Instruction: Generate impression based on findings.

Input: Male 58 years old who presented with abdominal pain and jaundice s/p EUS/ERCP 11/18/16 showing choledocholithiasis s/p sphincter tomy, here to evaluate for duct clearance. ABDOMEN:LIVER, BILIARY TRACT: There is an impacted stone at the origin of the right hepatic duct with associated wall thickening, narrowing and likely stricture (series 1501, image 18). This stone correlates with the area of abrupt cut off of at the level of the right hepatic duct on the MRCP images (series 1301 and 1403). There are numerous additional stones within the more proximal right hepatic ducts which are moderately dilated. The left hepatic duct and extrahepatic biliary ducts are normal in caliber.Two subcentimeter right hepatic lesions are slightly hyperintense on T2 and hypointense on T1 and are indeterminant (series 107, image 302).SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 12 mm, complex cystic lesion in the midpole of the right kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Impacted stone at the origin of the right hepatic duct with associated wall thickening, narrowing and likely stricture. Numerous additional stones are seen in the more proximal right hepatic ducts which are moderately dilated.2.Subcentimeter right hepatic lesions are indeterminant. Follow-up in 3-6 months is recommended.3.Complex cystic lesion in the right kidney can be followed up with the hepatic lesions.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other hereditary ataxiasClinical question: r/o lumbar plexopathySigns and Symptoms: see above Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level associated with encroachment of the right-sided exiting nerve root within the neural foramen. This is unchanged since the prior exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and endplate reactive change present at this level. The endplate reactive change is high signal on T2 and low signal on T1 as well as contrast enhancement. There is mild narrowing of the neural foramina at this level but no encroachment of the exiting nerve roots within the neural foramina. The fat at the lateral recess is not effaced on either side. Compared to the prior exam the disc bulge at this level as regressed.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge, loss of disc space height and disc desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a diffuse disc bulge associated with endplate reactive change at this level. The endplate reactive change is high signal on T2 and low signal on T1 as well as contrast enhancement. At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is some encroachment of the right-sided exiting nerve roots at the L5-S1 level within the neural foramen. 2.There are multilevel degenerative changes present in the lumbar spine.3.There are some subacute endplate reactive changes present in the lumbar spine at L2-3 and L4-5.4.Since the prior exam a disc bulge at the L4-5 has become less prominent.


Instruction: Generate impression based on findings.

Input: 66-year-old with history of T3 N1 rectal cancer status post chemo/RT and surgical resection on 9/3/2008. Baseline prior to receiving chemotherapy. CHEST:LUNGS AND PLEURA: 1 to 2-mm pleural-based right upper lobe nodules have not increased in size as compared to the prior examination. These are nonspecific.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified granuloma within the spleen are unchanged.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: Right lower quadrant ostomy has been created in the interval. There is a nonobstructive peristomal hernia. No other abnormalities identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: 1.7-cm near density exophytic lesion off of the uterus is nonspecific. This could represent a leiomyoma. This could not be identified on the previous exam due to lack of intravenous contrast. This could be further evaluated with MRI or gynecologic ultrasound. The uterus is fluid-filled. BLADDER: No significant abnormality noted.LYMPH NODES: No definite lymphadenopathy is identified. The previously described lymph nodes are not identified on the current study. Loops of bowel are in the current location of the previously described lymph nodes.BOWEL, MESENTERY: The rectal wall is thickened, consistent with either the patient's primary malignancy or post treatment changes.BONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine. There is no evidence of osseous metastatic disease.OTHER: No significant abnormality noted.

Output: 1. Rectal thickening is reidentified, consistent with either patient's primary mass or post treatment changes.2. Nonspecific pulmonary micronodules are unchanged from the prior examination.3. Nonspecific 1.7 cm hypodense exophytic lesion off of the uterus. This is nonspecific by CT and could be further evaluated with gynecologic ultrasound or MR as clinically indicated.


Instruction: Generate impression based on findings.

Input: Left brain stem cavernous malformation: surveillance. The lesion with extensive susceptibility effect within the left aspect of the pontomedullary junction has not significantly changed, measuring approximately 5 mm in diameter. There is no evidence of associated developmental venous anomaly or surrounding edema. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the cavernous malformation within the left aspect of the pontomedullary junction.


Instruction: Generate impression based on findings.

Input: 66 year old male with history of atrial flutter, hypertension, obstructive sleep apnea, diabetes with new, asymptomatic complete heart block. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 235 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 107 ml (normal range 47+/-19), the LV mass index is 37 g/m2 (normal range 85+/-15), and the LV mass is 88 g (normal range 164+/-36). There is thinning of the mid to apical anterior and anteroseptal walls with associated hypokinesis. There is a non-transmural myocardial infarction involving this territory (mid to apical anterior and anteroseptal walls). This territory has an intermediate probability of viability. There is additionally another region of late gadolinium enhancement involving the mid-myocardium layer of the basal anteroseptum. This pattern of late gadolinium enhancement is not typical for myocardial infarction and suggests the presence of a focal secondary underlying fibrosing, infiltrative, or inflammatory process which may be the mechanism of the patient's heart block. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 211 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is significantly dilated (43 mm)Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with normal systolic function (LVEF 55%). 2. There is thinning of the mid to apical anterior and anteroseptal walls with associated hypokinesis. There is a non-transmural myocardial infarction involving this territory (mid to apical anterior and anteroseptal walls). This territory has an intermediate probability of viability. 3. There is additionally another region of late gadolinium enhancement involving the mid-myocardium layer of the basal anteroseptum. This pattern of late gadolinium enhancement is not typical for myocardial infarction and suggests the presence of a focal secondary underlying fibrosing, infiltrative, or inflammatory process which may be the mechanism of the patient's heart block. 4. The right ventricle is mildly dilated with normal systolic function (RVEF 55%). 5. Moderate biatrial enlargement. 6. Significant dilation of the main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: ischemic stroke History: R sided weakness No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: No change from CT HEAD WO with report dated 1/25/2016 12:57 PM.42 years Female (DOB:2/27/1973)Reason: Hx of lung cancer with Pulmonary embolism on anticoagulation with persistent headache evaluate for brain mets History: headachePROVIDER/ATTENDING NAME: ANUBHA GANJOO CARA A ROSENBAUM 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: 1.MRI of the brain is within normal limits there is no evidence for intracranial mass lesion or other explanation for the patient's headaches based on this MRI of the brain.2.There is no evidence for brain metastases


Instruction: Generate impression based on findings.

Input: 83-year-old female presents with cognitive decline. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate periventricular and subcortical cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are prominent compatible with volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Moderate predominantly periventricular white matter T2 hyperintensity is nonspecific, but may reflect chronic small vessel ischemic disease and could conceivably contribute to a component of vascular dementia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 48-year-old female with right-sided weakness, expressive aphasia, left frontal lobe hypodensity identified on prior CT. A recently identified new focus of parenchymal hypo-attenuation in the left frontal lobe premature white matter demonstrates restricted diffusion with matching ADC hypointensity consistent with acute ischemia. There are also other smaller foci of restricted diffusion in the left hemisphere, not identifiable on the prior CT, within the left MCA distribution. There is associated enhancement, however a lack of susceptibility abnormality.A previously identified focus of restricted diffusion within the left mid and superior cerebellar peduncle identified on the 2013 study no longer demonstrates diffusion restriction.A focus of T2 hyperintensity within the right middle cerebellar peduncle is again noted, unchanged. The previous focus of restricted diffusion involving the left middle cerebellar peduncle now demonstrates mild T2 hyperintensity.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift. The midline structures and cranial-cervical junction are normal. Other than a tiny focus of mucosal thickening within the medial left maxillary sinus, the paranasal sinuses and mastoid air cells are clear. Flow signal abnormality within the posterior circulation is consistent with abnormalities identified on previous CT angiogram performed on 4/9/2015.

Output: 1.MRI evidence for subacute ischemia within the left MCA territory.2.Flow signal abnormality within the posterior circulation is consistent with abnormalities identified on previous CT angiogram performed on 4/9/2015.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: fluctuating weakness r handSigns and Symptoms: stuttering hand weakness MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right A1 segment is smaller than the left A1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally with small P1 segments.. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is no evidence for extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: BRAIN: The exam is markedly degraded due to severe artifact likely related to dental amalgam. Within this limitation, there is no enhancing mass, mass effect or midline shift. There is signal heterogeneity in the pons and upper medulla which is suspected to be artifactual. There are no detectable white matter lesions on the limited T2 images. The ventricles and basal cisterns are normal in size and configuration. There is no hydrocephalus.IACs: The exam is markedly degraded due to severe artifact likely related to dental amalgam. Within this limitation, there is no detectable pathologic enhancement of the bilateral cranial nerves 7/8 complexes in the visualized cisternal and intracanalicular portions. The remaining markedly segments are distorted by artifact.

Output: 1.Nondiagnostic exam due to severe artifact likely related to patient's dental amalgam.2.No detectable pathologic enhancement of the visualized cisternal and intracanalicular cranial nerves 7/8 complexes.3.No hydrocephalus, large intracranial mass or mass effect.


Instruction: Generate impression based on findings.

Input: 63-year-old male with HCC, status post RFA, increasing AFP. Assess for liver lesions. ABDOMEN:LIVER, BILIARY TRACT: The ablation cavity of the hepatic dome measures 5.7 x 5.5 cm (series 9 image 188), and surrounding T1 hyperintense foci could represent residual blood products. Stable wedge-shaped ablation cavity in hepatic segment 2/3. There are multiple small arterially enhancing foci in the posterior and inferior right hepatic lobe that demonstrate subtle washout and thin peripheral enhancement versus pseudocapsule formation (series 9 images 140, 148, 164, 169).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Enlarged periportal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There are multiple small arterially enhancing foci in the posterior and inferior right hepatic lobe that demonstrate central washout and thin continuous peripheral enhancement/pseudocapsule formation. These findings are concerning for multifocal HCC/metastases.2.Stable ablation cavities in the hepatic dome and segment 2/3.


Instruction: Generate impression based on findings.

Input: Left arm mass The examination is limited by the patient's body habitus, by motion artifact, and by the inability to patient to tolerate the exam. There is also significant asymmetry fat suppression which further limits evaluation of the mass.Note that the area in question was designated by vitamin E markers. In the region of interest is prominence of the subcutaneous fat which appears unencapsulated. Postcontrast images are limited by inhomogeneous fat saturation but there is no obvious nodular or thick septal enhancement identified. The underlying muscle signal and caliber is normal as is the marrow signal of the humerus.

Output: Examination is limited as detailed above. Within the limits, there is prominence of the subcutaneous fat of the left humerus without obvious abnormal enhancement. The findings most likely represent a lipoma but if there is continued clinical concern, repeat examination can be performed.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial hemorrhage. Signs and symptoms: Right arm weakness. Unenhanced CT of brain:There is no definite evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns are within normal range for patient's stated age of 77. Note should be made that very small acute cortical strokes can be missed on CT examination and for further follow-up and MRI is recommended.

Output: No definitive evidence of intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Right hip pain MR evaluation demonstrates severe osteoarthritic changes as previously observed on plain film including bone-on-bone narrowing, bulky osteophytes, large subchondral cysts and sclerotic changes. In association, mild flattening of the femoral head is observed superiorly with large either confluent subchondral cysts without complication of suspected AVN. The surrounding capsule demonstrates minimal inflammation in no significant effusion, suspected mild synovitis .Mild red marrow changes. The remaining and partially visualized pelvis is unremarkable. Surrounding musculature of the mild atrophy is otherwise also unremarkable.

Output: Moderate avascular necrosis of the hip with superimposed severe primary or secondary osteoarthritis.


Instruction: Generate impression based on findings.

Input: No evidence of acute ischemic or hemorrhagic lesion.A couple of left superior frontal gyrus and precentral gyrus high signal intensities on FLAIR/T2 lesions are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Left frontal lobe FLAIR/T2 white matter high signal intensities are non specific.


Instruction: Generate impression based on findings.

Input: 76 year-old female with right renal mass. Status post stroke. Hypertension. Suspected right upper pole renal mass seen on the recent ultrasound examination. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: Mild cardiomegaly. No acute infiltrates or effusions. Dense pleural-based posterior calcification at the right lung base appears benign. Precardiac lymph nodes measure up to 1.5 cm in length.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys show moderate atrophy bilaterally. In the right midpole region there is a 3-cm diameter cystic lesion with attenuation measuring approximately 11 Hounsfield units, indeterminate. Additional smaller cystic lesions are present in the right kidney. No associated lymphadenopathy. There is a 1.6-cm exophytic mass at the left lower renal pole with attenuation of 58 Hounsfield units. These lesions could be further characterized with dedicated contrast enhanced CT or MRI, but this may not be possible due to the patient's renal failure.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Contiguous thoracic spine bridging osteophytes compatible with diffuse idiopathic skeletal hyperostosis. Degenerative changes.OTHER: Fat containing umbilical hernia. PELVIS:UTERUS, ADNEXA: Atrophic uterus. BLADDER: Bladder is contracted with apparent mild wall thickening.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis. BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis. Old fracture deformity with callous at a right hip intertrochanteric region.OTHER: No significant abnormality noted

Output: Bilateral renal masses. The right midpole mass appears to be an atypical cyst. The left lower pole mass is indeterminate and may be solid.


Instruction: Generate impression based on findings.

Input: Distended 57-year-old female status post right labral tear in 2012 and continued left hip pain, please evaluate for labral healing. ACETABULAR LABRUM: Gadolinium appears to enter the anterior superior labrum, consistent with tear.ARTICULAR CARTILAGE AND BONE: Again demonstrated is diffuse thinning of the articular cartilage of the right acetabulum with subchondral cyst formation of the acetabulum, progressed in comparison prior examination and most severe along the medial aspect of the acetabulum. There is worsening subchondral sclerosis and cystic change adjacent to the labral tear within the anterior, superior labrum.SOFT TISSUES: Soft tissues appear within normal limits without pathologic signal.ADDITIONAL

Output: Anterosuperior labral tear as outlined above. Progressive osteoarthritis compared to to 2012 as outlined above.


Instruction: Generate impression based on findings.

Input: Ms. Robinson is a 56 year old female with a personal history of right breast mastectomy in 2001 for IDC treated with radiation and chemotherapy. Personal history of benign left breast biopsy in 2010 for fibroadenoma. She has no current breast related complaints. Right breast: Patient is status post right breast mastectomy. There is no abnormality in the right chest wall. Left breast: There is scattered fibroglandular tissue in the left breast. Mild parenchymal enhancement is noted. Stable lobulated mass with susceptibility artifact is again seen at the 4 o'clock position of the left breast, compatible with biopsy proven fibroadenoma. No abnormal enhancement is seen in the left breast. Axillae: No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with right-sided weakness. Evaluate for stroke. Numerous patchy areas of restricted diffusion are seen within the left frontal lobe, corresponding to areas of hypoattenuation noted on prior CT. Also noted is a 13 mm region of restricted diffusion involving the left basal ganglia which likewise correlates to a lesion noted on prior CT.The affected regions above demonstrate corresponding T2 hyperintensity but there is no significant generalized mass effect. A single focus of susceptibility is noted within the left frontal lobe diffusion restricting region compatible with microscopic or petechial blood product. No significant intracranial hemorrhage is seen.The background brain demonstrates numerous scattered foci of white matter T2 hyperintensity which are not diffusion restricting and which likely correspond to chronic small vessel ischemic disease. No abnormal extra axial fluid collections are detected. The ventricles are normal in size and morphology.Motion artifact limits image quality of the MRA. No significant flow related signal is seen within the distal ICA, to the level of the communicating segment where some reconstitution of flow occurs. This is in agreement with findings noted on prior CTA. The left MCA vessels demonstrate reduced caliber when compared to those on the right, and in particular, the M2 branches of the superior division seem to be most conspicuously affected. The remaining intracranial vascular distributions are free of significant stenosis.

Output: 1.Patchy acute ischemia involving the left frontal lobe and left basal ganglia.2.Findings are likely related to complete or near complete occlusion of the left ICA with associated attenuation of some of the left MCA branch vessels.3.No evidence of significant hemorrhagic conversion is seen. Findings compatible with chronic microvascular ischemic disease are demonstrated.


Instruction: Generate impression based on findings.

Input: 19 years, Female, Chiari malformation status post decompression surgery in 2012. Headache, neck pain and dizziness. There are postsurgical changes of remote suboccipital craniectomy and posterior arch of C1 resection for Chiari malformation. There is preservation of the CSF spaces and preservation of biphasic flow ventrally and dorsally at the foramen magnum. Susceptibility artifact is seen related to the prior surgery. Remainder of the brain parenchyma is unremarkable. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Postoperative changes related to Chiari decompression with preservation of the CSF spaces and CSF flow ventrally and dorsally at the foramen magnum. Remainder of the brain parenchyma appears unremarkable.


Instruction: Generate impression based on findings.

Input: 3-D T1 images are slightly degraded by artifact.There is an elongated appearance of the head shape in the AP dimension, which relates to scaphocephaly from premature fusion of the sagittal suture. Mild prominence of the ventricles and subarachnoid space anteriorly bilaterally. Questioned mild delay of myelination in the frontal and temporal lobes, provided corrected age.Stable cavum septum pellucidum. Basal cisterns are patent. No midline shift or mass effect. There is no diffusion abnormality, acute hemorrhage, or abnormal enhancement. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: No focal abnormality. Mild prominence of anterior subarachnoid spaces and ventricles likely relates to benign external hydrocephalus of infancy, which usually resolves by two years of age. Follow-up imaging may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: History of surgical excision of a benign papilloma the left breast in June 2009. History of benign biopsy of the right breast. Family history of breast cancer in her mother at age 49. There is scattered fibroglandular tissue in both breasts, more prominent than prior studies.Moderate parenchymal enhancement is noted bilaterally.Multiple enhancing foci are present in both breast, likely parenchymal enhancement. One small enhancing mass (6 x 4 x 4 mm) is seen in the lower outer left breast. Kinetics of this mass is slow initial uptake and persistent pattern, suggesting benign etiology.No abnormal lymph nodes are identified in either axillary region.

Output: Benign appearing small mass in the left breast at lower outer quadrant. Short term MRI follow up in 6 months is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: 80-year-old female patient with right hip pain x3 days after bone marrow biopsy. There is diffuse heterogeneity of the bone marrow with decreased T1 signal intensity compatible with cellular replacement of marrow. There is increased signal intensity about the inferior right sacroiliac joint. Although there is no associated linear T1 signal abnormality, there is concern for insufficiency fracture given patient's history and appearance on STIR imaging. Moderate osteoarthritis affects the bilateral hip joints.

Output: Findings concerning for right sacroiliac joint insufficiency fracture. Bone marrow replacement and heterogeneity as described above.


Instruction: Generate impression based on findings.

Input: Metastatic medullary thyroid cancer with questionable CT findings. There is a homogeneously enhancing dural-based mass along the lateral aspect of the left posterior fossa, which measures up to 20 mm. There is mild mass effect upon the left cerebellar hemisphere, but no evidence of associated edema. There is no evidence of intracranial hemorrhage or acute infarct. There is a subcentimeter focus of encephalomalacia in the left caudate. There is no abnormal intraparenchymal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A dural-based mass along the lateral aspect of the left posterior fossa that measures up to 20 mm likely represents a meningioma versus less likely a dural metastasis.2. No evidence of intraparenchymal brain metastases. 2. Chronic left caudate lacunar infarct.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with pain and weakness. Evaluate for spinal cord process. Cervical:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen.Within the limitations of mild motion artifact, no convincing cord signal abnormality is detected. No pathologic epidural process is suspected.The spinal canal is congenitally slender without significant superimposed disc degeneration, focal canal narrowing or compromise of the neural foramina.Thoracic:The thoracic kyphosis is mildly exaggerated, but sagittal alignment is otherwise within normal limits. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen.No definite spinal cord signal abnormality is detected. No epidural abnormality is suspected.The intervertebral discs are preserved with no significant bulging or herniation. The spinal canal and neural foramina remain patent.There may be a small left pleural effusion.

Output: 1.No significant spinal cord abnormality is detected.2.The spinal canal and neural foramina remain patent.3.Possible small left pleural effusion.


Instruction: Generate impression based on findings.

Input: History of pancreatic cancer, depression with flat affect. Evaluate for metastatic disease. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. There is evidence of prior small left cerebellar infarct. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial metastatic disease.2. Minimal global parenchymal volume loss, which appears within normal limits for age.3. Small chronic left cerebellar infarct. 4. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma, known T9 compression fracture: back pain. There is a heterogenous tumor in the T9 vertebral body that measures up to 25 mm. There is up to 40% loss of height of the T9 vertebral body centrally, which may be due to a combination of pathological fracture and underlying intravertebral disc herniation, which is otherwise apparent at multiple other levels of the thoracic spine. There is no retropulsion of tumor into the spinal canal. There is no spondylolisthesis. The spinal cord appears to be intact. There is a partially imaged bulky right hilar mass.

Output: 1. A metastasis n the T9 vertebral body measures up to 25 mm. There is up to 40% loss of height of the T9 vertebral body centrally, which may be due to a combination of pathological fracture and underlying intravertebral disc herniation, which is otherwise apparent at multiple other levels of the thoracic spine.2. A partially imaged right hilar metastatic disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Compression of brain Unspecified visual disturbance LumbagoClinical question: Chiari malformation, vision changes, new symptoms, evaluate for changes/ please do with cSF flow studySigns and Symptoms: Chiari, vision changes, back pain, spine survey MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils are low lying extending approximately 2 or 3 mm below the level of foramen magnum. There is biphasic flow at the level of the foramen magnum. Incidental note is made of partial empty sella.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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. 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.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is some disc desiccation at this level associated with a disc bulge and some narrowing of the neural foramina bilaterally. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this levelAt 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.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are couple minor disc bulge is present in the thoracic spineLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk dessication present at this level. There is a small disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a disc bulge present at C5-6 associated with some encroachment of the exiting nerve roots within the neural foramina.2.The cerebellar tonsils are low-lying. There is no evidence for ventriculomegaly or syrinx appreciated3.There are mild degenerative changes present in the thoracic and lumbar spine.


Instruction: Generate impression based on findings.

Input: 54-year-old male with right elbow pain. LIGAMENTS: The ulnar collateral ligament appears intact within the limitations of a non arthrogram study. The radial collateral ligament appears intact. TENDONS: There is an ossicle within the common extensor tendon as seen on prior radiographs. There is increased signal intensity within the tendon surrounding this ossicle indicating degeneration and/or partial thickness tearing of the tendon, which appears to have progressed when compared to the prior study. There is minimal increased signal intensity within the origin of the common flexor tendon, which may reflect a mild tendinosis, but is of questionable significance. The triceps tendon appears intact. The biceps and brachialis tendons appear intact.ARTICULAR SURFACES AND BONE: There are tiny osteophytes indicating mild osteoarthritis. There is a small amount of fluid within the elbow but no large effusion. We see no focal osteochondral defects.SURROUNDING STRUCTURES: Markers were placed along the posterior aspect of the elbow. There are numerous foci of signal void along the posterior soft tissues of the elbow presumably representing prior surgery with band-like signal coursing through the subcutaneous fat perhaps representing scarring. The signal intensity of the musculature of the elbow is normal. There is mild increased signal intensity within the ulnar nerve proximal to the cubital tunnel, which could represent a mild neuritis, but the clinical significance of this finding is uncertain.

Output: 1. Increased signal intensity within the common extensor tendon at its origin, surrounding an ossicle, indicating degeneration and perhaps partial thickness tearing that is more prominent on the current study than on the prior examination.2. Slight increased signal intensity within the ulnar nerve proximal to the cubital tunnel may represent a mild neuritis, but this is equivocal. We see no findings to suggest impingement of the nerve.3. Foci of metallic susceptibility artifact in the posterior soft tissues of the elbow presumably represent prior surgery.


Instruction: Generate impression based on findings.

Input: BRAIN: There are postoperative findings related to suboccipital craniectomy cranioplasty for resection of a posterior fossa mass. There is no evidence of residual enhancing tumor, however, there is an anteromedial nonenhancing nodular focus of T2 hyperintensity on the right that measures 11 x 7 mm, previously 7 x 7 mm. There is an unchanged prominent extra axial CSF space along the left cerebellar hemisphere. The ventriculostomy catheter has been removed and the ventricles are decreased in size. For example, the lateral ventricles measure 36 mm in transverse dimension, previously 42 mm and the third ventricle measures 6 mm is in transverse dimension, previously 9 mm. There is no evidence of acute infarct. The myelination pattern is appropriate for age. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. 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 with the conus terminating at L2. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable.

Output: 1.Postoperative findings related to posterior fossa tumor resection without evidence of residual enhancing tumor, however, a non-enhancing nodular focus of T2 hyperintensity along the right anteromedial resection margin has grown slightly. While non-specific and possibly treatment related, this raises concern for tumor progression and close attention on follow-up imaging is suggested. 2.No evidence of intracranial or spinal metastases.


Instruction: Generate impression based on findings.

Input: Altered mental status. Evaluate for brain edema or midline shift. A small focus of increased density in the right cerebellar hemisphere is unchanged from the prior CT. Please note that the previously described small enhancing lesions seen on the prior MRI are not visualized on this noncontrast head CT. There is no evidence of intracranial hemorrhage, mass, edema, or midline shift. 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: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: There is persistent marked dilatation of the lateral ventricles with absence of septum pellucidum. There is a VP shunt tube with right parietal approach and positioning of the distal tip to the right of the midline at the level of the lateral ventricles. There is a subdural catheter with the right hemispheric subdural space. Both above catheters are unchanged. The ventricular size has decreased from 12 cm transfrontal diameter on the previous study to 9.1 cm ion the current study with interval expansion of the brain parenchyma. As before, the cerebral aqueduct is not well visualized. There is a low lying leftward cerebellar tonsil extending 1.4 cm below the foramen magnum. The cerebellum is dysmorphic with partial rhombencephalosynapsis. The superior cerebellum herniates through the cerebellar incisura, which is more prominent than on the previous study, likely indicating interval growth of parenchyma. There is minimal detectable CSF flow around the cerebellum and across the foramen magnum on cine flow imaging.

Output: 1. Interval improvement in the degree of ventriculomegaly with concomitant expansion or growth of the brain parenchyma. Stable positioning of the ventricular and subdural catheters.2. Low lying cerebellar tonsil with partial rhombencephalosynapsis. The superior cerebellum herniates through the cerebellar incisura, which is more prominent than on the previous study, likely indicating parenchymal growth.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, history of grade 2 oligodendroglioma, status post RT and now status post cyclecycle #4 of PCV. Again seen is expansile T2/FLAIR hyperintensity involving the left temporal lobe including the left middle and inferior temporal gyri as well as the fusiform gyrus consistent with known tumor. Gyriform susceptibility effect within the lesion correlates to calcification noted on prior CT. Small focal area of enhancement within this lesion also remains unchanged. Sequelae of prior lesion biopsy are also again demonstrated. Focus of FLAIR hyperintensity in the left posterior frontal corona radiata is slightly more prominent and may represent posttreatment change.A subcentimeter nonenhancing focus of T2 hyperintensity within the right superior cerebellum is unchanged. No new or concerning parenchymal lesions are seen. No significant generalized mass effect is observed. The ventricles remain normal in size and morphologyy.

Output: 1.Compared to 4/1/2015 and 1/20/2016, there is no evidence of progression of the left temporal lobe oligodendroglioma. Increase in prominence of FLAIR hyperintensity in the left posterior frontal corona radiata may represent posttreatment change.2.Subcentimeter focus of T2 hyperintensity involving the right cerebellum remains unchanged since 5/9/2015. This lesion is nonspecific and may represent prior infarct, although can be further assessed on future follow-up studies.


Instruction: Generate impression based on findings.

Input: 75-year-old female with jaundice ABDOMEN:LIVER, BILIARY TRACT: Innumerable lesions scattered throughout the liver highly suspicious for metastatic disease.Marked intrahepatic biliary ductal dilatation leading up to the Klatskin point. A mass at the Klatskin point extends into the common bile duct as well as infiltrates into the liver parenchyma. The common bile duct does not opacify.Enlarged periportal lymph node measuring 12 mm (series 11, image 341).The hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nonenhancing fluid intensity left adrenal lesion may represent a cyst.KIDNEYS, URETERS: Left interpolar and inferior pole renal cyst. Additional subcentimeter T2 hyperintense lesions are likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate hiatal hernia. Colonic diverticulosis without evidence of diverticulitis. No peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mass invading the Klatskin point and common bile duct with intrahepatic extension and extension into the common bile duct. Innumerable lesions scattered throughout the liver are highly suspicious for metastatic disease. Findings are most concerning for cholangiocarcinoma.Findings discussed with Dr. Choi at 1704 on 7/14/16.


Instruction: Generate impression based on findings.

Input: Esophageal cancer. There is slight interval decrease in size of the mass in the left temporo-occipital region, now measuring up to 21 mm, previously 23 mm. Likewise, there is significant change in size of the left frontal lobe lesion, now measuring up to 14 mm, previously 14 mm, although the extent of surrounding vasogenic edema has increased. In addition, the right frontal lobe lesion is not discernible. There is no evidence of acute intracranial hemorrhage or acute territorial infarct. 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 skull, orbits, and scalp soft tissues are unremarkable. However, there is persistent fluid within the bilateral middle ears and mastoid air cells and mild scattered paranasal sinus mucosal thickening.

Output: 1. Slight interval decrease in size of the temporo-occipital region, but no significant interval change in size of the left frontal lobe lesion, although the associated vasogenic edema has increased. The right frontal lobe lesion is not discernible.2. Persistent nonspecific effusions within the bilateral middle ears and mastoid air cells, which may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: CC and type III, follow-up. Multiple bihemispheric variable sized signal voids lesions including left side medulla lesion on gradient echo scans indicating multifocal variable sized cavernoma. The size, number and MR characteristics do not show any significant interval change since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal bihemispheric scattered supratentorial and infratentorial cavernomas, no change since prior scan.No evidence of acute ischemic or hemorrhagic lesion on the scan.


Instruction: Generate impression based on findings.

Input: 51-year-old male with a sacral lesion. There is a 7 mm small focus with lobulated margins within the posterior aspect of the S4 vertebral body which is low signal intensity in T1-weighted images and high signal intensity on T2-weighted images. There is minimal if any enhancement following contrast administration. This may represent a benign notochordal remnant or perhaps a small cartilaginous rest based on its lobulated contours. There is also low signal intensity within the right sacral wing adjacent to the sacroiliac joint that shows enhancement following gadolinium administration. We suspect that this is degenerative in etiology, based on its proximity to the sacroiliac joint. There also appears to be low signal intensity along the iliac margin of the joint compatible with sclerosis. There is an additional small focus of signal abnormality and enhancement more posteriorly within the ilium, along the sacroiliac joint, which is also likely degenerative in etiology. Facet joint osteoarthritis affects the lower lumbar spine. Degenerative disc disease affects the lower lumbar spine.

Output: 1. Small lobulated focus of signal abnormality in the S4 vertebral body may represent a benign notochordal remnant or a small cartilaginous rest.2. Foci of signal abnormality along the right sacroiliac joint are likely degenerative in etiology.3. Degenerative disc disease and facet joint osteoarthritis of the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: 12-year-old male with tuberous sclerosis. Redemonstrated is an enhancing mass in the region of the right foramen of Monro, which measures up to 32 mm. In AP dimension, unchanged There is no significant change in the numerous bilateral lateral ventricular subependymal nodules and appearance of the ventricular system. Likewise, the numerous scattered cortical and subcortical tubers appear unchanged. There is no evidence of acute infarction or hemorrhage. The cerebral flow voids are grossly unremarkable. Previously demonstrated bilateral mastoid effusions have significantly improved. The skull and orbits appear unchanged.

Output: No significant interval change in the subependymal giant cell astrocytoma and other intracranial stigmata of tuberous sclerosis complex.


Instruction: Generate impression based on findings.

Input: Sagittal images are diagnostic although axial images are motion degraded. Given this caveat:There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no MRI evidence of ligamentous injury. There are no stenoses.

Output: 1.Sagittal images are diagnostic although axial images are motion degraded.2.No MRI evidence of spinal cord or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Reason: please include proximal femur soft tissue sarcoma History: new onset of pain Note is made of increased signal abnormality on fluid sensitive sequences along the posterior aspect of the left hip and thigh abutting the medial aspect of the hamstring musculature and vastus lateralis. There is minimal, if any, enhancement on postcontrast sequences, however, no nodular or masslike enhancement is seen. No focal masses are identified. Skin markers overlie the posterior aspect of the thigh, presumably corresponding to the patient's surgical scar. There is diffuse mild fatty infiltration of the imaged musculature of the left hip and thigh. There are multiple foci of metallic susceptibility artifact within the soft tissues along the posterior aspect of the thigh, presumably postsurgical in etiology. There is linear decreased signal abnormality within the subcutaneous tissue along the posterior aspect of the thigh likely representing postsurgical scarring. No bone marrow signal abnormality is identified. There is a small amount of fluid within the left hip which is likely of no clinical significance.

Output: Minimally enhancing signal abnormality within the soft tissues along the posterior aspect of the left hip and thigh likely representing postsurgical change/granulation tissue. While no masslike enhancement is identified to suggest residual or recurrent disease, follow-up examination is recommended to evaluate for interval change, particularly given the lack of prior examinations for comparison.


Instruction: Generate impression based on findings.

Input: GH deficiency on insulin tolerance test: tiredness. There is no evidence of pituitary or parasellar lesions. The pituitary gland is not enlarged. The infundibulum is intact. There is no mass effect upon the optic apparatus or cavernous sinuses.

Output: No evidence of pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: Shoulder pain, cyst The examination is significantly limited by motion artifact.ROTATOR CUFF: There is a full-thickness tear of the distal anterior fibers of the supraspinatus. This is superimposed upon diffuse tendinopathy of the supra and infraspinatus tendons. The teres minor tendon is intact. There is mild tendinopathy of the superior fibers of the subscapularis although there is no evidence of full-thickness tear.SUPRASPINATUS OUTLET: Severe osteoarthritis affects the acromioclavicular joint. A large multiseptated cystic lesion is seen arising from the acromioclavicular joint which is significantly increased from the prior exam. The mass measures approximately 3.7 x 3.1 cm in the greatest craniocaudal and transverse dimensions. Following gadolinium administration, there is no central or solid enhancement. A small amount of fluid containing a calcified body is noted within the subacromial recess.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint. There is degenerative tearing of the anterior and superior labrum.BICEPS TENDON: Evaluation of the biceps tendon is markedly limited due to motion artifact however the intra-articular portion is not well seen which may relate to partial tearing.

Output: 1. Markedly limited exam due to motion artifact.2. Cystic mass arising from the acromioclavicular joint likely represents a degenerative cyst (Geyser phenomenon).3. Small full-thickness tear of the supraspinatus tendon with other findings described.


Instruction: Generate impression based on findings.

Input: Headache, retroorbital pain/pressure in right eye, diplopia, and decreased visual acuity. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: The bilateral globes and optic nerves are intact. The lacrimal glands, extraocular muscles, orbits fat, and vessels are unremarkable bilaterally. There is no evidence of intraorbital mass lesions.

Output: Unremarkable brain and orbits.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Avantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Avantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. The patient was sedated (conscious sedation) during the procedure. Visualase transperineal template was used to localize the lesion in the left apical peripheral zone of the prostate at the site of the T2 hypointense lesion. Using the Visualase transperineal template, an 18-gauge MR- compatible needle was inserted into the left apex of the prostate. Upon confirmation of the tip of the needle close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and four cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the left apical peripheral zone lesion.


Instruction: Generate impression based on findings.

Input: Chiari decompression with syrinx. Brain: There are postoperative findings related to Chiari decompression. There is intact cerebrospinal fluid flow across the anterior neo-foramen magnum, but it is diminished posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.Cervical Spine: There is a persistent cervical syrinx that extends from C3-4 to C6-7 and measures up to 6 mm in diameter. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Findings related to Chiari decompression with diminished cerebrospinal fluid flow across the posterior neo-foramen magnum.2. Persistent cervical syrinx.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is complex tearing the medial meniscus involving the body and posterior horn with both horizontal and vertical components. There is increased intrasubstance signal within the lateral meniscus reflecting degeneration but there is no discrete lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There is moderate to severe degeneration of the articular cartilage of the medial compartment with full-thickness cartilage loss along the medial femoral condyle above the posterior horn of the medial meniscus with small underlying subchondral cysts. There is moderate degeneration of the articular cartilage of the patella particularly along the lateral facet which is also associated with small subchondral cysts. There is relatively mild degeneration of the articular cartilage of the lateral compartment with focal heterogeneity above the posterior horn of the lateral meniscus. There are small tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There are prominent enthesophytes arising from the patella at the attachment of both the patellar and quadriceps tendons. There is thickening of the distal quadriceps tendon with associated ossification indicating chronic degenerative tendinosis. ADDITIONAL

Output: Complex tear of the medial meniscus with osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: pain in the left knee, concern for ACL injury MENISCI: There is truncation of the posterior horn of the lateral meniscus with abnormal linear intermediate signal intensity, consistent with a predominantly radial tear. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There are no focal defects in the articular cartilage. There is extensive T2 hyperintense signal within the posterolateral and posteromedial tibial plateau and lateral femoral condyle, consistent with bone marrow edema/contusion. There is slight depression of the lateral femoral condyle with associated bone marrow edema.LIGAMENTS: There is complete disruption of the fibers of the anterior cruciate ligament with abnormal globular intermediate signal, consistent with complete tear. The PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: 1. Complete ACL tear.2. Radial tear through the posterior horn of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. 31-year-old female with history of osteosarcoma and leukemia with chest radiation. Family history of breast cancer in 2 maternal aunts in their 50s. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C). Stable 5 mm benign morphology mass within the left central medial breast, when comparing it with MRI study of 6/14/2016.No suspicious masses, microcalcifications or areas of architectural distortion are present.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Lung cancer with brain metastases status post treatment. There is interval decrease in size of the numerous supratentorial and infratentorial ring-enhancing lesions, many of which contain susceptibility effect suggestive of chronic hemorrhage. For example, a right precentral gyrus lesion measures up to 12 mm, previously 16 mm and a left posterior midbrain lesion measures up to 8 mm, previously 11 mm. The vasogenic edema associated with the lesions has also diminished. There are unchanged multiple enhancing lesions in the skull, the largest of which measure up to approximately 10 mm. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small left maxillary sinus retention cyst. There is an unchanged nonspecific punctate nodule in the left frontal scalp. There is mild mucosal thickening and/or fluid within the right mastoid air cells.

Output: 1. Interval decrease in size of the numerous intracranial metastases and associated vasogenic edema.2. Unchanged skull metastases.3. Unchanged mildly low-lying cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: Male 69 years old Reason: R/O HCC History: Hx of HCV; ? HBV LIVER: Liver measures 14 cm. There is a calcified lesion in the liver measuring 1.3 x 0.9 cm. Because of the shadowing from the calcifications this lesion cannot be optimally evaluated. MRI of the liver may be helpful for further evaluation. There is a simple cyst at the dome of the liver. Mildly coarse echotexture of the liver without sonographic evidence of cirrhosis.BILIARY TRACT: No evidence of cholelithiasis or biliary dilatation.PANCREAS: Not visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 8.9 cm. RIGHT KIDNEY: Right kidney measures 10.1 cm. Left kidney measures 8.8 cm. No focal lesions or hydronephrosis. Both kidneys are slightly echogenic. OTHER: No significant abnormalities noted.

Output: A focal area of calcification within the liver. Due to shadowing from the calcifications this lesion/area cannot be optimally evaluated. MRI of liver may be helpful for further evaluation.


Instruction: Generate impression based on findings.

Input: Personal history of other disorders of nervous system and sense organs [V12.49] / Disturbance of skin sensation [782.0] / Other musculoskeletal symptoms referable to limbs(729.89) [729.89], Reason for Study: ^Reason: r/o stroke/mass lesion There is no evidence of acute ischemic or hemorrhagic lesion.On gadolinium enhanced scan, there is a prominent right posterior sylvian vein which is connected to the the left hemispheric parietal vein without evidence of vascular tingling or increased vascularity indicating most likely normal variation.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI scan.


Instruction: Generate impression based on findings.

Input: 67 year-old female with confusion. There is no evidence of intracranial hemorrhage, mass or edema. Confluent periventricular and subcortical areas of hypoattenuation are consistent with chronic small vessel ischemic disease, which was present on 2010 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.Atherosclerotic calcifications in both internal carotid arteries.

Output: 1.No acute intracranial abnormality. However, CT is not sensitive in detecting acute ischemic change and MRI is recommended if clinical suspicion for nonhemorrhagic stroke persists.2.Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 62-year-old male with metastatic prostate cancer and known thoracic involvement. Rule-out cord compression. Exam limited by motion.Within these limitations, the vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. There is diffuse abnormal bone marrow signal intensity throughout the spine and there is involvement of the vertebral bodies and pedicles. There is evidence of extra-osseous spread, worse from T3 to T8 which causes spinal canal narrowing and is described in more detail on the accompanying same day dedicated thoracic spine MRI.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Diffuse spinal osseous metastases and extraosseous spread, most severe in the thoracic spine, which is more fully characterized on the accompanying dedicated thoracic MRI.


Instruction: Generate impression based on findings.

Input: Right parotid mass. There is a well-defined, bosselated, T2 hyperintense, heterogeneously enhancing mass in the superficial portion of the right parotid gland that measures 19 AP x 14 RL x 31 SI mm. The mass appears to be situated inferior to the main trunk of the right intraparotid facial nerve. The other major salivary glands are unremarkable. There is no evidence of significant lymphadenopathy in the neck. There are left thyroid nodules that measure up to 12 mm. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: 1. A right parotid gland tumor that measures up to 31 mm likely represents a Warthin tumor or perhaps a pleomorphic adenoma. The tumor does not have mass-effect upon the main trunk of the intraparotid facial nerve.2. Nonspecific left thyroid nodules measuring up to 12 mm. Follow up via thyroid ultrasound may be useful.


Instruction: Generate impression based on findings.

Input: History of sella mass: please evaluate for any interval change. There is a homogeneously enhancing mass within an expanded sella, which measures 16 AP x 15 RL x 14 SI mm, which is not significantly changed. There is no significant encroachment upon the cavernous sinuses and there is no mass effect upon the optic apparatus. The pituitary stalk is intact and situated in the midline. However, the posterior pituitary bright spot is not evident. The imaged portions of the brain are unchanged. The imaged portions of the sinonasal cavities are grossly unremarkable.

Output: No significant interval change in the sella mass, which likely represents a macroadenoma.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with left-sided weakness and facial droop. A solidly enhancing mass centered on the right cerebral peduncle and midbrain has increased in size now measuring 22 x 17 mm axial plane, previously 12 x 12 mm. The lesion contains some internal susceptibility likely related to petechial blood product.Edema related to this lesion has progressed as well and now spreads from the internal capsule down to the pons. The cerebral aqueduct appears to be narrowed but at present remains patent.No additional enhancing lesions are seen. No other areas of significant parenchymal signal abnormality, edema or mass effect are observed. There are no abnormal extra-axial fluid collections. The ventricles remain normal in caliber and morphology.

Output: Interval increase in size of a tumor centered on the right cerebral peduncle and midbrain.


Instruction: Generate impression based on findings.

Input: MRA HEAD: There is a rounded focus of signal loss in the location of the previously described distal right ICA aneurysm, which is consistent with the known coil mass. There is a linear area of flow related enhancement just medial to the coil mass, which is favored to represent a previously seen tiny vein. There is no definite flow-related enhancement within the coil mass itself. There is slightly decreased flow related enhancement within the cavernous portion of the right internal carotid artery, which is likely related to previous stent placement upon angiographic image review.The left internal carotid and bilateral middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of aneurysm. There is an area of encephalomalacia in the left frontal lobe, which corresponds to the patient's evolved prior hematoma. Lumbar Spine: The spinal cord terminates abnormally low, with the conus medullaris located just above the level of the inferior endplate of the L3 vertebral body. There is no evidence of a fatty filum terminale. There is no cord signal abnormality. For the purposes of numbering, there are 5 lumbar-type vertebral bodies. The vertebral body and intervertebral disc space heights are well-preserved. There is a diffusely heterogeneous appearance of the bone marrow with overall low signal, which is nonspecific but may be the result of sclerosis. There are multilevel degenerative changes as detailed below. T11-T12: There is thickening of the ligamentum flavum with mild central spinal canal stenosis. There is no significant neuroforaminal stenosis at this level.T12-L1: There is no significant central spinal canal or neuroforaminal stenosis.L1-L2: There is no significant central spinal canal or neuroforaminal stenosis.L2-L3: There is no significant central spinal canal or neuroforaminal stenosis.L3-4: There is no significant central spinal canal stenosis. There is shallow right foraminal disc protrusion with mild right neuroforaminal stenosis. There is no significant left neuroforaminal stenosis.L4-L5: There is approximately 6 mm of anterolisthesis of L4 on L5 with uncovering of the disc at this level. There is mild central spinal canal stenosis and compression of the thecal sac. There is facet hypertrophy and mild ligamentum flavum thickening with moderate bilateral neural foraminal stenosis. L5-S1: There is facet hypertrophy with moderate to severe left neural foraminal and moderate right neuroforaminal stenosis. There is no significant central spinal canal stenosis. There are no definite osseous changes to suggest prior surgery at this level, however, the left ligamentum flavum appears somewhat attenuated which could be postoperative.A right renal and liver cysts are incidentally noted, which appear similar to the prior CT abdomen dated 7/29/2014.

Output: 1. Findings of prior coil embolization of a distal right ICA aneurysm without evidence of complication. No new aneurysms are seen. 2. Heterogeneous bone marrow with diffuse low signal is non-specific but may represent sclerosis such as due to renal osteodystrophy, or a diffuse infiltrating process. If clinically indicated, a bone scan may be obtained for further evaluation. 3. Multilevel degenerative changes of the lumbar spine, most pronounced at L4-5 and L5-S1 as detailed above.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, status post fall, hit occiput, with headaches, vertigo and altered thinking. Assess for subdural. Numerous scattered foci of T2 hyperintensity are seen within the periventricular and subcortical white matter bilaterally. No restricted diffusion is demonstrated. No parenchymal edema or mass effect is observed. The pattern of intracranial enhancement is within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The left vertebral artery is small, likely a normal anatomic variation. Bone marrow signal characteristics are within normal limits.

Output: 1. Numerous scattered small white matter lesions are identified in the cerebral hemispheres. The differential for this is broad and would include chronic microvascular ischemic disease, sequelae of prior demyelination, gliosis, vasculitis or migrainous headache, among others.2. No acute intracranial abnormality and no additional findings which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 49-year-old female with left elbow decreased range of motion. Evaluate for tendon tear. LIGAMENTS: No significant abnormality noted.TENDONS: The triceps tendon appears normal. The biceps tendon appears normal. The flexor and extensor compartment tendons at the elbow appear normal.ARTICULAR SURFACES AND BONE: Articular cartilage appears normal. Bone marrow signal intensity appears normal.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Small joint effusion about the elbow. Otherwise unremarkable MRI study of the left elbow.


Instruction: Generate impression based on findings.

Input: Compression of brain [G93.5], Reason for Study: ^Reason: chiari malformation, headaches, orbit hemangioma, yearly follow up , please do with csf flow studay History: headaches, chiari46 years Female (DOB:3/29/1970)Reason: chiari malformation, headaches, orbit hemangioma, yearly follow up , please do with csf flow studay History: headaches, chiariPROVIDER/ATTENDING NAME: DAVID M. FRIM SERVICES ANCILLARY MRI BRAINExamination demonstrates postoperative change status post suboccipital craniectomy for Chiari decompression. There is downward herniation of the pointed cerebellar tonsils with resultant effacement of the CSF spaces at the craniocervical junction. CINE phase contrast CSF flow sequence shows maintained bidirectional CSF flow on the anterior aspect of the foramen magnum but not obvious on the posterior aspect. Comparing to prior scan, these findings have not been changed.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection, hemorrhage, or restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.MRI C-SPINEThere is no evidence of syrinx.Spinal cord signal intensity appears to be normal.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. At the level of C34 and C45, there are diffuse bulging of disc which abut thecal sac, no spinal canal stenosis is seen.At the level of C56, there is broad based central to left disc protrusion which indents thecal sac with minimal to mild left lateral recess stenosis.Above described disc diseases have not shown any interval change since prior scan.

Output: 1. Postoperative status of known Chiari malformation, no unusual finding.2. Normal spinal cord signal intensity, in particular, no evidence of syrinx.3. Disc herniation at the level of C56 central to left, unchanged.


Instruction: Generate impression based on findings.

Input: 42 years Female (DOB:8/7/1973)Reason: history of cns vasculitis, eval for changes History: history cns vasculitisPROVIDER/ATTENDING NAME: JAMES J CURRAN JAMES J CURRAN There is encephalomalacia present along the right some central lobule extending to the adjacent pre and postcentral gyri and right inferior parietal lobule and posterior aspect of the right superior temporal gyrus. There are associated signal changes in the adjacent right superior parietal lobule and right middle frontal gyrus. There is associated ex vacuo effect along the right lateral ventricle. There is some associated gyriform susceptibility effect present.A small focus of encephalomalacia is present along the left parietal lobe in a watershed zone just behind the postcentral sulcus. There are patchy foci of T2 and FLAIR signal hyperintensity left middle frontal gyrus.There is atrophy of the right cerebral peduncle. There are findings suggestive of Wallerian degeneration.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Encephalomalacia along the right middle cerebral artery distribution associated with Wallerian degeneration.2.Small foci of encephalomalacia in the left parietal lobe and patchy lesions in the left middle frontal gyrus which are probably related to prior vascular events.


Instruction: Generate impression based on findings.

Input: 60-year-old male with a history of HCV and cirrhosis. Rule out HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No focal mass lesions are identified. No intra-or extrahepatic biliary ductal dilation. There is a focus of enhancement along the periphery of the dome of the liver which does not demonstrate washout and likely represents edge artifact versus a perfusion anomaly.SPLEEN: Splenomegaly. Note is made of perisplenic varices suggestive of portal hypertension.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.Cirrhotic liver morphology without evidence of focal mass lesion, as clinically questioned.2.Findings suggestive of portal hypertension.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of other parts of nervous systemClinical question: eval grade II astrocytoma.Signs and Symptoms: grade II astrocytoma.Comments: Grade II astrocytoma s/p bx and RT. Now on TMZ. | Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The marrow signal is hyperintense on T1 suggestive of prior radiation treatment. Patient is status post cervical spine surgery with laminectomies at C5 and C6.There is a T2 hyperintense mass within the spinal cord extending from the C3-4 disc space level down to the C7 vertebral body level measuring 46 x 11 mm in sagittal dimensions which is eccentric towards the right hemicord. It previously measured 44 x 10 mm in sagittal dimensions. Greatest axial dimensions at the C5-6 level are currently 15 x 12 mm and previously were 14 x 11 mm.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.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.MRI thoracic spine:There is redemonstration of a T2 hyperintense mass within the thoracic spinal cord centered within the left hemicord measuring approximately 109 mm in length which extends from the T2-3 level to the T8 vertebral level. It previously measured similar length. It measures 11 x 9 mm in greatest axial dimensions at the T4-5 level and has not changed since the prior exam.The thoracic vertebral bodies are appropriate in the overall alignment and height. There are marrow signal changes present along the posterior aspect of the thoracic vertebral bodies with hyperintense T1 signal.

Output: 1.The intra-axial thoracic spinal cord mass is stable compared to the prior exam. This is known to represent astrocytoma.2.There is slight increase in the size of the patient's cervical thoracic spinal cord intra-axial mass. This is known to represent astrocytoma.3.Status post cervical spine surgery4.Marrow signal changes in the visualized thoracic and cervical spinal cord is likely due to prior radiation treatment


Instruction: Generate impression based on findings.

Input: Reason: history of autoimmune hepatitis, hepatocellular carcinoma presents with pancreatitis History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with numerous T1 hyperintense nodular foci, suspicious for regenerative nodules (although corresponding T2 hypointense signal difficult to appreciate). There is a T2 hyperintense, hyperenhancing lesion within segment 5/8 which demonstrates avid arterial enhancement and associated washout as well as restricted diffusion, compatible with hepatocellular carcinoma with reference measurements below. There are 2 additional smaller hyperenhancing lesions within segment 7 which do not demonstrate definite washout or restricted diffusion. There is a subcentimeter T2 hyperintense structure in the hepatic dome which lacks enhancement and may reflect a cyst.The hepatic veins are diminutive. The portal vein appears patent.Cholelithiasis. There is mild diffuse gallbladder wall edema which is nonspecific in the setting of ascites.There is mild narrowing of the common hepatic duct just distal to the confluence which may be related to adjacent vessel or hepatic nodule without associated significant upstream dilation. The common bile duct is normal in caliber measuring up to 5 mm. No evidence of choledocholithiasis.SPLEEN: Splenomegaly.PANCREAS: There is diffuse pancreatic edema and mild enlargement as well as mild restricted diffusion which is compatible with acute pancreatitis. The pancreatic parenchyma enhances homogeneously without evidence of pancreatic necrosis. No loculated peripancreatic fluid collections are identified.The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. There are several punctate foci of susceptibility artifact in the distribution of the renal sinuses suggestive of nephrolithiasis. The renal parenchyma enhances homogeneously.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal pelvic ascites.INDEX LESION MEASUREMENTS (Current exam date/time: 9/6/2016 18:10:26)SEGMENT 5/8 HEPATIC LESION: 3.9 x 2.6 cm (Image 133, Series 13).SEGMENT 7 HEPATIC LESION, MORE POSTERIOR: 1.8 x 1.1 cm (Image 116, Series 13).SEGMENT 7 HEPATIC LESION, MORE ANTERIOR: 1.0 x 0.7 cm (Image 113, Series 13).

Output: 1.Nodular cirrhotic liver with sequela of portal hypertension.2.Hyperenhancing lesion with washout in hepatic segment 5/8 compatible with hepatocellular carcinoma.3.Two additional hyperenhancing hepatic lesions in segment 7 which lack washout and do not currently fulfill criteria for hepatocellular carcinoma but should be followed closely on subsequent examinations.4.Cholelithiasis and diffuse gallbladder wall thickening which is nonspecific in setting of mild abdominopelvic ascites.5.No evidence of choledocholithiasis or pancreatic duct dilation.


Instruction: Generate impression based on findings.

Input: 63 years, Female, right face and arm sensory alterations. Reports a brain hemorrhage in April 20, 2014, unknown etiology. Any sign of vascular malformation.. Compared to prior there is interval development of focus of susceptibility effect in the left thalamus with mild volume loss and consistent with chronic hemorrhage. No adjacent mass, abnormal enhancement, or abnormal flow voids. No additional foci of susceptibility effect are appreciated elsewhere in the brain. There is moderate burden of T2/FLAIR hyperintense lesions involving the bilateral periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. No restricted diffusion to suggest acute ischemia. No findings to suggest acute intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Evidence of chronic hemorrhage involving the left thalamus. No underlying mass, abnormal flow-voids, or abnormal enhancement is appreciated. Finding has developed in the interval when compared to 4/26/2013.2. Moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 60 year old male with right lower quadrant abdominal pain referred to testes. Rule out appendicitis. US exam negative for testicular torsion. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 1.9 cm diameter right upper pole renal cortical lesion appears uniloculated and may be a mass or atypical cyst. Contents measure approximately 60 HU. Further evaluation with non-contrast CT scan or dedicated renal MRI is recommended to distinguish a solid renal mass, if indicated. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Appendix is normal. BONES, SOFT TISSUES: Small gas bubble in right pubic symphysis may be due to osteoarthritis, seen best on axial image 125/142 and coronal image 66/131. OTHER: No significant abnormality noted

Output: No appendicitis. Small gas bubble in right pubic symphysis, may be due to osteoarthritis. Hyperdense 1.9 cm diameter right upper pole renal mass, may be further evaluated with non-contrast CT scan or dedicated renal MRI, if indicated.


Instruction: Generate impression based on findings.

Input: MRI CARD W/VASODILATOR STRESS WWO CNTRST, 11/13/2015 1:00 PM First Pass PerfusionDuring hyperemia, there was a perfusion defect noted in the inferior wall.Viability/ Myocardial ScarThere is late gadolinium enhancement noted in the basal inferolateral wall. The pattern is not typical of myocardial infarction and could be consistent with fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is mild to moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 35%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 245 ml (normal range 142+/-34), the LV end systolic volume index is 75 ml/m2 (normal range 25+/-9), the LVESV is 158 ml (normal range 47+/-19), the LV mass index is 62 g/m2, and the LV mass is 131 g. There is hypokinesis of the basal to mid inferoseptum, inferior and inferolateral walls. Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 170 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is mild to moderately dilated.Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe SOV measures 35mm. The ascending aorta measures 42mm. The aortic arch prior to the inominate artery is 38mm. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is moderate atherosclerosis of the descending thoracic aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is a small left pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a perfusion defect noted in the inferior wall.2. There is late gadolinium enhancement noted in the basal inferolateral wall. The pattern is not typical of myocardial infarction and could be consistent with fibrosis, inflammation, or infiltration. The entire myocardium is viable.3. The left ventricle is mild to moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 35%There is hypokinesis of the basal to mid inferoseptum, inferior and inferolateral walls.4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.5. Dilation of the ascending aorta (measurements as above).6. There is a small pericardial effusion. Consider transthoracic echo for further evaluation and follow up.7. Bi-atrial enlargement. 8. See extra cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: pain, hx of breast CA History: pain, hx of breast CA There is no marrow abnormality or abnormal enhancement to correspond to possible lesion seen on radiograph. No abnormal enhancement or other findings to suggest a metastatic lesion throughout the tibia or fibula. No evidence of acute fracture or malalignment. No gross abnormalities are seen about the knee or ankle. No abnormal soft tissue lesions seen.

Output: No evidence of metastatic disease or acute abnormality to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 70 years, Female, numbness and tingling in left arm, known early stage lung cancer. Also decrease in left hand grip. Brain: There is no intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the pons, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Examination is moderately motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. No suspicious enhancement is seen within the cervical spine. The cervical spinal cord has normal signal characteristics and overall morphology. Epidural mass in the thoracic spine with leftward displacement of the cord is better assessed on recent MRI from 2/13/2016.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex. No significant spinal canal stenosis. There is mild left neural foraminal stenosis related to uncovertebral hypertrophy.C5-6: Small disc osteophyte complex. No significant spinal canal stenosis. Mild bilateral neural foraminal narrowing.C6-7: Small disc osteophyte complex. No significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal narrowing.C7-T1: Small disc osteophyte complex No significant compromise to the spinal canal. Mild right and moderate left neural foraminal narrowing. There is linear increased enhancement/vascularity involving the epidural space and neural foramen on the left, and possibly related to the left-sided foraminal stenosis. No associated nodularity or thickening to suggest a neoplastic etiology.Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of intracranial metastatic disease.2. Mild to moderate chronic small vessel ischemic disease.3. Multilevel degenerative changes in the cervical spine which are suboptimally assessed due to motion degradation. There is however no significant spinal canal stenosis at any level or cord signal abnormality. There are varying degrees of mild to moderate neural foraminal narrowing which are detailed above. Linear enhancement/vascularity at the left C7-T1 level is most likely on a benign basis. No associated nodularity or thickening to suggest a neoplastic etiology.4. No evidence of metastasis to the cervical spine. Enhancing epidural mass involving the upper thoracic spine with leftward displacement of the cord is partially imaged and better assessed on recent thoracic MRI from 2/13/2016.