Instruction: Generate impression based on findings.

Input: Craniopharyngioma status post laser ablation and proton beam radiation. There are bilateral transfrontal catheters that terminate in the suprasellar mixed cystic and solid craniopharyngioma. Although many of the cystic components of the tumor have decreased in size, the overall size of the tumor has not significantly changed, measuring up to approximately 25 mm. There is patchy T2 hyperintensity in the adjacent brain parenchyma and optic apparatus, which appears to have increased slightly in extent. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Although many of the cystic components of the tumor have decreased in size, the overall size of the craniopharyngioma has not significantly changed, measuring up to approximately 25 mm. However, the patchy T2 hyperintensity, which may represent edema in the adjacent brain parenchyma and optic apparatus appears to have increased slightly in extent.


Instruction: Generate impression based on findings.

Input: Left renal mass seen on CT. ABDOMEN:LIVER, BILIARY TRACT: Mildly nodular liver contour. No suspicious liver lesion. Patent vasculature. Cholelithiasis without cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal superior pole 5.7 x 5 5 cm cyst (series 4/12). Anteriorly there is a small mural nodule which does not demonstrate enhancement (series 4/12).In the anterior cortex of the right kidney interpolar region is a stable 2.9 x 1.9 cm angiomyolipoma (series 1000/37).Immediately inferior is a 3.1 x 2.4 cm intrinsically T1 hyperintense (series 10/43) nonenhancing lesion compatible with a hemorrhagic/proteinaceous cyst.In the left kidney interpolar region posterior cortex there is a 1.3 cm T2 hypointense lesion. The lesion demonstrates mild postcontrast enhancement. There is also signal loss on the T2-weighted fat-suppressed images (series 4/19). The lesion does demonstrate some signal loss on out of phase imaging suggesting intra-voxel fat (series 1002/49). RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Indeterminate 1.3 cm left renal interpolar region lesion is stable in size. We favor that this represents an angiomyolipoma. Possibility of Renal cell carcinoma cannot be excluded. However, continued imaging follow-up is recommended.2.Stable right renal angiomyolipoma measuring 2.9 cm.3.Simple and minimally complex right renal cysts.4.No suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Reason: 40F with twisting injury during exercise, now with persistent left medial knee pain not relieve with rest/NSAIDs/PT, ?meniscal injury, ?ligamentous injury History: 40F with twisting injury during exercise, now with persistent left medial knee pain not relieve with rest/NSAIDs/PT, ?meniscal injury, ?ligamentous injury MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage defects. Bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Normal-appearing knee without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 64 years, Male, Reason: 64 y/o M with PMH of ADHF presents with concern for liver lesion on previous imaging, please evaluate History: as above. ABDOMEN:LUNG BASES: Small bilateral pleural effusions. LIVER, BILIARY TRACT: Diffuse reticular pattern with dilated hepatic veins, likely representing passive hepatic congestion. Hepatomegaly.There is a lesion in segment 6/7 measuring 1.4 cm (501/22) with a focus of enhancement which persists on delayed phase images. There is an additional adjacent lesion which is mildly hyperintense on T2 with minimal irregular enhancement and delayed phases (1001/22). A few smaller faint T2 hyperintense lesions are also present.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Increased T2 signal and enlargement of the left psoas muscle.OTHER: Moderate ascites.

Output: 1.There are two right hepatic lobe lesions enhancing lesions. These do not meet criteria for hemangioma and have a non specific appearance. Differential considerations include metastatic disease, regenerative nodules in the setting of hepatic venous congestion. The stability in their size suggests against metastasis. If needed a biopsy of these lesions can be performed.2.Diffuse reticular pattern within the liver suggests passive congestion.3.Moderate ascites.4.Increased T2 signal and enlargement of left psoas muscle.


Instruction: Generate impression based on findings.

Input: 86 year old female with a repeat head CT secondary to worsened mental status change. There is no evidence of intracranial hemorrhage, mass or edema. Small lacunae in the right basal ganglia. Few diffuse hypodensities consistent with minimal small vessel disease, age indeterminate, essentially within normal limits for the patient's age. If there is clinical concern for acute ischemia an MRI may be considered. Overall, there is no change when compared to the previous study.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable exam.


Instruction: Generate impression based on findings.

Input: Unexplained anorexia and dysgeusia. The postcontrast images are motion degraded. Confluent biparietal deep white matter T2/FLAIR hyperintense, T1-hypointense signal is not associated with diffusion restriction. There are scattered smaller T2/FLAIR hyperintense lesions throughout the cerebral white matter bilaterally also without diffusion restriction. Following contrast injection, there is no contrast enhancement in any of these lesions. An incidental left parietal developmental venous anomaly is present. There is no mass or mass effect. There is no midline shift. The CSF-containing spaces are symmetrically enlarged, reflecting mild volume loss. The vascular flow voids are present. Accounting for probable calcifications in the globi pallidi, there is no susceptibility artifact to indicate intracranial hemorrhage.The paranasal sinuses and mastoid air cells are clear. The orbits are notable for bilateral cataract surgery. There is no destructive skull lesion.

Output: 1.No evidence of acute infarct, intracranial mass, or mass effect. No abnormal enhancement.2.Patchy confluent areas and scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific but compatible with moderate chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: pain and swelling History: pain \T\ swelling. MENISCI: Lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: Previously seen likely full-thickness articular cartilage defect at the posterior weightbearing surface of the lateral femoral condyle is no longer visualized. Previously seen far anterior lateral tibial plateau focal full thickness cartilage degeneration with underlying bone marrow edema is no longer visualized. New partial-thickness defect of the articular cartilage of the lateral tibial plateau with underlying bone marrow edema measures approximately 8 mm in AP dimension.Medial tibiofemoral articular cartilage is intact.There is thinning of the articular cartilage of the medial trochlea. There is a focal full-thickness defect of the articular cartilage of the medial facet of the patella. Otherwise, the articular cartilage of the patellofemoral compartment is intact.Small bone island is again noted within the posterior medial tibial metaphysis.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Left knee:1.New full-thickness defect involving the lateral tibial plateau with underlying bone marrow edema. New focal full-thickness defect of the medial facet of the patella.2.Moderate joint effusion.3.Interval resolution of lateral femoral condyle articular cartilage defect and suspected chondral loose body.Right knee: Lateral femoral condyle. 1.Full-thickness defect involving the central trochlea with underlying bone marrow edema. Partial-thickness articular cartilage defect involving the lateral femoral condyle.2.Small joint effusion.3.Nonspecific edema within Hoffa's fat pad.4.Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: 42 year old female patient with cervical cancer, plan for radiation therapy. Pretreatment MRI. PELVIS:UTERUS, ADNEXA: There is a T2 intermediate signal mass which involves the anterior lip of the cervix and extends into the vagina. The mass is slightly smaller in size compared to the prior study measuring approximately 3.0 x 2.3 cm (image 11, series 901), though exact measurement and delineation is difficult. The inferior portion of the mass effaces the vagina and the posterior margin cannot be differentiated from the rectal wall inferiorly; rectal involvement is noted excluded. 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: 1. Lower cervical/upper vaginal mass appearing slightly smaller in size compared to the prior study. 2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Follow-up of stage IV mucosal melanoma with large infiltrating mass in the maxillary sinus as well as metastatic disease status post radiation therapy to the sinus mass, now on Ipilimumab. There are post-treatment findings in the left sinonasal region. There is an mildly and heterogeneously enhancing mass centered in the medial left maxillary sinus with extension into the infundibulum and left maxillary alveolus, as well as slight extension into the inferior extraconal left orbit and into an expanded left pterygopalatine fossa with involvement of the anterior portions of foramen rotundum and Vidian canal. Overall, the mass measures up to approximately 5 cm. There are otherwise obstructed secretions in the left lateral maxillary sinus, ethmoid air cells, and sphenoid sinuses. There is a nonspecific subcentimeter lesion in the left nasal ala. There is diffuse enhancement of the left masticator muscles with otherwise preservation of the architecture, indicative of denervation effects. There is a subcentimeter left vallecular retention cyst. There is no evidence of significant lymphadenopathy in the imaged portions of the neck. The major salivary glands appear to be intact. The imaged intracranial structures are unremarkable.

Output: 1. A mass centered in the left maxillary sinus is compatible with melanoma and superimposed treatment effects. The mass measures up to approximately and extends into surrounding spaces, including the left orbital periosteum and pterygopalatine fossa with evidence of perineural spread in the central skull base region. Previous studies are currently unavailable in the University of Chicago PACS, which precludes comparison to prior disease status.2. Nonspecific subcentimeter left nasal ala lesion.


Instruction: Generate impression based on findings.

Input: 60 year-old male with lung cancer and brain metastases now with acute onset left hemiparesis evaluate for stroke. Hyperdense focus identified in the right occipital region corresponds to hemorrhagic metastatic lesion on recent MRI. Other lesions from MRI heart difficult to identify on the current examination. No definite new lesions are identified. No evidence of new bleed. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Hyperdense focus corresponding to hemorrhagic metastatic lesion seen on recent MRI seen in right occipital lobe. No other acute findings are seen.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with headache. No restricted diffusion is seen. There are a few scattered foci of T2 hyperintensity within the bilateral frontal white matter showing no significant interval change. The largest lesion is on the right and measures up to 6 mm.No evidence of parenchymal edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology.

Output: 1.No evidence of acute ischemia or any other acute intracranial abnormality.2.Scattered small foci of nonspecific white matter signal abnormality are redemonstrated in the frontal lobes without significant interval change.


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: r/o osteomyelitis History: chronic left hip ulcer in paraplegic. Bilateral irregular skin defects overlying both hip joints consistent with provided history of skin ulceration with surrounding abnormal enhancement and edema of the soft tissues on the left side. Immediately subjacent to the left skin abnormality there is a 1.3 x 4.2 cm rim enhancing collection of gas which immediately overlies a rim enhancing fluid collection measuring approximately 4.9 x 2.4 cm. This contains a fluid-fluid level. This directly overlies the bone and there is a small localized area of enhancement within the left greater trochanter. There is marked abnormal enhancement and edema predominantly involving the left gluteal musculature extending to the proximal left thigh, consistent with inflammation. There is diffuse muscle atrophy consistent with history of paraplegia.There is a smaller 2.5 x 1.6 cm fluid collection overlying the right greater trochanter without rim enhancement.Air within the urinary bladder, presumably secondary bladder catheterization. Multiple prominent iliac lymph nodes are nonspecific.

Output: 1. Fluid collection overlying the left greater trochanter with surrounding inflammatory changes predominantly involving the gluteal muscles and overlying skin ulceration. The appearance is highly suspicious for abscess. Greater trochanter bursitis is felt less likely. Small localized area of enhancement within the underlying left greater trochanter raises the possibility of associated osteomyelitis.2. Nonenhancing fluid collection overlying the right greater trochanter is suggestive of trochanteric bursitis.


Instruction: Generate impression based on findings.

Input: 45-year-old female with history of left breast MR guided biopsy with pathology result of focal ALH. Short term follow up MRI was recommended for a non-mass enhancement at right upper inner breast seen in the previous MRI (3/13/15). There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancing lesions are seen in the right breast. Previously seen non-mass enhancement in upper inner quadrant is no longer present in the right breast.In the left breast, a few areas of benign nodular enhancement are unchanged. There is no suspicious enhancing lesion in the left breast  No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness and metastatic prostate cancer. As on the prior examination, the T12 vertebral body is considered to be the last rib-bearing vertebra. There are 6 nonrib-bearing lumbar-type vertebrae. Mild degenerative grade 1 retrolistheses of L3 on L4 and L4 on L5 are demonstrated. The vertebral body heights are maintained. There is diffuse abnormal bone marrow signal throughout the imaged osseous structures related to metastatic disease. There is epidural extension of tumor throughout the lumbar spine and in the visualized portion of the lower thoracic spine on sagittal images. This results in moderate spinal canal stenosis at the L3 and L4 levels. There is severe spinal canal stenosis at the L5 and L6 levels. There are also multilevel degenerative changes, which have also progressed since the prior examination. The degenerative changes contribute to varying degrees of spinal canal and neural foraminal stenoses. There is moderate to severe spinal canal stenosis related to a posterior disc protrusion and extrusion with mild caudal migration at L4-5 and a central disc protrusion with facet arthropathy at L5-6. There is moderate bilateral neural foraminal narrowing at the L4-5 level as well as moderate right and severe left neural foraminal narrowing at the L5-6 level. There is multilevel disc desiccation and intervertebral disc height loss, which is severe at L4-5. The visualized portion of the distal spinal cord and conus medullaris appear normal in signal and morphology on sagittal images only. There is redundancy of the cauda equina nerve roots above the levels of stenosis at L4-5 and L5-6. At L2 and L3 levels, there is again CSF signal intensity displacing the nerve roots to the left and anteriorly.

Output: 1. Abnormal bone marrow signal throughout the imaged axial skeleton has progressed from the prior examination and is compatible with diffuse osseous metastatic disease. Multiple levels of epidural extension contribute to varying degrees of spinal canal and neural foraminal stenosis. The most pronounced degree of spinal canal stenosis is at the L4-5 and L5-6 levels.2. Interval progression of lumbar degenerative disease of the lumbar spine contributing to spinal canal and neuroforaminal stenosis, as described above. 3. Possible arachnoid cyst versus altered cerebrospinal fluid dynamics at the L2 to L3 levels.


Instruction: Generate impression based on findings.

Input: The evaluation is limited by motion degradation. There is a punctate focus of what appears to be mildly restricted diffusion and high T2 signal within the left precentral gyrus and an additional punctate focus of what may be mildly restricted diffusion within the right cerebellum. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage or mass. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, pituitary gland, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening and secretions. There is fluid in the bilateral mastoid air cells.

Output: 1. Punctate lesions within the left precentral gyrus and within the right cerebellum, likely represent subacute ischemic infarcts related to emboli from endocarditis.2. Fluid in the bilateral mastoid air cells.Findings discussed with Dr. Khatibi at 946am on 10/19/2016.


Instruction: Generate impression based on findings.

Input: Reason: What is the hypodensity in the right temporal lobe? History: Above with R-sided headache and left thigh, left upper arm numbness 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.

Output: MRI of the brain is within normal limitsMRI BRAIN WWO, 4/29/2015 5:13 PMCLINICAL INFORMATION:Reason: What is the hypodensity in the right temporal lobe? History: Above with R-sided headache and left thigh, left upper arm numbnessCOMPARISON: None.TECHNIQUE: The University of Chicago adult basic brain MRI protocol with and without contrast was followed . mL multihance was usedFINDINGS:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of diffusion restriction present along the medial aspect of the right temporal lobe extending into the right occipital lobe measuring 64 x 25 mm in axial dimensions. It is located along the right fusiform gyrus. An additional focus of diffusion restriction is present along the right hippocampus. A 7-mm focus of diffusion restriction is present in the right parietal lobe at the inferior parietal lobule Several punctate foci of diffusion restriction are present in the left and right occipital lobe, right inferior parietal lobule and right inferior temporal gyrus. A punctate focus of diffusion restriction is present at the left frontal lobe medially. There is associated enhancement present along the right fusiform gyrus lesion which is somewhat patchy and partially cortically based.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.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with glioblastoma multiforme status post RT and temazolamide. Evidence is seen of prior resection or partial resection of a tumor involving the left inferior and middle frontal gyri. Since the prior examination, irregularly marginated, nodular enhancement deep to the resection site has increased in size. These areas of enhancement do correlate with elevated rCBV. The degree of associated T2 hyperintensity surrounding this lesion along with local mass effect has also increased from prior.No additional areas of pathologic intracranial enhancement are suspected. Ill-defined FLAIR hyperintensity just below the lesion within the left basal ganglia is unchanged. Likewise, ill-defined bilateral periatrial T2 hyperintensity, and scattered discrete foci of cerebral white matter T2 hyperintensity, are unchanged including when compared to the preoperative examination. No intracranial hemorrhage is suspected. The ventricles and sulci are slightly more prominent than on prior examination suggesting underlying mild parenchymal volume loss.

Output: Since the prior examination, there has been an increase in the size of irregularly marginated enhancement within the left frontal lobe tumor bed. The degree of surrounding T2 hyperintense signal and edema has also increased. The enhancing tissue corresponds to elevated rCBV which favors true tumor progression. Pseudoprogression is considered a less likely diagnosis.


Instruction: Generate impression based on findings.

Input: Male, 76 years old, with progressive left temporal GBM. Functional assessment of speech is required for surgical planning. Of the tested language paradigms, the most reliable language related cortical activation was seen with the verb generation and sentence completion paradigms. While language related activity was variably observed in both hemispheres depending on the paradigm, overall language cortical activation is left dominant. Broca's area activity is seen on both paradigms in it's expected location of the left inferior frontal gyrus, primarily pars triangularis and pars orbitalis. Wernicke's area activity is best visualized on the sentence completion paradigm where it is seen along the posterior aspect of the superior left temporal sulcus. On comparison to the most recent outside MRI, both Broca's and Wernicke's areas appear to be well removed from the enhancing lesion in the left temporal lobe, but both areas are closed approached by the non-enhancing T2 signal abnormality which surrounds the lesion.

Output: Successful functional MRI for language mapping with Broca's and Wernicke's areas identified on the left as above.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. At the left lamina and spinous process of C3, there is sclerotic lesion with mild expansion. Subtle changes of similar appearance are also seen at level of C2. The left C2 - C3 facet joint is indistinct. Given the history of breast cancer, metastatic disease needs to be considered, although the lack of significant progression based on comparison of prior MRI is less typical. Degenerative disease is again present, with disc-osteophyte complex at C5-C6 level, causing spinal canal stenosis. There is also neural foramina narrowing bilaterally secondary to degenerative disease of uncovertebral joints.

Output: 1. Sclerotic lesions at left lamina and spinous process of C2 and C3 vertebral levels, which can represent metastatic disease, although the reported stability between the two prior MRI studies is unusual.2. Degenerative disease of the cervical spine as described above. Please also correlate with MRI cervical spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Please perform Dr.Javed's MS protocol and compared to prior exam. Signs and symptoms: Progression of multiple sclerosis. Pre-and post enhanced brain MRI:This examination is performed utilizing Dr, Javed's dedicated multiple sclerosis protocol.Examination demonstrates extensive supratentorial parenchymal white matter chronic findings of multiple sclerosis without evidence of enhancement.There is interval change in the appearance of the findings compare to prior exam secondary to interval evolution of previously noted larger enhancing lesions. There is however no convincing evidence of progression of disease since prior study. Note should be made that the very large number of lesions and also significant technique difference between the two exams makes precise comparison less accurate. This is a similar observation is exam.Mild prominence of the lateral ventricles with maintained midline a similar to prior exam.Pre-and post enhanced cervical MRI:There are no prior exams of the cervical spine for comparison.Examination demonstrates at least two well identified foci of T2 hyperintensity of the cervical cord suggestive of demyelinating disease. Findings are located posteriorly at the cervicomedullary junction of the cord and posteriorly at C3 level. Axial T2 weighted series also demonstrate a lesion in the midline and extending posteriorly at C6 and C7 disk level. There is limited view of upper thoracic spine also demonstrates focal areas of T2 hyperintensity at T1 on the right and larger lesion at T1 -- T2 disk level occupying most of the cord.There is no appreciable change in the cord caliber secondary to these findings and no detectable abnormal enhancement.

Output: 1.Pre-and post enhanced brain MRI demonstrate no evidence of an enhancing plaque and without convincing evidence progression of disease since prior study. There is suggestion of decreased size of a few of previously noted larger plaques suggestive of interval evolution to chronic state.2.Pre-and post enhanced MRI of the cervical spine demonstrate multiple nonenhancing lesions of the cervical cord and uppermost visualized thoracic cord as detailed. Findings consistent with chronic demyelinating disease and without resultant change in the caliber of the cord or abnormal enhancement. There are no prior exams for comparison.


Instruction: Generate impression based on findings.

Input: Chronic back pain and history of degenerative disease. History of breast cancer. Evaluate for progression of degenerative disease and metastases. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Moderate degree of levoscoliosis again noted and can be better assessed with standing radiographs. Minimal anterolisthesis of L5 on S1. Bone marrow signal is benign with multiple scattered foci of T1 hyperintensity as well as a nonspecific focus of enhancement involving the L3 vertebral body, which remains unchanged and most likely benign. No evidence of metastatic disease. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy with no significant spinal canal stenosis. There is mild right neural foraminal narrowing. No significant left neural foraminal stenosis. L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy with no significant spinal canal stenosis. There is moderate right neural foraminal narrowing similar to prior. No significant left neural foraminal stenosis. L3-L4: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy with no significant spinal canal stenosis. There is moderate right neural foraminal narrowing similar to prior. Mild left neural foraminal stenosis. L4-L5: Mild disc bulge, ligamentum flavum thickening, and advanced left-sided facet arthropathy. No significant spinal canal stenosis. There is severe left neural foraminal stenosis similar to prior and mild right neural foraminal narrowing. L5-S1: Mild disc bulge, ligamentum flavum thickening, and bilateral, left worse than right, facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate left neural foraminal stenosis which has progressed in the interval. No significant right neural foraminal stenosis.Paraspinous soft tissues demonstrate mild atrophy involving the paraspinous musculature but are otherwise under marked.

Output: 1. Multilevel degenerative changes in the lumbar spine including levoscoliosis with slight progression in the interval. There is no significant spinal canal stenosis at any level. There is moderate right L2-L3 and L3-L4 as well as severe L4-L5 neural foraminal stenosis. Individual levels as above.2. Multilevel facet arthropathy, relatively worse at L4-L5 and L5-S1 which may also be contributing to low back pain.3. No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.CERVICAL SPINE: 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 spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of intracranial or cervical spinal cord demyelinating lesions.


Instruction: Generate impression based on findings.

Input: 58-year-old male with abdominal pain and weight loss. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Mild dilation of the main pancreatic duct diffusely, greatest in the body were measures up to 5 mm. There is mild relative narrowing seen at the junction of the body and head where the duct is tortuous, but there is no definite stricture. There is a 5 x 3 mm cystic lesion in the uncinate process which demonstrates connection to the main pancreatic duct via a small side branch, most suspicious for side branch intraductal papillary mucinous neoplasm. No suspicious features on postcontrast images. The dilation of the main pancreatic duct raises the question of combined type intraductal papillary mucinous neoplasm. Normal physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 2.4 x 2 cm cystic lesion in the inferior pole the left kidney with small amount of intrinsic high T1 material dependently, likely due to hemorrhage and/or proteinaceous debris. The lesion also contains a few enhancing septa inferiorly. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Findings suspicious for side branch IPMN in the uncinate process with mild dilation of the main pancreatic duct, raising the question of combined type IPMN. Continued follow-up is recommended.2. Complex cyst in the left kidney with findings suggestive of a Bosniak 2F lesion, at least one-year follow-up with renal protocol MRI is recommended.


Instruction: Generate impression based on findings.

Input: Right knee pain. Evaluate for ACL, MCL tear Unchanged minimally depressed lateral tibial plateau fracture. There is no significant joint effusion.MENISCI: No significant abnormality noted. No evidence of meniscal tears.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. No evidence of ligamental tears. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Minimally depressed lateral tibial plateau fracture. No evidence of ligamentous or meniscal injury.


Instruction: Generate impression based on findings.

Input: Right trigeminal neuralgia. There is a venous structure that courses along the superior aspect of the right trigeminal nerve cisternal segment, without apparent displacement of the nerve. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a subcentimeter left nasopharyngeal retention cyst.

Output: A venous structure courses along the superior aspect of the right trigeminal nerve cisternal segment.


Instruction: Generate impression based on findings.

Input: Reason: Gait disorder History: above The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the neural foramina. There is disk desiccation and a disk bulge at this level associated with mild posterior ligamentous hypertrophy. Overall there is a mild degree of spinal stenosis at this level with some partial effacement of spinal fluid ventral and posterior to the spinal cord.At C3-4 there is disk desiccation and a disk bulge at this level associated with mild posterior ligamentous hypertrophy. Overall there is a moderate degree of spinal stenosis at this level with effacement of spinal fluid ventral and posterior to the spinal cord and mild flattening of the spinal cord. There is some narrowing of the neural foramina bilaterally at this level as a result of bilateral uncovertebral osteophyte formation and disk material. This neural foramen narrowing is worse on the left than the right side. There is encroachment of the exiting nerve roots at this level on the left side.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is disk desiccation and a disk bulge at this level. There are small uncovertebral osteophytes present at this level.At C5-6 there is no significant compromise to the spinal canal. There is disk desiccation, loss of disk space height and a disk bulge at this level associated with uncovertebral osteophytes. There is some narrowing of the neural foramina bilaterally at this level as a result of bilateral uncovertebral osteophyte formation and disk material. This neural foramen narrowing is worse on the left than the right side. There is encroachment of the exiting nerve roots at this level on the left side.At C6-7 there is no significant compromise to the spinal canal. There is disk desiccation, loss of disk space height and a minor disk bulge at this level associated with uncovertebral osteophytes. There is some narrowing of the neural foramina bilaterally at this level as a result of bilateral uncovertebral osteophyte formation and disk material. There is encroachment of the exiting nerve roots at this level.At C7-T1 there is no significant compromise to the spinal canal. There is disk desiccation, loss of disk space height and a minor disk bulge at this level associated with uncovertebral osteophytes. There is some narrowing of the neural foramina bilaterally at this level as a result of bilateral uncovertebral osteophyte formation and disk material. There is encroachment of the exiting nerve roots at this level.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C3-4 and a milder spinal stenosis at C2-3 . There is multilevel neural foramen encroachment of the exiting nerve roots present particularly on the left side at C3-4 and C5-6 and bilaterally at C6-7 and C7-T1.


Instruction: Generate impression based on findings.

Input: Cirrhosis and hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Liver contour: Nodular liver morphology with caudate and left hepatic lobe hypertrophy compatible with cirrhosis. T2 hyperintense reticular liver parenchyma consistent with fibrosis. Features of portal hypertension: Splenomegaly. Patent vasculature.Lesions: There are numerous well defined T2 hyperintense nonenhancing hepatic cysts. Several intrinsically T1 hyperintense nonenhancing lesions likely represent proteinaceous contents. Numerous small siderotic nodules are also noted, as evident on the in-phase imaging.Segment IVb, inferior medial segment of the left lobe, lesion demonstrates new from prior nodule in nodule appearance with central T1 hypointensity and T2 hyperintensity and peripheral T1 hyperintensity and T2 hypointensity (series 11/34 and series 4/12). The entire lesion measures 3.0 x 2.2 cm, unchanged from the prior. The central component demonstrates late arterial enhancement and fading (i.e. becomes isointense to liver parenchyma) on the transitional/equilibrium phase and demonstrates hepatobiliary agent uptake on the hepatobiliary phase, measuring 1.5 x 1.5 cm (series 9/13). On the prior study the lesion did not demonstrate enhancement as evident on the subtraction imaging. This likely represents a large dysplastic nodule developing a central high-grade dysplastic nodule without meeting strict imaging criteria for HCC.Approximately 2.3 x 2.0 cm mildly T2 hyperintense (series 9/8) arterial enhancing lesion (series 12/23) in segment 7/8 demonstrating washout (series 13/23). The lesion demonstrates intralesional fat on in/out of phase imaging, an ancillary feature further supporting the diagnosis of HCC .Arterial enhancing region in the peripheral segment VII (series 12/24) without definite washout on the more delayed imaging likely represents a transient hepatic intensity difference given its somewhat wedge-shaped appearance and peripheral location. Normally distended gallbladder with small gallstones.SPLEEN: Splenomegaly measuring 18.4 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.2.3 cm segment 7/8 lesion meets imaging criteria for HCC.2.The segment IVb medial segment of the left lobe 3 cm nodule is stable in size but demonstrates interval nodule in nodule appearance development with a 1.5 cm central nodule demonstrating arterial enhancement without washout. This is suspicious for an early central HCC/higher grade dysplastic nodule developing within a lower grade dysplastic nodule. Short interval follow-up is recommended.3.Cirrhosis with stigmata of portal hypertension including splenomegaly.


Instruction: Generate impression based on findings.

Input: Malignant melanoma of skin of other and unspecified parts of face [172.3] / Neoplasm of uncertain behavior of skin [238.2] / Malignant neoplasm of kidney, except pelvis No evidence of acute ischemic or hemorrhagic lesion on the scan.There is about 14mm x 4mm sized dural based enhancing lesion on the right temporal area which does not show any interval change in terms of its size and MR characteristics since prior exam. This lesion is likely represent meningioma, the possibility of metastatic lesion is less likely.Otherwise there is no evidence of abnormal enhancing lesion on this scan.Minimal non specific small vessel ischemic lesions are seen on FLAIR images.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures are normal. There is about 5mm downward displacement of cerebellar tonsil indicating borderline Chiari malformation. No evidence of cervical spine signal abnormality.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal brain parenchymal enhancement.2. Right temporal dural enhancing lesion (14mm x 4mm) likely represent meningioma, no change since prior scan.3. Downward displacement of cerebellar tonsil indicating borderline Chiari malformation, no change since prior exam.


Instruction: Generate impression based on findings.

Input: Confusion x 6 hrs and witnessed GTC. The images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. The cerebellar tonsils are mildly low lying, up to 4 mm. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No definite evidence of potential seizure foci, although the images are markedly degraded by patient motion.2. Mildly low lying cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Evaluate extent of disease. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.2 x 4.0 cmPeripheral Zone: No dominant lesion. Please note that the diffusion-weighted images are nondiagnostic.Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No dominant lesion, seminal vesicle lesion, extraprostatic extension or pelvic lymphadenopathy.2.Please note that the diffusion-weighted images are nondiagnostic. The patient will be called back for repeat DWI images without an endorectal coil at no cost to the patient.


Instruction: Generate impression based on findings.

Input: Brain:No diffusion restriction is seen to suggest acute ischemia. There is no susceptibility weighted artifact to suggest intracranial hemorrhage. The brain parenchyma signal is within normal limits without evidence of mass lesion.Perivascular spaces are noted in the bilateral corona radiata.The ventricles, sulci, and cisterns are normal in size and configuration.The orbits are intact. Mild mucosal thickening is seen in the anterior ethmoid air cells and left sphenoid sinus. Cervical spine:Alignment is normal. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. No spinal canal or neural foraminal stenoses.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. No spinal canal or neural foraminal stenoses.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. There is no fatty filum. The spinal cord appropriately moves ventrally on prone images. The visualized intra-abdominal and paraspinal contents are unremarkable. No spinal canal or neural foraminal stenoses.

Output: 1.Normal brain MRI.2.No evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: Reason: Sinus cancer compare to last CT. Measure 1) Soft tissue mass in left nasal cavity, 2) soft tissue mass R. orbit medial rectus muscle, 3) Soft tissue L. orbit, 4) left level 2 lymph node, 5) right level 2 lymph node, 6) 2nd right level 2 lymph node. History: post 2 cycles of therapy. Neck CT:There is interval progression of abnormal soft tissue centered within the left nasal cavity which displaces the nasal septum to the right and abuts the left maxillary antrum. The soft tissue abnormality measures 4.3 x 2.8 cm (series 80280, image 25) compared to prior measurement of 4.1 x 2.2 cm in extent (image 17, series 80288). There is increased tumor filling the left nasal cavity causing increased obliteration of the nasal cavity, and further extension into the left maxillary antrum causing increased trapped secretion within the left maxillary sinus.The soft tissue mass erodes through the lamina papyracea to invade both extraconal orbital spaces. Soft tissue within the right orbit is inseparable from the medial rectus muscle and measures 4.1 x 1.3 cm (series 8034, image 10) compared to prior measurement of 3.8 x 1.6 cm (image 13, series 4) on the prior exam. Soft tissue within the left orbit displaces the medial rectus muscle medially and probably also involves the muscle directly. It measures 2.7 x 1.7 cm compared to prior measurement of 3.0 x 1.4 cm (image 13, series 4) on the prior exam. The slight differences in measurements may be related to differences in sampling.Abnormal soft tissue fills both orbital apices. There is evidence of impingement of the optic nerves bilaterally. Small foci of erosion within the superior orbital walls bilaterally are unchanged. Tumor extends through these cranial defects, particularly on the left where there is evidence of intracranial involvement, better seen on the patient's prior MRI. Soft tissue invasion with bone erosion involves the sphenoid sinuses as well as the sella, foveae ethmoidalis and cribriform plate, similar to the prior examination. Soft tissue invasion of the left sphenopalatine foramen, pterygopalatine fossa and pterygomaxillary fissure appears similar to the prior exam.Postsurgical change involving the anterior aspect of the right maxillary bone is again seen. The patient has undergone right partial maxillectomy, antrostomy and ethmoidectomy. Mucosal thickening within the remaining right maxillary sinus appears similar to the prior exam.Reference lymph node measurements are as follows:Left level 2 (image 8034, series 39): 1.1 cm in short axis, compared to 1.2 cm previously. Right level 2 (image 41, series 8034): 1.3 cm in short axis, compared to 1.2 cm previously.Right level 2 (image 43, series 8034): 1.1 cm in short axis, compared to similar measurement previously.Scattered additional pathological cervical lymph nodes are again seen. There is irregular right level 5 node which demonstrates increased infiltration of surrounding fat and is suggestive of progression of lymphadenopathy with extracapsular extension. There is increased soft tissue stranding and fat reticulation, which may be related to post-treatment effect.The epiglottis, valleculae, piriform sinuses, glottis and suglottic airway are normal.The parotid and submandibular glands, as well as the thyroid, are unremarkable. The cervical vessels are patent. The lung apices show no significant abnormality. Sclerosis within the C5 and C6 vertebral bodies, suspicious for metastatic disease, is unchanged.

Output: 1.Interval progression of left nasal cavity mass with extension into the left maxillary sinus and cribriform plate.2.Soft tissue mass invasion of the extraconal orbital spaces unchanged. There is extension into orbital apices causing optic nerve impingement.3.Extensive skull base invasion appears similar to the prior examination.4.Stable size of numerous pathological cervical lymph nodes with reference measurements as above. However, a right level 5 node demonstrates increased infiltration of surrounding fat and is suggestive of progression of lymphadenopathy with extracapsular extension. 5.Stable bony sclerotic lesions suggestive of metastatic disease in the cervical spine.


Instruction: Generate impression based on findings.

Input: New onset seizures and ESRD due to renal agenesis, inflammatory myopathy, APLS, Raynaud's, HTN, and colitis. There are scattered areas of subcortical white matter T2 hyperintensity predominantly involving the left parietal and occipital lobes, and to a lesser extent portions of the right cerebral hemisphere. There are also scattered foci of T2 hyperintensity in the deep white matter. The hippocampi are unremarkable and there is no evidence of heterotopia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids appear to be grossly intact. There are artifacts related to dental braces.

Output: Scattered white mater lesions in the bilateral cerebral hemispheres predominantly involving the left parietal and occipital lobes likely represent posterior reversible encephalopathy syndrome versus less likely a demyelinating or infectious process, although characterization is limited by the lack of intravenous contrast (acknowledging the patient's renal failure). Discussed with Dr. Ardelt on 3/26/2015 at 10:15 AM.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with history of C3-C5 epidural abscess, evaluate for resolution on antibiotics. Previously demonstrated fluid within the left C4-5 facet joint, and edema in the facet complex and the surrounding paraspinal soft tissues, have nearly completely resolved. There does remain some ill-defined enhancement in these areas but this is also improved. Posterior epidural thickening at the L4 level has improved as well. No definite epidural or paraspinal fluid collections are seen.A dextroscoliosis of the cervical spine is redemonstrated. Grade 1 anterolisthesis of C4 relative to C5 is demonstrated. A grade 2 anterolisthesis of C5 relative to C6 is unchanged. Marked left facet degeneration is again seen at C3-4, C4-5 and C5-6. Mild spinal canal narrowing is redemonstrated at C4-5 and C5-6.

Output: Interval improvement in signal abnormalities centered on the left C4-5 facet complex. No evidence of any residual epidural or paraspinal fluid collection is seen.


Instruction: Generate impression based on findings.

Input: Reason: patient with dermatomyositis with increased weakness of shoulders now with high CK and aldolase History: patient with dermatomyositis with increased weakness of shoulders now with high CK and aldolase Left humerus:There is patchy irregular increased signal abnormality on fluid sensitive sequences as well as enhancement of the lateral aspect of the brachialis muscle belly just proximal to the level of the myotendinous junction at the level of the mid to distal humeral diaphysis (image 7; series 12). Otherwise no abnormal enhancement or mass lesions are identified. The imaged musculature of the left arm is otherwise unremarkable. There is an enchondroma within the humeral head. Otherwise no bone marrow signal abnormality is identified. Although this examination was not protocoled for detailed evaluation of the shoulder, the glenohumeral joint alignment is anatomic and no large effusion is evident.Right humerus:There is also patchy irregular increased signal abnormality on fluid sensitive sequences as well as enhancement along the lateral aspect of the brachialis muscle belly on the right, to a lesser degree than the left, at the level of the myotendinous junction at the level of the distal humeral diaphysis (image 19; series 3). The remainder of the musculature is unremarkable. No bone marrow signal abnormality is identified. Although this examination was not protocoled for detailed evaluation of the shoulder, no large effusion is evident. The glenohumeral joint alignment is anatomic. No additional pathologic enhancement or focal mass lesions are identified

Output: Nonspecific enhancing signal abnormality of the brachialis muscles, left greater than right, which could represent a myositis in the correct clinical setting.


Instruction: Generate impression based on findings.

Input: 68 year-old female with infiltrative lesion in the left temporal lobe undergoing preoperative surgical planning. Redemonstration of an infiltrative T2 hyperintense lesion in the left temporal lobe and extending into the left occipital lobe, parietal lobe, and splenium of the corpus callosum. There is local mass effect with sulcal effacement and effacement of the temporal horn of the left lateral ventricle.Stable additional areas of T2 hyperintensity in the periventricular white matter compatible with chronic small vessel ischemic changes.Postcontrast images demonstrate 2 small nodular foci of enhancement in the left temporal lobe measuring up to 3 mm. There is asymmetrically increased vascularity in the left temporal lobe with dilatation of the temporal branches of the left posterior cerebral artery.The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: No significant interval change in large infiltrative masslike lesion centered in the left temporal lobe with extension of the occipital and parietal lobes.


Instruction: Generate impression based on findings.

Input: Male, 11 years old, status post Chiari decompression with syrinx, 6 month follow-up. The vertebral body numbering system on the prior examination will be preserved which accounts for transitional vertebral body morphology with the last fully formed disc space designated L4-S1.Postoperative findings are again seen compatible with Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. The caliber of the CSF space at the level of the neo-foramen magnum is unchanged. CSF flow signal along the ventral brainstem is slightly attenuated due to mild retroflexion of the dens, similar to prior. Mild flow related signal is seen along the dorsal aspect of the the neo-foramen magnum. The cerebellar tonsils demonstrate stable morphology and terminate at the level of C1.A focal cervical cord syrinx at the C2 level has increased very slightly in size, now measuring 6 x 6 x 13 mm, previously 6 x 5 x 12 mm. No other spinal cord abnormalities are seen.The conus tip terminates at the T12-L1 level which is normal. The cauda equina is unremarkable. Prominence of the ventral epidural soft tissues at C2 is a stable finding. No intraspinal mass is detected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is seen.The intervertebral discs are normal with no evidence of significant spinal canal or neuroforaminal stenosis.Intraperitoneal fluid is again seen. The urinary bladder is distended.

Output: 1.Redemonstration of postoperative findings status post Chiari decompression.2.The caliber of the CSF space at the foramen magnum, the morphology of the cerebellar tonsils, and degree of CSF flow through the foramen magnum are all unchanged.3.A focal cervical cord syrinx at the C2 level has increased very slightly in size. No new cord abnormalities are detected.4.Incidental note is again made of intraperitoneal fluid and distention of the urinary bladder.


Instruction: Generate impression based on findings.

Input: 46-year-old male with history of prostate cancer who presents for prostate MRI. PELVIS:PROSTATE:Prostate Size: 3.7 x 4.2 x 2.5 cmPeripheral Zone: There is a T2 hypointense lesion measuring 1.0 x 0.8 cm (series 1001, image 16) in the right base with corresponding low ADC signal and contrast enhancement. There is probable extracapsular extension. This lesion also abuts the right seminal vesicle and invasion cannot be excluded.An additional subcentimeter T2 hypointense lesion with corresponding low ADC signal in the left base (series 1001, image 15).Central Gland: No significant abnormality.Seminal Vesicles: As detailed above.Extracapsular Extension: Probably extracapsular extension from the right base lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with prostate cancer in the right base with extracapsular extension and abutment of the right seminal vesicle with invasion not excluded.2.Suspicious subcentimeter left base lesion.


Instruction: Generate impression based on findings.

Input: Precocious puberty. Pituitary: The pituitary gland is not enlarged and there is no evidence of mass lesions. The infundibulum is intact. There is no evidence of ectopic posterior pituitary bright spot of hypothalamic hamartoma. The optic chiasm and cavernous sinuses are intact. Brain: There is an unchanged bilateral periventricular nodular lesions with grey matter signal characteristics, right larger than left. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of pituitary or hypothalamic lesions.2. Findings compatible with subependymal heterotopic gray matter along the bilateral lateral ventricles.


Instruction: Generate impression based on findings.

Input: Ms. Ostroff is a 44-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. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Biopsy signal artifact is present in the right lateral breast in the area of previously biopsied non-mass enhancement. Multiple foci are seen in each breast, but none are uniquely suspicious. Apparent washout in several foci is due to slight motion, as visual inspection of these foci reveals a persistent enhancement pattern and a slight change in position of several foci from one post contrast sequence to the last sequence. No abnormal lymph nodes are identified in either axillary region.A few high T2 signal hepatic lesions are likely benign such as cysts.

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


Instruction: Generate impression based on findings.

Input: Reason: 34 yo female with hx of gallbladder polyp; please evaluate for abnormalities. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal background parenchymal signal intensity and enhancement. There are a couple small cysts within segment 6/7. No suspicious focal hepatic lesions are identified. The hepatic vasculature appears patent.The gallbladder is normally distended and lacks diffuse wall thickening. There is a filling defect within the gallbladder along the body wall with reference measurements below which demonstrates enhancement and is compatible with a polyp. Otherwise, there is equivocal irregular focal thickening of the gallbladder wall at the fundus (series 7, image 26) which is nonspecific but could reflect adenomyomatosis and/or small polyps.The biliary system is nondilated. There is mild apparent focal narrowing of the common hepatic duct just proximal to the confluence which is favored to reflect artifact from crossing vessel given lack of upstream dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal parenchymal signal intensity and enhancement without focal lesions identified. The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/19/2016 08:00:00)GALLBLADDER FILLING DEFECT: 0.9 x 1.0 cm (Image 60, Series 10).

Output: 1.10 mm enhancing gallbladder polyp differential considerations for which include adenomatous polyp and adenocarcinoma; surgical consultation is recommended. No evidence of extramural invasion.2.Additional focal thickening of the gallbladder wall fundus may reflect adenomyomatosis or additional small polyps.


Instruction: Generate impression based on findings.

Input: 67-year-old male patient with recent prostatectomy and persistently mildly elevated PSA. Evaluate prostatic fossa and evaluate for lymph nodes. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. There are postoperative changes in the prostate bed but no definite measurable lesion.Peripheral Zone: Surgically absent.Central Gland: Surgically absent.Seminal Vesicles: Surgically absent.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No evidence of tumor recurrence at the surgical bed. No enhancing osseous lesions.OTHER: No significant abnormality noted.

Output: 1.Status post prostatectomy without evidence recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: 81 year old woman. Evaluate for ICH/CVA. There is no evidence of intracranial hemorrhage, mass or edema. There are extensive periventricular and subcortical regions of hypoattenuation consistent with small vessel ischemic disease. These findings are age-indeterminate. If acute stroke remains a clinical concern, recommend evaluation with MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Extensive, age-indeterminate findings of small vessel ischemic disease. 2. No CT findings of acute cortical stroke or hemorrhage.


Instruction: Generate impression based on findings.

Input: Evaluate for biliary tract obstruction. Abnormal liver enzymes. ABDOMEN:LIVER, BILIARY TRACT: Increased size of multiple hepatic lesions, which contain peripheral rim enhancement, suspicious for metastases. For example, segment 4A T2 hyperintense reference lesion measures 2.1 x 2.0 cm (series 601, image 28), previously 1.0 by x 0.9 cm. There is a T2 hyperintense nodule within the porta hepatis measuring 3.7 x 3.0 cm (series 601, image 25), previously 1.3 x 1.3, which causes mass effect on the common bile duct and upstream biliary ductal dilatation. The portal and hepatic veins are patent. SPLEEN: Multiple T2 hypointense lesions within the spleen, compatible with calcifications, probably sequela of prior granulomatous infection.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst, unchanged. Left kidney is unremarkable. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Increased hepatic hilar adenopathy, with mass effect on the proximal and mid common bile duct. For example, a periportal lymph node measures 2.6 x 1.5 cm (series 701, image 85), previously 1.8 x 1.2 cm.BOWEL, MESENTERY: Right upper quadrant heterogeneous lesion measures 8.1 x 6.5 x 6.1 cm (series 12 1, image 42), unchanged. There is resultant scalloping of the inferior right hepatic lobe. There is no evidence of bowel obstruction or ileus.BONES, SOFT TISSUES: Lumbar levo curvature.OTHER: No significant abnormality noted.

Output: 1.Increased hepatic metastases and hilar adenopathy with mass effect on the proximal and mid common bile duct, resulting in mild intrahepatic biliary ductal dilatation.2.Unchanged nonspecific right upper quadrant cystic lesion, possible peritoneal implant.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer to brain treated with whole brain RT. There are post-treatment findings related to right parietal metastasectomy. There is confluent T2 hyperintensity and susceptibility effect upon the surgical margins, but evidence of recurrent tumor in this region. There is interval decrease in size of the left superior frontal gyrus and right lingual gyrus lesions, which both measure 3 mm in width, previously 5 mm. There is a right lateral occipital lobe developmental venous anomaly. There is encephalomalacia in the right posterior cerebral artery territory and in right pons, where there is also punctate susceptibility effect. There is ex vacuo dilatation of the right posterior lateral ventricle. There is unchanged nonspecific diffuse cerebral white matter, left pons, and middle cerebellar peduncle T2 hyperintensity. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Post-treatment findings related to right parietal metastasectomy without evidence of recurrent tumor in this region.2. Interval decrease in size of the left superior frontal gyrus and right lingual gyrus metastases.3. Chronic right posterior cerebral artery territory and right pons infarcts.


Instruction: Generate impression based on findings.

Input: History of metastatic chromophobe renal cancer to the liver status post radiofrequency ablation. ABDOMEN:LIVER, BILIARY TRACT: The previously seen 1.3 x 1.1 cm enhancing lesion in the inferior right hepatic lobe is now a nonenhancing ablation zone measuring 1.3 x 0.7 cm. No abnormal diffusion restriction is seen. No new lesions are seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No suspicious soft tissue is seen in the surgical bed. No significant abnormality noted in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Incompletely imaged ventral abdominal wall diastasis/hernia.OTHER: Small amount of pelvic free fluid, possibly physiologic.

Output: 1. Nonenhancing ablation zone seen in the region of the prior metastatic liver nodule.2. No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with thoracic abscess status post surgical decompression and removal. Evidence of instrumented posterior fusion is again seen at T7-T12. Decompressive laminectomy also has been performed from T8 through T10.Artifact from the fixation instruments does impede the assessment of structures from T7 through T12. Visualization is, however, better than on prior examinations. Again seen is extensive endplate destruction and loss of vertebral body height centered at T9-10. Vertebral body and disc material protrudes into the anterior paraspinal space at this level, particularly on the right. Within the limitations of the artifact, it does appear that spinal canal narrowing and cord compression seen previously at T9-T10 secondary to ventral epidural encroachment has been relieved. Assessment of cord morphology and cord signal through this region is not reliable.Above and below the operative field, no significant vertebral body or spinal canal abnormalities are detected, and the spinal cord is within normal limits. Incidental note is made of numerous renal cystic lesions.

Output: Postoperative findings are seen compatible with instrumented posterior fusion from T7 through T12 as well as decompressive surgery from T8 through T10.Extensive disc space and vertebral body destruction is again seen centered at T9-10 compatible with the history osteomyelitis discitis. Disc and osseous material continues to protrude into the anterior paraspinal space at this level. Within the limitations of artifact, it does appear that the ventral epidural encroachment at T9-10 which previously caused a significant canal stenosis and cord compression has been relieved.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out brain metastases. Signs and symptoms: Known spinal cancer. Pre and post contrast brain MRI: Negative diffusion weighted images.Examination demonstrate normal anatomic cord morphology and with normal signal intensity on all MRI sequences. Unremarkable sacral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease.Normal signal intensity of calvarium and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.On paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol which does not include axial images and without contrast.Within this limitation there is normal anatomical alignment of vertebral column. There is no evidence of mass effect on the cord or central spinal stenosis at any level.Marrow signal replacement involving the posterior articulating facet of T8 as well as diffusely involving vertebral body of L2, L3 and partial involvement of anterior body of S1 on highly suspected for osseous metastatic lesions. There is mild compression deformity of the superior endplate of L2 with subtle bulge of the compressed vertebra into the spinal canal.The signal intensity and caliber of the cord as well as cauda equina remains within normal and is nonenhanced study.Pre and post enhanced lumbosacral MRI:There is diffuse marrow signal replacement involving the vertebral body of L2 and left pedicle with enhancement consistent with metastatic disease. There is mild compression deformity of superior endplate of L2 and evidence of ventral epidural spread of tumor at this level which also extends into the left neural foraminal with resultant compromise. There is however no spinal stenosis.Metastatic lesion is also noted involving extensively the vertebral body of L3 and left pedicle with enhancement. There is no evidence of fracture or malalignment and no central spinal stenosis or neural foraminal compromise.Small focus of marrow signal replacement with enhancement involves the anterior-inferior aspect of S2 vertebral body consistent with metastatic lesion. No epidural spread of tumor.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.Note is also made of marrow signal replacement with enhancement involving the left iliac wing measuring at 13 x 22 and right iliac wing measuring 7 x 6 mm consistent with additional osseous metastatic lesions.

Output: 1.Negative pre and post enhanced brain MRI.2.Nonenhanced cord compression complete spine MRI demonstrate no cord compression. There are however multiple osseous metastatic lesions present. There is metastatic lesion involving L2 vertebrae and with mild compression fracture of superior endplate. Normal signal intensity and caliber of the cord and without evidence of spinal canal compromise or stenosis at any level.3.Pre and post enhanced MRI of lumbar spine demonstrate metastatic lesions involving extensively vertebral body of L2 and L3 and to a lesser degree anterior body of S1 and with lesions in bilateral iliac wings (L>R) as detailed as detailed/measured above. Mild compression fracture of superior endplate of L2 vertebrae with metastases. There is extraosseous spread of tumor into the ventral epidural space at L2 and with extension and compromise of the left lateral recess and left neural foramina at L2-L3 as detailed. No central spinal stenosis or leptomeningeal enhancement.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression.

Output: No acute cord compression. A dedicated, complete, segment-specific MRI is recommended if symptomology localizes.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:12/4/1971)Reason: proptosis OS, r/o mass or lesion History: proptosis OSPROVIDER/ATTENDING NAME: JEFFREY W NICHOLS JEFFREY W NICHOLS MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .There is some minor opacities in the ethmoid air cells and left maxillary sinus.There is an extra-axial enhancing lesion present in the posterior fossa measuring 14 x 10 mm axial dimensions which abuts the right cerebellar hemisphere. It is adjacent to the junction of the sigmoid and transverse sinuses. It has a low signal intensity centrally on T2 and T1 images and enhances homogeneously.

Output: 1.No intraorbital mass is identified.2.There is a posterior fossa extra-axial mass present without significant mass effect which statistically most likely represents a meningioma.3.A email with sent to the referring physicians Dr Nichols and Dr Zabanieh


Instruction: Generate impression based on findings.

Input: Pain and swelling after fall TENDONS: No significant abnormality noted.LIGAMENTS: There is there is mild thickening and irregularity of the anterior talofibular ligament which may represent strain or partial tearing.ARTICULAR SURFACES AND BONE: There is a small focus of articular cartilage loss and marrow edema within the talar dome medially best seen on series 10 image 18. The remaining marrow signal intensity of the ankle is normal.ADDITIONAL

Output: 1. Small focus of marrow signal edema within the talar dome medially may represent a small osteochondral lesion of indeterminate age.2. Irregularity and thickening of the anterior talofibular ligament a represent partial tearing or sprain.


Instruction: Generate impression based on findings.

Input: 57-year-old man with history of prostate cancer on surveillance. PELVIS:PROSTATE:Prostate Size: 47 x 32 mm.Peripheral Zone: The peripheral zone appears normal without discrete focus of abnormal signal, diffusion-weighted abnormality, or enhancement.Central Gland: No significant abnormality noted.Seminal Vesicles: Seminal vesicles are normal.Extracapsular Extension: N/ABLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No MR evidence of prostate adenocarcinoma.


Instruction: Generate impression based on findings.

Input: 15 year-old male with history of infiltrating cerebellar astrocytoma status-post subtotal resection, here with headache. Evaluate for ICH. A right frontal shunt catheter has its tip in the left lateral ventricle. There is no significant ventricular dilation. The ventricular size is unchanged since the recent MRI.There is deformity of the cerebellar vermis with foci of calcification. This is compatible with residual tumor. However, evaluation of this is limited due to the lack of intravenous contrast.There is no evidence of intracranial hemorrhage.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of intracranial hemorrhage. 2. Partially calcified mass is again seen in the posterior fossa. This is incompletely evaluated due to lack of intravenous contrast.3. Unchanged right frontal shunt catheter with no evidence of hydrocephalus.


Instruction: Generate impression based on findings.

Input: Female, 13 years old. Uterine anomaly vs. uterine agenesis and vaginal agenesis. Abd pain, abnml USEXAMINATION: MRI pelvis without and with IV contrast 07/27/2016 PELVIS:UTERUS, ADNEXA: The uterus is small measuring 1.4 x 2.1 x 2.4 cm. The normal uterine layers are not identified. An even smaller focus of soft tissue to the left of the uterus is of uncertain etiology. There appears to be a cervix and suggestion of a vagina, but the vagina cannot be traced to the perineum or urethra. The ovaries are normal, with multiple follicles of varying sizes.BLADDER: The bladder is distended.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction. No free intra-abdominal air or abnormal free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid. The kidneys are normal in appearance.

Output: 1.Very small, dysmorphic uterus.2.There appears to be cervix and suggestion of a vagina, but the vagina cannot be traced to the perineum or urethra. 3.The ovaries are normal.


Instruction: Generate impression based on findings.

Input: Reason: eval for RTC History: right should pain ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is partial thickness tearing of the articular surface fibers of the supraspinatus, approximately 2.5 cm from its insertion on the greater tuberosity, involving less than 50% of the tendon width, with delamination extending to the level of the myotendinous junction. There is approximately 1 cm of retraction. There is thickening and intermediate signal intensity within the infraspinatus indicating moderate tendinosis. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is intermediate signal intensity within the posterior and superior glenoid labrum indicating degeneration/degenerative tearing.BICEPS TENDON: There is thickening and intermediate signal intensity within the tendon of the long head of the biceps at its transition from the bicipital groove to the rotator interval indicating tendinosis. The tendon appears intact.ADDITIONAL

Output: 1. Partial thickness laminar tear of the articular surface fibers of the supraspinatus with mild retraction as described above. 2. Rotator cuff and long head of the biceps tendinosis.


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain, elevated LFTs and leukocytosis. Susceptibility artifact from the patient's spinal fixation hardware limits some of the imaging sequences, particularly the diffusion weighted images which are non-diagnostic.ABDOMEN:LUNG BASES: Small right greater than left pleural effusion with minimal basilar atelectasis.LIVER, BILIARY TRACT: There is intrahepatic and extrahepatic biliary ductal dilatation with the common bile duct measuring 16 mm. The duct is dilated to the level of the superior aspect of the pancreatic head where it tapers abruptly. A short segment of the common bile duct is seen just proximal to the ampulla. At this level the pancreatic head is prominent, measuring 2.7 x 2.3 (series 1405/180), T2-hypointense and demonstrates relatively early and persistent enhancement relative to the background mildly atrophic pancreas. There is mild spiculation of the contours of the pancreatic head. The pancreatic duct is at the upper limits of normal in caliber. There is no soft tissue encasement or caliber abnormality of the adjacent SMV, splenic vein, protal vein or SMA. Posterior peri-pancreatic head lymph node measuring 7 mm in short-axis. No additional prominent lymph nodes.The gallbladder is mildly distended. There is mild smooth focal gallbladder wall thickening to 4 mm along the lateral aspect of the gallbladder which may reflect focal adenomyomatosis. The remainder of the gallbladder is normal in thickness. There is mild pericholecystic fluid. No filling defect to suggest gallstones.Minimal perihepatic fluid.There is mild loss of hepatic parenchymal signal intensity on out of phase imaging suggesting fatty infiltration. No focal suspicious hepatic lesion.SPLEEN: Minimal perisplenic fluid. The spleen is normal in size.PANCREAS: See the discussion above.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Symmetric minimal perinephric fat stranding. Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Distended gallbladder with significant intra and extrahepatic biliary ductal dilatation to the pancreatic head. A pancreatic head mass is suspected, as described above, specifically a pancreatic adenocarcinoma or less likely a cholangiocarcinoma. EUS/ERCP evaluation and biopsy is recommended.2.Small pleural effusions.


Instruction: Generate impression based on findings.

Input: pain and focal crepitus at the superior aspect of the knee. Evaluate for structural abnormalities. MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. No evidence of cartilage degeneration or thinning.LIGAMENTS: The anterior and posterior cruciate ligaments are normal. The medial and lateral collateral ligaments are normal.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Small joint effusion, otherwise normal examination.


Instruction: Generate impression based on findings.

Input: Reason: Assess IPMN History: Hx of IPMN ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal background parenchymal signal intensity and enhancement. There is redemonstration of several hepatic cysts, not significantly changed. No suspicious focal hepatic lesions are identified.The hepatic vasculature appears patent.Status post cholecystectomy. No intrahepatic biliary duct dilatation. Common bile duct measures up to 8 mm in diameter, not significantly changed.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal background parenchymal signal intensity and enhancement. There is redemonstration of a cystic lesion within the uncinate process which possibly communicates with the pancreatic duct and which most likely represents a sidebranch intraductal pancreatic mucinous neoplasm, not significantly changed in size with reference measurements below. The lesion lacks suspicious features such as a solid components or enhancement. The pancreatic duct is not dilated. No additional focal pancreatic lesions are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small duodenal diverticulum; unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/16/2016 12:40:56)PANCREATIC UNCINATE PROCESS CYSTIC LESION: 1.6 x 1.5 cm (Image 16, Series 501); 1.7 x 1.6 cm on prior (9/29/2014) (Image 7, Series 4).

Output: Cystic lesion in the uncinate process of the pancreas compatible with a sidebranch IPMN, not significantly changed.


Instruction: Generate impression based on findings.

Input: Evaluate for ganglion cyst LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Dorsal soft tissue mass consistent with a ganglion cyst


Instruction: Generate impression based on findings.

Input: 18-year-old male with Bannayan-Riley-Ruvalcaba syndrome and arteriovenous malformation involving his pelvis, left buttock, and left lower extremityEXAMINATION: MRI left femur and MRI pelvis without and with intravenous contrast 12/9/2016 A mass in the left piriformis is present and not significantly changed measuring 7.3 x 5.4 cm (series 7, image 20). The mass demonstrates heterogeneous T2 signal with internal areas of high T1 signal intensity, suggestive of fat, and minimal enhancement. Internal tubular serpiginous structures are present compatible with dilated blood vessels. There is similar mass effect on the left posterolateral wall of the rectum.A mass in the left semimembranosus/semitendinosus muscles is present, also not significantly changed measuring 6.4 cm x 5.5 cm (series 26, image 33). Similarly to the piriformis lesion, the mass is mildly enhancing and contains dilated blood vessels as well as heterogeneous T2 signal with internal areas of high T1 signal intensity.Ectatic tubular structures are present within the soft tissues of the left lower extremity similar to prior compatible with dilated veins.No new sites of disease.Bone marrow signal intensity is normal.

Output: Unchanged vascular malformations in the left piriformis and left semimembranosus/semitendinosus muscles. The lesions demonstrate MRI features suggestive of fibro-adipose vascular anomalies (FAVA).


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post repeat TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. Patent hepatic vasculature.Anterior right hepatic lobe ablation cavity (see 9, image 38) measures 3.6 x 3.7 cm, previously 3.6 x 3.7 cm. The ablation cavity demonstrates intrinsic high T1 signal without enhancement, compatible with intracavitary blood products and/or proteinaceous material.At the location of the previously described 2 adjacent suspicious arterially enhancing lesions within segment 7/8, there is a new ablation cavity from intervening ablation (series 9, image 18) measuring 2.4 x 3.5 cm. Ablation cavity demonstrates intrinsic high T1 signal without internal enhancement, compatible with intracavitary blood products and/or proteinaceous material. The ablation cavity demonstrates equivocal thin rim enhancement (e.g., anteriorly on image 14 series 8/image 13 series 101) which may be treatment related, no corresponding washout seen on subsequent more delayed imaging.No new suspicious arterially enhancing lesions are identified.Status post cholecystectomy. No biliary ductal dilatation.SPLEEN: Mild splenomegaly with spleen measuring up to 14.7 cm in length. Large splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Slight left adrenal nodularity is similar to prior.KIDNEYS, URETERS: Subcentimeter renal cysts not significantly changed.RETROPERITONEUM, LYMPH NODES: Stable mildly enlarged portacaval and gastrohepatic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Focal fat-containing T2 hyperintense lesion in the left L2 vertebral body which has been previously biopsied and may represent a hemangioma, not significantly changed.OTHER: No significant abnormality noted.

Output: Interval ablation of 2 adjacent suspected HCC lesions in the right hepatic lobe without evidence of residual or recurrent hepatocellular carcinoma. The ablation cavity demonstrates equivocal thin rim enhancement which may be treatment related, no corresponding washout seen on subsequent more delayed imaging. Continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: 48-year-old male with left knee pain and swelling. MENISCI: There is linear signal abnormality within the posterior horn of the medial meniscus extending to the tibial articular surface consistent with a horizontal cleavage tear, extending to involve the body of the meniscus. The anterior horn appears intact. There is linear increased signal abnormality within the body and posterior horn of the lateral meniscus which extends to the tibial articular surface consistent with a horizontal tear. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. There is partial-thickness articular cartilage degeneration along the lateral aspect of the weightbearing surface of the medial femoral condyle, best seen on series 801. The lateral and patellofemoral compartments appear relatively spared.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial and lateral meniscus as described above. 2. Articular cartilage degeneration as described above. 3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Male, 55 years old. Status post traumatic fall onto shoulder; suspect supraspinatus +/- infra tears. Shoulder pain, weakness ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon with approximately 1 cm of retraction. The tear is between 1.5 and 2 cm in AP dimension with possible sparing of some of the posterior fibers of the tendon. There is thickening and increased signal intensity within the supraspinatus tendon proximally, likely representing a combination of retraction and tendinosis. The supraspinatus muscle appears normal. There is mild tendinosis of the distal infraspinatus tendon, and the infraspinatus muscle appears normal. The teres minor tendon and muscle appear normal. There is mild tendinosis of the subscapularis tendon but no tear, and the subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small joint effusion. A focus of intermediate signal in the subscapularis recess may represent a cartilage fragment. There is degeneration and tearing of the superior labrum with juxtalabral cysts posteriorly.BICEPS TENDON: There is mild increased signal intensity within the intra-articular portion of the tendon of the long head of the biceps, suggesting mild tendinosis.

Output: Full-thickness tear of the supraspinatus tendon and other findings as described above.


Instruction: Generate impression based on findings.

Input: Multiple Sclerosis on Tysabri for 15 months. Several sequences are motion degraded.BRAIN: There are multiple T2 hyperintense lesions in the periventricular and subcortical white matter, which have not significantly changed in number or size. Many of the lesions demonstrate T1 hypointensity. There are no enhancing lesions. There is no evidence of intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. CERVICAL SPINE: There are multiple stable small T2 hyperintense lesions primarily in the upper cervical spine without abnormal enhancement or interval progression since the prior study. 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.THORACIC SPINE: There are several T2 hyperintense lesions in the thoracic cord from T8 to T12 which are similar to prior examination No new lesions are seen. There is no abnormal enhancement. The vertebral body heights in the thoracic spine are intact and the alignment is normal. There is disc desiccation, small bulge and Schmorl's node at the T9-T10 level. There is no significant spinal canal or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1.No significant interval change in the demyelinating lesion in the brain and cervical and thoracic spinal cord.2.No evidence of PML.


Instruction: Generate impression based on findings.

Input: Reason: L leg weakness, confusion, dysarthria, improving. consideration for in the cord vm vascular malformation v tumor MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No evidence for acute ischemic stroke or other intracranial lesion which can explain the patient's symptoms. MRI of the brain is within normal limits.2.No evidence for cervical spine mass or spinal cord lesion to explain the patient's symptoms. There are only minor degenerative changes in the cervical spine.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:9/4/1960)Reason: MS, f/u progression History: weaknessPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is redemonstration of a moderate degree of periventricular and subcortical white matter lesions which have not changed since the prior exam. Similar lesions are perpendicularly oriented to the lateral ventricles and there is involvement of the corpus callosum. Additionally, there are lesions in the internal capsules, left basal ganglia and cerebellum which are also stable since the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Since the previous exam there is no significant change in the common cerebellar, internal capsule, corpus callosum, periventricular and subcortical white matter lesions. These are compatible with the patient's clinical diagnosis of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 75-year-old female with drop attacks, subsequent nausea; rule out posterior circulation hemorrhage, TIA There are increasing periventricular and subcortical hypoattenuating lesions which is nonspecific but may represent increased small vessel disease of indeterminate age. Recommend MRI if high clinical concern for ischemic CVA. Again seen is an evolving right basal ganglia lacunar infarct. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and sulci are prominent which is consistent with mild parenchymal volume loss. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Increased small vessel disease of indeterminate age. No evidence of acute intracranial hemorrhage. Recommend MRI if high clinical concern for ischemic CVA.Mild parenchymal volume loss and evolving lacunar infarct as described above.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with intractable temporal lobe epilepsy. Sensorimotor and cortex mapping for epilepsy presurgical evaluation. Sensorimotor cortical activation observed during the hand, foot and face/tongue motor tasks maps to its expected locations along the pre- and post-central gyri.All tested language paradigms produced reliable language related cortical activation. Language is left dominant with task-dependent minor contributions from the right hemisphere.There is robust cortical activity in the pars orbitalis of the left inferior frontal lobe and modest activity on certain paradigms in the pars opercularis, either or both of which could reflect Broca's area. Fairly robust cortical activity in Wernicke's area is identified along the posterior aspect of the left superior temporal sulcus.

Output: Sensorimotor cortical activity maps as expected along the pre- and post-central gyri.Language is left dominant. Broca's area is identified as expected in the pars orbitalis and/or opercularis of the left inferior frontal lobe. Wernicke's area is identified as expected along the posterior aspect of the superior temporal sulcus.