Instruction: Generate impression based on findings.

Input: Clinical question: Vascular versus Alzheimer. Signs and symptoms: Memory loss starting 1.5year ago. Nonenhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates numerous small narrowing size foci of FLAIR and T2 hyperintensity primarily in the periventricular white matter of cerebral hemispheres as well as bilateral basal ganglia, the sclerosis and minimally in the subcortical white matter of cerebral hemispheres. The findings are consistent with chronic small vessel ischemic strokes which are hemorrhagic in the basal ganglia. The signal intensity of the cerebral cortex, bilateral thalami, pons and cerebellum/vermis remains within normal.The cortical sulci and ventricular system as well as the CSF spaces are within normal and without finding to suggest parenchymal volume loss.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are unremarkable.Images through the orbits are unremarkable.All paranasal sinuses are visualized and pneumatized however a small retention cyst in the dependent right maxillary sinus is noted.

Output: 1.No acute intracranial process.2.Moderate chronic and minimally hemorrhagic small vessel ischemic strokes primarily in the periventricular and bilateral basal ganglia and to a lesser degree in the subcortical white matter as detailed.3.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces for patient's stated age.


Instruction: Generate impression based on findings.

Input: Numbness on right side Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained . Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc osteophyte complex. No significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowing.C4-5: Disc osteophyte complex including a central disc protrusion which contacts the ventral cord. There is mild to moderate degree of spinal canal stenosis. There is mild to moderate right and no significant left neural foraminal stenosis.C5-6: Small disc osteophyte complex including small central disc protrusion with mild spinal canal stenosis and no significant left neural foraminal stenosis. Mild right neural foraminal narrowing.C6-7: There is a central/right central disc extrusion with 8 mm caudal migration. Herniation also erodes into the posterior superior corner of the C7 vertebral body. Disc material contacts the ventral cord. There is mild to moderate degree of spinal canal stenosis at this level. Neural foramina are patent.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 heterogeneous appearance of the thyroid gland with a nodule in the right measuring up to 15 mm.

Output: 1. Multilevel degenerative changes in the cervical spine including a right central disc extrusion at the C6-C7 level. There is mild to moderate degree of spinal canal stenosis at the C4-C5 and C6-C7 levels where the disc herniations mildly indent the ventral cord. No cord signal abnormality. Additional details as above.2. Heterogeneous thyroid gland with 15 mm nodule involving the right thyroid lobe.


Instruction: Generate impression based on findings.

Input: Reason: 65-year-old female with a history of metastatic pancreas cancer please compare to previous imaging and provide index lesion measurements for RECIST History: As above ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. No discrete suspicious lesion or pathologic enhancement to suggest metastatic disease.Patent portal and hepatic vasculature. No intrahepatic or extrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted. Patent splenic vein.PANCREAS: Again seen is a poorly defined infiltrative pancreatic mass, measuring 2.7 x 1 .6 cm, previously 2.7 x 1.8 cm (series 4 image 22). The body and pancreatic tail are again noted to be markedly atrophied distal to this mass with chronic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of peritoneal metastasis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in size of infiltrative pancreatic mass without evidence of distant metastatic disease.


Instruction: Generate impression based on findings.

Input: Female 76 years old Reason: r/o tear History: Pain. Decreased mobility Multiple sequences are degraded by motion.ROTATOR CUFF: There is full-thickness tearing of the supraspinatus tendon near its insertion with retraction of the tendon fibers by approximately 2 cm. This full-thickness tear involves essentially the entire AP distance of the supraspinatus. Moderate to severe muscle atrophy of the supraspinatus. Fluid is present within the subdeltoid bursa, consistent with full thickness tearing. However, the infraspinatus appears intact, with some mild increased T2 signal indicating tendinopathy. The teres minor and subscapularis are intact. SUPRASPINATUS OUTLET: Type I acromion. Osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Degenerative cysts within the humeral head indicating osteoarthritis. Labrum is intact.BICEPS TENDON: Biceps tendon is situated within the bicipital groove and is normal in appearance. ADDITIONAL

Output: 1.Full-thickness tearing, retraction, and atrophy of the supraspinatus tendon and muscle as detailed above. 2.Mild infraspinatus tendinopathy.3.Osteoarthritis


Instruction: Generate impression based on findings.

Input: Developmental delay, porencephaly, 4 month history of progressive hearing loss, gait decline, change in speech, and multifocal pains, intracranial bleeding, new-onset seizure like episodes and 50pound weight loss. Brain: There are bifrontal porencephalic cysts and deficiency of much of the septum pellucidum. There is layering intermediate T1 and low T2 signal hemorrhage in the occipital horns of the bilateral lateral ventricles. There is extensive supratentorial and infratentorial superificial siderosis. There are bilateral cerebral convexity subdural fluid collections, measuring 16 mm on the left and 6 mm on the right, with compression of the underlying brain. The ventricular system is unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is staphylomatous deformity of the right globe. There is a left maxillary retention cyst and mild right maxillary sinus mucosal thickening.Lumbar Spine: There is diffuse T2 hypointensity along the surface of the imaged spinal cord. There is also a small amount of high T1 and low T2 signal material within the inferior spinal canal. 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 spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Bifrontal porencephalic cysts.2. Layering acute hemorrhage in the occipital horns of the bilateral lateral ventricles and subacute hemorrhage in the inferior spinal canal. 3. Bilateral cerebral convexity subdural effusions, left larger than right.4. Extensive superficial siderosis involving the intracranial contents and imaged potions of the spinal cord.


Instruction: Generate impression based on findings.

Input: 65 year old with right axillary lymph nodes swelling and cluster of powdery calcifications in the left lower inner quadrant. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST AND AXILLA:In the left breast at middle 3:30 position, there is an enhancing circumscribed mass measuring 15 x 6 x 5 mm (AP x LR x CC). The mass shows branching-shape, likely intraductal papilloma.No abnormal enhancement is seen in the lower inner quadrant, where powdery calcifications are present. No abnormal lymph nodes are identified in left axillary region.RIGHT BREAST AND AXILLA:In the right axilla, at least four abnormally enlarged lymph nodes along with normal morphology lymph nodes.The largest lymph node measures 25 mm in maximum diameter.No abnormal enhancement is seen in right breast.

Output: 1. An enhancing mass in the left breast at 3:30 position. MR-directed ultrasound was performed for this mass and a correlate was detected. Ultrasound guided biopsy for the correlate was performed later today.2. At least 4 abnormally enlarged lymph nodes in the right axilla.3. No abnormal enhancing lesion in the right breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: History of metastatic medullary thyroid cancer, compare to previous. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma demonstrates decreased signal on out of phase images compatible with hepatic steatosis. There is redemonstration of numerous, scattered ill-defined enhancing foci throughout the liver compatible with hypervascular metastases. In general, the lesions demonstrate high T2 signal, restricted diffusion, and arterial enhancement. For future comparison, an example reference lesion in the inferior most aspect of the right hepatic lobe (series 7, image 146) measures 1.4 x 1.7 cm. The hepatic vasculature appears patent. There is cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous renal simple cysts are present bilaterally. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Ill-defined enhancing lesions throughout the liver suspicious for hypervascular metastases. Reference lesion for future comparison is provided.


Instruction: Generate impression based on findings.

Input: New diagnosis of high-grade prostate cancer, staging exam. Recent biopsy showed Gleason score 9 (4+5) adenocarcinoma of left base. PELVIS:PROSTATE:Prostate Size: 4.7 x 2.9 x 3.7 cm.Peripheral Zone: There is a lesion centered in the left base extending into the mid gland (series 801, image 16) measuring 1.5 x 2.2 cm which demonstrates low T2 and ADC signal. The lesion bulges the capsule and likely extends into the left neurovascular bundle. There is asymmetric enlargement and signal abnormality involving the left seminal vesicle compatible with tumor extension.Central Gland: No significant abnormality.Seminal Vesicles: Asymmetric enlargement and signal abnormality involving the proximal left seminal vesicle compatible with tumor extension.Extracapsular Extension: Probable extension into the left neurovascular bundle and left seminal vesicle as described above.BLADDER: No significant abnormality noted.LYMPH NODES: No abnormally enlarged symptoms are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Prostate cancer centered at left base peripheral zone extending into the left mid gland. There is associated bulging of the capsule as well as probable extension into the left neurovascular bundle and left seminal vesicle.


Instruction: Generate impression based on findings.

Input: 31-year-old with history of breast cancer presenting with lower extremity weakness. Cord abnormality noted on prior MRI. Redemonstration of widespread osseous metastatic disease throughout the visualized spine. There are multiple compression deformities throughout the thoracic spine most notably at T3, T9, and T11 with at most 50 percent loss of vertebral body height, but without significant retropulsion of the fracture fragments. There is mild increase in the thoracic kyphosis centered around T3 compression deformity. Alignment is otherwise maintained.There is extensive enhancing tumor in the paraspinal soft tissues which becomes confluent from T3 to T8. There is filling of the neural foramen at these levels with tumor. There is also extensive multilevel extension into the ventral epidural space which creates at most mild spinal canal stenosis. Redemonstration of a focal intramedullary signal abnormality in the thoracic cord at the T12-11-1 level. There is increased T2 signal as well as slight expansion of the cord. Postcontrast images show a 6 x 4 x 6 mm focus of enhancement as well as extensive deposits noted along the visualized cord.Note is made of multiple expansile rib metastases and associated right pleural effusion.

Output: 1.Focus of expansile intramedullary enhancement and increased T2 signal in the spinal cord at the T12-L1 level compatible with an intramedullary metastasis.2.Numerous drop metastases along the visualized thoracic spinal cord.3.Widespread osseous metastatic disease appears similar to prior studies. There are numerous stable compression deformities without significant fragment retropulsion.4.Widespread paraspinal tumor enhancement with multilevel neural foraminal/epidural extension creating at most mild spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 82 years old, with known degenerative disc disease, left lower extremity sural neuropathy, and sciatica, narrowing on last MRI one year ago. Presenting with progressive left lower extremity pain over the past two weeks. Grade 1 anterolisthesis of L4 relative to L5 is unchanged. Sagittal alignment is otherwise unremarkable. Vertebral body heights are preserved. No concerning marrow replacement is seen. Degenerative endplate signal change is noted at L5-S1.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed by level below.Partially imaged disc bulging and disc protrusions in the lower thoracic spine show no significant interval change. Again seen is generalized loss of disc T2 signal in the lumbar spine with loss of disc height most notably at L5-S1, unchanged. Additional level specific findings are as follows:L1-2: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes. L3-4: Moderate facet hypertrophy and significant ligamentum flavum thickening. Moderate bulging disc. Moderate generalized spinal canal stenosis with slight crowding of the cauda equina. Mild bilateral foraminal narrowing. No significant interval changes. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Disk bulging and disc uncovering. Severe generalized spinal canal stenosis with crowding and impingement of the cauda equina nerve roots. Mild bilateral foraminal narrowing. No interval changes. L5-S1: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc and osteophytic spurring. Moderate generalized spinal canal stenosis with particular effacement of the lateral recesses and likely impingement of the transiting S1 nerve roots. Moderate bilateral foraminal narrowing. No interval changes. Incidental note is again made of a staghorn calculus within the left renal collecting system. The right kidney is atrophic and contains at least one cyst.

Output: No significant interval change in multilevel degenerative disease is seen when compared to the prior examination from 2014. Significant spinal canal stenosis is seen at L3-4, L4-5 and L5-S1 with moderate bilateral foraminal narrowing at L5-S1.


Instruction: Generate impression based on findings.

Input: Chronic migraine without aura, not intractable, without status migrainosus [G43.709], Reason for Study: ^Reason: structural cause for headache History: headache No evidence of acute ischemic or hemorrhagic lesion.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 mastoid air cells are clear.Multiple retention cysts on bilateral maxillary sinuses, and sphenoid sinus.

Output: Normal brain MRI except multiple paranasal sinus retention cysts.


Instruction: Generate impression based on findings.

Input: MRI brain: Again seen are multiple supratentorial T2/FLAIR hyperintense lesions involving the subcortical and periventricular white matter, including callososeptal interface, grossly unchanged since 8/23/2014. Some of the lesions demonstrate corresponding T1 hypointensity. There is no enhancement associated with any of these lesions. There are no new lesions in the brain parenchyma.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRI cervical spine: There is a patchy area of increased T2 signal abnormality in the right lateral aspect of the cervical cord at C2 level, progressed compared to 1/7/2011. There is a stable tiny focus of increased T2 signal abnormality at C1, unchanged from prior. There are patchy areas of increased signal intensity within the cervical cord extending from C3 to C4 bilaterally which are slightly progressed since the prior exam from 1/7/2011. No definite enhancement is appreciated corresponding to the lesions in the cervical cord. No new lesions in the cervical cord.The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. MRI thoracic spine: There are multiple areas of patchy increased signal intensity within the thoracic cord at T3, T4-T6, T9, T10 and T11, similar to prior. No evidence of abnormal enhancement or new lesions are seen in the thoracic cord.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Multiple T2/FLAIR hyperintense lesions in the brain consistent with known demyelinating disease. Compared to 8/23/2014 no new lesions are seen. No lesions with enhancement to suggest active demyelination.2. Patchy T2 hyperintensity involving the cervical cord appears slightly increased at the C2 and C3-C4 levels when compared to MRI dated 1/7/2011. No definite enhancement to suggest active demyelination.3. Patchy areas of demyelinating plaques throughout the thoracic cord with no enhancing lesions, not significantly changed since MRI dated 1/7/2011.


Instruction: Generate impression based on findings.

Input: Obstructive hydrocephalus. Status post neurocytoma resection 3 months ago. There has been evolution of the postoperative changes since the previous examination. Foci of diffusion restriction in the surgical bed and along the right transparietal surgical tract are improved and probably reflect residual blood products and other postoperative change. Right frontal infarct and edema have evolved, with less extensive white-matter T2-hyperintensity with associated overlying cortical laminar necrosis. There is a linear surgical tract in the left frontal lobe from previous biopsy.The right transparietal ventriculostomy catheter has been removed and the tract is larger than before which probably reflects evolution of the ischemic changes along the tract. There is also T2-hyperintensity along the right parietal surgical tract, probably gliosis given previous postoperative findings. There is new significant focal expansion of the posterior parts of the right lateral ventricle and its temporal horn, which is probably caused by adhesions in the posterior body. The anterior right lateral ventricle is unchanged. The third and left lateral ventricle are mildly more expanded than previously but are not particularly dilated. Small amount of residual heterogeneous tumor along the roof of the right lateral ventricle is probably present as described before. It was compressed previously by blood and other postoperative change, and has now emerged as an oval area of abnormality. Foci of susceptibility effect in the ventricles, along the tentorium and in the surgical cavities are reflective of blood products. There is mild contrast enhancing dural thickening underlying the craniotomy flaps, within expected. There is minimal, somewhat linear contrast enhancement in the right transparietal surgical tract, which is probably postoperative in nature relating to granulation tissue. The major cerebral flow voids are intact. Severe mucosal thickening completely opacifies the right maxillary sinus. There is also mucosal thickening involving the right anterior ethmoid sinuses and the hypoplastic right frontal sinus.

Output: 1.Expected evolution of the postoperative findings in the right frontal and parietal lobes.2.Following removal of the right transparietal ventriculostomy catheter, there has been interval focal dilatation of the right lateral ventricle posterior to presumed adhesions in the posterior body.3.An area of oval residual tumor has now emerged along the roof of the right lateral ventricle.


Instruction: Generate impression based on findings.

Input: 40 year old female with biopsy proven left breast cancer with metastatic left axillary lymph node presents for breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.LEFT BREAST:There are multiple, irregularly shaped enhancing masses at posterior upper outer quadrant. Most of these masses are connected, and large conglomerated masses are formed. The conglomerated masses measure 59 x 41 x 54 mm (AP x LR x CC), consistent with biopsy proven carcinoma. A marker clip is identified within the masses. In addition to the conglomerated masses, innumerable enhancing foci are present in the upper outer - lower outer quadrant. Those enhancing foci are suspicious for satellites. Total distance of all these lesions is 102 x 68 x 78 mm. Peritumoral edema is present posterior to the conglomerated masses, RIGHT BREAST:No abnormal enhancement is seen in right breast. AXILLAE:In the left axilla, a lymph node with partially enlarged cortex is present at superior aspect, with a marker clip, consistent with proven metastatic lymph node. No other abnormal lymph node is seen in the left axilla.No abnormal lymph nodes are identified in right axillary region.

Output: 1. Proven left breast cancer with likely multiple satellites in the upper - lower outer quadrant.2. Proven metastatic left axillary lymph node.3. No MR evidence for malignancy in the right breast or right axilla. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Right parotid mass. There are enlarged right parotid lymph nodes, measuring up to 27 mm. There are also mildly prominent right level 2 and supraclavicular lymph nodes. The left cervical lymph nodes are not particularly enlarged. The left parotid and bilateral submandibular glands are unremarkable. The upper aerodigestive tract appears to be intact. The orbits and imaged intracranial structures are unremarkable. The osseous structures appear to be intact.

Output: Right parotid and cervical lymphadenopathy may represent reactive lymphadenitis, such as Cat scratch disease, or perhaps Castleman disease, or a lymphoproliferative disorder.


Instruction: Generate impression based on findings.

Input: Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter [T81.31XA], Reason for Study: ^Reason: preoperative planning for surgery 2/2 History: preoperative planning for same day surgery Scan was performed with the Stealth protocol for preoperative localization.Redemonstration of posterior right hemispherectomy status.Right-sided extra-axial fluid collection with air-fluid level, dysmorphic left lateral ventricle and third ventricle with multifocal loculation, are unchanged.

Output: Preoperative localization scan with STEALTH protocol.No significant interval change since prior scan.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with optic neuritis. Brain: There are numerous T2 hyperintense lesions in the supratentorial and infratentorial white matter, While some of the lesions appear to be less conspicuous and associated enhancement has resolved, such as in the left inferior left frontal gyrus subcortical white matter and bilateral periventricular white matter, there is persistent enhancement associated with the right gyrus rectus subcortical white matter lesion and newly apparent enhancement and mild swelling of the left prechiasmatic optic nerve segment ad left aspect of the optic chiasm. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration, with mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening and abundant secretions in the right maxillary sinus. The skull and scalp soft tissues are grossly unremarkable.Orbits: There is no evidence of abnormal signal or enhancement of the intraorbital optic nerves. The bilateral globes, lacrimal glands, extraocular muscles, and orbital fat appear unremarkable. There is no evidence of intraorbital mass lesions.Cervical Spine: There has been overall interval decrease in the degree of swelling and conspicuity related to multiple T2 hyperintense lesions in the cervical spinal cord. There is a persistent subcentimeter focus of enhancement in the left spinal cord at the level of the dens, but otherwise interval resolution of other areas of enhancement in 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 spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Numerous intracranial demyelinating lesions with overall decrease in the associated enhancement, although enhancement associated with the right gyrus rectus subcortical white matter lesion persists and enhancement and mild swelling of the left prechiasmatic optic nerve segment ad left aspect of the optic chiasm is newly apparent.2. Decreased edema associated with multiple demyelinating lesions in the cervical spinal cord, along with overall interval decrease in the associated enhancement, although a small area of enhancement in the left spinal cord at the level of the dens persists.3. Findings suggestive of acute right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: Unspecified visual disturbance [368.9], Reason for Study: ^Reason: cause of vision loss History: vision loss Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.Orbit MRIThere is pre-septal soft tissue swelling which shows high signal intensity on T2 weighted image and enhancement indicating possible cellulitis.The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Normal brain MRI, Neck MRA and Brain MRV.3. Possible pre-septal cellulitis on the right as described above.


Instruction: Generate impression based on findings.

Input: Right-sided neck pain, right upper extremity radicular symptoms, and right lower back pain. Cervical Spine: A posterior disc osteophyte complex and uncovertebral joint hypertrophy at C3-4 result in mild central and bilateral neural foraminal stenosis. There are no significant degenerative changes identified at the other cervical spinal levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Lumbar Spine: There are small annular fissures at L2-3 and L5-S1, with an associated slight posterior disc bulge. However, there is no significant central canal or neuroforaminal narrowing at these or other lumbar spine levels. The vertebral body heights are preserved and there is no spondylolisthesis. The vertebral bone marrow signal is unremarkable. The distal spinal cord and cauda equina display normal signal and morphology. The conus medullaris tip is located at the T12-L1 level. The paravertebral soft tissues are unremarkable.

Output: 1.Mild spinal canal and bilateral neural foraminal stenosis at C3-4.2.Small annular fissures associated slight posterior disc bulging at L2-3 and L5-S1, but no significant central canal or neuroforaminal narrowing.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56 year old female with family history of breast cancer in her sister, mother, maternal grandmother, maternal great aunt, and maternal cousin. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 65-year-old female with metastatic carcinoid tumor off therapy. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Status post segment 4/5 liver lesion resection cavity is is stable in size and appearance. The referenced right posterior liver lesion and reference segment 7/8 lesion are also unchanged in size. Reference measurements are provided below.Multiple additional scattered lesions which are bright on diffusion weighted images and many of which show washout on delayed post contrast images are similar in size and distribution compared to the prior exam. No definite new lesions are identified.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Fat-containing lesion in the inferior pole of the left kidney is consistent with an angiomyolipoma and remains unchanged. Right renal cysts are also unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post hemicolectomy.BONES, SOFT TISSUES: Diastases of the rectus abdominis muscle.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/28/2016 09:00:00)LIVER RESECTION CAVITY: 2.4 x 1.9 cm (Image 23, Series 601); 2.4 x 1.9 cm on prior (11/30/2015) (Image 26, Series 301).RIGHT POSTERIOR LIVER LESION: 0.7 cm (Image 25, Series 601); 0.7 cm on prior (11/30/2015) (Image 28, Series 301).SEGMENT 7/8 LESION: 1.2 x 1.0 cm (Image 192, Series 1005); 1.2 x 1.0 cm on prior (11/30/2015) (Image 32, Series 901).

Output: 1.Stable size and appearance of liver resection cavity and liver lesions suspicious for liver metastases.2.No definite new metastasis.


Instruction: Generate impression based on findings.

Input: 71 year old man with previous wide complex tachycardia who underwent EP ablation, with right atrial enlargement noted during procedure, now referred for cardiac MRI. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 181 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 81 ml (normal range 47+/-19), the LV mass index is 34 g/m2 (normal range 85+/-15), and the LV mass is 71 g (normal range 164+/-36). There is a small area of late gadolinium enhancement in the basal inferolateral which is nearly transmural, and suggestive of prior infarction. There are no wall motion abnormalities. There is no evidence of myocardial iron overload or intracardiac thrombus.Left AtriumThe left atrium is moderately enlarged. The interatrial septum appears aneurysmal.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged.Aortic ValveThe aortic valve is trileaflet. The aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation. AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The thoracic aorta is tortuous.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 pericardial effusion.Extracardiac FindingsDextroscoliosis. Hepatic and renal cysts.

Output: 1. Normal size LV with normal systolic function (EF 55%).2. Small area of late gadolinium enhancement in the basal inferolateral wall which is transmural and consistent with infarction.3. Normal size RV with normal systolic function (EF =56%).4. Biatrial dilation. 5. Mild aortic regurgitation.


Instruction: Generate impression based on findings.

Input: Female; 54 years old. Reason: Crohn's Disease with elevated fecal calprotectin History: Active Symptoms of Crohn's Diease with known ileal/duodenal strictures ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Long segment stricturing with skipped areas of mild focal dilation in the distal and terminal ileum measuring approximately 40-50 cm in length, similar in appearance to prior study. Mild bowel wall thickening and mucosal hyperenhancement is also similar prior study and suggestive of mild active disease. Stable fibrofatty perforation and engorgement of the vasa rectal. No abscess or fistula is seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: L4 vertebral body hemangioma is unchanged.OTHER: No significant abnormality noted.

Output: Mild active inflammatory bowel disease on background chronic stricturing of the distal and terminal ileum, similar to prior exam.


Instruction: Generate impression based on findings.

Input: 78-year-old female with upper motor neuron signs, facial weakness, and dementia. Motion artifact markedly degrades image quality. There is an extra-axial enhancing mass overlying the anterior left frontal lobe, which contains susceptibility effect, measuring approximately 3.1 x 2.0 x 3.0 cm. There is mass effect upon the right frontal lobe, but no discernible vasogenic edema. There are a few scattered foci of increased T2 signal within the cerebral white matter, including a subcortical focus in the right inferior frontal gyrus. There is no evidence of acute infarction. There is a nonspecific focus of susceptibility artifact in the right superior frontal gyrus, which may represent chronic microhemorrhage. There is mild diffuse parenchymal volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is degenerative spondylosis in the imaged upper cervical spine.

Output: 1.An extra-axial mass overlying the left anterior frontal lobe likely represents a meningioma.2.A few cerebral white matter lesions are nonspecific, but may represent chronic ischemic disease, although characterization is limited by the marked motion artifact.3. No evidence of acute infarction.4. Mild diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: 53-year-old male with right shoulder and neck pain/radiculopathy. The vertebral body heights are preserved. There is mild loss of intervertebral disc height and disc signal throughout the cervical spine related to with degenerative disease. There is a small focus of increased T2 marrow signal in the C5 vertebral body may represent an atypical intraosseous hemangioma. Reactive marrow signal is present along the vertebral body endplates at C3-4. There is mild straightening of the cervical lordosis, but no spondylolisthesis. At C2-C3, there is a small disc osteophyte complex asymmetric to the left, but no significant spinal canal or neural foraminal stenosis. At C3-C4, there is asymmetric hypertrophy of the right uncovertebral joint with moderate right neural foraminal stenosis and mild spinal canal stenosis. At C4-C5, there is a small disc-osteophyte complex with trace right neural foraminal stenosis, but no significant spinal canal or left neural foraminal stenosis. At C5-C6, there is minimal uncovertebral joint hypertrophy, but no significant spinal canal or neural foraminal stenosis. At C6-C7, there is a small disc-osteophyte complex with minimal right neural foraminal narrowing, but no significant left neural foraminal or spinal canal stenosis. At C7-T1, there is no disc bulge, spinal canal stenosis, or neuroforaminal narrowing.

Output: Multilevel spondylosis, which is most pronounced at C3-4, where there is moderate right neural foraminal stenosis and mild spinal canal narrowing.


Instruction: Generate impression based on findings.

Input: Foot ulcer There is abnormal low T1 signal with corresponding high T2 signal within the distal portion fibula, best seen on series 18 and 21, image 7/68. Although there is no discrete bony erosion, the findings are concerning for early osteomyelitis. No additional areas of focal osteomyelitis are identified. There is no evidence of focal fluid collection/abscess. There mild diffuse soft tissue edema surrounding both the medial and lateral malleoli. Diffuse increased signal is also noted within the plantar musculature which also may be reactive given the patient's history of a muscular dystrophy.

Output: Findings concerning for early osteomyelitis of the distal fibula although the exam is limited as the distal fibula is not included on axial sequence. No additional areas of definite osteomyelitis are identified and there is no evidence of abscess. If surgical intervention is being considered, repeat MRI for confirmation should also be considered.


Instruction: Generate impression based on findings.

Input: Pineal cyst - stable? History: dizziness. There is no appreciable interval change in the pineal gland cyst, which measures up to 12 mm. There is no evidence of intracranial hemorrhage or acute infarct. There are a few unchanged punctate foci of nonspecific susceptibility effect in the cerebral hemisphere. The brain parenchyma otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged pineal gland cyst.


Instruction: Generate impression based on findings.

Input: Suspected Chiari malformation with worsening symptoms: headaches and neck pain. Brain: The cerebellar tonsils are not particularly low-lying and display rounded morphologies. There is intact cerebrospinal fluid flow across the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged mild periventricular T2 hyperintensity associated with the right lateral ventricle. The ventricles are unchanged in size and configuration, with effacement of the right frontal horn and relative prominence of the rest of the right lateral ventricle. 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.Cervical Spine: The spinal cord displays normal signal and morphology, without evidence of syrinx. There is straightening of the cervical vertebral column alignment in the sagittal plane, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of Chiari type 1 malformation.2. Unchanged deformed appearance of the right lateral ventricle, which may be related to periventricular leukomalacia.3. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: sensory disturbances (right side numbness) No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. The left PCA is fetal origin.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain and neck MRAs.


Instruction: Generate impression based on findings.

Input: Ms. Ostroff is a 43 -year-old female with a strong family history of breast cancer, including mother, maternal aunt, maternal cousin, and paternal grandmother. She has a personal history of benign right breast biopsy. She has no current breast related complaints. There are multiple scattered foci of enhancement seen in both breasts, compatible with moderate background parenchymal enhancement. None of these foci are more suspicious than the rest. Susceptibility artifact from biopsy marker clip is identified in the right lateral breast, at site of prior benign MR guided breast biopsy. A small focus of enhancement in the central left breast, mid depth, is stable when compared to the prior MRI exam. There is no abnormal enhancement identified within either breast.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Multiple myeloma, evaluate for disease progression. Again seen is an enhancing lesion involving the base of the dens which appears slightly smaller since remote study from 7/17/2014 and compatible with treated lesion. No evidence of increased osseous destruction. No associated epidural tumor.No other suspicious lesions are evident within the cervical spine to suggest progressive multiple myeloma. There are suspected multiple foci of T2 hyperintensity in the cervical cord such as the left lateral C5 level where there is also volume loss as well as additional levels such as C2-C3 and C4 levels without associated cord expansion or significant volume loss. No associated enhancement. Some of these foci such as the left C5 lesion were evident on prior study from 1/20/2015 while the other foci are not definitively seen. Motion degradation on the STIR sequence limits optimal evaluation.Vertebral body heights in the cervical spine are normal. There is partial ankylosis involving the C4 and C5 vertebral bodies as well as the posterior elements on the left. There is severely diminished disc height loss at the C3-C4 level, which was also present previously. There is moderate degree of spinal canal stenosis at the C2-C3, C3-C4, C4-C5, C5-C6, C6-C7, and to a slightly lesser degree C7-T1 levels.Degenerative changes are seen in the cervical spine as described below:C2-3: Disc osteophyte complex and ligamentum flavum thickening with mild to moderate degree of spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis. Bilateral facet arthropathy, severe on the right.C3-4: Disc osteophyte complex and ligamentum flavum thickening with mild to moderate spinal canal stenosis. There is moderate to severe bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: Disc osteophyte complex and ligamentum flavum thickening with mild to moderate spinal canal stenosis. There is moderate left and minimal right neural foraminal stenosis.C5-6: Disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis. There is also moderate to severe bilateral neural foraminal stenosis related to uncovertebral hypertrophy. C6-7: Disc osteophyte complex and mild ligamentum flavum thickening. There is mild to moderate spinal canal stenosis. There is also moderate bilateral left worse than right neural foraminal stenosis.C7-T1: Mild disc bulge with no significant spinal canal stenosis. There is mild left neural foraminal stenosis related to facet arthropathy. Right neural foramen is grossly patent. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Enhancing C2 lesion is slightly decreased in size compared to prior exams dating back to 7/17/2014 and compatible with treated lesion. No new or enlarging lesion to suggest progressive multiple myeloma in the cervical spine. 2. Multilevel degenerative changes throughout the cervical spine with up to moderate spinal canal stenosis at multiple levels similar to prior study. There is also multilevel neural foraminal stenosis, up to moderate to severe at the C3-C4 and C5-C6 levels.3. Subtle patchy T2 signal abnormality at multiple levels in the cervical cord, particularly at the left C5 level with there is also volume loss compatible with myelomalacia. Etiology of the signal abnormality is nonspecific but may be related to chronic compression, radiation related injury, or less likely inflammatory/demyelinating process.


Instruction: Generate impression based on findings.

Input: 92-year-old female with ongoing left hip pain and mild osteoarthritis on recent radiographs. Mild osteoarthritis affects the left hip. There is a small amount of fluid within the joint, but no frank joint effusion. Evaluation of the labrum is limited due to lack of intra-articular contrast, however, there is linear intermediate signal intensity traversing the superior labrum suggesting a tear. There is severe fatty atrophy of the gluteus minimus muscle bilaterally. There is mild atrophy of the left gluteus medius muscle. On the large field-of-view images, there is mild osteoarthritis of the right hip. Severe degenerative disc disease and facet joint osteoarthritis affects the lower lumbar spine with spinal stenosis that could be better evaluated with dedicated spine imaging if clinically warranted. There is mild increased signal intensity within the adductor musculature and gluteal musculature of the hip, on T2-weighted images, which may reflect early denervation atrophy with a mild myositis considered less likely. We see no findings to suggest a stress fracture. The bone marrow signal intensity is within normal limits.

Output: 1. Mild osteoarthritis of the left hip.2. Severe degenerative disc disease and osteoarthritis of the lower lumbar spine and other findings as described above.


Instruction: Generate impression based on findings.

Input: 11 years Male (DOB:8/31/2004)Reason: history of cavernoma s/p resection, seizures, headaches History: as abovePROVIDER/ATTENDING NAME: CHARLES J MARCUCCILLI CHARLES J MARCUCCILLI The patient is status post left temporal lobe surgery for removal of a cavernous malformation. The appearance of the surgical bed remains stable compared to the prior exam. There are is susceptibility effect along the surgical margins where there was a cerebral cavernous malformation previously. This susceptibility effect was present preoperatively as well.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: The patient is status post left temporal lobe surgery for removal of the cerebral cavernous malformation. Compared to the prior exam there is no significant interval change


Instruction: Generate impression based on findings.

Input: 68-year-old female with history of lung cancer with brain metastases presenting with intermittent aphasia concerning for TIA/stroke. Evaluate for hemorrhage or stroke. Extensive low-attenuation is seen within the subcortical and periventricular white matter, compatible with prior therapy for brain metastasis versus small vessel ischemic disease. No intracranial hemorrhage or definite cortical stroke is evident, though contrast enhanced MRI is recommended for further evaluation if clinical suspicion remains high. The remaining cerebral and cerebellar hemispheres and brainstem demonstrate normal attenuation and morphology. The ventricles are midline, with normal alignment morphology. No abnormal extraction fluid collections are evident.The calvarium and other osseous structures are normal in appearance, with no evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Diffuse white matter disease which may be due to prior therapy for brain metastases or small vessel ischemic disease. If clinical concern for acute stroke remains, MRI is recommended.


Instruction: Generate impression based on findings.

Input: 53-year-old male with left knee pain MENISCI: There is an oblique flap tear involving the body and posterior horn of the medial meniscus extending to the tibial articular surface. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: No abnormal marrow signal. Mild partial thickness (greater than 50%) fissuring along the lateral patellar facet without underlying marrow changes. The trochlear cartilage is intact. The cartilage in the medial and lateral compartments is intact. Small tricompartmental osteophytes are present.LIGAMENTS: The ACL and PCL is intact. Lateral collateral ligament complex is intact. There is small amount of fluid surrounding the MCL which may suggest a grade 1 sprain.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Medial meniscal tear.2.Grade 1 sprain of the MCL.


Instruction: Generate impression based on findings.

Input: Brain MRI:When comparing supratentorial brain to infratentorial posterior fossa structures, there is a diffuse and global low level of diffusion restriction more prominently involving cortices. Previously identified subdural hemorrhages along the convexities bilaterally as well as adjacent to the falx and tentorium are again noted, better demonstrated on prior CT. The FLAIR technique best demonstrates that there is scattered subarachnoid hemorrhage throughout the supratentorial compartment. There are no masses, mass effect, or midline shift. Prominence of the CSF spaces around the cerebellum are noted, of uncertain significance. The ventricles are normal in size and shape without evidence of hydrocephalus. The cerebellar tonsils are in appropriate position. Fluid is noted within the mastoid air cells and middle ear cavities. Susceptibility at the right paramedian vertex is suggestive of a monitoring device.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. Neck MRA: The study is limited by motion degradation. Given this caveat:There are is antegrade flow within the bilateral carotid and vertebral artery systems. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There are no MRI findings of dissection.

Output: 1.The constellation of MRI features is most consistent with anoxic injury with a low level of global supratentorial restricted diffusion, primarily involving cortices.2.Subdural hemorrhages along the convexities bilaterally as well as adjacent to the falx and tentorium are again noted.3.There is scattered subarachnoid hemorrhage throughout the supratentorial compartment.4.Negative MRA of the brain.5.Negative MRA of the neck.


Instruction: Generate impression based on findings.

Input: Male 62 years old with left face and hand numbness, evaluate for interval progression of white matter disease New area of prominent increased left posterolateral medullary FLAIR/T2 signal with associated mild parenchymal expansion. The lesion does not show restricted diffusion. Prior exam demonstrates patchy increased T2 signal just caudal to this lesion, which may represent artifact. Additional scattered bilateral predominantly periventricular T2/FLAIR hyperintense white matter lesions with corresponding T1 hypointensity appear stable from prior exam. Possibility of underlying minimal chronic small vessel disease is not excluded. Diffuse sulcal and ventricular prominence more than expected for patient's age.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. Mild paranasal sinus mucosal thickening in the maxillary sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1) New left posterolateral medullary T2/FLAIR hyperintense lesion with associated mild expansion, most likely representing a new and likely active demyelinating plaque, which may involve the left spinal trigeminal tract given patient's reported symptoms. Evaluation limited due to lack of contrast.2) Chronic bilateral periventricular predominant white matter lesions consistent with known demyelinating disease, which appear stable from prior exam. Overall, mild T1 and T2 burden of disease.


Instruction: Generate impression based on findings.

Input: 60 year old man with 4-day history of instability, double vision, mild aphasia. There are no CT findings of hemorrhage, mass, or edema. There are no CT findings of stroke. However, if stroke is of clinical concern recommend MRI.The ventricles and basal cisterns are normal in size and configuration.There is plagiocephaly. The skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Unremarkable brain CT.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with lower extremity weakness. Alignment is anatomic. Vertebral body height and morphology are within normal limits. A transitional L5 vertebral body is seen. T1/T2 bright foci in the L3 and L4 vertebral bodies most likely represent benign hemangiomas. Generalized reduced bone marrow signal on T1 and T2-weighted images without edema likely correlates to increased osseous density on prior CT. A Schmorl's node deformity is evident along the superior L2 endplate.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are seen.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Unremarkable. L4-5: Mild facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L5-S1: Unremarkable. A heterogeneous left renal lesion is evident.

Output: 1.No evidence of significant disc degeneration, spinal canal stenosis or neuroforaminal narrowing is seen to account for the patient's symptoms.2.Generalized reduced marrow signal likely correlates to increased osseous density seen on prior CT and may reflect renal osteodystrophy.3.A heterogeneous left renal lesion is better assessed on prior exams.


Instruction: Generate impression based on findings.

Input: There is mild straightening of the normal cervical lordosis. There is minimal retrolisthesis of C5 on C6. Cervical spine alignment is otherwise within normal limits. The vertebral body and disc space heights are preserved. The disks are diffusely desiccated. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Individual levels as below:C2-C3: No significant spinal canal or foraminal stenosis.C3-C4: Right greater than left uncovertebral osteophytes. No significant spinal canal stenosis. Mild-moderate right foraminal stenosis.C4-C5: Left greater than right uncovertebral osteophytes. No significant spinal canal stenosis. Mild-moderate left foraminal stenosis.C5-C6: Moderate right paracentral disc osteophyte complex which mildly impresses upon the ventral spinal cord and results in mild spinal canal stenosis. The dorsal thecal sac at this level remains widely patent. Left greater than right uncovertebral osteophytes. Mild-moderate left foraminal stenosis.C6-C7: Mild paracentral disc protrusion. No significant central canal or foraminal stenosis.C7-T1: No significant central or foraminal stenosis.

Output: Mild degenerative changes as described above including mild spinal canal stenosis at C5-C6 as well as mild-moderate neuroforaminal narrowing at C3-C4, C4-C5, and C5-C6.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with metastatic esophageal cancer to the brain status post SRS to a left cerebellar lesion. The enhancing lesion seen previously within the peripheral left cerebellum has further decreased in size and is now a barely detectable 1 mm focus of enhancement and susceptibility (see image 63 series 301). No new enhancing lesions are seen. No evidence of significant parenchymal mass effect is detected. The ventricular system is normal in size and morphology.

Output: Continued interval decrease in size of a left cerebellar metastatic lesion which is now barely detectable as a punctate focus of enhancement.


Instruction: Generate impression based on findings.

Input: Incontinence, weakness, lumbar spine pain The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no significant spinal canal stenosis in the cervical, thoracic, or lumbar spine. No evidence of cord compression. Lumbar neural foramina are grossly preserved based on the sagittal sequences.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Right shoulder pain Radiographs dated 9/2/2016ROTATOR CUFF: There is full-thickness tearing of the supraspinatus tendon with retraction to the level of the glenoid. Tearing extends posteriorly to involve the anterior of the infraspinatus tendon which also appears to demonstrate a full-thickness tear. Heterogeneous signal near the insertion of the tendons likely represents at least some scar. The teres minor tendon is intact. There is tendinopathy of the superior fibers of the subscapularis however there is no evidence of full-thickness tear.There is mild fatty atrophy of the supraspinatus, infraspinatus, and superior portion of the subscapularis.SUPRASPINATUS OUTLET: There is mild acromioclavicular arthrosis. A small amount of fluid is noted within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the glenoid labrum is limited by motion artifact. Within these limits, there is no evidence of full-thickness tear. The glenohumeral joint alignment is normal. There is no evidence of fracture. Degenerative marrow signal is noted at the greater tuberosity.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Full-thickness tears of the supraspinatus and infraspinatus tendon with retraction to the level of the glenoid. There is mild associated fatty atrophy of the rotator cuff musculature.


Instruction: Generate impression based on findings.

Input: Female 68 years old Reason: 68yo female with history of uterine cancer with vaginal cuff nodularity on exam and CT. Please evaluate for recurrence. History: Vaginal cuff nodularity UTERUS, ADNEXA: Status post cystectomy. Vagina is distended with complex fluid. There is significant wall thickening involving the vaginal cuff with surrounding inflammation. There is likely a fistulous tract between the vaginal cough anteriorly to the sigmoid colon, best seen on image number 625, series number 1601. The wall of the rectosigmoid is diffuse thickened. BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Significant wall thickening of the vaginal cuff and inflammatory changes. No definite mass is identified. There is likely a fistula to the sigmoid colon from the vaginal cuff anterolaterally. Clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: Right hip pain, possible fracture Mild osteoarthritis affects the right hip but we see no fracture or other abnormal bone marrow signal. Additionally, there is no evidence of abnormal muscle signal or edema. Mild osteoarthritis affects the left hip which contains a small joint effusion although this is not necessarily of any current clinical significance.There is degenerative disc disease of the lower lumbar spine with what appears to be narrowing of the canal at the L4-L5 level however this would be better evaluated with dedicated imaging of the lumbar spine if clinically warranted.Note is made of an enlarged fibroid uterus.

Output: Osteoarthritis of the right hip with other findings described above. There is no evidence of fracture.


Instruction: Generate impression based on findings.

Input: History of malignant neoplasm of head and neck cancer on the right, increased uptake on the right carotid bifurcation on PET and mass on US exam. 1. Neck MRIMotion artifacts degraded image quality.There is 9.4mm x 10mm x 12mm sized relatively well defined mass on the right carotid bifurcation. The mass shows high signal intensity on T2 weighted images with some signal void areas within the mass, low signal intensity on T1 weighted images and well enhancing on post Gad enhancement. These findings are consistent with paraganglioma (carotid body tumor).The right side neck shows decreased soft tissue and non visualization of platysma muscle as well as right submandibular gland indicating postoperative status. Left side submandibular gland is still well visualized.The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Limited view of the intracranial structure is unremarkable. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, and thyroid glands are unremarkable. No lymphadenopathy or mass is noted. 2. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. Right CCA bifurcation shows about 40% of luminal stenosis and the left CCA appears to be normal but tortuous. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. 9.4mm x 10mm x 12mm sized mass on the right carotid bifurcation. The MR characteristics and location of the mass is consistent with carotid body tumor.2. About 40% luminal stenosis on the right CCA bifurcation


Instruction: Generate impression based on findings.

Input: Clinical question: History of brain lesion, evaluate for change in size. Signs and symptoms: Surveillance scan. Pre-and post-enhanced brain MRI:Examination redemonstrates a left paraclinoid residual enhancing meningioma measuring at 10 x 15-mm in transaxial dimensions. This lesion is remeasured on prior exam and demonstrates no convincing evidence of interval change in its size or morphology. Stable postoperative changes of left frontal craniotomy and expected minimal uniform dural thickening and enhancement.Negative diffusion weighted series.Extensive left anterior temporal encephalomalacia and to a lesser degree left inferior frontal encephalomalacia with resultant ex vacuo dilatation of the adjacent cortical sulci. Residual gliosis in the left frontal and temporal lobe similar to prior exam.Findings of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes in the subcortical, periventricular and minimally of right basal ganglia and moderately in the pons without convincing evidence of change since prior study.Stable normal size of ventricular system and with maintained midline.

Output: 1.Stable residual left paraclinoid meningioma since prior study as measured /measured above.2.Negative diffusion weighted images and stable findings of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes.3.Stable extensive postoperative changes of the left frontal craniotomy, extensive left anterior temporal and left inferior frontal S. malacia and gliosis.


Instruction: Generate impression based on findings.

Input: Please refer to the subsequent MRI report for further information.Exposure time: 3 minutes and 3 seconds.

Output: Successful arthrogram injection of the right wrist.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with multiple sclerosis, recent Wallenberg's syndrome and left-sided weakness. Evaluate for new MS lesions. Multiple T2 hyperintense lesions are evident prominently within the periventricular white matter appearing similar to the prior examination. No new or growing cerebral lesions are seen. A lesion noted on the prior examination within the left posterolateral medulla is barely detectable if at all on the present examination. Mild generalized parenchymal volume loss is seen. No evidence of edema or mass effect is detected. No abnormal extra-axial collections are noted. Ventricular size morphology are unchanged.

Output: 1.Several scattered lesions compatible with multiple sclerosis are redemonstrated showing no significant interval change in size. No new lesions are detected.2.A lesion detected on the prior examination within the left posterolateral medulla is less conspicuous than previously seen.


Instruction: Generate impression based on findings.

Input: 18 year old female with history of Ewing sarcoma now with metastases. Status post craniotomy for tumor resection. Patient has small postoperative subdural collection The patient is status post left frontal craniotomy appeared and there is an extra-axial hemorrhagic fluid collection of present underneath the craniotomy flap with a fluid fluid level associated some air bubbles. It is adjacent to the high convexities and measures approximately 9 mm in thickness . AP hypodense subdural component extends more posteriorly measuring approximately 5 mm in thickness and is also unchanged. There is mild midline shift the shift of the Falx cerebri up to approximately 6 mm to the right of the midlineA 0.7 cm hyperdense focus is present adjacent to the right chest appear frontal gyrus which has an extra-axial location. It was present on the MRI of 11/17/09.There is vasogenic edema present where the patient's known mass was paired this is edema pattern is stable since 11/19/09 MRI. There is some mass effect associated.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.Status post left frontal craniotomy for tumor surgery with the some findings which can be accounted for on the basis of a immediate postoperative effects such as a lobe of intracranial air and subgaleal soft tissue swelling.2.There is a left-sided subdural hemorrhagic fluid collection present with some mild mass effect and midline shift. This has not changed since the prior exam.3.A 7mm extra-axial hyperdense focus is present adjacent to the right superior frontal gyrus. This could represent a small meningioma.


Instruction: Generate impression based on findings.

Input: 54 year old female. Mass in the tail of the pancreas per OSH CT scan. Evaluate for abnormalities. ABDOMEN:LIVER, BILIARY TRACT: Punctate T2 hyperintense focus in the right hepatic lobe, likely a cyst. Hepatomegaly measuring 18 cm. Diffuse signal loss in the liver on opposed phase images consistent with fatty infiltration. No suspicious hepatic mass. No biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: 1.1 cm lesion in the posterior aspect of the pancreatic tail that follows signal and enhancement of the spleen on all sequences, likely an intrapancreatic splenule (series 7, image 25). Normal T1 signal intensity of the pancreas without evidence of atrophy. No evidence of pancreatic malignancy. No pancreatic ductal dilatation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Horseshoe kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small and mildly enlarged clustered retroperitoneal lymph nodes, including a right periaortic node that is 1.8 x 1 cm (series 7, image 14).BOWEL, MESENTERY: Small clustered mesenteric lymph nodes adjacent to the distal SMV (series 5, image 58).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Incompletely imaged right periesphageal lymph node at the level of the left atrium that is 1.4 x 2.5 cm (series 7, image 40).

Output: 1.1.1 cm lesion in the posterior aspect of the distal pancreatic tail, likely an intrapancreatic splenule. No specific evidence of pancreatic malignancy.2.Clustered small and mildly enlarged retroperitoneal lymph nodes, etiology of which is unclear. Enlarged right periesophageal lymph node.3.Horseshoe kidney.


Instruction: Generate impression based on findings.

Input: 65-year-old male with history of GBM status post resection, chemotherapy, radiation therapy. Now still on chemo status post URI two weeks ago, presents with left sided weakness.IMAGE ACQUISITIONS: Brain CT without contrast There is a large cystic mass with surrounding edema in the right frontal lobe. Findings have worsened since the prior MRI study. There is 15 mm of leftward midline shift. Significant mass effect is noted on the right lateral ventricle. Findings are suggestive of tumor recurrence.

Output: Increase in the large cystic mass and surrounding edema in the right frontal lobe suggestive of tumor recurrence. A subsequent brain MRI study has been interpreted.


Instruction: Generate impression based on findings.

Input: Clinical question: 5 days of R hand weakness and dysmetria, eval for signs of CVA vs posterior circulation defectSigns and Symptoms: R hand weakness, R hand dysmetria, abnormal coordinationComments: Clinical question to be answered (appropriate, detailed history MUST be included in order to assure exam appropriateness \T\ accuracy of interpretation):->5 days of R hand weakness and dysmetria, eval for signs of CVA vs posterior circulation defect | Signs and Symptoms:->R hand weakness, R hand dysmetria, abnormal coordination MRI of the brainA focus of diffusion restriction is present in the left centrum semiovaleThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact but very small. The right vertebral artery significantly smaller than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The right vertebral artery significantly smaller than the left vertebral artery.

Output: 1.There is acute infarction present in the left centrum semiovale. This corresponds to the left middle cerebral artery territory2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Although there is no convincing evidence for dissection, the dissection protocol was not followed. A small dissection could be overlooked as a result.4.The right vertebral artery appears to be small on a congenital or on the basis of chronic severe occlusive disease.


Instruction: Generate impression based on findings.

Input: Female; 62 years old. Reason: post prandial abdominal pain, weight loss, history of NF 2. ABDOMEN:LIVER, BILIARY TRACT: Scattered arterially enhancing foci are identified in the liver which do not persist on delayed imaging and are thus nonspecific. The largest of these measures 1.2 x 1.3 cm in the dome of the diaphragm and has some intrinsic T2 signal (series 1002, image 727). Patent hepatic vasculature. No biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: See discussion below. BOWEL, MESENTERY: Multilobulated circumscribed mass is noted between the uncinate process of the pancreas and the C loop of the duodenum which measures 2.7 x 2.0 cm (series 801, image 20). This mass demonstrates increased signal on T2 and diffusion weighted images, with possible mild heterogeneous enhancement. Several prominent surrounding lymph nodes are also seen. It has mass effect on the duodenum.Nonspecific small polypoid lesion in the stomach in the gastric body (series 1004, image 589). BONES, SOFT TISSUES: Several mildly enhancing lesions are noted within the lumbar spine and soft tissues. Soft tissue masses are also noted within the thecal sac, with resultant left sided neuroforaminal dilatation most pronounced at L4/L5 and L5/S1. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above discussion.BONES, SOFT TISSUES: See above discussion.OTHER: No significant abnormality noted.

Output: 1.Multilobulated, T2 hyperintense mass between the uncinate process and duodenal C-loop as described above. Differential considerations include neurofibroma/schwannoma given the patient's history of neurofibromatosis; (gastrinoma, cystic neuroendocrine tumor, GIST, are also in the differential). Follow-up with endoscopy or upper GI series is suggested to evaluate for duodenal obstruction. 2.Nonspecific small polypoid lesion in the stomach, for which dedicated follow-up can also be considered. 3.Soft tissue lesions in the thecal sac and several mildly enhancing lesions in the lumbar spine; these may also represent plexiform neurofibromas/schwannomas given their imaging appearance but dedicated MRI of the lumbar spine is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: Cervical cancer with possible brain mets on CT head. There are two enhancing lesions within the inferior left cerebellar hemisphere that measure up to 8 mm and 4 mm each. There is mild surrounding vasogenic edema. There is no evidence of intracranial hemorrhage 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: Subcentimeter lesions within the left cerebellar hemisphere likely represent metastases.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, paresthesias. Evaluate for progression. There are greater than 10 foci of T2/flair hyperintensity in the bilateral periventricular and subcortical white matter with appearance and distribution compatible with known demyelinating disease. Compared to 3/19/2014, there is no definite evidence of new lesions. There is possible T2/flair hyperintense lesion involving the right superior cerebellar vermis which is favored to be artifact, axial FLAIR 27/78, and was not seen on prior. Left callosal body lesion is decreased in size in the interval. Juxtacortical lesion involving the left precentral gyrus again seen. Few T1 hypointense lesions such as in the left superior parietal lobule are again seen. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma volume appears within normal limits. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No new demyelinating lesions are definitively appreciated to suggest disease progression.


Instruction: Generate impression based on findings.

Input: Reason: Left Knee Med Meniscus Tear vs Chondromalacia History: left knee pain MENISCI: There is faint intrasubstance signal within the posterior horn and body of the medial meniscus that extends to the tibial articular surface suggesting degenerative tearing/fraying, but we see no specific imaging features of an unstable tear. There is slight medial extrusion of the body of the medial meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patella, particularly along the medial facet, with degeneration involving greater than 50% of the cartilage thickness. There is a small underlying subchondral cyst. We suspect there is also degeneration of the articular cartilage of the medial facet of the femoral trochlea, inferiorly. There is also near full-thickness degeneration of the articular cartilage along the weightbearing portion of the medial femoral condyle above the posterior horn of the meniscus. There is degeneration of the articular cartilage along the medial tibial plateau, just anterior to the anterior horn of the meniscus. There is also increased signal intensity within the articular cartilage of the weightbearing portion of the lateral femoral condyle suggesting focal degeneration. There are small tricompartmental osteophytes.LIGAMENTS: The cruciate ligaments appear intact, although there is perhaps mild mucoid degeneration. The collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tricompartmental cartilage degeneration as described above.2. Degeneration and mild degenerative undersurface tearing of the medial meniscus.3. Lobulated and septated collection of fluid signal intensity posterior to the distal femur likely either representing ganglion formation arising from the medial head of the gastrocnemius or distention of the subgastrocnemius bursa. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 67 years, Female, ataxia. Rule out ischemia. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Mild global parenchymal volume loss is evident, with relatively greater involvement of the bilateral parietal lobes. Major flow-voids are preserved.Empty sella is incidentally noted with prominent expansion of the sella. There is also enlargement of the Meckel's caves which are CSF filled. Right lens implant. There is mild scattered paranasal sinus opacification including mucous retention cysts in the bilateral maxillary and left frontal sinuses.

Output: 1. No evidence of acute infarct, intracranial hemorrhage, or mass. 2. Mild chronic small vessel ischemic disease.3. Empty sella which is enlarged as well as enlarged CSF spaces in the Meckel's caves. These findings are nonspecific but can be seen with intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Right knee pain and swelling following MENISCI: There is subtle abnormal signal intensity of the margin of the lateral meniscus suspicious for a small inner margin tear or fraying. This is best appreciated on series 601 image 18 and series 401 image 23. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild abnormal marrow signal of the medial femoral condyle posteriorly which is thought to represent a cortical desmoid. The marrow signal of the bone is otherwise normal. The articular cartilage of the medial, lateral, and patellofemoral compartments is preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings suspicious for small inner margin tear/fraying of the lateral meniscus.2. Probable cortical desmoid of the medial femoral condyle posteriorly.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (5/21/16) performed at Northwestern Memorial Hospital. There is a known left breast cancer. BREAST MRI (5/21/16):Breast MRI was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is an enhancing mass at 12:00 position in the left breast measuring 10 x 12 x 8 mm, with metallic artifact internally. This lesion corresponds to the known breast cancer. Elsewhere, no abnormal enhancing lesions are seen in left or right breast.No abnormal lymph nodes are identified in either axillary region.

Output: Unifocal cancer in the left breast at 12:00 position.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Neck pain. Minimal bulging of disc at the level of C7-T1.Otherwise there is no evidence of disc herniation or disc degeneration.The cranial-cervical junction is normal. Cervical lordosis appears to be slightly lessen but within normal limits. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: Minimal bulging of disc at the level of C7-T1 otherwise unremarkable C-spine MRI..


Instruction: Generate impression based on findings.

Input: Left shoulder pain after trauma. Concern for rotator cuff injury. ROTATOR CUFF: There is mild to moderate thickening and increased T2 signal within the distal fibers of the supraspinatus tendon compatible with mild to moderate tendinosis. The supraspinatus muscle is normal. The infraspinatus, teres minor, and subscapularis muscles/tendons are intact.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. Foci of increased T2 signal within the humeral head are likely cysts. There is abnormal signal intensity within the superior labrum extending posteriorly consistent with degeneration.BICEPS TENDON: There is increased signal within the intraarticular portion of the long head of the biceps tendon compatible with a mild to moderate tendinosis. ADDITIONAL

Output: 1. Mild to moderate supraspinatus tendinopathy. No full thickness rotator cuff tear.2. Mild to moderate biceps tendinopathy. 3. Degeneration of the labrum as described above.


Instruction: Generate impression based on findings.

Input: 80 year-old female urothelial cancer. Restaging. CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules are predominantly peripheral and some are pleural based. Bibasilar dependent atelectatic changes. No nodule larger than 4 mm was found.MEDIASTINUM AND HILA: Diffuse calcified lymph nodes in the mediastinum. Small amount of coronary artery calcification. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 1 x 2.6 cm inferior right hepatic lobe cystic lesion appears uniloculated and benign. Subcentimeter hypodensities are bilobar and too small to characterize. SPLEEN: No significant abnormality noted.PANCREAS: 8 x 10 mm distal pancreatic parenchymal cystic focus (coronal image 43, axial image 82 of series 3). If indicated, obtain MRI/MRCP for further evaluation, if indicated. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic calcifications in the aorta. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral lung micronodules and subcentimeter liver hypodensities are too small to characterize.Pancreatic tail 1 cm cystic lesion. see above. No measurable metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: R knee medial meniscus tear History: R knee pain Patient motion artifact limits multiple sequences.MENISCI: There is globular signal abnormality within the posterior horn of the medial meniscus indicating intrasubstance degeneration. No unstable meniscal tear is evident. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is subjective thinning of the articular cartilage along the lateral femoral condyle posteriorly. There is full-thickness articular cartilage degeneration along the lateral facet and median eminence of the patella with underlying subchondral signal abnormality. There is near full-thickness articular cartilage degeneration along the medial facet of the patella with underlying subchondral signal abnormality. There is a focal full-thickness articular cartilage defect along the inferior femoral trochlea, centrally, with underlying subchondral signal abnormality. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is thickening and intermediate signal intensity within the proximal fibers of the lateral collateral ligament proper which may reflect prior injury or sprain. There is edema along the superficial band of the MCL indicating a sprain. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis of the knee including articular cartilage degeneration most pronounced along the patellofemoral articulation.2. Sprain of the MCL.3. Intrasubstance degeneration of the medial meniscus without evidence of a meniscal tear.4. Moderate size joint effusion with small Baker's cyst.


Instruction: Generate impression based on findings.

Input: 63-year-old male with generalized weakness, questionable aspiration pneumonia, and partial left facial droop. Evaluate for left-sided stroke. Questionable loss of gray-white differentiation in the right frontal region raises the possibility of acute stroke, though this may be further characterized by MRI. Encephalomalacia in the left MCA territories compatible with prior stroke. There is no intracranial hemorrhage or abnormal extra-axial fluid collections. The ventricles are midline, with normal volume and morphology.The calvaria and other osseous structures are intact. Visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Loss of gray-white differentiation in the right frontal lobe may represent acute stroke, with no evidence of acute intracranial hemorrhage. Further evaluation by MRI is recommended.2. Evidence of old stroke in the left MCA territory.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: concern for tumor History: right facial weakness Brain MRIDue to patient motion artifact, especially post contrast scans are nondiagnostic.There is ill defined intra-axial mass involving left frontal lobe, temporal lobe anterior aspect as well as insular cortex with the significant surrounding edema generating mass effect. There is about 7.2 mm midline shift at the level of foramen of Monro.There is no evidence of acute ischemic lesion, however, the mass shows petechial susceptibility artifacts within the lesion indicate hemorrhagic component.Although is nondiagnostic, axial postcontrast enhancement scan shows relatively intense enhancement of the lesion with overlying dural matter.Constellation of above findings indicate possible diagnosis of primary brain tumor such as glioblastoma or metastatic disease.Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There are opacifications within the left sphenoid sinus and right posterior ethmoid sinus indicate high protein content retention cyst or high protein content fluid collection.Brain MRA 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate diminutive left MCA distal M2 and M3 segment indicating external compression due to intra axial mass lesion. Otherwise no remarkable finding.No intracranial arterial aneurysm. No intracranial arterial luminal stenosis.

Output: 1. Left fronto temporal intracranial mass with surrounding edema and mass effects likely represent malignant lesion such as glioblastoma or metastatic lesion.2. Extrinsic compression toward left MCA M2 and M3 segment as described above, otherwise no remarkable finding on brain MRA.


Instruction: Generate impression based on findings.

Input: 29-year-old male with purulent drainage, cellulitis and tenderness particularly at the second MCP joint. Evaluate for osteomyelitis. There is subcutaneous edema about the midfoot and forefoot most pronounced along the dorsal aspect of the metatarsals. There is soft tissue irregularity along the dorsal aspect of the fourth metatarsal head consistent with ulceration which extends to the level of the extensor tendon at the level of the fourth MCP joint. There is increased signal abnormality on fluid sensitive sequences in the surrounding area which presumably represents a combination of packing material and granulation tissue. There is rounded fluid signal intensity in the surrounding area, dorsal to the fourth metatarsal head which is suspicious for a small abscess, measuring 13 mm in its largest dimension. There are foci of fluid signal intensity within the interspaces between the first and second digit as well as between the second and third digit, which may represent confluent edema, although a bursitis could also be considered. There is increased signal abnormality within the base of the proximal phalanx of the fourth digit on fluid sensitive sequences without associated decreased signal abnormality on T1-weighted sequences. These findings are most consistent with reactive osteitis. There is no convincing evidence of osteomyelitis as clinically questioned.

Output: Extensive subcutaneous and soft tissue edema about the midfoot and forefoot consistent with the stated history of ulceration with associated cellulitis. Signal abnormality within the base of the proximal phalanx of the fourth toe appears most consistent with reactive osteitis. There is no convincing evidence of osteomyelitis. There is a small 13 mm fluid collection along the dorsal aspect of the fourth metatarsal head suspicious for abscess formation. No large drainable collection is identified.