Instruction: Generate impression based on findings.

Input: Post craniotomy with aneurysm clipping. New symptoms and worsening headaches Non-infused head CT:Minimal area of low attenuation in the inferior aspect of right frontal lobe near the surgical site of clipped aneurysm may represent edema or encephalomalacia. This finding remains stable since prior exam. Expected postoperative changes of right-sided frontal craniotomy with interval improvement since prior study. Patchy nonspecific foci of subcortical low attenuation could represent small was ischemic disease. This appears a slightly more pronounced on the current exam than prior study. Recommend follow-up with an MRI. There is no evidence of cortical low attenuation to suggest ischemic cortical stroke.Widened subarachnoid space along the inner table of the skull in the right posterior frontal and parietal is highly suspected only small subdural collection. This is also a new finding since prior exam. There is very subtle effacement of cortical sulci secondary to finding.

Output: 1.Findings I do suspect that of small vessel disease of indeterminate age with interval worsening since prior study. Recommend follow-up with an MRI to exclude new subcortical ischemic strokes.2.A small CSF density subdural in the right posterior frontal -- parietal with minimal effacement of adjacent cortical sulci is a new finding since prior exam3.there is no evidence of any acute cortical stroke, hemorrhage, hydrocephalus or midline shift.


Instruction: Generate impression based on findings.

Input: 58 years, Male, Reason: Pt is a 58 y/o male with prostate cancer, liver abnormality on CT, evaluate to r/o mets in patient wtih prostate cancer History: prostate cancer, liver abnormal on CT. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Segment 8 lesion demonstrates discontinuous nodular enhancement with high T2 signal and progressive enhancement measuring 1.5 x 1.1 cm, compatible with a hemangioma. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Enhancing foci within the L1 and L2 right transverse processes are suspicious for osseous metastasis.OTHER: No significant abnormality noted.

Output: 1.Hepatic lesion identified on the prior exam is compatible with a hemangioma.2.Osseous enhancing lesions within the right transverse processes of L1 and L2 are suspicious for metastases.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for ankle fracture left History: Pain and edema lateral ankle joint after increase walking at Disney 3 weeks ago Note is made of bone marrow signal abnormality within the anterior process and posterior to the posterior facet of the calcaneus with associated linear decreased signal abnormality on all pulse sequences indicating stress fractures. There is degenerative bone marrow signal abnormality and subchondral cyst formation within the navicular and medial cuneiform. No osteochondral defects are identified. No additional fractures are seen. The flexor and extensor tendons appear intact. There is a longitudinal split tear of the peroneus brevis. The Achilles tendon appears intact however, there is intermediate signal intensity within the distal fibers of the Achilles tendon suggesting mild tendinosis or interstitial tearing. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact. There is nonspecific subcutaneous edema most pronounced along the lateral aspect of the ankle. While some of this edema becomes more confluent along the lateral aspect of the ankle, no drainable fluid collection is identified. There is a small amount of fluid within the tibiotalar and subtalar joints.

Output: 1. Stress fractures of the calcaneus and other findings as described above.2. Longitudinal split tear of the peroneus brevis.


Instruction: Generate impression based on findings.

Input: Low back and thigh pain. Evaluate for lumbar spine pathology. The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is developmental narrowing of the lumbar central spinal canal with shortened pedicles. The vertebral body and disk heights are well-maintained. There is mild disc height loss from L3-4 to L5-S1 with mild disc desiccation throughout the lumbar spine. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L2 level. T12-L1: As seen on the sagittal images, there is a mild disc bulge which indents the thecal sac. No significant neuroforaminal stenosis.L1-L2: There is a shallow central disc protrusion with moderate facet hypertrophy and ligamentum flavum thickening. No significant neural foraminal or central canal stenosis.L2-L3: No disc bulge. There is mild to moderate ligamentum flavum thickening but no neural foraminal or central canal stenosis.L3-L4: A disc bulge is noted with moderate ligamentum flavum thickening. This causes mild right neural foraminal stenosis and moderate central canal stenosis. No neural foraminal stenosis is noted on the left.L4-L5: Again seen is a disc bulge more prominent towards the right. There is facet hypertrophy and ligamentum flavum thickening. This results in mild right neuroforaminal stenosis and moderate to severe central canal stenosis. No left neural foraminal stenosis.L5-S1: A mild disc bulge is present with facet hypertrophy and ligamentum flavum thickening. However there is no neural foraminal or central canal stenosis.Incidental note is made of a nonspecific left renal upper pole T2 hyperintense lesion statistically most likely representing a renal cyst. The remaining visualized intra-abdominal and paraspinal soft tissues are unremarkable.

Output: Moderate degenerative changes of the lumbar spine superimposed on developmental narrowing. This is most prominent at the L3-4 and L4-5 levels, with up to moderate to severe central canal stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: Reason: eval meniscus, patellofemoral joint, MPFL History: knee pain, patellofemoral MENISCI: Bilateral menisci are intact without evidence of tear.ARTICULAR CARTILAGE AND BONE: There is a lesion along the lateral aspect of the tibial metadiaphysis compatible with a nonossifying fibroma, confirmed on prior radiograph. There is otherwise no abnormal marrow signal. Articular cartilage is intact.LIGAMENTS: No significant abnormality noted. Specifically, the medial and lateral patellofemoral ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact. ADDITIONAL

Output: 1.No acute abnormality. Specifically, the menisci, extensor mechanism and patellofemoral ligaments are intact.2.Nonossifying fibroma of the proximal tibia.


Instruction: Generate impression based on findings.

Input: Evaluate liver mass. ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous expansile mass involving the left hepatic lobe measuring up to 8.8 x 7.4 cm (series 5/29) in axial dimension which extends along its inferior margin laterally to involve the left subhepatic space. In the craniocaudal dimension the lesion measures 9.4 cm (series 4/12). The lesion demonstrates heterogeneous signal intensity with regions of intermediate and high T2-weighted hyperintensity. The lesion has thick peripheral and internal septations which demonstrate enhancement and multiple cystic components. T2 hyperintense foci demonstrate restricted diffusion. The lesion is hypointense on T1-weighted imaging.The liver is otherwise normal in morphology.Cholelithiasis with a gallstone in the gallbladder neck/cystic duct junction. The gallbladder itself is distended without gallbladder wall thickening, pericholecystic fluid or specific evidence of acute cholecystitis.There is mild intrahepatic biliary ductal dilatation. The common bile duct is dilated up to 1.3 cm but tapers smoothly to the level of the ampulla without a definite stone or lesion.SPLEEN: The spleen is normal in morphology size, signal intensity and enhancement without a focal lesion.PANCREAS: The pancreas is normal in morphology and signal intensity without a focal lesion or pancreatic ductal dilatation. Punctate pancreatic head cystic focus measuring 7 mm appears to communicate with the main pancreatic duct and likely represents a sidebranch IPMN.ADRENAL GLANDS: Mild adrenal gland thickening without a discrete lesion.KIDNEYS, URETERS: Kidneys are normal in morphology and enhancement without hydronephrosis or focal lesion.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Moderate hiatal hernia with the proximal gastric body within the thorax.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Heterogeneous left hepatic lobe lesion likely represents an abscess, particularly given elevated white count. Follow-up to resolution is recommended. The abscess to appears to have decompressed into the left subhepatic space. The source of infection is not clearly demonstrated.2.Distended gallbladder with gallstone at the hepatic neck/cystic duct junction without additional specific findings of acute gallbladder inflammation. 3.Dilated common bile duct without a definite obstructing lesion or stone. Correlate with LFTs and consider MRCP/ERCP as clinically warranted to evaluate the distal CBD.


Instruction: Generate impression based on findings.

Input: Female 66 years old with intractable knee pain. Evaluate for avascular necrosis. MENISCI: There is a complex tear of the body and posterior horn of the medial meniscus with a horizontal component contacting the tibial articular surface (series 901, image 8) and a radial component near the anchor (series 1001, image 17). The anterior horn of the medial meniscus and the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is thinning and fraying of the articular cartilage of the femoral trochlea and areas of full-thickness cartilage loss along the medial patellar facet and patellar eminence. There is associated reactive marrow change in both patella and the femur.There is a focal full-thickness fissure along the weightbearing surface of the medial femoral condyle (series 901, image 11). The articular cartilage of the medial tibial plateau is thinned but without full thickness defect. The articular cartilage in the lateral compartment is relatively preserved. There are small tricompartmental osteophytes.Outside of the reactive marrow changes described above, the bone marrow signal intensity is within normal limits with no findings to suggest avascular necrosis or acute fracture.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex tear of the posterior horn of the medial meniscus as described above.2.Areas of full-thickness cartilage loss in the medial femoral condyle and patella.3.Mild osteoarthritis.4.No findings to suggest avascular necrosis or acute fracture.


Instruction: Generate impression based on findings.

Input: 70-year-old male with elevated PSA and abnormal rectal exam. Patient presents for evaluation of evaluation of the prostate gland. PELVIS:PROSTATE:Prostate Size: 5.3 x 3.3 x 5.1 cmPeripheral Zone: There is a focal T2 hypointense lesion with corresponding low ADC signal and enhancement in the right apex peripheral zone. This focus measures approximately 4 x 3 mm (series 1701, image 9).Central Gland: The central gland is heterogeneous with multiple well-defined foci most consistent with benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter right apex peripheral zone lesion suspicious for carcinoma.2.No evidence of extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: Female 70 years old Reason: 70F with complex renal cyst on ultrasound, please further evaluate. Stage 3 CKD, should NOT get contrast. History: left renal cyst The study is limited in the absence of intravenous contrast.ABDOMEN:LUNG BASES: Fat signal soft tissue lesion at the thoracic inlet without complexity/nodule is most compatible with an intrathoracic lipoma.LIVER, BILIARY TRACT: No significant abnormality noted. Cholelithiasis. Adenomyomatosis of the gallbladder fundus.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilobed left renal cyst with thin internal septations measures 1.6 x 3.2 x 1.1 cm. No nodules are identified within the cystic lesion. Evaluation is limited in the absence of intravenous contrast.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Thinly septated cystic lesion in the left kidney. No nodules are identified however evaluation is limited in the absence of intravenous contrast.2.Cholelithiasis.3.Intrathoracic lipoma.


Instruction: Generate impression based on findings.

Input: 45 year old with recently diagnosed ILC in the left upper outer quadrant (3 sites). Evaluate extent of disease. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Left breast:In the 3 o'clock radian, mid-depth, corresponding to the site of the coil clip there is focal non-mass enhancement measuring 14 x 11 x 13 mm (AP x transverse x CC).In the 3 o'clock radian, posterior depth, corresponding to the site of the ribbon clip there is focal non-mass enhancement measuring 13 x 10 x 10mm (AP x transverse x CC).In the 2 o'clock radian, posterior-depth extending into the axillary tail, corresponding to the site of the wing clip there is focal non-mass enhancement measuring 5 x 6 x 5 mm (AP x transverse x CC).In total the areas of enhancement extending along the lateral border of the left breast measure 34 x 14 mm. The biopsy clips are positioned centrally within the corresponding lesions. No additional sites of abnormal enhancement in the left breast. The anterior ducts contain high T1 signal fluid likely related to prior biopsy.Right breast:In the 12 o'clock radian, mid-depth, there is a 4 mm focus of enhancement which demonstrates washout kinetics. No additional abnormal enhancement in the right breast.Axilla:No axillary lymph nodes bilaterally.

Output: 1. 3 regions of non-mass enhancement extending along the lateral aspect of the left breast corresponding to the sites of the patient's biopsy proven invasive lobular carcinoma. No additional foci of abnormal enhancement in the left breast.2. 4-mm focus of abnormal enhancement within the right upper central breast. MRI guided biopsy is recommended for further evaluation. No additional foci of abnormal enhancement in the right breast.3. No abnormal axillary lymph nodes bilaterally.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 48-year-old female with hepatic encephalopathy with decreased level of consciousness. Evaluate for cerebral edema. There is no evidence of intracranial hemorrhage. Bilateral, lateral temporal lobe decreased attenuation consistent with edema which is unchanged when compared with previous brain MRI , 10/7/08.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: Stable examination.


Instruction: Generate impression based on findings.

Input: 68-year-old female with left temporal slowing. Evaluate for seizure focus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive T2 hyperintensity throughout much of the cerebral white matter. There is no focal hippocampal lesion. There is no abnormal intracranial enhancement. There is diffuse cerebral and cerebellar volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild left maxillar sinus mucosal thickening.

Output: Extensive cerebral volume loss and white matter abnormality may represent chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 2-year-old male with pancreatitis. Evaluate for structural abnormalities.EXAMINATION: MRI MRCP without and with intravenous contrast 12/16/2016 10:00 The pancreatic head, body and majority of the tail is normal demonstrating normal homogeneous enhancement. The distal aspect of the pancreatic tail is indistinct with adjacent intermediate signal intensity, stranding and free fluid. A complex rim-enhancing structure is present in the region of the distal pancreatic tail measuring 3 cm x 2 cm (series 1601, image 38). There are enhancing septations within the fluid collection in the left upper quadrant. There are adjacent smaller loculated fluid collections in the left lower quadrant (for example series 1601, image 29). No pancreatic ductal dilatation. Moderate amount of fluid is present in the upper abdomen. Stranding of the perinephric fat on the left is noted. No intra or extrahepatic biliary ductal dilatation. The liver, spleen and gallbladder are normal.The kidneys demonstrate normal enhancement with symmetric excretion of contrast. The bladder is moderately distended.The adrenal glands are normal.Bilateral small pleural effusions.

Output: 1. Focal pancreatitis of the pancreatic tail with adjacent peripancreatic fluid collection demonstrating complex features likely representing a peripancreatic fluid collection transitioning into a pseudocyst. There are adjacent smaller loculated fluid collections.2. No biliary or pancreatic ductal dilatation.3. Moderate amount of fluid in the upper abdomen with multiple septations in the left upper quadrant. This extends inferiorly and posteriorly involve the left perinephric space.4. Bilateral small pleural effusions.


Instruction: Generate impression based on findings.

Input: Acute lymphoblastic leukemia, in remission [C91.01], Reason for Study: ^Reason: Evaluate for PRES History: Headaches in patient day + 8 from MUD cord transplant on cyclosporine No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening of paranasal sinuses with the retention cyst on the left maxillary sinus.

Output: 1. No evidence of abnormal enhancement.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with pain and pop at L2-3 after lifting heavy object. Pain radiates to upper buttocks. Symptoms of two weeks' duration. The last vertebral body bearing fully formed ribs will be designated T12. This numbering scheme gives five fully lumbar type vertebral bodies and a transitional S1 vertebral body.Spinal alignment is anatomic. Vertebral body heights are preserved. Patchy areas of fatty marrow signal are seen. No worrisome marrow replacement or evidence of marrow edema is detected.The visualized spinal cord, conus and cauda equina are within normal limits.Disc T2 signal diminishes slightly at lower lumbar levels but overall disc height is preserved throughout.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: There may be a very small subchondral cyst along the left superior L4 endplate. Otherwise unremarkable. L4-5: Possible very small left foraminal disc protrusion. Slight effacement of the left lateral recess. No significant generalized spinal canal stenosis. No significant foraminal narrowing on either side. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Mildly bulging disc. Effacement of the right lateral thecal sac. Mild generalized spinal canal stenosis. No significant foraminal narrowing on either side. S1-S2: Facet hypertrophy greater on the right. No significant spinal canal or foraminal stenosis.

Output: No large disc herniation, significant spinal canal or neuroforaminal stenosis is detected on this examination. At most, there may be a very small left foraminal disc protrusion at L4-5. Fairly substantial facet hypertrophy is also evident at L5-S1 and S1-2.


Instruction: Generate impression based on findings.

Input: Persistent right shoulder pain. Status post fall. ROTATOR CUFF: There is complete tearing of the supraspinatus tendon with approximately 2.8 cm of retraction and mild to moderate fatty atrophy of the supraspinatus muscle. The infraspinatus, teres minor, and subscapularis muscles/tendons are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There are degenerative cystic changes of the humeral head. Glenohumeral alignment is within normal limits. Mild osteoarthritis affects the glenohumeral joint.The labrum is grossly intact.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Complete tearing of the supraspinatus tendon as described above.


Instruction: Generate impression based on findings.

Input: 58-year-old female with a new breast lesion, needs MRI for further workup.Biopsy-proven ILC in the right breast at 3:00 position from outside hospital. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast:Right breast 2:30 position a spiculate heterogeneously enhancing mass is noted measuring 10 x 12 x 11 mm 4(AP X ML X CC). Clip artifact identified within it. Left breast: No abnormal enhancement is seen in left breast. Axillae: No abnormal lymph nodes are identified in either axillary region.

Output: Unifocal cancer right breast measuring 12 mm in maximum dimension. No abnormality in left breast and bilateral axillary region. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 57-year-old male patient with history of multiple sclerosis presents with limb weakness. Evaluate for progression. BRAIN: Allowing for slight differences in technique including imaging plane and slice thickness, there is no definite change in numerous areas of increased T2/flair signal in the periventricular, cingulate-callosal junction, and to a lesser degree subcortical white matter. Stable lesions are seen in the cerebral peduncles, pons and left cerebellum. There is stable atrophy of the corpus callosum. These findings are compatible with the patient's history of multiple sclerosis and are not significantly changed compared to prior exam. There is no evidence of mass effect or midline shift.There is minimal mucosal thickening in the left maxillary and ethmoid sinuses, decreased compared to prior exam. CERVICAL SPINE:No new cord lesions. There is redemonstration of small foci of T2 hyperintensity in the cord at right C3-4 to C4-5 with atrophy. There is a small lesion at the C7 level on the right anteriorly, also similar to prior. There is near-anatomic alignment of the cervical spine. Bone marrow signal is benign. Level specific findings:C2-3: There is no significant spinal canal stenosis or neural foraminal narrowing at this level.C3-4: Left paracentral disc osteophyte complex and ligamentum flavum thickening causing mild spinal canal stenosis and mild to moderate bilateral neural foramina narrowing.C4-5: No significant neural foraminal narrowing or spinal canal stenosis. C5-6: No significant spinal canal stenosis or neural foramina narrowing. C6-7: Left uncovertebral hypertrophy with mild left neural foramina narrowing. No significant spinal canal or right neural foraminal narrowing. C7-T1: No significant spinal canal or neural foraminal narrowing.The right vertebral artery is small as before.

Output: 1.Numerous lesions in the supratentorial and to a lesser degree infratentorial white matter are compatible with the patient's history of known demyelinating disease and are not significantly changed allowing for differences in technique. No new lesions are seen.2.Small lesions in the cervical cord with associated atrophy are also not significantly changed. No new lesions in the cervical cord.3.Multilevel degenerative disk disease of the cervical spine as described above with mild spinal canal stenosis at C3-4 remains unchanged.


Instruction: Generate impression based on findings.

Input: Reason: ? Rotator cuff tear History: pain ROTATOR CUFF: There is a complete tear of the supraspinatus with retraction to the level of the glenohumeral joint. This tear extends posteriorly to involve the anterior fibers of the infraspinatus as well. Overall the tear measures nearly 2.5 cm in AP dimension. There is relatively mild fatty atrophy of the supraspinatus muscle. There is also mild fatty infiltration of the infraspinatus along the myotendinous junction. The teres minor muscle and tendon appear intact. There is perhaps mild undersurface tendinosis of the subscapularis with small cysts within the underlying humeral head. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint without evidence of a large effusion. There is mild heterogeneity of the anterior labrum as well as the posterior superior labrum that may reflect degeneration, but we see no fluid-filled tear. Mild osteoarthritis affects the glenohumeral joint. The humeral head is high riding.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps which may reflect minimal tendinosis. The tendon itself appears intact.

Output: Full-thickness retracted rotator cuff tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: Pain lateral left knee. Question of new or recurrent damage to the articular cartilage of the lateral condyle or lateral meniscus. MENISCI: There is slight blunting of the free edge of the posterior horn of the lateral meniscus which may reflect mild inner edge fraying or interval partial meniscectomy. However, we see no findings of an unstable lateral meniscal tear. The medial meniscus appears intact. The root is slightly ill-defined, but this is unchanged from the prior study.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the lateral tibial plateau anterior to the posterior meniscal horn appears slightly thickened on the current study compared to the prior study, likely reflecting results from interval microfracture. There is heterogeneity and increased signal intensity of the articular cartilage in this region which could reflect degeneration but the clinical significance remains uncertain. We see no definite fluid-filled defect of the cartilage. A small subchondral focus of signal abnormality in the lateral tibial plateau is likely related to a combination of microfracture and degeneration. There is progression of thinning of the articular cartilage along the weight-bearing portion of the lateral femoral condyle indicating degeneration although we see no definite fluid-filled full thickness defects. Small foci of signal abnormality in the underlying bone likely represent sequela of microfracture. The medial compartment articular cartilage is normal. There is a full thickness fissure through the articular cartilage of the medial trochlea, which was not present previously.LIGAMENTS: The patient is status post ACL reconstruction. The graft appears intact. The posterior cruciate ligament is intact. The collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings compatible microfracture of the lateral tibia/femur as described above.2. Minimal blunting of the free edge of the posterior horn of the lateral meniscus may represent mild fraying or interval surgery, but we see no evidence of an unstable tear.3. New full-thickness fissure of the trochlear cartilage as described above.4. Other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: Right shoulder pain evaluate for SLAP tear History: Right shoulder pain ROTATOR CUFF: The supraspinous, infraspinous, subscapularis, and teres minor tendons appear intact without evidence of tearing or tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is signal irregularity along the anterior superior glenoid labrum which is likely postsurgical. There is no discrete focal linear signal abnormality or additional findings to suggest focal labral tear.BICEPS TENDON: The biceps tendon is intact without evidence of tearing or tendinopathy. ADDITIONAL

Output: Mild irregularity of the anterior superior glenoid labrum is favored to represent postsurgical changes. There are no findings to suggest focal labral tear.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: Hypodense lesion in pancreas in immunosuppressed transplant patient, malignancy vs fatty infiltrate History: as above ABDOMEN:LIVER, BILIARY TRACT: Mild hepatic steatosis. No focal hepatic lesions. Hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Small T2 hyperintense lesion in the head of the pancreas measures 0.9 x 0.7 cm (image 12/series 601). Lesion shows no significant enhancement. The lesion is located adjacent to the pancreatic duct. There is suggestion of connection to the pancreatic duct. The lesion most likely represents a small side branch duct IPMN. There is no pancreatic atrophy. The remainder of the pancreatic duct is normal in caliber. There are few other small T2 hyperintense foci along the course of the pancreas which may also represent small side branch that IPMNs.ADRENAL GLANDS: Left adrenal is mildly hyperplastic. Right adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small infrarenal abdominal aortic aneurysm measures 3 cm (image 97 series 1101).No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter lesion in head of pancreas most likely represents a small IPMN. There are several other small foci in the body and tail of the pancreas which may also represent IPMNs. M.R.C.P. in 12 to 18 months is suggested to evaluate for size change.


Instruction: Generate impression based on findings.

Input: Suspected left ischemic optic neuropathy after cataract extraction and history of Neurofibromatosis type 1. There are bilateral lens implants. The globe contents are otherwise grossly unremarkable. The bilaterally optic nerves are not enlarged and do not display discernible abnormal enhancement. There is no evidence of mass lesions within the bilateral orbits. The lacrimal glands, intraorbital vessels, extraocular muscles, and orbital fat appear unremarkable bilaterally. The optic chiasm and cavernous sinuses are intact. There are punctate enhancing skin nodules in the temporal scalp regions bilaterally. The imaged portions of the intracranial structures are unremarkable.

Output: 1. Bilateral lens implants, but no evidence of optic nerve or orbital lesions. However, MRI is generally not very sensitive for detecting small ischemic lesions of the optic nerves.2. Punctate enhancing skin nodules in the temporal scalp regions bilaterally likely represent neurofibromas in the setting of Neurofibromatosis type 1.


Instruction: Generate impression based on findings.

Input: Male, 82 years old, with weakness in the proximal legs bilaterally, possibly worse on the left. A mild scoliotic curvature of the lumbar spine is seen. There is a grade 1 anterolisthesis of L4 relative to L5, and a grade 1 retrolisthesis of L5 relative to S1. Vertebral body height and morphology are within normal limits allowing for some right lateral degenerative wedging of L3 and L4. No evidence of concerning marrow replacement is seen. Endplate edema is noted at L3-4 related to disc degeneration. No other areas of significant marrow edema are seen.The visualized distal spinal cord is unremarkable. The conus tip terminates at the L1-2 level which is normal. The nerve roots of the cauda equina are unremarkable except as discussed below.The discs of the lumbar spine show loss of height and loss of T2 signal characteristics. The endplates demonstrate degenerative irregularity. Bulky anterior osteophytes are present at all levels. Additional level specific findings are as follows.T12-L1: Mild left facet hypertrophy. Mild bulging disc with a shallow left paracentral protrusion. Narrowing of the left lateral recess. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis with mild crowding of the cauda equina. Severe left and moderate right foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis with mild crowding of the cauda equina. Moderate bilateral foraminal narrowing. L3-4: Facet hypertrophy, worse on the right, and ligamentum flavum thickening. Bulging disc. Moderate to severe generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. L4-5: Marked facet hypertrophy bilaterally. Ligamentum flavum thickening. Disc bulging and disc uncovering due to spondylolisthesis. Severe generalized spinal canal stenosis with complete exclusion of CSF and likely impingement of the cauda equina nerve roots. Moderate right and mild left foraminal narrowing. L5-S1: Mild facet hypertrophy. Mild disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. Cortical thickening and irregularity is seen along the left SI joint. The visualized left iliac bone shows heterogeneous marrow signal and the cortical margins are somewhat irregular as well.

Output: Significant disc degeneration is seen at all levels of the lumbar spine. The L4-5 level is most significantly affected with a severe generalized spinal canal stenosis and likely impingement of the descending cauda equina nerve roots. Moderate spinal canal stenosis is seen at L3-4 and at L2-3.Also noted is cortical thickening and irregularity along the left SI joint. In addition, the left iliac bone as visualized demonstrates heterogeneous marrow signal characteristics and ill-defined margins. These findings are of uncertain significance. Correlation with history of prior trauma is suggested. Based on this examination, the findings appear chronic, and the need for dedicated imaging should be determined clinically.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with right facial and jaw pain. Patchy foci of periventricular and subcortical T2 hyperintensity are seen in the bilateral cerebral hemispheres. No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid is detected. Relatively symmetric T2 hyperintensity in the bilateral cerebral peduncles likely reflects dilated perivascular spaces as it suppresses on FLAIR. The ventricular system is patent and normal in size.Although not a dedicated examination for the assessment of cranial nerves, no definite or large abnormalities are suspected within the suprasellar or prepontine cisterns.

Output: 1.No specific findings to account for the patient's pain.2.Patchy nonspecific white matter signal abnormality is seen which may reflect chronic microvascular ischemic disease or the chronic sequelae of demyelination, vasculitis or some other inflammatory process.


Instruction: Generate impression based on findings.

Input: left frontal intra axial mass lesion, preop planning for biopsy. Intra axial T2 high signal intensity lesion involving left middle frontal gyrus and mid to lower pre central gyrus with gyral swellings are seen. On Gad enhancement images, there is almost no contrast enhancement was seen on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There is localized retention cyst on the left anterior aspect of the sphenoid sinus.

Output: Left middle frontal and pre central gyrus intra axial lesion with gyral swelling as described above.


Instruction: Generate impression based on findings.

Input: Ms. Hemingway is a 31-year-old female with a strong family history of breast cancer in mother and two maternal great aunts. She is BRCA-2 positive. She presents for MRI high-risk screening evaluation. There is extreme amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 61 years, Male, Reason: 61 M with metastatic PNET, please eval for interval change. History: none. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Numerous arterially enhancing hepatic metastases are overall unchanged. A right segment 5 lesion measures 2.2 x 1.9 cm (9/45), previously 2.2 x 2.0 cm. A segment 5/6 reference lesion measures 2.1 x 2.0 cm (9/59), previously 2.2 x 2.0 cm. Mild intrahepatic biliary ductal dilatation is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Ill-defined lesion in the pancreatic head measures 2.2 x 1.7 cm (9/62), previously 2.3 x 1.5 cm. No pancreatic ductal dilatation.ADRENAL GLANDS: Mild nonspecific thickening of the left adrenal behind.KIDNEYS, URETERS: Left renal cyst and mild left atrophy is unchanged.RETROPERITONEUM, LYMPH NODES: Mildly enlarged peripancreatic node (9/52) is stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination with unchanged pancreatic head mass and numerous hepatic metastases.


Instruction: Generate impression based on findings.

Input: T2 hyperintense and heterogenously enhancing mass seen in the left frontal operculum, measuring 48 x 38 mm (401/129), increased in size since the previous study. There is increased and extensive vasogenic edema tracking to the midline and to the left parietal and occipital lobes. The left lateral ventricle is compressed with mass effect and slight midline shift.Since the prior exam the patient has developed a couple new enhancing foci in the periventricular white matter and subependymal region adjacent to the trigone of the left lateral ventricle and along the left half of the corpus callosum. There is adjacent linear contrast enhancement along the adjacent left transmedullary veins contiguous with the left frontal lobe mass.In addition, another T2 hyperintense and heterogeneously enhancing mass is seen in the left parietal lobe, measuring 40 x 28 mm (301/147), and unchanged in size.A 3mm thick subdural T2 hyperintensity is seen along the left parietal lobe at the craniotomy flap which is unchanged from the previous study of 9/2/2015.The eyeball lenses are thin.

Output: 1.Examination was performed for the purpose of stereotactic guidance during surgery.2.Since the prior exam a left frontal lobe mass has increased in size. The associated mass effect has also increased and there is now mild midline shift.3.Since the prior examination enhancing periventricular lesions have developed adjacent to the trigone of the left lateral ventricle and the splenium of the corpus callosum. This appears to track from the left frontal lobe.4.Since the prior exam a left parietal lobe mass has not changed substantially


Instruction: Generate impression based on findings.

Input: Altered mental status with periprocedural seizure-like activity. Evaluate for seizure, air embolus, or stroke. Image quality is significantly degraded by motion artifact. There is no evidence of large acute intracranial hemorrhage, or mass effect. There is slight increased signal of the posterior limb of the left internal capsule on the diffusion weighted imaging, but there is no corresponding increased T2 signal abnormality. Given extensive motion artifact, this is favored to be artifactual. There are scattered patchy areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.Significant motion artifact limits evaluation. No evidence of large acute intracranial hemorrhage or mass effect.2.Mild increased signal of the posterior limb of the left internal capsule on the diffusion weighted imaging, without corresponding increased T2 signal abnormality, is favored to be artifactual and related to extensive motion. Consider repeat of the diffusion weighted imaging when the patient is able.3.Scattered foci of abnormal T2 signal abnormality in the periventricular and subcortical white matter, which are nonspecific, but most consistent with moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Chiari malformation. Status post decompression. Annual follow-up of syrinx. Cervical spine:There are postoperative findings related to Chiari decompression surgery. The cerebellar tonsils display an unchanged configuration and position. There is preserved biphasic flow across the anterior neo-foramen magnum. There is mild but easily detectable CSF flow across the posterior craniocervical junction which is unchanged. There is a long-segment cervicothoracic syrinx which is not significantly changed in the cervical region since the previous examination.There is unchanged loss of the usual cervical lordosis and a small posterior disc-osteophyte complex at C5-6 without significant spinal canal stenosis. The vertebral bone marrow signal characteristics are unchanged without suspicious focality. There is no vertebral body height loss. Thoracic spine:The thoracic component of the syrinx is stable to slightly improved in some areas. There is no significant thoracic degenerative disease. The vertebral bone marrow signal characteristics are unchanged without suspicious focality. There is no vertebral body height loss.

Output: 1.Unchanged postoperative findings related to Chiari decompression. The CSF space at the foramen magnum is well expanded and CSF flow is seen both anterior and posterior to the spinal cord and brainstem.2.Stable to mildly improved cervicothoracic syrinx.


Instruction: Generate impression based on findings.

Input: Male 42 years old Reason: Examine distal pancreas to r/o evidence of malignancy History: recurrent pancreatitis, cystic lesion in tail ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Biliary tree is without diagnostic abnormality.SPLEEN: No significant abnormality noted.PANCREAS: There is focal enlargement of the pancreatic tail with small cystic focus representing measuring 7 x 7 mm. Previously this measured 1.0 x 0.9 cm. This area has slight abnormal enhancement. This is similar sized lesion adjacent to this at the tip of the tail. The peripancreatic inflammation has mostly resolved. Splenic vein is patent. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Improvement in the pancreatic inflammation involving the tail.2.Cystic pancreatic focus in the pancreatic tail is decreased in size.3.Persistent mild enlargement of the pancreatic tail with slight abnormal enhancement but no definite underlying lesion. A follow-up exam in 6 weeks to 3 months after the resolution of the pancreatitis is recommended.


Instruction: Generate impression based on findings.

Input: History of Whipple procedure for a benign obstructing ampullary mass, specifically a pancreatic type IPMN. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a Whipple procedure including a hepaticojejunostomy. No intrahepatic or extrahepatic biliary ductal dilatation. The liver is normal in morphology, size, signal intensity and enhancement without a discrete lesion.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes of a Whipple procedure with pancreatico-enterostomy.There is interval increase in near diffuse pancreatic ductal dilatation up to 8 mm (series 12/4). There is a focal narrowing at the level of the residual pancreatic body with approximately 50% caliber change (series 7/48).No stigmata of acute or chronic pancreatitis. No measurable peripancreatic fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes of the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Interval increase in near diffuse pancreatic ductal dilatation up to 8 mm without an obstructing mass/lesion suggesting stenosis at the pancreatico-enterostomy anastomosis. There is also an approximately 50% focal stenosis at the level of the residual pancreatic body.2.No stigmata of acute or chronic pancreatitis. No fluid collection.3.Hepaticojejunostomy without evidence of complication.


Instruction: Generate impression based on findings.

Input: Chronic bilateral otalgia and headache. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is atrophy of the imaged part of the right parotid gland.Internal auditory canals: The bilateral cranial nerve 7 and 8 complexes are intact. The anterior inferior cerebellar arteries loop within the internal auditory canals. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1.No intracranial hemorrhage, mass, or acute infarct. 2.No evidence of retrocochlear or inner ear lesions.3.Atrophy of the right parotid gland may reflect previous inflammation/infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Several sequences are mildly limited by motion artifact. There is no restricted diffusion to suggest acute infarction. There is redemonstration of increased T2/FLAIR signal abnormality within the left mesial temporal lobe including the left inferior aspect of the left hippocampal body and left parahippocampal gyrus which is not significantly changed since the 3/8/2011 exam. There is a new subcentimeter focus of increased T2/FLAIR signal within the right head of the caudate likely representing a new but chronic lacunar infarct. No additional new intraparenchymal focal signal abnormalities are identified. There is no evidence of intracranial hemorrhage or mass effect. 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. Small mucous retention cysts are present within the bilateral maxillary sinuses. The midline structures and craniocervical junction are within normal limits.

Output: 1.No evidence of acute infarct. T2/FLAIR hyperintensity involving the right caudate head likely represents a chronic lacunar infarct but is new since 8/11/2011.2.Redemonstration of signal abnormality in the left medial temporal lobe which is favored to represent sequela of prior injury.


Instruction: Generate impression based on findings.

Input: Dedicated images through the sella demonstrate a normal size of the pituitary gland. No focal abnormal signal intensity or mass is seen within the pituitary gland. There is normal homogeneous enhancement. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.Images of the brain demonstrate no intracranial mass or mass effect. No parenchymal signal abnormality. No evidence of ischemia or hemorrhage. No extra-axial collections. Ventricles are normal in size. The midline structures and craniocervical junction are within normal limits. Major flow-voids are preserved. There is mild left sphenoid sinus opacification. Bone marrow signal and extracranial soft tissues are otherwise grossly unremarkable.

Output: No evidence of pituitary micro- or macroadenoma. Noncontrast evaluation of the brain is also unremarkable.


Instruction: Generate impression based on findings.

Input: History of end-stage renal disease. Renal cell carcinoma status post bilateral nephrectomy. Lack of intravenous contrast limits evaluation for solid organ, bowel and vascular pathology.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Small volume of perihepatic ascites.SPLEEN: Small volume perisplenic fluid.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post bilateral nephrectomy. No discrete soft tissue mass in the nephrectomy bed to suggest recurrent or residual tumor.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination. No evidence of recurrent or residual tumor within the limitations of a nonenhanced study.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with Chiari malformation. Postoperative findings are seen compatible with Chiari decompression. A suboccipital craniectomy and resection of the posterior arch of C1 have been performed. A small fluid collection is seen within the posterior operative soft tissues along with some bubbles of air.The caliber of the foramen magnum has been expanded. The cerebellar tonsils demonstrate changes likely related to cautery. The CSF space at the foramen magnum does, however, remain narrow, and on CSF flow imaging, minimal if any flow related signal is seen at this level. Outside of the posterior fossa, no areas of significant parenchymal signal abnormality are seen. No edema or mass effect is detected. The lateral ventricles remains slightly prominent but this finding is unchanged.

Output: Findings are seen compatible with recent Chiari decompressive surgery. A small fluid collection in the posterior soft tissue operative bed could represent a small pseudomeningocele or possibly just a seroma. The foramen magnum has been expanded, though the CSF space remains narrowed and there is no significant CSF flow through this level. A repeat imaging after the resolution of postoperative edema will likely provide a better assessment of the decompression.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, status post cervical fusion with neck pain and stiffness. Evidence of anterior instrumented fusion is seen across C5-6. Slight reversal of the cervical lordosis may be in part positional. Other than surgical changes, vertebral body morphology is within normal limits. No pathologic marrow replacement or edema is observed.The visualized spinal cord shows intensity and morphology. No epidural lesions are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Small central disc osteophyte which may just contact the ventral cord but causes no significant generalized spinal canal compromise. The neural foramina are patent. C5-6: No spinal canal stenosis or neuroforaminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation asymmetric to the right. No significant spinal canal or foraminal compromise. C7-T1: Left facet arthropathy. No significant spinal canal compromise. Mild left foraminal narrowing.

Output: 1.Postoperative findings compatible with C5-6 anterior instrumented fusion.2.Mild central disc osteophyte formation at C4-5 without significant spinal canal or foraminal compromise.3.Facet arthropathy on the left at C7-T1 which causes mild narrowing of the neural foramen.


Instruction: Generate impression based on findings.

Input: 72 year old man with history of sickle cell anaemia, referred for evaluation of myocardial iron overload. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 185 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19). There is mild left ventricular hypertrophy. 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. T2 Star time in the interventricular septum is 32ms, which is not consistent with myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 101 ml/m2 (normal range 82+/-16), the RVEDV is 95 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 105 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is evidence of a right pleural effusion and groundglass opacities in bilateral lung fields. Please see recent dedicated CT chest for further details. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%.2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. T2 Star time in the interventricular septum is 32ms, which is not consistent with myocardial iron overload.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 73-year-old male with ongoing pain in the left knee. MENISCI: The posterior horn of the medial meniscus is markedly disrupted with a small remnant remaining.ARTICULAR CARTILAGE AND BONE: There is loss of the hyaline cartilage along the surface of both the femur and tibia medially. There is is loss of hyaline cartilage along the medial facet of the patella. There is thinning along the lateral facet.There is significant bone marrow edema within both the femur and tibia in the medial compartment. There is a small amount of bone marrow edema within the patella centrally.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Severe degenerative changes of the left knee as described above.


Instruction: Generate impression based on findings.

Input: 79 year-old female with dizziness and nausea for 5 days. Evaluate for stroke. There is no evidence of intracranial hemorrhage, mass or edema. Posterior right occipital hypodensity with extension to the cortex and adjacent ventricular compensation, consistent with previous stroke. No evidence of new cortical stroke. Multiple areas of diffuse periventricular and subcortical white matter hypodensity consistent with small vessel ischemic disease. 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: 1. Small vessel ischemic disease and previous old stroke without evidence of new cortical stroke.2. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 49 year old female with medullary thyroid cancer. Measure left parotid and left paratracheal lymph node. HEAD CT:Previously seen area of linear hypodensity involving the left parietal occipital region is again noted and unchanged compatible with known metastasis in this area seen on 12/10/07 that has been treated with radiosurgery. This residual hypodensity is most likely due to subsequent infarction. There is no definite enhancing mass lesion on this CT as was seen on the MRI. No new areas of vasogenic edema. The ventricles are normal and midline. The visualized calvarium and skull base are normal. There is mild opacification of the ethmoid air cells that is unchanged.No abnormal extra-axial fluid collections are identified. The ventricles are normal in volume and are midline.NECK CT:The previously described enhancing left parotid mass is again seen and appears slightly smaller in the same location where it was previously measured. The current measurements are 2.7 x 1.3 cm (image 43/1 on one). It is difficult to separate from the adjacent normal parotid gland. There are areas of circular hyperdense regions further superiorly that also appears slightly smaller. There is surrounding enhancing lymphadenopathy that is unchanged especially in the left parapharyngeal region. The fascial planes are within the left and a continue to be effaced with a mild amount of fat stranding in the subcutaneous tissues. Postsurgical changes of a radical left neck dissection are stable.High density within the left the region compatible with prior silicone injection, stable.The visualized lung apices are normal. There is an enlarged right paratracheal lymph node that is incompletely evaluated but appears slightly smaller in comparison to the prior examination measuring approximately 17x 8 mm (image 99/11). Please refer to the dedicated chest CT report performed at the same time. The visualized osseous structures are normal.

Output: 1. Stable region of encephalomalacia in the left parieto-occipital region most compatible with infarction post radiosurgery of a metastatic lesion in this area.2. Decreasing multi-loculated rim enhancing left parotid mass with stable surrounding lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Ms. Warshaw is a 27 year-old female with history of BRCA mutation, found to have a new area of mammographically occult linear nonmass enhancement in the left lateral breast at the 3:00 position. Patient presenting for MRI guided biopsy.. On subtraction images, there is a subtle 2 cm area of non masslike enhancement in the left lateral breast which becomes more conspicuous on the delayed postcontrast image. This finding corresponds to previously reported finding on MRI study of 7/21/2016. This was chosen as a target.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor with the aid of DynaCad software. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 6 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen digital radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a left unilateral digital mammogram CC and ML views to locate the percutaneously placed clip. The clip is appropriately located with respect to the biopsied target, and is located in the left upper outer breast with no evidence of any complications due to the procedure. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Tremblay under direct supervision of Dr. Sheth who was present throughout the procedure.

Output: Successful MR guided core needle biopsy of the enhancing lesion at 3 o'clock in the left breast. Successful clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other malaise and fatigueClinical question: stroke, MS flare?Signs and Symptoms: left side weak There is a focus of diffusion restriction measuring approximately 6 mm in size located in the right centrum semiovale and subcortical white matter of the right precentral gyrus.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.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Many of these are perpendicularly oriented to the lateral ventricles. Additional T2 and FLAIR sequence high signal foci are present in the internal capsules and brainstem.Subdural effusions in the posterior fossa are likely related to atrophy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a small focus of diffusion restriction in the subcortical white matter adjacent to the right precentral gyrus compatible with acute infarction.2.There are periventricular and subcortical white matter lesions as well as lesions in the internal capsules and brainstem present of a mild to moderate degree which are compatible with patient's clinical history of multiple sclerosis. Compared to the previous exam there is no significant change3.There is no evidence for acute demyelinating plaque.


Instruction: Generate impression based on findings.

Input: 64 year old with history of right lumpectomy at an outside hospital in 2005 for IDC and right simple mastectomy in February 2013 for recurrent IDC. Status post right mastectomy.There is heterogeneous amount of fibroglandular tissue in the left breast.Minimal parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in the left breast or in the right mastectomy bed. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Dedicated images through the sella demonstrate a normal height of the pituitary gland. No focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.Patient is status post left sided craniotomy. Previously demonstrated left infratemporal fossa mass and left intraorbital tumor component is incompletely visualized in the current exam. Please refer to dedicated MRI dated 12/23/2015 for details.There is opacification of the left mastoid air cells.

Output: 1. No abnormal lesions are identified in the pituitary gland.. 2. Please refer to dedicated MRI dated 12/20/2015 for the details pertaining to the left infratemporal fossa mass and intraorbital extension.


Instruction: Generate impression based on findings.

Input: Clinical question: left-sided CVA. Signs and symptoms:left headaches, indeterminant right arm numbness. Nonenhanced head CT:Examination demonstrates extensive periventricular and subcortical low attenuation white matter. Findings are nonspecific however with no appreciable interval change since prior CT and MRI exams. There is no evidence of intracranial hemorrhage mass effect, midline shift or hydrocephalus.Calvarium is intact. Paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of an acute intracranial findings.2.Extensive periventricular and subcortical low-attenuation of white matter.


Instruction: Generate impression based on findings.

Input: 21 years, Female, with cystic lesion in the left frontal brain on CT. A left frontal approach ventriculostomy shunt catheter is redemonstrated with the tip terminating in the anterior horn of the left lateral ventricle near the midline. A focal area of susceptibility artifact at the level of the catheter tip may relate to calcification or tiny metallic component. The ventricles are again diffusely dilated since 9/25/2003, but unchanged since 8/24/2016. The 4 cm cystic fluid collection in the white matter of the left frontal lobe, which surrounds the ventriculostomy catheter is again noted. This lesion demonstrates signal characteristics identical to CSF on all sequences. No enhancing component is identified. There is associated mild mass effect on the frontal horn of the left lateral ventricle with downward displacement and minimal, 6 mm, rightward midline shift at the level of the cyst. There also appears to be septation/loculation of fluid involving the frontal horn and body of the left lateral ventricle. Surrounding T2 hyperintense signal may reflect edema and/or gliosis. There is also linear area of gliosis demonstrated in the right frontal lobe, presumably related to old right frontal approach ventriculostomy catheter. Fourth ventricle also noted to be dilated as seen on recent CT. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage is noted. There is no solid or suspicious enhancing intracranial mass identified. 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: 1. CSF fluid collection surrounding the left transfrontal approach ventriculostomy catheter in the left frontal lobe as seen on prior CT of the head. Mild associated mass effect and surrounding edema and/or gliosis. No evidence of superimposed infection.2. Mildly dilated ventricular system as seen on recent CT including the fourth ventricle. There is also suggestion of septation within the left lateral ventricle.


Instruction: Generate impression based on findings.

Input: Metastatic carcinoma, preop planning for tumor resection. There are postoperative findings related to right frontal and right suboccipital craniotomy. There is minimal linear intrinsic T1 hyperintensity versus enhancement along the margin of the right temporal lobe resection cavity. There is a lesion in the right cerebellar hemisphere that measures up to 10 mm. There is also a lesion in the right occipital lobe that measures up to 20 mm. There is a small right middle frontal gyrus developmental venous anomaly. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Skin-based fiducial markers are present.

Output: Pre-treatment planning sequences demonstrate postoperative findings in the right anterior temporal lobe and right cerebellar hemisphere, with a subcentimeter lesion in the right cerebellar hemisphere treatment bed, and a lesion in the right occipital lobe compatible with metastases, but no convincing evidence of recurrent tumor in the right temporal lobe.Discussed with Dr. Chmura at 11:45 AM on 5/14/15.


Instruction: Generate impression based on findings.

Input: 55-year-old male with a smoldering myeloma screening for clinical trial. Multiplanar multisequence MRI of the pelvis was performed before and after administration of 18 cc's of intravenous Mulithance per the research protocol.

Output: Multiplanar multisequence MRI of the pelvis was performed before and after administration of 18 cc's of intravenous Mulithance per the research protocol.


Instruction: Generate impression based on findings.

Input: 36 year old male with worse headache of life No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Images through posterior fossa demonstrate slight bony remodeled all foramina magnum with crowding of the cerebellar tonsils at the level of foramina magnum. This findings are suspected for ectopic cerebellar tonsils. This finding can be further evaluated with a dedicated MRI of brain.Calvarium, paranasal sinuses and mastoid air cells are unremarkable

Output: 1.No evidence of acute findings.2.Highly suspected Chiari malformation. Further evaluation with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Grade III oligodendroglioma with 1p19q deletion, status post treatment. There are postoperative findings related to right frontal lobe tumor resection. There is unchanged confluent T2 hyperintensity along the margins of the resection cavity, as well as scattered foci of susceptibility effect in this region, but there is no abnormal nodular enhancement. There is also a small amount of confluent periventricular white matter T2 hyperintensity along the frontal horn of the left lateral ventricle. There is no evidence of acute intracranial hemorrhage or acute infarct. The brainstem and cerebellum appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No evidence of intracranial tumor progression.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of prostate cancer. Right base medial 4+3, right base lateral 4+3, right apex lateral 3+3. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.6 x 3.0 cm.Peripheral Zone: There is diffuse hemorrhage throughout the midgland peripheral zone, likely related to recent biopsy, which limits evaluation. There is focal hemorrhage in the right lateral base.There is a T2 hypointense focus with associated restricted diffusion in the left mid gland with surrounding hemorrhage measuring 4 x 4 mm. Additionally, in the right base there is a T2 hypointense lesion with associated restricted diffusion extending into the left base measuring 8 x 4 mm.Linear T2 signal extends from the peripheral zone into the neurovascular bundle, however given the morphology, this is not felt to represent tumor.Central Gland: BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left mid gland and right/left base peripheral lesions are suspicious for adenocarcinoma. No evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Right knee pain and stiffness Examination is limited by motion artifact and by the patient's body habitus precluding the use of a dedicated knee coil.MENISCI: There is maceration of the posterior horn of the medial meniscus with absence of much of the body reflecting extensive tearing. The anterior horn appears relatively intact. The lateral meniscus appears preserved.ARTICULAR CARTILAGE AND BONE: There is extensive articular cartilage loss of the medial compartment and both the tibial and femoral components. There is diffuse thinning of the articular cartilage of the lateral compartment but within the limits of the exam, we see no discrete full-thickness defect. There is diffuse thinning of the articular cartilage of the patellofemoral compartment with scattered areas of partial-thickness degeneration. There are large tricompartmental osteophytes. There is diffuse marrow edema throughout the medial compartment which is likely degenerative in nature.LIGAMENTS: There is poor visualization of the ACL although there are some fibers seen traversing the intercondylar notch and this is likely the result of extensive mucoid degeneration. The PCL is intact. The collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are relatively intact.ADDITIONAL

Output: 1. Severe osteoarthritis of the knee particularly the medial compartment.2. Extensive tearing of the medial meniscus.3. Mucoid degeneration of the ACL.4. Moderate joint effusion with mild synovitis.


Instruction: Generate impression based on findings.

Input: Again seen are postoperative changes related to resection of a left frontal periventricular lesion. Postsurgical changes of left-sided subdural shunt catheter placement are also again seen. Catheter tip is within the left-sided subdural collection. Compared to most recent CT from 5/2/2016, subdural collections are similar measuring approximately 9 mm on the right and 18 mm on the left, but decreased since prior MRI from 4/4/2016. The ventricular system is decreased since CT dated 5/2/2016, for example the lateral ventricles measure 29 mm in the transverse dimension, previously approximately 51 mm. Third and fourth ventricles have also significantly decreased in size in the interval. Blood products in the posterior aspect of the lateral ventricles are again seen with signal abnormality on the current study which may be related to chronic dependent blood products, although more acute blood products are not definitively excluded. There are no findings to definitively suggest new hemorrhage. Extensive low T2 signal throughout the surface of the brain with susceptibility effect most compatible with superficial siderosis is again noted and not grossly increased in the interval since prior MRI from 4/4/2016. Note there is extensive artifact related to the subdural shunt with limits evaluation on the susceptibility weighted sequence.Interval decrease in periventricular T2 hyperintensity is noted since prior MRI likely reflecting improvement in hydrocephalus with decrease in transependymal flow. Mild apparent diffusion restriction along the right lateral ventricle margin may be related to blood products.Additional findings including bilateral frontal porencephaly and communication of the CSF spaces with the extra-axial collections are again noted. Extra-axial CSF collection/arachnoid cysts in the posterior fossa are not significantly changed. No significant midline shift or herniation. Major vascular flow voids are preserved. Maxillary sinus mucus retention cysts again seen.

Output: 1. Extensive supra- and infratentorial superficial siderosis is again seen and may explain hearing loss. No findings to suggest worsening siderosis or new hemorrhage since prior.2. Bifrontal porencephaly with CSF spaces communicating with subdural collections again seen. There is interval decrease in ventriculomegaly compared to most recent CT from 5/2/2016. Bilateral subdural collections are similar to most recent CT 5/2/2016 and decreased since MRI 4/4/2016.


Instruction: Generate impression based on findings.

Input: There is loss of the normal cervical lordosis with straightening of the cervical spine. No cord signal abnormality seen. A focus of T1 hyperintensity is seen at C7, which may represent focal fat versus small hemangioma. There is a nonspecific focus of low T1 and T2 signal intensity involving the left lateral aspect of T1 vertebral body, possibly a sclerotic lesion such as bone island.C2-C3: No significant spinal canal or neural foraminal compromise. C3-C4: No significant spinal canal or neural foraminal compromise.C4-C5: Trace disc bulging with no evidence of spinal canal or neural foraminal compromise.C5-C6: There is mild disc bulge which partially effaces the ventral thecal sac. Widely patent dorsal thecal sac. No significant spinal canal or neural foraminal stenosis. C6-C7: Trace disc bulging with no spinal canal or neural foraminal compromise.C7-T1: No spinal canal or neural foraminal compromise.

Output: Minimal degenerative changes in the cervical spine. No significant spinal canal or neural foraminal stenosis. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Left hip pain and cyst There is moderate to severe osteoarthritis affecting the left hip. A collection of rim-enhancing fluid is seen inferior to the femoral head with a tail that extends towards the femoral neck. This collection measures 2.6 x 1.5 cm in the transverse dimension and 1 cm in the craniocaudal dimension and we suspect this reflects inflammation of the obturator externus bursa. There is relatively little fluid and synovitis within the hip joint itself. There is mild osteoarthritis affecting the right hip.The bone marrow signal of the remaining pelvis is otherwise normal. The remaining musculature of the hip is also normal. The large field-of-view images demonstrate the presence of a right inguinal hernia which may contain a loop of bowel although this is better appreciated on the comparison CT. Note is made of a fibroid uterus, the largest measuring approximately 5.5 cm. Multiple flow-voids within the pelvis adjacent to the uterus may reflect pelvic congestion. There is a small amount of free fluid in the pelvis.

Output: Osteoarthritis of the left hip with left obturator externa bursitis and additional findings described above.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. There is a heterogeneously enhancing, low T1 and T2 signal intensity left temporal region calvarium lesion that measures up to 5 cm in length with epidural extension that measures up to 7 mm in thickness. There is mild miss effect upon the underlying brain parenchyma. There also appears to be mild subgaleal extension of tumor. There is no evidence of intracranial hemorrhage or acute infarct. There is mild nonspecific periventricular cerebral white matter T2 hyperintensity, but no evidence of intraparenchymal enhancing lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Left temporal calvarium region metastasis with epidural extension measuring up to 7 mm in width.


Instruction: Generate impression based on findings.

Input: Atypical meningioma: surveillance. There are interval postoperative findings related to posterior parietal cranioplasty for resection of recurrent meningioma. There is interval increase in size of the heterogeneously enhancing mass in the resection cavity that measures up to approximately 70 mm overall, previously approximately 50 mm. There is extensive vasogenic edema in the surrounding brain parenchyma. There is persistent prominent leptomeningeal enhancement, with increase in size and number of small nodular enhancing foci in the left precuneus. There is also sulcal prominent susceptibility effect in the right frontal and left parietal lobes, which may represent chronic hemorrhage or cortical vein thrombosis. There are unchanged scattered foci of nonspecific cerebral white matter T2 hyperintensity in the anterior frontal lobes. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are bilateral lens implants. There are persistent secretions in the left frontal sinus.

Output: Postoperative findings related to parietal convexity meningioma resection with interval increase in size of the tumor and extensive vasogenic edema in the surrounding brain parenchyma, as well as what appears to be regional leptomeningeal tumor spread.


Instruction: Generate impression based on findings.

Input: 14-year-old female with history of tuberous sclerosis.EXAMINATION: MR kidneys without and with intravenous contrast 12/16/2016 Exam is limited slightly by patient motion.Previously noted subtle faint area of increased T2 signal intensity in the periphery of the right hepatic lobe is not present on today's exam; its evaluation is slightly limited by patient motion. The gallbladder is normal. No intra or extrahepatic biliary ductal dilatation.The pancreas is normal with no pancreatic ductal dilatation.The spleen is normal.The adrenal glands are symmetric and normal.Exophytic lesion in the in the right mid kidney anteriorly demonstrating low signal intensity on the fat saturated sequences compatible with an angiomyolipoma is unchanged measuring 17 mm (series 501, image 12). Additional smaller lesion more posterior laterally measures 9 mm is also unchanged (series 501, image 12). Two 5-mm lesions in the midportion of the left kidney demonstrating low signal intensity on the fat saturated sequences likely additional angiomyolipomas are also unchanged (series 501, image 21). Numerous bilateral subcentimeter cysts are present. No hydronephrosis. No new renal lesions are present.Bone marrow signal intensity is normal.The soft tissue are normal.

Output: Bilateral angiomyolipomas and subcentimeter cysts are unchanged.


Instruction: Generate impression based on findings.

Input: Reason: eval for signs of portal hypertension and cirrhotic morphology History: s/p liver transplant for histiocytosis X, biopsy in 2008 at NMH showed stage 3 fibrosis ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of liver transplantation. The biliary enteric anastomosis appears normal. No intrahepatic biliary ductal dilatation. No evidence of cirrhosis. No suspicious hepatic lesions. No findings to suggest portal hypertension.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left cortical cystic lesions are 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: Status post liver transplant without evidence of cirrhosis or findings to suggest portal hypertension.


Instruction: Generate impression based on findings.

Input: Abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size. Loss of signal intensity on in-phase imaging, suggests iron deposition. No focal suspicious lesion.The common duct measures 7 mm and tapers smoothly to the level of the ampulla. No cholelithiasis or choledocholithiasis. Normally distended gallbladder without evidence of gallbladder inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant biliary ductal dilatation, gallstones/choledocholithiasis or obstructing lesion.2.Findings suggesting iron deposition may be related to prior blood transfusions.


Instruction: Generate impression based on findings.

Input: Reason: h/o whipple surgery, 2015. Had f/u CT scan on last year. New find of subtle enhancing lesion of the right gluteal minimis measuring 1x1x4. Please evaluate History: none There is a small mass within the right gluteus minimus muscle measuring 1.6 x 1.3 x 4.0 cm (AP x TR x CC). It is slightly hyperintense to skeletal muscle on T1-weighted images and hyperintense to skeletal muscle on T2-weighted images and demonstrates uniform enhancement following contrast administration. Superiorly, there appear to be streaky foci of high signal intensity within the lesion that we suspect represent peripheral and septal fat overgrowth that may be seen with venous malformation ("intramuscular hemangioma"). Subjectively, the size of the mass appears similar to that of the CT examination from 4/7/16 and we are not convinced of interval growth. We see no additional soft tissue masses. There is a small amount of fluid within the right iliopsoas bursa. The bone marrow signal intensity is within normal limits. There is a small round focus of signal heterogeneity in the right ilium adjacent to the right sacroiliac joint which may represent a degenerative cyst. Degenerative disc disease affects the lower lumbar spine. Mild osteoarthritis affects the hips and pubic symphysis. Note is made of a fat-containing left inguinal hernia.

Output: Small mass in the right gluteus minimus muscle as described above. The mass has some characteristics that are suggestive of a venous malformation/intramuscular hemangioma, however, if previous outside CT examinations or MRI examinations are available, we would recommend obtaining those scans for comparison. If prior examinations are not available for comparison, and interval change cannot be excluded, then referral to orthopedic oncology and possible subsequent biopsy may be considered.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with persistent low back pain with radiation. A grade 1 anterolisthesis of L4 relative to L5 is demonstrated. Spinal alignment is otherwise unremarkable.Schmorl's node deformities are present at L3-4. Vertebral body morphology is otherwise within normal limits. No evidence of concerning marrow replacement or marrow edema is demonstrated.The visualized spinal cord, conus and cauda equina are within normal limits except as discussed below.T11-12: As visualized on sagittal images only, mild bulging disc with mild foraminal narrowing but no significant spinal canal stenosis.T12-L1: Unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy. Minimal bulging disc. No significant spinal canal or neuroforaminal stenosis. L4-5: Severe facet hypertrophy with ligamentum flavum thickening. Disc bulging and disc uncovering. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L5-S1: Moderate facet hypertrophy. Mild bulging disc. No significant generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing.

Output: Disc degeneration at L4-5 with disc bulging and uncovering, in combination with marked posterior element hypertrophy, result in a significant spinal canal stenosis with crowding of the cauda equina.Moderate right and mild left foraminal narrowing at L4-5, with severe right and moderate left foraminal narrowing at L5-S1.


Instruction: Generate impression based on findings.

Input: Reason: known cervical disc disease, syncope and fall, pain and decreased ROM since, assess for disc disease and fracture. History: known cervical disc disease, syncope and fall, pain and decreased ROM since, assess for disc disease and fracture. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk dessication present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is loss of disk space height associated with some endplate and uncovertebral osteophytes.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is loss of disk space height associated with some endplate and uncovertebral osteophytes.At C4-5 there is no significant compromise to the spinal canal. There is loss of disk space height associated with some endplate and uncovertebral osteophytes. There is narrowing of the left neural foramen with some encroachment of the left exiting nerve roots which has not significantly progressed since 2008.At C5-6 there is no significant compromise to the spinal canal. There is loss of disk space height associated with some endplate and uncovertebral osteophytes. There is narrowing of the neural foramina at this level which has minimally changed since the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is loss of disk space height associated with some endplate and uncovertebral osteophytes.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes in the cervical spine associated with encroachment of exiting nerve roots on the left side at C4-5 and bilaterally at C5-6. This has minimally progressed wince the prior exam in 2008.


Instruction: Generate impression based on findings.

Input: 31 years Male (DOB:8/8/1984)Reason: Please perform Dr Javed MS protocol (with DTI) History: PML due to idiopathic lymphopeniaPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD There is redemonstration of T2 signal hyperintensity involving the subcortical and periventricular white matter of the right occipital lobe and parietal lobe, the splenium of the corpus callosum and to lesser degree the subcortical and periventricular white matter of the left occipital lobe and left parietal lobe. Additionally there is T2 and FLAIR signal hyperintensity present along the posterior aspect of the left superior frontal gyrus and to lesser degree left middle frontal gyrus. When compared to the 6/11/2016 exam the extent of these signal hyperintensities has mildly progressed despite the short time interval especially when one looks at the left middle frontal gyrus and left superior frontal gyrus. On the right side there appears to be some extension into the posterior most aspect of the right paracentral lobule subcortical white matter which is relatively new. 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 in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam of 6/11/2016 there appears to be some mild further extension of white matter disease into the left frontal lobe and right paracentral lobule. This compatible mild progression of the patient's clinical diagnosis of PML.


Instruction: Generate impression based on findings.

Input: Reason: 52M w/ rectal CA s/p TEM for routine surveillance History: as above PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral hip arthroplasty devices and posterior stabilization rods in the lower lumbar spineOTHER: Trace amount of free fluid in the pelvis.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Biopsy proven left breast cancer and metastatic left axillary lymph node. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally. The marked background enhancement is a limitation to this study. The proven malignancy in the left upper breast near 12:00 is seen as an irregularly enhancing mass with internal artifact from the Hydromark biopsy clip and measures 2.1 x 2.3 x 2.1 cm. Mild enhancement extending towards the skin from this mass is likely related to the recent biopsy. There is an additional mass in the left lower outer breast that measures 1.6 x 1.2 x 1.2 cm. Also, inferior to the index mass near the central 9:00-9:30 position is a smaller enhancing mass measuring up to 7 mm that has a lack of central enhancement. This may represent a benign etiology such as peripherally enhancing cysts. Within the right breast, an area of rounded enhancement in the lower inner quadrant may represent globular parenchyma. This measures 1.7 x 1.5 x 1.2 cm. The two biopsied lymph nodes in the left axilla are seen and measure 1.1 and 1.6 cm respectively. It is noted also that lymph nodes in the right axilla are at least as large as those on the left and have mildly thickening cortices of at least 5 mm. Representative nodes measure up to 1.6 and 2.0 cm. A high T2 signal left hepatic lobe lesion is probably benign such as a cyst or hemangioma.

Output: Marked background enhancement in this patient with newly diagnosed left breast cancer, with the index mass measuring up to 2.3 cm. The background enhancement limits this exam. However, the following additional findings should be further evaluated with MRI directed ultrasound:1. A 1.6 cm mass in the left lower outer quadrant. If no ultrasound correlate is found, then MRI guided biopsy would be necessary. 2. A 7 mm enhancing lesion in the central left 9:00-9:30 position. If no ultrasound correlate is found, then 6 month MRI should be considered.3. A right lower inner quadrant 1.7 cm area of enhancement that more likely represents globular parenchyma and could also be followed on MRI if ultrasound is negative.4. Right axillary lymph nodes, which are as prominent or more so than the proven left axillary metastatic lymph node. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Lumbar spine CT for planning pedicle screw fusion at L4-L5. There is grade 1 anterolisthesis of L4. Vertebral body heights are maintained. Multilevel anterior osteophytes are consistent with osteoarthritis. The caliber of the lumbar spinal canal appears small.At L1/L2, L2/L3, and L3/L4, there is mild diffuse disk bulge and disk space narrowing without significant compromise to the spinal canal or neural foramina. Schmorl's nodes are again identified at the superior endplate of L2 and inferior endplate of L3.At L4/L5 there is grade 1 anterolisthesis of L4. In addition, there is a diffuse disk bulge, subchondral sclerosis, bilateral facet and ligamentum flavum hypertrophy causing moderate to marked central spinal stenosis and bilateral encroachment of the lateral recesses, right greater than left. Neural foraminal narrowing is identified on the right. Synovial cyst identified at this level on the prior MRI is not identified on today's CT.At L5/S1, there is diffuse disk bulge and loss of disk space height without compromise to the central spinal canal or neural foramina.

Output: Degenerative changes most prominent at L4-L5 consisting of a diffuse disk bulge, hypertrophic facet and ligamentum flavum changes, and mild anterolisthesis causing central spinal stenosis, encroachment of bilateral lateral recesses, right greater than left, and neural foramina narrowing on the right. The patient had a synovial cyst demonstrated on the prior exam at L4-5. This exam is not sensitive to detecting synovial cyst.