Instruction: Generate impression based on findings.

Input: Male, 15 years old, with low back pain. The pedicles, the superior articulating facets, and to a lesser degree the laminae of L4 are edematous. However, it does not appear that the pars interarticularis are fractured.No other concerning marrow signal change is seen. Vertebral body morphology is within normal limits. The lumbar lordosis is somewhat straightened but this could be positional. Alignment is otherwise unremarkable.The visualized distal spinal cord is unremarkable. The conus tip terminates at the L1 level which is normal. The nerve roots of the cauda equina disperse evenly through the thecal sac. No epidural abnormality is seen.The intervertebral discs demonstrate preservation of height and normal signal intensity. No significant disc bulge or disc herniation is seen. Mild facet arthropathy is demonstrated at L4-5. No spinal canal or foraminal stenosis is seen.

Output: Edema within the pedicles, superior articulating facets and to a lesser degree the laminae of L4 may represent a stress reaction. The pars interarticularis appear to be intact.Mild facet arthropathy is evident at L4-5. Elsewhere, no significant abnormalities are seen.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:1/19/1947)Reason: AMARANTH STUDY SUBJECT - ALZHEIMER'S DISEASE CLINICAL TRIAL History: MEMORY LOSSPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The temporal horns of the lateral ventricles are relatively large. This was also the case on the prior MR of the brain from 8/7/2014. Biventricular diameter is approximately 42 mm on the current exam and similar dimensions on the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A T2 hyperintense lesion is redemonstrated in the right lower midbrain.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 mucous retention cyst in the left maxillary sinus and 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. The eyeball lenses are thin.

Output: 1.There is mild ventriculomegaly present which could be related to brain atrophy though could also related to normal pressure hydrocephalus.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Small lesion in the right midbrain is likely related to old lacunar infarct


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for growth of a GBM. Patient had MRI on 3-24-15 during RT after seizure. Please compare MRI to prior imaging. Signs and symptoms: GBM. Pre- and post enhanced brain MRI:Examination demonstrates interval resolution of previously noted small right frontal subdural and small amount of epidural collection under a right large craniotomy flap.There is also interval decreased size and resolution of blood product within the surgical cavity since prior study.The remaining surgical cavity in the right superior temporal gyrus posteriorly demonstrate iso to hypointense T1 signal and mixed T2 signal intensity content. The cavity measures approximately 39 x 22 mm in transaxial dimensions. It demonstrate a thick irregular focus of enhancement posteriorly measuring approximately 28 x 18 mm in transaxial dimensions measured (post enhanced series 13 image 17) and highly suggestive of residual tumor. There is also an additional solid focus of enhancement along the superior aspect of the surgical cavity measuring at 20 x 20 mm (axial post enhanced series 13 image 14) which is also highly suggestive of tumor regrowth. There is also a small nodular focus of enhancement along the posterior medial aspect of surgical cavity measuring 8 x 8 mm in transaxial dimensions (axial post enhanced series 13 image 14) which is also concerning for residual/regrowth of tumor. A thin mildly irregular band of enhancement surrounds the rest of the surgical cavity. There is extensive surrounding FLAIR hyperintensity in the pattern of vasogenic edema however without significant mass effect and with resolution of previously noted deviation of midline to the left.There is no detectable additional foci of parenchymal or leptomeningeal enhancement.Interval resolution of leftward midline deviation and with stable normal size of the ventricular system.

Output: 1.Interval expected evolution of postoperative changes of right craniotomy with resolution of a small subdural and an epidural collection under craniotomy flap.2.Interval decreased size of right temporal surgical cavity and resolution of acute blood products within the surgical cavity.3.There are multiple solid loculated foci of enhancement along the posterior, superior and medial aspects of the surgical cavity wall all concerning for regrowth of tumor as detailed/measured above.4.Extensive FLAIR hyperintensity surrounding the surgical cavity with slight progression since prior exam however without evidence of significant mass effect and interval resolution of midline shift to the left.


Instruction: Generate impression based on findings.

Input: Please do a portable CT patient is intubated and ventilated. Patient with intracranial hemorrhage or 63 years old. The CSF spaces are appropriate for the patient's stated age. There is redemonstration of a large left basal ganglia hematoma currently measuring 38 x 43 millimeters which measures similar to the prior exam. It is associated with a satellite foci of hemorrhage in the left inferior frontal gyrus measuring about 10 mm x 9 mm also unchanged since prior exam . It is also Associated with a small amount of intraventricular blood in the lateral ventricles. There is mass effect present with shift of the septum pellucidum approximately 2 mm to the right of midline and the shift of the third ventricle approximately a 3 mm the right of midline. The suprasellar cistern appears intact. Since the previous exam the amount of the vasogenic edema associated with this and a focus of hemorrhage appears to be stable.There is a hyperdense focus present in the left temporal lobe anterior pole measuring 10 mm in diameter on the previous exam which is not visible on the current exam. there a hyperdense focus present in the the right precentral gyrus measures approximately 8 mm in diameter and previously measured 5 mm in diameter. A couple are present along the pars marginalis bilaterally each measuring about 4 or 5 mm and several are present along the left superior frontal gyrus which are all adjacent to each other. Overall these have been identified on the gradient echo MRI. It can also be identified on prior CT scan .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.Since the previous exam of there has not been a significant change. There is redemonstration of multiple hemorrhagic foci in both hemispheres. The left basal ganglia lesion is the largest as indicated above. A right precentral gyrus lesion appears slightly larger. A left anterior temporal pole lesion is not identified on the current exam probably due to use of portable CT technique.


Instruction: Generate impression based on findings.

Input: 66-year-old man right native kidney nephrectomy for renal cell seen. Assess contralateral native kidneys for cystic changes and 4 right kidney fossa. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Two lesions in the spleen previously identified on the MR reidentified. One near the splenic hilus which is hypodense on image 29/170 measuring 1.9 x 1.7 cm in the peripheral subcapsular area measuring 2.1 x 1.9-cm which is hypervascular. These likely represent hemangiomas and are unchanged in size from the MRI.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postsurgical changes right renal fossa with no evidence of local recurrence.The left kidney is small with numerous cysts consistent with chronic medical renal kidney disease. Most of the cysts are typical. On the lateral cortex two cysts are high density but do not enhance. These is seen pre-contrast coronal image 51/129 and delayed image 73/114. The larger more cephalad lesion measures 1.6 cm in diameter and it abuts a smaller more caudal lesion measuring 1.4 cm in diameter neither of which show significant change in density.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prominent measuring 6.4-cm transverse by 5.2-cm AP is seen on axial image 137/170.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Renal allograft in the right iliac fossa demonstrates normal nephrogram and excretion. Heavy calcifications surrounding the dorsal aspect of the renal allograft is identified. This could represent a calcified old hematoma or foreign body. Correlate clinically.

Output: No evidence of local recurrence in right renal fossa. None of the lesions in the left kidney is suspicious for neoplasm. Prominent prostate. Calcified structure dorsal to renal allograft correlate with surgical history.


Instruction: Generate impression based on findings.

Input: 20-year old female with history of ACL repair now with laxity on exam. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Postsurgical changes from prior ACL reconstruction with tunnels in the distal femur and proximal tibia. There is bone marrow edema about the posterior tibial plateau and lateral femoral condyle compatible with contusions related to posterior subluxation of the femur relative to the tibia. The articular cartilage is unremarkable.LIGAMENTS: There is intermediate signal abnormality of the remaining superior ACL fibers with complete disruption of the reconstructed anterior cruciate ligament. The PCL, MCL, and LCL complex are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Postsurgical changes of prior ACL reconstruction with tear of the ACL graft.2.Contusions compatible with posterior subluxation of the femur relative to the tibia.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: 58-year-old female with knee pain. Right knee:There is narrowing of the medial tibiofemoral compartment and tricompartmental osteophytes indicating moderate osteoarthritis. There is a 2 cm opacity within the soft tissues medial to the distal femoral metaphysis. Additional soft tissue opacity is seen more inferiorly at the level of the joint line. While this may represent components of a Baker's cyst, it is nonspecific, and further evaluation with MRI could be considered to evaluate for the presence of a soft tissue mass.Left knee:There is medial compartment narrowing and tricompartmental osteophytes indicating moderate to severe osteoarthritis.

Output: 1. Osteoarthritis of both knees.2. Rounded soft tissue density within the medial aspect of the right knee. While this could represent a lobulated Baker's cyst or bursa, further evaluation with MRI could be considered to evaluate for a soft tissue mass.These findings were discussed with Dr. Glick via phone at 12:25 pm on 11/6/15.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with worsening back pain. Assess for spinal stenosis. Spinal alignment is anatomic. Vertebral body morphology is within normal limits. Marrow signal characteristics are mildly heterogeneous, but there is no evidence of concerning marrow replacement or marrow edema. The visualized spinal cord, conus and cauda equina are unremarkable.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small superimposed right paracentral superior extrusion, and a right foraminal protrusion. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disc with a right foraminal and far lateral predominance. No significant spinal canal stenosis. Moderate right foraminal narrowing. L4-5: Severe facet hypertrophy and ligamentum flavum thickening. Minimal bulging disc. No significant spinal canal stenosis. Mild left foraminal narrowing. L5-S1: Severe right and moderate left facet hypertrophy. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: Relatively mild multilevel degenerative disc disease with no areas of high-grade spinal canal or neuroforaminal stenosis.Facet arthropathy does become progressively worse at lower levels, with severe degeneration affecting L4-5 bilaterally and L5-S1 on the right.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to T2-L1 posterior spinal fusion with residual mild scoliosis with a leftward apex at T2-T3 and a rightward apex at T8-T9. There is a slightly heterogeneous T1 and T2 hyperintense posterior epidural fluid collection extending from C3 through T1 that measures up to 4 mm in thickness and results in mass effect upon the central canal, spinal cord, with spinal canal stenosis. There is associated abnormal T2 hyperintensity within the spinal cord at the C5-C6 level. In addition, there is reversal of the normal cervical lordosis and mild posterior disc osteophyte complexes at C4-C5 and C5-C6 that also contribute to the spinal canal narrowing. There are also scattered thoracic epidural blood products without spinal cord compression. The vertebral body and disc space heights are preserved. There is mild paranasal sinus mucosal thickening and minimal fluid within the mastoid air cells. There is T2 hyperintensity within the left lung base and a small right pleural effusion.

Output: 1.Post-operative findings related to T2-L1 posterior fusion and T2-T4 hematoma evacuation. There is a 4 mm thick posterior epidural hematoma at C3-T1 that in combination with reversed cervical lordosis and mild disc disease results in cord compression with abnormal T2 hyperintense cord signal. There are also residual epidural blood products within the thoracic spine without cord compression. 2.Small right pleural effusion and left lower lobe signal abnormality that may represent atelectasis or pneumonia.


Instruction: Generate impression based on findings.

Input: Male; 34 years old. Reason: HCC screening History: cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Mild hypertrophy of the left and caudate lobes of the liver, suggesting a cirrhotic liver morphology. Normal surface contour. No focal hepatic lesions. Mild diffuse fatty infiltration. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst.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: Suggestion of a cirrhotic liver morphology and mild diffuse fatty infiltration, but no focal hepatic lesions.


Instruction: Generate impression based on findings.

Input: Back pain with pain radiating into her right leg; dragging right leg Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Individual levels, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge. Otherwise, no significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Small perineural cyst along the left S2 nerve root incidentally noted.

Output: Examination is essentially unremarkable. Specifically no significant spinal canal or neural foraminal stenosis in the lumbar spine at any level to explain patient's symptoms.


Instruction: Generate impression based on findings.

Input: 26 year old man with history of hypertension, diabetes, sarcoidosis, presenting with new onset heart failure, referred for cardiac MRI for further evaluation of possible underlying etiologies of heart failure. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 174 ml/m2 (normal range: 74+/-15), the LVEDV is 353 ml (normal range 142+/-34), the LV end systolic volume index is 150 ml/m2 (normal range 25+/-9), the LVESV is 306 ml (normal range 47+/-19), the LV mass index is 101 g/m2 (normal range 85+/-15), and the LV mass is 205 g (normal range 164+/-36). LV dysfunction is global with regional variation. Although there is no focal late gadolinium enhancement noted, which would typically suggest no myocardial infiltration, inflammation, or fibrosis, the global relative enhancement (3.0-3.5) and native myocardial T1 times (~1150ms) are both elevated suggesting that there may be diffuse myocardial inflammation or fibrosis.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 23%, the RV end diastolic volume index is 119 ml/m2 (normal range 82+/-16), the RVEDV is 242 ml (normal range 142+/-31), the RV end systolic volume index is 92 ml/m2 (normal range 31+/-9), and the RVESV is 187 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is bi-leaflet tethering of the mitral valve without significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThere is tethering of the tricuspid valve. 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. The IVC is dilated. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions, right greater than left. Mediastinal lymphadenopathy is noted. 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. Severe LV dilation with severely reduced systolic function (LVEF 13%). Although there is no focal late gadolinium enhancement noted, which would typically suggest no myocardial infiltration, inflammation, or fibrosis, the global relative enhancement (3.0-3.5) and native myocardial T1 times (~1150ms) are both elevated suggesting that there may be diffuse myocardial inflammation or fibrosis. Given the clinical context of known sarcoidosis, these findings would support the diagnosis of cardiac sarcoidosis. A cardiac FDG-PET scan may be helpful. 2. Normal RV size with severely reduced systolic function (RVEF 23%). 3. Small pericardial effusion. 4. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with multiple sclerosis and right foot drop. Assess for new lesions. Brain:Several small foci of T2 hyperintensity are again seen in the periventricular white matter and left cerebellum showing no significant change in size. These lesions demonstrate a moderate degree of T1 hypointensity which, at least in regards to the lesion along the left ventricular atrium, has become more conspicuous compared to prior. No new lesions are seen. No significant parenchymal edema or mass effect is detected. There are no abnormal extra-axial fluid collections. The ventricles remain normal in size and shape. Volume of the corpus callosum and the brain in general is relatively preserved.Cervical spine:Vague patchy T2 hyperintensity is again seen through a majority of the cervical spine. The segment spanning from C2 to C3 is particularly affected with evidence of cord volume loss on the left. These findings are unchanged with no evidence of any new cord lesions.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No epidural abnormalities are seen. No significant compromise of the spinal canal or neural foramina is detected.Thoracic spine:Scattered areas of abnormal spinal cord signal are again seen, for example on the right at T3-4, centrally at T6-7 and central left at T8. These pre-existing lesions show no significant interval change, and no new lesions are detected.The thoracic kyphosis is mildly exaggerated. Otherwise, alignment is anatomic. Vertebral body height and morphology are within normal limits. Scattered foci of marrow T2 hyperintensity within numerous vertebral bodies are unchanged and may reflect atypical hemangiomas.A small central disc protrusion is unchanged at T6-7. No significant compromise of the spinal canal or neural foramina is suspected.

Output: 1.Scattered white matter lesions are redemonstrated in the brain showing no significant interval change in size. One lesion, along the left ventricular atrium, demonstrates progressive T1 hypointensity. No new lesions are seen.2.Scattered lesions in the spinal cord are also redemonstrated without significant interval change in size. No new spinal cord lesions are seen.


Instruction: Generate impression based on findings.

Input: There is an unchanged homogeneously enhancing left vestibular schwannoma measuring up to 12 mm. There is no extension through the porus acusticus or into the labyrinthine structures. The right internal auditory canal is intact. There is an unchanged 10 mm diameter cystic pineal gland without nodular enhancement. There are bilateral lens implants. The imaging potions of the skull, including prominent right occipital arachnoid granulations, are unchanged.

Output: No significant interval change in left vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: Reason: 53 yo male with hx of pancreas cyst; please evaluate for changes and or abnormalities History: pancreas cyst. ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: 11 x 7 mm T2 hyperintense cystic lesion at the posterior aspect of the pancreatic body with communication to the main pancreatic duct, unchanged (axial series 4/21). This lesion is remeasured on axial T2 imaging (axial series 4/19 on prior study) due to being poorly visualized on MRCP sequences on the current exam. No suspicious features. Mild atrophy of the pancreatic tail with slight prominence of the pancreatic duct within the tail, not significantly changed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cyst.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: Unchanged posterior pancreatic body cystic lesion, compatible with side branch IPMN.


Instruction: Generate impression based on findings.

Input: Sacral decubitus ulcer, evaluate for osteomyelitis There is a large ulceration of the left gluteal soft tissues which abuts and involves a portion of the left posterior ischium. The posterior ischium demonstrates abnormal signal intensity on both T1 and T2-weighted sequences consistent with osteomyelitis. Abnormal marrow signal intensity also involves a portion of the posterior medial acetabulum but the femoral head is of normal marrow signal intensity. Following contrast administration, there is abnormal enhancement of the posterior ischium and acetabulum reflecting inflammation. There is surrounding soft tissue edema and enhancement reflecting additional inflammation. There is diffuse muscle atrophy and deformity of the pelvis related to the patient's underlying spina bifida.A small left-sided hip joint effusion is present.

Output: Ulceration of the left gluteal soft tissues with osteomyelitis of the left ischium and a portion of the posteromedial acetabulum. The marrow signal of the femoral head is normal.


Instruction: Generate impression based on findings.

Input: Claudication, question neurogenic. Rule out lumbar disc disease and spinal stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is straightening of the lumbar spinal curvature as seen before. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below, overall similar to prior MRI from 2/14/2012L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Disc bulge with central annular fissure, mild bilateral facet arthropathy and ligamentum flavum thickening. There is no significant central spinal canal stenosis. Mild bilateral neural foraminal stenosis. L5-S1: Disc bulge and mild bilateral facet arthropathy. There is partial effacement of the right lateral recess. No significant central spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine are not significantly changed since 2/14/2012. There is no significant central spinal canal stenosis at any level as questioned.


Instruction: Generate impression based on findings.

Input: Known pancreatic lesion. Surgical planning. ABDOMEN:LIVER, BILIARY TRACT: Four lesions are identified within the liver, unchanged in size since prior CT December 17, 2015. The largest is located within segment 7 measuring 2.2 x 1.6 cm (Series 6, image 15), with peripheral contrast enhancement and fill-in on delayed imaging, compatible with a hemangioma. 2 lesions within the hepatic dome are similar in appearance and also likely hemangiomas. A smaller segment 6 lesion measures 0.8 x 0.8 cm (Series 7, image 12), but does not demonstrate contrast enhancement and remains indeterminate. The liver is smooth in contour. There is no biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a complex multilobulated cystic lesion within the pancreas, with the dominant component measuring 5.6 x 4.2 cm (series 6, image 14). An adjacent lobular cystic component measures 1.3 x 1.2 cm (series 6, image 12). The dominant cystic component contains irregular thickening and enhancement of the anterior wall, which was FDG avid on PET/CT August 24, 2015. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Complex cystic lesion within the pancreas with mural nodularity, FDG avid on PET/CT August 24, 2015, compatible with metastatic disease.2.Four hepatic lesions are identified, with the 3 larger lesions most likely hemangiomas. A smaller, subcentimeter lesion in segment 6 is indeterminate, but most likely benign.


Instruction: Generate impression based on findings.

Input: Pain. Positive O'brien's. Question of right shoulder labral tear. ROTATOR CUFF: The rotator cuff tendons and muscles are intact. No muscle atrophy is identified.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. No fluid is is seen within the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is intact. The labrum is intact.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Intact labrum.2. No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Back pain. History of breast carcinoma. Lytic lesions in the vertebral bodies of T1, T7, and L1 levels are seen, correlating with abnormalities seen on prior MRI. The lesion at L1 involves both anterior and posterior elements. In addition, there are also lytic lesions in T2, T3, T4, T10, T11 and T12 vertebrae. There is also a lesion at the medial head of the right eighth posterior rib.There is pathological fracture of L1, with retropulsion and epidural mass causing spinal canal stenosis. These findings are better seen on the prior MRI study. There is no evidence of kyphoplasty changes in the thoracic spine.

Output: Lytic lesions in multiple vertebral levels and right 8th rib, consistent with metastasis. There are additional lesions seen compared to prior MRI study. Pathological fracture of L1 with epidural mass, causing compromise of the spinal canal.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, history of lung cancer with metastases. Status post chemotherapy. Restaging exam. No evidence of any intracranial mass, focal parenchymal edema, or pathologic enhancement is seen.No significant pathologic parenchymal signal abnormality is seen. At most, there may be a very small defect within the inferior right cerebellum compatible with a small chronic ischemic lesion. No restricted diffusion is detected.No evidence of any abnormal extra axial fluid collections are seen. No intracranial hemorrhage is detected. The ventricles are mildly prominent the level of the atria, but are otherwise unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: History of cirrhosis. Cystic pancreatic lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with T2 hyperintense particular changes compatible with fibrosis. Segment VIII subcentimeter intrinsically T1 hyperintense lesion without restricted diffusion, unchanged, likely a dysplastic nodule. Findings of iron deposition. No suspicious focal lesion. No biliary ductal dilatation. Multiple subcentimeter T2 hyperintense foci are too small to characterize but likely represent simple cysts.Normally distended gallbladder.SPLEEN: Perisplenic varices.PANCREAS: The T2 hyperintense nonenhancing lesion in the uncinate process measures 4.6 x 3.0 cm (series 8/13), compared to 3.8 x 2.4 cm previously. It contains 2 thin septations without mural nodularity. No definite communication with the pancreatic duct is apparent. The main pancreatic duct is normal in caliber.Decrease in intrinsic T1 weighted signal intensity of the pancreatic parenchyma.Pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal basilar atelectasis.

Output: 1.Interval mild increase in size of the uncinate process cystic lesion now measuring 4.6 cm with at least 2 peripheral thin septations without mural nodularity or suspicious enhancing components. 2.Cirrhotic liver morphology without suspicious focal lesion. Stable probable dysplastic nodule.


Instruction: Generate impression based on findings.

Input: Respiratory distress syndrome. Extreme prematurity (born at 27 weeks gestational age; now 38 weeks). History of septic shock. Myelination is appropriate for the adjusted gestational age. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are preserved. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid intensity in the left middle ear cavity and mastoid air cells.

Output: 1.No definite evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Myelination is appropriate for the adjusted gestational age.


Instruction: Generate impression based on findings.

Input: 25-year-old male with a history of sickle cell disease and left-sided AVN presents with decreased joint mobility and right hip pain. There is marked deformity of the right femoral head corresponding to findings seen on recent radiographs. Note is made of increased bone marrow signal abnormality within the right ischium, acetabulum, iliac bone, and femoral head on fluid sensitive sequences with associated decreased signal abnormality on T1-weighted images. There is also increased signal abnormality within the gluteal musculature bilaterally, right greater than left, as well as within the right iliopsoas muscle. These findings likely represent osteonecrosis/bone infarction with surrounding inflammatory change, although infection cannot be completely excluded by this examination. There is a small right-sided joint effusion likely related to the synovitis from the aforementioned osteonecrosis. There is also increased bone marrow signal abnormality on fluid sensitive sequences within the left iliac bone also suggesting osteonecrosis. Note is made of extensive metallic susceptibility artifact corresponding to the orthopedic fixation of the left hip.

Output: Findings most consistent with advanced osteonecrosis resulting in subchondral collapse and severe secondary degenerative changes affecting the right hip. There is inflammatory change in the surrounding musculature as well as synovitis affecting the right hip, also likely related to the aforementioned avascular necrosis, although infection cannot be completely excluded by this examination.


Instruction: Generate impression based on findings.

Input: 46-year-old woman with history of UC status post subtotal colectomy and NASH cirrhosis being evaluated for liver transplant. ABDOMEN:LIVER, BILIARY TRACT: There are large geographic areas of poorly defined signal loss on opposed phase images (series 704, images 43 and 58). There are subcentimeter hepatic cysts, but no additional focal hepatic lesions are identified. Patient is status post cholecystectomy.SPLEEN: The spleen is normal.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a right inferior pole renal cyst. The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post colectomy and there is a partially visualized left lower quadrant ostomy.BONES, SOFT TISSUES: Mental hernia noted containing loops of small bowel without evidence of incarceration.OTHER: No significant abnormality noted.

Output: Areas of hepatic steatosis without focal lesion.


Instruction: Generate impression based on findings.

Input: 28 year-old male with a history of Crohn's disease and enterovesical fistula. Presents with suprapubic pain and stool in the urine. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is increased T2 signal abnormality, wall thickening and enhancement of the terminal ileum, measuring approximately 10 cm in length. Additionally, there is complex fistula formation in the right lower quadrant with foci of enhancing linear increased T2 signal abnormality extending from the terminal ileum to involve the sigmoid colon, as well as extending to additional portions of the distal ileum. These findings are consistent with enterocolonic and enteroenteric fistula formation. There is loculated interloop fluid in the right lower abdomen immediately adjacent to the aforementioned matted and tethered loops of small bowel.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Asymmetric thickening of the bladder wall is nonspecific, but may be reactive.BOWEL, MESENTERY: There is increased T2 signal abnormality, wall thickening and enhancement of a long segment of terminal ileum, measuring at least 10 cm in length. Additionally, there is a fistulous network in the adjacent area in the right lower quadrant with foci of enhancing linear increased T2 signal abnormality extending from the terminal ileum to involve the sigmoid colon, as well as extending to additional portions of the distal ileum. These findings are consistent with enterocolonic and enteroenteric fistula formation. There is loculated interloop fluid in the right lower abdomen immediately adjacent to the aforementioned matted and tethered loops of small bowel with associated peripheral enhancement or restricted diffusion suspicious for abscess formation.BONES, SOFT TISSUES: There is a focus of fluid signal intensity in the soft tissues immediately anterior to the gluteal crease, measuring 10 x 11 mm, suspicious for abscess formation. Additionally, note is made of a 9 x 10-mm focus of fluid signal intensity in the soft tissues along the right lateral base of the penis, which is also suspicious for abscess formation.

Output: 1.Findings consistent with active inflammatory bowel disease involving the distal small bowel and terminal ileum with a complex fistulous network with stellate configuration in the right lower quadrant. There are apparent entero-colonic and entero-enteric fistula formation as detailed above.2.Interloop fluid adjacent to the aforementioned fistulous network in the right lower quadrant with associated peripheral enhancement, suspicious for abscess formation. 3.Multiple small fluid collections in the soft tissues of the perineum, including the right lateral base of the penis and gluteal crease, suspicious for abscess formation, reference measurements provided above.4.Asymmetric thickening of the bladder wall nonspecific but likely reactive in etiology.


Instruction: Generate impression based on findings.

Input: Surveillance for IPMN. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. Segment 4A cyst. Segment 2 lobular arterially enhancing lesion which is isointense to liver parenchyma on T1-weighted and mildly hyperintense on T2-weighted ages. It becomes isointense to liver parenchyma on portal venous and delayed phase imaging, compatible with a focal nodular hyperplasia. It measures 4.9 x 4.3 cm.The gallbladder is diffusely filled with gallstones. No specific evidence of gallbladder inflammation. There are multiple filling defects within the distal common bile duct compatible with choledocholithiasis. The common duct measures 9 mm, compared to 7 mm previously.SPLEEN: The spleen is normal in size and signal intensity.PANCREAS: The pancreas is normal in morphology and signal intensity. The punctate focus adjacent to the main pancreatic duct (series 7/59 and series 9/27) is unchanged. This may represent a very small side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large exophytic left renal septated cyst without suspicious postcontrast enhancement. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pleural effusions.

Output: 1.Cholelithiasis without evidence of gallbladder inflammation. Choledocholithiasis with mild-moderate biliary ductal dilatation, increased from the prior.2.No significant >5 mm cystic pancreatic lesion is seen on today's study. Previously described punctate pancreatic head cystic focus is unchanged.3.Minimal increase in size of the segment 2 lesion, compatible with focal nodular hyperplasia.


Instruction: Generate impression based on findings.

Input: 47-year-old female with a history of coccygeal chordoma status post resection. Patient presents with pain. Again seen are post operative changes of prior coccygeal resection, appearing similar to the prior study. There is increased signal abnormality on fluid sensitive sequences, which does not enhance on postcontrast images most consistent with postoperative changes. Note is made of foci of metallic susceptibility artifact in the surrounding area also likely postoperative in etiology. No pathologic enhancement is identified on postcontrast sequences. No evidence of residual or recurrent tumor.The patient is status post hysterectomy. There is a focus of increased signal abnormality on both T1 and T2-weighted images within the S2 vertebral body, which demonstrates fat signal intensity on all sequences, likely representing a hemangioma, appearing similar to the prior study. No additional bone marrow signal abnormality is identified. Although this examination was not protocoled for evaluation of the lumbar spine, there is an apparent disc protrusion at the level of L5/S1, which results in narrowing of the lateral recess and posterior displacement of the S1 nerve root as well as left neural foramen narrowing, which can be a source of pain. There is also an apparent disc protrusion at the level of L4/L5. There is increased signal abnormality within the protrusion suggestive of an annular fissure, which can be a source of pain. These findings are better characterized on the recent MRI lumbar examination. Please see the accompanying report for additional details.

Output: Postoperative changes without evidence of residual or recurrent tumor. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Severe left sided headache with blurry vision. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of cerebral white matter T2 hyperintensity bilaterally. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A few scattered foci of cerebral white matter T2 hyperintensity bilaterally are nonspecific, but may represent chronic small vessel ischemia. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 45-year-old female with history of liver mass. LIVER: Echogenic hepatic parenchyma. The liver measures 20.2 cm in craniocaudal length. Portal vein with normal direction and flow measuring 29.8 cm/s.Stable echogenic lesion in the posterior right hepatic lobe measuring 3.4 x 3.1 x 2.1 cm (prior 3.3 x 2 x 2.6 cm). This region correlates with the previously described segment 6 lesion with MRI characteristics suggestive of a hepatic adenoma.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No gallstones or gallbladder wall thickening.PANCREAS: Unremarkable appearance of the visualized pancreas parenchyma. Incomplete visualization of the pancreatic body and tail due to overlying bowel gas.SPLEEN: The spleen measures 10.3 cm in length. Normal echogenicity.RIGHT KIDNEY: The right kidney measures 13 cm in length. No hydronephrosis. Normal echogenicity of the renal parenchyma. OTHER: The left kidney measures 13 cm in length. No hydronephrosis. Normal echogenicity of the renal parenchyma.

Output: Stable echogenic lesion of the posterior right hepatic lobe. On the 2/17/2016 MRI abdomen exam, this lesion demonstrated MRI characteristics compatible with a hepatic adenoma.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [728.87], Reason for Study: ^Reason: STROKE History: LEFT WEAKNESS There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There are multiple white matter lesions with tissue loss involving right basal ganglia, left side of corpus callosum and left periventricular white matter. These lesions are non specific with uncertain etiology but can be related to white matter disease or multifocal ischemic infarction.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal white matter lesions with tissue losses as described above. Possible etiology include white matter disease such as demyelination process and multifocal chronic ischemic infarctions.


Instruction: Generate impression based on findings.

Input: Memory loss and difficulty with word finding. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a nonspecific punctate focus of T2 hyperintensity in the right coronal radiata and mild T2 hyperintensity surrounding the right frontal horn. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are postoperative findings related to endoscopic sinus sugary with diffuse mucosal thickening in the left maxillary and ethmoid sinuses.

Output: Nonspecific punctate focus of T2 hyperintensity in the right coronal radiata and mild T2 hyperintensity surrounding the right frontal horn, which may represent small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: History of thymic cancer. Post therapy scan 6 -- 26 -- 08 showed left uptake in thyroid bed. Left submandibular uptake (node versus salivary gland).? Faint uptake in the right lung base. Please evaluate (A) is submandibular area uptake a node versus salivary gland. (B.) are there any lung metastases. (C) rule out other Mets. CT of soft tissues of the neck:Images through the skull base including cavernous sinuses remain within normal limits. Paranasal sinuses and mastoid air cells are also unremarkable.The parotid glands remain within normal limits in morphology and pattern of enhancement.The signal intensity and morphology of the left submandibular gland is within normal limits.In the left submandibular region there is no evidence of new finding since prior MRI examination of 8 -- 30 -- 2008. Either an accessory salivary gland or a small node (however with a fatty hilar region) is noted. This remains identical to what was noted on prior MRI. The submandibular gland on the left remains within normal limits with no abnormal enhancement. The left submandibular gland however appears larger than the right side which is also a finding that was noted on prior MRI examination. The mandibles remains within normal limits and there is no evidence of any dental abnormality to account for increased uptake.Images at the level of the thyroid bed failed to demonstrate any residual enhancing thyroid tissue. Metallic clips bilaterally in the thyroid bed however obscure the detail. There is no evidence of any pathologic adenopathy in the neck.Limited images through the apices of the lungs are unremarkable. Limited images of mediastinum are unremarkable.Extensive postoperative changes of anterior fusion of the cervical spine is noted and there is however no evidence of any destructive bony lesion.

Output: No evidence of a mass or pathologic adenopathy. Please review detailed report above.


Instruction: Generate impression based on findings.

Input: Status post fusion, now with left lower extremity weakness There are postsurgical changes of prior anterior cervical fusion at the C4-C5 levels. There is at least moderate degree of spinal canal stenosis at the C4-C5 and to a lesser degree C5-C6 and C3-C4 levels which appears improved since remote cervical spine MRI dated 4/5/2011. There may be cord signal abnormality at this level related to myelomalacia although not well assessed.There is mild spinal canal stenosis at the T11-T12 level. No significant spinal canal stenosis in the thoracic spine. There are postsurgical changes of laminectomy and posterior spinal fusion from L3 to L6. There is ill-defined STIR signal at the level of the lumbar thecal sac, much of which is likely artifactual. There is no discrete epidural hematoma evident within the limits of the artifact. Lumbar disc bulges extending into the neural foramina are again seen. Surgical drain is in place.Vertebral body heights and alignment are grossly maintained in the cervical, thoracic, and lumbar spine aside from loss of cervical lordosis.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No findings to suggest acute cord compression are appreciated. Assessment of the lumbar spine is somewhat limited due to the spinal fusion hardware. There is also at least moderate degree of spinal canal stenosis evident at the C4-C5 and C5-C6 levels which appears overall improved when compared to prior preoperative cervical spine MRI dated 4/5/2011.Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine and dedicated cervical and lumbar spine imaging can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: 18-year-old with history of stroke status post pial synangiosis at outside hospital. MRI: There is extensive encephalomalacia throughout the vast majority of the right side cerebral hemisphere with relative sparing of the inferior frontal and anterior mesial temporal lobes. There is associated right brainstem Wallerian degeneration, ex vacuo dilatation of the right lateral ventricle, right Dyke-Davidoff-Masson, as well as approximately 7 mm of rightward midline shift. There is mild periventricular T2 hyperintensity in the left cerebral hemisphere. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The orbits are unremarkable. MRA: There is a patent anastomosis between the bilateral superficial temporal arteries and distal branches of the middle cerebral arteries. Otherwise, there is extensive steno-occlusive diease of the anterior circulation, right more than left. There is also proliferation of lenticulostriate collateral vessels within the basal ganglia. Right dominant vertebrobasilar. There is a right posterior communicating artery that communicates with collateral vessels. The right posterior cerebral artery is diminutive, while the left right posterior cerebral artery, basilar artery, and vertebral arteries are intact.

Output: 1. Extensive chronic infarction of the right cerebral hemisphere, but no evidence of acute infarction.2. Patent bilateral pial synangiosis, but extensive steno-occlusive disease involving the anterior circulation with moyamoya, right more severe than left.


Instruction: Generate impression based on findings.

Input: AMS, new onset right sided flaccid weakness. There is high T2 signal and restricted diffuse in the bilateral medial thalami, left midbrain, left occipital lobe and medial thalamus, right posterior insula ad temporal stem, and right frontal and parietal lobe. There is a subcentimeter area of high T2 signal in the right splenium of the corpus callosum without apparent restricted diffusion. There are small areas of encephalomalacia in the anterior right thalamus and midbrain. There is no evidence of intracranial hemorrhage. 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple recent infarcts in the distribution of the artery of Percheron or top of the basilar, left posterior cerebral artery, and right middle cerebral artery territories, superimposed upon chronic infarcts of the right thalamus and midbrain.Discussed with Dr. Hornik at 3PM on 8/10/15.


Instruction: Generate impression based on findings.

Input: 57 year old female with fever. Evaluate for bleed. Bifrontal white matter hypoattenuation appears stable since prior exam and is most consistent with vasogenic edema secondary to known intraparenchymal metastases. Ill-defined round hypodensities just superior to the lateral ventricles correlate with known intraparenchymal metastases seen on recent MRI. Internal focus of hyperattenuation in left lesion is unchanged and could represent focus of calcification.There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration.Large expansile mass originating from right frontal bone and involving right orbit walls obliterates the superior right nasal cavity and ethmoid air cells, consistent with presumed fibrous dysplasia. Intraorbital soft tissues and optic canal are unremarkable. Multiple lytic skull lesions consistent with patient's known metastatic breast cancer are not significantly changed. Complete opacification of the left maxillary sinus is unchanged.

Output: 1.No acute intracranial abnormality or hemorrhage. However, noncontrast CT is not sensitive in detecting infectious process or metastases.2.Focus of hyperattenuation in the left parasagittal intraparenchymal lesion is unchanged and likely represents focus of calcification versus hemorrhage of the metastases.3.Bifrontal white matter hypoattenuation consistent with vasogenic edema secondary to known brain metastases or postradiation change is unchanged.4.No significant change in right frontal skull mass most consistent with fibrous dysplasia.5.Stable multiple lytic skull lesions consistent with known metastases.


Instruction: Generate impression based on findings.

Input: Pain TENDONS: There is a small amount of fluid within the tendon sheath of the flexor hallucis longus which may reflect a mild tenosynovitis or fluid extension from the joint. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. There is minimal linear intermediate signal intensity within the distal fibers of the Achilles tendon which may represent a mild tendinosis.LIGAMENTS: 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, however, increased signal abnormality on fluid sensitive sequences within the posterior talofibular ligament likely reflecting edema.ARTICULAR SURFACES AND BONE: Note is made of an os trigonum. There is increased bone marrow signal abnormality within the os trigonum as well as within the posterior aspect of the body of the talus. No additional bone marrow signal abnormalities identified. Fluid extends from the tibiotalar joint cephalad into the posterior subtalar recess in the surrounding area. ADDITIONAL

Output: Findings indicating os trigonum syndrome as described above. Other findings as described.


Instruction: Generate impression based on findings.

Input: Altered mental status. There is no evidence of acute ischemic lesion on the scan.A couple of focal susceptibility lesions on on the left high frontal and right occipital lobe on gradient echo images indicating chronic microscopic hemorrhagic lesions.Patch high signal intensity lesions on bilateral periventricular white matter and centrum semiovale on FLAIR images indicate nonspecific small vessel ischemic disease. There is a large perivascular space visualized on the left inferior aspect of basal ganglia which is normal finding.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, The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses except frontal sinus which had prior surgery and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Although limited noncontrast enhanced MRA neck images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.2. Extensive nonspecific small vessel disease.3. Normal intracranial MRA.4. No evidence of significant luminal stenosis on neck MRA. If clinically indicated, CTA of the neck can be considered for further imaging evaluation.


Instruction: Generate impression based on findings.

Input: Headaches, paresthesias, reevaluate white matter lesions. Brain: There are least 6 T2/flair hyperintense lesions involving the supratentorial white matter as well as the left thalamus. Many of these lesions demonstrate a morphology and distribution highly suggestive of demyelinating disease. Compared to outside MRI dated 1/13/2015, there is interval development of a new lesion measuring approximately 1 cm in size involving the left posterior callosal body with enhancement. Otherwise no other new lesions or abnormal parenchymal or meningeal enhancement is appreciated. Brain parenchymal volume is preserved. T1 hypointensity associated with some of the lesions is noted including the left periatrial white matter and adjacent to the left temporal horn. There is restricted diffusion associated with the enhancing left posterior callosal body lesion. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable for age. 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. Cervical spine: Examination is slightly limited due to patient motion. No abnormal signal however is seen within the cervical cord to suggest demyelinating disease. There is trace prominence of the central canal at the C6-C7 level, which is of doubtful clinical significance. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. There is no significant disk disease, spinal canal, or neural foramina stenosis at any level in the cervical spine. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multiple T2/flair hyperintense lesions in the supratentorial white matter with distribution and morphology highly suggestive of demyelinating disease. Compared to 1/13/2015, there is interval development of a new lesion with enhancement involving the left posterior callosal body which is suggestive of active demyelination. Consider further correlation with CSF analysis.2. No T2 hyperintense lesions or abnormal enhancement within the cervical cord is identified. There is trace prominence of the central canal at the C6-C7 level, which is of doubtful clinical significance.


Instruction: Generate impression based on findings.

Input: H/o strokes. The previously seen right occipital hypoattenuation appears less when compared to prior exam. There appears hypoattenuation in the right cerebellum, which is compatible with findings on the prior MRI. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: Stable right posterior cerebral artery territory subacute stroke. Otherwise unremarkable CT head.


Instruction: Generate impression based on findings.

Input: Anterolateral ankle pain TENDONS: There is longitudinal split tearing of the peroneus longus at and distal to the peroneal tubercle. The remaining tendinous structures appear intact.LIGAMENTS: The lateral collateral ligament complex and the distal syndesmotic complex are intact. There is loss of the normal fatty striations of the deep fibers of the deltoid which may reflect prior sprain; however the deltoid ligament complex otherwise appears intact.ARTICULAR SURFACES AND BONE: There is a nondisplaced fracture of the base of the anterior process of the calcaneus with edema in the adjacent marrow. There is low signal intensity along the fracture margin suggesting it is subacute in nature. The anterior process of the calcaneus also appears prominent and closely approaches the lateral margin of the navicular raising the question of a nonosseous coalition. There is a small subtalar effusion. There is mild osteoarthritis of the tibiotalar joint and talonavicular joints but there is no evidence of an osteochondral defect. Additional osteoarthritic changes are seen in the midfoot and tarsometatarsal joints. A tiny amount of fluid signal is seen dorsal to the head of the talus which may represent a synovial cyst or ganglion.ADDITIONAL

Output: 1. Nondisplaced fracture through the base of the anterior process of the calcaneus with possible nonosseous calcaneonavicular coalition.2. Osteoarthritis of the ankle and foot as described above without evidence of focal osteochondral defect.3. Longitudinal split tearing of the peroneus longus which is of questionable clinical significance.4. Additional findings described above.


Instruction: Generate impression based on findings.

Input: 72-year-old male with cirrhosis of the liver. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Again seen is thrombosis of the splenic vein, partial thrombosis of the main portal vein and thrombosis of a branch of the right portal vein. Delayed enhancement corresponding to bandlike increased T2 signal at the porta hepatis likely represents fibrosis and is unchanged.8mm enhancing focus right hepatic lobe (502/517) with apparent washout on delayed images. Additional nonenhancing lesions likely represent cysts.SPLEEN: Splenomegaly. Wedge-shaped peripheral hypoattenuation likely represents infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing subcentimeter T2 hyperintensities likely represent cysts and are unchanged. Subcentimeter left upper pole hemorrhagic cyst is stable.RETROPERITONEUM, LYMPH NODES: Small linear signal abnormality in the proximal celiac artery extending approximately 1.5 cm (502/407) likely represents a small dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Body wall collateral vessels are noted. Bilateral gynecomastia. Lower thoracic vertebral body hemangioma.OTHER: No significant abnormality noted.

Output: 1.Signal abnormality in the right hepatic lobe in the distribution of the thrombosed right portal vein is indeterminate. Follow-up of this region on subsequent exams is recommended.2.Thrombosis of the splenic vein, partial thrombosis of the main portal vein and thrombosis of a branch of the right portal vein.3.Splenic vein thrombosis.4.Small probable dissection of the proximal celiac artery.


Instruction: Generate impression based on findings.

Input: Female, 21 years old. History of blue finger and thumb intermittently. TENDONS: There is a small amount of fluid within the extensor tendon sheaths, likely physiologic. BONES: There is no abnormal enhancement or bone marrow edema. No focal osseous lesions.ANGIOGRAM: The ulnar artery and the takeoff of the superficial palmar arch is well-opacified and normal in caliber. The common palmar digital arteries are patent proximally, however there is gradual tapering and the proper digital arteries are not well opacified distal to the bifurcation. The digital artery supplying the radial aspect of the fifth finger is well opacified distally, however the artery arising from the superficial palmar arch supplying the ulnar side of the fifth finger is communicated and poorly opacified.The radial artery gives rise to the deep palmar arch. The radial artery and deep palmar arch are patent but are diminutive in caliber. The princeps pollicis artery and the radial artery of the index finger arise from the deep palmar arch and are also diminutive, as are the metacarpal arteries through the ulnar aspect of the deep palmar arch.ADDITIONAL

Output: Diminutive caliber of the radial artery, deep palmar arch, and metacarpal arteries, most severely involving the thumb and index finger. This can be related to vasospasm as can be seen with Raynaud's disease, less likely vasculitis or upstream chronic embolization. If more detailed evaluation is needed, further evaluation with conventional catheter angiography could be performed.


Instruction: Generate impression based on findings.

Input: Evaluation somewhat limited due to differences in slice thickness especially without of the prior exam. There is redemonstration of postoperative changes from prior posterior fossa mass resection. There is persistent minimal linear nodular enhancement along the left anterolateral aspect of the fourth ventricle, which remains decreased in overall extent from the May 2014 exam. It currently measures 4 x 5 mm in greatest axial dimensions, compared to previous 4 x 2 mm on 11/6/2014, although this could in part relate to due to differences in technique. There are no new remote foci of pathological enhancement. There remain areas of T2/FLAIR hyperintensity along the resection cavity margins in the cerebellum. There is no diffusion restriction, midline shift, mass effect, or extra-axial collection.

Output: Persistent minimal nodular enhancement along the left lateral fourth ventricular margin, with apparent and slight increased conspicuity which may be due to differences in technique. Findings are overall decreased in extent compared to May 2014. Continued close follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Please evaluate neck and ear pain. Enhanced CT of the soft tissues of the neck:60 cc of Omnipaque 350 was administered.Limited images of the intracranial demonstrate findings suggestive of small was ischemic disease.Images through the skull base, cavernous sinuses, bilateral Petrus bones and paranasal sinuses are unremarkable. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.Images through the neck demonstrate no evidence of a mass or any pathologic adenopathy.Calcification and cystic changes of left lobe of thyroid there is suspected of goiter. Very limited view of the apices of the lungs are unremarkable.Examination demonstrates extensive degenerative disk disease of the cervical spine and hypertrophic changes of posterior elements. No evidence of lytic or sclerotic changes. There is no evidence of fracture or malalignment. There is however unusual presentation of posterior arch of C1 projecting anterior to the posterior elements of C2. This may be result of extensive degenerative changes at C1 -- C2 level. This can be started around or through the dedicated MRI of the cervical spine.

Output: 1.Negative enhanced CT of soft tissues of neck for tumor or pathologic adenopathy.2.Excessive degenerative changes of cervical spine and with unusual appearance of location of posterior arch of C1 anterior to the posterior elements of C2. There is no evidence of fracture or malalignment. If patient's neck pain persists recommend follow-up with dedicated MRI of cervical spine.


Instruction: Generate impression based on findings.

Input: 47 years Male (DOB:7/24/1969)Reason: stroke History: strokePROVIDER/ATTENDING NAME: NAVNEET CHEEMA TAO L XIE MRI of the brainThere are punctate foci of diffusion restriction identified in the left midbrain, the right paramedian vermis the medial aspect of the left cerebellar hemisphere as well as a couple punctate foci of diffusion restriction in the right medial temporal lobe and occipital lobe. There are additional punctate focus of diffusion restriction present along the right paramedian corpus callosum at the anterior aspect of the body of the corpus callosum.The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of cavum septum pellucidum and cavum vergaeThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present as well as some patchy lesions in the brainstem which are identified on the FLAIR and T2 images. These were also present on the prior exam and have not changed substantially.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is hypoplastic. There is fetal origin of the right posterior cerebral artery associated with a hypoplastic right P1 segment. The left posterior communicating is a small. The vertebral arteries are similar in size. The left P1 segment and the proximal superior cerebellar arteries are partially obscured by artifact on the time-of-flight MRA of the brain, however, preserved visualized on the contrast-enhanced MRA of the neck.There is extracranial origin of the right posterior inferior cerebellar artery present.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery. The right vertebral artery is slightly larger than the left vertebral artery and

Output: 1.Multiple (approximately 5) microinfarcts are present along the posterior circulation with an additional lesion along the right half of the corpus callosum anterior body.2.Although there is no direct evidence for intracranial cerebrovascular occlusive disease the proximal portions of the left posterior cerebral artery and superior cerebellar arteries are obscured by artifact on the time-of-flight MRA, however, on the contrast enhanced MRA of the neck it does not appear that the left posterior cerebral artery has any significant stenosis associated with it.3.Periventricular and subcortical white matter lesions of a mild degree as well as some patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. They are stable relative to the prior exam.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: New delerium of unclear etiology. On Tacrolimus. Concern for PRES History: Delerium The bone marrow signal intensity of clivus, upper cervical spine as well as skull show low signal intensity on T1 weighted image.On Gad enhanced scan, the clivus and some portion of C2 and C3 vertebral bodies show enhancement. Constellation of above findings indicate conversion of fatty marrow to red marrow or diffuse infiltrative condition or post bone marrow transplantation status with possibly associated with inflammation or infectious condition of clivus and vertebral bodies. Clinical correlation is recommended.No evidence of acute ischemic or hemorrhagic lesion.Scattered T2/FLAIR high signal intensity lesions on periventricular white matter is nonspecific, could represent small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings are seen on the bilateral ethmoid sinuses, sphenoid sinus and bilateral maxillary sinuses are seen.

Output: 1. Abnormal bone marrow signal intensity involving clivus, upper cervical spine and skull which indicate conversion of fatty marrow to red marrow, diffuse infiltrative lesions or post bone marrow transplantation status.2. Abnormal enhancement of clivus and upper cervical vertebral bodies indicate possible infectious or inflammatory lesions.3. No evidence of acute ischemic or hemorrhagic lesion. 4. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 85 year-old female with mental status changes. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal patchy areas of diffuse hypoattenuation in the periventricular distribution consistent with small vessel ischemic disease, age indeterminate. There is clinical concern for acute ischemia, an MRI may be considered. No acute cortical stroke is seen.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. Sinus disease affects the right maxillary sinus.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: ischemia, right arm weakness and confusion History: as above There are restricted diffusion lesions on the right inferior parietal lobule without evidence of hemorrhagic transformation indicating acute/subacute ischemic infarction.Punctate right frontal superior frontal gyrus is non specific, indicating possible calcification or chronic blood product including small cavernous malformation.Although thick (4mm) slice thickness, the full length of the right MCA M1 segment was not clearly demonstrated. Thus, brain MRA or CTA can be considered for further imaging evaluation.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Acute/Subacute ischemic infarction on the right inferior parietal lobule without hemorrhagic transformation as described above.Brain MRA or CTA can be considered for intracranial vascular evaluation.


Instruction: Generate impression based on findings.

Input: Evaluate ventricle size. Status post subgaleal shunt. Now with increasing HC. No evidence of change in the size of lateral ventricles since prior MRI examination of 7 -- 9 -- 2009. No evidence of ventricular shunt. No evidence of hemorrhage, edema, mass-effect, midline shift.

Output: No evidence of change in the size of particular system since prior MRI exam.


Instruction: Generate impression based on findings.

Input: Male 55 years old Reason: 55M with elevated and rising PSA and negative TRUS biopsy History: as above PELVIS:PROSTATE:Prostate Size: The prostate measures 6.2 x 4.5 x 6.0 cm.Peripheral Zone: Slightly heterogeneous. No focal suspicious lesion.Central Gland: Markedly enlarged and heterogeneous.Seminal Vesicles: No significant abnormality.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.The posterior gland is enlarged. There is no focal suspicious lesion.


Instruction: Generate impression based on findings.

Input: Right arm and leg weakness. There is a heterogeneous hypodensity associated with calcifications located in the left parietal lobe. This finding was present on the recent MRI of the brain. There are periventricular hypodensities present which are matched with periventricular white matter changes identified on the recent MRI of the brain. There is no evidence for a new hemorrhage. There are calcifications present along the left parietal lobe and gyral structures.The patient is status post left-sided craniotomy.Limbic calcifications are present in the right eyeballThe visualized mastoid air cells and middle ears are clear. Visualized ethmoid and frontal sinuses are clear.

Output: 1.Status post left sided craniotomy for brain tumor. There is associated the mass effect at the site of the enhancing tumor identified on a recent MRI comparing to the previous CT scan from February there appears to be progression. If clinically appropriate to more accurately explain the patient's symptoms an MRI of the brain may be of benefit. There is no acute hematoma identified within the tumor bed rather there appear to be gyral calcifications along medial tumor bed.2.Periventricular hypodensities of a marked degree are present and have been present since the prior MRI exam and were less conspicuous on the February exam. This could represent post treatment change or tumor infiltration. The former more likely.


Instruction: Generate impression based on findings.

Input: 50-year-old female with right knee cyst versus mass seen on plain film. MENISCI: The lateral meniscus appears intact. There is intrasubstance degeneration of the posterior horn of the medial meniscus. There is a full-thickness radial tear of the posterior horn of the medial meniscus, near its root (image 12; series 10). There is degenerative tearing of the posterior horn and body of the medial meniscus. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral compartment with underlying degenerative subchondral signal abnormality. There is relative sparing of the lateral compartment articular cartilage. There is full-thickness articular cartilage degeneration affecting the patellofemoral joint with large areas of the lateral facet of patella and femoral trochlea completely devoid of articular cartilage with underlying subchondral cyst formation. There are also areas completely devoid of articular cartilage along the medial facet of the patella. There are tricompartmental osteophytes.LIGAMENTS: There is thickening of the anterior cruciate ligament suggestive of prior injury or sprain. The PCL appears intact the MCL appears intact. The LCL appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. Note is made of patella alta. The Insall Salvati ratio measures 1.6, which can be seen in patient's with patellofemoral instability.ADDITIONAL

Output: 1. Moderate joint effusion extending posteromedially into a Baker's cyst with findings indicating a synovitis. 2.2 cm lobulated focus of fluid signal intensity along the medial femoral condyle corresponding to the findings seen on recent radiographs, likely represents a lobulated component of the aforementioned Baker's cyst.2. Severe osteoarthritis of the right knee most pronounced along the patellofemoral joint and other findings as described above.3. Radial tear of the posterior horn of the medial meniscus with additional complex degenerative tearing as described above.


Instruction: Generate impression based on findings.

Input: Intractable epilepsy. Many of the images are degraded by patient motion. There are findings related to right frontal craniotomy and right frontal cortical resective surgery. There is a 15 mm wide extra-axial fluid collection deep to the craniotomy flap. There is extensive T2 hyperintensity surrounding the resection cavity and extending across the midline along the corpus callosum. There is blurring of grey-white matter differentiation along the right superior frontal sulcus adjacent to the surgical margin. There is associated mild midline shift to the right and ex vacuo dilatation of the right lateral ventricle. The hippocampi are grossly unremarkable. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The orbits are grossly unremarkable.

Output: Findings related to right frontal cortical resective surgery with extensive T2 hyperintensity surrounding the resection cavity and extending across the midline along the corpus callosum may represent encephalomalacia and/or gliosis. Superimposed edema related to seizure activity and perhaps underlying areas of cortical dysplasia are potential considerations as well.


Instruction: Generate impression based on findings.

Input: Headaches In comparison with the prior examination no evidence of any interval change in the size of the lateral ventricles which contain a right-sided ventricular catheter is noted. The fourth ventricle is not visualized and also remains similar to prior exam. Widening of the posterior fossa at the level from in magnum and low positioning of the cerebellar tonsils (left greater than right) is consistent with Chiari malformation. All these findings remain stable since prior exam. There are no prior MRI examination.

Output: Stable CT of brain since prior examination from 2007.


Instruction: Generate impression based on findings.

Input: 20-year-old male presents with persistent right knee pain after a sports injury. MENISCI: There is a complex tear of the posterior horn of the lateral meniscus with both vertical and horizontal components. Similarly, there is also complex tear of the medial meniscus with both vertical and horizontal components as well.ARTICULAR CARTILAGE AND BONE: The articular cartilage is unremarkable. There is bone marrow edema in the lateral tibial plateau and in the lateral condyle. Incidental note is made of multiple bone islands.LIGAMENTS: There is a complete tear of the anterior cruciate ligament. The posterior cruciate ligament, lateral collateral ligament complex, and medial collateral ligament are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complete tear of the anterior cruciate ligament with complex tears of the medial and lateral menisci.


Instruction: Generate impression based on findings.

Input: Left lateral tongue cancer, evaluate for extent and neck metastasis. There is an infiltrative and enhancing mass that involves the left oral tongue and floor of mouth, which measures up to 55 mm. The tumor does not extend across the midline and the mandible appears to be intact. There is an enlarged left level 2A lymph node which measures 16 x 20 mm in axial section. The other cervical lymph nodes are not enlarged by size criteria, although left level 1, 3, and 4 are relatively larger on the left side than on the right side. There is a probable suprahyoid thyroglossal duct cyst that measures up to 15 mm. The thyroid salivary glands are intact. The osseous structures, orbits, and imaged intracranial structures are unremarkable. There is a small left maxillary sinus retention cyst.

Output: 1. An infiltrative and enhancing mass that involves the left oral tongue and floor of mouth, which measures up to 55 mm, is compatible with squamous cell carcinoma.2. An enlarged left level 2A lymph node may represent metastatic or reactive lymphadenopathy. The other cervical lymph nodes are not enlarged by size criteria, although left level 1, 3, and 4 are relatively larger on the left side than on the right side, which are also nonspecific.


Instruction: Generate impression based on findings.

Input: History of subdural hematoma, now 2 week history of intermittent right lower extremity and right upper extremity weakness/numbness. Evaluate for subacute stroke. Again seen are subdural collections along the bilateral cerebral convexities, measuring up to 25 mm on the right, previously 15 mm in a similar plane from CT dated 4/24/2015, and up to 9 mm on the left previously 9 mm as well. There is susceptibility consistent with blood products within the right-sided collection with mild loculations. There is increased mass effect on the right frontoparietal sulci, effacement of the right lateral ventricle, and increase in leftward midline shift from 3 mm to 8 mm at the level of the septum pellucidum. No uncal herniation. Minimal subdural blood products also suspected in the posterior fossa bilaterally. Small fluid collection in the right parietal scalp is again noted measuring up to 9 mm x 3.9 cm in the transverse and AP dimensions which communicates with the subdural collection via the prior posterior burr hole. Mild enlargement of the left lateral ventricle is noted which may be getting entrapped.No restricted diffusion to suggest acute ischemia. Again seen are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes and similar to prior. Major flow-voids are preserved. Parenchymal volume loss is noted particularly on the left.Partially empty sella incidentally noted. Minimal mucosal thickening in the paranasal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits. Two right-sided burr holes again noted.

Output: 1. Compared to CT 4/24/2015, there is interval increase in size of right frontoparietal convexity subdural hematoma measuring up to 25 mm, previously 13 mm. There is significant increase in mass effect with leftward midline shift measuring 8 mm, previously 3 mm. Mild enlargement of the left lateral ventricle is also noted which may be getting entrapped. 2. No significant change in small left-sided subdural collection with signal features mostly compatible with a hygroma. No significant mass effect. 3 Small right parietal scalp fluid collection again noted which communicates with the subdural collection via previously placed burr hole.4. Moderate chronic small vessel ischemic disease. No evidence of recent infarct.Dr. Ali discussed findings with Dr. Cotts at 1050 on 5/15/2015. Patient was transported to the ED for further evaluation.


Instruction: Generate impression based on findings.

Input: 59-year-old female with 3 day history of headache and now has altered mental status. Evaluate for bleed. Patchy nonspecific areas of low attenuation are seen in periventricular white matter with a more discrete focus seen in the right thalamus as well as vague hypoattenuation in the left pons. While these may represent sequela from small vessel ischemic disease, they are of indeterminate age and acute infarct cannot be excluded. If acute infarct is suspected, an MRI should be considered.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.High density material in the left globe may represent a dislodged lens.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Patchy, nonspecific areas of low-attenuation in the periventricular white matter with a more discrete focus seen in the right thalamus and vague hypoattenuation in the left pons. Without prior comparison studies, it is difficult to distinguish between sequela from small vessel ischemic disease from acute infarct. If acute stroke is clinically suspected, an MRI should be considered.Findings were discussed with the MICU service (pager 3577) via telephone at the time of dictation.


Instruction: Generate impression based on findings.

Input: 22-year-old male with CML status post stem cell transplant with acute mental status changes. Diffuse low density seen throughout the subcortical and periventricular white matter, indicating significant white matter disease, grossly unchanged from MRI performed 5/1/2008. Diffuse intracerebral edema resulting in effacement of sulci and narrowing of the lateral ventricles is unchanged to slightly progressed compared to the prior MRI, though significantly increased from prior CT. There is no evidence of intra-cranial hemorrhage or abnormal extra-axial fluid collections. The ventricles are midline, with no evidence of midline shift.The visualized calvarium and other osseous structures are within normal limits. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Significant diffuse white matter abnormality and cerebral edema, slightly progressed from MRI performed 5/1/2008. Differential considerations include drug reaction or auto-immune reaction to stem cell transplant, less likely infection. Contrast-enhanced MRI may be considered to further evaluate this abnormality.Results were discussed with the clinical service at the time of interpretation.


Instruction: Generate impression based on findings.

Input: New cervical pain, positive Spurling sign Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is reversal of cervical lordosis. Alignment of the cervical spine is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild generalized facet arthropathy.Degenerative changes are seen in the cervical spine as described below:C2-3: Small central disc protrusion with partial effacement of the ventral thecal sac. No significant compromise to the spinal canal or neural foramina.C3-4: Central and left paracentral disc protrusion with effacement of the ventral thecal sac. No significant compromise to the spinal canal or neural foramina.C4-5: Left paracentral disc protrusion which effaces the ventral thecal sac and mildly indents the left ventral cord. Dorsal thecal sac is patent at this level. Mild bilateral neural foraminal narrowing.C5-6: There is a disc bulge which effaces the ventral thecal sac and extends into the left neural foramen. The disc bulge indents the ventral cord. Dorsal thecal sac remains patent. There is moderate left and mild right neural foraminal stenosis.C6-7: Mild disc bulge. No significant spinal canal or neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina. Small perineural cysts incidentally noted.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Opacification of the bilateral mastoid air cells noted.There appears to be a large soft tissue structure involving the visualized retropharyngeal soft tissues in the midline and extending to the level of the right carotid space with mass effect. There appears to be signal loss on the STIR sequence.

Output: 1. Degenerative changes in the cervical spine with multilevel disc bulges and disc protrusions, which along with kyphotic angulation of the spine result in impression on the ventral cord. Dorsal thecal sac remains patent. No evidence of high-grade spinal canal stenosis in the cervical spine or cord signal abnormality.2. There is moderate left C5-C6 neural foraminal stenosis. There is mild bilateral C4-C5 and mild right C5-C6 neural foraminal stenosis.3. Partially imaged large mass involving the visualized retropharyngeal soft tissues. There is intrinsic T1 hyperintensity with signal loss on the sagittal STIR sequence suggesting this is a lipoma. However would recommend obtaining a dedicated neck CT or neck MRI for better assessment and exclude other etiologies.4. Opacification of the bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: Female 58 years old with urethral cancer receiving chemoradiation. Evaluate for extent of disease; brachytherapy radiation planning. PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy.Again seen is thickening and irregular, intermediate T2 signal in the anterolateral left vaginal wall and involving the posterior urethra. This is further described below. BLADDER: Large saddle urethral diverticulum is unchanged. Again seen within this diverticulum is a 25 x 17 x 26 mm T2 intermediate enhancing mass (series 501, image 27 and series 601, image 43) extending into the bladder base, previously 25 x 17 x 24 mm. Heterogeneity and enhancement of the adjacent pelvic floor and surrounding fat indicates local invasion similar to the previous exam. The mass abuts the urogenital diaphragm on the left. LYMPH NODES: 12 x 9 mm left pelvic wall lymph node with mild enhancement is suspicious for metastatic disease (series 501, image 49 and series 401, image 35).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 11 x 7 mm cystic structure anterior to the femoral neck likely represents a para labral cyst, unchanged.

Output: 1.Stable size and appearance of locally infiltrative soft tissue mass extending along the posteriolateral left urethra to the anterolateral left vaginal wall consistent with the patient's known urethral cancer.2.Prominent left pelvic wall lymph node is suspicious for metastatic disease.3.Stable large saddle urethral diverticulum.


Instruction: Generate impression based on findings.

Input: Redemonstrated are findings of delayed myelination with the myelination pattern more appropriate for perhaps a 9 month-old. There remains mild global volume loss and minimal susceptibility effect within the occipital horns. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal although evaluation is limited in this unmyelinated brain. The ventricles and basal cisterns are unchanged in size and configuration without interval dilatation. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. Redemonstrated is fluid within bilateral middle ear cavities and mastoid air cells.

Output: 1.Delayed myelination with the myelination pattern appropriate for an approximate 9 month-old. 2.Stable mild global volume loss.3.Stable intraventricular likely chronic blood products.4.Redemonstrated is fluid within bilateral middle ear cavities and mastoid air cells.


Instruction: Generate impression based on findings.

Input: New vertigo, right eye blurred vision, and headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is left frontal lobe developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. Incidental left frontal lobe developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: History of acute pancreatitis and gallstones. ABDOMEN:LUNG BASES: Post-sternotomy changes.LIVER, BILIARY TRACT: Normal liver morphology. No focal hepatic lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder containing large gallstones without gallbladder wall thickening, pericholecystic fluid or other inflammatory changes.The common bile duct is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: There is mild decrease in T1 weighted pancreatic parenchymal signal suggesting parenchymal dysfunction. The pancreas enhances homogeneously following contrast administration. No peripancreatic fluid collection. No arterial or venous complication. 8 x 8 mm cystic lesion in the pancreatic body (series 501/27), likely a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A left anterolateral bladder diverticulum is noted.

Output: 1. Large gallstones within a normally distended gallbladder without evidence of acute cholecystitis. No choledocholithiasis.2. Decreased T1-weighted pancreatic parenchymal signal suggesting parenchymal dysfunction compatible with stated history of acute pancreatitis without evidence of complication.