan from February 28, 2016. Then, the collection was limited to the L4 level and caused only mild-to-moderate mass-effect on the thecal sac. The osseous and paravertebral soft tissue abnormalities were also less pronounced.


Instruction: Generate impression based on findings.

Input: Back pain. History of breast carcinoma. Lytic lesions in the vertebral body of L1 levels are seen, correlating with abnormalities seen on prior MRI. The lesion at L1 involves both anterior and posterior elements. There is pathological fracture of L1, with retropulsion and epidural mass causing spinal canal stenosis. These findings are better seen on the prior MRI study. In addition, there are also lytic lesions involving the right transverse process, pedicle and facet of L4, extending into the right neural foramen. There are multiple lesions in bilateral iliac bones.There is no evidence of kyphoplasty changes in the lumbar spine. The uterus appears bulky, with calcifications.There is a 4 mm hypodense lesion at the inferior pole of the left kidney, too small to categorize.

Output: 1. Lytic lesions in multiple vertebral levels and pelvis, consistent with metastasis. Pathological fracture of L1 with epidural mass, causing compromise of the spinal canal.2. Bulky uterus with calcifications, which may be secondary to fibroids. Please correlate with pelvic ultrasound if clinically indicated.3. Small hyperdense left renal lesion, too small to characterize. This may represent a small hyperdense cyst, and can correlated with ultrasound.


Instruction: Generate impression based on findings.

Input: Reason: neurofibromas History: pain There is straightening of cervical lordosis, which may be related to patient positioning. No evidence of subluxation. The marrow signal is benign. Vertebral body heights are maintained. There is redemonstration of fragmented minimally expansile syrinx extending from C4 level to C6/7 level appearing grossly stable from prior study. At its largest diameter of the cavity measures 3 mm. The surrounding spinal cord signal is unremarkable. No intraspinal hematoma or mass. The visualized paraspinal contents are unremarkable. Chiari malformation is partially seen. Major cervical vasculatures with normal flow voids. The intervertebral disk spaces show preservation of height with mild disk desiccation. There may be very small central disk-osteophyte complexes at C3-4 and C4-5. No evidence of significant spinal stenosis is seen. There is a small nodule in the right posterior subcutaneous tissue.

Output: 1.Fragmented cervical cord syrinx extending from approximately the mid C4 vertebral body to the C6-7 disk space and measuring at most 3 mm in diameter appearing similar to prior study.2. Mild degenerative disk disease with no evidence of significant spinal stenosis or foraminal narrowing.3.Borderline low lying cerebellar tonsil is partially seen.


Instruction: Generate impression based on findings.

Input: MRI Brain:There are multifocal small areas of restricted diffusion involving the bilateral right greater than left medial cerebellar hemispheres, left temporal lobe and right middle frontal lobe compatible with acute infarcts. There is no focal mass effect, hydrocephalus midline shift or herniation. Note that hemorrhage cannot be evaluated for on this exam. RIght frontal sinus mucosal thickening and partial opacification of the sphenoid sinuses.MRA Brain: Motion degradation limits full evaluation, especially involving the circle of Willis. Within these limitations, there is no gross stenosis involving the proximal ICA, MCA or ACA branches. There is the appearance of a focal stenosis involving the proximal left P2 segment. The vertebral arteries, basilar artery and right PCA are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: Only axial DWI and sagittal T1 sequences were obtained involving the brain MRI. Despite this limitation, multiple acute infarcts are seen involving the bilateral medial inferior cerebellar hemispheres, left temporal lobe and right middle frontal gyrus. There is no focal mass effect, hydrocephalus midline shift or herniation. Note that hemorrhage cannot be assessed on this exam.Limited MRA evaluation of the brain vasculature given extensive motion especially through the circle of Willis. Within these limitations there is the appearance of a focal stenosis involving the proximal left P2 segment. The remainder of the intracranial vasculature is grossly without significant flow limiting stenosis.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with left lower extremity weakness and diplopia. Brain: There are unchanged extensive supratentorial and infratentorial high T2 signal cerebral white matter lesions without definite associated enhancement. Many of there demonstrate low T1 signal. There are multiple punctate foci of susceptibility effect in the bilateral deep grey matter, brainstem, cerebellum that likely represent chronic microhemorrhage. There is no evidence of intracranial mass or acute infarct. The major intracranial flow voids are grossly intact. There is a left maxillary sinus retention cyst. The extracranial structures are otherwise unremarkable.

Output: 1. No significant interval change in the extensive supratentorial and infratentorial demyelinating lesions and no evidence of acute infarction.2. Multiple punctate foci of susceptibility effect in the bilateral deep grey matter, brainstem, cerebellum that likely represent chronic hypertensive microhemorrhage.


Instruction: Generate impression based on findings.

Input: 76-year-old woman with INR greater than 15.2 who presents status post fall. There is no evidence of intracranial hemorrhage or mass. Old left occipital and left cerebellar strokes with relative sparing of the medial temporal lobe. Ex vacuo dilatation of the ventricles consistent with ischemic volume loss. No cortical stroke. Extensive small vessel disease anteriorly, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic ischemic changes as described above. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Ms. Byars is a 59-year-old female with recently diagnosed node positive right breast cancer, with recent CT chest abdomen pelvis with concerning lymph nodes, presenting for MRI to assess extent of disease as well as assess contralateral breast. There is scattered fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, at the 12:30 position, is an irregular, spiculated mass with heterogeneous enhancement (with clip artifact within it), measuring 2 x 2 x 1.4 cm (AP by transverse by CC), corresponding to patient's known high-grade invasive ductal carcinoma. Multiple additional masses extend laterally, superiorly, and posteriorly to this index lesion, with additional surrounding areas of nonmass enhancement.In the lateral right breast, at the 10:00 position (with adjacent clip artifact) is an area of nonmass enhancement with multiple adjacent enhancing foci, measuring 6.3 x 1.9 x 2.6 cm (AP by transverse by CC), corresponding to area of known ductal carcinoma in situ. There is a small associated hematoma/seroma at the site of stereotactic biopsy, which measures 2.0 x 1.1 cm.In total, the area of mass and nonmass enhancement extends from roughly the 10:00 to 2:00 position in the right breast, measuring 13.8 x 10.0 x 7.3 cm (AP by transverse by CC), and extending to the nipple.There are a total of 4 enlarged right axillary lymph nodes, the largest of which contains a biopsy clip, and measures 18 x 15 mm; these nodes demonstrate hypermetabolic activity on recent PET/CT.An enlarged right intramammary lymph node is also identified, which measures 1.9 x 1.1 cm, which also demonstrated hypermetabolic activity on recent PET/CT.There is no suspicious enhancing foci in the left breast. There are mildly prominent left axillary lymph nodes, which retain their normal architecture and fatty hila.

Output: 1.Extensive mass and nonmass enhancement in the right breast, corresponding to known right breast malignancy, with enlarged right axillary and right intramammary lymph nodes, as described above.2.No abnormal enhancement in the left breast or left axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain. Signs and symptoms: No back pain. Nonenhanced lumbar MRI:Lower most visualized thoracic spine and thoracic cord from T10 inferiorly are unremarkable.Examination demonstrates extensive degenerative disc disease throughout the lumbar spine.T12-L1 demonstrate moderate disc disease and loss of disc height and mild hypertrophic changes of posterior elements without spinal stenosis or neural foraminal compromise.L1-L2 advanced disc disease and loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or significant neural foraminal compromise.L2-L3 demonstrates advanced disc disease and loss of disc height, moderate left and mild right facet and ligamentum flavum hypertrophy changes is present. Constellation of findings results in mild central spinal stenosis with moderate bilateral (L>R) neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, significant asymmetric left-sided facet hypertrophy changes and mild right facet and ligamentum flavum hypertrophy. Constellation of changes results in mild to moderate central spinal stenosis with significant left and moderate right neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, significant asymmetric right-sided ligamentum flavum and facet hypertrophy and to a lesser degree on the left. Constellation of changes results in significant bilateral neural foraminal and right lateral recess compromise with mild central spinal stenosis.L5-S1 demonstrate evidence of bilateral pars defect, mild grade 1 anterolisthesis, significant bilateral neural foraminal compromise and no central spinal stenosis.No detectable paraspinal soft tissue abnormalities.

Output: 1.L5-S1 demonstrate extensive degenerative changes, bilateral pars defect, mild grade 1 anterolisthesis, significant bilateral neural foraminal compromise without spinal stenosis.2.Extensive degenerative changes at L2-L3, L3-L4 and L4-L5 levels with resultant multilevel mild central spinal stenosis as detailed.3.Degenerative changes also results in bilateral neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Pain. Carpal abutment with possible TFCC tear. LIGAMENTS: The lunotriquetral and scapholunate ligaments appear intact. No contrast is noted within the midcarpal joint space.TRIANGULAR FIBROCARTILAGE COMPLEX: There is mild intermediate signal intensity within the ulnar fibers and lamina of the articular disc of the triangular fibrocartilage which may reflect focal degeneration or synovitis, but this is equivocal, and I see no gadolinium traversing the disc to indicate a tear. No gadolinium is noted within the distal radioulnar joint. Gadolinium does extend from the radiocarpal joint proximally along the medial aspect of the distal ulna volar to the extensor carpi ulnaris tendon, which could represent disruption of the medial capsular structures, but the clinical significance of this finding is uncertain.TENDONS: There is a longitudinal split of the extensor carpi ulnaris tendon distal to the ulnar styloid. The tendon otherwise appears normal, without fluid in the sheath, and hence this may represent a normal variant. The remaining tendons appear normal. BONES: The bones of the wrist appear normal.

Output: Possible mild focal degeneration/synovitis of the ulnar fibers and lamina of the articular disc of the triangular fibrocartilage, but this is equivocal and no fluid-filled tear is evident. Gadolinium extending from the radiocarpal joint proximally along the medial aspect of the ulna could represent a defect in the medial capsular structures, but is of uncertain clinical significance.


Instruction: Generate impression based on findings.

Input: Female 34 years old; Reason: Right foot pain and swelling. There is a small ossicle dorsal to the talonavicular joint that may represent old trauma. There is a small posterior calcaneal spur. There is mild anterior ankle soft tissue swelling.

Output: Mild anterior ankle soft tissue swelling and other findings as above. We see no acute fracture.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: Radiosurgery planning History: radiosurgery planning single brain met 77 years Male (DOB:5/12/1939)Reason: Radiosurgery planning History: radiosurgery planning single brain metPROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA There is about 9 mm sized ring-enhancing nodule on the left post central gyrus with surrounding edema. Comparing to prior scan, the lesion is more conspicuous but the size appears to be unchanged. The conspicuity of the lesion is more likely related to different machine magnet strength.There is no evidence of new abnormal enhancing lesion on the scan.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: Unchanged left postcentral gyrus rim-enhancing lesion since prior scan in terms of size and signal characteristics.


Instruction: Generate impression based on findings.

Input: Reason: evaluate left renal mass History: hx of oncocytoma left kidney sp partial nephrectomy, now with new left renal mass. 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: Postsurgical changes of the left lower pole partial nephrectomy. In the upper pole, previously seen cystic lesion with central solid component measures 1.6 x 1.1 x 1.7 cm (series 701 image 27, series 601 image 18), previously 1.7 x 2.5 x 1.6 cm. The cystic component is no longer visualized with new peripheral T1 hyperintense signal compatible with hemorrhage. There is segmental inversion with centrally arterial enhancement and delayed peripheral enhancement. Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Solid enhancing left upper pole renal neoplasm with hemorrhage.


Instruction: Generate impression based on findings.

Input: There is no diffusion abnormality to suspect acute stroke. There is a small area of encephalomalacia in the posterior right cingulate gyrus with punctate foci of susceptibility artifact, perhaps related to prior ischemia or trauma. There are bilateral, scattered areas of subcortical white matter T2 signal hyperintensity. The ventricles and sulci are normal in size and configuration. Parenchymal volume appears normal. There are no abnormal foci of enhancement. The major intracranial vascular structures enhance normally. There is no midline shift or mass effect.

Output: 1.Moderate scattered white matter signal abnormality suggestive of small vessel ischemic disease.2.No evidence of acute ischemic infarct, hemorrhage, mass, or degenerative process.


Instruction: Generate impression based on findings.

Input: 26-year-old female with right knee pain after traumatic injury during soccer now with lateral knee pain, instability, buckling and pain on McMurray's MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Nondisplaced fracture along the proximal lateral tibial metaphysis with surrounding bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Nondisplaced fracture along the proximal lateral tibial metaphysis.


Instruction: Generate impression based on findings.

Input: Abdominal pain. Evaluate for pseudocyst or chronic pancreatitis. Pancreatic head biopsy 10/2/2015 without malignancy identified. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 20 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation. Normally distended gallbladder without gallstones or inflammation.The vessels are patent. No suspicious liver lesion.SPLEEN: The spleen is normal in size.PANCREAS: Adjacent to the right anterolateral aspect of the pancreatic head abutting the adjacent duodenum/gastric pylorus there is a region of heterogeneous low T1 weighted signal intensity with mild postcontrast predominately peripheral enhancement and central T2-weighted intermediate hyperintensity. There is no associated pancreatic ductal dilatation or significant parenchymal atrophy. There is no discrete restricted diffusion. The degree of peri-pancreatic inflammatory changes seen on prior CT is significantly improved.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter left renal inferior pole cyst.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Small fat containing periumbilical hernia without complication.OTHER: No significant abnormality noted.

Output: Adjacent to the right anterolateral aspect of the pancreatic head is a heterogeneous T1 and T2 weighted signal intensity focus (or clustered foci) with mild peripheral enhancement suggestive of stigmata of previously documented acute pancreatitis. No discrete lesion is evident. However, continued surveillance imaging is suggested to document resolution and/or decrease in size.


Instruction: Generate impression based on findings.

Input: No evidence of intracranial hemorrhage or acute infarction. There are no extra-axial fluid collections or subdural hematomas. No evidence of intracranial mass, mass effect, or midline shift. There is no pathologic enhancement within the brain. The ventricles and sulci are normal in size. The cerebellar tonsils are normal in position. Flow-voids are present within the major vessels indicating patency. There is scattered opacification of the ethmoid air cells, sphenoid sinuses and bilateral mastoid air cells. Mucosal thickening of the bilateral maxillary sinuses is also noted. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: No specific findings to account for the patient's altered mental status.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with numbness, tingling and visual disturbance. History of meningioma. Sequelae of right parietal craniotomy are redemonstrated. There remains mildly thickened subjacent craniotomy defect, but no suspicious or nodular enhancing tissue is evident in the operative region. The underlying right parietal parenchyma shows evidence of mild hemosiderin staining and very slight anatomic distortion and encephalomalacia likely related to surgery.Elsewhere in the brain, no pathologic enhancement is seen. A developmental venous anomaly is suspected within the right superior frontal gyrus. No evidence of edema or mass effect is detected. No abnormal extra-axial fluid collections are seen. Ventricles are within normal limits for size. Incidental note is made of prominent choroid plexus cysts at the level of the atria.

Output: Postoperative findings are redemonstrated compatible with right parietal craniotomy. No findings are seen to suggest recurrent tumor. No new intracranial lesions are detected.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer to bone: some visual changes on right field, some headaches. There appears to be a punctate enhancing focus in the left cerebellar hemisphere. There is no evidence of intracranial hemorrhage or acute infarct. There is a small left parietal lobe developmental venous anomaly. There is a nonspecific punctate focus of high T2 signal in the right frontal lobe deep white matter without associated 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: An apparent punctate enhancing focus in the left cerebellar hemisphere may represent a metastasis.


Instruction: Generate impression based on findings.

Input: 58 year-old male status post tonic-clonic seizure on heparin infusion. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal regions of diffuse hypodensity in a periventricular distribution within the deep white matter is consistent with small vessel ischemic disease, age indeterminate. No new cortical stroke is seen.Focal area of left posterior parietal encephalomalacia consistent with previous ischemia. If there is clinical concern for acute ischemia, an MRI may be considered.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: Multifocal regions of small vessel ischemic disease, age indeterminate. No definite cortical stroke is seen. If there is clinical concern for acute ischemia, an MRA may be considered.


Instruction: Generate impression based on findings.

Input: Diagnosis: Epilepsy, unspecified, not intractable, without status epilepticusClinical question: seizure; evaluate for structural abnormalitySigns and Symptoms: seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A couple punctate periventricular white matter lesions present which are high signal on T2 and FLAIR MRI and not changed since the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities which are unchanged since prior exam. The visualized portions of the mastoid air cells are partially opacified The visualized portions of the orbits are intact. There is somewhat more opacification of the mastoid air cells on the current exam when compared to the previous exam.Incidental note is made of partial empty sella finding which was previously present as well.

Output: 1.No abnormal mass lesions or other lesions are identified intracranially to explain the patient's seizures. MRI of the brain is age-appropriate.2.Opacification of mastoid air cells is nonspecific but could be related to retained secretions. It is somewhat more evident on the current exam when compared to the prior


Instruction: Generate impression based on findings.

Input: Patient with headaches, evaluate for CSF flow through foramen magnum and CSF leak in the lumbar spine. Head: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. 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 cerebellar tonsils are in normal position and demonstrate preserved rounded morphology. CSF flow sequence is technically degraded however there is flow ventrally and dorsally at the foramen magnum. No abnormal intracranial enhancement identified.Lumbar spine:Low-lying conus near the lumbosacral junction and postoperative changes related to prior cord untetherings again seen. Distal thecal sac is ectatic and demonstrates septations, findings which are not appreciably changed since 5/23/2016. No new or enlarging fluid collections. As before, the distal spinal cord abuts and may be adherent to the posterior thecal sac; re-tethering can be considered in the appropriate clinical setting.No significant change in diameter craniocaudal extent of distal cord syrinx compared to 5/23/2016 and 3/30/2016.Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. The bone marrow demonstrates a normal signal. No spinal canal or neural foraminal stenosis.

Output: 1.MRI of the brain is within normal limits. CSF spaces at the foramen magnum are preserved. CSF flow sequence is technically limited but there is flow ventrally and dorsally at the foramen magnum.2.No significant change in diameter craniocaudal extent of distal cord syrinx compared to 5/23/2016 and 3/30/2016.3.Postoperative changes related to multiple cord untetherings. Unchanged appearance of the expanded distal thecal sac compared to study from 5/23/2016, compatible with post operative change. No new or enlarging fluid collections to suggest CSF leak. If there remains high clinical suspicion for an active CSF leak within this region, further evaluation with myelogram may be considered.


Instruction: Generate impression based on findings.

Input: Person injured in unspecified vehicle accident, sequela [V89.9XXS], Reason for Study: ^Reason: Assess brain injury History: 13 yo s/p motor vehicle accident, with R subdural hematoma, s/p bolt Brain MRIMotion artifact degraded exam quality.Redemonstration of right hemispheric subdural hematoma with subtle mass effects against underlying brain parenchyme and localized subtentorial subdural hematoma.There is focal brain edema and subarachnoid blood products at the site of ICP monitoring device at the right superior frontal gyrus. There is no evidence of acute ischemic lesion.The ventricles, sulci and cisterns are unremarkable except minimal effacement of right lateral ventricle. Normal flow voids are identified in the major intracranial vessels. Mucosal thickening of sphenoid sinus. Opacifications on bilateral mastoid air cells.Cervical spine MRIThere is straightening of cervical lordosis which is non specific. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy.

Output: 1. Right hemispheric subdural hematoma with minimal mass effects as described above, unchanged compared to prior CT scan.2. No evidence of acute ischemic infarction. No evidence of brain parenchymal hemorrhage except some blood products at the right superior frontal gyrus where ICP monitoring device was inserted.3. Straightening of cervical spine, otherwise unremarkable Cervical spine MRI.


Instruction: Generate impression based on findings.

Input: 43 year old with proven IDC grade 3 with DCIS grade 3 in right breast, presents for staging MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A few cysts are present in the posterior right breast.An enhancing mass, a proven carcinoma, is present at anterior 4 o'clock position in the right breast, measuring 15 x 14 x 13 mm (AP x LR x CC). A marker clip is identified at posterior aspect within this mass. Just lateral to this mass, there is a non-mass enhancement, which is a proven IDC with DCIS, measuring 29 x 8 x 21 mm. Inferior part of this non-mass enhancement reaches to the skin. There is a 10 mm hematoma at the anterior-lateral aspect of this non-mass enhancement. A marker clip is at the posterior aspect within this hematoma. Overall size of the mass and non-mass enhancement is 30 x 24 x 29 mm.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven carcinoma in the right breast. Inferior aspect of the non-mass enhancement reaches to the skin.2. No MRI evidence of malignancy in the left breast or either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 31-year-old female with right ankle anterolateral mass. Markers were placed over patient's palpable right ankle mass. Deep to these markers, there is a lobulated collection of fluid signal intensity arising from the sinus tarsus and extending into the soft tissues lateral to the talus between the anterior talofibular ligament and peroneus tertius. This collection measures up to 3 x 2 cm in greatest transverse dimension and up to 3 cm in greatest craniocaudal dimension. There is little if any enhancement of this collection on postcontrast images, and the findings are compatible with a ganglion.TENDONS: Tendons appear normal.LIGAMENTS: The visualized ligaments are intact, including the distal tibiofibular syndesmotic ligament and visualized components of the deltoid ligament.ARTICULAR SURFACES AND BONE: No significant abnormality noted. No osteochondral defects.ADDITIONAL

Output: Ganglion as described above.


Instruction: Generate impression based on findings.

Input: Reason: shoulder pain History: pain ROTATOR CUFF: There is complete rupture of the supraspinatus tendon with retraction to the level of the glenohumeral joint. There is mild fatty atrophy of the supraspinatus. There is extension of this tearing to involve the anterior fibers of the infraspinatus. There is an interstitial tear of the infraspinatus at the level of the myotendinous junction. There is thickening and intermediate signal intensity of the infraspinatus indicating a moderate tendinosis. There is a tiny interstitial tear of the subscapularis at the level of its insertion. The teres minor muscle and tendon appear intact. SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. There are foci of low signal intensity internally which may reflect a bursitis. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the superior and anterior labrum likely representing degeneration and degenerative tearing. Mild osteoarthritis affects the glenohumeral joint.BICEPS TENDON: The tendon of the long head of the biceps is poorly visualized at its transition from the bicipital groove to the rotator cuff interval and is likely disrupted.ADDITIONAL

Output: 1. Complete rupture of the supraspinatus tendon with extension of the tear to involve the infraspinatus tendon.2. Probable complete rupture of the tendon of the long head of the biceps as described above.3. Osteoarthritis of the shoulder and other findings as described above.


Instruction: Generate impression based on findings.

Input: 18-year-old female with pain. Evaluate for labral tear. ROTATOR CUFF: There is mild intermediate signal intensity within the supraspinatus tendon indicating tendinosis. The supraspinous muscle appears normal. The remaining rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted. GLENOHUMERAL JOINT AND LABRUM: Glenohumeral joint alignment is anatomic. The articular cartilage appears normal. Bone marrow signal intensity is normal.BICEPS TENDON: The long head of the biceps tendon appears normal.ADDITIONAL

Output: Mild tendinosis of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain. Signs and symptoms: Same. Nonenhanced lumbar MRI:The lowermost visualized thoracic spine demonstrate extensive disk disease and loss of disk height with resultant central spinal stenosis at T10 -- T11 level. Moderate bilateral neural foraminal compromise is also detected.T12 -- L1 demonstrate advanced disk disease and loss of disk height, mild grade 1 retrolisthesis, mild bilateral facet and ligamentum flavum hypertrophy. There is no central spinal stenosis however moderate right neural foraminal compromise is present.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild degenerative changes and without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk desiccation and loss of height, moderate bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis and mild to moderate right neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and loss of disk height, broad based bulging disk, significant bilateral facet and ligamentum flavum hypertrophic changes. There is resultant significant central spinal stenosis and with severe right and moderate left neural foraminal compromise.L5 -- S1 demonstrate mild degenerative disk disease and mild bilateral facet and ligamentum flavum hypertrophy. There is moderate right neural foraminal compromise and unremarkable otherwise.

Output: 1.Extensive degenerative changes at L4 -- L5 with resultant significant central spinal stenosis as detailed.2.Degenerative changes at T10 -- T11 resulting in central spinal stenosis and neural foraminal compromise.3.No evidence of central spinal stenosis at any other level.4.Multi-level neural foraminal compromise however is noted as detailed per level above.


Instruction: Generate impression based on findings.

Input: Year old female a history of metastatic thyroid carcinoma and supraclavicular lymph node enlargement LUNGS AND PLEURA: Stable scattered small micronodules with a calcified granuloma in the left paramediastinal region. No new suspicious pulmonary masses or nodules. No evidence of a pleural effusion.MEDIASTINUM AND HILA: Right paratracheal enlarged lymph node (image 28, series 4) now measures 17 mm by 17 mm, previously, measuring 22 mm x 21 mm. Right hilar lymph node cannot be accurately measured without intravenous contrast material.CHEST WALL: Progressive sclerosis involving the T9 osteolytic lesion. A radiolucency is still noted in the T11 vertebrae. MRI of the thoracic spine can better evaluate these lesions.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Interval decrease in the mediastinal lymphadenopathy.2.No suspicious pulmonary nodules. Stable scattered micronodules.3.Progressive sclerosis involving the T9 osteolytic metastasis. Radiolucency is identified in the T11 vertebrae. MRI of the spine is is recommended for better evaluation.


Instruction: Generate impression based on findings.

Input: 60-year-old male status post Roux-en-Y hepaticojejunostomy for chronic choledocholithiasis. Patient has known duodenal diverticulum. ABDOMEN:LIVER, BILIARY TRACT:Multiple new focal liver lesions, as detailed below:New peripheral segment 8 lesion measuring 1.6 x 2.5 cm (series 9/10) that demonstrates T2 hyperintensity, restricted diffusion, and progressive enhancement, suspicious for metastasis.New peripheral segment 5 lesion measuring 3.3 x 2.2 cm that demonstrates T2 hyperintensity, restricted diffusion, arterial and delayed enhancement, and overlying capsular retraction, suspicious for metastasis.New segment 6 lesion measuring 1.8 x 1.6 cm that demonstrates T2 hyperintensity, restricted diffusion, and progressive enhancement, suspicious for metastasis.A previously seen lesion in the left hepatic lobe, suggestive of FNH, is not evident on the current exam.Postsurgical changes from hepaticojejunostomy with patent biliary enteric anastomosis seen. Stable small loculated fluid collection posterior and medial to the biliary enteric anastomosis, which may be related to postoperative change (series 8/79). The gallbladder is presumably surgically absent.Slight prominence of the central intrahepatic biliary ducts noted. There has been interval increased dilation of the native common bile duct stump, measuring up to 12 mm (series 8/62). There is abrupt transition point at the ampulla of Vater, where there is a small round enhancing mass seen measuring up to 11 x 9 mm (series 23/28).Overall, the findings are most suspicious for cholangiocarcinoma of the native distal common bile duct/ampulla with multiple hepatic metastases.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal simple cyst.RETROPERITONEUM, LYMPH NODES: Moderate porta hepatis lymphadenopathy is similar to prior study.BOWEL, MESENTERY: Duodenal diverticulum, similar to prior study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings are most suspicious for cholangiocarcinoma of the distal common bile duct/ampulla with multiple hepatic metastases.


Instruction: Generate impression based on findings.

Input: History of prostate cancer bilaterally in right base, mid, and apex, and left lateral apex. PELVIS:PROSTATE:Prostate Size: 6.2 x 4.0 x 4.2 cm. Peripheral Zone: Multiple subcentimeter foci of T2 hypointensity and diffusion restriction in the mid-gland likely represent areas of carcinoma. Central Gland: There is a 2.2 x 1.6 cm area of T2 hypointensity with diffusion restriction and enhancement (series 1201, image 10) in the anterior aspect of the apex, compatible with carcinoma. The remainder of the prostate is enlarged and heterogeneous with nodules, compatible with marked BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted. No suspicious osseous lesions.

Output: 1.Dominant 2.2 cm mass in the anterior aspect of the prostatic apex compatible with carcinoma. No evidence of extracapsular extension or pelvic lymphadenopathy.2.Subcentimeter foci in the peripheral zone bilaterally also compatible with carcinoma.