Instruction: Generate impression based on findings.

Input: History of AVM treated with radiosurgery presents with burning smell sensation. There is no significant interval change in the overall size of the residual vascular malformation in the region of the vein of Galen, measuring up to 15 mm, as before, although the signal characteristics have evolved, with new areas of T1 and T2 hyperintensity. In addition, a portion of the lesion displays enhancement. Otherwise, there is no evidence of acute infarct or other intracranial mass lesions. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is persistent scattered paranasal sinus mucosal disease. The orbits are intact.

Output: The residual portion of the vein of Galen region vascular malformation is unchanged in size, but displays interval evolution of the signal characteristics and enhancement, which may represent an organizing hematoma or "Masson tumor".


Instruction: Generate impression based on findings.

Input: Knee locking. Loose body versus meniscal tear MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal right knee MRI


Instruction: Generate impression based on findings.

Input: Clinical question: Rule-out acute intracranial bleed. Signs and symptoms: Acute altered mental status. CT of brain without infusion:Large vessel intracranial vascular calcification of carotids and vertebral arteries are again identified. Very minimal scattered patchy areas of low-attenuation in the periventricular and subcortical white matter of bilateral cerebral hemispheres are concerning for minimal small vessel disease. Age of these is strokes cannot be determined on CT. Precise comparison with the prior examination for detection of new or small vessel stroke is not possible. Small vessel disease was noted on prior CT and MRI exam.No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: Findings consistent with small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Epilepsy. Six-month follow-up of cavernous malformation. There is a non-enhancing focus of susceptibility effect in the left anterior frontal lobe, within the deep white matter of the superior frontal gyrus, that measures up to 7 mm. There is no appreciable associated vasogenic edema and this has not changed since the previous examinations. There is an unchanged, contrast enhancing lesion with serpentine susceptibility effect involving the lingual sulcus (likely extraparenchymal) in the anteromedial left occipital lobe that measures up to 20 mm. In addition, there is a focus of brush-like enhancement and susceptibility effect in the right pons that measures up to 3 mm. This also has not changed. There is no evidence of acute intracranial hemorrhage or acute cerebral infarct. 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 subcentimeter cystic lesion along the lateral aspect of the left mandibular condyle is stable, possibly representing a synovial cyst.

Output: 1. Subcentimeter lesion in the left frontal lobe likely represents a cavernous malformation, without evidence of acute hemorrhage.2. An enhancing lesion involving the left lingual sulcus (extraparenchymal), centered in the anterior occipital lobe, may also represent a type of vascular malformation. A dedicated MRA or CTA may be useful for further evaluation.3. A punctate enhancing lesion in the right pons is compatible with a capillary telangiectasia.4. These lesions are unchanged compared to the examinations of April and January 2015.


Instruction: Generate impression based on findings.

Input: 54-year-old male with numbness and tingling. Non-enhanced CT of the cervical spine:Axial 3-mm nonenhanced CT of the cervical spine is obtained. Sagittal and coronal 2-D reformatted images were obtained as well.The bony density in the alignment the vertebral column is unremarkable. Very minimal degenerative disk disease is identified.Limited view of the skull base and review of foramina magnum are unremarkable.There is no evidence of bony central spinal stenosis.Minimal compromise of the left neural foramina at C5 -- C6 secondary to hypertrophic changes of the left uncovertebral is noted.Mild compromise of the left neural foramina at C6 -- C7 also secondary to hypertrophic changes of uncovertebral is present. This examination is otherwise unremarkable.For better evaluation of cervical spine and in particular for better assessment of soft tissues in particular the disk material and ligaments which could result in compromise of the neural foramina an MRI is recommended. This examination is not sensitive for detection of subtle abnormalities of the disk including herniated disk.

Output: 1.Mild degenerative disk disease and resultant compromise of the left neural foramina at C5 -- C6 and C6 -- C7 levels. No detectable bony central spinal stenosis.2.MRI examination of cervical spine is significantly more sensitive for detection of subtle disk abnormalities, neural foramina compromise and the spinal cord.


Instruction: Generate impression based on findings.

Input: History of congenital hydrocephalus. Rule out shunt malfunction. Fussiness and abdominal pain. There is redemonstration of abnormal cleavage of the forebrain and large associated dorsal cyst, findings consistent with holoprosencephaly. The appearance of the brain parenchyma is unchanged apart from subtle area of apparent mineralization in the right cerebral hemisphere possibly evolving site of prior insult or conceivably artifact. No parenchymal mass lesion or other focus of abnormal attenuation.There is redemonstration of a right posterior approach shunt catheter terminating within the dorsal cyst. There is no visible kinking or discontinuity in the visualized portions of the shunt catheter/reservoir system. Position of the tip is unchanged. There is also unchanged size of the dorsal cysts and rudimentary ventricular system with which it communicates, making allowances for technique differences. No new focal fluid collection or evidence of acute intracranial hemorrhage. There remains some tonsillar descent better seen on prior brain MRI. However, there is no frank brain herniation or gross midline shift.There remains macrocephaly with towering appearance of the cranial vault. Degree of sutural diastases appears to be diminished compared to the prior examination as expected with interval skull growth. There does remain some left-sided posterior plagiocephaly which was present previously.Paranasal sinuses are subtotally opacified and there is also opacification of the left mastoid air cells and middle ear cavities and the right mastoid air cells. Orbital contents are unremarkable.

Output: Stable size of dorsal cyst and rudimentary ventricular system with which it communicates status post ventricular peritoneal shunt. No acute intracranial hemorrhage. Findings are consistent with lobar holoprosencephaly.


Instruction: Generate impression based on findings.

Input: There is no restricted diffusion to suggest acute ischemic infarction. Prominence of the ventricles and cortical sulci is compatible with cerebral volume loss. There is slight predominance of the volume loss in the mesial temporal lobes. Punctate and confluent foci of increased T2/FLAIR signal in the supratentorial white matter as well as the pons is compatible with moderate chronic small vessel ischemic changes. There is no midline shift or herniation. The major cerebral flow voids are intact. A small mucus retention cyst is present within the left maxillary sinus. The midline structures and craniocervical junction are within normal limits.

Output: 1.No evidence of acute infarction.2.Moderate chronic small vessel ischemic changes.3.Cerebral volume loss with slight prominence in the mesial temporal lobes which can be seen in the clinical setting of Alzheimer dementia.


Instruction: Generate impression based on findings.

Input: Diagnosis: Spinal stenosis, lumbar region, with neurogenic claudicationClinical question: spinal stenosisSigns and Symptoms: pain and weakness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a levocurvature to the lumbar spine. There is left lateral translation of L4 on L5 and right lateral translation of L2 on L3. In addition the right side of the endplates at the L3-4 disc space abut each other.On T2 STIR imaging there is high vertebral body signal adjacent to the L4-5 endplates. On the prior exam similar finding was present at L2-3 and L5-S1.At L5-S1 there is no significant compromise to spinal canal. There is some left lateral translation of L5 on S1. There is loss of disc space height, endplate reactive change, diffuse disc bulge and facet hypertrophy at this level which results in effacement of the fat within the neural foramina bilaterally and encroachment of the exiting nerve roots with foramina bilaterally. There is fluid in the right facet joint at this level. Compared to the prior exam this has not changed substantially.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with facet hypertrophy bilaterally but worse on the right compared to the left. There is left lateral translation of L4 on L5 There is some mild triangulation of the thecal sac. There is ligamentum flavum hypertrophy at this level. There is encroachment of the right-sided exiting nerve roots at this level as a result of facet hypertrophy and disc bulge. Overall there is a mild degree of spinal stenosis present at this level. There is also some mild encroachment of the nerve roots at the right lateral recess at this level. Compared to the prior exam this has not changed substantially.At L3-4 there is no significant compromise to spinal canal or neural foramina. The right aspect of the endplates at this level abut each other. There is some facet and ligamentum flavum hypertrophy present at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is right lateral translation of L2 on L3 present. There is mild narrowing of the spinal canal at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a levocurvature of the lumbar spine present associated with multilevel degenerative changes as detailed above with encroachment of the exiting nerve roots bilaterally at L5-S1 and on the right side at L4-5. There is also some encroachment of the nerve roots of the right lateral recess at L4-5.2.Since the prior exam findings suggest that there is greater subacute inflammatory change on the current exam at L4-5 on the present study whereas this was previously the case at other levels on the prior exam.


Instruction: Generate impression based on findings.

Input: MRI BREAST BILAT CAD WWO, 4/14/2015 6:14 PMREASON FOR STUDY: Screening, genetic/family history There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Susceptibility artifact from biopsy marker clip is identified in the left central breast, from prior benign breast biopsy. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Lateral knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the left knee.


Instruction: Generate impression based on findings.

Input: Clinical question: History of pituitary microadenoma, evaluate for interval change. Signs and symptoms: None. Pre and post enhanced pituitary MRI:Examination redemonstrated a hypoenhancing pituitary microadenoma on the left and with subtle extension across the midline to the right within the pituitary gland. It measures 8.6 x 6.6 mm in size (measuring on coronal postenhanced series 801 image 8). Although when compared with prior exam the craniocaudad axis is minimally larger from prior measurements of 6 mm it cannot be confirmed with certainty on sagittal post enhanced series which measures nearly identical to prior exam. There is subtle elevation of the diaphragmatic sella however without extension into the basal cistern. Pituitary stalk remains in midline and with normal size and pattern of enhancement. Bilateral cavernous sinuses are also remain normal in signal intensity and pattern of enhancement.

Output: Stable pituitary microadenoma as detailed above. Please see comments.


Instruction: Generate impression based on findings.

Input: Pain and decreased range of motion for 3 years. Evaluate for severe osteoarthritis, rotator cuff tear. ROTATOR CUFF: There is a complete tear of the supraspinatus tendon at its insertion with approximately 1 cm of retraction. There is marked fatty atrophy of the supraspinatus muscle. The infraspinatus muscle is also markedly atrophied, however the tendon is intact. The teres minor muscle/tendon is intact. There is atrophy of superior fibers of the subscapularis muscle, however the tendon is intact.SUPRASPINATUS OUTLET: Osteoarthritis affects the acromioclavicular joint. The acromiohumeral interval is significantly narrowed.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is displaced superiorly. Degenerative subchondral cysts are noted in the humeral head along with osteophytes.The labrum is grossly normal.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Complete tear of the supraspinatus muscle with muscle atrophy as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out bleed. Signs and symptoms: History of mass. Non-enhanced CT of brain:Examination demonstrates a high density extra axial mass along the clivus and dorsum sella. This mass abuts the clivus however no definitive bony changes of the clivus. The mass is well-demarcated and measures 26-mm in cranial cephalad axis and 12.4-mm in AP axis on sagittal reformatted image 26. On axial image 9 the largest transaxial dimension of this tumor are 16.8 x 19.2-mm.superior A. the mass projects into the basal cistern and inferiorly in mid section of clivus. There is no evidence of any edema of brain parenchyma associated with this mass. Subtle mass effect on the pons and posterior displacement is noted. The exact etiology of this finding is not clear. The mass is not correctly state of any particular tumor. Differentials could include a hamartoma, mesenchymal type tumor, neuroepithelial cysts, aneurysm as well as less likely possibility of a meningioma. Follow-up with an enhanced MRI examination is recommended. There is normal density and morphology of brain parenchyma and no evidence of hemorrhage, edema, midline shift or hydrocephalus. The gray -- white matter differentiation is well preserved.

Output: 1.Nonspecific extra axial mass in the prepontine cistern extending along the clivus and superiorly terminates and is inseparable from the floor of the third ventricle. Follow-up with an MRI exam is recommended. There is no associated parenchymal edema.2.Unremarkable CT examination of brain otherwise.


Instruction: Generate impression based on findings.

Input: Neck pain, left arm pain, paresthesias down spine. Evaluate for syrinx, demyelination, Chiari. Also low back pain. Cervical: Craniovertebral junction appears within normal limits. No findings to suggest Chiari malformation. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. There is some motion degradation on the sagittal T2 and STIR sequences; however, no abnormal cord signal is appreciated. Cord volume is maintained. No evidence of syrinx.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There is a small disc bulge at the T3-T4 level which contacts the ventral cord without significant spinal canal or neural foraminal stenosis overall at this level based on the sagittal sequences.Lumbar: Examination is slightly motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from mild straightening which may positional. Bone marrow signal is benign. The conus medullaris is normal in position without signal abnormality. Apparent T2 hyperintensity in the partially imaged lower thoracic cord on sagittal T2 and STIR sequences is probably artifactual.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: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Cervical and lumbar spine MRI are within normal limits for patient's age. Specifically, no evidence of demyelinating disease in the cervical cord. No evidence of syrinx. No evidence of Chiari malformation. No significant disc herniation or spinal canal or neural foraminal stenosis in the cervical or lumbar spine.2. Disc bulge at T3-T4 with mild impression on the ventral cord. Dorsal thecal sac is preserved with no significant stenosis overall at this level.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of meninges, unspecified [D32.9], Reason for Study: ^Reason: h/o tentorial meningoma History: surveillance There is 16mm x 13mm x 14mm sized left posterior fossa extra axial well circumscribed enhancing lesion which extends into the occipital bone but the outer table appears to be intact. The lesion generates minimal mass effects against the left cerebellar hemisphere, no change since prior scan. The size and MR characteristics do not show any significant interval change since prior scan. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Underlying brain shows multifocal scattered high signal intensity lesions on FLAIR/T2 weighted images on bihemispheric white matter indicating nonspecific small vessel ischemic disease. No change since prior scan.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: 1. No interval change of the left posterior fossa extra axial mass lesion in terms of size and MR characteristics since prior scan.2. No change of non specific small vessel ischemic disease since prior scan.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:5/26/1959)Reason: stroke work up History: right sided weaknessPROVIDER/ATTENDING NAME: HELENE G RUBEIZ HELENE G RUBEIZ There is a 5 mm focus of diffusion restriction present along the medial aspect of the left temporal lobe. This is associated with T2 signal hyperintensity and FLAIR signal hyperintensity. Additionally there are punctate foci of diffusion restriction present in the left middle frontal gyrus, the left centrum semiovale and the left postcentral gyrus as well as gray matter adjacent to the posterior aspect of the deep portion of the left superior frontal sulcusThere is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These predominate over the left hemisphere when compared to the right.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple punctate foci of microinfarct and scattered in the left middle cerebral artery territory.2.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. These clearly predominate over the left hemisphere. Given the above findings of left middle cerebral artery territory microinfarcts and these findings, the possibility that there is underlying carotid stenosis on the left side is raised. Study of the carotid vasculature may be of further benefit if clinically appropriate.


Instruction: Generate impression based on findings.

Input: Elevated PSA, evaluate for Prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.1 x 4.7 x 4.5 cmPeripheral Zone: In the right mid gland peripheral zone there is a small subtle focus demonstrating T2 weighted hypointensity (series 401/67) with associated restricted diffusion (series 503/2 44) that measures 5 x 4 mm. There is a band of hypointensity in the anterior prostate involving the anterior fibromuscular stroma which shows avid enhancement on postcontrast and restricted diffusion. Otherwise the peripheral zone is atrophic. Central Gland: Hypertrophied central gland without any suspicious nodule.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No definite evidence of extracapsular extensionBLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific external iliac lymph nodes are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Highly suspicious right mid gland peripheral zone and anterior prostate lesions.2. Nonspecific small external iliac lymph nodes.


Instruction: Generate impression based on findings.

Input: migraine, intermittent right arm pain. No evidence of acute ischemic or hemorrhagic lesion.There are multifocal scattered somewhat confluent high signal lesions on bilateral hemispheres on FLAIR images. In particular, those lesions are located on right centrum semiovale, bilateral periventricular white matter, right trigone area, right middle cerebellar peduncle and bilateral frontal lobes. Signal intensities of most of lesions appear to be lessen since prior exam, however, current examination has been performed in different magnetic strength, thus cannot be comparable.Previously suggested subtle enhancement on optic apparatus around optic chiasm is not appreciable on today's scan. There is no abnormal enhancement on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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: Multifocal high signal foci on bilateral hemispheres and posterior fossa on FLAIR indicating possible demyelinating disease such as MS, no change of lesions' distribution and size since prior exam.


Instruction: Generate impression based on findings.

Input: Infection Note that the exam is significantly limited by motion artifact as well as by the presence of a right total hip arthroplasty has a lack of intravenous contrast. Hip: Within these limits, there is no evidence of a large joint effusion. The visualized portion of the humeral head appears intact. There is no abnormal marrow signal within the acetabulum or the visualized portion of the humeral head. There is no abnormal marrow signal within the remaining pelvis or left hip.Femur: Note that the distal humerus is not completely visualized. Within the limits of the exam, the distal humerus appears normal in signal as does the surrounding thigh musculature.

Output: Limited examination. Within the limits, there is no evidence of large joint effusion or significant marrow changes of the right hip to suggest septic arthritis.


Instruction: Generate impression based on findings.

Input: 29 years Female (DOB:10/1/1987)Reason: assess for meningioma causing 5th cranial nerve palsy History: 5th cranial nerve palsyPROVIDER/ATTENDING NAME: AMBER TALYN PINCAVAGE AMBER TALYN PINCAVAGE No abnormal mass lesions are appreciated. There appears to be platybasia present

Output: This is an incomplete exam. The patient decided to reschedule. There appears to be platybasia present. No obvious abnormal mass lesions are appreciated on the limited available images.


Instruction: Generate impression based on findings.

Input: 40 year old male with status epilepticus now with ST elevations on the monitor. Mental status changes. The previously seen right frontal hematoma has resolved. The surrounding encephalomalacia demonstrates some evolutionary change. Subtle left occipital low attenuation posteromedial to the left occipital horn indicates an area of previous hemorrhage better seen on prior MRI.There is very subtle loss of gray-white matter differentiation at the left parietal-occipital region which probably corresponds to the cortical signal abnormality reported on prior MRI.There is no evidence of new intracranial hemorrhage. Prominent ventricles; unchanged. There is no extra-axial fluid collection.The visualized osseous structures are unremarkable except for a Burr hole in the right frontal bone. Prominent cerebellar folia indicating volume loss.

Output: 1. Further resolution of the previously identified right frontal hematoma, with associated right frontal encephalomalacia. 2. Left posterior parietal encephalomalacia; unchanged from previous.3. No new hemorrhage is identified.4. Subtle loss of gray-white matter differentiation at the left parietal-occipital region probably corresponds to the cortical signal abnormality reported on prior MRI. Follow-up with MRI should be considered for better evaluation.


Instruction: Generate impression based on findings.

Input: 70 year old male with history of recurrent right posterior parietal meningioma after initial resection (2003). Poor candidate for re-resection, now status post frameless stereotactic radiosurgery. Follow up. Compared to 8/19/2014 there is slight enlargement of extra-axial enhancing mass along the posterior parietal convexity which extends extracranially. There is an osseous defect which is partly postsurgical. Mass measures approximately 5.8 x 3.1 cm (sagittal postgad image 15/27) and 5.1 cm in the transverse dimension (coronal T2 28/34) previously 4.2 cm in the transverse dimension. There is significant interval decrease in the previously necrotic appearance of the tumor with more solid tissue demonstrated on the current study. Extensive gliosis and cystic encephalomalacia involving the right parietal lobe is not significantly changed. Additional areas of T2/flair hyperintensity in the bilateral periventricular and subcortical white matter are also not significantly changed and compatible with chronic small vessel ischemic disease.Again seen invasion of into the superior sagittal sinus with partial occlusion similar to prior with the superior sagittal sinus appearing patent anterior and posterior to the mass. 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. The visualized portions of the paranasal sinuses again demonstrate diffuse opacification of the left frontal sinus as well as some scattered mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1)Compared to 8/19/2014, there is mild interval enlargement of the posterior parietal meningioma which extends extracranially through calvarial defect. There is interval increase in solid component of the tumor and decrease in previously necrosis.2)No significant interval increase in intracranial mass effect. There is extensive gliosis, cystic encephalomalacia, and some vasogenic edema in the right parietal lobe similar to prior. 3)Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Male, 9 years old, with staring spells and right leg and arm numbness. The left amygdala is subjectively thicker than the right with very questionable mild FLAIR hyperintensity. No masslike lesion is seen in either medial temporal lobe. No corresponding pathologic enhancement is detected. The hippocampal bodies are relatively symmetric and unremarkable.Elsewhere in the brain, no structural abnormalities are detected. There are no areas of abnormal parenchymal signal intensity. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is observed. The ventricles are normal in size and morphology. The pattern of parenchymal enhancement is within normal limits.

Output: 1.Asymmetry of the amygdalae is seen, left side thicker than right. The significance of this finding is uncertain and correlation with EEG data is recommended when available. A general differential for this finding would include normal anatomic variation, post ictal effect, a manifestation of MTS, or even a neoplastic process. A follow-up examination in three to six months is suggested.2.The remainder of the brain is free of signal abnormality, structural deformity or pathologic enhancement.


Instruction: Generate impression based on findings.

Input: Please evaluate for signs of remote hemorrhage or contusion: neonatal seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a linear flow void that traverses the left posterior cingulate region. The brain parenchyma otherwise appears unremarkable, without evidence of heterotopia or hamartomas. There is an expected degree of myelination. There is a subcentimeter left choroid fissure cyst. The ventricles and basal cisterns are otherwise normal in size and configuration and the extra-axial cerebrospinal fluid spaces are not enlarged. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Probable developmental venous anomaly in the left posterior cingulate region. Otherwise, no evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: Reason: elevated alkaline phosphatase History: as above ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation. There is a lesion within the caudate seen only on the arterial phase measuring 1.3 x 0.8 cm (11/53) which is isointense on T2-weighted images.SPLEEN: Small splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No intra or extrahepatic biliary ductal dilatation.2.Enhancing lesion within the caudate seen only on the arterial phase. Differential diagnosis includes focal nodular hyperplasia, adenoma or a perfusional abnormality.


Instruction: Generate impression based on findings.

Input: 31 years Female (DOB:6/6/1984)Reason: eval for disc herniation History: lbp for years now 3 weeks of increased pain and right sided sciatica.PROVIDER/ATTENDING NAME: HOLLY J BENJAMIN HOLLY J BENJAMIN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk dessication at this level and a small right paracentral disk protrusion which is unchanged. There is mild right sided facet hypertrophy which is also stable.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disk dessication at this level and a small central disk protrusion which is unchanged.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Previously noted uterine/adnexal lesions are not not included on this exam.

Output: There are mild and stable degenerative changes in the lower lumbar spine without compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: There is interval resolution of the previously demonstrated subcentimeter focus of high T2 signal in the midline of the splenium of the corpus callosum. The brain parenchyma appears now unremarkable and there is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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: Interval resolution of the subcentimeter focus of high T2 signal in the midline of the splenium of the corpus callosum, which was therefore compatible with a transient splenial lesion, as suggested on the prior MRI.


Instruction: Generate impression based on findings.

Input: 62 year old with history of hypertension, diabetes, and acute lymphoblastic leukemia presenting for evaluation of left ventricular systolic dysfunction.MEDICATIONS: metoprolol succinate, lisinopril, hydralazine First Pass PerfusionDuring hyperemia, there is a small perfusion defect in the basal infero-septal and possibly extending to the mid-inferoseptal slice. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 95 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 48 ml (normal range 47+/-19), the LV mass index is 40 g/m2, and the LV mass is 67 g. The systolic dysfunction is global.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 113 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral small pleural effusions. 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. There is a small defect in the basal infero-septum (possible extending to the mid-inferoseptum). 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly reduced systolic function (LVEF 50%).4. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 74 year old male with an adrenal mass. ABDOMEN:LIVER, BILIARY TRACT: There is a 3.1 x 2.6 cm irregular mass in segment 2 of the liver with associated increased T2 signal abnormality and continuous/uninterrupted peripheral nodular enhancement on post contrast sequences suspicious for metastatic disease.SPLEEN: There is mass effect on the splenic vessels by the large necrotic mass adjacent to the right kidney.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal gland is not definitively identified and may be engulfed or in continuity with the large heterogeneous, enhancing irregular mass, which is seen in alongside the superior pole of the left kidney, mass measures 10.0 x 8.3 cm (24; series 501). Given that the epicenter of the mass is suprarenal, an adrenal origin (as opposed to a large exophytic mass of renal origin) is favored. Alternatively, a dedifferentiated liposarcoma that engulfs the adrenal gland is another differential consideration. There is a right adrenal nodule that measures 3.1 x 2.8 cm, which demonstrates persistent enhancement on post contrast images and is suspicious for metastatic disease. KIDNEYS, URETERS: There is a large mass that appears to abut/exert mass effect on the left kidney. Given that the epicenter of the mass is suprarenal, an adrenal origin (as opposed to a large exophytic mass of renal origin) is favored. The left renal vein appears patent. Multiple subcentimeter foci of fluid signal intensity in the right kidney, too small to characterize, but likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: There is luminal narrowing of the intrahepatic IVC, vessel appears patent. Prominent lymph nodes also seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 3.6 x 2.8 cm mass in the right psoas muscle with associated heterogeneous enhancement (13; series 501). There is a 4.0 x 2.8 cm enhancing heterogeneous mass in the region of the left psoas muscle (9; series 501). Numerous additional subcentimeter enhancing foci are identified within the paraspinal musculature along the lower thoracic and upper lumbar spine. There is also an enhancing mass lesion along the lateral left hemiabdomen (4; series 1104). These findings are consistent with metastatic disease.Note is made of multiple foci of bone marrow signal abnormality in the pelvis and thoracolumbar spine, consistent with osseous metastatic disease.OTHER: There are numerous bilateral pulmonary nodules, consistent with metastatic disease, appearing increased in size when compared to the most recent CT examination when allowing for differences in technique. Trace bilateral pleural effusions.

Output: 1. Large enhancing 10.0 cm mass in the expected location of the left adrenal gland, which appears most consistent with a primary adrenal carcinoma, other differential considerations include metastatic disease or dedifferentiated liposarcoma with engulfment of adrenal gland, an exophytic renal malignancy is felt to be less likely given the suprarenal epicenter of the mass. 2. Right adrenal, hepatic, pulmonary, osseous and soft tissue metastatic disease, interval progression from the prior CT examination suggested, when allowing for differences in technique.


Instruction: Generate impression based on findings.

Input: 69-year-old female with acute stroke. There is no evidence of intracranial hemorrhage, mass or edema. Minimal lucency within the subcortical white matter of the right frontal region is nonspecific. If there is clinical concern for acute stroke an MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Minimal lucency within the right frontal region, nonspecific. If there is clinical concern for acute stroke an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 38-year-old male with history of UC s/p ex lap, loop ileostomy, EUA, drainage of perirectal abscess evaluate response of drainage Presacral soft tissue and peritoneal/retroperitoneal inflammatory changes are better evaluated on recent prior CT abdomen/pelvis. Right paraspinal muscle abscess measures 1.6 x 2.1 cm (series 801 image 8), previously 2.6 x 2.1 cm, with persistent focus of gas. Left paraspinal muscle abscess measures 1.3 x 1.8 cm (series 801 image 6), previously 1.6 x 2.1 cm, with persistent focus of gas. There is surrounding paraspinal inflammatory changes.Previously seen sacral epidural abscess measures 0.6 x 0.4 cm (series 801 image 8), previously 0.9 x 0.4 cm. Previously seen lumbar epidural abscess measures 0.8 x 0.6 cm (series 801 image 14), previously 1.2 x 0.9 cm. There is decreased mass effect on the thecal sac. No new abnormal fluid collection is identified. Bone marrow signal is benign. Alignment is normal without subluxation. Vertebral body heights and disc heights are maintained. Normal appearing conus terminates at L1 level. No intraspinal hematoma or mass. No significant degenerative disc disease.

Output: 1. Persistent but decreasing in size sacral and lumbar epidural and paraspinal soft tissue abscesses.2.There is extensive retroperitoneal and peritoneal inflammatory change present which we best assessed using CT of the abdomen if clinically appropriate.


Instruction: Generate impression based on findings.

Input: Reason: hx of osteoporosis and ALL. Assess for compression fractures and nerve compression. History: pain. The 12th ribs are hypoplastic. Sagittal alignment is within normal limits without sagittal spondylolisthesis.There is a wedge compression deformity involving the T12 vertebral body with approximately 40% loss of height anteriorly as well as mild retropulsion posteriorly which results in mild central canal stenosis at the T11-12 level without direct cord impingement. The fracture is new compared to the 12/10/2015 chest CT but appears similar to the outside 8/8/2016 lumbar radiograph. There is mild associated increased STIR signal within the T12 vertebra compatible with a subacute course. Vertebral bone marrow signal is otherwise within normal limits without suspicious space-occupying lesions. Thoracic vertebral body heights and disc spaces are otherwise preserved. No epidural collections are identified. The spinal cord displays normal signal and morphology. Minimal degenerative changes are identified within the thoracic spine without additional significant stenosis. A right perineural cyst is incidentally noted T10-11. The paravertebral soft tissues are unremarkable.

Output: Subacute compression fracture of T12 with associated mild retropulsion and mild central canal stenosis.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is abnormal morphology and signal intensity of the posterior horn of the medial meniscus consistent with tearing. Is also blunting of the inner free edge of the body as seen on the coronal views suggesting a radial component. The anterior horn appear relatively preserved. There may be mild intrasubstance degeneration of the lateral meniscus but there is no evidence of tear.ARTICULAR CARTILAGE AND BONE: There is a full-thickness defect of the articular cartilage of the medial femoral condyle measuring approximately 1.5 cm in length. The articular cartilage of the medial tibial plateau appears relatively preserved. There is mild heterogeneity of the articular cartilage of the lateral compartment but this is otherwise intact. There is a focus of full-thickness articular cartilage loss involving the lateral patellar facet measuring approximately 1.5 cm. This is superimposed upon moderate articular cartilage degeneration. There is full-thickness articular cartilage loss of the lateral femoral trochlea as well. There are tricompartmental osteophytes.An ovoid focus of low signal intensity measuring 5 mm is seen just inferior to the posterior horn of the lateral meniscus. A second larger ovoid focus of low signal intensity is identified in the intercondylar notch measuring approximately 13 mm. These may represent loose bodies within the joint.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: The cruciate and collateral ligaments are intact.ADDITIONAL

Output: 1. Medial meniscus tearing as described above. The lateral meniscus appears relatively preserved.2. Varying degrees of tricompartmental articular cartilage loss with full-thickness defects involving the medial femoral condyle and lateral patellar facet. There are probable loose bodies within the joint as well.3. Large Baker's cyst.


Instruction: Generate impression based on findings.

Input: 73-year-old female with right upper extremity pain. Evaluate for tendinitis/"myelitis". Evaluation is limited secondary to patient motion artifact. Additional sequences were not able to be obtained due to the patient's inability to tolerate the examination.There is abnormal signal intensity within the elbow joint representing a joint effusion and probable synovitis. Mild osteoarthritis affects the elbow joint, but we see no bone marrow edema or erosions. We see no osteomyelitis. The remaining bone marrow signal is normal. The triceps, biceps, and brachialis tendons appear intact. Evaluation of the common flexor and extensor tendons is limited. There is increased signal intensity within the common extensor tendon, at its origin, suggesting tendinosis. There may also be mild tendinosis of the common flexor tendon, but this is equivocal. Evaluation of the ligaments is limited, but we see no gross abnormalities. The remaining soft tissue structures are unremarkable.

Output: Extremely limited study showing an elbow joint effusion and/or synovitis with osteoarthritis of the elbow and other findings as described above.


Instruction: Generate impression based on findings.

Input: Dementia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several scattered areas of cerebral white matter T2 hyperintensity. The ventricles and sulci are mildly prominent diffusely. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are mild degenerative changes in the partially-imaged cervical spine.

Output: 1. Mild diffuse cerebral volume loss, without a discrete pattern to suggest a particular neurodegenerative condition. Nevertheless, a brain PET may be useful for further evaluation, if clinically warranted.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.3. Several scattered areas of cerebral white matter T2 hyperintensity are nonspecific, but may represent the result of chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 45-year-old male with possible pancreatic pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Occlusion of the splenic vein with multiple collateral vessels noted.PANCREAS: Multiple T2 hyperintense cystic lesions about the pancreatic tail with thin walls. The largest is within the lesser sac and measures up to 10.2 x 10.7 cm (series 12/52), containing a small amount of internal debris and exerting mass effect with anterior displacement of the pancreatic tail and stomach. Multiple additional smaller lesions are seen near the pancreatic tail and extending into the left upper quadrant near the splenic hilum, as well as a small lesion at the lateral aspect of the descending duodenum. The lesions have no demonstrable connection to the main pancreatic duct, which is normal in caliber. Findings are most compatible with multiple pancreatic pseudocysts.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Susceptibility artifact from clips related to prior G-tube noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings most compatible with multiple pancreatic pseudocysts with the largest within the lesser sac exerting mass effect as detailed above.


Instruction: Generate impression based on findings.

Input: 16-year-old female with new onset pain and weakness on testing. Assess for repeat rotator cuff tear. Personal history of partial undersurface tear of the supraspinatus tendon and posterior labral tear. ROTATOR CUFF: There is thickening and increased signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. There is a partial-thickness undersurface tear of the infraspinatus tendon measuring approximately 4 mm in the AP dimension. There is a trace amount of fluid within the subacromial bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Again seen is a prominent middle glenohumeral ligament with absence of the anterior superior glenoid labrum, consistent with a normal variant Buford complex. Although this examination was not protocoled for evaluation of the glenoid labrum, there appears to be deformity with increased signal abnormality within the posterior superior glenoid labrum suggestive of degenerative tearing.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Findings suggestive of internal impingement including a partial-thickness undersurface tear of the infraspinatus and tearing of the glenoid labrum. No full-thickness rotator cuff tear is evident.


Instruction: Generate impression based on findings.

Input: Clinical question: Atrophy. Signs and symptoms: Memory loss. Nonenhanced head CT:The cortical sulci, ventricular system and CSF cisterns are within normal range for patient's stated age of 85.Periventricular and subcortical patchy foci of low attenuation are concerning for mild small vessel ischemic strokes of indeterminate age.MRI is more sensitive for assessment of the extent of this finding.Mild calcification of cavernous carotid bilaterally is present.No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact.Image images through the orbits are unremarkable.Mastoid air cells and middle ear cavities as well as all visualized paranasal sinuses are unremarkable.

Output: Mild small vessel ischemic strokes of indeterminate age and unremarkable exam otherwise. In particular no convincing evidence of atrophy for patient's stated age.


Instruction: Generate impression based on findings.

Input: 47 year-old female with bilateral lower quadrant pain for 3 months following uterine biopsy with right lower quadrant pelvic pain. ABDOMEN:LUNG BASES: A left upper lobe calcified nodule represents a granuloma.LIVER, BILIARY TRACT: Three subcentimeter hypodense lesions are too small to characterize but likely represent simple hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Subcentimeter soft tissue protrusion extending from the fundus of the uterus likely represents uterine fibroid. 1.3 cm cyst adjacent to the left posterior and lateral cervix. 3-cm left adnexal cyst.The uterus is normal size, with fluid in the endometrial cavity. Otherwise unremarkable for a 47 year old female. If there is concern for gynecologic abnormality, further evaluation with transvaginal ultrasound or MRI may be helpful as clinically appropriate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No specific gynecologic abnormality, but if this is suspected, further evaluation with transvaginal ultrasound or MRI may be helpful as clinically appropriate.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Left-sided weakness. Nonenhanced CT of brain:There is diffuse low-attenuation of the left cerebellum along its inferior portion. I cannot be certain whether this represent a stroke or is artifact please correlate with history and physical exam and if there is worsening of neurological condition follow-up with an MRI is recommended. There is no evidence of hemorrhage. Right-sided pontine stroke shows no definite change. Fourth ventricle remains within normal size and in midline. No evidence of any significant mass effect in the posterior fossa. Images through supratentorial space are unremarkable.

Output: 1.No evidence of hemorrhage since prior study.2.Larger area of low attenuation in the inferior left cerebellum could represent an artifact however possibility of an additional stroke cannot be ruled out. Correlate with history and neurological exam and if there is deterioration follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: History of jaundice in a patient with PSC. Evaluate for cholangiocarcinoma. 15 lb weight loss, new jaundice, increased AP and pruritis. Elevated CA19-9 (49). ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with marked left lobar hypertrophy and atrophy of the right hepatic lobe, progressed from prior. Gradual enhancement of the right lobe is compatible with fibrosis.Changes from hepaticojejunostomy.Compared to 2009 there is significant increase in multifocal narrowing and dilatation of the intrahepatic biliary tree. This includes a 7 mm smooth appearing stricture (series 801/71) of the left hepatic biliary duct without associated enhancement. At or near the hepaticojejunostomy anastomosis there is 7 mm focal stricture associated with mild gradual wall enhancement (series 1101/280).Several probable transient hepatic intensity differences, without a suspicious intrahepatic lesion.Cholecystectomy. SPLEEN: Mild to moderate splenomegaly. The spleen is displaced into the left lower quadrant.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Compared to 2009 there has been significant increase in intrahepatic biliary ductal dilatation and multi-focal strictures.2.At or near the hepaticojejunostomy there is 7 mm focal stricturing associated with mild gradual wall enhancement (series 1101/280). A stricture, benign or malignant/with underlying periductal infiltrating cholangiocarcinoma cannot be excluded.


Instruction: Generate impression based on findings.

Input: Evaluate for lesion in periaquaductal grey matter; cyclic vomiting. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum and display slightly pointed morphologies. The posterior fossa also appears to have a rather small capacity. There is no evidence of lesions in the periaqueductal region or elsewhere in the brainstem otherwise. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings suggestive of possible Chiari type 1 malformation.2. Left tympanomastoid fluid may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: Elevated PSA, evaluate for target lesion PELVIS:PROSTATE:Prostate Size: 3.3 x 5.3 x 3.5 cm (AP x TR x CC).Peripheral Zone: 10 x 10 mm well-circumscribed nodular focus of heterogeneous T2 signal near junction of transition zone and peripheral zone (series 1101, image 19), likely a partially exophytic BPH nodule. Central Gland: Benign prostatic hyperplasia. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific perirectal lymph node measuring up to 1.3 cm (was 2001, image 132).BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Nodular focus of T2 signal abnormality near junction of transition zone and peripheral zone at the right base, indeterminate but a BPH nodule is favored. No other suspicious prostatic focus seen otherwise. 2. Prominent perirectal lymph nodes are nonspecific given the patient's history of ulcerative colitis, favored to be reactive.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and weakness ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus tendon indicating moderate tendinosis. There is perhaps focal undersurface fraying posteriorly but no evidence of a fluid-filled tear. The tendinosis extends posteriorly to affect the anterior fibers of the infraspinatus tendon which is otherwise intact. The supraspinatus and infraspinatus muscles are normal without evidence of strain or tearing. The teres minor and subscapularis tendons and muscles are normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal and there is no frank fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted.

Output: Rotator cuff tendinosis and possible mild focal undersurface fraying but without a discrete fluid-filled tear.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (3/31/15, 4/6/15, 10/9/15, 11/2/15), ultrasound images of right breast (10/12/15), images from ultrasound guided biopsy and postprocedural right mammographic images (11/2/2015), breast MRI (11/10/2015), ultrasound images of right breast (11/12/2015), images from stereotactic needle biopsy of right breast and postprocedural right mammographic images (11/19/2015) performed at Presence St. Joseph Medical Center. For comparison, digital mammographic images (1/11/14) are available. DIGITAL MAMMOGRAPHIC IMAGES (3/31/15, 4/6/15, 10/9/15, 11/2/15): The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution.In the right breast at lateral aspect around 9:00 position, there are pleomorphic calcifications, including fine linear type with a developing focal asymmetry. The calcifications are extending segmentally in discontiguous fashion, measuring 60 x 40 mm (AP x LR). The focal asymmetry is present at posterior aspect of these calcifications, measuring 11 mm. There is another asymmetry seen best on CC view at medial anterior aspect of the right breast measuring 7 mm.A circumscribed oval mass with multiple coarse benign-appearing calcifications is present at 12:00 position in the right breast, likely a fibroadenoma.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/12/15):Ill-defined hypoechoic mass measuring 7 x 9 mm at 9:00 position with echogenic rim is detected, corresponding to the focal asymmetry seen on the mammogram at posterior aspect of the segmentally distributed calcifications.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/2/2015):Ultrasound guided biopsy was performed for the mass at 9:00 position with an appropriate needle placement. Postprocedural mammograms demonstrate a marker clip (Hydromark) at the site of the focal asymmetry at 9:00 position in the right breast.Per outside radiology report, the result was malignant.BREAST MRI (11/10/2015):The study was performed with a protocol outlined in the outside report.There are 2 enhancing masses in the right breast, one at 9:00 position measuring 19 x 13 x 12 mm (AP x LR x CC), and the other at 3:00 position measuring 14 x 21 x 11 mm. The one at 9:00 position is proven carcinoma and the marker clip is present at the anterior aspect of this mass. Non-mass enhancement is present between the two masses, measuring 49 x 71 x 20 mm.No abnormal enhancement is seen in the left breast.No abnormal lymph nodes are present in either axilla.ULTRASOUND IMAGES OF RIGHT BREAST (11/12/2015):The study was performed as second look ultrasound to look for a correlate of MR detected mass at 3:00 position in the right breast. No sonographic correlate was detected in this study.IMAGES FROM STEREOTACTIC NEEDLE BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/19/2015):Stereotactic biopsy was performed for the asymmetry best seen on CC view at medial right breast, because the asymmetry is likely correlating to the MR detected mass at 3:00 position. Postprocedural mammograms demonstrate a marker clip at upper inner aspect of the right breast, near the site of the enhancing mass seen on the MRI. Distance between 2 clips is 135 mm on CC view.Per outside radiology report, the biopsy result was malignant; invasive ductal carcinoma.

Output: 1. Biopsy proven carcinoma in the right breast, 2 sites; one at 9:00 position and the other at 3:00 position. Mammograms demonstrate suspicious calcifications segmentally at lateral right breast and MRI demonstrates extensive non-mass enhancement between the two malignant masses in the right breast.2. No mammographic or MR evidence of malignancy in the left breast.3. No MR evidence of abnormal lymph nodes in either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 39 years Male (DOB:7/13/1976)Reason: patient with soft tissue mass in left lumbar paraspinal region. Concern for lipoma. He also has h/o psoriasis and would want SI joints to be looked at as well to r/o sacroiliitis. Does not need dedicated SI joints MRI. History: patient with soft tissue mass in left lumbar paraspinal region. Concern for lipoma. He also has h/o psoriasis and would want SI joints to be looked at as well.Referring Attending: REEM H JAN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There are Tarlov cysts present in the sacral spinal canal. The sacroiliac joints are not entirely included on this exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and disc bulge present at this level there is right-sided endplate reactive change present which is high signal on T1 suggesting chronic endplate reactive change.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height, disc desiccation and a disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a Schmorl's node present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or exiting nerve roots.2.No lipoma is identified


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with GBM on Avastin and temozolomide. Findings are redemonstrated compatible with prior right craniotomy and tumor resection from the posterior right frontal lobe. The region of the resection cavity contains T2 heterogeneous thickened tissue which, on comparison with multiple prior examinations, shows a slow interval increase in size. On postcontrast images, most this tissue does not enhance. However, there is patchy, discontiguous thin and/or nodular enhancement particularly along the anterior and inferior margins of this tissue which is stable to minimally increased from the prior exams. On rCBV mapping, most of this tissue demonstrates very low blood volume. Areas of elevated volume around the margins could simply represent sulcal vascularity. Elevated blood volume along the inferior margin, however, is more convincing.T2 hyperintensity extending through the white matter of the surrounding parenchyma has progressed from the prior examination, with local mass effect in the form of sulcal effacement. It also appears that the degree of susceptibility indicating microscopic blood product within and around the lesional tissue has increased from prior exams though this could partly be due to imaging at higher field strength.No discontiguous or contralateral lesions are suspected. Scattered foci of T2 hyperintensity elsewhere in the brain are unchanged and nonspecific. The ventricular system is stable in size and morphology.

Output: Heterogeneous tissue within the right posterior frontal resection bed shows a slow but steady increase in size over multiple prior examinations. The lesional tissue shows a pattern of patchy, discontiguous enhancement which may reflect partial suppression by antiangiogenic therapy. A majority of the lesional tissue shows low rCBV, but some elevated blood volume is noted along the inferior margin of the lesion correlating with an area of enhancement.Overall, the findings are concerning for residual and slowly progressive tumor, some features of which are likely masked by antiangiogenic therapy. A mixed process with both tumor and treatment effect would also be likely.


Instruction: Generate impression based on findings.

Input: PNET with neuraxis dissemination; now status post chemoradiation in November 2015 and hemiparesis. Brain: There is a large heterogeneous mass in the right frontoparietal region that is not significantly changed in size. However, there is extensive supratentorial and infratentorial leptomeningeal enhancement. There is also new nodularity and diffuse enhancement along the margins of the ventricles, as well as intraventricular debris, perhaps with a hemorrhagic component. There increased ventricular dilatation. There are bilateral cerebral convexity subdural fluid collections, left larger than right. There is no evidence of acute infarct. Spine: There is extensive diffuse leptomeningeal enhancement throughout the spinal neuraxis. There are also multiple foci of T2 hyperintensity and swelling within the spinal cord. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant extrinsic spinal canal stenosis.

Output: 1. Progression leptomeningeal disease throughout the neuraxis and intraventricular disease, which is compatible with cerebrospinal fluid dissemination of tumor, with associated edema in multiple areas of the spinal cord and superimposed intraventricular hemorrhage. The right frontoparietal PNET is otherwise unchanged.2. Small bilateral cerebral convexity subdural fluid collections without significant mass effect.


Instruction: Generate impression based on findings.

Input: 41-year-old female with multiple sclerosis, leg weakness, evaluate for progression. Brain: Redemonstrated are numerous supratentorial and infratentorial T2 hyperintense white matter lesions, without definite new lesion. Many display T1 hypointensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is new mild mucosal thickening within the ethmoid air cells. The remainder the paranasal sinuses and the mastoid air cells are clear. Expected vascular flow voids are demonstrated.Thoracic Spine: Redemonstrated are nonenhancing T2 hyperintense lesions throughout the thoracic spinal cord, unchanged in appearance, with the most prominent lesion noted at the T9 level. There are no new lesions. Thoracic vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are no stenoses. The paravertebral soft tissues are unremarkable.

Output: 1.Numerous cerebral supratentorial and infratentorial demyelinating lesions are stable without definite new lesion. 2.Stable nonenhancing demyelinating lesions of the thoracic spine.


Instruction: Generate impression based on findings.

Input: Abnormal findings on diagnostic imaging of other specified body structures [R93.8] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: evaluate for brainstem stroke or mass, was seen by Dr. Arun ( Optho) today and abnormal occular exam Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.Subtle high signal intensity on DWI (series 404, image 176) does not show diffusion restriction, thus likely represent an artifact.Patch bilateral T2/FLAIR high signal intensity lesions are seen, most likely represent nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickening on bilateral maxillary sinuses and ethmoid sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. There is more than 50% luminal stenosis at the proximal basilar artery just below bilateral AICA origin.The left vertebrobasilar junction also shows more than 50% of luminal stenosis.No intracranial arterial aneurysm is seen.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement. 2. Non specific small vessel ischemic disease.3. Proximal basilar artery and left vertebrobasilar junction stenosis (more than 50%) on non contrast MRA. If indicated, more precise imaging evaluation of basilar artery and left vertebrobasilar junction stenosis can be obtained with head and neck CT angiography.


Instruction: Generate impression based on findings.

Input: Male; 77 years old. Reason: 77M Extensive hx of pancreatobiliary complications and interventions s/p chole 2012 with biliary stent for bile leak, ERCP pancreatitis 2014 c/b pseudocyst, and 1/2015 cysto-gastrostomy stent to drain the pseudocyst. s/p ERCP 3/18/15 for stent exchange History: pancreatic pseudocyst ABDOMEN:LUNG BASES: Stable persistent right basilar nonspecific atelectasis/consolidation. Trace right pleural effusion.LIVER, BILIARY TRACT: Stable subcentimeter left hepatic cyst. Status-post cholecystectomy.Stable mild dilation of the common bile duct measuring up to 8 mm with distal smooth tapering. Stable mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Previously seen 1.7 x 1.1 cm peripancreatic fluid collection at the junction of the body and tail has resolved. No new peripancreatic fluid collections. Previously seen AXIOS cystogastrostomy stent has been removed. Double-pigtail plastic biliary stent placed during ERCP on 3/18/15 is not visualized.Mild pancreatic parenchymal atrophy is seen at the junction of the body and tail with loss of normal T1 signal in the distal body and tail, suggestive of chronic pancreatitis.The pancreatic duct within the head and downstream body appears normal. Again, there is a short segment of the pancreatic duct at the junction of the upstream body and tail that is not well visualized, which could be related to underlying stricturing. Slight prominence of the upstream pancreatic duct in the tail with some side branches visualized, which can be seen in chronic pancreatitis.Normal physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable renal cysts.RETROPERITONEUM, LYMPH NODES: IVC filter. Mild amount of mural thrombus in the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval resolution of peripancreatic fluid collection. No new peripancreatic fluid collections.2.Findings suggestive of mild chronic pancreatitis with possible stricturing of the pancreatic duct at the body/tail junction, as detailed above. Normal physiologic response to secretin.3.Stable persistent right basilar nonspecific atelectasis/consolidation, though continued CT follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Male, 24 years old. Reason: left knee meniscus tear History: left knee pain and swelling MENISCI: There is a complex tear of the posterior horn of the medial meniscus with vertical and horizontal components. The anterior horn is intact. The posterior horn of the lateral meniscus appears small and triangular, without abnormal internal signal, likely postoperative in etiology.ARTICULAR CARTILAGE AND BONE: There is mild bone marrow edema at the medial femoral condyle, and at the lateral and medial tibial plateaus. The articular cartilage appears normal.LIGAMENTS: Status post ACL repair, with normal appearance of the postoperative ligament. The PCL appears normal. The collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Persistent complex tear of the posterior horn of the medial meniscus as described above. Probable postsurgical changes of the lateral meniscus.2.Postoperative changes of ACL repair.3.Joint effusion and other findings as described above.


Instruction: Generate impression based on findings.

Input: Female 38 years old Reason: secretin stimulation needed - recurrent acute pancreatitis; history of lap chole in 2001 - but still stones in remnant cystic duct vs. partial gallbladder?? History: secretin stimulation needed - recurrent acute pancreatitis, history of lap chole in 2001 - but still stones in remnant cystic duct vs. partial gallbladder?? ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are subcentimeter hypervascular lesions that are too small to characterize. There is severe narrowing and thrombosis of the portal vein about the porta splenic confluence. The intrahepatic portion of the portal vein is patent.There are postsurgical clips in the gallbladder fossa. There is a fluid containing structure within the gallbladder fossa measuring 4.1 x 3.2 cm that contains multiple small stones. This is in connection with the bile duct and may represent either a gallbladder remnant or dilatation of the cystic duct remnant. The wall is thin measuring under 2 mm. There is no surrounding inflammation.Intrahepatic bile ducts and common bile duct are normal in caliber. No luminal filling defects to suggest stones.SPLEEN: Spleen is enlarged. There are multiple perigastric venous collaterals from splenic venous thrombosis.PANCREAS: There is residual inflammation about the tail of the pancreas that extends into the splenic hilum and to lesser degree around the head and proximal body of the pancreas. The pancreatic duct is mildly dilated within the tail with a possible tiny pseudocyst in the tail. There is subtle narrowing in the midportion of the pancreatic duct.Slightly blunted response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a right renal cyst. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple small stones within either a residual bladder or dilated cystic duct remnant without choledocholithiasis or biliary ductal dilatation.2.Residual inflammation in the pancreas with mild tail pancreatic ductal dilatation and narrowing in the mid pancreatic duct which may represent a developing stricture or due to residual inflammation.3.Thrombosed splenic vein and portal vein near the portal splenic confluence with venous collaterals.


Instruction: Generate impression based on findings.

Input: 30 years Female (DOB:11/22/1985)Reason: headache History: migraine headachePROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits to the extent of the exam. Please note that this is a limited exam relative to the typical University of Chicago protocol. No susceptibility weighted imaging was acquired, no axial T1 imaging was acquired and no coronal T2 imaging was acquired.


Instruction: Generate impression based on findings.

Input: 53-year-old man status post below-knee amputation. Evaluate for osteomyelitis. There has been amputation through the Chopart joint. There is soft tissue ulceration and irregularity along the anterior margins of the talus and calcaneus, with several foci of gas within the subcutaneous soft tissues and associated abnormal bone marrow signal consistent with osteomyelitis. The tendons of the ankle are grossly normal, although muscle atrophy is noted.

Output: Osteomyelitis affecting the anterior aspects of the talus and calcaneus.


Instruction: Generate impression based on findings.

Input: 43 year old female with known left breast cancer status post neoadjuvant chemotherapy and positive left axillary lymph node. Personal history of benign left breast biopsies for tubular adenoma and fibroadenoma and benign right axillary lymph node biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left superior breast, at site of known malignancy, there is revisualization of an irregular enhancing mass measuring 11 x 15 x 12 mm (AP x ML x SI: previously 23 x 17 x 19 mm). Biopsy marker clip is located centrally within this malignancy. Degree of enhancement has significantly reduced.Biopsy-proven tubular adenoma (5:00 position) and biopsy-proven fibroadenoma (9:00 position) of the left breast are unchanged.RIGHT BREAST:No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.AXILLA: The two biopsied left axillary lymph nodes measure 17 x 7 mm and 8 x 6 mm respectively (previously 17 x 7 mm and 11 x 5 mm). Right axillary lymph nodes including biopsy proven benign lymph nodes appear unchanged.

Output: 1. Interval decrease in size of left breast index malignancy and stable - mild decrease in size of left axillary lymph nodes.2. No MR evidence of malignancy in the right breast.3. Stable biopsy-proven tubular adenoma and fibroadenoma of the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 36 years old. 5mo s/p hip scope for labral repair. Persistent pain. ACETABULAR LABRUM: The labrum appears intact, without evidence of tearing.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. The visualized osseous structures are normal, with normal cortical thickness and marrow signal.SOFT TISSUES: No solid mass lesion, discrete fluid collection, or other focal soft tissue abnormality is identified. ADDITIONAL

Output: No evidence of labral tear or other significant abnormality on MR to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Lumbar stenosis, L4-L5 right disc protrusion, rule out spine compression. Worsening of the low back pain, weakness of bilateral legs, right greater than left, tingling and numbness bilateral legs. 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. There is no abnormal enhancement.Multiple sequences are motion degraded, which slightly limit evaluation. Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge with dorsal annular fissure. No spinal canal or neural foraminal stenosis.L4-L5: There is a disc bulge eccentric to the right with a small right lateral recess and foraminal protrusion component. Small dorsal annular fissure. There is partial effacement of the right lateral recess with contact of the right L5 nerve root. There is also mild right neural foraminal narrowing which may be affecting the right L4 nerve root. No significant central canal stenosis. Left neural foramen is patent. L5-S1: Mild disc bulge. No significant spinal canal stenosis. There is mild right and mild to moderate left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Degenerative changes in the lumbar spine at the L4-L5 and L5-S1 levels as above with partial effacement of the right lateral recess at the L4-L5 level as well as relatively mild L4-L5 and L5-S1 neural foraminal stenosis as described above. No high-grade spinal canal or high-grade neural foraminal stenosis at any level is appreciated.


Instruction: Generate impression based on findings.

Input: Reason: assess for contusion/chondral injury of her right knee patellofemoral joint History: anterior/anterior medial knee pain, s/p fall directly onto knee MENISCI: Poorly defined hyperintense signal in the posterior horn and body of the medial meniscus indicates intrasubstance myxoid degeneration. We see no meniscal tear.ARTICULAR CARTILAGE AND BONE: Mild increased signal within the articular cartilage of the patella centrally suggests focal but near full thickness degeneration. The bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: A small focus of T2 hyperintense signal in the subcutaneous fat along the anterolateral aspect of the distal quadriceps tendon is consistent with contusion. There is mild increased signal intensity within the underlying tendon which may likewise represent contusion but we see no fluid-filled tears.ADDITIONAL

Output: 1. Small soft tissue contusion along the knee as described above.2. Small focus of degeneration of the patellar cartilage as described above.


Instruction: Generate impression based on findings.

Input: New onset headache and visual changes (left hemiscinitillations transiently), psoriatic arthritis, possible lupus, and leukopenia. Brain: There cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum, which appears to be crowded. The posterior fossa also has a small capacity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The supratentorial brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there appear to be prominent upper neck lymph nodes.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. Low-lying cerebellar tonsils in a configuration suggestive of Chiari 1 malformation.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.3. No evidence of orbital lesions.4. Prominent upper neck lymph nodes may be related to an autoimmune condition.


Instruction: Generate impression based on findings.

Input: Male 20 years old Reason: eval for meniscal pathology History: R knee pain/locking s/p injury 7/8 MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is minimal bone marrow edema within the anterior medial femoral condyle. No significant associated T1 marrow abnormality. The remaining bone marrow signal is normal. No focal articular cartilage defect.LIGAMENTS: The ACL, PCL, MCL and lateral collateral complex is intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Minimal bone marrow edema within the anterior medial femoral condyle. Otherwise, unremarkable MRI of the knee.


Instruction: Generate impression based on findings.

Input: Pain and popping sensation with history of scapholunate disassociation. LIGAMENTS: Intra-articular contrast is again identified within both the mid carpal and radiocarpal joints after intra-articular injection of the mid carpal joints was performed. Intra-articular contrast is again visualized traversing the scapholunate ligament, indicative of tear (series #901, images 59-68). Further, contrast appears to traverse the lunotriquetral ligament, new from prior examination and best seen on series #901, image 53 and confirmed by arthrogram.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact without intra-articular contrast identified within the distal radioulnar joint.TENDONS: No significant abnormality noted. BONES: The previously visualized increased marrow signal within the triquetrum has improved in comparison to prior examination. No other significant abnormalities. ADDITIONAL

Output: 1. Findings consistent with disruption of the scapholunate ligament as described above. Further, the lunotriquetral ligament appears disrupted, a new finding in comparison to prior examination. The triangular fibrocartilage complex remains intact.2. Interval improvement of the bone contusion of the triquetrum.


Instruction: Generate impression based on findings.

Input: Right sided tinnitus, hearing loss, HA, LAN. There are multiple, greater than 10 foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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. There is a defect in the left lamina papyracea with orbital fat herniation.

Output: 1. Findings suggestive of a demyelinating process, such as multiple sclerosis.2. A defect in the left lamina papyracea with orbital fat herniation may be due to prior fracture or developmental in nature.


Instruction: Generate impression based on findings.

Input: L4 lytic lesion. please provide biopsy Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Following the procedures no significant hematomas was identified.

Output: L4vertebral bone biopsy under CT guidance. A total of nine samples were delivered to surgical pathology for analysis.


Instruction: Generate impression based on findings.

Input: 43-year-old male with history of renal cell carcinoma status post partial nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. No focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval decrease in size of a partially exophytic right interpolar kidney T2 hyperintense cyst. No hydronephrosis.Post changes of the partial left nephrectomy. Retroaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Scattered right mesenteric lymphadenopathy is not significantly changed when compared to the prior exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical appearance of a partial left nephrectomy without evidence of recurrent or metastatic disease.2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Cardiac arrest [427.5], Reason for Study: ^Reason: eval for ischemic injury History: altered mental status There are multifocal bihemispheric subtle restricted diffusion areas including bilateral basal ganglia, bilateral caudate nucleus head, bilateral occipital lobes and bilateral mesial thalami indicating diffuse hypoxic injury.There are high signal intensity lesion on FLAIR and T2 weighted images on the pons without involving cortical surface of pons which may indicate associated osmotic demyelination such as central pontine myelinolysis. Correlation of the patient's history especially electrolyte level would help in differential diagnosis.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 are clear.Bilateral mastoid air cells are opacified.

Output: 1. Multifocal restricted diffusion lesions indicating acute ischemic infarction on bilateral basal ganglia, mesial thalami, caudate nucleus, parietal lobes and occipital lobes. The distribution of lesions are compatible with global hypoxic injury.2. Relatively well demarcated high signal intensity lesions on pons with sparing cortical surface indicate possibility of osmotic demyelination.


Instruction: Generate impression based on findings.

Input: 56-year-old male patient with pain. Evaluate for meniscal tear. MENISCI: Again seen is a complex tear of the posterior horn of the medial meniscus and blunting of the free edge of the posterior horn, similar to prior.Complex meniscal tearing including horizontal and vertical components, predominantly affecting the posterior horn and body, as well as blunting of the free edge appears similar to prior.ARTICULAR CARTILAGE AND BONE: Tricompartmental osteophytes are noted. There is a full-thickness chondral defect in the weightbearing portion of the medial femoral condyle, progressed compared to prior MRI. This defect measures up to 2.3 cm in AP dimension and 1.3 cm in mediolateral dimension. There is also a large area of full-thickness chondral loss in the weightbearing portion of the medial tibial plateau with subtle subchondral reactive marrow changes. There are numerous chondral defects in the posterior weightbearing portions of the lateral compartment, similar to prior. There is thinning and partial-thickness fissuring of the patellar cartilage.LIGAMENTS: The anterior cruciate ligament is not visualized, unchanged compared prior examination and compatible with a chronic full-thickness tear. The posterior collateral ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Tricompartmental chondromalacia with progression of full-thickness chondral defects in the medial compartment.2.No significant interval change in medial and lateral meniscal complex tearing.3.Baker's cyst containing at least one loose body.4.Chronic anterior cruciate ligament tear.


Instruction: Generate impression based on findings.

Input: Please evaluate for cord compression: history of cyst and new urinary and stool incontinence. There is mild multilevel degenerative spondylosis of the cervical spine, without evidence of spinal cord compression. There are apparent scattered hyperintensities along the spinal cord on the STIR sequences. There is reversal of the usual cervical lordosis, by no evidence of spondylolisthesis. There is a normal thoracic and lumbar spinal column alignment. There is mild concavity of the superior T11 endplate. The vertebral body heights and bone marrow signal are otherwise grossly intact. There is multilevel degenerative spondylosis in the lumbar spine. In particular, there is a cyst that appears to arise from the right ligamentum flavum and projects into and considerably narrows the spinal canal. There appears to be a left thyroid nodule that measures up to approximately 20 mm.

Output: 1. Mild multilevel degenerative spondylosis of the cervical spine, but no evidence of spinal cord compression. 2. Multilevel degenerative spondylosis in the lumbar spine. In particular, there is a cyst that appears to arise from the right ligamentum flavum and projects into and considerably narrows the spinal canal, but does not appear to be significantly changed since 10/27/15. Please refer to the prior lumbar spine report for additional details regarding the degenerative spondylosis. 3. Scattered hyperintensities along the spinal cord on the STIR sequences are likely artifactual, although actual lesions cannot be entirely excluded on this limited exam.4. Apparent left thyroid nodule. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:7/17/1947)Reason: stroke rule out History: stroke rule out with new onset AMSPROVIDER/ATTENDING NAME: KOUROSH D REZANIA KOUROSH D REZANIA MRI of the brainNo diffusion weighted abnormalities are appreciated.This a focus of encephalomalacia present in the right middle frontal gyrus associated with some gyral signal loss and susceptibility imaging. A similar focus is present in the left middle frontal gyrus.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Patchy T2 and FLAIR signal hyperintensities are present in the brainstem.No abnormal mass lesions are appreciated intracranially. 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 some mild mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Patient motion degrades some of the pulse sequence acquisitions.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. The posterior communicating arteries are not readily identified. The right vertebral artery appears to be hypoplastic.

Output: 1.No evidence for cerebrovascular occlusive disease. 2.No evidence for intracranial aneurysm..3.Findings suggest a small foci of encephalomalacia in the right and left middle frontal gyri. Most likely these are related to ischemic events.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. Additional patchy lesions in the brainstem are also likely vascular related5.The exam is degraded due to patient motion which could excrete obscure some subtle abnormalities.6.There is no evidence for acute ischemic cerebral infarction.