Instruction: Generate impression based on findings.

Input: 47-year-old female with low back pain, hand weakness, left arm numbness, leg weakness. Evaluate for stenosis, radiculopathy explaining hand weakness. CERVICAL SPINE: Alignment and vertebral body heights are maintained. Craniocervical junction is intact. No evidence of ligamentous injury. Marrow signal is benign. Spinal cord signal is within normal limits. No significant spinal canal or neural foraminal stenosis.LUMBAR 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. Marrow signal is benign; focal increased T1/T2 signal within L1 vertebral body likely a benign hemangioma. There are minimal degenerative changes with no acute fracture or subluxation. Minimal circumferential disc bulge at L3-4 and L4-5 noted with no significant neural foraminal or spinal canal stenosis.

Output: Minimal degenerative changes in the lumbar spine. No compromise to the cervical or lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 12-year-old female with right wrist pain. Evaluate for Salter Harris fracture of distal radius versus occult scaphoid fracture. Patient motion artifact limits examination.LIGAMENTS: Although this examination was not protocoled for detailed evaluation of the ligaments, there are no findings to suggest disruption of the scapholunate or lunotriquetral ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact within the limitations of a non arthrogram study.TENDONS: The flexor and extensor tendons appear intact. BONES: Note is made of linear decreased signal abnormality on T1-weighted images traversing the distal radial metaphysis consistent with a nondisplaced fracture. There is increased signal abnormality on fluid sensitive sequences consistent with bone marrow edema in the surrounding area. No additional fractures are identified. No additional bone marrow signal abnormality is seen. The scaphoid appears within normal limits as clinically questioned.ADDITIONAL

Output: Nondisplaced fracture of the distal radial metaphysis as described above.


Instruction: Generate impression based on findings.

Input: Neck pain, left cervical radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is minimal anterolisthesis of C3 on C4. Alignment is otherwise maintained. Small foci of T1 hyperintensity involving the C1, C2, and C4 vertebral bodies compatible with focal fat or hemangioma. Mild endplate changes on a degenerative basis are seen. No suspicious osseous lesions. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild diffuse congenital narrowing of the spinal canal. No evidence of high-grade stenosis or cord compression.Degenerative changes are seen in the cervical spine as described below:C2-3: There is facet arthropathy on the left with mild left neural foraminal stenosis. Mild ligamentum flavum thickening. No significant spinal canal or right neural foraminal narrowing. C3-4: There is bilateral uncovertebral hypertrophy resulting in moderate to severe right and moderate left neural foraminal stenosis. No significant spinal canal stenosis.C4-5: Minimal retrolisthesis and small disk osteophyte complex. There is bilateral uncovertebral hypertrophy resulting in moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis.C5-6: There is mild to moderate bilateral neural foraminal narrowing related to uncovertebral hypertrophy. No significant spinal canal stenosis.C6-7: There is mild bilateral neural foraminal narrowing. No significant spinal canal narrowing. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. There is mild diffuse congenital narrowing of the spinal canal on the basis of mild pedicle hypoplasia with mild superimposed degenerative changes. No high-grade spinal canal stenosis at any level or cord signal abnormality.2. There is neural foraminal narrowing bilaterally at multiple levels, particularly C3-C4, C4-C5, and C5-6, as detailed above .


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with multiple sclerosis, assess efficacy of current DMT. Multiple small T2 hyperintense and mildly T1 hypointense lesions are seen mostly clustered in the bilateral periventricular regions. As before, some of these lesions extend to the corpus callosum and are oriented radially relative to the ventricles. Accounting for differences in technique between scans, no clearly new or growing lesions are seen. However, one lesion in the right corona radiata has decreased in size (see image 50 series 801).One punctate focus of enhancement is seen within the right centrum semiovale (image 120 series 1201), unchanged from the prior exam. Elsewhere, no definite pathologic enhancement is seen. No edema or mass effect is observed. There are no abnormal extra-axial fluid collections. The ventricles are normal in size and morphology. Brain parenchymal volume is preserved.

Output: Multiple lesions are redemonstrated compatible with the diagnosis of multiple sclerosis. No definite new or growing lesions are observed. However, one rather prominent lesion on the prior examination in the right corona radiata has clearly decreased in size. One punctate focus of enhancement in the right centrum semiovale is unchanged and may simply represent a small vascular structure.


Instruction: Generate impression based on findings.

Input: New onset headache with syncope and weakness. 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.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 63-year-old female with a history of spinal stenosis and back pain with sciatica. Evaluate for spinal stenosis. The vertebral column alignment is within normal limits. There is mild loss of vertebral body height involving the superior endplate of L1 with evidence of Schmorl's nodes. There is variable disc height loss with disc desiccation involving the T12-L1, L4-5 and L5-S1 discs. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1: There is a mild disc bulge but no significant compromise to spinal canal or neural foramina.L1-L2: There is mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L2-L3: There is mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L3-L4: There is a left greater than right disc bulge and mild-moderate facet arthropathy with ligamentum flavum thickening which contributes to moderate spinal canal stenosis as well as mild right and moderate left neuroforaminal narrowing. There is also mild left and moderate right lateral recess stenosis. There is a small effusion involving the left L3-4 facet joint.L4-5: There is a disc bulge with a large left paracentral disc extrusion which along with facet arthropathy and ligamentum flavum thickening results in severe spinal canal stenosis and moderate bilateral neuroforaminal narrowing. There is also severe left and moderate to severe right lateral recess stenosis. L5-S1: There is a small disc bulge, facet arthropathy and ligamentum flavum thickening but no significant compromise of the spinal canal or neuroforamina.Incidentally seen left renal cystic lesions likely represent benign renal cysts.

Output: Multilevel spondylotic changes most prominent at the L4-5 level where a large left paracentral disc extrusion contributes to severe spinal canal stenosis, severe left and moderate-severe right lateral recess stenosis, and moderate bilateral neuroforaminal narrowing.


Instruction: Generate impression based on findings.

Input: 48-year-old male patient with history of two patellar dislocations in 2008 and 2011 as well as instability. Assess medial patellofemoral ligament, trochlear dysplasia, measure TT-TG. MENISCI: There is attenuation of the posterior horn and body of the medial meniscus, which could represent chronic attritional tearing or changes from partial meniscectomy. There is obliquely oriented linear signal in the peripheral fibers of the body and posterior horn of the medial meniscus that extends to the tibial articular surface. While this is compatible with a tear, this may represent intrasubstance degeneration that preceded a partial meniscectomy and now contacts the articular surface.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the medial patellar facet. There is also focal thinning along the anterior aspect of the lateral femoral condyle that is associated with osteophyte formation. No additional fluid-filled cartilage defects are seen.LIGAMENTS: The anterior cruciate ligament is slightly thickened, which may represent mucoid degeneration, however, we see no tear. The posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact. The medial patellofemoral ligament appears thin and its femoral attachment is not clearly defined, which may represent chronic injury; however, we see no edema adjacent to the medial retinaculum to suggest recent injury.EXTENSOR MECHANISM: The extensor mechanism is intact. The Insall-Salvati ratio is within normal limits.ADDITIONAL

Output: 1.Focal full-thickness articular cartilage defect of the medial facet of the patella.2.The medial patellofemoral ligament appears thinned and its femoral attachment is not clearly defined, which may represent chronic injury. However, we see no edema adjacent to the retinaculum to suggest recent injury nor do we see other specific features of patellofemoral instability.3.Abnormal signal within the meniscus as described above may represent tearing or prior meniscectomy changes.4.Mucoid degeneration of the anterior cruciate ligament.5.Edema along the posterolateral aspect of the distal femoral metaphysis is of uncertain etiology, but could represent a tear of an accessory plantaris muscle or lateral segmental anomalous origin of the gastrocnemius muscle.


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB:3/28/1978)Reason: evaluate cystic lesions while receiving RT for craniopharyngioma History: nonePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA There is redemonstration of a large cystic mass centered in the suprasellar cistern which is embedded self into the third ventricle.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: Examination is performed for stereotactic guidance. There is a suprasellar cystic type mass present which has been identified on prior exams.


Instruction: Generate impression based on findings.

Input: Female 80 years old with left shoulder biceps tendonitis, rotator cuff strain. Evaluation is somewhat limited by patient motion artifact.ROTATOR CUFF: There is marked tendinopathy of the supraspinatus and infraspinatus with a partial-thickness articular surface tear of the supraspinatus (series 1501, image 9). Moderate tendinopathy affects the subscapularis. The teres minor tendon is intact. There is no significant fatty atrophy of the musculature. There is no significant fluid within the subacromial subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum demonstrates some degenerative changes but is grossly intact. There are severe degenerative changes of the glenohumeral joint with joint space narrowing, chondral loss, and subchondral cyst formation.BICEPS TENDON: The biceps tendon is intact and normally located within the bicipital groove. ADDITIONAL

Output: 1.Marked supra and infraspinatus tendinopathy. Moderate tendinopathy of the subscapularis. 2.Partial-thickness articular surface tear of the supraspinatus tendon.3.Nonvisualization of the coracohumeral ligament consistent with frozen shoulder.4.Degenerative changes at the glenohumeral and acromioclavicular joints.


Instruction: Generate impression based on findings.

Input: 62-year-old male experiencing worsening back pain, history of Chiari, syrinx, tethered cord Cervical:There is a mild reversal of the normal cervical lordosis. Partial fusion is again seen across the C3-4 intervertebral disk. Vertebral body heights are normal. There is a benign hemangioma within the C6 vertebral body. No worrisome marrow replacement or marrow edema is detected.The cerebellar tonsils extend slightly below the level of the foramen magnum, more so on the right where descent below the foramen is approximately 3 mm. The tonsils remain relatively rounded. These findings are unchanged.Prominence of the central canal spinal cord is demonstrated beginning at approximately C5 and extending into the thoracic region. The caliber of the central canal reaches 2 mm at its maximum. These findings are unchanged.C2-3: No spinal canal stenosis or neuroforaminal narrowing, unchanged. C3-4:Osteophytic ridging asymmetric to the left paracentral and foraminal zones. This results in effacement of the left ventral thecal sac and mild flattening of the spinal cord. No cord signal abnormality is seen. The left neural foramen is moderately narrowed. No interval changes.C4-5: Left facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes.C5-6: Left facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes.C6-7: Minimal posterior disk osteophyte formation. No spinal canal stenosis. No foraminal narrowing. No interval changes. C7-T1: Unremarkable and unchanged. Thoracic:Previously demonstrated marrow edema within the anterior aspect of the T11 vertebral body has decreased, and there is a slight increase in marrow edema involving the anterior vertebral body of T10. As before, there is a large bridging osteophyte across these vertebral bodies, thus the edema is felt to be secondary to spondylitic reactive endplate change. A T1/T2 dark band which traverses the anterior/inferior corner of the T11 vertebral body is unchanged relative to prior examinations and corresponds to a sclerotic band on CT. Marrow edema is also seen along the T4-5 disk and in the T4 vertebral body is unchanged, also at a level where there is a large anterior osteophyte. Vertebral body heights are preserved. Spinal alignment is anatomic.As above, prominence of the central spinal canal begins in the cervical region and continues to the T1-2 level. Intermittent mild prominence of the central canal begins again at the T3-4 level and continues to approximately the T7-8 level, unchanged. As before, the spinal cord is somewhat diminutive, particularly at lower levels.No evidence of significant disk disease, spinal canal or neuroforaminal stenosis is seen in the thoracic spine. Mild facet hypertrophy is evident at some levels.Postoperative scarring is seen within the soft tissues of the lower thoracic region and there is evidence of surgical deformity of the posterior elements at T9-10.Lumbar:The L5 vertebral body demonstrates a mild transitional morphology. Vertebral body height is preserved. No concerning marrow replacement or evidence of marrow edema is seen.Absence of posterior elements is redemonstrated at least partially at L4 and from L5 through the sacrum region. The spinal cord remains low-lying descending at least to the L5 level ultimately thinning and fanning out and blending with a network of soft tissue strands which traverse the lower thecal sac. These findings are unchanged.The spinal cord is congenitally narrow particularly from L2 through L3. Additional level specific findings are as follows:L1-2: Marked facet hypertrophy and ligamentum flavum thickening. Minimal disk bulge. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. These findings are unchanged. L2-3: Marked facet hypertrophy. Ligamentum flavum thickening. Diffusely bulging disk. Central stenosis has progressed from moderate to severe to now severe central stenosis. Moderate bilateral foraminal narrowing. L3-4: Marked facet hypertrophy and mild ligamentum flavum thickening. Bulging disk. Moderate spinal canal stenosis. Mild bilateral foraminal narrowing. These findings are unchanged.L4-5: Marked facet hypertrophy. Bulging disk with central protrusion. No spinal canal stenosis. Mild bilateral foraminal narrowing. These findings are unchanged.L5-S1: Marked facet hypertrophy. No spinal canal stenosis. No foraminal narrowing. These findings are unchanged.

Output: 1.Stable low lying cerebellar tonsils.2.Prominence of the central canal of the spinal cord beginning in the cervical region and continuing in discontinuous fashion through the thoracic region are unchanged.3.Low lying spinal cord which continues at least to the L5 level where it begins to thin and fan out, ultimately terminating in a network of soft tissue strands which traverse the lower thecal sac, unchanged.4.At L2-3 central stenosis has progressed from moderate to severe to now severe central stenosis. 5.Stenoses elsewhere are stable and described in detail above.


Instruction: Generate impression based on findings.

Input: 65-year-old female with increasing alpha-fetoprotein (AFP 84), cirrhosis, preliver transplant evaluation. Assess for liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. TIPS stent is patent. Nonspecific prominent lymph nodes in the gastrohepatic and periportal distribution. In hepatic segment 4A, there is a 5 x 6.1 cm ill-defined lesion peripheral enhancement and peripheral restricted diffusion (series 10012 images 195, 308) (series 10 image 93). Invasion of the medial segment of the left portal vein is suspected (series 12 image 191).SPLEEN: Splenomegaly measuring 15.2 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole simple cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No peritoneal disease.BONES, SOFT TISSUES: Suspected osseous hemangioma of the T12 vertebral body (coronal series 6 image 28).OTHER: Small right pleural effusion.INDEX LESION MEASUREMENTS (Current exam date/time: 11/11/2016 08:30:00)SEGMENT 4A LESION: 6.1 x 5.0 cm (Image 195, Series 12).

Output: Suspicious peripherally enhancing mass of hepatic segment 4A measuring 5 x 6.1 cm. The differential includes cholangiocarcinoma versus poorly differentiated hepatocellular carcinoma. Findings were discussed with Dr. Aronsohn via telephone on 11/11/2016 at 15:30.


Instruction: Generate impression based on findings.

Input: 60-year-old male with renal cell carcinoma, evaluate for metastases. There is a lesion in the right posterior temporal lobe with T2 intermediate signal, diffusion restriction and mild uniform enhancement with a slightly more prominent curvilinear peripheral enhancing component. This lesion measures 1.9 x 1.7 cm (13/133). This lesion contains a punctate focus of susceptibility, which could represent microhemorrhage, however no significant intrinsic T1 shortening or susceptibility is seen. A second lesion with intermediate T2 signal and diffusion restriction and mild uniform enhancement in the left posterior frontal lobe measures 2.0 x 2.3 cm (13/193). Again, no significant intrinsic T1 shortening or susceptibility is seen within this lesion to suggest hemorrhage. Anteriorly, this lesion demonstrates a region of more T2 hyperintense nonenhancing signal which could represent a small cystic component. There are a few punctate foci of increased T2 signal scattered throughout the cerebral white matter without enhancement or mass effect, including a focus in the anterior left frontal lobe, which are nonspecific.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.Enhancing lesions in the right posterior temporal and left posterior frontal lobes likely represent metastasis. No MRI findings of significant internal hemorrhage are seen. Hyperattenuation on prior CT likely reflected high cellularity.2.A few punctate foci of increased T2 signal are nonspecific but may be related to chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 71-year-old female with abdominal pain ABDOMEN:LUNG BASES: Right lower lobe calcified granuloma.LIVER, BILIARY TRACT: Moderate intra-/extrahepatic biliary ductal dilatation, not significantly changed.Enhancing lesion at the dome of the liver, most likely hemangioma, unchanged.SPLEEN: No significant abnormality notedPANCREAS: Mild pancreatic ductal dilatation is seen. The body and tail of the pancreas remain atrophic.ADRENAL GLANDS: 4.2 x 3.4 cm left adrenal nodule, increased in size and previously described as an adenoma on MRI 11/07.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Atrophic versus absent.BLADDER: A Foley catheter is looped within the bladder and can be retracted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Again noted is a linear hyperdense object in the mesentery with surrounding fat stranding/granulation tissueA metallic clip is seen adjacent to the rectosigmoid colon, unchanged.No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Linear hyperdensity within the mesentery with associated inflammatory changes, not significantly changed.Left adrenal mass, increased in size. It was previously demonstrated to contain microscopic fat on MRI from 11/07, compatible with an adenoma. However, given increase in size, biopsy can be consideredStable biliary and pancreatic ductal dilatation.No evidence of obstruction.


Instruction: Generate impression based on findings.

Input: 67-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.3 x 2.9 x 6.0 cm.Peripheral Zone: Right peripheral apical T2 hypointense lesion with associated decreased ADC measuring 11 x 8 mm. No appreciable enhancement.There is an additional similar-appearing focus in the left mid gland measuring 6 x 5 mm. No appreciable enhancement.Mild bilateral peripheral increased T1 signal compatible with hemorrhage.Central Gland: BPHSeminal Vesicles: No significant abnormality noted.Extracapsular Extension: No definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Highly suspicious peripheral lesion in the right apex without definite extracapsular extension.2. Smaller lesion in the left mid gland also suspicious for multifocal disease.3. Scattered areas of hemorrhage.


Instruction: Generate impression based on findings.

Input: Evaluate for osteomyelitis. History of septic joint and knee pain/swelling. Several sequences are limited by patient motion artifact. There is a moderate sized joint effusion with thick rim enhancement consistent with septic arthritis. Multifocal subchondral bony erosions are present, most significant at the medial tibial plateau and medial femoral condyle. There is also edema within the distal femoral metadiaphysis and tibial metadiaphysis which likely represents a combination of reactive osteitis and osteomyelitis. We see no discrete intraosseous abscess. Small subchondral erosion of the patella with mild marrow edema is present. The bone marrow intensity within the fibula appears normal. There is also suggestion of periosteal reaction along the distal femur and proximal tibia. There is enhancement of soft tissues above the suprapatellar pouch, as well as the popliteus and quadriceps muscles, indicating inflammation. There is also a defect involving the distal quadriceps tendon, which may reflect a partial tear or prior surgery. The posterior horn of the medial meniscus along with much of the body is not visible, and the anterior horn of the medial meniscus is displaced anteriorly, indicating extensive tearing/destruction. The lateral meniscus appears intact. Cartilage loss most markedly affects the medial tibiofemoral compartment.The anterior cruciate and posterior cruciate ligaments are intact. There is edema and enhancement along the medial collateral ligament, but the ligament appears intact. The lateral collateral ligament complex appears intact.

Output: Septic arthritis with bony erosion/osteomyelitis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male 51 years old Reason: elevated psa History: elevated psa PELVIS:PROSTATE:Prostate Size:4.0 x 4.2 x 4.2 cm.Signal abnormality: Dominant focus of T2 hypointense signal abnormality at the mid gland anteriorly which measures 2.4 x 1.5 cm (series 704, image 144) which is dark on ADC. Additional subcentimeter focus in the left apex posteriorly measuring 0.8 x 0.6 cm (series 704, image 104). These are suspicious for foci of prostatic carcinoma.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant 2.4 cm focus of signal abnormality within the anterior prostate with additional subcentimeter focus in the posterior left apex. These are suspicious for foci of prostatic carcinoma. No evidence of seminal vesical invasion or extracapsular extension.


Instruction: Generate impression based on findings.

Input: 18-year-old male patient with history of sickle cell anemia and abnormal right knee radiograph. MENISCI AND LIGAMENTS: The medial and lateral menisci are intact. The anterior cruciate alignment, posterior cruciate ligament, lateral collateral ligament, and medial collateral ligament complex are intact.BONE AND MARROW: Increased T2 signal in the medullary cavity of the distal femoral metaphysis and proximal tibial metadiaphysis with thick peripheral enhancement. The abnormal T2 signal in the distal tibia extends to the cortex posteriorly.SYNOVIUM: No joint effusion or synovitis.MUSCULATURE: The musculature is normal in appearance.ADDITIONAL

Output: Findings compatible with bone infarct in the distal femur and proximal tibia. Extra-osseous focus of increased T2 signal along the posterior femoral bone infarct may be reactive due to new bone formation or weakening of the cortex/periosteum.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: please do Dr. Javed MS protocol and compare to priorSigns and Symptoms: headaches, weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of T2 and FLAIR hyperintense small periventricular white matter lesions which are perpendicularly oriented to the lateral ventricles. These are stable compared to the prior exam. Additionally there are a few T2 and FLAIR hyperintense subcortical white matter lesions present which are also stable compared to the prior exam. There are T2 and FLAIR hyperintense white matter lesions present within the internal capsules which were also present on the prior exam.There is a punctate right thalamic lesion present which can be identified on the prior exam from 3/19/2013.Ill-defined signal T2 and FLAIR hyperintensities within the brain stem also remains stable. A couple punctate T2 and FLAIR hyperintense lesions in the cerebellum are also stable.No abnormal enhancing lesions are appreciated within the brain parenchyma.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: There is redemonstration of white matter lesions scattered throughout the supratentorial brain and brainstem which have been stable since prior exams.


Instruction: Generate impression based on findings.

Input: Female 30 years old with abdominal wall desmoid. Evaluate for progression/recurrence. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is no suspicious liver lesion. The gallbladder is normally distended without cholelithiasis. There is no biliary ductal dilatation. The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation.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: A subcentimeter T2 hypointense focus with minimal to no enhancement along the left ventral abdominal wall at the level of the mid kidney measures 8 x 5 mm (series 6, image 38). Comparison is difficult due to differences in technique however the lesion previously measured up to 15 mm and appears to decrease in size. No new lesions are identified.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is retroverted. Multiple follicles are seen in both ovaries with a dominant left follicle measuring up to 2.5 cm, likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is trace pelvic free fluid.

Output: The lesion in the left anterior abdominal wall (at the level of the mid kidney) appears to have decreased in size since the previous outside exam accounting for differences in technique, this could represent scarring or residual desmoid. No new lesions are identified.


Instruction: Generate impression based on findings.

Input: 75 years, Female, multiple myeloma and breast cancer, carries diagnosis of vasovagal syncope, presenting today after spell concerning for epileptic seizure. There is no intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small ischemic disease. Small probable chronic lacunar infarct involving the right right frontal corona radiata and anterior aspect of the caudate body; prominent perivascular space remains an alternative possibility. No hydrocephalus. No extra-axial collections. No evidence of acute ischemia or hemorrhage. Bilateral hippocampi are symmetric in size and signal characteristics with grossly preserved internal architecture; no findings to suggest mesial temporal sclerosis. Major flow-voids are preserved. Pituitary gland is slightly prominent in size for age which is nonspecific. There is heterogeneous marrow signal which may be related to known multiple myeloma. There are however no discrete destructive osseous lesions demonstrated.

Output: 1. No evidence of intracranial metastatic disease. No findings to suggest seizure focus are appreciated.2. Mild to moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 32-year-old male with cirrhosis who presents for follow-up of liver lesion. ABDOMEN: Susceptibility artifact from left gastric embolization coils obscures upper left hemiabdomen and limits evaluation of the left hepatic lobe and partially of the right hepatic lobe.LIVER, BILIARY TRACT: Mild nodularity of the liver contour. No suspicious arterially enhancing lesions.Referenced hypoinensive, nonenhancing segment 4 lesion measures 1.8 x 1.3 cm (series 5, image 129), previously measuring 2.2 x 1.5 cm; the lesion does not demonstrate dropout on out of phase images on the current examination. No lesion on the hepatobiliary phase is identified.Transjugular intrahepatic portosystemic shunt is patent. Portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland is not visualized given the susceptibility artifact. The right adrenal gland is normal in size and morphology.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.Nonspecific segment 4 lesion is most likely a perfusion defect.2.Chronic liver disease without evidence of suspicious arterially enhancing lesions. Patient should continue with regular screening.


Instruction: Generate impression based on findings.

Input: Vertigo. History of CVA 2/2010. Following for CVA No intracranial bleed, mass effect, edema, or midline shift. Moderately prominent extra-axial space and sulci. A moderate size patchy low attenuation is present in the left corona radiata, centrum semiovale, and left deep gray nuclei, new since previous CT, consistent with the acute infarction seen on 2/4/2010 MRI. It is consistent with interval maturation of an infarction with expected encephalomalacia. Within the limitation of the CT, which has less sensitive evaluation of the posterior fossa structures, it appears unremarkable. Basal cisterns are patent. Moderate vascular calcifications. No hydrocephalus. Opacification of right mastoid air cells, new since previous study. Otherwise, the rest of the visualized paranasal sinuses and mastoid air cells are clear

Output: 1. No intracranial bleed. 2. Interval maturation of the previously seen left sided white matter and deep gray matter MCA distribution acute infarction seen on 2/4/2010 MRI. 3. New right mastoid air cells congestive/inflammatory disease.


Instruction: Generate impression based on findings.

Input: Reason: r/o cord compression History: back pain. Acute onset saddle anesthesia and urinary incontinence. Cervical spine:The patient is status post anterior fusion at C5, C6 and C7. The exam is degraded by patient motion artifact.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is disk desiccation and some endplate osteophytes as well as a disk bulge at this level. Since the prior exam there has been regression of the spinal stenosis at this level.At C3-4 there is diffuse disk bulge associated with posterior ligamentous hypertrophy and effacement of spinal fluid ventral and posterior to spinal cord creating a moderate degree of spinal stenosis. This is stable compared to the prior exam.At C4-5 there is central disk protrusion associated with effacement of spinal fluid ventral and posterior to spinal cord creating a moderate degree of spinal stenosis. Since the prior exam there has been regression of the spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal. There is some narrowing of the neural foramina due to disk material at this level. Compared to the prior exam there is been some improvement in the spinal stenosis at this level.The vertebral artery flow voids appear to be intact.Lumbar 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. The exam is degraded by patient motion artifact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy present at this level, disk desiccation and a disk bulge. There is narrowing of the neural foramina at this level left worse than right. Compared to prior exam this is stableAt L4-5 there is loss of disk space height, disk desiccation, diffuse disk bulge and bilateral facet and ligamentum flavum hypertrophy associated with mild anterior subluxation of L4 and L5. Overall there is a moderate degree of spinal stenosis at this level. Additionally there is partial effacement of fat within the neural foramina bilaterally with mild encroachment of the exiting nerve roots within the neural foramina. When compared to the previous exam there does not appear to be any significant change.At L3-4 there is loss of disk space height, disk desiccation, diffuse disk bulge and bilateral facet and ligamentum flavum hypertrophy . Overall there is a moderate to severe degree of spinal stenosis at this level. Additionally there is partial effacement of fat within the neural foramina bilaterally with mild encroachment of the exiting nerve roots within the neural foramina. When compared to the previous exam there does not appear to be any significant change.At L2-3 there is loss of disk space height, disk desiccation and disk bulge associated with some facet and ligamentum flavum hypertrophy. Overall there is a mild to moderate degree of spinal stenosis at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.Are multiple large renal cysts present. These were also present on the October exam as well and not substantially different

Output: 1.The exams are degraded by motion artifact which can obscure more subtle abnormalities or more subtle changes.2.There are multilevel degenerative changes present in the cervical spine resulting in multilevel spinal stenosis. Within the cervical spine spinal stenosis at that C2-3, C4-5 and C7-T1 has improved were as spinal stenosis at see C3-4 remains relatively stable when compared to 7/25/11.3.There are multilevel degenerative changes are present in the lumbar spine resulting in spinal stenosis at L2-3, L3-4 and L4-5 worse at L3-4. This is stable when compared to the prior exam of 10/20/14


Instruction: Generate impression based on findings.

Input: 65-year-old female with pancreatic cysts are seen on endoscopic ultrasound (10/2012) and additional prior ABDOMEN:LIVER, BILIARY TRACT: Scattered T2 subcentimeter hyperintensities. No suspicious liver lesions. No intrahepatic or extrahepatic biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a 4 mm cystic lesion in the uncinate process. There is no visualized connection with the main pancreatic duct.There is a 12 x 12 mm cystic lesion in the head of the pancreas. There is visualized connection with the main pancreatic duct. No abnormal enhancement or mural nodularity.The largest cystic lesion measures 14 x 12 mm in the neck of the pancreas. There is visualized connection with the main pancreatic duct. No abnormal enhancement or mural nodularity.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.Cystic lesions in the head and neck of the pancreas with a visualized connection with the main pancreatic duct compatible with IPMNs. No suspicious features.2.A 4 mm cystic lesion in the uncinate process likely also represents a sidebranch IPMN although connection with main pancreatic duct is not visualized.


Instruction: Generate impression based on findings.

Input: bilateral hand tingling. There is reversal of the usual cervical lordosis. There are posterior disc-osteophyte complexes at C5 though C7 that result in mild spinal canal narrowing and considerable bilateral neural foraminal narrowing at these levels. There is no significant spinal canal or neural foraminal narrowing at the other cervical spine levels. However, there is also mild upper thoracic spinal canal stenosis associated with degenerative spondylosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Posterior disc-osteophyte complexes at C5 though C7 result in mild spinal canal narrowing and considerable bilateral neural foraminal narrowing at these levels. There is no significant spinal canal or neural foraminal narrowing at the other cervical spine levels. However, there is also mild upper thoracic spinal canal stenosis associated with degenerative spondylosis.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact.ORBITS: There is thickening as well as abnormal T2 hyperintensity and enhancement of the right nasolacrimal sac and nasolacrimal duct. There is also swelling and abnormal T2 hyperintensity of the right lower lid. The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.PITUITARY: There is a normal pituitary height for age. The infundibulum is midline. There is no evidence for pituitary or suprasellar mass. The optic chiasm, cavernous sinuses and intracranial portions of the optic nerves are normal in appearance.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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 skull and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits. There is fluid within the left sphenoid sinus and right mastoid air cells.

Output: 1.RIght nasolacrimal sac and duct enlargement, edema, and enhancement with associated edema of the right lower lid. The nasolacrimal sac size is grossly unchanged compared with the CT dated 4/30/2014 although the etiology is uncertain. 2.Normal pituitary MRI. 3.Normal brain MRI. 4.Minimal nonspecific fluid within the left sphenoid sinus and right mastoid air cells.


Instruction: Generate impression based on findings.

Input: 66 years, Female, status post left MCA posterior division stroke, status post TPA and embolectomy. Assess stroke burden.. There is restricted diffusion predominantly involving the territory of the posterior division of the left middle cerebral artery including the posterior aspect of the left superior and middle temporal gyri. Additional foci of restricted diffusion are noted in the left insula and subinsular white matter as well as scattered foci involving the left frontal and parietal cortical, subcortical, and deep white matter. These acute infarcts have evolved since CT from 8/16/2015. No evidence of hemorrhagic transformation. No significant mass effect. There is encephalomalacia predominantly involving the right frontal lobe extending to the insular cortex and operculum with minimal component including the right anterior parietal lobe and basal ganglia. There is associated ex vacuo dilatation of the right lateral ventricle. Cavum septum pellucidum and cavum vergae incidentally noted. No hydrocephalus.Additional scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Remainder of the brain, sella, orbits, and extracranial soft tissues are unremarkable within the limitations of motion degraded exam.

Output: 1. Acute infarct in the left MCA territory, predominantly involving the posterior division including the posterior temporal lobe, with additional left hemispheric foci of infarct as described above. No evidence of hemorrhagic transformation or significant mass effect.2. Chronic right MCA territory infarct.


Instruction: Generate impression based on findings.

Input: Limited images of the spine demonstrate numerous foci of signal abnormality within the visualized osseous structures compatible with widespread osseous metastases. The most prominent lesion involves the T4 vertebral body with extension into the bilateral posterior elements as well as right greater than left epidural extension resulting in significant narrowing of the spinal canal and cord compression. Additional epidural tumor is present at T12 with nearly circumferential narrowing of the spinal canal which also compresses the cord but less severely than at T4.

Output: Widespread spinal osseous metastatic disease resulting in severe narrowing of the spinal canal at T4 with associated cord compression and additional narrowing at T12. Dedicated imaging of the spine without and with contrast can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: Female, 60 years old. Reason: 60 y/o with personal Hx of breast Ca, need diagnostic UTS to eval large left thyroid nodule History: 60 y/o with personal Hx of breast Ca, need diagnostic UTS to eval large left thyroid nodule RIGHT LOBE MEASUREMENTS: 5.4 x 2.2 x 1.7 cmLEFT LOBE MEASUREMENTS: 6.4 x 3.0 x 3.0 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Homogeneous echotexture. Subcentimeter, spongiform right inferior pole thyroid nodule measures 0.6 x 0.4 x 0.6 cm. No microcalcifications or significant internal vascularity.LEFT LOBE: Heterogeneous echotexture with predominantly solid and somewhat spongiform left mid pole nodule which measures 3.6 x 2.3 x 2.6 cm. This nodule will be subsequently biopsied. Additional more inferior nodule with a similar sonographic appearance measures 1.3 x 0.9 x 1.3 cm. No microcalcifications or significant internal vascularity is noted in either nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing left level 3 neck lymph node measures 1.3 x 0.5 x 0.9 cm.OTHER: No significant abnormality noted.

Output: 1. Predominantly solid and somewhat spongiform left mid pole nodule which will be subsequently biopsied. Additional more inferior left thyroid lobe nodule has a similar sonographic appearance.2. Subcentimeter, spongiform right thyroid nodule without suspicious features.


Instruction: Generate impression based on findings.

Input: Stigmata of agenesis of the corpus callosum is again seen. The ventricles and sulci are stable in size, even comparing back to more remote MRI comparisons. There is again diffuse significant dilatation of the supratentorial ventricles.There has been interval decrease in size of the left frontoparietal chronic subdural collection which is increased in homogeneity with minimal residual collection measuring up to 0.7 cm in maximum dimension compared to 1.0 cm previously. There is essentially stable prominence of extra-axial space of CSF signal intensity along the right interhemispheric fissure, anterior right greater than left frontal lobe, as well as along both anterior temporal lobes. On T2/FLAIR images, there is suggestion of possible thin septations within these areas of extra axial space prominence, in addition to minimal peripheral vasculature. There is persistent flattening of the anterior temporal lobes which may suggest arachnoid cysts, which is stable from previous exam. Stable focal prominence of T2 hyperintensity within the midline posterior fossa may be likely related to cisterna magna versus retrocerebellar cyst.There are no areas of abnormal parenchymal signal. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mild mucosal thickening in the maxillary sinuses.

Output: 1. Slight reduction in the size of the left frontoparietal extraaxial chronic collection. 2. Stable findings of complete agenesis of corpus callosum. 3. Stable dilatation of extra-axial space especially anteriorly, with possible middle cranial fossa arachnoid cysts.


Instruction: Generate impression based on findings.

Input: There is an enhancing and expansile lesion involving both the body and odontoid process of C2 with disruption of the cortex. Extension of enhancing material is noted beyond cortical borders, especially on the left where there is a small amount of epidural material (however without significant associated mass effect upon the adjacent the thecal sac), as well as extending anterolaterally. This latter process abuts the left vertebral artery, which remains patent. This does not involve the adjacent disc level. Although it effaces the anterior CSF at the level of the odontoid tip, there is no cord abutment or displacement.A similar appearing, yet much smaller, process is also present within the T2 vertebral body. Although this may represent discogenic reactive endplate change, a secondary lesion cannot be excluded.A third, even smaller, process along the superior endplate of C6 has a similar appearance, yet location morphology is much more suggestive of reactive endplate change.There is diffuse marrow signal abnormality, specifically demonstrating T1 and T2 hypointensity which is not typical for a patient of stated age 65 years.The cervical and upper thoracic cord is normal in signal without abnormal enhancement. C2/3: UnremarkableC3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. Mild left neural foraminal stenosis.C4/5: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. Mild right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and bilateral facet hypertrophy. Moderate bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. Moderate left neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.There is an enhancing and expansile lesion involving both the body and odontoid process of C2 with disruption of the cortex. Extension of enhancing material is noted beyond cortical borders, especially on the left where there is a small amount of epidural material (however without significant associated mass effect upon the adjacent the thecal sac), as well as extending anterolaterally. This latter process abuts the left vertebral artery, which remains patent. This does not involve the adjacent disc level. Although it effaces the anterior CSF at the level of the odontoid tip, there is no cord abutment or displacement.2.A similar appearing, yet much smaller, process is also present within the T2 vertebral body. Although this may represent discogenic reactive endplate change, a secondary lesion cannot be excluded.3.There is diffuse marrow signal abnormality, specifically demonstrating T1 and T2 hypointensity which is not typical for a patient of stated age 65 years.4.These foci are most consistent with involvement from the patient's AML, and do not have the expected MRI appearance of osteomyelitis/diskitis or abscess.5.A third, even smaller, process along the superior endplate of C6 has a similar appearance, yet location morphology is much more suggestive of reactive endplate change.


Instruction: Generate impression based on findings.

Input: 43-year-old female with left shoulder pain for 3 to 4 months. Please evaluate for rotator cuff tear versus supraspinatus tendinopathy. ROTATOR CUFF: The rotator cuff appears intact without evidence of tear or other significant pathology. There is mild tendinosis of the distal supraspinatus.SUPRASPINATUS OUTLET: No significant abnormality of the supraspinatus outlet is visualized. The supraspinatus muscle belly appears normal in signal.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a linear tear of the superior glenoid labrum, (best seen on series #7, image 8) that extends to be articular surface just adjacent to the biceps insertional site.BICEPS TENDON: The biceps tendon appears intact without significant signal abnormality. ADDITIONAL

Output: 1. Small tear of the superior glenoid labrum.2. Mild tendinosis affects the distal supraspinatus tendon without evidence of tear.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of spinal stenosis with acute worsening of pain. The visualized calvaria and skull base are radiographically normal.Cervical spine alignment is anatomic. Vertebral body heights and density is within normal limits. The foramen magnum is unremarkable.C2-3 is unremarkable.C3-4 demonstrates neuroforaminal compromise bilaterally with mild central spinal stenosis and ventral hypertrophic changes.C4-5 demonstrates mild spinal stenosis and ventral hypertrophic changes with neuroforaminal narrowing but laterally.C5-6 demonstrates bilateral neuroforaminal narrowing, and advanced degenerative disk disease.C6-7 demonstrates bilateral neuroforaminal narrowing, and advanced degenerative disk disease.C7-T1 demonstrates bilateral neuroforaminal narrowing.T10-11 and T11-12 demonstrates severe degenerative disk disease and near complete loss of disk height.T10/11 demonstrates significant neuroforaminal compromise.T12-L1 is unremarkable.L1-2 is unremarkable.L2-3 shows degenerative disk disease with hypertrophy of the posterior elements.L3-4 demonstrates a large diffuse bulging of disk density material that extends to the ventral epidural space greater on the left which may represent diffuse disk bulge or hypertrophic changes. For further elucidation of this level an MRI may be considered. Advanced degenerative disease is noted with sclerotic end plate changes and vacuum phenomenon. Neuroforaminal compromise is noted bilaterally and a high suspicion for central spinal stenosis.L4-5 demonstrates advanced degenerative disease with vacuum phenomenon. There is complete right neuroforaminal compromise by lateral hypertrophic changes. There is a high suspicion for a tight central spinal stenosis.The L5-S1 shows advanced degenerative disease and a significant diffuse disk bulge. Neuroforaminal compromise affects the right side. The left neuroforamina remains patent.

Output: Multilevel degenerative disk disease, neuroforaminal compromise and spinal stenosis as described above.


Instruction: Generate impression based on findings.

Input: Laser ablation for seizures. There is are postoperative findings related to recent laser ablation of posterior left lateral ventricle subependymal heterotopia, with peripheral enhancement at the ablation zones. Portions of the heterotopia remain adjacent to the ablations zones and there is a dysmorphic appearance of the regional left cingulate gyrus. There are also postoperative findings related to remove of left temporal deep brain electrodes. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Postoperative findings related to recent laser ablation of posterior left lateral ventricle subependymal heterotopia.


Instruction: Generate impression based on findings.

Input: 70-year-old female with smoldering myeloma. Evaluate for bone lesions. BONE MARROW: There is a lobulated focus of increased signal abnormality on fluid sensitive sequences within the intertrochanteric region of the left femur with the imaging characteristics most consistent with an enchondroma. No additional bone marrow signal abnormality is identified.SOFT TISSUES: There is nonspecific subcutaneous edema along the posterior aspect of the lumbar spine. The imaged musculature of the pelvis is normal in appearance.JOINTS: There is a small amount of fluid within the hips without evidence of a large effusion.ADDITIONAL

Output: Findings most consistent with a benign enchondroma within the left femur without evidence of a definite myelomatous deposit affecting the pelvis.


Instruction: Generate impression based on findings.

Input: 90 years Female (DOB:4/6/1926)Reason: assess for new stroke History: right-sided weakness and slurred speechPROVIDER/ATTENDING NAME: THOMAS L FISHER JACQUELINE T. BERNARD There is a punctate focus of diffusion restriction present in the right paramedian pons. This is newThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are several lesions of T2 and FLAIR signal hyperintensity in the brainstem and cerebellum.On susceptibility imaging there is a focus of susceptibility effect associated with low signal on T2 imaging in the left postcentral gyrus which on T2 measures approximately 19 x 7 mm axial dimensions. This was present on the prior exam and is unchanged Additionally there are multiple punctate foci of susceptibility effect in the subcortical white matter of both hemispheres. Additionally there is a punctate focus of susceptibility effect in the left medial thalamus and the left upper thalamus. These were also present on the prior exam and have not changed significantly.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 demonstrate mucous retention cysts in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a punctate acute microinfarct infarct in the right paramedian pons. This is new since the prior exam.2.There is redemonstration of a hemorrhagic focus in the left postcentral gyrus probably from an old hemorrhage.3.Multiple microhemorrhages in the brain parenchyma involving predominantly subcortical white matter are present. Most likely these are related to amyloid angiopathy based on the pattern but this is somewhat nonspecific.4.Periventricular and subcortical white matter lesions as well as a couple lesions in the brainstem and cerebellum of a mild degree are nonspecific. At this age they are most likely vascular related. They are essentially stable and compared to prior exam


Instruction: Generate impression based on findings.

Input: Pain, previous history of microfracture. Assess for "LFC" chondral injury MENISCI: No significant abnormality noted. Both menisci are well visualized and intact.ARTICULAR CARTILAGE AND BONE: Moderate signal focal irregularity is observed in the trochlea with moderately deep grade 3 clefts ulceration with underlying focal marrow changes. Minimal chondromalacia (grade 1) is observed underlying the patella.In addition a larger (5 mm) yet similar in depth focal ulceration is observed along the posterior aspect of the lateral femoral condyle (image 22 series 10). Similar underlying minimal immediate marrow changes and edema.Unremarkable 2 small bone islands are observed in the same condyle more proximally.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Grade 3 chondral injury observed in the trochlea and lateral femoral condyle, as described.


Instruction: Generate impression based on findings.

Input: 14 year old male with osteoblastoma status post resection in January 2013 presenting for pre-operative planning. This exam is markedly limited by artifact from the patient's dental braces as well as by patient motion. The diffusion sequence is non-diagnostic and the fat saturation is markedly degraded by susceptibility limiting this study.There is again a large expansile mass arising from the left aspect of the C3 vertebral body, involving the left pedicle and transverse process. There is extension cranially to involve C2 and caudally to involve C4. Central lower signal correlates with areas of dense calcification. The well-defined portion of the mass is grossly unchanged in size compared with the recent CT, measuring up to 42 x 44 mm (series 901 image 23). Overall, the mass is much larger than the original tumor.There is prominent associated infiltrative pattern T2 hyperintensity and enhancement within the adjacent soft tissues following tissue and muscular planes, including the prevertebral space with extension to the right side at the C2-C5 levels. There is extension into the widened left C2-C3 and C3-C4 foramen, as well as asymmetric abnormal signal and enhancement suggested along the left C4-C5, and C5-C6 foramina. There is anterior displacement of the left cervical vessels, greatest at the level of the carotid bifurcation with associated likely reactive changes. The left C3-C4 neural foramen extension results in near complete effacement of CSF space at this level and overall moderate spinal canal stenosis. There is no definite cord signal abnormality. Evaluation at these levels is markedly limited by artifact from the patient's braces.There is absent flow within the left vertebral artery compatible with prior embolization. The other flow voids are present. There is also a dilated collateral vessel arising inferiorly and coursing along the lateral aspect of the mass, possibly supplying the mass but not well evaluated on this exam. Another tortuous collateral vessel is seen along the inferomedial aspect of the mass. There are grossly unchanged nonspecific bilateral cervical lymph nodes that are not significantly enlarged. There is ill-defined abnormal signal intensity within the C2-C5 vertebrae.The thyroid and parotid glands are unremarkable. Submandibular glands are not well assessed on this exam. The airways are patent. The imaged intracranial structures are unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved.

Output: 1.Markedly limited exam secondary to patient's dental braces and motion artifact, specifically at the level of the lesion.2.Large expansile mass with central calcification arising from the left aspect of the C3 vertebral body is grossly unchanged compared with the recent CT, and much larger than the original mass. This would be compatible with recurrent osteoblastoma, perhaps of the more aggressive type.3.Extensive signal abnormality and enhancement involving the C2-C5 vertebrae and paravertebral soft tissues likely represents associated "flare phenomenon" rather than tumor.4.There is complete effacement of the CSF space at the C3-C4 level secondary to left foraminal extension of tumor but no definite cord signal abnormality at this time.


Instruction: Generate impression based on findings.

Input: Acute posttraumatic headache, neck pain, and left arm weakness and numbness. BRAIN:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The small chronic left orbital medial and floor blowout fractures are unchanged. The orbits are otherwise unremarkable. The chronic right nasal fracture is not well demonstrated. There is no other skull fracture and scalp soft tissues are grossly unremarkable accounting for artifact partially obscuring the right frontal scalp. CERVICAL SPINE:The study is at least mildly degraded by motion.The sagittal alignment is anatomic. There is no evidence of fracture. The vertebral bodies are preserved in height. There is multilevel disc-osteophyte degenerative disease that is most pronounced at C7-T1 and C6-C7, where dorsal osteophytes do mildly narrow the spinal canal. Uncovertebral proliferative change results in mild-to-moderate foraminal stenoses, most notable for moderate bilateral T1-T2 and right C6-C7 foraminal stenoses. The paravertebral soft tissues are unremarkable. STIR imaging shows no significant edema in the pre or paravertebral soft tissues and ligaments. The spinal cord, accounting for motion, shows no signal abnormality. There is no epidural hematoma.BRACHIAL PLEXUS:The study is at least mildly degraded by motion. There is also artifact overlying the right mid clavicular portion. Otherwise, there is no mass or signal abnormality along the course of the brachial plexus on either side. However, there are changes suggestive of bilateral rotator cuff pathology manifested by abnormal signal within and between the tendons as well as subjacent marrow signal abnormality and joint fluid. These findings are not adequately assessed on this examination.

Output: 1.Brain: Unremarkable examination with no acute intracranial hemorrhage or mass/mass-effect.2.Cervical spine: Degraded by motion. No MR evidence for acute osseous or soft tissue injury. Multilevel degenerative cervical spondylosis resulting in mild spinal canal stenosis and up to moderate foraminal stenoses as described above.3.Brachial plexus: Degraded by motion. No gross brachial plexus abnormality. However, there are changes of bilateral rotator cuff pathology but are not completely assessed. If clinically indicated, shoulder MRI would provide better assessment.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop MRI for scoliosis. Signs and symptoms: Scoliosis. Non-enhanced total spine MRI:Examination of cervical region demonstrate normal development of vertebral column. There is normal anatomical alignment of cervical spine however with exaggerated cervical kyphosis. Foramen magnum is unremarkable and there is no evidence of spinal stenosis at any level. There is no convincing evidence of neural foraminal compromise at any level. The signal intensity and caliber of the cervical cord remains within normal. Examination of thoracic spine demonstrate significant levoscoliosis. There is however normal development of vertebral column and without evidence of congenital malformation the vertebral bodies or the posterior elements. There is normal anatomical alignment of vertebral column.There is apparent uniform slightly smaller caliber of the thoracic cord however without detectable signal abnormality cord.There is normal termination of cord at mid L1 levelThere is no evidence of neural foraminal or spinal canal compromise or stenosis at any level.Examination of lumbosacral spine demonstrate normal anatomical development of the vertebral bodies and the posterior elements. There is normal anatomical alignment the vertebral column however with exaggerated lordosis and with near horizontal axis of the sacral vertebral column. There is no spinal stenosis or neural foraminal compromise at any level. There is normal anatomical morphology and signal intensity of the conus and the cauda equina and in particular no evidence of fatty filum or tethered cord.

Output: 1.Significant levoscoliosis of lumbosacral spine.2.Significant reversal of cervical lordosis, exaggerated lower lumbar lordosis with resultant sacrum on a horizontal plane as detailed.3.No continental developmental anomaly of the vertebral bodies or the posterior elements.4.Unremarkable foramen magnum, normal signal intensity of the cord, conus and the cauda equina, normal termination of the cord at mid L1 level and without evidence of cord tethering.5.No evidence of a perispinal soft tissue abnormalities.


Instruction: Generate impression based on findings.

Input: Pulmonary fibrosis. History of syncope. Headache x 1 month. Question bleed or midline shift. There is no evidence of intracranial hemorrhage, mass or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent mild small vessel ischemic disease, age indeterminate by CT. There is a left high convexity cortical stroke of indeterminate age. If the patient is symptomatic, an MRI may be considered for further evaluation. Vascular calcifications are noted within the cavernous carotid and vertebral arteries. Calcification within the parotid glands bilaterally may be from prior infection and appears unchanged.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: Small vessel ischemic disease. Left high convexity cortical stroke of indeterminate age. If the patient is symptomatic, an MRI may be considered for further evaluation. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Heel ulcer Soft tissue ulceration is seen overlying the dorsum of the foot at the level of the calcaneus. There is no evidence of abnormal T1 marrow signal to confirm osteomyelitis. A small amount of increased marrow signal is noted on the STIR sequence which may reflect some reactive osteitis.There is diffuse edema of the plantar musculature.The visualized ligamentous and tendinous structures of the ankle are otherwise grossly intact. Osteoarthritis affects the midfoot and tibiotalar joint.

Output: Soft tissue ulceration overlying the heel without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type I and intramuscular lesions, pain in left leg. Patient had resection of neurofibromas in the right and left thigh in 2014. On the prior exam, two dominant circumscribed intramuscular neurofibromas were identified in the left thigh, the first anteromedially and the second posterolaterally. There has been interval resection of the anteromedial neurofibroma with postsurgical scarring noted within the overlying soft tissues. The posterolateral (biceps femoris) neurofibroma demonstrates bright T2 signal with a targetoid appearance and measures 1.0 x 1.6 x 3.1 cm (AP x TV x CC), previously 1.9 x 1.5 x 3.2 cm. Additional numerous cutaneous and subcutaneous neurofibromas seen in the left thigh are similar to prior exam. No muscle edema or fatty atrophy. Bone marrow signal of the left femur is within normal limits.On the large field-of-view images, there is a diffuse neurofibroma along the posterior medial aspect of the right thigh. Focal neurofibromas are seen along and within the medial musculature of the right thigh as well as along the posterior right acetabulum. Additionally, multiple cutaneous and subcutaneous neurofibromas are seen, similar in distribution to the prior exam. Also redemonstrated is deformity the distal femur presumably due to a combination of mesenchymal dysplasia and prior surgery.

Output: 1. No change in size of the biceps femoris neurofibroma in the posterolateral left thigh. 2. Interval resection of the neurofibroma previously identified in the left thigh anteromedial musculature.3. Additional features of neurofibromatosis as described.


Instruction: Generate impression based on findings.

Input: 9-year-old male with hearing reformation, syrinx, and tethered cord. Brain: Redemonstrated are postoperative findings related to Chiari decompression and fourth ventricular stenting. The cerebellum assumes an unchanged configuration, with persistent low lying tonsils. There is also persistent retroflexion of the dens. There is persistent diminished CSF flow across the posterior craniocervical junction, with relatively intact flow across the anterior craniocervical junction, both unchanged in appearance. There is no change in the appearance of a subcentimeter cystic space within the collapsed fourth ventricle, adjacent to rightward aspect of the stent, itself unchanged in position. There is no evidence of hydrocephalus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is mild scattered paranasal sinus opacification. Bilateral mastoid air cells remain clear. Spine: There has been no change in caliber of a long segment syrinx, measuring up to 6 mm in width, previously 6 mm. There is an unchanged fibrofatty filum terminale that measures up to 2 mm in width. The conus medullaris terminates at L2-3. These findings are unchanged. Upon prone maneuvering, the conus translates anteriorly, although a portion of the cauda equina does not.The vertebral column alignment is unchanged. The vertebral body heights are preserved. The paraspinal muscles are unchanged.

Output: 1.Stable postoperative findings relate to Chiari malformation treatment with unchanged configuration of the cerebellar tonsils demonstrating unchanged diminished CSF flow across the posterior craniocervical junction as well as an unchanged cystic space within the collapsed fourth ventricle adjacent to rightward aspect of a fourth ventricular stent.2.Unchanged long-segment syrinx.3.Unchanged fibrofatty filum terminale. Upon prone maneuvering, the conus translates anteriorly, although a portion of the cauda equina does not.


Instruction: Generate impression based on findings.

Input: Female, 32 years old, with intractable right temporal epilepsy. Functional MRI requested for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical activation maps as expected along the bilateral calcarine sulci. Reliable activity to indicate the location of the lateral geniculate nuclei could not be achieved.Of the tested language paradigms, the most reliable language related cortical activation is seen with the verb generation and sentence completion paradigms. Language is left dominant. Broca's area activity is identified in its customary location of the left inferior frontal gyrus, predominantly pars opercularis. Several foci of activity are seen within the left superior and middle temporal gyri, any or all of which could reflect Wernicke's area activity.

Output: Successful functional MRI for presurgical planning. The sensorimotor cortex is visualized along with the primary visual cortex. Language is left dominant with Broca's and Wernicke's areas visualized in their accustomed locations.


Instruction: Generate impression based on findings.

Input: 53 year old with high risk lesion (papilloma with atypia and ADH) in the left breast found on recent US guided biopsy (1/27/15), presents for research MRI. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a lobulated enhancing mass with internal clip artifact at posterior 6 o'clock position, measuring 12 x 12 x 7 mm (AP x LR x CC) in the left breast. This is the high risk lesion which was biopsied recently.There is an additional enhancing lesion, which is an irregularly shaped mass measuring 11 x 11 x 11 mm, at anterior 1 o'clock position in the left breast.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. The biopsied high risk lesion in the left breast shows mass-like enhancement at posterior 6 o'clock position2. Additional enhancing mass at at anterior 1 o'clock position in the left breast. MR directed ultrasound and possible biopsy is recommended. If sonographic correlation is not obtained, MR guided biopsy is recommended.3. No MRI evidence for malignancy in the right breast.4. No abnormal axillary lymph nodes in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 69-year-old female with lung mass. No with increasing headaches and slurred speech Area of vasogenic edema within the right cerebellum with mass effect and deviation of the fourth ventricle is noted. This is believed to represent edema from a metastatic lesion and should be further evaluated with a dedicated MRI of brain. Within the area of edema a suspect neck right tumor is noted. No evidence of hemorrhage is present.Images through supratentorial brain parenchyma also demonstrates small area of low attenuation in the subcortical white matter of right posterior frontal which also is suspected for edema surrounding a small metastatic lesion.No evidence of hemorrhage or midline shift is detected.Calvarium remains within normal limits. Minimal findings of chronic otitis are noted evident by opacification of few of the mastoid air cells.

Output: 1.Highly suspected necrotic tumor within the posterior fossa on the right with surrounding edema and smaller supratentorial area of vasogenic edema. Both of these regions need to be further evaluated with a dedicated post diffuse MRI of brain.


Instruction: Generate impression based on findings.

Input: 68 year female. Smouldering multiple myeloma. Evaluate for myelomatous lesions. Heterogeneous signal intensity of the lower lumbar spine and pelvis with no focal myelomatous lesion. T1 hyperintensity in the central sacrum consistent with fatty marrow. Mild osteoarthritis of the bilateral hips.Degenerative arthritic changes of the lower lumbar spine, refer to same day MRI complete spine report for further details.

Output: No focal suspicious lesion. Degenerative arthritic changes.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disturbance of skin sensation Muscle weakness (generalized)Clinical question: eval for vascular malformation, pt with acute intraparenchymal hemorrhageSigns and Symptoms: left pronator drift, decreased sensation left face The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated.There is a 9 x 7 mm axial dimension signal hypointense focus associated with susceptibility effect located within the right superior frontal gyrus adjacent to the bottom of the right superior frontal sulcus. It has a popcorn-like appearance on T1-weighted imaging. It is associated with a small developmental venous anomaly.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 demonstrate a small mucous retention cysts in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Findings are suggestive of a cerebral cavernous malformation located in the right superior frontal gyrus.


Instruction: Generate impression based on findings.

Input: Pain, twisted ankle TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Normal exam.


Instruction: Generate impression based on findings.

Input: Reason: MRV - Eval lower extremity venous structures for patency distal iliac to femoral-saphenous junction History: ex preemie, immunodeficiency, infected central line RLEEXAMINATION: MRI of the pelvis was performed before and after the administration of 2 mL of gadolinium. Postcontrast MRA/MRV sequences were obtained. Additional 3-D reformatted images generated on a separate workstation are also provided for interpretation. MRA: The aorta, iliac arteries, common femoral arteries, and proximal popliteal arteries are patent. The deep femoral arteries are not well visualized beyond the most proximal portion.MRV: The right common iliac and external iliac veins are patent but are small in caliber. No common femoral vein is visualized on the right, there are however multiple small/discontinuous collateral vessels in the right thigh. There is an apparent tangle of vessels in the right pelvis, likely representing collateral venous drainage from the right leg (series 1101, image 65). There are prominent lumbar veins which likely provide the majority of the drainage from the right lower extremity as the right common iliac vein upstream to this point is markedly attenuated (series 1101, image 29), which may be secondary to slow flow in the IVC related to the indwelling catheter.A catheter is present in the left femoral vein which extends into the IVC, terminating cranially out of the field of view. The rate of flow cannot be well assessed given the presence of the catheter. There is mural thickening of the visualized left lower extremity veins suggesting inflammation/scarring, which may be related to long-standing catheterization.MRI: Postsurgical changes in the abdomen are noted, including a ventral abdominal wall defect.

Output: 1.Nonvisualization of the right common femoral vein with multiple small and discontinuous collaterals in the right thigh.2.Attenuation of the right common iliac vein, with an enlarged lumbar venous system, which is likely providing the majority of venous drainage from the right lower extremity.3.Mural thickening of the left common iliac and femoral veins suggesting inflammation/scarring secondary to long-standing catheterization.


Instruction: Generate impression based on findings.

Input: 51-year-old male patient post TACE/RFA. Evaluate for new or recurrent HCC. Reevaluate faint enhancement noted adjacent to segment 7/8 cavity on prior MRI. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is a segment 5 lesion cavity measuring approximately 3.9 x 3.2 cm (image 52, series 11). There is no evidence of marginal recurrent or residual disease.The 7/8 ablation cavity measures approximately 3.1 x 2.2 cm (image 71, series 11). Again seen is faint nodular enhancement along the anterior superior aspect of the ablation cavity, appearing similar to the 5/26/2016 study and similar in location to a lesion on a pretreatment scan. There is an additional faint focus of enhancement more posteriorly. Neither of these foci show washout on more delayed imaging. No new suspicious arterial enhancing lesion is identified. Mild diffuse interstitial T2 signal abnormality may reflect mild hepatic fibrosis. The patient is status post cholecystectomy. No intrahepatic biliary ductal dilatation.SPLEEN: The spleen measures 14 cm in length without a focal lesion.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.Postablation changes of segment 5 without specific evidence of marginal recurrent or residual disease.2.Redemonstration of faint nodular enhancement (more anteriorly located focus in particular is at site of preexisting neoplastic lesion when compared to pretreatment imaging) along the segment 7/8 ablation cavity, no washout seen on more delayed imaging. Continued follow up is recommended.


Instruction: Generate impression based on findings.

Input: 54 years, Male, Reason: 54 yo male with newly dx HOP cancer, with questionable liver lesions on OSH imaging. Needs MRI Liver to further characteriize liver lesions History: None. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There are multiple subcentimeter lesions which are bright on T2 and progressively fill in on delayed phases, compatible with hemangiomas. However, there are 4 lesions which are bright on T2 weighted images and do not completely fill in on delayed images but instead have rim enhancement. For example, a segment 8 lesion measures 1.1 x 1.3 cm (905/320). The portal vein is patent. No intrahepatic biliary ductal dilatation.SPLEEN: There is splenic vein thrombosis with multiple perisplenic collaterals.PANCREAS: There is a hypoenhancing lesion in the in the pancreatic head which measures 2.3 x 1.5 cm (901/27) and likely corresponds to patient's known pancreatic adenocarcinoma. No evidence of vascular involvement including the portal system or hepatic veins.There is loss of the normal contour of the distal pancreas with low T1 signal, diffusion restriction and peripancreatic inflammatory changes suggesting acute pancreatitis. A hypointense rim is observed, a finding which may be seen in autoimmune pancreatitis. There is a thick walled collection superior to the pancreatic tail along the greater curvature of the stomach with adjacent inflammatory changes. Multiple small peripancreatic lymph nodes are noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes including a left para-aortic node measuring 1.3 x 1.0 cm (901/143). An enlarged periportal node measures 2.0 x 1.2 cm (901/233).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreatic head mass likely corresponds to patient's known pancreatic adenocarcinoma.2.There are numerous enhancing lesions with signal characteristics suggestive of hemangiomas. However, there are a few lesions with delayed ring enhancement which would be atypical for a hemangioma and given patient's known pancreatic cancer, are suspicious for neoplasm.3.Mild retroperitoneal lymphadenopathy.4.Inflammatory changes in the body and tail of the pancreas suggests acute pancreatitis. There is loss of the normal lobular contour with a thin rim, a finding which may be seen in the setting of autoimmune pancreatitis. Correlation with serum IgG-4 levels and clinical symptoms is recommended.5.Splenic vein thrombosis.6.Thick rimmed fluid collection adjacent to the pancreatic tail. A peripancreatic fluid collection is favored, however this could also represent an inflamed gastric diverticula.Findings discussed with primary team at 3:30 p.m. on 2/27/2015.


Instruction: Generate impression based on findings.

Input: 60 year old man with history of paroxysmal atrial fibrillation who is referred for cardiac MRI prior to planned atrial fibrillation ablation procedure. Left VentricleThe left ventricle is mild-moderately dilated with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 250 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 101 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 113 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. The left atrial volume is 151mL (left atrial volume index 72mL/m2). There is no left atrial appendage thrombus.Right VentricleThe right ventricle is moderately dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 133 ml/m2 (normal range 82+/-16), the RVEDV is 283 ml (normal range 142+/-31), the RV end systolic volume index is 66 ml/m2 (normal range 31+/-9), and the RVESV is 141 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated. The right atrial volume is 99mL (right atrial volume index 47mL/m2).Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The sinus of Valsalva measures 35mm. The ascending aorta is mildly dilated (41x42mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.The dimensions of the individual pulmonary veins are as follows:RUPV : 20 x 19mmRLPV: 16 x 19mmLUPV: 16 x 16mmLLPV: 15 x 17mmPulmonary ArteryThe main pulmonary artery is upper normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. Mild-moderately dilated left ventricle with normal systolic function (EF 62%).2. Moderately dilated right ventricle with normal systolic function (EF 50%). 3. Moderate biatrial dilatation. 4. Mild ascending aorta dilation. 5. Pulmonary vein anatomy and dimensions as noted above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for any pathology in the head in context of a new pulmonary findings. Signs and symptoms: New pulmonary infiltrate. At top of liver transplant list. Unenhanced head CT:Right cerebellar pica territory cortical stroke is again identified. The age of this stroke cannot be determined due to its small size. To entirely exclude subacute state of stroke recommend MRI exam. No change since prior exam.Subtle patchy areas of low attenuation in the subcortical and periventricular white matter of bilateral cerebral hemispheres are believed to represent small vessel ischemic disease of indeterminate age.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Calvarium, paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable

Output: 1.No interval change since prior exam.2.Small right pica territory cerebellar stroke of indeterminate age.3.Small vessel disease of indeterminate age.4.No detectable acute intracranial process.


Instruction: Generate impression based on findings.

Input: 74 year old female with pancreatic cysts ABDOMEN: Susceptibility artifact from lumbar stabilization hardware limits evaluation.LIVER, BILIARY TRACT: Cholelithiasis. Stable hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: Multiple T2 hyperintense foci throughout the pancreas, some of which appear to be connected to the pancreatic duct, not significantly changed from prior examination. Reference pancreatic body cystic lesion measures 1.2 x 1.3 cm (series 8, image 25), unchanged. The main pancreatic duct is normal in caliber. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Limited by susceptibility artifact from lumbar stabilization hardware. Large left renal cysts. The inferior most suspicious septated.RETROPERITONEUM, LYMPH NODES: Limited by susceptibility artifact from lumbar stabilization hardware.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Significant susceptibility artifact from spinal hardware.OTHER: No significant abnormality noted.

Output: 1.Stable probable sidebranch IPMNs in the pancreas as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out mass lesion involving left cranial nerve VI. Signs and symptoms: Left cranial nerve VI palsy, facial numbness and paresthesia. Pre- and post enhanced brain MRI:Examination is performed utilizing the cranial nerve protocol.Negative diffusion weighted series.Examination is degraded due to mild motion artifact however within this limitation there is no evidence of signal abnormality or abnormal enhancement of the cranial nerves.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Unremarkable calvarium and images through the skull base.Unremarkable bilateral cavernous sinuses and bilateral Meckel's caves.Unremarkable images through the orbits and including coronal fat sat post enhanced series.The signal void of major intracranial arterial branches are identified and unremarkable. X line the signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.

Output: Negative pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 5 day old ex-35 5/7 WGA female infant of a diabetic mother who we are seeing for episodic desaturations to the 50's as well as abnormal head CT. The images are degraded by motion artifact. There is trace subdural T1 hyperintensity along the posterior cerebral convexities. Prominent curvilinear susceptibility effect overlying the left medial cerebellar hemisphere. There is no evidence of acute infarct. There is paucity of myelination involving the peri-rolandic regions. The left lateral ventricle is slightly larger than the right lateral ventricle, which can represent a normal variant. The ventricles do not appear to be dilated otherwise. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute infarct.2. Trace subdural hemorrhages posteriorly.3. Prominent curvilinear susceptibility effect overlying the left medial cerebellar hemisphere likely represents a prominent tentorial vein, which may represent an anatomic variant, although a vascular malformation cannot be entirely excluded and an MRA may be useful for further evaluation.4. Apparent delayed myelination.


Instruction: Generate impression based on findings.

Input: Other symptoms and signs involving cognitive functions and awareness [R41.89], Reason for Study: ^Reason: r/o cva History: cog impairment, motor changes No evidence of acute ischemic or hemorrhagic lesion.Minimal T2/FLAIR high signal intensity lesions especially on periventricular white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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. Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 65-year-old man with history of Gleason 9 prostate adenocarcinoma in the left lateral base, right lateral base, and right mid gland on outside biopsy from 9/1/2016. PELVIS:PROSTATE:Prostate Size: 38 x 31 mm.Peripheral Zone: Multiple areas of markedly decreased T2 signal and ADC abnormality identified in the peripheral zone. The first in the right mid gland (301/48) measures 18 x 16 mm and appears to extend beyond the prostatic capsule (301/49) and involve the neurovascular bundle. This area of signal abnormality may be confluent with an area of abnormality in the right base (301/56) which measures 16 x 14 mm and also extends beyond the prostatic capsule. These areas of signal abnormality are also seen to be enhancing and there is abnormal enhancement of the right lateral urethra in the mid gland (1401/1531).An additional area of signal abnormality in the left base (301/60) measures 10 x 7 mm.Central Gland: The central gland is unremarkable.Seminal Vesicles: The right-sided tumor appears to be the right seminal vesicles and abuts the left seminal vesicle.Extracapsular Extension: Extracapsular extension of the right prostatic tumor with involvement of the neurovascular bundle. Left base tumor also appears to extend beyond the prostatic capsule.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple enlarged lymph nodes are seen bilaterally. Enhancing right iliac lymph node (1601/135) measures 11 mm. Enlarged left obturator lymph node is partially visualized (301/99) and measures 9 mm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple sites of prostatic signal abnormality in the right mid gland, right base, and left base highly suspicious for adenocarcinoma.2.Extracapsular tumor extension with involvement of the urethra, seminal vesicles bilaterally, and the neurovascular bundle on the right.3.Bilateral pelvic lymphadenopathy suspicious for nodal metastases.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with stage IV melanoma and known brain metastases, reevaluate disease status. Numerous scattered lesions are demonstrated throughout the brain and cerebellum compatible with treated metastatic foci. All of these lesions induce strong susceptibility artifact, and a few show intrinsic T1 hyperintensity. None demonstrates any significant or convincing enhancement, and none is associated with significant parenchymal edema. No new lesions are suspected.Evidence of prior right parietal craniotomy is again seen with encephalomalacia in the underlying brain parenchyma, unchanged. Confluent periventricular white matter T2 hyperintensity is unchanged and may be related to prior therapy. No significant edema or mass effect is detected. No acute intracranial hemorrhage is seen. The ventricular system is stable and within normal limits for size.

Output: Numerous lesions are redemonstrated compatible with treated metastatic foci. On comparison with the prior examination, there has been no significant interval change. Specifically, no new or growing lesions are suspected.